Chronic Filariasis Research Articles

Diagnostic value of vascular endothelial growth factor and interleukin-17 in association with molecular diagnosis of Wuchereria bancrofti infection

ObjectiveTo explore effective diagnosis of Wuchereria bancrofti through DNA-based techniques followed by assessment of vascular endothelial growth factor concentration (VEGF-C) and interleukin 17 (IL-17) as indicators for lymphatic endothelial cell activation, proliferation and massive tissue reaction that may be a good indicator for ongoing lymphatic filariasis. MethodsBlood samples were collected from 38 patients: 23 males (60.5%) and 15 females (39.5%) with filariasis and from controls (60 from a non-endemic and 22 from endemic areas). PCR was used to prove infection. A specific and sensitive ELISA was used to determine serum IL-17 and VEGF-C. ResultsA total of 28 patients (46.7%) were positive by PCR, while 10 patients (16.7%) were negative by PCR. Serum level of vascular endothelial growth factor was significantly high in acute cases [(2 147.00 ± 556.00) pg/mL] and in cases of early elephantiasis [(1 950.00 ± 638.00) pg/mL] and lowest in cases of late elephantiasis, endemic and non endemic controls [(1 238.00 ± 443.00), (807.11 ± 6.20) and (857.00 ± 91.50) pg/mL respectively]. Serum IL-17 was found to be significantly high in acute cases, early elephantiasis and late elephantiasis cases [(8 601 ± 1131), (7 867 ± 473) and (6 593 ± 378) pg/mL respectively] when compared to endemic controls [(3 194 ± 1 500 pg/mL)] and non endemic controls [(3 416 ± 1 101) pg/mL]. ConclusionsVEGF-C and its inducing factor IL-17 are expected to gain more importance in filariasis. Targeting such factors might ameliorate the pathology in chronic filariasis.

Disability Related to Self - care management among patients with Chronic Lymphatic filariasis in Kerala, India

Background Disability in self-care is a part of physical domain and is described as the inability to withstand bodily disruptions in normal functional performance. This study was conducted to determine the pattern of self-care management in patients with chronic lymphatic filariasis and to determine the disability in self-care on the basis of gender, duration of disease and stage of the disease in Kerala. Materials and Methods This cross-sectional study was conducted from 2008 to 2009 among individuals suffering from chronic lymphatic filariasis in Kannur District, Kerala State, India. 200 individuals with chronic lymphatic filariasis participated in this research. An interviewer-administered questionnaire, which had structured closed-ended questions and semi-structured open-ended questions, was used for data collection. A door-to-door survey was conducted to recruit the required sample size. Data analysed using SPSS version 21. Results In the present study 200 individuals (151 females and 49 males) with chronic lymphatic filariasis were participated. The mean age observed was 58.8 years with a minimum of 25 years and a maximum of 85 years. The factors included under self-care were bathing, grooming, dressing, and bowel and bladder management. The severity of self-care management shows that more than 60% had no difficulty in any of the self-care activities. 40% reported having at least some problem in toileting. Among the total participants, 3.5% reported extreme difficulty in bathing, followed by 1% in grooming, 1% in dressing and 1% in toileting. Some degree of bowel management problems was reported by 61.5% participants, and 67.5% had bladder management problems. Though males and females experienced bladder problems, former experienced them more. In both the groups the median score observed for bathing, grooming, dressing and toileting was ‘none’. There was no statistically significant difference in the median score observed between males and females. The leading difficulties related to self-care experienced by participants with duration of disease greater than 40 years were toileting (72.7%), bathing 39.4%, grooming 9.1%, and dressing (3.0%). Both bowel and bladder management problems were experienced by 85% of the participants having duration of disease greater than 40 years whereas 2.6% each experienced extremely severe bladder and bowel management problems. Statistically significant difference in median score was observed in bathing (p<0.05), grooming (p<0.05), Toileting (p<0.05) and bowel management (p<0.05), which shows as the duration of the disease increases; the difficulty for self-care management also increases. Maximum respondents with difficulty in toileting were in stage seven, the intensity ranged from a little to a lot. All distributions were statistically not different except for self-care related to toileting (p<0.05). Conclusion: The prevalence of difficulty in self-care management showed variations between the genders, duration of the disease and stage of the disease. DOI: http://dx.doi.org/10.3126/nje.v5i1.12375

IL-4–, TGF-β–, and IL-1–Dependent Expansion of Parasite Antigen-Specific Th9 Cells Is Associated with Clinical Pathology in Human Lymphatic Filariasis

Th9 cells are a subset of CD4(+) T cells, shown to be important in allergy, autoimmunity, and antitumor responses; however, their role in human infectious diseases has not been explored in detail. We identified a population of IL-9 and IL-10 coexpressing cells (lacking IL-4 expression) in normal individuals. These cells respond to antigenic and mitogenic stimulation, but are distinct from IL-9(+) Th2 cells. We also demonstrate that these Th9 cells exhibit Ag-specific expansion in a chronic helminth infection (lymphatic filariasis). Comparison of Th9 responses reveals that individuals with pathology associated with filarial infection exhibit significantly expanded frequencies of filarial Ag-induced Th9 cells, but not of IL9(+)Th2 cells in comparison with filarial-infected individuals without associated disease. Moreover, the per cell production of IL-9 is significantly higher in Th9 cells compared with IL9(+)Th2 cells, indicating that the Th9 cells are the predominant CD4(+) T cell subset producing IL-9 in the context of human infection. This expansion was reflected in elevated Ag-stimulated IL-9 cytokine levels in whole blood culture supernatants. Finally, the frequencies of Th9 cells correlated positively with the severity of lymphedema (and presumed inflammation) in filarial-diseased individuals. This expansion of Th9 cells was dependent on IL-4, TGF-β, and IL-1 in vitro. We have therefore identified an important human CD4(+) T cell subpopulation coexpressing IL-9 and IL-10, but not IL-4, the expansion of which is associated with disease in chronic lymphatic filariasis and could potentially have an important role in the pathogenesis of other inflammatory disorders.

Travelers visiting friends and relatives (VFR) and imported infectious disease: Travelers, immigrants or both? A comparative analysis

Immigrants are increasingly traveling back to their countries of origin to visit friends and relatives (VFRs). They account for an important proportion of all international travelers and have a high risk for certain travel-related infectious diseases. We describe the spectrum of infectious diseases diagnosed in a cohort of 351 VFRs and compare them with two previously published cohorts: of immigrants and travelers attended at our centre. The most frequent diagnoses observed among VFRs were typical travel-associated infections such as malaria (75 [21.4%]), traveler's diarrhea 17 [4.8%]), intestinal parasites (16 [4.6%]) and dengue (11 [3.1%]). Asymptomatic chronic infectious diseases, such as latent tuberculosis (56 [16%]), chronic viral hepatitis (18 [5.1%]) and filariasis (18 [5.1%]), probably acquired before migration, were also observed. VFRs should thus be approached from two perspectives as concerns imported infectious diseases: as travelers and as immigrants. Etiological studies focusing on the presenting complaint as well as systematic screening for other latent infectious diseases should be performed.

Nematode Asparaginyl-tRNA Synthetase Resolves Intestinal Inflammation in Mice with T-Cell Transfer Colitis

The therapeutic effects of a controlled parasitic nematode infection on the course of inflammatory bowel disease (IBD) have been demonstrated in both animal and human models. However, the inability of individual well-characterized nematode proteins to recreate these beneficial effects has limited the application of component immunotherapy to human disease. The nematodes that cause chronic human lymphatic filariasis, Brugia malayi and Wuchereria bancrofti, are among the parasites that induce immune suppression. Filarial lymphatic pathology has been shown to involve NF-κB pathway-dependent production of vascular endothelial growth factor (VEGF), and stimulation of VEGF expression has also been reported by interleukin 8 (IL-8) via NF-κB pathways. Previously, we have shown that the filarial asparaginyl-tRNA synthetase (rBmAsnRS) interacts with IL-8 receptors using a combination of extracellular loops that differ from those bound by IL-8. To test the hypothesis that rBmAsnRS might induce an anti-inflammatory effect in vivo, we studied the effects of rBmAsnRS in an established murine colitis model using T-cell transfer mice. T-cell transfer colitis mice treated intraperitoneally with 100 μg of rBmAsnRS four times over 2 weeks showed resolution of cellular infiltration in the colonic mucosa, along with induction of a CD8(+) cellular response. In addition, rBmAsnRS induced a rise in IL-10 production from CD3(+) and lipopolysaccharide (LPS)- and cytosine phosphate guanosine (CPG)-stimulated splenic cells. In summary, this work demonstrates a novel anti-inflammatory nematode protein, supports the hygiene hypothesis, and supports continued refinement of alternative immunotherapies for treatment of IBD.

Lymphangiosarcoma arising after 33 years within a background of chronic filariasis: a case report with review of literature

Cutaneous angiosarcoma or lymphangiosarcoma represents an uncommon aggressive tumor known to arise on a background of chronic lymphedema secondary to various etiologies, principally following surgery or irradiation. There have been rarely reported cases of angiosarcoma following infective conditions that eventuate with lymphatic stasis. We report a case of angiosarcoma arising after 33 years within a background of filariasis. Awareness of this association can lead to early diagnosis and appropriate treatment of this potentially fatal malignant tumor.

A rare case of reversible acquired AA-type renal amyloidosis in a chronic filariasis patient receiving antifilarial therapy

Lymphatic filariasis is a major health problem in India with a large number of patients tending to be asymptomatic. In the Southeast and South Asian regions, Wuchereria bancrofti is the most prevalent parasite, causing filariasis in 99.4% of cases. While kidney involvement is a rare event in chronic filariasis, this case is unique because AA-type renal amyloidosis occurs in chronic W. bancrofti infection. We present here a unique case of lymphatic filariasis. The patient, a 25-year-old male who was previously diagnosed with right lower limb filarial lymphedema and had undergone lymphovenous anastomosis, was admitted for evaluation of persistent nephrotic-range proteinuria. Autoimmune markers in the form of anti-nuclear antibodies, anti-double-stranded DNA and anti-neutrophil cytoplasmic antibody were negative; C3 was normal. Urine analysis revealed inactive sediment with moderate proteinuria. Both serum and urine electrophoresis were negative for paraproteins and bone marrow aspirate and biopsy were normal. Evidence of active filarial infection was established on the basis of microfilariae in the peripheral smear and a positive W. bancrofti antigen test. Kidney biopsy revealed renal amyloidosis when stained with Congo red and anti-AA immunostain. The patient's proteinuria improved on conservative management with angiotensin-converting enzyme inhibitors and a course of antifilarial drugs. His proteinuria returned to <1g/24h with normalization of renal function and no significant proteinuria on periodic follow-up at 6-month and 1-year intervals. Repeat kidney biopsy after 1.5years showed regression of amyloidosis. Repeat demonstration of filarial antigen and microfilariae in the peripheral smear were negative on multiple occasions during the follow-up period. Although various chronic infections can lead to secondary renal amyloidosis, this is the first case reported in world literature where secondary amyloidosis developed as a complication of chronic filarial infection due to W. bancrofti. This is probably also the first case reported in world literature where renal amyloidosis has an etiological association with W. bancrofti infection and where patient symptoms improved with antifilarial and antiproteinuric management.

Human Lymphatic Filariasis: Genetic Polymorphism of Endothelin-1 and Tumor Necrosis Factor Receptor II Correlates With Development of Chronic Disease

Hydrocele and elephantiasis are 2 clinically very diverse and often mutually exclusive chronic manifestations of human bancroftian filariasis. Plasma levels of endothelin-1 (ET-1), a major angiogenic factor, and tumor necrosis factor receptors (TNFRs) that regulate host inflammation have been associated with development of chronic filariasis, although their genetic basis are not known. We studied polymorphisms of ET-1 (Ala288Ser) and TNFR-II (Met196Arg) genes by means of the polymerase chain reaction confronting 2 pairs primers method and restriction fragment length polymorphism, respectively. Plasma ET-1 level was measured by enzyme-linked immunosorbent assay. Met196Arg genotype frequency of TNFR-II polymorphism was significantly greater in hydrocele patients, compared with elephantiasis patients (OR, 4.34 [95% CI, 2.04-9.20]). Conversely, a significantly high prevalence of the Ala288Ser mutation of ET-1 was observed in elephantiasis patients, compared with hydrocele cases (OR, 2.15 [95% CI, 1.13-4.10]). Decreased plasma ET-1 levels associated significantly with Ala288Ser mutation in the study population. A combined analysis indicated a 23-fold higher risk for developing elephantiasis in individuals with TNFR-II (Met196Met) and ET-1 mutants (Ala288Ser + Ser288Ser). ET-1 (Ala288Ser) and TNFR-II (Met196Arg) polymorphisms are associated with development of one or the other form of chronic disease in bancroftian filariasis.

Serum α‐1‐acid glycoprotein concentration in clinically healthy puppies and adult dogs and in dogs with various diseases

alpha-1-acid glycoprotein (AGP) is an acute-phase protein and a serum marker of inflammation and neoplasia in humans. AGP concentrations in diseased dogs and the potential effects of age, breed, and sex have not been elucidated. The purpose of this study was to examine differences in AGP concentration based on age, sex, and breed in a large population of clinically healthy dogs and to compare AGP concentrations in dogs with various diseases. Serum was obtained from clinically healthy puppies (n=74) and adults (n=172) of both sexes, and included mongrels (n=205) and Beagles (n=41). Serum also was obtained from 192 dogs with various diseases, including 8 with pyometra that were sampled before, and 1, 2, 3, and 10 days after surgery. AGP concentration was measured by single radial immunodiffusion. Statistical comparisons were made among age, sex, breed, and disease groups. Serum AGP in healthy adult mongrels was 364+/-106 mg/L (reference interval, 152-576 mg/L). AGP was lowest in newborns (n=11, 122+/-54 mg/L) and gradually increased to adult levels by 3 months of age. Median AGP concentration was highest in dogs with parvovirus (n=17, 2100 mg/L), distemper (n=7, 1250 mg/L), and pyometra (n=18, 2480 mg/L) and was also significantly higher in dogs with acute filariasis, renal failure, urolithiasis, pancreatitis, hepatitis, trauma, hyperadrenocorticism, and immune-mediated hemolytic anemia. Dogs with acute filariasis and acute hepatopathy had significantly higher AGP concentrations than dogs with chronic filariasis and chronic hepatopathy. Serum AGP concentration decreased gradually following surgery for pyometra but remained increased after 10 days (896+/-175 mg/L). Because of significantly lower AGP in puppies, the age of dogs should be considered when using AGP as a marker of disease. Serum AGP may be a useful marker of inflammatory disease in dogs and may help differentiate acute and chronic stages of disease.

The experience of living with chronic manifestations of Lymphatic Filariasis among patients 15 years and older in developing countries: a systematic review

Lymphatic filariasis is considered a disease of the poor with painful and profoundly disfiguring consequences. It is transmitted by the mosquito. Lymphatic filariasis is found among persons residing in rural areas and at the periphery of communities predominantly in developing countries in the tropics.To present the best evidence regarding the experiences of persons living with chronic manifestations of lymphatic filariasis, their experiences of treatment strategies and how the condition influences their social relationships within the context of developing countries.Study subjects were persons 15 years and older with chronic lymphatic filariasis living in developing countries.Phenomena of interest Publications that were selected considered the experiences of persons living with chronic lymphatic filariasis, their experiences of treatment measures and their social relationships.Types of studies Qualitative research papers (including but not limited to: phenomenology, grounded theory, action research, narrative studies, descriptive studies, ethnographies, cultural studies, behavioral studies, case studies and feminist research) exploring the experiences of persons living with chronic manifestations of lymphatic filariasis within the context of developing countries SEARCH STRATEGY: A three-step search strategy was utilised to search for published and unpublished studies over the period of 1980-2007. MEDLINE and CINAHL were initially searched for keywords and index terms that were then used to search across all the other data bases and finally the reference list of identified studies.Eligible publications were assessed by two independent reviewers for methodological validity using the standardised critical appraisal tools of the Joanna Briggs Institute Qualitative Assessment and Review Instrument (JBI-QARI) DATA EXTRACTION: Data extraction was conducted using the standardised data extraction tools of the JBI-QARI. Extracted information consisted of details on relevant aspects of the identified studies.Study findings were categorised according to the JBI-QARI degrees of credibility scale, and placed in categories of similar meaning. Categories were finally meta-synthesised.Six (6) included studies yielded 41 findings that were placed in 8 categories and finally meta-synthesised into 3 synthesised findings: CONCLUSION: Policy guidelines on chronic lymphatic filariasis management need to provide a holistic approach with the involvement of communities.Much more research into elephantiasis management should be encouraged; so should qualitative research with rigorous methodological approaches into all aspects of lymphatic filariasis.Interventions should address in concert with other needs the psycho-emotional health of patients. Counseling should be incorporated into surgical management of hydroceles to allay fears of death.

The experience of living with chronic manifestations of Lymphatic Filariasis among patients 15 years and older in developing countries: a systematic review.

Lymphatic filariasis is considered a disease of the poor with painful and profoundly disfiguring consequences. It is transmitted by the mosquito. Lymphatic filariasis is found among persons residing in rural areas and at the periphery of communities predominantly in developing countries in the tropics. To present the best evidence regarding the experiences of persons living with chronic manifestations of lymphatic filariasis, their experiences of treatment strategies and how the condition influences their social relationships within the context of developing countries. Study subjects were persons 15 years and older with chronic lymphatic filariasis living in developing countries.Phenomena of interest Publications that were selected considered the experiences of persons living with chronic lymphatic filariasis, their experiences of treatment measures and their social relationships.Types of studies Qualitative research papers (including but not limited to: phenomenology, grounded theory, action research, narrative studies, descriptive studies, ethnographies, cultural studies, behavioral studies, case studies and feminist research) exploring the experiences of persons living with chronic manifestations of lymphatic filariasis within the context of developing countries SEARCH STRATEGY: A three-step search strategy was utilised to search for published and unpublished studies over the period of 1980-2007. MEDLINE and CINAHL were initially searched for keywords and index terms that were then used to search across all the other data bases and finally the reference list of identified studies. Eligible publications were assessed by two independent reviewers for methodological validity using the standardised critical appraisal tools of the Joanna Briggs Institute Qualitative Assessment and Review Instrument (JBI-QARI) DATA EXTRACTION: Data extraction was conducted using the standardised data extraction tools of the JBI-QARI. Extracted information consisted of details on relevant aspects of the identified studies. Study findings were categorised according to the JBI-QARI degrees of credibility scale, and placed in categories of similar meaning. Categories were finally meta-synthesised. Six (6) included studies yielded 41 findings that were placed in 8 categories and finally meta-synthesised into 3 synthesised findings: CONCLUSION: Policy guidelines on chronic lymphatic filariasis management need to provide a holistic approach with the involvement of communities. Much more research into elephantiasis management should be encouraged; so should qualitative research with rigorous methodological approaches into all aspects of lymphatic filariasis. Interventions should address in concert with other needs the psycho-emotional health of patients. Counseling should be incorporated into surgical management of hydroceles to allay fears of death.

Impact of seven rounds of mass administration of diethylcarbamazine and ivermectin on prevalence of chronic lymphatic filariasis in south India

To evaluate the impact of seven rounds of mass administration of diethylcarbamazine (DEC) and ivermectin on the prevalence of chronic lymphatic filariasis and to compare it with that observed in a placebo arm in a community-level trial. Cross-sectional clinical surveys were carried out before and after seven rounds of mass drug administration (MDA). About 54-75% of the target population were treated at each round of MDA. After seven rounds, the hydrocele prevalence had declined from the pre-intervention level of 20.5-5.1% (P < 0.05) in the DEC arm, from 23.9% to 10.4% (P < 0.05) in the ivermectin arm and from 20.4% to 10.9% (P < 0.05) in the placebo arm, equivalent to reductions of 75.3%, 56.6% and 46.6%, respectively. The lymphoedema/elephantiasis prevalence declined only marginally and without statistical significance from 3.7% to 3.2%, 4.6% to 3.9% and 2.9% to 2.3% in the DEC, ivermectin and placebo arm. After the seventh MDA, none of the sampled people in the 0-20 age group was found with hydrocele and there was a statistically significant decline in hydrocele prevalence in all other age groups in the communities treated with DEC, the drug known to have macrofilaricidal effect. The impact was relatively less in ivermectin arm. Repeated DEC administration has the potential to prevent incidence of new hydrocele cases and may resolve the manifestation at least in a proportion of affected people. Apart from reducing the microfilaraemia prevalence and transmission of infection, MDA also results in significant public health benefits by reducing the burden of hydrocele in treated communities.

Elephantiasis of the female genitalia—case report

We present a rare case of elephantiasis of the female external genitalia due to lymphatic filariasis. Our patient, from an endemic zone of India, came with massive debilitating swelling of her external genitalia. The huge size of the swelling hindered her walking and day-to-day life. Clinical examination and investigations confirmed chronic lymphatic filariasis leading to elephantiasis of the female external genitalia. She underwent successful excisional surgery. This paper reviews the extreme rarity of the condition, the disease problem in India and discusses the social aspects of the disease with a brief review of the control and the management strategy.

The Experience of Living with Co-Morbidities of Chronic Lymphatic Filariasis among Patients 15 Years and Older in Developing Countries: A Systematic Review.

Review Objectives The objective of this systematic review is to understand the experiences of persons 15 years and older living with Chronic Lymphatic Filariasis (CLF) in developing countries. The specific review questions are: 1. What are the experiences of persons living with CLF? 2. What are the experiences of persons with CLF about strategies used to prevent/ treat the condition? 3. What is the influence of CLF on social relationships of persons affected? Inclusion criteria Types of Participants The review will consider publications that focus on developing countries and specifically include people of 15 years and older with manifestations of CLF. Phenomena of Interest The review will focus on studies that investigate the experience of living with manifestations of CLF. The review will also focus on studies that address the experiences and subjective opinions of persons that have employed various strategies of prevention/ treatment of the condition. The review will also consider studies that address the social relationships of persons living with CLF.

The Experience of Living with Co-Morbidities of Chronic Lymphatic Filariasis among Patients 15 Years and Older in Developing Countries: A Systematic Review

The Experience of Living with Co-Morbidities of Chronic Lymphatic Filariasis among Patients 15 Years and Older in Developing Countries: A Systematic Review

Community's Knowledge and Perceptions about Filarial Elephantiasis and Hydrocele in Coastal Orissa, India

This study assesses people's knowledge and perceptions on transmission, prevention and eradication of elephantiasis and hydrocele, common manifestations of chronic lymphatic filariasis (LF). The assessment was done during mass drug administration (MDA) of the programme to eliminate LF in the State of Orissa, India. A household survey with pre-tested interview questionnaire was conducted in four LF endemic districts of Orissa state, India, where the MDA has been taken place. The sampling units (clusters of households) of the household survey are taken based on (1) urban/rural and (2) type of or absence of health facility. A total of 1,448 respondents were selected randomly. Majority of the respondents heard about elephantiasis and hydrocele. About one third of them know that mosquito bite is the cause of elephantiasis but very few people know about hydrocele. Around 50% of the respondent believed that elephantiasis could be cured completely, while almost 60% said that it could be totally removed from the community. But for hydrocele, more than 80% of respondents showed a positive approach for cure and nearly about 70% said that hydrocele could totally be eradicated from community. Various causes and methods of cure and prevention were suggested. Around 55% of respondents suggested that elephantiasis can be eradicated by taking medicine, but only 40% felt that hydrocele can be cured by taking medicine. Basic knowledge on LF is poor and relatively low proportion of people knows that LF can be eliminated by taking medicine. As there are plans to undertake further rounds of MDA in Orissa, people's knowledge has to be strengthened and perception and attitudes have to be addressed to achieve positive behavioural change, which eventually lead to higher compliance of MDA.

The impact of chronic lymphatic filariasis on labor inputs in the Niger delta, Nigeria

The loss of labor and work time in people affected by chronic lymphatic filariasis in six rural communities of the Niger Delta area of Southeastern Nigeria was investigated. The disability caused by this chronic disease resulted in partial loss of work. The mean (standard deviation) time that each of these chronic cases spent on economic activities were significantly less (P< 0.01) than that observed in the controls. Chronic lymphatic filariasis also affected time used for domestic activities, with the mean (SD) between chronic cases and controls being 2.62 (3.25) h/day (t = 6.62, P < 0.01). The difference in labor input was significantly lower in the female cases than in males both during rainy and dry seasons. It as observed that males with chronic filariasis lost 13.5% of the time they could have spent on economic activities (maximum, 7 hours), while affected females lost 10.3% (maximum 6 hours). The loss of labor and labor time coupled with the treatment cost and health burden in communities with poor health care system portray the need to properly prioritize the control/elimination of lymphatic filariasis in the study area. Keywords: Chronic lymphatic filariasis; labor inputs; rural community; Niger Delta; NigeriaInternational Journal of Natural and Applied Sciences Vol. 2 (3) 2006: pp. 246-249

Antigen‐specific immune complexes in urine of patients with lymphatic filariasis

Lymphatic filarial subjects with disease manifestations exhibit significantly elevated levels of immune complexes (ICs) in their circulation. The objective of the study was to explore the possible excretion of filaria-specific soluble ICs in urine of subjects with lymphatic filariasis. Paired urine (overnight) and serum samples were analyzed for complement activating filarial antigen containing immune complexes by enzyme-linked immunosorbent assay (ELISA). Antigen-specific ICs were detected in urine samples of 34% of subjects with filarial disease manifestations while the frequency of occurrence was low in microfilaremic subjects. The titer of urine ICs is significantly high in subjects with chronic filariasis as compared to microfilaria (mf) carriers. The occurrence of filaria-specific ICs in urine and their passage through the filtering structures of the kidney is suggestive of the focal or diffuse damage in those subjects. Detection of ICs in urine may provide a noninvasive means of assessing the extent of renal damage in patients with lymphatic filariasis.

Impact of chronic lymphatic filariasis on quantity and quality of productive work among weavers in an endemic village from India

To assess the impact of hydrocele and lymphoedema on the quantity and quality of productive work of weavers. Case-control study in an endemic village in Andhra Pradesh, India. We collected qualitative data on work activities from cases and age- and sex-matched controls through informal discussions and observation. The mean (+/-standard deviation) daily work time of cases was 7.38 h (+/-2.47), significantly less than that of controls (8.17+/-2.41 h). Lost work time was equivalent to around 29 days of work in a year. Gender had significant influence on the mean number of working hours in this occupational group. Most cases could not weave, which is physically demanding, and preferred less strenuous tasks such as spinning, starching, dyeing or sizing. Hard physical labour constitutes 71.5% of total work time among patients and 83.7% in controls. As income also depends on the type of work, cases earn less. Filariasis has an adverse impact on the productivity of weavers, and morbidity management strategies and control programmes need to take this into account.

Lymphatic filariasis: possible pathophysiological nexus with oxidative stress

Wuchereria bancrofti-mediated lymphatic filariasis is widely prevalent. Diversity in immune response presumably may lead to myriad clinical presentations, such as overt chronic filariasis, occult filariasis with atypical systemic manifestation and asymptomatic microfilariae carrier state. Anticipated oxidative stress during inflammatory response to infective conditions might complicate the immune response and thus might alter the disease outcome. The present study was carried out to assess the status of oxidative stress in different clinical presentations of bancroftian filariasis. Twenty-five microfilariae carriers and 30 cases each of chronic filariasis and occult filariasis were compared to 30 endemic normal individuals. Serum malondialdehyde level and superoxide dismutase enzyme activity were measured by spectrophotometric methods and levels of filarial antigen were measured by ELISA. In the filarial cases, the levels of these parameters were assayed again after treatment with diethylcarbamazine citrate (DEC). Results showed significant (P<0.05) association of oxidative stress with chronic and occult filariasis but not with microfilarial carriers. DEC therapy in both clinical cases and carriers resulted in a significant reduction of oxidative stress associated with decreased antigen level (P<0.01). These findings suggest the possible involvement of oxidative stress in filarial disease pathology.