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Treatment is somewhat controversial, as no drug can fully control or reverse the disease, and treatment may cause serious acute inflammatory symptoms Diethylcarbamazine is the drug of choice, but it cannot cure infections due to its limited action against adult worms Asymptomatic infection and acute lymphangitis are treated with this drug (2 mg/kg three times daily) for 10 14 days, leading to a marked decrease in microfilaremia Therapy may be accompanied by allergic symptoms, including fever, headache, malaise, hypotension, and bronchospasm, probably due to release of antigens from dying worms For this reason, treatment courses may begin with a lower dosage, with escalation over the first 4 days of treatment Recent studies have suggested that single annual doses of diethylcarbamazine (6 mg/kg), alone or with ivermectin (400 mcg/kg) or albendazole (400 mg) may be as effective as longer courses of diethylcarbamazine When onchocerciasis or loiasis is suspected, it may be appropriate to withhold diethylcarbamazine to avoid severe reactions to dying microfilariae; rather, ivermectin plus albendazole may be given, although these drugs are less active than diethylcarbamazine against adult worms Appropriate management of advanced obstructive disease is uncertain Drainage of hydroceles provides symptomatic relief, although they will recur Therapy with diethylcarbamazine cannot reverse chronic lymphatic changes but is typically provided to lower worm burdens An interesting new approach under study is to treat with doxycycline (100 200 mg/d for 4 6 weeks), which kills obligate intracellular Wolbachia bacteria, leading to death of adult filarial worms Secondary bacterial infections must be treated Surgical correction may be helpful in some cases



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The diagnosis of lymphatic filariasis is strongly suggested by characteristic findings of lymphangitis or lymphatic obstruction in persons with risk factors for the disease The diagnosis is confirmed by finding microfilariae, usually in blood, but this may be difficult In addition, microfilariae may be absent, especially early in the disease progression (first 2 3 years) or with chronic obstructive disease To increase yields, blood samples are obtained at about midnight in most areas, but not in the South Pacific, where microfilaremia is diurnal Smears are evaluated by wet mount to identify motile parasites and by Giemsa staining; these examinations can be delayed until the following morning, with storage of samples at room temperature Of note, the periodicity of microfilaremia is variable, and daytime samples may yield positive results Microfilariae may also be identified in hydrocele fluid or chylous urine Eosinophilia is usually absent, except during acute inflammatory syndromes Available serologic tests, including bentonite flocculation, indirect hemagglutination, ELISA, and indirect fluorescent antibody tests, may be helpful but cannot distinguish between past and active infections Rapid antigen tests with sensitivity and specificity over 90% are available Adult worms may also be found in lymph node biopsy specimens (although biopsy is not usually clinically indicated) or by ultrasound of a scrotal hydrocele or lymphedematous breast When microfilaremia is lacking, especially if sophisticated techniques are not available, diagnoses may need to be made on clinical grounds alone





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Calculate the bus admittance matrix Ybus and the bus impedance matrix Z bus for the power system shown in Figure P10-2 SOLUTION The voltage sources can be converted to current sources, and the series impedances between each bus can be replaced by a single admittance, resulting in the system shown below Note that we have labeled each bus with a number

Avoidance of mosquitoes is a key measure; preventive measures include the use of screens, bed nets (ideally treated with insecticide), and insect repellents Studies have shown that community-based treatment with single annual doses of effective drugs offers a highly effective means of control The current WHO strategy for control includes mass treatment of at risk communities with single annual doses of diethylcarbamazine plus albendazole or, for areas with onchocerciasis, albendazole plus ivermectin

Figure 7-37 Two PINGs (successful PING on top, unsuccessful PING on bottom)

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Bockarie MJ et al Efficacy of single-dose diethylcarbamazine compared with diethylcarbamazine combined with albendazole against Wuchereria bancrofti infection in Papua New Guinea Am J Trop Med Hyg 2007 Jan;76(1):62 6 [PMID: 17255231] Johnston KL et al Wolbachia in filarial parasites: targets for filarial infection and disease control Curr Infect Dis Rep 2007 Jan;9(1):55 9 [PMID: 17254505] Ramzy RM et al Effect of yearly mass drug administration with diethylcarbamazine and albendazole on bancroftian filariasis in Egypt: a comprehensive assessment Lancet 2006 Mar 25;367(9515):992 9 [PMID: 16564361] Tisch DJ et al Mass chemotherapy options to control lymphatic filariasis: a systematic review Lancet Infect Dis 2005 Aug; 5(8):514 23 [PMID: 16048720]

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