Recent trends in treatment and management of filariasis.

Filariasis is the name for a group of tropical diseases caused by various thread-like parasitic round worms (nematodes) and their larvae. The larvae transmit the disease to humans through a mosquito bite. Filariasis is characterized by fever, chills, headache, and skin lesions in the early stages and, if untreated, can progress to include gross enlargement of the limbs and genitalia in a condition called elephantiasis. While filariasis is rarely fatal, it is the second leading cause of permanent and long-term disability in the world. The World Health Organization (WHO) has named filariasis one of only six "potentially eradicable" infectious diseases and has embarked upon a 20-year campaign to eradicate the disease. These infections have a significant economic and psychosocial impact in endemic areas, disfiguring and/or incapacitating more than 40 million individuals. Studies from the Indian subcontinent have shown that infected patients lose significant time from work because of the disease costing the national treasury a minimum of $842 million per year. The treatment of filariasis consists of using medicines that kill the worms combined with the treatment to relieve the symptoms. Filariasis may be treated in early, mild cases with a three-week course of antifilarial drugs. This medication usually cures the infection, but may cause a reaction marked by fever, illness, and muscle or joint pains. Treatment for symptomatic relief includes bed rest, antibiotic use for secondary infections, elastic stockings and pressure bandages to reduce swelling and fluid accumulation, and suspensory bandaging for swollen testicles or breasts. Chronic infections are more difficult to treat effectively. Small accumulations of fluid may benefit from local injection of sclerosing (condensing) agents. Surgery may be required. Mass accumulations may be managed using shunt procedures combined with removal of excess fatty and fibrous tissue, drainage and physical therapy.