Year : 2005 | Volume
: 21 | Issue : 1 | Page : 24--26
Medical treatment of filariasis and chyluria
Department of Urology, SGPGIMS Lucknow, UP, India
M S Ansari
Department of Urology,SGPGIMS Lucknow,UP
The medical treatment of filariasis and chyluria is based on dietary modification, i.e. a diet excluding fat, supplemented by medium chain triglycerides (MCT) and high protein content. Drug therapy include administration of antifilarial drugs like diethylcarbamizine (DEC), ivermectin and albendazole. Annual mass drug administration of DEC combined with albendazole is recommended by the Global Programme to Eliminate Lymphatic Filariasis (GPELF) in endemic areas. DEC-medicated salt has been effectively used in various filarial endemic countries and as well as in certain parts of India. Vector control is a useful means in addition to chemotherapy in control of lymphatic filariasis.
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Ansari M S. Medical treatment of filariasis and chyluria.Indian J Urol 2005;21:24-26
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Ansari M S. Medical treatment of filariasis and chyluria. Indian J Urol [serial online] 2005 [cited 2020 Jun 1 ];21:24-26
Available from: http://www.indianjurol.com/text.asp?2005/21/1/24/19546
Parasitic nematode worms, which produce filariasis in humans place approximately one billion people at risk in more than 75 countries. Filariasis is a significant health problem and more than 100 million people are infected with these diseases. Repeated filarial attacks lead to obstruction of lymph flow resulting in rupture of dilated lymphatics in to urinary system. Prolonged chyluria results in loss of weight and subcutaneous fat, hypoprotenemia, lymphopenia and anaemia. Initially medical treatment should be tried in every case, which consists of dietary modification, antifilarial drugs, bed rest and high amount of fluid intake. ,,,
Nutrition support has played a major role in the treatment of chyluria, both to prevent malnutrition and to minimize chyle production and its flow. Fat containing medium chain triglycerides (MCT; Correction of anaemia
Correction of anaemia needs administration of hematenics along with multivitamins. Oral iron supplementation along with generous intake of green leafy vegetables and sticking to other dietary measures described above usually improve the haemoglobin level in these patients. Patients with gross haematuria (haematochyluria) warrant blood transfusion.
In addition to DEC therapy symptomatic treatment with antiinflammatory, analgesics and antipyretics along with bed rest should also be considered in case of acute attack and lymhadenitis. Use of abdominal binders during acute attacks of chyluria; elevation of affected limb, application of elastic bandage and special message help in the management of swollen lymphadematous limb. Patients with urinary retention secondary to chylous clot need cystoscopy and bladder wash. Bladder irrigation through a three way foley catheter may also be useful in cases of recurrent urinary retention.
Therapeutic control at community level
Therapy of a community in high prevalent area may consist of selective or mass treatment. In mass therapy DEC is administered to the total population barring children and pregnant women. In mass treatment parasitological diagnosis may be omitted in order to make the treatment cost effective. In selective treatment microfilarial carriers or patients with symptomatic disease are identified through various screening programmes. The drug may be administered in widely spaced doses (100 mg for adults and 50 mg for children once weekly, once monthly or bimonthly over a period of 1 year) or added to the table salt.,, Annual mass drug administration (MDA) using diethylcarbamizine (DEC, 6 mg/kg) combined with albendazole (alb 400 mg) is recommended by the Global Programme to Eliminate Lymphatic Filariasis (GPELF). WHO programme strategies focus on both transmission and morbidity control. For interruption of transmission it is recommended that the entire population at risk to be treated once yearly with single dose of two drug regimens, i.e. albendazole 400 mg plus ivermectin 150 mg/kg in African endemic countries and albendazole plus DEC 6 mg/kg in other parts of the world.
Studies in India and abroad (China, Tazania) demonstrated the benefit of cooking salt fortified with DEC citrate for the control of lymphatic filariasis. In India, DEC-medicated salt has been introduced on a commercial basis in certain parts of India, which is endemic for filariasis. Salt fortified with (0.25-0.33% w/w) DEC is administered with the food. After 1 year of treatment, the prevalence and intensity of microfilaremia were both reduced by more than 95%, while antigenemia levels were reduced by 60%.,
Vector control is a useful means in addition to chemotherapy in control of lymphatic filariasis. Effective control rapidly reduces the transmission thus reducing the prevalence of filariasis. The various preventive measures are; environmental control of breeding sites (elimination of stagnant water), larvicidal drugs and the spray of insecticides. Besides local hygiene, proper clothing, use of repellants and mosquito net are other important measures.
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