Bancroftian filariasis in children and adolescents: clinical–pathological observations in 22 cases from an endemic area

Travelers' tropical skin diseases: Challenges and interventions

Tropical regions receive a significant part of the traveling population. It is very important that health professionals are familiar with the main tropical skin diseases and able to advice patients appropriately. This article reviews the main tropical diseases of travelers, with an emphasis on diagnosis, management, and prevention. Among others, cutaneous larva migrans, myiasis, tungiasis, Chagas disease, Dengue fever, African trypanosomiasis, filariasis, and leishmaniasis are discussed. Increasing awareness among travelers and health care professionals can help reduce morbidity and mortality. Continued research on new drugs and vaccines is needed to reduce the risks of tropical diseases.

Mapping of Wuchereria bancrofti infection in children and adolescents in an endemic area of Brazil

A parasitological survey was conducted among children and adolescents in the municipality of Jaboatão dos Guararapes, Brazil to describe the occurrence and spatial distribution of lymphatic filariasis. Microfilaraemia was investigated through the thick smear technique, using 50 μl of capillary blood that was collected at night. The spatial analysis used a digital base map of the municipality, divided into districts, which were classified as hypoendemic, mesoendemic or hyperendemic. 8670 children were examined and 96 cases of microfilaraemia were identified (1.1%). The prevalence rate did not differ significantly between the sexes. Occurrences of filarial infection increased with increasing age: the greatest prevalence was recorded between 15 and 18 years of age (P<0.05). There were 49 reports of clinical manifestations. The spatial distribution of microfilaraemia according to residential district showed that 13 (54.2%) of the 24 districts investigated were positive. Approximately 33% of the districts were hyperendemic. The results demonstrated that the pediatric population had intense early exposure to the parasite, thus characterizing filariasis as endemic in the municipality. The spatial analysis allowed identification of areas with greater occurrence of infection among children, and showed localities where the populations most exposed to transmission were concentrated. Epidemiological surveillance of microfilaraemia among children and spatial analysis are important local transmission indicators and form instruments for planning actions within the Global Program to Eliminate Lymphatic Filariasis, since they make it possible to identify priority areas.

Efficacy of home-based lymphoedema management in reducing acute attacks in subjects with lymphatic filariasis in Burkina Faso

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.

[Aspects of the social realities of children and adolescents seen at a reference service for bancroftian filariasis in Recife, state of Pernambuco]

The authors report on aspects of the social realities of children and adolescents living in Jaboatão dos Guararapes, State of Pernambuco, who were diagnosed with Bancroftian filariasis infection and were treated at the Filariasis Teaching, Research and Care Center of the Federal University of Pernambuco (Health Sciences Center), which is a tertiary-level reference service for filariasis. The patients' housing conditions were quantified and classified as subhuman, with a direct relationship with the maintenance of Bancroftian filariasis transmission, and the authors highlight the need for political decisions regarding the implementation of basic sanitation projects.

Doppler ultrasonography reveals adult-worm nests in the lymph vessels of children with brugian filariasis

Although ultrasonography has allowed 'nests' of live adult worms and dilated lymphatics to be detected in the early stages of infection with Wuchereria bancrofti, previous attempts to locate such adult-worm nests in brugian filariasis have been unsuccessful. In this study, the successful location of live adult Brugia malayi parasites, in the lymphatics of the axilla, thigh, epitrochlear region and/or popliteal fossa of children aged 3-15 years, is described for the first time. The 'filarial dance sign' (FDS), which indicates the presence of live adult worms, was observed in six children with microfilaraemia and in eight children who, though amicrofilaraemic, either had experienced an episode of lymphoedema (one) or were only positive for antifilarial IgG4 antibodies (seven). In bancroftian infection, the adult-worm nests have mostly been seen in asymptomatic but microfilaraemic subjects. The suspected worm nests, 18 in the 14 children, were all confirmed using colour-power and pulse-wave Doppler examinations. The worm nests were distinctly smaller and the wriggling movements were less rapid and less conspicuous than those seen in bancroftian filariasis. The importance of these findings in the management and control of lymphatic filariasis is discussed.

Chronic clinical manifestations related to Wuchereria bancrofti infection in a highly endemic area in Kenya

Clinical examinations were conducted in an effort to provide baseline data for a pilot filariasis elimination programme implemented in a Wuchereria bancrofti-endemic focus in Malindi district, Kenya. Of 186 males aged 15 years and above examined, 64 individuals (34.4%) had hydrocele, and the prevalence of the manifestation in those above 40 years old was 55.3%. The prevalence of leg lymphoedema in persons aged 15 years and above was 8.5%, with a higher rate in males (12.6%) than in females (5.7%). The overall prevalence of inguinal adenopathy was 8.6%, and males had a significantly higher (12.9%) prevalence of adenopathy than females (5.1%) (P<0.001). The data in the present study provided support for consideration of filarial infection as a possible cause of inguinal lymphadenopathy in bancroftian filariasis-endemic areas. The results of this study also indicate that lymphatic filariasis is a serious public health problem in the northern coastal areas and morbidity control programmes should be implemented to alleviate the suffering of those affected.