Dr Tariq Jagnarine
Family Medicine, Endocrinology/ Diabetes
Lymphatic Filariasis (LF) is a debilitating disease that can cause swelling in the extremities and genitals area, once it has manifested, it cannot be reversed. Around 60,000 people in Guyana are already affected by filaria, and approximately 90% live in endemic areas, at risk of contracting the disease.
The Ministry of Health, Guyana, in collaboration with the Pan American Health Organization (PAHO) launched the Mass Drug Administration (MDA) campaign in Guyana since 2017. The yearly exercise will see health workers and volunteers visiting homes, workplaces and schools in eight regions throughout the country (1, 2,3,4,5, 6, 7 and 10) to administer the pills.
The countries of the Americas agreed to a collective approach to the elimination of communicable diseases throughout Latin America and the Caribbean. The Elimination Initiative identifies a wide range of diseases and related conditions, including lymphatic filariasis, as potential candidates for elimination in the Region, and enables countries to consolidate efforts and resources towards ending these diseases and ensuring public health.
Filariasis is a tropical disease caused by parasitic worms that are spread through mosquito bites. The skin gets thick and hard, resembling an elephant’s skin. Although medically known as lymphatic filariasis, the term elephantiasis is commonly used because symptoms include swelling and enlargement of the arms and legs.
The World Health Organization (WHO) estimate that 120 million people worldwide are affected by filaria.
Causes
The following 3 types of parasitic roundworms cause elephantiasis:
* Wuchereria bancrofti
* Brugia malayi
* Brugia timori
Wuchereria bancrofti worms cause 90 percent of all cases of elephantiasis. Brugia malayi causes most of the others.
TRANSMISSION
Mosquitoes are responsible for spreading the parasites that cause filariasis.
* Firstly, mosquitoes become infected with roundworm larvae when they take a blood meal from an infected human.
* The mosquitoes then bite someone else, passing the larvae into their bloodstream.
* Finally, the worm larvae migrate to the lymphatics via the bloodstream and mature in the lymph system.
RISK FACTORS
Elephantiasis can affect anyone who is exposed to the parasites that cause the disease. The risk of exposure is greatest for people who:
* Live long-term in tropical and subtropical regions like Guyana
* Are regularly bitten by mosquitoes
* Live in unhygienic conditions
The regions where these roundworms are found include:
* Africa
* India
* South America
* Southeast Asia
SYMPTOMS OF FILARIA
Most people who are infected will not show symptoms, despite damage to the lymph system and kidneys. Those who do get symptoms most commonly experience swelling of the:
* Legs
* Arms
* Breasts
* Genitals
* Also, they can have impaired immune function because of damage to their lymph system. They tend to get more bacterial infections of the skin, causing it to become dry, thick, and ulcerated with repeated infections.
* Other symptoms during these repeated bacterial infections include a fever and chills.
DIAGNOSIS
The Diagnosis is mainly done through taking the following:
* A medical history
* Inquiring about symptoms
* Performing a physical examination
* A blood examination would be required to confirm a parasitic infection. In most parts of the world the roundworms are most active at night, so the blood sample must be collected during this time, according to the Centers for Disease Control and Prevention (CDC).
* Alternative tests may be used to detect the parasites, but they may show negative results because symptoms can develop years after the initial infection.
* X-rays and ultrasounds may also be done to rule out other conditions that could be causing the swelling.
TREATMENTS
People with an active infection can take medications to kill the worms in the blood. These medications stop the spread of the illness to others, but they do not completely kill off all the parasites.
Antiparasitic drugs that may be prescribed include:
* Diethylcarbamazine (DEC)
* Ivermectin
* Albendazole
* Doxycycline (an option)
Other symptoms may be managed with:
* Antihistamines
* Analgesics
* Antibiotics
Not everyone with elephantiasis will need medication. This is because they may no longer carry the worms in their system despite the presence of symptoms. People can manage the swelling and skin infections in these cases by:
* Gently washing the swollen and damaged skin every day with soap and water
* Moisturizing the skin
* Elevating swollen limbs to improve the flow of fluid and lymph
* Disinfecting wounds to prevent secondary infections
* Exercising regularly to support the lymphatic system, as directed by a doctor
* Wrapping the limbs to prevent further swelling
Surgery may be recommended in rare cases to remove damaged lymphatic tissue or relieve pressure in certain areas, such as the scrotum.
Some people with filariasis may wish to seek emotional and psychological support in the form of:
* Individual counselling, support groups and online resources
COMPLICATIONS
Without medical treatment, the microscopic parasites may live for years in the lymphatic system, causing destruction and damage. The lymph system is responsible for transporting excess fluid and proteins and fighting infections. Fluid builds up when it does not function correctly. The accumulation of fluid leads to swelling of the tissue and reduced immune function.
Filariasis is associated with several physical and emotional complications, including:
* Disability: Filariasis is a leading cause of permanent disability across the globe. It may be difficult to move the affected body parts, which makes working or engaging in household tasks more difficult.
* Secondary infections: Fungal and bacterial infections are prevalent among those with elephantiasis because of damage to the lymph system.
* Emotional distress: The condition can cause people to worry about their appearance, which could lead to anxiety and depression.
* Loss of Jobs
* Stigma and Discrimination
PREVENTION
The best way to prevent filariasis is to avoid mosquito bites. People who visit or livein countries at risk should:
* Sleep under a mosquito net
* Cover up their skin with long sleeves and trousers
* Use insect repellent
* Participate in the mass drugs administration campaign by take your filarial Pills when visited by health care workers. These pills includes: Diethylcarbamazine (DEC), Ivermectin, Albendazole, they are given base on person’s height from the age of 2. These drugs are not given during pregnancy or persons seriously ill.
Some of the most common side effect of these include: headaches, drowsiness, vomiting, diarrhoea, abdominal cramps
TAKEAWAY
Filariasis is a tropical disease spread through mosquito bites. People living in affected tropical or subtropical areas are most at risk of infection. However, short-term visitors to these regions have a very low risk of getting filaria or related conditions. People with symptoms of the condition, including swelling and skin thickening, should see their doctor immediately. This disease symptoms can be managed through medications, lifestyle changes, and emotional support. To avoid its complications- TAKE YOUR FILARIA PILLS!
