Prevention of acute adenolymphangitis in brugian filariasis: comparison of the efficacy of ivermectin and diethylcarbamazine, each combined with local treatment of the affected limb

Abstract

Acute attacks of adenolymphangitis (ADL) not only force patients with lymphatic filariasis to seek medical attention but also hasten the progression of filarial oedema. Patients with filariasis-associated ADL are currently treated with repeated courses of the antifilarial drug diethylcarbamazine (DEC), with or without antibiotics and anti-inflammatory agents. In this double-blind, placebo-controlled study, the efficacy of local treatment of the affected limb combined with repeated doses of ivermectin or DEC, in preventing the occurrence of ADL in Brugia malayi lymphatic filariasis, was examined. Overall, 120 patients who had each had at least two ADL attacks in the previous year were each admitted to the study at the time of an ongoing episode of ADL. The patients were randomly allocated to receive 12, monthly treatments of ivermectin (400 micrograms/kg), DEC (10 mg/kg) or placebo, in addition to local care of the affected limbs. There was a significant reduction in the frequency of ADL attacks in each of the three groups during the 2-year study period (P < 0.001 for each comparison). Most importantly, there were no significant differences in frequency of attacks between the three groups, either at the end of the treatment phase or at the end of the post-treatment phase (P > 0.15 for each comparison), suggesting that foot care combined with appropriate use of local antibiotics or antifungals is adequate to reduce the number of ADL attacks. The implications of these observations for planning morbidity control in lymphatic filariasis are discussed.

Impact of a Community-Based Lymphedema Management Program on Episodes of Adenolymphangitis (ADLA) and Lymphedema Progression - Odisha State, India

“…The rate of ADLA was lowest six months after enrollment, yet a decrease was sustained over the two year period of the study. These findings are consistent with other studies which have also found a decrease in ADLA episodes following enrollment in a lymphedema management program [2], [3], [13], [14], [23], [24]. Other programs have found a similar plateauing of the ADLA rate 3–12 months after beginning lymphedema management [13], [14].…”

“…An ADLA episode was defined by patient self-report of two or more of the following symptoms: redness, pain, or swelling of the leg or foot, with or without the presence of fever or chills, [3], [19]. Patients were asked how many times they had an ADLA episode in the previous 30 days.…”

Impact of basic lymphedema management and antifilarial treatment on acute dermatolymphangioadenitis episodes and filarial antigenaemia

“…On contrary, others reported that the antifilarial drugs (ivermectin and albendazole) even though important in the sustained reduction of blood microfilaria levels, have no role in the management of lymphedema or acute attacks. [26] Epidemiologic associations between transmission intensity and the prevalence of lymphedema have suggested to some investigators that third-stage larvae trigger lymphedema. [2728] This hypothesis is supported by observations of decreases in lymphedema prevalence and severity following mass treatment with antifilarial drugs.…”

Evaluating the Burden of Lymphedema Due to Lymphatic Filariasis in 2005 in Khurda District, Odisha State, India

“…Lymphedema severity was established based on the seven stage classification system developed by Dreyer, et al [16]. ADL episodes were defined as any period of pain, redness, and/or swelling of the affected leg, which may have been accompanied by fever and/or chills [18, 19]. …”