Friday, November 23, 2012

Lymphatic Filariasis, A Neglected Disease

by Ernesto T. Solidum



“Lymphatic Filariasis or Elephantiasis” was discussed at the weekly Kapihan held at DRSTMH Conference Room on November 17, 2012. Guests were Dr. Cornelio V. Cuachon, Jr. PHO I, Dr. Victor A. Santamaria, OIC PHO II and Dr. Felma Dela Cruz of Philippine Medical Association.

According to Dr. Cuachon, lymphatic filariasis is a neglected tropical disease found in 183 countries, affecting 120 million people mostly in Africa, Asia and South America. As a public health problem, it is caused by a parasite transmitted by female mosquito Aedes porellus. The microscopic thread-like worm attacks the lymphatic system resulting to various physical deformities, permanent disability and death of a person.

Persons may exhibit either one of three clinical signs namely: chronic (no outward clinical signs despite the presence of microscopic filariasis in the blood), chronic (disease gradually develops 5-15 years after death of adult filariasis parasite) and acute (enlargement of lower extremities, genitals and breasts).

Trained medical personnel can detect the disease by nocturnal blood examination. Potent drug is diethylcarbamazine tablets widely used since 1948. Mass treatment target persons two years old and above living in established endemic areas usually during the campaign period October to November each year. The other strategies include capability building program or training of medical personnel and distribution of insecticide treated mosquito nets and screens.

Based on the 2012 data, out of 532 suspected cases in Libacao, 33 were positive for filariasis or 6.2 percent. In Madalag, out of 445 persons, 7 or 1.5 percent were positive. With more than 1.0 percent occurrence, the World Health Organization (WHO) classifies Aklan as moderately affected.

Dr. Dela Cruz disclosed the mode of transmission of parasite is from a diseased person to another as the mosquito feeds on human blood for increased fertility. Male mosquito is harmless which feeds on nectar and plant juices. Eggs are lain on water deposited on axel of leaves of bananas, abaca, bromeliads and water lilies.

Since heavy vegetation and precipitation are predisposing factors to multiplication of the pest, both Libacao and Madalag are conducive to mosquito outbreak. They are carrier of dengue, malaria and filariasis. For the latter case however, victims due to their physical condition namely: legs resembling trunk of elephants, coco sized testicles and monstrous dangling breasts surely will shun medical treatment. This also holds true with patients afflicted with STD’s especially HIV/AIDS.

It is very unfortunate that the victims of lymphatic filariasis are in the bottom 20 percent of our society and living in remote and inaccessible areas of Aklan. Equally sad is the hardship and expense of medical personnel to reach identified endemic areas. Regular intake of the potent drug has proven effective to reduce the incidence from 6.2 to less than 1.0 percent, one year after mass treatment. The coverage, according to Dr. Cuachon, is only 65 percent since the budget is very limited. WHO stipulates however that coverage must be 85 percent which needs more funding.

The use of diethycarbamazine has added benefits as it controls other internal parasites like hookworm, pinworm and roundworm. Furthermore, the use of insecticide treated mosquito nets has the potential to reduce incidence not only of filariasis but other deadly diseases like malaria and dengue. It appears that prevention of certain diseases is directly related to the management of the environment like destroying or eliminating mosquito’s breeding places. Early detection also plays a crucial role in disease treatment and rehabilitation. 

The monitoring and evaluation program for filariasis elimination campaign for Iloilo, Capiz, Aklan and Antique by PHO-DOH and WHO is on-going. It is vital that the scourge be stamped out since it is preventable. Prevention and control require simple cooperation between the health authorities and the affected individuals. /MP

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