Abstract
Lymphedema related to lymphatic filariasis (LF) is a disabling condition that commonly manifests in adolescence. Fifty-three adolescents, 25 LF infected and 28 LF non-infected, in age and sex-matched groups, using the Binax ICT rapid card test for filarial antigen were recruited to the study. None of the participants had overt signs of lymphedema. Lymphedema assessment measures were used to assess lower limb tissue compressibility (tonometry), limb circumference (tape measure), intra- and extra-cellular fluid distribution (bioimpedance) and joint range of motion (goniometry). The mean tonometric measurements from the left, right, and dominant posterior thighs were significantly larger in participants with LF compared to participants who had tested negative for LF (p = 0.005, p = 0.004, and p = 0.003, respectively) indicating increased tissue compressibility in those adolescents with LF. ROC curve analysis to define optimal cut-off of the tonometry measurements indicated that at 3.5, sensitivity of this potential screening test is 100% (95%-CI = 86.3%, 100%) and specificity is 21.4% (95%-CI = 8.3%, 41.0%). It is proposed that this cut-off can be used to indicate tissue change characteristic of LF in an at-risk population of PNG adolescents. Further longitudinal research is required to establish if all those with tissue change subsequently develop lymphedema. However, thigh tonometry to identify early tissue change in LF positive adolescents may enable early intervention to minimize progression of lymphedema and prioritization of limited resources to those at greatest risk of developing lifetime morbidity.
Highlights
The mosquito-borne parasitic disease lymphatic filariasis (LF) is endemic in around 81 tropical countries, has a global burden of around 120 million cases, and is classified by the World Health organization as the second most common cause of long term disability after mental illness [1]
The effects of lymphatic filariasis (LF) on the lymphatic system often become apparent during adolescence when the lower limb swells due to lymphedema and males develop hydrocele
There is no simple or mobile field method to identify those at greatest risk of developing lymphedema or those with early subclinical lower limb change
Summary
The mosquito-borne parasitic disease lymphatic filariasis (LF) is endemic in around 81 tropical countries, has a global burden of around 120 million cases, and is classified by the World Health organization as the second most common cause of long term disability after mental illness [1]. Three species of filarial parasites cause LF. Wuchereria bancrofti, the cause of Bancroftian filariasis, accounts for 90% of the cases worldwide. Brugian filariasis is caused by Brugia malayi, which is found in eastern Asia, and Brugia timori, which is confined to Timor and adjacent islands. All three species cause similar lymphatic disease but only Bancroftian filariasis causes hydrocele and all are controlled and treated by the same methods [2]. LF has a wide clinical spectrum ranging from debilitating acute bacterial dermatolymphgangioadenitis (ADLA) attacks, covert lymphatic and renal disease, and various degrees of lymphedema, to the terrible disfiguring, and often socially ostracizing, chronic manifestations of hydrocele and elephantiasis [3]
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