A 50 year old military man returns to the UK after a long service in the Tropics

Question Number 0015

A 50 year old military man returns to the UK after a long service in the Tropics. He complains of a swollen right limb and right scrotum. On examination he is found to have pitting edema and hyperkeratosis. His limb is not reddened and not hot to touch. Microfilariae are found in his blood.
The most appropriate treatment should include

a) Inferior vena cava filter
b) compression stockings
c) albendazole
d) local application of steroid ointment
e) arteriogram of the lower limb


Correct Answer: Cmicrofilariae in the blood

Lymphatic filariasis is caused by a nematodal infection with Wuchereria or Brugia species. It occurs in endemic areas throughout the tropical parts of the world, with a predilection for developing countries where poor socioeconomic conditions are favorable for mosquito vector breeding. A definitive diagnosis often depends on the parasitologic demonstration of the microfilariae in the blood. Presentation may vary from very insidious to severe. Pitting edema progresses to brawny edema, and thickening of subcutaneous tissue and hyperkeratosis. In many areas the most common chronic manifestation is a hydrocele. Annual single-dose co-administration of two drugs (ivermectin + albendazole) reduces blood microfilariae by 99% for a full year; even a single dose of one drug administered annually can result in 90% Effective diagnosis of infection with these parasites is required both for administration of drugs to infected individuals and for monitoring of control programs. There has been considerable effort expended in developing other forms of diagnosis, in particular immunoassays for measuring antibody and circulating parasite antigen as well as molecular-biology-based assays for detecting parasite DNA

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