Extralymphatic disease due to bancroftian filariasis

Infection with Wuchereria bancrofti, Brugia malayi, or B. timori not only affects the structure and function of lymphatic vessels but is also associated with extralymphatic pathology and disease. Because it is now possible to detect living adult worms by ultrasonography, much emphasis is placed on lymphatic pathology. However, the finding of renal damage in asymptomatic microfilaremic carriers has led to increased recognition of the importance of extralymphatic clinical manifestation in bancroftian filariasis. The authors present a number of clinical syndromes that may be manifestations of extralymphatic filarial disease and discuss possible mechanisms that cause these conditions. The main purpose of this paper is to raise the awareness of students and physicians of the prevalence and the importance of extralymphatic disease in bancroftian filariasis so that it is diagnosed and treated properly and also to alert for the need of additional research in this area.

Dietilcarbamazina no tratamento da filariose bancroftiana / Diethylcarbamazine in the treatment of Bancroft's filariasis

Os autores realizaram uma ampla revisão sobre o tratamento da filariose bancroftiana com a droga dietilcarbamazina. Os aspectos interessantes sobre o histórico de sua descoberta e os conceitos básicos de sua farmacologia foram relatados de forma resumida. Ênfase especial, por outro lado, foi dada às especulações feitas pelos diversos autores sobre os achados intrigantes descritos na literatura. Foram trazidos os novos avanços sobre o conhecimento da doença, como por exemplo, a visualização pela ultra-sonografia do verme vivo de Wuchereria bancrofti, no seu hospedeiro natural, o homem. Isso possibilitou a compreensão de muitos dos achados aparentemente paradoxais encontrados na literatura sobre o tratamento da infeção com a DEC. Assim, devido à inexistência de uma droga sucessora que reunisse efeitos micro e macrofilaricidas ideais e aos novos conhecimentos sobre a bancroftose e sobre a própria dietilcarbamazina, foi-lhe conferido um novo realce. Esses aspectos a colocaram numa posição de destaque no cenário da infecção, à época do seu quase cinqüentenário de existência.

The authors presented a detailed review about the treatment of bancroftian filariasis with diethylcarbamazine. The interesting aspects about the drug discovery and the basic concepts about its pharmacology were reported in a summarised form. On the other hand, emphasis was made about the speculation done by several authors about the intriguing findings regarding its efficacy reported in the literature. Latter, it was brought the new advances about the disease, as for example, the visualization by ultrasound of living Wuchereria bancrofti adult worm on its natural host--the human being. This made possible the comprehension of several paradoxical issues reported, focusing the treatment of infection using diethylcarbamazine. So far, because of the lack of ideal drug with micro and macrofilaricidal properties, together with the new understand about the disease and the new parameters for monitoring the efficacy of the drug, diethylcarbamazine has back its importance conquered at the begin of its discovery, almost fifth years ago.

Detection of living adult Wuchereria bancrofti in a patient with tropical pulmonary eosinophilia

Tropical pulmonary eosinophilia (TPE) is a relatively unusual and diagnostically challenging manifestation of infection with Wuchereria bancrofti. The pathogenesis of TPE remains unclear, although immune hyperresponsiveness to the microfilarial stage of the parasite is thought to play an essencial role. Microfilariae are almost never detected in the peripheral blood of persons with TPE and living adult worms have not been reported. Thus, no parasitologic marker has existed with which to assess the effectiveness of antifilarial treatment. In 1986, a 74-year old man from Olinda, Pernambuco, Brazil, developed classic signs and symptoms of filarial TPE. Within 48 h after beginning treatment with diethylcarbamazine (DEC), the drug of choice for TPE, his symptoms dramatically improved. He remained symptom-free until June 1994, when he again developed signs and symptoms of TPE. To visualize the adult worm and monitor the macrofilaricidal effectiveness of DEC treatment, ultrasound examinations of the scrotal area were performed before, during, and for 6 months after treatment. These examinations revealed diffuse dilatation of the lymphatic vessels of the spermatic cord and movements characteristic of living adult W. bancrofti known as the "filaria dance sign". Although the patient responded clinically to treatment, no change was noted in the filaria dance sign throughout the observation period. Visualization of adult W. bancrofti by ultrasound can be used to monitor the parasitologic effectiveness of treatment for TPE and to explore the relationship between death of the adult worm and recurrence of symptoms.

Investigacao sobre a passagem transplacentaria de microfilarias de Wuchereria bancrofti em recem-nascidos de maes microfilaremicas / Investigation on transplacental passage of Wuchereria bancrofti microfilariae in newborns of microfilaremic mothers

A ocorrencia de microfilarias circulantes de Wuchereria bancrofti foi pesquisada em 304 gestantes da Unidade Mista Prof. Barros Lima e do Hospital das Clinicas da Universidade Federal de Pernambuco pelo Centro de Pesquisas Aggeu Magalhaes. A microfilaremia materna foi investigada pela filtracao de sangue venoso, sendo encontrados 13 casos positivos (4,2 por cento). A pesquisa de microfilarias no sangue do cordao umbilical de suas criancas foi negativa (6/13), assim como no sangue periferico destas ate 72 horas pos-parto e com 6 meses de vida. As amostras de leite coletadas destas maes tambem nao apresentaram microfilarias. Os autores sugerem que a ocorrencia de lesoes placentarias seja um possivel fator envolvido na passagem transplacentaria de microfilarias, e que a exposicao in utero a microfilarias e/ou antigeno filarial possam influenciar a resposta a uma infeccao filarial adquirida posteriormente, sendo importante o acompanhamento clinico e laboratorial de criancas expostas previamente a antigenos filariais em periodos precoces do desenvolvimento humano.

In vitro differentiation of Wuchereria bancrofti (Filariidae)

Wuchereria bancrofti microfilariae were isolated from blood of infected individuals and cultured in vitro under several conditions. RPMI 1640 and TC-199 media supplemented with fetal or human serum were able to support the microfilariae for periods up to 35 days at 37-C (viability > 85%). In contrast, in minimal essential medium the microfilariae did not survive for more than 48h. In culture kept at 28-C, where viability was much lower (approximately 10% on day 15), microfilariae differentiated into type IV larvae ("sausage form). The in vitro maintainance of microfilarial larval forms is particularly important in the case of W. bancrofti due to the absence of an experimental model for the disease