Molecular detection of filarial nematode from Culicoides biting midges (Diptera: Ceratopogonidae) in northeastern Thailand

@#Culicoides Latreille biting midges are important blood feeding insects. Many species are pests and vectors of the disease causing agents including viruses, protozoa and filarial nematodes which can be transmitted to humans and other animals. However, knowledge of the role of Culicoides as vectors of filarial nematodes is limited, particular in Thailand, where at least 100 species of the genus Culicoides have been reported. In this study, a molecular approach using the 12S rRNA gene sequence was used to detecting the filarial nematode in four common biting midge species, C. actoni Smith, C. oxystoma Kieffer, C. peregrinus Kieffer and C. mahasarakhamense Pramual, Jomkumsing, Piraonapicha & Jumpato in animal shelters from northeastern Thailand. A total of 1,721 specimens were used for molecular screening. An unidentified Onchocercidae sp. was detected in a specimen of C. mahasarakhamense collected from Maha Sarakham province. This filarial species shows 93% sequence similarity with an unidentified Onchocercidae sp. isolated from Culex mosquitoes. Phylogenetic analyses revealed that Onchocercidae sp. from C. mahasarakhamense formed a clade with strong bootstrap support (100%) with filarial species detected in birds. Thus, it is very likely that the Onchocercidae sp. found in this study employes birds as vertebrate hosts which agrees with feeding behavior of C. mahasarakhamense which is known to feed on chicken. Further study is requiring to examine whether this biting midge species is a competent vector of this Onchocercidae sp.

Coverage evaluation of Mass Drug Administration (MDA) for lymphatic filariasis in a district of Bundelkhand Region of Uttar Pradesh

Introduction: Lymphatic filariasis results in severe disability that leading to severe social and economic burden at each level from individual to family, and community. This study was carried out to assess the coverage and compliance of MDA. Methods: From 300 households (1837 individuals) in both rural & urban area were covered in coverage evaluation survey by systematic selection of subunits using probability proportionate to size (PPS). Each household was visited by WHO designated team and data were collected using predesigned questionnaire. Data was compiled on MS-excel spreadsheet, frequency and percentage were calculated. Results: The overall effective coverage for all drugs was low (19.1%). The coverage was low, compliance was higher in urban as compared to rural area. Females had better coverage and compliance than males. The primary reasons for drug not offered was nobody came to offer drug, drug not swallowed was not sick, drug swallowed was useful information from drug administrator (DA). Only one female reported adverse effect. Conclusion: Increase in coverage along with decrease in coverage-compliance gap is needed to achieve filariasis elimination that warrants intense IEC activities using different platforms, development of better drug delivery strategies and strengthening monitoring system.

Interruption of lymphatic filariasis transmission in Manaus, a former focus of Wuchereria bancrofti in the Western Brazilian Amazon / Interrupción de la transmisión de la filariasis linfática en Manaos, anteriormente un foco de Wuchereria bancrofti en la Amazonia occidental de Brasil / Interrupção da transmissão da filariose linfática em Manaus, anteriormente um foco de Wuchereria bancrofti na parte leste da Amazônia brasileira

ABSTRACT Objective. To confirm the absence of Wuchereria bancrofti autochthonous cases in Manaus, a former focus of lymphatic filariasis in the Western Brazilian Amazon. Methods. A field survey was carried out in 2016 using immunochromatographic rapid tests (ICT card) for the detection of circulating filarial antigens in blood. The sample included a group of 3 000 schoolchildren aged 6 to 10 years enrolled in schools from different urban areas of Manaus (including the former lymphatic filariasis focus in the city) and a group of 709 adolescents and adults, between the ages of 11 and 85 years, born and raised in different areas of Manaus. Results. All of the individuals tested negative for W. bancrofti antigen. Conclusions. Although Manaus was once considered endemic, this focus no longer seems to be active for lymphatic filariasis transmission. The results of this study could support the certification by the World Health Organization of the lymphatic filariasis transmission elimination exercise in Brazil.

RESUMEN Objetivo. Confirmar la ausencia de casos autóctonos de Wuchereria bancrofti en Manaos, anteriormente un foco de filariasis linfática en la Amazonia occidental de Brasil. Métodos. En el 2016 se llevó a cabo una encuesta en el terreno con pruebas rápidas inmunocromatográficas (tiras inmunocromatográficas) para detectar antígenos filáricos circulantes en sangre. La muestra constó de un grupo de 3 000 escolares de 6 a 10 años matriculados en escuelas de diferentes zonas urbanas de Manaos (incluida la zona que anteriormente era el foco de filariasis linfática en la ciudad) y de un grupo de 709 adolescentes y adultos, de edades comprendidas entre 11 y 85 años, nacidos y criados en diferentes áreas de Manaos. Resultados. Todas las personas dieron negativo en la prueba de antígeno de Wuchereria bancrofti. Conclusiones. Aunque hubo un tiempo en que Manaos se consideraba zona endémica, parece que este foco de transmisión de la filariasis linfática ya no está activo. Los resultados de este estudio podrían brindar apoyo a la certificación de la Organización Mundial de la Salud respecto de los esfuerzos realizados en Brasil para eliminar la transmisión de la filariasis linfática.

RESUMO Objetivo. Confirmar a ausência de casos autóctones de Wuchereria bancrofti em Manaus, anteriormente um foco da filariose linfática na parte leste da Amazônia brasileira. Métodos. Uma pesquisa de campo foi realizada em 2016 com o uso de teste rápido por imunocromatografia (cartão ICT) para detecção de antígenos de microfilárias circulantes no sangue. A amostra estudada consistiu de um grupo de 3 000 crianças escolares entre 6 e 10 anos de idade matriculados em escolas de diferentes áreas da zona urbana de Manaus (englobando a área anteriormente com o foco de filariose linfática) e um grupo de 709 adolescentes e adultos entre 11 e 85 anos de idade nascidos e crescidos em diferentes áreas de Manaus. Resultados. Todos os indivíduos pesquisados tiveram teste negativo para o antígeno da W. bancrofti. Conclusões. Apesar de Manaus ter sido anteriormente uma área endêmica, parece que não existe mais foco ativo de transmissão da filariose linfática na cidade. Os resultados deste estudo podem servir para embasar a certificação pela Organização Mundial da Saúde da eliminação da transmissão da filariose linfática no Brasil.

Avaliação do kit Filaria Deteção; IgG4 produzido com o antígeno recombinante Wb123 para diagnóstico da filariose linfática no Brasil / Evaluation of the Filaria Detection; IgG4 kit employing recombinant Wb123 antigen for diagnosis of lymphatic filariasis in Brazil / Evaluación de pruebas de anticuerpos antifiláricos IgG4, fabricado con el antígeno recombinante Wb123, para el diagnóstico de la filariasis linfática en Brasil

RESUMO O Plano Global de Eliminação da Filariose Linfática, lançado pela Organização Mundial da Saúde em 2000, propõe o uso de testes de detecção de antígeno circulante filarial como ferramenta diagnóstica para avaliação e monitoramento das ações de controle da parasitose. Entretanto, esses testes, apesar de apresentarem alta sensibilidade, não conseguem detectar com eficiência a infecção em seu estágio inicial, quando ainda não existe a presença de helmintos adultos. Considerando essa limitação, a pesquisa de anticorpos antifilariais tem sido apontada como uma alternativa, uma vez que os anticorpos produzidos contra as larvas infectantes do parasito são detectados antes da presença de antígeno circulante filarial. O objetivo deste estudo foi definir o ponto de corte e avaliar a acurácia do kit Filaria Detect™ IgG4 produzido com o antígeno recombinante Wb123 para diagnóstico da filariose linfática no Brasil. Para isso, foi realizado um estudo de avaliação de teste diagnóstico, no qual foram utilizadas 256 amostras de soro: 79 (30,9%) obtidas de indivíduos microfilarêmicos e 177 (60,1%), de indivíduos amicrofilarêmicos e que testaram negativo para os testes imunológicos Bm14 CELISA e Og4C3 ELISA. A definição do ponto de corte ideal, bem como da acurácia do kit Filaria Detect™ IgG4, foi obtida através da construção de curvas ROC, sendo a densidade óptica de 0,239 aquela na qual o teste obteve melhor desempenho, com sensibilidade de 81,0% e especificidade de 96,6%. Os resultados obtidos demonstraram que o kit Filaria Detect™ IgG4 é uma ferramenta promissora para investigação e monitoramento de áreas submetidas ao tratamento em massa para filariose linfática.

ABSTRACT The Global Programme to Eliminate Lymphatic Filariasis, launched by the World Health Organization in the year 2000, proposes the use of circulating filarial antigen tests as a diagnostic tool to assess and monitor initiatives to control filarial infection. However, despite a high sensitivity, these tests are not efficient to detect infection at early stages, before worms have reached the adult stage. Considering this limitation, anti-filarial antibody testing has been suggested as an alternative, given that the antibodies produced against the larvae are detectable before the presence of circulating filarial antigen. The objective of the present study was to determine the diagnostic cut-off and the accuracy of the Filaria Detect™ IgG4 kit employing recombinant Wb123 antigen for diagnosis of lymphatic filariasis in Brazil. For that, we performed a diagnostic evaluation study in which 256 serum samples were analyzed: 79 (30.9%) obtained from microfilaremic individuals and 177 (60.1%) from amicrofilaremic individuals who tested negative with the Bm14 CELISA and Og4C3 ELISA immunologic tests. The ideal cutoff as well as the Filaria Detect™ IgG4 kit accuracy were determined based on ROC curve analyses, with an optical density of 0.239 identified as the cutoff with the best performance, with 81.0% sensitivity and 96.6% specificity. The results show that the Filaria Detect™ IgG4 kit is a promising tool for investigation and monitoring of areas undergoing mass drug administration for lymphatic filariasis.

RESUMEN En el programa mundial de eliminación de la filariasis linfática, puesto en marcha por la Organización Mundial de la Salud en el año 2000, se propone el uso de pruebas de detección del antígeno filárico circulante como instrumento de diagnóstico para la evaluación y el seguimiento de las medidas de control de la parasitosis. Sin embargo, esas pruebas, a pesar de tener un alto grado de sensibilidad, no permiten detectar con eficiencia la infección en su fase inicial, cuando todavía no existen helmintos adultos. En vista de esa limitación, se ha señalado como una opción el estudio de anticuerpos antifiláricos, puesto que los anticuerpos producidos contra las larvas infectantes del parásito se detectan antes de la existencia de antígeno filárico circulante. El objetivo de este estudio fue definir el punto de corte y evaluar la exactitud del estuche Detect™ para pruebas de anticuerpos antifiláricos IgG4, fabricado con el antígeno recombinante Wb123, para el diagnóstico de la filariasis linfática en Brasil. Para ello, se realizó un estudio de evaluación de la prueba diagnóstica, en el cual se utilizaron 256 muestras de suero, a saber, 79 (30,9%) obtenidas de personas microfilarémicas y 177 (60,1%) de personas amicrofilarémicas, que arrojaron resultados seronegativos en las pruebas inmunológicas CELISA Bm14 y ELISA Og4C3. La definición del punto de corte ideal y de la exactitud del estuche Detect™ se obtuvo con la construcción de curvas de la característica operativa del receptor (ROC); una densidad óptica de 0,239 marcó el mejor nivel de desempeño de la prueba, con una sensibilidad de 81,0% y una especificidad de 96,6%. Los resultados obtenidos demostraron que el estuche Detect™ es un instrumento prometedor para la investigación y el seguimiento de las regiones donde se realiza un tratamiento masivo de la filariasis linfática.

Incidence of filariasis in clinically diagnosed primary vaginal hydrocele

Background: Lymphatic filariasis is caused by a mosquito-borne parasite affecting roughly 100 million people round the world. There is consensus that hydrocele is the most frequent clinical manifestation of bancroftian filariasis. In endemic areas, about 40% of men are suffering from testicular hydrocele. With this background, the present study was aimed to find the incidence of filariasis in clinically diagnosed primary vaginal hydrocele.Methods: A hospital based prospective, cross-sectional study was conducted with 60 patients diagnosed clinically as primary vaginal hydrocele coming to the department of surgery, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Pimpri, Pune, to assess the incidence of filariasis.Results: Anti-filarial antibody and circulating filarial antigen in serum were detected in 5 (8.3%). Out of 60 patients and anti-filarial antibody was detected in hydrocele fluid of 2 (3.3%) patients. 2 patients out of these 5 showed microfilaria in peripheral blood smear and eosinophilic infiltrates in histopathological examination of sac.Conclusions: In 5 out of 60 cases both anti-filarial antibody and circulating filarial antigen in serum are positive thus proving that incidence of filarial hydrocele is 8% in clinically diagnosed primary vaginal hydrocele which is supposed to be idiopathic. Even though these cases have presented as clinically primary vaginal hydrocele, they are found to be filarial hydrocele after analysis of serum and hydrocele fluid. So, it is advised that all cases of clinically diagnosed primary vaginal hydroceles should be investigated for filariasis and if not, may lead to recurrence in these cases.

Diagnosis of elephantiasis nostras verrucosa as a clinical mani-festation of Kaposi's sarcoma / Diagnóstico de elefantiasis nostras verrucosa como mani-festación clínica del Sarcoma de Kaposi

Elephantiasis nostras verrucosa, a rare manifestation of Kaposi's sarcoma, is a progressive cutaneous hypertrophy caused by chronic non-filarial lymphedema secondary to obstruction of the lymphatic system that can lead to severe disfigurement of parts of the body that have gravity-dependent blood flow, due to edema, fibrosis, and hyperkeratosis, especially lower extremities. Among the various conditions that can induce chronic lymphedema are tumors, trauma, radiotherapy, obesity, hypothyroidism, chronic venous stasis, and AIDS-related Kaposi's sarcoma. Kaposi's sarcoma is a vascular tumor associated with the presence of human gammaherpesvirus 8 that is predominantly cutaneous, locally aggressive, with metastasis, and is associated with the production of factors that favor inflammation, lymphatic obstruction, and lymphedema.

A study on causes and management of acute scrotal conditions

Acute scrotal conditions form a significant proportion of cases in surgical ward. They contribute to significant morbidity in younger age group and mortality in older age group. In this study we have attempted to study the causes, aetiology, prevalence and management of acute scrotal conditions. The prevalence in descending order was Acute epididymo orchitis, Pyocele, Hematocele, Fournier’s gangrene, Acute filarial scrotum, Testicular torsion, Scrotal abscess, Mumps orchitis, scrotal trauma. Of these Epididymo orchitis, mumps orchitis and Filarial scrotum were treated conservatively with antibiotics, rest and scrotal support. Fournier’s gangrene, Scrotal abscess and scrotal trauma with wound debridement and reconstruction. Pyocele and hematocele by incision and evacuation of pus and blood respectively. Testicular torsion is treated by surgical de rotation and B/L orchidopexy. Orchidectomy was done if warranted in hematocele, pyocele, and testicular torsion.

Cutaneous angiosarcoma: report of three different and typical cases admitted in a unique dermatology clinic

Abstract: Angiosarcoma is a rare and aggressive tumor with high rates of metastasis and relapse. It shows a particular predilection for the skin and superficial soft tissues. We report three distinct and typical cases of angiosarcoma that were diagnosed in a single dermatology clinic over the course of less than a year: i) Angiosarcoma in lower limb affected by chronic lymphedema, featuring Stewart-Treves syndrome; ii) a case of the most common type of angiosarcoma loated in the scalp and face of elderly man and; iii) a skin Angiosarcoma in previously irradiated breast. All lesions presented characteristic histopathological findings: irregular vascular proliferation that dissects the collagen bundles with atypical endothelial nuclei projection toward the lumen.

An alternative strategy to generate coding sequence of macrophage migration inhibitory factor-2 of Wuchereria bancrofti.

Background & objectives: Different developmental stages of Wuchereria bancrofti, the major causal organism of lymphatic filariasis (LF), are difficult to obtain. Beside this limitation, to obtain complete coding sequence (CDS) of a gene one has to isolate mRNA and perform subsequent cDNA synthesis which is laborious and not successful at times. In this study, an alternative strategy employing polymerase chain reaction (PCR) was optimized and validated, to generate CDS of Macrophage migration Inhibitory Factor-2 (wbMIF-2), a gene expressed in the transition stage between L3 to L4. Methods: The genomic DNA of W. bancrofti microfilariae was extracted and used to amplify the full length wbMIF-2 gene (4.275 kb). This amplified product was used as a template for amplifying the exons separately, using the overlapping primers, which were then assembled through another round of PCR. Results: A simple strategy was developed based on PCR, which is used routinely in molecular biology laboratories. The amplified CDS of 363 bp of wbMIF-2 generated using genomic DNA splicing technique was devoid of any intronic sequence. Interpretation & conclusions: The cDNA of wbMIF-2 gene was successfully amplified from genomic DNA of microfilarial stage of W. bancrofti thus circumventing the use of inaccessible L3-L4 transitional stage of this parasite. This strategy is useful for generating CDS of genes from parasites that have restricted availability.

Prevalence of filarial parasites in domestic and stray cats in Selangor State, Malaysia

Objective: To determine the prevalence of the filarial parasites,. ie.,. Brugia malayi, Brugia, Brugia pahangi(B. pahangi), Dirofilaria immitisand. Dirofilaria repens (D. repens) in domestic and stray cats. Methods: A total of 170 blood sample were collected from domestic and stray cats and examined for filarial worm parasites in two localities, Pulau Carey and Bukit Gasing, Selangor State, Malaysia. Results: The overall prevalence of infection was 23.5% (40/170; 95% CI = 17.4-30.6). Of this, 35% (14/40; 95% CI = 22.1-50.5) and 50% (20/40; 95% CI = 35.2-64.8) were positive for single B. pahangi nd D. repens, respectively. The remaining of 15% (6/40; 95% CI = 7.1-29.1) were positive for mixed B. pahangi and D. repens. In addition, 75% of the infected cats were domestic, and 25% were strays. No Brugia malayi and Dirofilaria immitis was detected. Eighty-four cats were captured at Pulau Carey, of which 35.7% (30/84) were infected. Among the cats determined to be infected, 93% (28/30; 95% CI = 78.7-98.2) were domestic, and only 6.7% (2/30; 95% CI = 19.0-21.3) were strays. Conversely, the number of infected cats was three times lower in Bukit Gasing than in Pulau Carey, and most of the cats were stray. Conclusions: B. pahangi and D. repens could be the major parasites underlying filariasis in the study area. Adequate prophylactic plans should be administrated in the cat population in study area.

Loiasis in a Japanese traveler returning from Central Africa

We encountered a probable case ofloiasis in a returned traveler from Central Africa. A 52-year-old Japanese womanpresented to our hospital complaining of discomfort in her eyes and skin. She reportedhaving frequently visited Central Africa over many years and having been extensivelyexposed to the rainforest climate and ecosystem. Although no microfilariae werefound in her blood, there was an elevated level of IgG antibodies against thecrude antigens of<i> Brugia pahangi</i>,which have cross-reactivity with <i>Loa loa</i>.She was treated with albendazole for 21 days, after which the antigen-specificIgG level decreased and no relapse occurred.

Loiasis in a Japanese Traveler Returning from Central Africa

We encountered a probable case of loiasis in a returned traveler from Central Africa. A 52-year-old Japanese woman presented to our hospital complaining of discomfort in her eyes and skin. She reported having frequently visited Central Africa over many years and having been extensively exposed to the rainforest climate and ecosystem. Although no microfilariae were found in her blood, there was an elevated level of IgG antibodies against the crude antigens of <i>Brugia pahangi</i>, which have cross-reactivity with <i>Loa loa</i>. She was treated with albendazole for 21 days, after which the antigen-specific IgG level decreased and no relapse occurred.

Prevalence of filarial parasites in domestic and stray cats in Selangor State, Malaysia

OBJECTIVE@#To determine the prevalence of the filarial parasites,ie.,Brugia malayi, Brugia, Brugia pahangi(B. pahangi), Dirofilaria immitisandDirofilaria repens (D. repens) in domestic and stray cats.@*METHODS@#A total of 170 blood sample were collected from domestic and stray cats and examined for filarial worm parasites in two localities, Pulau Carey and Bukit Gasing, Selangor State, Malaysia.@*RESULTS@#The overall prevalence of infection was 23.5% (40/170; 95% CI = 17.4-30.6). Of this, 35% (14/40; 95% CI = 22.1-50.5) and 50% (20/40; 95% CI = 35.2-64.8) were positive for single B. pahangi nd D. repens, respectively. The remaining of 15% (6/40; 95% CI = 7.1-29.1) were positive for mixed B. pahangi and D. repens. In addition, 75% of the infected cats were domestic, and 25% were strays. No Brugia malayi and Dirofilaria immitis was detected. Eighty-four cats were captured at Pulau Carey, of which 35.7% (30/84) were infected. Among the cats determined to be infected, 93% (28/30; 95% CI = 78.7-98.2) were domestic, and only 6.7% (2/30; 95% CI = 19.0-21.3) were strays. Conversely, the number of infected cats was three times lower in Bukit Gasing than in Pulau Carey, and most of the cats were stray.@*CONCLUSIONS@#B. pahangi and D. repens could be the major parasites underlying filariasis in the study area. Adequate prophylactic plans should be administrated in the cat population in study area.

Tropical pulmonary eosinophilia - A review.

Tropical pulmonary eosinophilia (TPE) is a syndrome of wheezing, fever and eosiniphilia seen predominantly in the Indian subcontinent and other tropical areas. Its etiological link with Wuchereria bancrofti and Brugia malayi has been well established. The pathogenesis is due to an exaggerated immune response to the filarial antigens which includes type I, type III and type IV reactions with eosinophils playing a pivotal role. Peripheral blood eosinophilia is usually striking with levels over 3000/μl being common. High serum levels of IgE and filarial-specific IgE and IgG are also found. The pathology may vary from an acute eosinophilic alveolitis to histiocytic infiltration depending on the stage of the disease. While earlier studies had suggested that the disease runs a benign course, more recent work has shown that untreated TPE could result in a fair degree of respiratory morbidity. Pulmonary function tests may show a mixed restrictive and obstructive abnormality with a reduction in diffusion capacity. The bronchoalveolar lavage (BAL) eosinophil count has a negative correlation with the diffusion capacity. Treatment consists of diethylcarbamazine (DEC) for at least three weeks. Despite treatment with DEC, about 20 per cent of patients may relapse. Steroids have shown to have a beneficial effect but the exact dose and duration is yet to be confirmed by randomized controlled trials. A specific and easily available marker is required for TPE in order to distinguish it from other parasitic and non-parasitic causes of pulmonary eosinophilia.

Multiple filarial species microfilaraemia: a comparative study of areas with endemic and sporadic onchocerciasis.

Background & objectives: The study was aimed at determining the pattern of co-occurrence of species of microfilaraemia between onchocerciasis endemic and sporadic populations. Methods: From every consenting person of one year and above, 50 μl of day and night blood samples were collected and processed respectively with Haemotoxylin and Giemsa as vital stains. Two skin snips (one each from the waist and the shoulder) were also taken from these individuals and processed. Results: Results showed single species microfilaraemia (86.4 and 82.3%), double species microfilaraemia (12.2 and 16.9%) and triple species microfilaraemia (1.4 and 0.7%) for endemic and sporadic populations respectively. All the species had single species microfilaraemia mostly, but Mansonella perstans and Loa loa showed greatest tendency towards double and triple species microfilaraemia. The prevalence of Wuchereria bancrofti microfilaraemia among those positive for Onchocerca volvulus was significantly lower than the overall prevalence of Wuchereria bancrofti. Wuchereria bancrofti microfilaraemia was most common among those who had L. loa microfilaraemia. Wuchereria bancrofti microfilarial intensity was higher among those with M. perstans microfilaraemia than among those positive for any of the other filarial species. Similarly, the intensity of M. perstans microfilaraemia among those positive for W. bancrofti exceeded the overall intensity of M. perstans. Conclusion: It is concluded that there was no definite pattern in mf densities discernible from co-occurrence infections either in the onchocerciasis endemic or sporadic population. There could be varied outcomes of onchocerciasis infection attributable to positive or negative regulatory effects of other pathogens harbored by the victims.

Programa de controle e eliminação da filariose linfática: uma parceria da Secretaria de Saúde de Olinda-PE, Brasil, com o serviço de referência nacional em filarioses / Elimination and control of lymphatic filariasis program: a partnership between the Department of Health in Olinda, Pernambuco state, Brazil and the national center of lymphatic filariasis

Ante o conhecimento técnico-científico sobre a bancroftose acumulado ao longo dos anos, somado ao conhecimento da biologia do parasito, sabe-se que somente o ser humano funciona como seu reservatório, que este parasito é transmitido por culicídeo, não se multiplica no hospedeiro, não é causador de uma doença infectocontagiosa e há disponibilidade de medicação eficaz. Segundo a Organização Mundial da Saúde, a doença é potencialmente eliminável até 2020. Este relatório descreve, pioneiramente, as ações do Programa de Eliminação da Filariose Linfática do município de Olinda, Pernambuco, Brasil, particularmente o tratamento coletivo efetuado pela equipe do Programa de Saúde da Família, a seleção de grupos sentinelas e o diagnóstico situacional da morbidade. São feitas, neste trabalho, recomendações para a avaliação e o acompanhamento do impacto dessas ações, com as diversas opções de diagnóstico integrado à avaliação vetorial, e também é ressaltada a importância da articulação entre o Serviço de Referência Nacional em Filarioses e a Secretaria de Saúde de Olinda, associando pesquisa e serviço, com o objetivo de assegurar o êxito do programa.

Comparison of tests for the detection of circulating filarial antigen (Og4C3-ELISA and AD12-ICT) and ultrasound in diagnosis of lymphatic filariasis in individuals with microfilariae

Significant advances were made in the diagnosis of filariasis in the 1990s with the emergence of three new alternative tools: ultrasound and tests to detect circulating antigen using two monoclonal antibodies, Og4C3 and AD12-ICT-card. This study aimed to identify which of these methods is the most sensitive for diagnosis of infection. A total of 256 individuals, all male and carrying microfilariae (1-15,679 MF/mL), diagnosed by nocturnal venous blood samples, were tested by all three techniques. The tests for circulating filarial antigen concurred 100 percent and correctly identified 246/256 (96.69 percent) of the positive individuals, while ultrasound detected only 186/256 (73.44 percent). Of the circulating antigen tests, ICT-card was the most convenient method for identification of Wuchereria bancrofti carriers. It was easy to perform, practical and quick.

Mudanças de paradigmas na filariose bancroftiana / Paradigm shift in bancroftian filariasis

Ao longo do tempo, a maneira como se entende um determinado assunto passa por modificações através da pesquisa científica. Na maioria das vezes, essas mudanças causam pequenas diferenças na estrutura total do tópico em questão. Outras vezes, entretanto, ocorrem mudanças revolucionárias que não só alteram a compreensão do assunto em si, mas promovem a abertura de diferentes perspectivas que podem desencadear o início de novas etapas de interpretações e de novos caminhos de conhecimento. Exemplo disso foram os estudos de Gregor Johann Mendel que levaram à descoberta de leis da hereditariedade que, por sua vez, revolucionaram a biologia e traçaram as bases da genética. Em algumas situações, as mudanças não só modificam a forma de pensar, mas também têm implicações práticas ao melhorar a qualidade de vida de muitos seres humanos. No seu livro A Estrutura de Revoluções Científicas, Thomas Kuhn se refere às ruturas nessa evolução científica como "mudanças de paradigma", um termo que hoje é usado de uma forma genérica para descrever uma modificação profunda em nossos pontos de referência. O paradigma de que o estágio adulto da Wuchereria bancrofti causava a obstrução do vaso linfático e desencadeava uma reação imunológica inevitável em indivíduos predispostos, provocando a elefantíase, foi substituído pela esperança de que ser infectado não mais significa, necessariamente, ser um potencial portador da forma mais deformante da disfunção linfática. A infecção bacteriana secundária de repetição (semelhante clinicamente à erisipela) é hoje reconhecida como o fator mais importante para a instalação e a progressão do linfedema crônico, nos indivíduos que vivem em áreas endêmicas de filariose linfática. Evitar ou minimizar os episódios agudos bacterianos é um processo factível para a maioria dos habitantes das comunidades endêmicas, através do uso regular de água e sabão: a forma mais simples de higiene já conhecida pelo ser humano.

The way a particular subject is understood changes over time as a result of scientific research. In most cases, these changes are minor, with limited effect on the overall knowledge on the subject. Sometimes, however, revolutionary changes occur and not only modify the understanding of the subject but open perspectives that can trigger new interpretations and new ways for expansion of scientific knowledge. The studies of Gregor Johann Mendel were a good example. They led to discovery of the laws of inheritance which, in turn, have revolutionized biology and provided the foundation for genetics. In certain situations, changes not only alter ways of thinking, but have practical implications, also improving the quality of life for many people. In his book The Structure of Scientific Revolutions, Thomas Kuhn refers to discontinuities in scientific development as a "change of paradigm", a term now used in a generic manner to describe a profound changes in our reference points. For lymphatic filariasis the old paradigm stated that Wuchereria bancrofti at the adult stage causes lymphatic vessel obstruction, triggering an inevitable immune response in predisposed individuals and leading to elephantiasis. This has been replaced by a new paradigm, which offers hope that W. bancrofti infection does not necessarily predispose to the disfiguring outward manifestation of lymphatic dysfunction. Repeated secondary bacterial infections (erysipela-like) are now recognized as the most important factor for initiation and progression of chronic lymphedema in individuals living in filariasis-endemic areas. Most inhabitants of endemic communities can prevent and minimize the acute bacterial episodes by regular use of soap and water, the simplest form of hygiene already well known to human beings.

Genomic-based discovery and validation of novel anti-filarial drugs.

Background: Lymphatic filariasis is a mosquito-transmitted disease, while onchocerciasis is transmitted by blackflies. There is no vaccine for these infections. New drugs are required for improvement of current therapies. Objective: This article reviews recent advances in filarial parasite genomics and opportunities for new antifilarial drug research. Methods and results: Genomic approach to filarial parasites provides new prospects for target validation. Comparative genomics filters enable us to select filarial parasite-specific gene products of interest. Functional genomics filters allow the selection of gene products essential for pathogen survival. The validated targets could be prioritized and categorized by informatics methods and manual curation. Conclusion: Lymphatic filariasis and onchocerciasis can be eliminated by either sterilizing or killing adult worms. It is most advantageous to target Wolbachia species for developing new drugs. Functional genomic approaches using microarrays, proteomics, and model organisms, have significantly expanded options for researchers. The genomic-based approach is promising for anti-filarial drug discovery in the future.

Filariasis in the new millennium.

The lndonesian national filariasis eradication program in its pursuit in obtaining microfilarial rates below 1% in filariasis endemic locations was on its right track until the monetary crisis started 3 years ago. This crisis which is not over yet at present is complicated by unstable public safety causing population shifts where people from filaria endemic locations seek refuge in non-endemic areas. This updated review will hopefully serve as a timely reminder to our physicians and health workers especially on the mode of filarial transmission as well as on its clinical presentations and presently accepted ways of manaqement. This paper also will serve as an introduction into the present breakthroughs in this new millenium as noted in the field of diagnostics and simplified mass treatment schedules making it possible for the elimination of lymphatic filariasis as a public health problem. A global alliance under the guidance of the World Health Organization with support of the multinational pharmaceutical companies for providing free expensive medication as needed. The WHO also cooperates closely with the Tropical Diseases Research task forces of Filariasis Intervention Research and of Product Development, that in the end will provide the means to eradicate this disease for once and forever from the face of the earth.