Lymphatic filariasis is a tropical infectious disease caused by infestation of the human lymphatic system with parasitic worms. Men represent a special risk group, especially for chronic lymphatic filariasis, which is associated with pronounced swelling in the genital area.

What is a lymphatic filariasis?

Lymphatic filariasis is a tropical disease of the lymphatic system that is caused by infection with certain worms (so-called filariae) of the nematode family and transmitted by mosquitoes.

A lymphatic filariosis manifests after an incubation period of one month to several years on the basis of acute inflammation of the lymph nodes and vessels, fevers, asthmatic complaints and allergic cough (acute phase). In the advanced stage of the disease, lymphatic filariasis can lead to permanent damage to the lymphatic vessels, through which the lymphatic fluid can no longer flow away and forms lymphvarices (extensions of the lymph nodes and vessels).

The influx of lymph into adjacent structures causes lymphedema, which can be extremely pronounced in the limbs, genitals, and chest, leading to elephantiasis, which is characteristic of chronic lymphatic filariasis.

causes

Lymphatic filariasis is due to infection with filamentous worms (filariae) of the nematode family (roundworms). The most important pathogens of lymphatic filariasis are Wuchereria bancrofti (Africa, Southeast Asia, Central and South America, Pacific), Brugia malayi (Southeast Asia) and Brugia timori (Indonesia).

In this case, the pathogens of a lymphatic filariasis are transmitted by mosquitoes, so-called Anopheles, which have infected beforehand in an infected person with worm larvae (microfilariae).

These mature in the organism of the mosquito to infective larvae. When a person is stung by an infected mosquito, the microfilariae settle in the lymphatic system via the bloodstream, where they mature into sexually mature filariae, produce additional larvae, and provoke the inflammatory reactions characteristic of the acute stage of lymphatic filariasis.

About three to eight months after infection, the microfilariae first infiltrate the blood system of those infected with lymphatic filariasis.

Symptoms, complaints & signs

A sympathetic filariasis can manifest itself through very different symptoms. The first symptoms often appear only months or years later. At the earliest three months after the infection, fevers and swollen lymph nodes set in. Due to the relocation of the lymphatic system, inflammation of the lymphatic vessels and lymph nodes can occur again and again.

Lack of treatment may leave lasting damage to the lymphatic system. Previously, lymphedema typically develops, causing swelling of the chest, genitals and limbs. The area around the infection hurts and causes an unpleasant feeling of pressure when touched. In extreme cases, the sympathetic filariasis can cause breathing difficulties and thereby trigger an asthma attack.

Accompanying this are general symptoms such as tiredness and exhaustion. The affected feel physically and mentally exhausted and are usually no longer able to pursue the daily tasks. Outwardly, the disease of the lymphatic system can be recognized by the visible swellings and the sickly appearance of those affected.

The doctor can detect increased blood levels for eosinophilic granulocytes, which clearly indicate a filariasis. If an immediate treatment, the symptoms usually resolve quickly. As a result of the weakening of the immune system, however, secondary fungal or bacterial infections may occur, which require independent therapy.

Diagnosis & History

Since lymphatic filariasis is a tropical infectious disease, stays abroad in the vulnerable areas provide a first indication of the diagnosis.

In addition, a lymphatic filariasis is diagnosed on the basis of the characteristic symptoms. As part of a blood analysis, an increased concentration of eosinophilic white blood cells in the serum (eosinophilia) as well as the antibodies specific for filaria can be detected. In the later course (chronic filariasis) microfilariae can be detected in the serum.

Since the pathogen infiltrates the blood, especially at night, the blood sample should be taken at this time. With early diagnosis and timely initiation of therapy, the infectious disease has a good prognosis.

Untyped, lymphatic filariasis leads to severe progression and very pronounced swelling (elephantiasis), which can be a significant psychological burden for those affected.

complications

In this disease, sufferers primarily suffer from a very high fever. It also comes to a strong fatigue and also to a tiredness of the patient. Also, the resilience is significantly reduced, so it may lead to different restrictions in the everyday life of the person concerned. Furthermore, inflammation of the lymph nodes, which can lead to pain.

In severe cases, sufferers have an asthma attack and generally have breathing difficulties. Severe breathing difficulties can also lead to a loss of consciousness, in which the affected person can also fall and injure themselves. Furthermore, swelling also occurs. Patients often suffer from mental stress or depression. The quality of life of the patient is significantly reduced and limited by this disease.

The treatment of this disease is usually done with the help of medication. There are no special complications. However, some of these medications may cause side effects, possibly causing a headache or fever. As a rule, the treatment results in a positive course of the disease. However, the immune system needs to recover after treatment so that the person is more susceptible to other diseases or infections.

When should you go to the doctor?

Once the typical signs of sympathetic filariasis are noticed, a visit to the doctor's office is advised. If the symptoms do not regress after a few days or become even stronger, a doctor must also be informed. The affected person speaks best immediately with the family doctor, who can clarify the filariasis or exclude. Subsequently, the appropriate treatment can be initiated and thereby further complications or long-term consequences averted.

If the symptoms occur a few months after traveling to one of the risk areas, a doctor's visit is recommended. A mosquito bite on holiday should be clarified by a doctor immediately after returning home. Even after contact with a potentially infected person, attention must be paid to any warning signs. The sympathetic filariasis is treated by a general practitioner or internist. In severe cases, a lymphologist or an infectious diseases clinic must be consulted. Children must be immediately presented to the pediatrician if there are signs of sympathetic filariasis.

Treatment & Therapy

The therapeutic measures are aimed primarily at killing the pathogens with the help of anthelminthic (vermifuge). These medications contain specific toxins that interfere with the metabolism of the pathogens. Good results were achieved in this regard with diethylcarbamazine, wherein the drug is administered over several days depending on the body weight of the person concerned (eg 50 mg on the 1st, 3 x 50 mg on the 2nd day, 3 x 100 mg on the 3rd day and 3 x 2 mg / kg body weight from the 4th to the 21st day of treatment).

Diethylcarbamazine, however, can cause side effects in the form of headache and fever. In addition, ivermectin (avermectin) is used for the treatment of microfilariae and albendazole (anthelminthic) for adult (adult) pathogens. Under certain circumstances, there are microfilariae in the lymphatic structures, which have already been enveloped by a capsule and accordingly do not respond to the therapy.

In these cases, the treatment of lymphatic filariasis must be repeated. Since the immune system is severely weakened in lymphatic filariasis, secondary infections (fungi, bacteria) may be present in some cases, which should be treated accordingly. A lymphatic drainage helps against lymphatic stasis. In cases of severe lymphedema (elephantiasis), surgical measures may be indicated in the case of lymphatic filariasis in order to eliminate lymphatic blockage.

Outlook & Forecast

The tropical disease has a favorable prognosis as soon as a medical treatment is used. The administration of medicines usually leads quickly to a relief of the existing symptoms. After a few weeks, the person affected can be released from treatment as cured.

Without the use of medical care there is often a worsening of general health. Delays in the healing process are expected and respiratory problems occur. These can cause anxiety or an acute and thus life-threatening situation. Therefore, for a favorable prognosis, the consultation of a doctor should take place at the first signs and physical changes.

In a stable immune system, the pathogens can usually be tackled quickly. The prescribed drugs support the body's defense system in the healing process and help ensure that the dead pathogens can be removed as quickly as possible from the organism. In addition, a lymphatic drainage helps against lymphatic drainage. With this treatment, the affected person is well placed and receives a good chance of a speedy recovery.

If complications occur, operational measures must be taken. An operation involves risks and can cause complications. If the procedure is trouble-free, the medical treatment is continued afterwards. To support a good prognosis an optimal nutrition should take place.

prevention

As no vaccine is currently available for lymphatic filariasis, the preventive measures are limited to exposition prophylaxis. This consists in wearing long clothing, the use of mosquito nets, which may be impregnated with insect repellent, and the use of so-called Reppelents (mosquito-repellent gels, sprays, lotions, creams) that protect against mosquito bites and thus lymphatic filariasis.

aftercare

This disease usually causes high fever in those affected. It comes to a permanent tiredness and exhaustion of those affected. The load capacity is significantly reduced, so it can come to many restrictions in everyday life. The quality of life of sufferers is significantly affected by the disease, therefore, the help of friends and relatives at this time is essential.

Affected persons suffer from severe respiratory distress and asthma attacks in severe cases, which is why they should refrain from physical exertion as far as possible. It is not uncommon for sufferers to suffer from severe depression and other mental illnesses because those affected can no longer actively participate in life. Supporting with the help of a psychologist can help to better accept the disease and to make dealing with it easier in the long term.

The treatment of the disease in most cases with the help of drugs that should be taken after the prescribed dose. However, after the treatment, the immune system is weakened, so that the patients are more susceptible to infections, so it is advisable to avoid excessive activism and to take the everyday life back gently.

You can do that yourself

Accompanying the drug therapy, filariasis patients themselves can take some measures to aid the healing process. Physical protection and bed rest are particularly important. Especially in the first three to five days of the disease, the immune system should not be charged further, so that the worms can be flushed out as quickly as possible.

An appropriate diet additionally promotes recovery and also relieves typical symptoms such as abdominal pain and nausea. The nutritional plan is best worked out with the help of a nutritionist. In addition, the weight should be reduced in case of lymphatic blockage. We recommend a healthy, low-salt diet, which is associated with a lot of exercise (after the acute illness phase) and stress avoidance.

If pain occurs, various remedies from naturopathy can be used in consultation with the doctor. Even with headaches, fever and asthma attacks may help alternative preparations, such as belladonna, devil's claw or arnica. If major complications arise in the course of the disease, the lymphatic filariasis must be consulted again to a doctor. In the case of a severe course, further self-help measures must be foreseen, insofar as the responsible physician does not propose anything to the contrary.

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