Preliminary findings from a cross-sectional study on lymphatic filariasis in children, in an area of India endemic for Brugia malayi infection

Abstract

As the more obvious clinical manifestations of the disease are very uncommon in children, lymphatic filariasis has been considered to be primarily a disease of adults. In many recent reports, however, there is evidence indicating not only that filarial infection is commonly acquired in childhood but also that many infected children already have irreversible damage to their lymphatics. The preliminary results of a cross-sectional study on the patterns of Brugia-attributable pathology in 7934 children (aged 3-15 years) who live in an area of India with endemic B. malayi infection confirm these trends. The children were screened for microfilaraemia, evidence of filarial disease, and the presence of antifilarial IgG(4) antibodies. One hundred children who were microfilaraemic but asymptomatic (32), with filarial disease or an history of such disease or microfilaraemia (29) or amicrofilaraemic and asymptomatic but seropositive for antifilarial IgG(4) (39) were investigated further. They were given detailed clinical examinations, their levels of microfilaraemia were evaluated (by counting microfilariae filtered out of blood samples), their lymphatics were explored by Doppler sonography, and their limbs were checked by lymphoscintigraphy. The 'filarial dance sign', which indicates the presence of live adult worms, was detected by sonography in 14 children (apparently the first time this sign has been observed in brugian filariasis). Lymphoscintigraphy revealed dilated lymphatic channels in the limbs of 80 of the children. At the end of the study, each of the 100 hospitalized children was treated with a single combined dose of diethylcarbamazine and albendazole; the aim is to follow-up the treated children every 6 months for 3 years. Even these preliminary results have important implications for filariasis-control programmes and emphasise the need for disability-alleviation efforts among children as well as adults.