Abstract
The Global Programme to Eliminate Lymphatic Filariasis (GPELF) has two major goals: to interrupt transmission of the parasite and to provide care for those who suffer the devastating clinical manifestations of the disease (morbidity control). This latter goal addresses three filariasis-related conditions: acute inflammatory episodes; lymphoedema; and hydrocele. Research during the last decade has confirmed the importance of bacteria as a cause of acute inflammatory episodes in filariasis-endemic areas, known as acute dermatolymphangioadenitis (ADLA). Current lymphoedema management strategies are based on the central role of ADLA as a trigger for lymphoedema progression. Simple intervention packages are in use that have resulted in dramatic reductions in ADLA rates, a lower prevalence of chronic inflammatory cells in the dermis and subdermis, and improvement in quality of life. During the past decade, the socioeconomic impact of ADLA and lymphoedema in filariasis-endemic areas has received increasing attention. Numerous operational research questions remain to be answered regarding how best to optimize, scale up, monitor, and evaluate lymphoedema management programmes. Of the clinical manifestations targeted by the GPELF, hydrocele has been the focus of the least attention. Basic information is lacking on the effectiveness and complications of hydrocele surgery and risk of post-operative hydrocele recurrence in filariasis-endemic areas. Data on the impact of mass administration of antifilarial drugs on filarial morbidity are inconsistent. Several studies report reductions in acute inflammatory episodes, lymphoedema, and/or hydrocele following mass drug administration, but other studies report no such association. Assessing the public health impact of mass treatment with antifilarial drugs is important for programme advocacy and morbidity control strategies. Thus, although our knowledge of filariasis-related morbidity and its treatment has expanded in recent years, much work remains to be done to address the needs of more than 40 million persons who suffer worldwide from these conditions.
Highlights
Lymphatic filariasis causes a wide range of clinical signs and symptoms, including lymphoedema, hydrocele, lymph scrotum, chyluria, tropical pulmonary eosinophilia (TPE), adenopathy, haematuria, and various manifestations of worms in ectopic sites [1], among oth-(page number not for citation purposes)Filaria Journal 2007, 6:2 http://www.filariajournal.com/content/6/1/2 ers
Research during the last decade has confirmed the importance of bacteria as a cause of acute inflammatory episodes in filariasis-endemic areas, known as acute dermatolymphangioadenitis (ADLA)
Of the clinical manifestations targeted by the Global Programme to Eliminate Lymphatic Filariasis (GPELF), hydrocele has been the focus of the least attention
Summary
Lymphatic filariasis causes a wide range of clinical signs and symptoms, including lymphoedema, hydrocele, lymph scrotum, chyluria, tropical pulmonary eosinophilia (TPE), adenopathy, haematuria, and various manifestations of worms in ectopic sites [1], among oth-(page number not for citation purposes)Filaria Journal 2007, 6:2 http://www.filariajournal.com/content/6/1/2 ers. The clinical manifestations and factors leading to progression of so-called 'filarial lymphoedema' are similar, if not identical, to those for lymphoedema in non-filariasis-endemic areas. The literature on management of lymphoedema in filariasis-endemic areas is relatively limited; considerably more is known about the pathogenesis, clinical management, and psychosocial impact of 'non-filarial' lymphoedema in Europe, Australia, and North America. It is outside the scope of this document to systematically review the literature on lymphoedema and hydrocele from non-endemic areas, we will refer to this literature in passing
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