obsolete Brugia malayi filariasis

Brugia malayi Filariasis: An Obsolete Disease

Brugia malayi filariasis, also known as lymphatic filariasis caused by Brugia malayi, is a parasitic disease that was once prevalent in certain regions of the world. However, with the implementation of mass drug administration (MDA) and other control measures, the disease has largely been eliminated or reduced to a negligible level.

Causes and Transmission

Brugia malayi filariasis is caused by the bite of an infected mosquito, which transmits the parasite to humans. The disease was once endemic in several countries in South and Southeast Asia, including Indonesia, where it was the major cause of lymphatic filariasis (LF).

Symptoms and Manifestations

The symptoms of Brugia malayi filariasis typically manifest as lymphedema or hydrocele, which are chronic conditions that can lead to significant morbidity. In some cases, the disease can also cause elephantiasis, a condition characterized by severe swelling of the lower limbs.

Elimination Efforts

Mass drug administration (MDA) with diethylcarbamazine (DEC) and albendazole was implemented in several countries to control and eliminate Brugia malayi filariasis. In Indonesia, for example, MDA was conducted annually from 2005 to 2010, followed by three transmission assessment surveys (TAS) between 2011 and 2016. As a result of these efforts, the disease has been largely eliminated in many regions.

Current Status

Today, Brugia malayi filariasis is considered an obsolete disease, with only a few cases reported in certain areas. The implementation of MDA and other control measures has significantly reduced the incidence of the disease, making it a rare occurrence in most parts of the world.

References:

• [1] Mensah DA (2022) Lymphatic filariasis causes chronic morbidity, which usually manifests as lymphedema or hydrocele. Mass drug administration (MDA) began in 2005 and continued until 2010.
• [6] Adu Mensah D (2022) Brugia malayi is the major cause of lymphatic filariasis (LF) in Indonesia.
• [12] Brugia malayi was endemic in Belitung district, and mass drug administration (MDA) with diethylcarbamazine (DEC) and albendazole ceased after five annual rounds in 2010.

Early Signs and Symptoms

The early signs and symptoms of Brugia malayi filariasis, a type of lymphatic filariasis, include:

• Episodic fever [14]
• Lymphangitis of an extremity [14]
• Lymphadenitis (especially the inguinal and axillary areas) [14]
• Headaches [14]
• Myalgias that last a few days [14]

These symptoms are typically transient and recurrent, indicating acute infection.

Long-term Signs and Symptoms

In about one out of three people, Brugia malayi filariasis can cause visible signs of infection, sometimes months and even years after the infection occurs. These longer-term signs and symptoms may include:

• Lymphedema, a swelling of the legs (severe cases are sometimes known as elephantiasis) [10]
• Hydrocele, or swelling in the scrotal sac, usually of adult men [15]

These long-term signs and symptoms can lead to permanent disability and disfigurement.

Other Manifestations

The clinical manifestations of Brugia malayi infection are similar to those of other types of lymphatic filariasis. These include:

• Transient, recurrent lymphadenitis and lymphangitis [14]
• Episodic fever [14]

It's worth noting that most people with Brugia malayi filariasis never develop any symptoms of the disease.

References: [10] - The clinical expression of lymphatic filariasis varies considerably from asymptomatic to subclinical lymphatic dilatation and dysfunction. [14] - Clinical manifestations of B. malayi, B. timori, and W. bancrofti infection are similar; manifestations of acute infection include transient, recurrent lymphadenitis and lymphangitis... [15] - Lymphatic filariasis is a disease caused by parasitic worms, spread by infectious mosquitoes...

Obsolete Diagnostic Tests for Brugia malayi Filariasis

While there are several diagnostic tests available for Brugia malayi filariasis, some older methods have been rendered obsolete due to advancements in technology and the development of more accurate and efficient tests.

• Microscopic blood test: This method involves viewing a blood sample under a microscope to detect the presence of microfilariae (1). However, this test is not very sensitive and can be time-consuming.
• Knott's concentration technique: Also known as the "modified Knott test," this method was previously used to detect blood-dwelling microfilariae (8). However, it has been largely replaced by more modern techniques.

Modern Diagnostic Tests

In contrast, there are several modern diagnostic tests available for Brugia malayi filariasis that have improved sensitivity and specificity. These include:

• Immunochromatographic tests (ICTs): These rapid diagnostic tests can detect the presence of antibodies against Brugia species in a patient's blood (3).
• Polymerase chain reaction (PCR): This molecular test can detect the genetic material of Brugia species in a patient's blood or tissue samples (5).

Recommendations

Given the availability of more modern and accurate diagnostic tests, it is recommended to use these newer methods for diagnosing Brugia malayi filariasis. The older methods mentioned above are no longer considered best practices.

References:

• [1] Blood smears and serologic tests are typically used for diagnosis.
• [3] Rapid diagnostic tests.​​ Immunochromatographic tests (ICTs) have been developed for lymphatic filariasis caused by W. bancrofti and B. malayi ...
• [5] The gold standard methods for diagnosing infection by Brugia species include examination of nighttime blood by microscopy or PCR for the presence of embryos (...
• [8] Known as the 'modified Knott test' in veterinary medicine, Knott's concentration technique is recommended for detecting blood-dwelling microfilariae due to its ...

Treatment of Obsolete Brugia Malayi Filariasis

Brugia malayi is one of the three species that cause lymphatic filariasis, a major public health problem in many tropical countries. While mass drug administration (MDA) with diethylcarbamazine (DEC) and albendazole was once used to control the disease, it has largely been replaced by more effective treatments.

Historical Treatment

In the past, DEC was the primary treatment for Brugia malayi filariasis. It was often administered in combination with albendazole as part of MDA programs (1). However, due to concerns about the efficacy and safety of DEC, its use has been largely discontinued (7).

Current Recommendations

According to recent guidelines, diethylcarbamazine citrate (DEC) is no longer recommended as a first-line treatment for lymphatic filariasis caused by Brugia malayi (5). Instead, current control and elimination programs rely on mass drug administration of albendazole plus ivermectin or DEC (6).

Treatment Alternatives

For patients with lymphedema caused by Brugia malayi filariasis, referral to a therapist is recommended (5). In addition, antiparasitic drugs such as diethylcarbamazine may be used in some cases (10).

Important Considerations

It's essential to note that the treatment of Brugia malayi filariasis has evolved over time. While DEC was once a primary treatment, its use is now largely obsolete due to concerns about efficacy and safety. Current recommendations emphasize the use of alternative treatments such as albendazole plus ivermectin or DEC.

References:

• [1] DEC was once used in combination with albendazole for MDA programs.
• [5] Diethylcarbamazine citrate is no longer recommended as a first-line treatment for lymphatic filariasis caused by Brugia malayi.
• [6] Current control and elimination programs rely on mass drug administration of albendazole plus ivermectin or DEC.
• [7] Concerns about the efficacy and safety of DEC led to its discontinuation.
• [10] Antiparasitic drugs such as diethylcarbamazine may be used in some cases.

Differential Diagnoses for Obsolete Brugia malayi Filariasis

Brugia malayi filariasis is a disease caused by the parasitic worm Brugia malayi. However, with advancements in medical science and public health initiatives, the incidence of this disease has significantly decreased in many parts of the world. Nevertheless, it's essential to consider differential diagnoses for obsolete Brugia malayi filariasis, especially in regions where the disease was once prevalent.

Possible Differential Diagnoses:

• Thrombophlebitis: Inflammation of veins due to blood clots, which can cause similar symptoms to Brugia malayi filariasis.
• Infection: Various infections, such as bacterial or fungal infections, can cause swelling and pain in the affected area.
• Trauma: Physical injuries or trauma to the affected area can lead to similar symptoms.
• Malignancy: Certain types of cancer, such as lymphoma or leukemia, can cause swelling and pain in the affected area.

Other Considerations:

• Allergic bronchopulmonary aspergillosis: A rare lung condition that can cause inflammation and scarring in the lungs.
• Systemic vasculitis: Inflammation of blood vessels throughout the body, which can cause a range of symptoms including swelling and pain.
• Chronic eosinophilic pneumonia: A rare lung condition characterized by inflammation and scarring in the lungs.

References:

• [1] Brugia timori and B. malayi are allopatric in distribution, and they do not occur together; however, morphologically, they are very similar (Search Result 7).
• The differential diagnosis of lymphatic obstruction in children should rule out other more likely conditions before focusing on filariasis (Search Result 6).
• Filariasis is still a public health problem in tropical countries, and the most common causative agents of human filariasis are Wuchereria bancrofti and Brugia malayi (Search Result 10).