Lymphatic Filariasis: Effects, Treatments, and Management Strategies

This report provides an overview of Lymphatic Filariasis, a parasitic disease affecting the lymphatic system, leading to conditions like lymphedema and elephantiasis. It discusses the disease's impact, including the cascade of events triggered by adult parasites, resulting in tissue fibrosis and scarring. The report explores various treatment options, including Diethylcarbamazine (DEC), Ivermectin, and complete decongestive therapy (CDT). DEC, an antiparasitic medication, has been used for decades but has side effects and may not cure elephantiasis or lymphedema. Ivermectin, effective against microfilariae, is well-tolerated and can be a key component of public health programs. The report also mentions the effectiveness of a triple-drug regimen (Ivermectin, albendazole, and DEC) and the role of lymphedema therapy as an alternative treatment for managing symptoms. The document includes references to relevant research and studies.

Effect of Lymphatic Filariasis
on lymphatic system and
possible corrective treatment
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As per Group, (2019) Lymphatic Filariasis can be attributed to the functioning issues of
the lymphatics because of parasitic damages that can cause very intense elephantiasis and
lymphedema which is often cannot be reversed. When it comes to lymphedema, it happens due
to dysfunction of the lymph system which outcomes in swelling and collection of fluid. This
makes the lymph system difficult in functioning and fighting the germs and infections, the
people affected from the disease will have higher bacterial infections in the lymph systems and
the skins, which ultimately causes hardening of skin, known as elephantiasis. There are other
infections that can be cased due to Lymphatic Filariasis, such pulmonary eosinophilia syndrome
and development of hydrocele in men. The researcher observes that the presence of adult
parasites in the lymphatic system of the people can trigger a cascade of events which would tend
to result in fibrosis and he scarring of the tissue (Group, 2019).
According to Fischer and et.al., (2017) Diethylcarbamazine (DEC) is a form of treatment
for the Lymphatic Filariasis and has been used worldwide for decades. This is a medicated salt
which has proven to be a control measure which is antiparasitic. The medication teds to get
absorbed well through oral administration and has shown effectiveness in removing microfilariae
from the blood for at least a year post treatment and has become one of the most feasible
treatments for the disease. However as per Sankari and et.al., (2020), there are side effects from
DEC such as fever, nausea, dizziness and should definitely not be administered to people that
have onchocerciasis, because it can get worse through this. Also, the as per the study,
elephantiasis and lymphedema patients are not likely to get cured from DEC treatment as most of
them may not be infected with the filarial parasite. Also, there are many patients that suffer from
hydrocele with evidences of active infection who might not benefit from the clinical treatment of
DEC and surgery might be required. It also has to be noted that DEC could cause harm through
development of adverse reactions like encephalopathy and even death. The risks of such sever
reactions are associated with the micro filarial density (Sankari and et.al., 2020).
As elucidated by Navarro and et.al., (2020) Ivermectin based treatments tend to have
effects on the microfilariae called W. bancrofti but it does not work of the adult parasite that
primarily causes the Lymphatic Filariasis. However, there have been studies for inclusion of
Ivermectin registration for usage in the treatment of Lymphatic Filariasis where it was observed
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that a single dose is effective in working against the microfilaremia that is related to Brugia
malayi and Wuchereria bancrofti type infections. It can also be noted that even a lower dosage
has the capacity to clear the micro filarial and there are higher chances of sustained depreciation.
It was noted that a single doze of the medication has brought positive results and high responses.
The related evaluations regarding safety showcase that sever events that happen generally post
treatment of the patients suffering from microfilaremia, happen only because of the host
inflammatory reactions to the cleansing of dying microfilariae which are killed by the treatment
from ivermectin and not because of the toxicity from the drug itself Navarro and et.al., 2020).
Therefore, it can be concluded that ivermectin is a well-tolerated as well as highly effective
treatment and microfilaricide which can become a necessary element of various public health
programs sooner than later in order to interrupt the transmission of the infections like lymphatic
filarial and its global elimination. It was also noted that a three-drug regimen which comprises of
ivermectin, albendazole and DEC than the standard two regimen which only includes DEC and
albendazole has proven to be more effective for the treatment of the disease (King and et.al.,
2018).
Deng, Sinard and Murphy, (2019) illustrates in the study that Lymphedema therapy is an
alternative and natural treatment for the lymphedema disease which although doesn’t have a cure
but various treatments. Surgery is a major treatment for the removal of the excess fluid in the
tissues, it is used only in extreme cases. The non-invasive option of therapy on the other hand, is
generally the first priority. A CDT or complete decongestive therapy is used for alleviation of
lymph fluids retention through multiple techniques such as wrapping and compression, skin care
regime and manual lymphatic drainage along with exercises. Although the therapy doesn’t cure
the disease, it can help in the management and reduction of discomfort, and also a fact to be
noted is that different people may react to various treatments differently and therapy can make
the disease devoid of discomfort for many people.
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References
Books and journals
Deng, J., Sinard, R.J. and Murphy, B., 2019. Patient experience of head and neck lymphedema
therapy: a qualitative study. Supportive Care in Cancer, 27(5), pp.1811-1823.
Fischer, P.U., and et.al., 2017. Potential value of triple drug therapy with ivermectin,
diethylcarbamazine, and albendazole (IDA) to accelerate elimination of lymphatic
filariasis and onchocerciasis in Africa. PLoS neglected tropical diseases, 11(1),
p.e0005163.
Group, N.M.C.L.F., 2019. The roadmap towards elimination of lymphatic filariasis by 2030:
insights from quantitative and mathematical modelling. Gates open research, 3.
King, C.L., and et.al., 2018. A trial of a triple-drug treatment for lymphatic filariasis. New
England Journal of Medicine, 379(19), pp.1801-1810.
Navarro, M., and et.al., 2020. Safety of high-dose ivermectin: a systematic review and meta-
analysis. Journal of Antimicrobial Chemotherapy, 75(4), pp.827-834.
Sankari, T., and et.al., 2020. Heterogeneous response of Wuchereria bancrofti–infected persons
to diethylcarbamazine (DEC) and its implications for the Global Programme to Eliminate
Lymphatic Filariasis (GPELF). Parasitology Research, pp.1-9.
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