1
|
Kini P, Wireko S, Osei‐Poku P, Asiedu SO, Amewu EKA, Asiedu E, Amanor E, Mensah C, Wilson MB, Larbi A, Boahen KG, Sylverken AA, Amato KR, Kwarteng A. Antibiotic resistance and mecA characterization of Staphylococcus hominis from filarial lymphedema patients in the Ahanta West District, Ghana: A cross-sectional study. Health Sci Rep 2023; 6:e1104. [PMID: 36778776 PMCID: PMC9904197 DOI: 10.1002/hsr2.1104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 01/26/2023] [Accepted: 01/27/2023] [Indexed: 02/10/2023] Open
Abstract
Background and Aim Filarial infections affect over 150 million people in the tropics. One of the major forms of filarial pathologies is lymphedema; a condition where the immune response is significantly altered, resulting in changes in the normal flora. Staphylococcus hominis, a human skin commensal, can also be pathogenic in immunocompromised individuals. Therefore, there is the possibility that S. hominis could assume a different behavior in filarial lymphedema patients. To this end, we investigated the levels of antibiotic resistance and extent of mecA gene carriage in S. hominis among individuals presenting with filarial lymphedema in rural Ghana. Method We recruited 160 individuals with stages I-VII lymphedema, in a cross-sectional study in the Ahanta West District of the Western Region of Ghana. Swabs from lymphedematous limb ulcers, pus, and cutaneous surfaces were cultured using standard culture-based techniques. The culture isolates were subjected to Matrix-Assisted Laser Desorption/Ionization Time of Flight (MALDI-TOF) mass spectrometry for bacterial identification. Antimicrobial susceptibility testing (AST) was performed using the Kirby-Bauer method. mecA genes were targeted by polymerase chain reaction for strains that were cefoxitin resistant. Results In all, 112 S. hominis were isolated. The AST results showed resistance to chloramphenicol (87.5%), tetracycline (83.3%), penicillin (79.2%), and trimethoprim/sulphamethoxazole (45.8%). Of the 112 strains of S. hominis, 51 (45.5%) were resistant to cefoxitin, and 37 (72.5%) of the cefoxitin-resistant S. hominis haboured the mecA gene. Conclusion This study indicates a heightened level of methicillin-resistant S. hominis isolated among filarial lymphedema patients. As a result, opportunistic infections of S. hominis among the already burdened filarial lymphedema patients in rural Ghana may have reduced treatment success with antibiotics.
Collapse
Affiliation(s)
- Priscilla Kini
- Department of Biochemistry and Biotechnology, College of ScienceKwame Nkrumah University of Science and TechnologyKumasiGhana,Kumasi Centre for Collaborative Research in Tropical MedicineKwame Nkrumah University of Science and TechnologyKumasiGhana
| | - Solomon Wireko
- Department of Biochemistry and Biotechnology, College of ScienceKwame Nkrumah University of Science and TechnologyKumasiGhana,Department of Laboratory TechnologyKumasi Technical UniversityKumasiGhana
| | - Priscilla Osei‐Poku
- Department of Biochemistry and Biotechnology, College of ScienceKwame Nkrumah University of Science and TechnologyKumasiGhana
| | - Samuel O. Asiedu
- Kumasi Centre for Collaborative Research in Tropical MedicineKwame Nkrumah University of Science and TechnologyKumasiGhana,Department of Theoretical and Applied Biology, College of ScienceKwame Nkrumah University of Science and TechnologyKumasiGhana
| | - Emmanuel K. A. Amewu
- Kumasi Centre for Collaborative Research in Tropical MedicineKwame Nkrumah University of Science and TechnologyKumasiGhana
| | - Ebenezer Asiedu
- Kumasi Centre for Collaborative Research in Tropical MedicineKwame Nkrumah University of Science and TechnologyKumasiGhana
| | - Ernest Amanor
- Department of Biochemistry and Biotechnology, College of ScienceKwame Nkrumah University of Science and TechnologyKumasiGhana
| | - Caleb Mensah
- Kumasi Centre for Collaborative Research in Tropical MedicineKwame Nkrumah University of Science and TechnologyKumasiGhana
| | - Mary B. Wilson
- Department of Biochemistry and Biotechnology, College of ScienceKwame Nkrumah University of Science and TechnologyKumasiGhana,Department of Biomedical EngineeringKoforidua Technical UniversityKoforiduaGhana
| | - Amma Larbi
- Department of Biochemistry and Biotechnology, College of ScienceKwame Nkrumah University of Science and TechnologyKumasiGhana
| | - Kennedy G. Boahen
- Department of Clinical Microbiology, School of Medical SciencesKwame Nkrumah University of Science and TechnologyKumasiGhana
| | - Augustina A. Sylverken
- Kumasi Centre for Collaborative Research in Tropical MedicineKwame Nkrumah University of Science and TechnologyKumasiGhana,Department of Theoretical and Applied Biology, College of ScienceKwame Nkrumah University of Science and TechnologyKumasiGhana
| | | | - Alexander Kwarteng
- Department of Biochemistry and Biotechnology, College of ScienceKwame Nkrumah University of Science and TechnologyKumasiGhana,Kumasi Centre for Collaborative Research in Tropical MedicineKwame Nkrumah University of Science and TechnologyKumasiGhana
| |
Collapse
|
2
|
Asiedu SO, Kini P, Aglomasa BC, Amewu EKA, Asiedu E, Wireko S, Boahen KG, Berbudi A, Sylverken AA, Kwarteng A. Bacterial diversity significantly reduces toward the late stages among filarial lymphedema patients in the Ahanta West District of Ghana: A cross-sectional study. Health Sci Rep 2022; 5:e724. [PMID: 35873398 PMCID: PMC9297296 DOI: 10.1002/hsr2.724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 07/02/2022] [Accepted: 07/05/2022] [Indexed: 11/27/2022] Open
Abstract
Background Lymphatic Filariasis (LF), a neglected tropical disease, has been speculated to be complicated by secondary bacteria, yet a systematic documentation of these bacterial populations is lacking. Thus, the primary focus of this study was to profile bacteria diversity in the progression of filarial lymphedema among LF individuals with or without wounds. Methods A cross-sectional study design recruited 132 LF individuals presenting with lymphedema with or without wounds from eight communities in the Ahanta West District in the Western Region, Ghana. Swabs from the lymphedematous limbs, ulcers, pus, and cutaneous surfaces were cultured using standard culture-based techniques. The culture isolates were subsequently profiled using Matrix-assisted Laser Desorption/Ionization Time of Flight Mass Spectrometry. Results Of the 132 LF participants recruited, 65% (85) had filarial lymphedema with no wounds. In total, 84% (235) of the bacterial isolates were identified. The remaining 16% (46) could not be identified with the method employed. Additionally, 129(55%) of the strains belonged to the phylum Firmicutes, while 61 (26%) and 45 (19%) represented Proteobacteria and Actinobacteria, respectively. Generally, irrespective of the samples type (i.e., wound sample and non-wound samples), there was a sharp increase of bacteria diversity from Stages 1 to 3 and a drastic decrease in these numbers by Stage 4, followed by another surge and a gradual decline in the advanced stages of the disease. The Shannon Diversity Index and Equitability for participants with and without wounds were (3.482, 0.94) and (3.023, 0.75), respectively. Further, Staphylococcus haemolyticus and Escherichia coli showed resistance to tetracycline, chloramphenicol, and penicillin. Conclusion The present study reveals a sharp decline in bacterial load at the late stages of filarial lymphedema patients. In addition, we report an emerging antimicrobial resistance trend of S. haemolyticus and E. coli against commonly used antibiotics such as tetracycline, chloramphenicol, and penicillin in communities endemic for LF in the Ahanta West District, Ghana. This could pose a huge challenge to the management of the disease; particularly as current treatments are not quite effective against the infection.
Collapse
Affiliation(s)
- Samuel O. Asiedu
- Department of Theoretical and Applied BiologyKwame Nkrumah University of Science and TechnologyKumasiGhana
- Kumasi Centre for Collaborative Research in Tropical MedicineKwame Nkrumah University of Science and TechnologyKumasiGhana
| | - Priscilla Kini
- Department of Theoretical and Applied BiologyKwame Nkrumah University of Science and TechnologyKumasiGhana
- Kumasi Centre for Collaborative Research in Tropical MedicineKwame Nkrumah University of Science and TechnologyKumasiGhana
| | - Bill C. Aglomasa
- Kumasi Centre for Collaborative Research in Tropical MedicineKwame Nkrumah University of Science and TechnologyKumasiGhana
| | - Emmanuel K. A. Amewu
- Department of Theoretical and Applied BiologyKwame Nkrumah University of Science and TechnologyKumasiGhana
| | - Ebenezer Asiedu
- Kumasi Centre for Collaborative Research in Tropical MedicineKwame Nkrumah University of Science and TechnologyKumasiGhana
| | - Solomon Wireko
- Department of Laboratory TechnologyKumasi Technical UniversityKumasiGhana
| | - Kennedy G. Boahen
- Department of Microbiology School of Medical SciencesKwame Nkrumah University of Science and TechnologyKumasiGhana
| | - Afiat Berbudi
- Division of Parasitology, Department of Biomedical Sciences, Faculty of MedicineUniversitas PadjadjaranBandungIndonesia
| | - Augustina A. Sylverken
- Department of Theoretical and Applied BiologyKwame Nkrumah University of Science and TechnologyKumasiGhana
- Kumasi Centre for Collaborative Research in Tropical MedicineKwame Nkrumah University of Science and TechnologyKumasiGhana
| | - Alexander Kwarteng
- Kumasi Centre for Collaborative Research in Tropical MedicineKwame Nkrumah University of Science and TechnologyKumasiGhana
- Department of Biochemistry and BiotechnologyKwame Nkrumah University of Science and TechnologyKumasiGhana
| |
Collapse
|
3
|
Enbiale W, Böer-Auer A, Amare B, Verdonck K, Davey G, van Griensven J, de Vries HJC. Podoconiosis: Clinical spectrum and microscopic presentations. PLoS Negl Trop Dis 2022; 16:e0010057. [PMID: 35604949 PMCID: PMC9166354 DOI: 10.1371/journal.pntd.0010057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 06/03/2022] [Accepted: 04/18/2022] [Indexed: 11/19/2022] Open
Abstract
Background
Podoconiosis is a skin Neglected Tropical Disease (skin NTD) that causes lymphoedema, and affects barefooted subsistence farmers in some tropical countries. The clinical presentation and histopathologic correlates of podoconiosis have been understudied. Here, we systematically document the clinical and histopathologic spectrum of podoconiosis.
Methods
This is a cross-sectional study in Durbete, Ethiopia from February 2018 to October 2019. Dermatologists performed a patient history, physical examination, filariasis test strip, and skin biopsy for histopathologic examination. The results were summarised and a descriptive statistical analysis and Wilcoxon rank sum test with continuity correction was done.
Results
We recruited 289 patients for the study, 178 (61.6%) had stage 1 or 2 podoconiosis, and 111(38.4%) stage 3 to 5 podoconiosis. 188 (64.1%) had a family history of podoconiosis. In 251 (86.9%) patients, both legs were affected by podoconiosis and in 38 (13.1%) only one leg was affected. 220 (77.5%) patients had warty lesions, 114 (39.4%) had nodules. The median number of episodes of Acute Dermato-Lymphangio-Adenitis (ADLA) reported by the patients in the last three months was 2 (interquartile range (IQR) 1–4). Increased episodes of ADLA were significantly associated with stage 3–5 podoconiosis (P = 0.002), while burning pain in the feet was more common in stage 1 or 2 podoconiosis. Stage 3–5 disease was histopathologically characterised by epidermal and dermal thickening, verrucous acanthosis, inflammatory cell infiltrates (predominantly lymphoplasmacytic), dilated and ectatic and a reduced number of lymphatic vessels, eccrine ductal hyperplasia, and sclerosis such as thickened collagen bundles.
Conclusion
We provide a detailed description of the different clinical patterns, associated clinical findings and the histopathologic spectrum of podoconiosis at different stages of the disease. Our observations should serve as a guide to classifying patients with podoconiosis for prognostic assessment and treatment decision.
Collapse
Affiliation(s)
- Wendemagegn Enbiale
- Bahir Dar University, College of Medicine and Health sciences, Bahir Dar, Ethiopia
- University of Amsterdam, Department of Dermatology, Amsterdam, The Netherlands
- * E-mail:
| | - Almut Böer-Auer
- Dermatologikum Hamburg, Hamburg, Germany
- Department of Dermatology, Münster University, Münster, Germany
| | - Bereket Amare
- Bahir Dar University, College of Medicine and Health sciences, Bahir Dar, Ethiopia
| | | | - Gail Davey
- Brighton and Sussex Medical School, Falmer, Brighton, United Kingdom
- School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | | | - Henry J. C. de Vries
- University of Amsterdam, Department of Dermatology, Amsterdam, The Netherlands
- Center for Sexual Health, Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Institute for Infection and Immunology, Infectious Diseases, Amsterdam, The Netherlands
| |
Collapse
|
4
|
Medeiros ZM, Vieira AVB, Xavier AT, Bezerra GSN, Lopes MDFC, Bonfim CV, Aguiar-Santos AM. Lymphatic Filariasis: A Systematic Review on Morbidity and Its Repercussions in Countries in the Americas. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 19:316. [PMID: 35010576 PMCID: PMC8751179 DOI: 10.3390/ijerph19010316] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 12/17/2021] [Accepted: 12/23/2021] [Indexed: 06/14/2023]
Abstract
The Global Program to Eliminate Lymphatic Filariasis (GPELF) is a program that aims to eliminate lymphatic filariasis by 2030. The GPELF strategy is based on interrupting transmission using mass drug administration (MDA) and, in parallel, managing morbidity cases. However, it has been seen that there is a shortage of research in the literature and public policies regarding this last pillar. In this study, we reviewed the literature and available information regarding the burden of filarial morbidity. In addition, we identified that in the Americas, the implementation of structured services with regard to morbidity assistance in the Americas was scarce. We formed a review that aimed to assess the pathogenesis, epidemiology, repercussions, and treatment of filarial morbidity in countries in the Americas where lymphatic filariasis is endemic. Structured searches were carried out on PubMed, LILACS, Scopus, and Web of Science databases without time and language restrictions. Three reviewers evaluated the 2150 studies and performed data extraction, and quality assessment by assigning scores to the studies found. The current literature and available information on the burden of filarial morbidity, as well as the implementation of structured services with regard to morbidity assistance in the Americas, were all found to be scarce. Now that this knowledge gap has been identified, both health services and researchers need to seek the implementation and enhancement of the maintenance of GPELF strategies that relate to the morbidity pillar.
Collapse
Affiliation(s)
- Zulma M. Medeiros
- Fundação Oswaldo Cruz, Departamento de Parasitologia, Instituto Aggeu Magalhães, Recife 50670-420, Brazil; (Z.M.M.); (A.T.X.); (A.M.A.-S.)
- Programa de Pós-Graduação em Ciências da Saúde, Universidade de Pernambuco, Recife 50100-130, Brazil
| | - Amanda V. B. Vieira
- Fundação Oswaldo Cruz, Departamento de Parasitologia, Instituto Aggeu Magalhães, Recife 50670-420, Brazil; (Z.M.M.); (A.T.X.); (A.M.A.-S.)
| | - Amanda T. Xavier
- Fundação Oswaldo Cruz, Departamento de Parasitologia, Instituto Aggeu Magalhães, Recife 50670-420, Brazil; (Z.M.M.); (A.T.X.); (A.M.A.-S.)
- Programa de Pós-Graduação em Ciências da Saúde, Universidade de Pernambuco, Recife 50100-130, Brazil
| | - Gilberto S. N. Bezerra
- Materials Research Institute, Technological University of the Shannon: Midlands Midwest, N37 HD68 Athlone, Ireland;
| | | | - Cristine V. Bonfim
- Ministério da Educação, Fundação Joaquim Nabuco, Diretoria de Pesquisas Sociais, Recife 52061-540, Brazil;
- Programa de Pós-Graduação em Saúde Coletiva, Universidade Federal de Pernambuco, Recife 50670-901, Brazil
| | - Ana M. Aguiar-Santos
- Fundação Oswaldo Cruz, Departamento de Parasitologia, Instituto Aggeu Magalhães, Recife 50670-420, Brazil; (Z.M.M.); (A.T.X.); (A.M.A.-S.)
| |
Collapse
|
5
|
Asiedu SO, Kwarteng A, Amewu EKA, Kini P, Aglomasa BC, Forkuor JB. Financial burden impact quality of life among lymphatic Filariasis patients. BMC Public Health 2021; 21:174. [PMID: 33478462 PMCID: PMC7818560 DOI: 10.1186/s12889-021-10170-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Accepted: 01/05/2021] [Indexed: 11/25/2022] Open
Abstract
Background Human lymphatic filarial pathology is the leading cause of disability and poverty among people living with the infection. The second goal of the Global Programme to Eliminate Lymphatic Filariasis (GPELF) is to manage the disease’s morbidity to improve patients’ quality of life. Consequently, the current study assessed the overall quality of life of lymphatic filariasis (LF) pathology patients in some selected endemic communities in rural Ghana. Method In the present study, the Lymphatic Filariasis Quality of Life Questionnaire (LFSQQ) was used to evaluate the effect of lymphatic filariasis on the quality of life of people, with the disease in nine (9) communities in the Ahanta West District of the Western Region of Ghana where mass drug administration is being implemented for the past twenty years. Pearson’s correlation, linear regression, and one-way analysis of variance (ANOVA) analyses were used to assess the associations between the LFSQQ instrument domains. Results Of the 155 study participants recruited, 115 (74.19%) were females, and 40 (25.81%) males. A greater proportion of the study participants (40, 25.8%) were presented with stage two (2) lymphoedema, while only two patients had stage seven (7) lymphoedema. The average of the overall quality of life scores of study participants was 68.24. There was a negative Pearson correlation (r = − 0.504, p-value < 0.001) between the stage of lymphoedema (severity of the disease) and the quality of life of the LF patients. In addition, a clear pattern of positive correlation (r = 0.71, p-value < 0.001) was observed between the disease burden and pain/discomfort domains of the study participants. Whereas the highest domain-specific score (85.03) was observed in the domain of self-care, we noted that the environmental domain, which consists of the financial status, was the lowest (45.94) among the study participants. Conclusion Our findings support previous works on the reduced quality of life among lymphatic filariasis patients with pathology. In this study, our results reveal a depressing financial condition among people presenting with late stages of LF pathologies, which eventually reduces their well-being.
Collapse
Affiliation(s)
- Samuel Opoku Asiedu
- Kumasi Centre for Collaborative Research in Tropical Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Alexander Kwarteng
- Kumasi Centre for Collaborative Research in Tropical Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana. .,Department of Biochemistry and Biotechnology, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
| | - Emmanuel Kobla Atsu Amewu
- Department of Biochemistry and Biotechnology, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Priscilla Kini
- Kumasi Centre for Collaborative Research in Tropical Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.,Department of Biochemistry and Biotechnology, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Bill Clinton Aglomasa
- Department of Biochemistry and Biotechnology, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - John Boulard Forkuor
- Department of Sociology and Social Work, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| |
Collapse
|
6
|
Douglass J, Hailekiros F, Martindale S, Mableson H, Seife F, Bishaw T, Nigussie M, Meribo K, Tamiru M, Agidew G, Kim S, Betts H, Taylor M, Kelly-Hope L. Addition of Lymphatic Stimulating Self-Care Practices Reduces Acute Attacks among People Affected by Moderate and Severe Lower-Limb Lymphedema in Ethiopia, a Cluster Randomized Controlled Trial. J Clin Med 2020; 9:jcm9124077. [PMID: 33348721 PMCID: PMC7766500 DOI: 10.3390/jcm9124077] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 12/11/2020] [Accepted: 12/14/2020] [Indexed: 01/13/2023] Open
Abstract
Lymphedema causes disability and exacerbates poverty in many countries. The management of lymphatic filariasis (LF) and podoconiosis-related lymphedema involves daily hygiene to reduce secondary infections, but self-massage and deep-breathing, which have proven beneficial in cancer-related lymphedema, are not included. A cluster randomized trial in northern Ethiopia investigated the effects of lymphatic stimulation for people affected by moderate to severe lymphedema. Participants were allocated to either standard (control n = 59) or enhanced (intervention n = 67) self-care groups. Primary outcomes were lymphedema stage, mid-calf circumference, and tissue compressibility. Secondary outcomes were the frequency and duration of acute attacks. After 24 weeks, fewer patients were assessed as severe (control −37.8%, intervention −42.4%, p = 0.15) and there were clinically relevant changes in mid-calf tissue compressibility but not circumference. There was a significant between-group difference in patients who reported any acute attacks over the study period (control n = 22 (38%), intervention n = 7 (12%), p = 0.014). Daily lymphedema self-care resulted in meaningful benefits for all participants with a greater reduction in acute episodes among people performing lymphatic stimulation. Observations of a change in lymphedema status support earlier findings in Bangladesh and extend the demonstrated benefits of enhanced self-care to people affected by podoconiosis.
Collapse
Affiliation(s)
- Jan Douglass
- Centre for Neglected Tropical Diseases, Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool L3 5QA, UK; (S.M.); (H.M.); (H.B.); (M.T.); (L.K.-H.)
- Correspondence:
| | - Fikre Hailekiros
- National Podoconiosis Action Network, Addis Ababa 1000, Ethiopia;
| | - Sarah Martindale
- Centre for Neglected Tropical Diseases, Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool L3 5QA, UK; (S.M.); (H.M.); (H.B.); (M.T.); (L.K.-H.)
| | - Hayley Mableson
- Centre for Neglected Tropical Diseases, Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool L3 5QA, UK; (S.M.); (H.M.); (H.B.); (M.T.); (L.K.-H.)
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool L69 3BX, UK
| | - Fikre Seife
- Diseases Prevention and Control Directorate, Federal Ministry of Health, Addis Ababa 1000, Ethiopia; (F.S.); (T.B.); (M.N.); (K.M.); (M.T.); (G.A.)
| | - Tesfahun Bishaw
- Diseases Prevention and Control Directorate, Federal Ministry of Health, Addis Ababa 1000, Ethiopia; (F.S.); (T.B.); (M.N.); (K.M.); (M.T.); (G.A.)
| | - Mekdes Nigussie
- Diseases Prevention and Control Directorate, Federal Ministry of Health, Addis Ababa 1000, Ethiopia; (F.S.); (T.B.); (M.N.); (K.M.); (M.T.); (G.A.)
| | - Kadu Meribo
- Diseases Prevention and Control Directorate, Federal Ministry of Health, Addis Ababa 1000, Ethiopia; (F.S.); (T.B.); (M.N.); (K.M.); (M.T.); (G.A.)
| | - Mossie Tamiru
- Diseases Prevention and Control Directorate, Federal Ministry of Health, Addis Ababa 1000, Ethiopia; (F.S.); (T.B.); (M.N.); (K.M.); (M.T.); (G.A.)
| | - Getnet Agidew
- Diseases Prevention and Control Directorate, Federal Ministry of Health, Addis Ababa 1000, Ethiopia; (F.S.); (T.B.); (M.N.); (K.M.); (M.T.); (G.A.)
| | - Susan Kim
- College of Medicine and Public Health, Flinders University, Bedford Park, SA 5042, Australia;
| | - Hannah Betts
- Centre for Neglected Tropical Diseases, Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool L3 5QA, UK; (S.M.); (H.M.); (H.B.); (M.T.); (L.K.-H.)
| | - Mark Taylor
- Centre for Neglected Tropical Diseases, Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool L3 5QA, UK; (S.M.); (H.M.); (H.B.); (M.T.); (L.K.-H.)
| | - Louise Kelly-Hope
- Centre for Neglected Tropical Diseases, Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool L3 5QA, UK; (S.M.); (H.M.); (H.B.); (M.T.); (L.K.-H.)
| |
Collapse
|
7
|
Chandler DJ, Grijsen ML, Fuller LC. With Bare Feet in the Soil: Podoconiosis, a Neglected Cause of Tropical Lymphoedema. Dermatology 2020; 237:236-247. [PMID: 32101870 DOI: 10.1159/000506045] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 01/19/2020] [Indexed: 11/19/2022] Open
Abstract
Podoconiosis is a form of lymphoedema that occurs in tropical highland areas in genetically susceptible individuals who are exposed to irritant volcanic soils. The disease is preventable through consistent use of footwear and attention to foot hygiene; however, in endemic areas there is a strong barefoot tradition, and many cannot afford shoes. Patients with podoconiosis face significant physical disability, psychological comorbidity, reduced quality of life and experience frequent episodes of systemic illness due to acute dermatolymphangioadenitis. This review provides an overview of this important and neglected tropical skin disease and summarizes the latest research findings.
Collapse
Affiliation(s)
- David J Chandler
- Dermatology Department, Brighton General Hospital, Brighton and Sussex University Hospital NHS Trust, Brighton, United Kingdom,
| | - Marlous L Grijsen
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom.,Eijkman-Oxford Clinical Research Unit, Jakarta, Indonesia
| | - Lucinda C Fuller
- Department of Dermatology, Chelsea and Westminster Hospital NHS Foundation Trust, London, United Kingdom.,International Foundation for Dermatology, London, United Kingdom
| |
Collapse
|
8
|
Mues KE, Klein M, Kleinbaum DG, Flanders WD, Fox LM. The Effect of a Regimen of Antifungal Cream Use on Episodes of Acute Adenolymphangitis (ADL) among Lymphedema Patients: An Application Using Marginal Structural Models. J Epidemiol Glob Health 2019; 8:176-182. [PMID: 30864760 PMCID: PMC7377573 DOI: 10.2991/j.jegh.2017.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Accepted: 10/25/2017] [Indexed: 11/27/2022] Open
Abstract
Episodes of adenolymphangitis (ADL) are a recurrent clinical aspect of lymphatic filariasis (LF) and a risk factor for progression of lymphedema. Inter-digital entry lesions, often found on the web spaces between the toes of those suffering from lymphedema, have been shown to contribute to the occurrence of ADL episodes. Use of antifungal cream on lesions is often promoted as a critical component of lymphedema management. Our objective was to estimate the observed effect of antifungal cream use on ADL episodes according to treatment regimen among a cohort of lymphedema patients enrolled in a morbidity management program. We estimated this effect using marginal structural models for time varying confounding. In this longitudinal study, we estimate that for every one-unit increase in the number of times one was compliant to cream use through 12 months, there was a 23% (RR = 0.77 (0.62, 0.96)) decrease in the number of ADL episodes at 18 months, however the RR’s were not statistically significant at other study time points. Traditionally adjusted models produced a non-significant RR closer to the null at all time points. This is the first study to estimate the effect of a regimen of antifungal cream on the frequency of ADL episodes. This study also highlights the importance of the consideration and proper handling of time-varying confounders in longitudinal observational studies.
Collapse
Affiliation(s)
- K E Mues
- Department of Epidemiology, Rollins School of Public Health & Laney Graduate School, Emory University, 1518 Clifton Rd., MS 1518-002-4AA (SPH: Epidemiology), Atlanta, GA 30322, United States
| | - M Klein
- Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Rd., Atlanta, GA 30322, United States
| | - D G Kleinbaum
- Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Rd., Atlanta, GA 30322, United States
| | - W D Flanders
- Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Rd., Atlanta, GA 30322, United States
| | - L M Fox
- Parasitic Diseases Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, 1600 Clifton Rd. NE, MS A-06, Atlanta, GA 30329-4027, United States
| |
Collapse
|
9
|
Dietrich CF, Chaubal N, Hoerauf A, Kling K, Piontek MS, Steffgen L, Mand S, Dong Y. Review of Dancing Parasites in Lymphatic Filariasis. Ultrasound Int Open 2019; 5:E65-E74. [PMID: 31312785 PMCID: PMC6629997 DOI: 10.1055/a-0918-3678] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 04/04/2019] [Accepted: 05/01/2019] [Indexed: 02/07/2023] Open
Abstract
Lymphatic filariasis is an infection transmitted by blood-sucking mosquitoes with filarial nematodes of the species Wuchereria bancrofti, Brugia malayi und B. timori . It is prevalent in tropical countries throughout the world, with more than 60 million people infected and more than 1 billion living in areas with the risk of transmission. Worm larvae with a length of less than 1 mm are transmitted by mosquitoes, develop in human lymphatic tissue to adult worms with a length of 7-10 cm, live in the human body for up to 10 years and produce millions of microfilariae, which can be transmitted further by mosquitoes. The adult worms can be easily observed by ultrasonography because of their size and fast movements (the so-called "filarial dance sign"), which can be differentiated from other movements (e. g., blood in venous vessels) by their characteristic movement profile in pulsed-wave Doppler mode. Therapeutic options include (combinations of) ivermectin, albendazole, diethylcarbamazine and doxycycline. The latter depletes endosymbiotic Wolbachia bacteria from the worms and thus sterilizes and later kills the adult worms (macrofilaricidal or adulticidal effect).
Collapse
Affiliation(s)
| | - Nitin Chaubal
- Thane Ultrasound Centre, Thane Ultrasound Centre, Thane, India
| | - Achim Hoerauf
- Institut für Med. Mikrobiologie, Immunologie und Parasitologie (IMMIP), Universität Bonn, Bonn, Germany
| | - Kerstin Kling
- Department of Infectious Disease Epidemiology, Robert Koch-Institute, Berlin, Germany
| | - Markus Schindler Piontek
- Caritas Krankenhaus Bad Mergentheim, Academic Teaching Hospital of the University of Würzburg, Medical Clinic 2, Bad Mergentheim, Germany
| | - Ludwig Steffgen
- Trainings-Zentrum Ultraschall-Diagnostik LS GmbH, Ultrasound, Mainleus, Germany
| | - Sabine Mand
- Institut für Med. Mikrobiologie, Immunologie und Parasitologie (IMMIP), Universität Bonn, Bonn, Germany
| | - Yi Dong
- Zhongshan Hospital, Ultrasound, Shanghai, China
| |
Collapse
|
10
|
Kwarteng A, Arthur YD, Yamba JK, Sylverken AA, Kini P, Ahuno ST, Owusu-Dabo E. Influence of seasonal variation on reported filarial attacks among people living with lymphedema in Ghana. BMC Infect Dis 2019; 19:442. [PMID: 31109288 PMCID: PMC6528377 DOI: 10.1186/s12879-019-4084-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 05/13/2019] [Indexed: 01/14/2023] Open
Abstract
Background Lymphatic Filariasis (LF) is a vector-borne neglected tropical disease caused by the filarial nematode parasites that can lead to the disfiguring swelling of the limbs (lymphedema or elephantiasis for late stage) and/or genitalia (hydrocele) in men. Growing evidence suggests that not only are filarial lymphedema patients confronted with huge societal stigma and discrimination, but also experience acute filarial attacks accompanied by swelling of the affected part(s), fever, wounds and peeling of the skin of affected limbs(s). However, the extent to which seasonal variation influence filarial attacks among people with lymphedema was highly speculated without empirical evidence and was thus investigated. Methods In light of this, a cross-sectional study where 142 (70.4% females and 29.6% males) lymphedema patients were recruited from 8 established Wuchereria bancrofti endemic communities in the Ahanta West District, Ghana was carried out to investigate the prevalence and seasonal variation (rainy/wet and dry seasons) of acute filarial attacks. Chi-square test was used to test for association between frequency of attacks and seasonality. The STROBE guidelines for reporting cross-sectional studies was adopted. Results The average lymphedema leg stage was 2.37 and 2.33 for left and right legs, respectively, while mossy lesions, sores and ulcers were observed among 33.1% of patients with late stage disease (elephantiasis). It was found that 97 (68.3%) of the study participants experience filarial attacks during the wet season and 36 (25.4%) reported the incidence of filarial attacks during both seasons (wet and dry) while 9 (6.3%) of the study participants did not experience any attack at all. Conclusions Findings from the present study show compelling evidence that the frequency and the prevalence of filarial attacks is significantly increased during wet seasons compared to the dry season. Electronic supplementary material The online version of this article (10.1186/s12879-019-4084-2) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Alexander Kwarteng
- Department of Biochemistry and Biotechnology, Kwame Nkrumah University of Science and Technology, PMB, KNUST, Kumasi, Ghana. .,Kumasi Centre for Collaborative Research in Tropical Medicine, Kwame Nkrumah University of Science and Technology, KNUST, Kumasi, Ghana.
| | - Yarhands Dissou Arthur
- Department of Interdisciplinary Studies, University of Education Winneba, Kumasi Campus, Kumasi, Ghana
| | - John Kanyiri Yamba
- College of Agriculture Education, University of Education Winneba, Asante Mampong, Mampong, Ghana
| | - Augustina A Sylverken
- Kumasi Centre for Collaborative Research in Tropical Medicine, Kwame Nkrumah University of Science and Technology, KNUST, Kumasi, Ghana.,Department of Theoretical and Applied Biology, Kwame Nkrumah University of Science and Technology, KNUST, Kumasi, Ghana
| | - Priscilla Kini
- Kumasi Centre for Collaborative Research in Tropical Medicine, Kwame Nkrumah University of Science and Technology, KNUST, Kumasi, Ghana
| | - Samuel Terkper Ahuno
- Department of Biochemistry and Biotechnology, Kwame Nkrumah University of Science and Technology, PMB, KNUST, Kumasi, Ghana.,Kumasi Centre for Collaborative Research in Tropical Medicine, Kwame Nkrumah University of Science and Technology, KNUST, Kumasi, Ghana
| | - Ellis Owusu-Dabo
- Kumasi Centre for Collaborative Research in Tropical Medicine, Kwame Nkrumah University of Science and Technology, KNUST, Kumasi, Ghana.,Department of Global and International Health, School of Public Health, Kwame Nkrumah University of Science and Technology, KNUST, Kumasi, Ghana
| |
Collapse
|
11
|
Yahathugoda TC, Weerasooriya MV, Samarawickrema WA, Kimura E, Itoh M. Impact of two follow-up schemes on morbidity management and disability prevention (MMDP) programme for filarial lymphedema in Matara, Sri Lanka. Parasitol Int 2018; 67:176-183. [DOI: 10.1016/j.parint.2017.11.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Revised: 11/21/2017] [Accepted: 11/21/2017] [Indexed: 10/18/2022]
|
12
|
Abstract
In the contemporary era of medical diagnosis via sophisticated radiographic imaging and/or comprehensive serological testing, a focused physical examination remains paramount in recognizing the cutaneous manifestations of chronic vascular disease. Recognition of the unique cutaneous signs of lymphatic and venous hypertension assists in the diagnosis as well as the staging and classification of both lymphedema and chronic venous insufficiency. Awareness of explicit dermatologic vasomotor manifestations aids not only in the identification of acrocyanosis, Raynaud phenomenon, pernio, and erythromelalgia but also mitigates confusion related to their clinical overlap. Although the clinical signs of peripheral artery disease are not necessarily specific or sensitive, a knowledge of suggestive dermatologic findings is helpful in recognition of severe limb ischemia. A brief review of the epidemiology, etiology, pathogenesis, and therapy of cutaneous related chronic vascular disease follows including an emphasis on characteristic clinical features supported by illustrative photographs.
Collapse
Affiliation(s)
- Steven M Dean
- Division of Cardiovascular Medicine, Ohio State University Wexner Medical Center, Columbus, OH.
| |
Collapse
|
13
|
Mues K, Klein M, Kleinbaum D, Flanders W, Fox L. The Effect of a Regimen of Antifungal Cream Use on Episodes of Acute Adenolymphangitis (ADL) among Lymphedema Patients: An Application Using Marginal Structural Models. J Epidemiol Glob Health 2018. [DOI: 10.1016/j.jegh.2017.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
- K.E. Mues
- Department of Epidemiology, Rollins School of Public Health & Laney Graduate School, Emory University, 1518 Clifton Rd., MS 1518-002-4AA (SPH: Epidemiology), Atlanta, GA 30322, United States
| | - M. Klein
- Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Rd., Atlanta, GA 30322, United States
| | - D.G. Kleinbaum
- Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Rd., Atlanta, GA 30322, United States
| | - W.D. Flanders
- Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Rd., Atlanta, GA 30322, United States
| | - L.M. Fox
- Parasitic Diseases Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, 1600 Clifton Rd. NE, MS A-06, Atlanta, GA 30329-4027, United States
| |
Collapse
|
14
|
Le Blond JS, Baxter PJ, Bello D, Raftis J, Molla YB, Cuadros J, Davey G. Haemolytic activity of soil from areas of varying podoconiosis endemicity in Ethiopia. PLoS One 2017; 12:e0177219. [PMID: 28493920 PMCID: PMC5426718 DOI: 10.1371/journal.pone.0177219] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2016] [Accepted: 04/24/2017] [Indexed: 02/05/2023] Open
Abstract
Background Podoconiosis, non-filarial elephantiasis, is a non-infectious disease found in tropical regions such as Ethiopia, localized in highland areas with volcanic soils cultivated by barefoot subsistence farmers. It is thought that soil particles can pass through the soles of the feet and taken up by the lymphatic system, leading to the characteristic chronic oedema of the lower legs that becomes disfiguring and disabling over time. Methods The close association of the disease with volcanic soils led us to investigate the characteristics of soil samples in an endemic area in Ethiopia to identify the potential causal constituents. We used the in vitro haemolysis assay and compared haemolytic activity (HA) with soil samples collected in a non-endemic region of the same area in Ethiopia. We included soil samples that had been previously characterized, in addition we present other data describing the characteristics of the soil and include pure phase mineral standards as comparisons. Results The bulk chemical composition of the soils were statistically significantly different between the podoconiosis-endemic and non-endemic areas, with the exception of CaO and Cr. Likewise, the soil mineralogy was statistically significant for iron oxide, feldspars, mica and chlorite. Smectite and kaolinite clays were widely present and elicited a strong HA, as did quartz, in comparison to other mineral phases tested, although no strong difference was found in HA between soils from the two areas. The relationship was further investigated with principle component analysis (PCA), which showed that a combination of an increase in Y, Zr and Al2O3, and a concurrent increase Fe2O3, TiO2, MnO and Ba in the soils increased HA. Conclusion The mineralogy and chemistry of the soils influenced the HA, although the interplay between the components is complex. Further research should consider the variable biopersistance, hygroscopicity and hardness of the minerals and further characterize the nano-scale particles.
Collapse
Affiliation(s)
- Jennifer S. Le Blond
- Department of Earth Sciences, Imperial College London, London, United Kingdom
- Core Research Labs, Natural History Museum, London, United Kingdom
- * E-mail:
| | - Peter J. Baxter
- Institute of Public Health, University of Cambridge, Cambridge, United Kingdom
| | - Dhimiter Bello
- Department of Work Environment, University of Massachusetts Lowell, MA, United States of America
| | - Jennifer Raftis
- The Queens Medical Research Institute, University of Edinburgh, Little France, Edinburgh, United Kingdom
| | - Yordanos B. Molla
- Department of Earth Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Wellcome Trust Centre for Global Health Research, Brighton and Sussex Medical School, University of Sussex, Brighton, East Sussex United Kingdom
| | - Javier Cuadros
- Department of Earth Sciences, Natural History Museum, London, United Kingdom
| | - Gail Davey
- Wellcome Trust Centre for Global Health Research, Brighton and Sussex Medical School, University of Sussex, Brighton, East Sussex United Kingdom
| |
Collapse
|
15
|
Narahari SR, Aggithaya MG, Moffatt C, Ryan TJ, Keeley V, Vijaya B, Rajendran P, Karalam SB, Rajagopala S, Kumar NK, Bose KS, Sushma KV. Future Research Priorities for Morbidity Control of Lymphedema. Indian J Dermatol 2017; 62:33-40. [PMID: 28216723 PMCID: PMC5286751 DOI: 10.4103/0019-5154.198039] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Background: Innovation in the treatment of lower extremity lymphedema has received low priority from the governments and pharmaceutical industry. Advancing lymphedema is irreversible and initiates fibrosis in the dermis, reactive changes in the epidermis and subcutis. Most medical treatments offered for lymphedema are either too demanding with a less than satisfactory response or patients have low concordance due to complex schedules. A priority setting partnership (PSP) was established to decide on the future priorities in lymphedema research. Methods: A table of abstracts following a literature search was published in workshop website. Stake holders were requested to upload their priorities. Their questions were listed, randomized, and sent to lymphologists for ranking. High ranked ten research priorities, obtained through median score, were presented in final prioritization work shop attended by invited stake holders. A free medical camp was organized during workshop to understand patients’ priorities. Results: One hundred research priorities were selected from priorities uploaded to website. Ten priorities were short listed through a peer review process involving 12 lymphologists, for final discussion. They were related to simplification of integrative treatment for lymphedema, cellular changes in lymphedema and mechanisms of its reversal, eliminating bacterial entry lesions to reduce cellulitis episodes, exploring evidence for therapies in traditional medicine, improving patient concordance to compression therapy, epidemiology of lymphatic filariasis (LF), and economic benefit of integrative treatments of lymphedema. Conclusion: A robust research priority setting process, organized as described in James Lind Alliance guidebook, identified seven priority areas to achieve effective morbidity control of lymphedema including LF. All stake holders including Department of Health Research, Government of India, participated in the PSP.
Collapse
Affiliation(s)
- S R Narahari
- Institute of Applied Dermatology, Central University of Kerala, Kasaragod, Kerala, India
| | | | - Christine Moffatt
- International Lymphoedema Framework, London; Division of Nursing and Healthcare, Faculty of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - T J Ryan
- Department of Dermatology, Churchill Hospital, Oxford, United Kingdom
| | - Vaughan Keeley
- Department of Lymphedema, Royal Derby Hospital, Derby, United Kingdom
| | - B Vijaya
- Department of Pathology, JSS Medical College, JSS University, Mysore, Karnataka, India
| | - P Rajendran
- Department of Biochemistry and Molecular Biology, Central University of Kerala, Kasaragod, Kerala, India
| | - S B Karalam
- Department of R&D, Oushadhi Ltd, Thrissur, Kerala, India
| | - S Rajagopala
- Department of Kaumarabhritya, Institute for Postgraduate Teaching and Research in Ayurveda, Jamnagar, Gujarat, India
| | - N K Kumar
- Dr. TMA Pai Endowment Chair, Manipal University, Indian Council for Medical Research, Chennai, Tamil Nadu, India
| | - K S Bose
- Institute of Applied Dermatology, Central University of Kerala, Kasaragod, Kerala, India
| | - K V Sushma
- Institute of Applied Dermatology, Central University of Kerala, Kasaragod, Kerala, India
| |
Collapse
|
16
|
|
17
|
Burden of lymphatic filariasis morbidity in an area of low endemicity in Brazil. Acta Trop 2016; 163:54-60. [PMID: 27427218 DOI: 10.1016/j.actatropica.2016.07.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Revised: 07/08/2016] [Accepted: 07/13/2016] [Indexed: 01/13/2023]
Abstract
The Global Programme to Eliminate Lymphatic Filariasis has two main components: interrupting transmission of lymphatic filariasis (LF) and managing morbidity and preventing disability. However, interventions to prevent and manage LF-related disabilities in endemic communities have been of limited extent. The aim of this study was to describe the prevalence of morbidity and its correlation with filarial infection, thereby filling a gap that existed regarding the data on morbidity in Brazil. Presence of Wuchereria bancrofti microfilaria was investigated using the thick smear technique. Information on parasitosis-related clinical manifestations was obtained using a questionnaire applied by community health agents with previous training and capacitation to know about and identify the disease. To analyze correlations, Pearson's correlation coefficient was used with the corresponding statistical significance test. 23,673 individuals were investigated: 323 presented microfilaremia (1.36%) and 741 (3.13%) had clinical complaints that were attributable to LF. Acute dermatolymphangioadenitis (ADLA) was the most prevalent condition (2.2%). Lymphedema, ADLA and chyluria were more commonly reported among female patients. There were positive associations between all the clinical complaints reported and filarial infection. Hydrocele presented the most strongly positive association (r=0.699; p<0.001). The present study showed that there is an association between clinical condition reported and the rate of infection among people living in an area of low endemicity for LF. It contributes data that might provide support for healthcare systems and thus optimize disease management, through incorporating surveillance measures directed towards preventing disability and reducing the psychosocial and economic impact of the disease on poor populations living in areas endemic for LF.
Collapse
|
18
|
Stillwaggon E, Sawers L, Rout J, Addiss D, Fox L. Economic Costs and Benefits of a Community-Based Lymphedema Management Program for Lymphatic Filariasis in Odisha State, India. Am J Trop Med Hyg 2016; 95:877-884. [PMID: 27573626 PMCID: PMC5062793 DOI: 10.4269/ajtmh.16-0286] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Accepted: 07/07/2016] [Indexed: 11/12/2022] Open
Abstract
Lymphatic filariasis afflicts 68 million people in 73 countries, including 17 million persons living with chronic lymphedema. The Global Programme to Eliminate Lymphatic Filariasis aims to stop new infections and to provide care for persons already affected, but morbidity management programs have been initiated in only 24 endemic countries. We examine the economic costs and benefits of alleviating chronic lymphedema and its effects through a simple limb-care program. For Khurda District, Odisha State, India, we estimated lifetime medical costs and earnings losses due to chronic lymphedema and acute dermatolymphangioadenitis (ADLA) with and without a community-based limb-care program. The program would reduce economic costs of lymphedema and ADLA over 60 years by 55%. Savings of US$1,648 for each affected person in the workforce are equivalent to 1,258 days of labor. Per-person savings are more than 130 times the per-person cost of the program. Chronic lymphedema and ADLA impose a substantial physical and economic burden on the population in filariasis-endemic areas. Low-cost programs for lymphedema management based on limb washing and topical medication for infection are effective in reducing the number of ADLA episodes and stopping progression of disabling and disfiguring lymphedema. With reduced disability, people are able to work longer hours, more days per year, and in more strenuous, higher-paying jobs, resulting in an important economic benefit to themselves, their families, and their communities. Mitigating the severity of lymphedema and ADLA also reduces out-of-pocket medical expense.
Collapse
Affiliation(s)
| | - Larry Sawers
- Department of Economics, American University, Washington, District of Columbia
| | - Jonathan Rout
- Church's Auxiliary for Social Action (CASA), Bhubaneswar, India
| | - David Addiss
- Children Without Worms, Task Force for Global Health, Decatur, Georgia
| | - LeAnne Fox
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia
| |
Collapse
|
19
|
Mues KE, Lammie PJ, Klein M, Kleinbaum DG, Addiss D, Fox LM. Changes in Antibody Levels during and following an Episode of Acute Adenolymphangitis (ADL) among Lymphedema Patients in Léogâne, Haiti. PLoS One 2015; 10:e0141047. [PMID: 26492462 PMCID: PMC4619626 DOI: 10.1371/journal.pone.0141047] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Accepted: 10/02/2015] [Indexed: 11/22/2022] Open
Abstract
Introduction Episodes of acute adenolymphangitis (ADL) are often the first clinical sign of lymphatic filariasis (LF). They are often accompanied by swelling of the affected limb, inflammation, fever, and general malaise and lead to the progression of lymphedema. Although ADL episodes have been studied for a century or more, questions still remain as to their etiology. We quantified antibody levels to pathogens that potentially contribute to ADL episodes during and after an episode among lymphedema patients in Léogâne, Haiti. We estimated the proportion of ADL episodes hypothesized to be attributed to specific pathogens. Methods We measured antibody levels to specific pathogens during and following an ADL episode among 41 lymphedema patients enrolled in a cohort study in Léogâne, Haiti. We calculated the absolute and relative changes in antibody levels between the ADL and convalescent time points. We calculated the proportion of episodes that demonstrated a two-fold increase in antibody level for several bacterial, fungal, and filarial pathogens. Results Our results showed the greatest proportion of two-fold changes in antibody levels for the carbohydrate antigen Streptococcus group A, followed by IgG2 responses to a soluble filarial antigen (BpG2), Streptococcal Pyrogenic Exotoxin B, and an antigen for the fungal pathogen Candida. When comparing the median antibody level during the ADL episode to the median antibody level at the convalescent time point, only the antigens for Pseudomonas species (P-value = 0.0351) and Streptolysin O (P-value = 0.0074) showed a significant result. Conclusion Although our results are limited by the lack of a control group and few antibody responses, they provide some evidence for infection with Streptococcus A as a potential contributing factor to ADL episodes. Our results add to the current evidence and illustrate the importance of determining the causal role of bacterial and fungal pathogens and immunological antifilarial response in ADL episodes.
Collapse
Affiliation(s)
- Katherine E. Mues
- Department of Epidemiology, Rollins School of Public Health and Laney Graduate School, Emory University, Atlanta, Georgia, United States of America
- * E-mail:
| | - Patrick J. Lammie
- Parasitic Diseases Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Mitchel Klein
- Department of Epidemiology, Rollins School of Public Health and Laney Graduate School, Emory University, Atlanta, Georgia, United States of America
| | - David G. Kleinbaum
- Department of Epidemiology, Rollins School of Public Health and Laney Graduate School, Emory University, Atlanta, Georgia, United States of America
| | - David Addiss
- Task Force for Global Health, Decatur, Georgia, United States of America
| | - LeAnne M. Fox
- Parasitic Diseases Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| |
Collapse
|
20
|
De Britto LJ, Yuvaraj J, Kamaraj P, Poopathy S, Vijayalakshmi G. Risk Factors for Chronic Intertrigo of the Lymphedema Leg in Southern India: A Case-Control Study. INT J LOW EXTR WOUND 2015; 14:377-83. [PMID: 26353823 DOI: 10.1177/1534734615604289] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Rich clinical experiences indicate that toe web intertrigo is a major predisposing condition for cellulitis/acute dermatolymphango adenitis (ADLA) and the number of lesions is the strongest predictor of frequency of ADLA in lymphedema (LE) patients. However, there is scanty information on the risk factors for the establishment of chronic toe web intertrigo in LE patients. We performed a case-control study recruiting 52 lower limb LE with intertrigo and 52 lower limb LE without intertrigo in community settings and assessed general and local potential risk factors for chronic intertrigo. Analysis of local risk factors revealed that topical application of oil, tingling and numbness of the extremities were associated independently with chronic intertrigo. In multivariate analysis, LE grades III and IV were associated with chronic intertrigo, after adjusting for tingling and numbness, prophylactic antibiotic, age group, and gender. From a public health perspective, LE patients of grades III and IV and patients under antibiotic prophylaxis should be self-motivated to look for the early symptoms of toe web intertrigo to prevent chronic stage and recurrent episodes of cellulitis. Patients with history of tingling and numbness of the periphery need to be monitored for pressure effects leading to poor vascularization and delayed healing of intertrigo.
Collapse
Affiliation(s)
| | - Jayaram Yuvaraj
- National Institute of Epidemiology, Indian Council of Medical Research, Chennai, India
| | - Pattabi Kamaraj
- National Institute of Epidemiology, Indian Council of Medical Research, Chennai, India
| | - Subbiah Poopathy
- Vector Control Research Centre, Indian Council of Medical Research, Puducherry, India
| | | |
Collapse
|
21
|
Olszewski WL, Zaleska M, Stelmach E, Swoboda-Kopec E, Jain P, Agrawal K, Gogia S, Gogia A, Andziak P, Durlik M. Cryptic Bacteria of Lower Limb Deep Tissues as a Possible Cause of Inflammatory and Necrotic Changes in Ischemia, Venous Stasis and Varices, and Lymphedema. Surg Infect (Larchmt) 2015; 16:313-22. [PMID: 26046245 DOI: 10.1089/sur.2014.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Infections and inflammation of the lower limb skin, soft tissues, and vessels are more common than in other body regions. The aim was to determine whether cryptic bacteria dwelling in deep tissues are the cause. METHODS We performed bacteriologic studies of specimens harvested from arteries of amputated ischemic legs, leg varices, and tissue fluid/lymph and lymphatics in lymphedema. RESULTS Calf arteries contained isolates in 61% and femoral arteries in 36%, whereas normal cadaveric organ donors' arteries in 11%. Bacterial deoxyribonucleic acid (DNA) was detected in 70%. The majority of isolates belonged to the coagulase-negative staphylococci and Staphylococcus aureus; however, highly pathogenic bacteria were also detected. All were sensitive to all antibiotics except penicillin. Saphenous vein varices contained bacterial cells in 40% and controls 4%; bacterial DNA was found in 69%. The majority of bacteria were S. epidermidis and S. aureus susceptible to all antibiotics except penicillin, Lymph and epifascial lymphatics limb contained bacteria in 60% and 33% samples, respectively and controls in 7%. Most were S. epidermidis susceptible to all antibiotics except penicillin. CONCLUSION Cryptic bacteria are present in lower limb tissues and may play a pathologic role in surgical site infections. Proper antibacterial prophylaxis should be considered when planning surgical interventions.
Collapse
Affiliation(s)
- Waldemar L Olszewski
- 1Department of Surgical Research Transplantation and Human Epigenetics, Medical Research Center, Polish Academy of Sciences, Warsaw, Poland.,2Department of Transplantation Surgery, Central Clinical Hospital, Ministry of Internal Affairs, Warsaw, Poland
| | - Marzanna Zaleska
- 1Department of Surgical Research Transplantation and Human Epigenetics, Medical Research Center, Polish Academy of Sciences, Warsaw, Poland
| | - Ewa Stelmach
- 1Department of Surgical Research Transplantation and Human Epigenetics, Medical Research Center, Polish Academy of Sciences, Warsaw, Poland
| | | | - Pradeep Jain
- 4Institute of Medical Sciences, Benaras Hindu University, Varanasi, India
| | - Karoon Agrawal
- 5Department of Burns, Plastic and Maxillofacial Surgery, Safdarjang Hospital and VM Medical College, New Delhi, India
| | - Sashi Gogia
- 6Amla Mediquip/Sanwari Bai Surgical Centre, New Delhi, India
| | - Arun Gogia
- 6Amla Mediquip/Sanwari Bai Surgical Centre, New Delhi, India
| | - Piotr Andziak
- 2Department of Transplantation Surgery, Central Clinical Hospital, Ministry of Internal Affairs, Warsaw, Poland
| | - Marek Durlik
- 2Department of Transplantation Surgery, Central Clinical Hospital, Ministry of Internal Affairs, Warsaw, Poland.,7Department of Surgical Research and Transplantology, Medical Research Center, Polish Academy of Sciences, Warsaw, Poland
| |
Collapse
|
22
|
Carlson JA. Lymphedema and subclinical lymphostasis (microlymphedema) facilitate cutaneous infection, inflammatory dermatoses, and neoplasia: A locus minoris resistentiae. Clin Dermatol 2015; 32:599-615. [PMID: 25160101 DOI: 10.1016/j.clindermatol.2014.04.007] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Whether primary or secondary, lymphedema is caused by failure to drain protein-rich interstitial fluid. Typically affecting a whole limb, it has become apparent that lymphedema can also affect localized regions of the skin, or it can be clinically silent but histologically evident, denoted by dilated lymphangiectases (latent lymphedema). Chronic lymph stasis has numerous consequences, including lipogenesis, fibrosis, inflammation, lymphangiogenesis, and immunosuppression. For example, lymphedema's disruption of immune cell trafficking leads to localized immune suppression, predisposing the area affected to chronic inflammation, infection (cellulitis and verrucosis), and malignancy (angiosarcoma and nonmelanoma skin cancer). The pathogenesis of lymphedema is reviewed and exemplified by describing how a combination of lymph stasis-promoting factors such as trauma, obesity, infection, and inflammatory disorders produces localized elephantiasis; furthermore, the finding of lymphangiectases is found to be common in numerous dermatologic disorders and argued to play a role in their pathogenesis. Lastly, it is discussed how antigen burden, which is controlled by lymphatic clearance, affects the immune response, resulting in immune tolerance, immunopathology, or normal adaptive immunity.
Collapse
Affiliation(s)
- J Andrew Carlson
- Divisions of Dermatopathology and Dermatology, Department of Pathology, Albany Medical College, MC-81, Albany, NY 12208.
| |
Collapse
|
23
|
Mues KE, Deming M, Kleinbaum DG, Budge PJ, Klein M, Leon JS, Prakash A, Rout J, Fox LM. Impact of a community-based lymphedema management program on episodes of Adenolymphangitis (ADLA) and lymphedema progression--Odisha State, India. PLoS Negl Trop Dis 2014; 8:e3140. [PMID: 25211334 PMCID: PMC4161333 DOI: 10.1371/journal.pntd.0003140] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Accepted: 07/23/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Lymphedema management programs have been shown to decrease episodes of adenolymphangitis (ADLA), but the impact on lymphedema progression and of program compliance have not been thoroughly explored. Our objectives were to determine the rate of ADLA episodes and lymphedema progression over time for patients enrolled in a community-based lymphedema management program. We explored the association between program compliance and ADLA episodes as well as lymphedema progression. METHODOLOGY/PRINCIPAL FINDINGS A lymphedema management program was implemented in Odisha State, India from 2007-2010 by the non-governmental organization, Church's Auxiliary for Social Action, in consultation with the Centers for Disease Control and Prevention. A cohort of patients was followed over 24 months. The crude 30-day rate of ADLA episodes decreased from 0.35 episodes per person-month at baseline to 0.23 at 24 months. Over the study period, the percentage of patients who progressed to more severe lymphedema decreased (P-value = 0.0004), while those whose lymphedema regressed increased over time (P-value<0.0001). Overall compliance to lymphedema management, lagged one time point, appeared to have little to no association with the frequency of ADLA episodes among those without entry lesions (RR = 0.87 (0.69, 1.10)) and was associated with an increased rate (RR = 1.44 (1.11, 1.86)) among those with entry lesions. Lagging compliance two time points, it was associated with a decrease in the rate of ADLA episodes among those with entry lesions (RR = 0.77 (95% CI: 0.59, 0.99)) and was somewhat associated among those without entry lesions (RR = 0.83 (95% CI: 0.64, 1.06)). Compliance to soap was associated with a decreased rate of ADLA episodes among those without inter-digital entry lesions. CONCLUSIONS/SIGNIFICANCE These results indicate that a community-based lymphedema management program is beneficial for lymphedema patients for both ADLA episodes and lymphedema. It is one of the first studies to demonstrate an association between program compliance and rate of ADLA episodes.
Collapse
Affiliation(s)
- Katherine E. Mues
- Department of Epidemiology, Rollins School of Public Health and Laney Graduate School, Emory University, Atlanta, Georgia, United States of America
- * E-mail:
| | - Michael Deming
- Parasitic Diseases Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - David G. Kleinbaum
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - Philip J. Budge
- Parasitic Diseases Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Mitch Klein
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - Juan S. Leon
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | | | | | - LeAnne M. Fox
- Parasitic Diseases Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| |
Collapse
|
24
|
Eddy BA, Blackstock AJ, Williamson JM, Addiss DG, Streit TG, Beau de Rochars VM, Fox LM. A longitudinal analysis of the effect of mass drug administration on acute inflammatory episodes and disease progression in lymphedema patients in Leogane, Haiti. Am J Trop Med Hyg 2013; 90:80-8. [PMID: 24218408 DOI: 10.4269/ajtmh.13-0317] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
We conducted a longitudinal analysis of 117 lymphedema patients in a filariasis-endemic area of Haiti during 1995-2008. No difference in lymphedema progression between those who received or did not receive mass drug administration (MDA) was found on measures of foot (P = 0.24), ankle (P = 0.87), or leg (P = 0.46) circumference; leg volume displacement (P = 0.09), lymphedema stage (P = 0.93), or frequency of adenolymphangitis (ADL) episodes (P = 0.57). Rates of ADL per year were greater after initiation of MDA among both groups (P < 0.01). Nevertheless, patients who received MDA reported improvement in four areas of lymphedema-related quality of life (P ≤ 0.01). Decreases in foot and ankle circumference and ADL episodes were observed during the 1995-1998 lymphedema management study (P ≤ 0.01). This study represents the first longitudinal, quantitative, leg-specific analysis examining the clinical effect of diethylcarbamazine on lymphedema progression and ADL episodes.
Collapse
Affiliation(s)
- Brittany A Eddy
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia; Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia; Atlanta Research and Education Foundation, Decatur, Georgia; Children Without Worms, Task Force for Global Health, Decatur, Georgia; Center for Tropical Disease Research and Training, University of Notre Dame, Notre Dame, Indiana; and Lymphatic Filariasis Program, Hôpital Sainte Croix, Léogane, Haiti
| | | | | | | | | | | | | |
Collapse
|
25
|
Ferguson J, Yeshanehe W, Matts P, Davey G, Mortimer P, Fuller C. Assessment of skin barrier function in podoconiosis: measurement of stratum corneum hydration and transepidermal water loss. Br J Dermatol 2013; 168:550-4. [DOI: 10.1111/bjd.12134] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
26
|
Stout NL, Brantus P, Moffatt C. Lymphoedema management: An international intersect between developed and developing countries.Similarities, differences and challenges. Glob Public Health 2012; 7:107-23. [DOI: 10.1080/17441692.2010.549140] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
27
|
Jullien P, Somé JD, Brantus P, Bougma RW, Bamba I, Kyelem D. Efficacy of home-based lymphoedema management in reducing acute attacks in subjects with lymphatic filariasis in Burkina Faso. Acta Trop 2011; 120 Suppl 1:S55-61. [PMID: 21470557 DOI: 10.1016/j.actatropica.2011.03.007] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2009] [Revised: 11/17/2010] [Accepted: 03/22/2011] [Indexed: 11/28/2022]
Abstract
One of the two main goals of the Global Programme to Eliminate Lymphatic Filariasis (LF) is to provide care for those suffering from the devastating clinical manifestations of this filarial infection. Among the 120 million infected people worldwide, up to 16 million have lymphoedema. The WHO strategy for managing lymphoedema is based on rigorous skin hygiene, exercise, antibiotics and antifungals when indicated. The aim is to reduce acute attacks of adenolymphangitis and cellulitis responsible for lymphoedema progression and disability. The objective of our study was to assess the effectiveness of home-based lymphoedema management implemented by the national health system of Burkina Faso. Any patient was eligible to participate in the study if suffering from LF-related lymphoedema of a lower limb at any stage, and receiving care as part of the health education and washing project between April 2005 and December 2007. The primary readout was the occurrence of an acute attack in the month preceding the consultation reported by the patient or observed by the care-giver. In all, 1089 patients were enrolled in the study. Before lymphoedema management intervention, 78.1% (95%CI: 75.5-80.5) of the patients had an acute attack in the month preceding the consultation; after four and half months of lymphoedema management, this was reduced to 39.1% (95%CI: 36.2-42.1). A reduction of acute attacks related to the number of consultations or related to the patients' age and gender was not observed. Our results suggest that the home-based lymphoedema management programme in the primary health care system of Burkina Faso is effective in reducing morbidity due to LF in the short-term (4.5 months). The lymphoedema management requires no additional human resources, but whether its effect can be sustained remains to be seen.
Collapse
Affiliation(s)
- Patrick Jullien
- Handicap International, 14 Avenue Berthelot, 69007 Lyon, France.
| | | | | | | | | | | |
Collapse
|
28
|
De Britto LJ, Das LK. Do the filarial lymphoedema patients''3 months recall' on acute dermato-lymphangio-adenitis (ADLA) correlate with streptococcal serology? J Eur Acad Dermatol Venereol 2011; 26:1031-4. [PMID: 21797929 DOI: 10.1111/j.1468-3083.2011.04182.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
AIM The aim of this study was to know the correlation of patients' 3 months recall on acute dermato-lymphangio-adenitis (ADLA) with anti-streptolysin O (ASO) serology and its application as a tool to know the burden of ADLA in the community. METHODS Fifty-nine lymphoedema (LE) patients and 27 age matched controls were clinically assessed for LE and the occurrence of ADLA during the previous 3 months was obtained by recall. After obtaining the informed consent, 2 mL of venous blood sample was collected and ASO was quantified in Olympus AU400 auto-analyzer. RESULTS When the results were computed as two groups, controls and LE patients with no reported ADLA and LE patients with reported ADLA (by 3 months recall), the ASO positivity and ASO titre was significantly higher in the later group (P < 0.05). When the results were computed as three groups, controls with no reported ADLA, LE patients with no reported ADLA and LE patients with reported ADLA, the ASO titre was significantly higher in LE patients reported ADLA (P < 0.05). CONCLUSION As ASO was measured in post-infection phase, we relied on the ASO titre for making conclusion. Patients' 3 months recall on ADLA correlates with the ASO titre and therefore, it could be considered as a tool to measure the burden of ADLA in the community. Multicentre community-based studies are needed to ascertain the findings.
Collapse
Affiliation(s)
- L J De Britto
- Unit of Clinical Epidemiology & Chemotherapy, Vector Control Research Centre, Indian Council of Medical Research, Pondicherry, India
| | | |
Collapse
|
29
|
Abstract
Lymphatic filariasis and onchocerciasis are parasitic helminth diseases that constitute a serious public health issue in tropical regions. The filarial nematodes that cause these diseases are transmitted by blood-feeding insects and produce chronic and long-term infection through suppression of host immunity. Disease pathogenesis is linked to host inflammation invoked by the death of the parasite, causing hydrocoele, lymphoedema, and elephantiasis in lymphatic filariasis, and skin disease and blindness in onchocerciasis. Most filarial species that infect people co-exist in mutualistic symbiosis with Wolbachia bacteria, which are essential for growth, development, and survival of their nematode hosts. These endosymbionts contribute to inflammatory disease pathogenesis and are a target for doxycycline therapy, which delivers macrofilaricidal activity, improves pathological outcomes, and is effective as monotherapy. Drugs to treat filariasis include diethylcarbamazine, ivermectin, and albendazole, which are used mostly in combination to reduce microfilariae in blood (lymphatic filariasis) and skin (onchocerciasis). Global programmes for control and elimination have been developed to provide sustained delivery of drugs to affected communities to interrupt transmission of disease and ultimately eliminate this burden on public health.
Collapse
Affiliation(s)
- Mark J Taylor
- Liverpool School of Tropical Medicine, Liverpool, UK.
| | | | | |
Collapse
|
30
|
Mackenzie CD, Lazarus WM, Mwakitalu ME, Mwingira U, Malecela MN. Lymphatic filariasis: patients and the global elimination programme. ANNALS OF TROPICAL MEDICINE AND PARASITOLOGY 2010; 103 Suppl 1:S41-51. [PMID: 19843397 DOI: 10.1179/000349809x12502035776630] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
The defining images of lymphatic filariasis are the horrendous disfigurements of lymphoedema, elephantiasis and hydrocele. These clinical presentations, although obviously important and life changing, are not, however, the only outcomes of this wide-spread filarial infection. The other effects of the disease range from severe, acute but short-term bouts of sickness to psychological impairment, poverty and family hardship. It is important to support cases of the disease through all means available, such as reparative hydrocelectomy, hygiene training and facilitation, and the provision of adequate chemotherapy. Although only a minority of the residents in any endemic community is affected with the severe clinical manifestations of this parasitic infection, these cases are central to, and important advocates for, the current global effort to eliminate the infection through mass drug administrations (MDA). Their clinical improvement acts as an important catalyst for the general population and encourages high compliance in the MDA. This communication discusses the central role that filariasis patients have played in the Tanzania Lymphatic Filariasis Elimination Programme to date, and covers some of the clinical successes achieved in the past 10 years. The abolition of the clinical manifestations of filarial infection remains the ultimate goal of the Global Programme to Eliminate Lymphatic Filariasis, and maintaining a focus on the affected individuals and their clinical condition is vital to that programme's overall success.
Collapse
Affiliation(s)
- C D Mackenzie
- Department of Pathobiology and Diagnostic Investigation, Michigan State University, East Lansing, MI 48824, USA.
| | | | | | | | | |
Collapse
|
31
|
Addiss DG, Louis-Charles J, Roberts J, Leconte F, Wendt JM, Milord MD, Lammie PJ, Dreyer G. Feasibility and effectiveness of basic lymphedema management in Leogane, Haiti, an area endemic for bancroftian filariasis. PLoS Negl Trop Dis 2010; 4:e668. [PMID: 20422031 PMCID: PMC2857874 DOI: 10.1371/journal.pntd.0000668] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2009] [Accepted: 03/12/2010] [Indexed: 11/24/2022] Open
Abstract
Background Approximately 14 million persons living in areas endemic for lymphatic filariasis have lymphedema of the leg. Clinical studies indicate that repeated episodes of bacterial acute dermatolymphangioadenitis (ADLA) lead to progression of lymphedema and that basic lymphedema management, which emphasizes hygiene, skin care, exercise, and leg elevation, can reduce ADLA frequency. However, few studies have prospectively evaluated the effectiveness of basic lymphedema management or assessed the role of compressive bandaging for lymphedema in resource-poor settings. Methodology/Principal Findings Between 1995 and 1998, we prospectively monitored ADLA incidence and leg volume in 175 persons with lymphedema of the leg who enrolled in a lymphedema clinic in Leogane, Haiti, an area endemic for Wuchereria bancrofti. During the first phase of the study, when a major focus of the program was to reduce leg volume using compression bandages, ADLA incidence was 1.56 episodes per person-year. After March 1997, when hygiene and skin care were systematically emphasized and bandaging discouraged, ADLA incidence decreased to 0.48 episodes per person-year (P<0.0001). ADLA incidence was significantly associated with leg volume, stage of lymphedema, illiteracy, and use of compression bandages. Leg volume decreased in 78% of patients; over the entire study period, this reduction was statistically significant only for legs with stage 2 lymphedema (P = 0.01). Conclusions/Significance Basic lymphedema management, which emphasized hygiene and self-care, was associated with a 69% reduction in ADLA incidence. Use of compression bandages in this setting was associated with an increased risk of ADLA. Basic lymphedema management is feasible and effective in resource-limited areas that are endemic for lymphatic filariasis. Lymphatic filariasis is a parasitic disease that is spread by mosquitoes. In tropical countries where lymphatic filariasis occurs, approximately 14 million people suffer from chronic swelling of the leg, known as lymphedema. Repeated episodes of bacterial skin infection (acute attacks) cause lymphedema to progress to its disfiguring form, elephantiasis. To help achieve the goal of eliminating lymphatic filariasis globally, the World Health Organization recommends basic lymphedema management, which emphasizes hygiene, skin care, exercise, and leg elevation. Its effectiveness in reducing acute attack frequency, as well as the role of compressive bandaging, have not been adequately evaluated in filariasis-endemic areas. Between 1995 and 1998, we studied 175 people with lymphedema of the leg in Leogane, Haiti. During Phase I of the study, when compression bandaging was used to reduce leg volume, the average acute attack rate was 1.56 episodes per year; it was greater in people who were illiterate and those who used compression bandages. After March 1997, when hygiene and skin care were emphasized and bandaging discouraged, acute attack frequency significantly decreased to 0.48 episodes per year. This study highlights the effectiveness of hygiene and skin care, as well as limitations of compressive bandaging, in managing lymphedema in filariasis-endemic areas.
Collapse
Affiliation(s)
- David G Addiss
- Division of Parasitic Diseases, National Center for Infectious Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.
| | | | | | | | | | | | | | | |
Collapse
|
32
|
|
33
|
Addiss DG, Brady MA. Morbidity management in the Global Programme to Eliminate Lymphatic Filariasis: a review of the scientific literature. FILARIA JOURNAL 2007; 6:2. [PMID: 17302976 PMCID: PMC1828725 DOI: 10.1186/1475-2883-6-2] [Citation(s) in RCA: 98] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/16/2006] [Accepted: 02/15/2007] [Indexed: 11/23/2022]
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.
Collapse
Affiliation(s)
- David G Addiss
- WHO Collaborating Center for Control and Elimination of Lymphatic Filariasis in the Americas, Division of Parasitic Diseases, Centers for Disease Control and Prevention, Mailstop F-22, 4770 Buford Highway, Atlanta, Georgia, 30341, USA
- Fetzer Institute, 9292 West KL Avenue, Kalamazoo, Michigan, 49009, USA
| | - Molly A Brady
- Lymphatic Filariasis Support Center, The Task Force for Child Survival and Development, 750 Commerce Dr, Suite 400, Decatur, Georgia 30030, USA
| |
Collapse
|
34
|
Abstract
Lymphatic filariasis (LF) is a disease not just treatable or controllable; it is a disease that can be eliminated. Indeed, LF is currently the target of a major global initiative to do just that; a few visionaries of the past 50 years did hypothesize that LF elimination was feasible. However, for most of the scientific and global health communities, the elimination of such a broadly disseminated, mosquito-borne disease has seemed highly unlikely. During the past decade, however, both the treatment strategies and the control strategies for LF have undergone profound paradigm shifts-all because of a rapid increase in knowledge and understanding of LF that derived directly from a series of remarkable achievements by the scientific and medical research communities. As a result, a public health dimension with a focus on affected populations, now supplements the earlier, predominantly patient-oriented clinical approach to LF. The early uncertainties, then the essential steps leading to this change in outlook are outlined below, followed by descriptions of the new strategy for LF elimination, the Global Programme created to attain this goal and the successes achieved to date.
Collapse
Affiliation(s)
- Eric A Ottesen
- Lymphatic Filariasis Support Centre, The Task Force for Child Survival and Development, 750 Commerce Drive Decatur, GA 30030, USA
| |
Collapse
|