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{{PBI|Filariasis}}
:* '''Filariasis'''::* 1. '''Lymphatic filariasis- '''Wuchereria bancrofti, Brugia malayi Brugia timori'''::* 2. '''Cutaneous filariasis- Onchocercia volvulus, Loa loa'''
{{PBI|Onchocerciasis}}:* '''Onchoceria volvulus cutaneous filariasis (river blindness) treatment'''{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy 2014 | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2014 | isbn = 978-1930808782 }}::* Preferred regimen: [[Ivermectin]] Single dose of 150mcg/kg po; repeat every 6-12 months until asymptomatic.  ::* Alternative regimen: If [[Ivermectin]] fails, consider [[Suramin]].::: Note (1): Onchocercia and  Loa loa may both be present. Check peripheral smear; if Loa loa microfilaria present, treat onchocercia first with [[Ivermectin]] before [[Diethylcarbamazine]] (DEC) for Loa loa.::: Note (2): Retreatment for microfilaremia often necessary q6-12 months as demonstrated by repeat blood smear or antigen testing.::: Note (3): Do not use [[Diethylcarbamazine]] (DEC) in Onchocerca volvulus due to increased risks of precipitating blindness.::* '''Treatment of endosymbiont Wolbachia (bacteria)''' may help clear infection:::* Preferred regimen: [[Doxycycline]] 100 mg qd or bid for 6-8 wks in lymphatic filariasis although effect may be more important for co-infecting pathogens such as Wuchereria or Onchocerca than loaloa.
{{PBI|Loiasis}}:* '''Loa loa cutaneous filariasis (eyeworm disease) treatment'''{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy 2014 | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2014 | isbn = 978-1930808782 }}::* Preferred regimen: [[Diethylcarbamazine]] (DEC) escalation recommended to reduce reactions on day 1-50 mg, day 2-50 mg tid, day 3-100 mg tid, Days4-21, 8-10mg/kg/day in 3 divided dose::* Alternative regimen: [[Albendazole]] 200mg po bid for 21 days::: Note: If concomitant onchocercia Loa loa, treat oncho first. Ifover 5,000 microfilaria/mL of blood, [[Diethylcarbamazine]] (DEC) can cause encephalopathy. Might start with albendazole for few days with or without steroids, then [[Diethylcarbamazine]] (DEC).
{{PBI|Wuchereria bancrofti}}:* '''Wuchereria bancrofti lymphatic filariasis (elephantiasis) treatment'''<ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref>::* Preferred regimen (1): Scaled dose [[Diethylcarbamazine]] (DEC) escalation recommended to reduce reactions on day 1-50 mg, day 2-50 mg tid, day 3-100 mg tid, Days 4-14, 2 mg/kg q8h for total of 72 mg over 14 days. ([[Diethylcarbamazine]](DEC) 2 mg/kg PO tid for 12 days (may be accompanied by systemic reaction to dying worms,local reactions include lymphadenitis, transient lymphedema)).::: Note: Corticosteroids or antihistamines may be needed to treat allergic reactions that develop as a consequence of dying microfilariae.
::* Preferred regimen (2):  [[Albendazole]] 400 mg PO single dose regimen {{and}} ([[Ivermectin]] 200 mcg/kg PO {{or}} [[Diethylcarbamazine]] 6mg/kg) may reduce or suppress microfilariae; however, this will not affect adultworms.::: Note (1): Most symptoms with Wuchereria bancrofti  are due to the adultworm.::: Note (2): Retreatment for microfilaremia often necessary q6-12 months as demonstrated by repeat blood smear or antigen testing.::: Note (3): Do not use [[Diethylcarbamazine]] (DEC) in Onchocerca volvulus due to increased risks of precipitating blindness.
::: Note (4): Skin snip technique is  skin snips can be obtained using a corneal  scleral punch, or more simply a scalpel and needle. The sample must be allowed to incubate for 30 minutes to 2 hrs in saline or culture medium, and then examined for microfilariae that would have migrated from the tissue to the liquid phase of the specimen. ::: Note (5): Site of infection:::: 5.1 General: filarial fever includes fever, chills, malaise during acute or recurrent episode.
:::: 5.2 Lymph:localized lymphadenitis, may be painful(red,warm) or painless, unilateral or bilateral groin swelling. May be due to adult worm or complicating bacterial infection.:::: 5.3 Derm:pruritus,dermatitis,subcutaneous nodules. :::: 5.4 Genital:scrotal or vulvar swelling/ hydrocele; may be able to visualize adult W.bancrofti worm by ultrasound. :::: 5.5 Extremities:unilateral or bilateral swelling, acute or chronic. May be extreme (classic elephantiasis) or mild. May be associated with recurrent bacterial cellulitis (abrupt onset of redness ,fever). :::: 5.6 Lungs:tropical pulmonary eosinophilia (miliary pattern on CXR, nocturnal paroxysmal cough, wheezing, accompanied by marked eosinophilia, responds to DEC, usually amicrofilaremic). :::: 5.7 Renal: chyluria, hematuria (rupture of dilated lymphatics into urinary excretory system). May see weightloss, hypoproteinemia, lymphopenia, anemia.
:::: 5.8 Musculoskeletal:acute monoarthritis (knee>ankle) which responds to DEC, tenosynovitis (rare), thrombophlebitis (rare).::: Note (6):::: Diagnosis 1.serological-antigen detection by commercially available card test ; IgG4 antibody (not filaria species specific and may cross react with other helminths);:::: Diagnosis 2.special maneuvers DEC provocative days test (induce microfilaremia with dose of DEC); polymerase chain reaction.:::: Diagnosis 3.skin snips  (detect Onchocerca volvulus, Mansonella streptocerca). Ultrasonography can detect adult W.bancrofti worms in scrotal lymphatics.
::* '''Treatment of endosymbiont Wolbachia (bacteria)''' may help clear infection:::* Preferred regimen: [[Doxycycline]] 100 mg qd or bid for 6-8 wks in lymphatic filariasis although effect may be more important for co-infecting pathogens such as Wuchereria or Onchocerca than loaloa.
{{PBI|Brugia malayi}}<ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref>
:* '''Brugia malayi, Brugia timori lymphatic filariasis (elephantiasis) treatment'''::* Preferred regimen (1): Scaled dose [[Diethylcarbamazine]] (DEC) escalation recommended to reduce reactions on day 1-50 mg, day 2-50 mg tid, day 3-100 mg tid, Days 4-14, 2 mg/kg q8h for total of 72 mg over 14 days. ([[Diethylcarbamazine]](DEC) 2 mg/kg PO tid for 12 days (may be accompanied by systemic reaction to dying worms,local reactions include lymphadenitis, transient lymphedema)).::: Note: Corticosteroids or antihistamines may be needed to treat allergic reactions that develop as a consequence of dying microfilariae.
::* Preferred regimen (2):  [[Albendazole]] 400 mg PO single dose regimen {{and}} ([[Ivermectin]] 200 mcg/kg PO {{or}} [[Diethylcarbamazine]] 6mg/kg) may reduce or suppress microfilariae; however, this will not affect adultworms.::: Note :::: Diagnosis 1.serological-antigen detection by commercially available card test ; IgG4 antibody (not filaria species specific and may cross react with other helminths);:::: Diagnosis 2.special maneuvers DEC provocative days test (induce microfilaremia with dose of DEC); polymerase chain reaction.:::: Diagnosis 3.skin snips  (detect Onchocerca volvulus, Mansonella streptocerca). Ultrasonography can detect adult W.bancrofti worms in scrotal lymphatics.

Revision as of 16:58, 7 July 2015


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  • Filariasis::* 1. Lymphatic filariasis- Wuchereria bancrofti, Brugia malayi Brugia timori::* 2. Cutaneous filariasis- Onchocercia volvulus, Loa loa
  • Onchocerciasis Return to Top
    :* Onchoceria volvulus cutaneous filariasis (river blindness) treatmentGilbert, David (2014). The Sanford guide to antimicrobial therapy 2014. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808782.::* Preferred regimen: Ivermectin Single dose of 150mcg/kg po; repeat every 6-12 months until asymptomatic.  ::* Alternative regimen: If Ivermectin fails, consider Suramin.::: Note (1): Onchocercia and Loa loa may both be present. Check peripheral smear; if Loa loa microfilaria present, treat onchocercia first with Ivermectin before Diethylcarbamazine (DEC) for Loa loa.::: Note (2): Retreatment for microfilaremia often necessary q6-12 months as demonstrated by repeat blood smear or antigen testing.::: Note (3): Do not use Diethylcarbamazine (DEC) in Onchocerca volvulus due to increased risks of precipitating blindness.::* Treatment of endosymbiont Wolbachia (bacteria) may help clear infection:::* Preferred regimen: Doxycycline 100 mg qd or bid for 6-8 wks in lymphatic filariasis although effect may be more important for co-infecting pathogens such as Wuchereria or Onchocerca than loaloa.
  • :* Loa loa cutaneous filariasis (eyeworm disease) treatmentGilbert, David (2014). The Sanford guide to antimicrobial therapy 2014. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808782.::* Preferred regimen: Diethylcarbamazine (DEC) escalation recommended to reduce reactions on day 1-50 mg, day 2-50 mg tid, day 3-100 mg tid, Days4-21, 8-10mg/kg/day in 3 divided dose::* Alternative regimen: Albendazole 200mg po bid for 21 days::: Note: If concomitant onchocercia Loa loa, treat oncho first. Ifover 5,000 microfilaria/mL of blood, Diethylcarbamazine (DEC) can cause encephalopathy. Might start with albendazole for few days with or without steroids, then Diethylcarbamazine (DEC).
  • Wuchereria bancrofti Return to Top
    :* Wuchereria bancrofti lymphatic filariasis (elephantiasis) treatment[1]::* Preferred regimen (1): Scaled dose Diethylcarbamazine (DEC) escalation recommended to reduce reactions on day 1-50 mg, day 2-50 mg tid, day 3-100 mg tid, Days 4-14, 2 mg/kg q8h for total of 72 mg over 14 days. (Diethylcarbamazine(DEC) 2 mg/kg PO tid for 12 days (may be accompanied by systemic reaction to dying worms,local reactions include lymphadenitis, transient lymphedema)).::: Note: Corticosteroids or antihistamines may be needed to treat allergic reactions that develop as a consequence of dying microfilariae.
  • Preferred regimen (2): Albendazole 400 mg PO single dose regimen AND (Ivermectin 200 mcg/kg PO OR Diethylcarbamazine 6mg/kg) may reduce or suppress microfilariae; however, this will not affect adultworms.::: Note (1): Most symptoms with Wuchereria bancrofti are due to the adultworm.::: Note (2): Retreatment for microfilaremia often necessary q6-12 months as demonstrated by repeat blood smear or antigen testing.::: Note (3): Do not use Diethylcarbamazine (DEC) in Onchocerca volvulus due to increased risks of precipitating blindness.
Note (4): Skin snip technique is skin snips can be obtained using a corneal scleral punch, or more simply a scalpel and needle. The sample must be allowed to incubate for 30 minutes to 2 hrs in saline or culture medium, and then examined for microfilariae that would have migrated from the tissue to the liquid phase of the specimen. ::: Note (5): Site of infection:::: 5.1 General: filarial fever includes fever, chills, malaise during acute or recurrent episode.
5.2 Lymph:localized lymphadenitis, may be painful(red,warm) or painless, unilateral or bilateral groin swelling. May be due to adult worm or complicating bacterial infection.:::: 5.3 Derm:pruritus,dermatitis,subcutaneous nodules. :::: 5.4 Genital:scrotal or vulvar swelling/ hydrocele; may be able to visualize adult W.bancrofti worm by ultrasound. :::: 5.5 Extremities:unilateral or bilateral swelling, acute or chronic. May be extreme (classic elephantiasis) or mild. May be associated with recurrent bacterial cellulitis (abrupt onset of redness ,fever). :::: 5.6 Lungs:tropical pulmonary eosinophilia (miliary pattern on CXR, nocturnal paroxysmal cough, wheezing, accompanied by marked eosinophilia, responds to DEC, usually amicrofilaremic). :::: 5.7 Renal: chyluria, hematuria (rupture of dilated lymphatics into urinary excretory system). May see weightloss, hypoproteinemia, lymphopenia, anemia.
5.8 Musculoskeletal:acute monoarthritis (knee>ankle) which responds to DEC, tenosynovitis (rare), thrombophlebitis (rare).::: Note (6):::: Diagnosis 1.serological-antigen detection by commercially available card test ; IgG4 antibody (not filaria species specific and may cross react with other helminths);:::: Diagnosis 2.special maneuvers DEC provocative days test (induce microfilaremia with dose of DEC); polymerase chain reaction.:::: Diagnosis 3.skin snips (detect Onchocerca volvulus, Mansonella streptocerca). Ultrasonography can detect adult W.bancrofti worms in scrotal lymphatics.
  • Treatment of endosymbiont Wolbachia (bacteria) may help clear infection:::* Preferred regimen: Doxycycline 100 mg qd or bid for 6-8 wks in lymphatic filariasis although effect may be more important for co-infecting pathogens such as Wuchereria or Onchocerca than loaloa.
  • Brugia malayi, Brugia timori lymphatic filariasis (elephantiasis) treatment::* Preferred regimen (1): Scaled dose Diethylcarbamazine (DEC) escalation recommended to reduce reactions on day 1-50 mg, day 2-50 mg tid, day 3-100 mg tid, Days 4-14, 2 mg/kg q8h for total of 72 mg over 14 days. (Diethylcarbamazine(DEC) 2 mg/kg PO tid for 12 days (may be accompanied by systemic reaction to dying worms,local reactions include lymphadenitis, transient lymphedema)).::: Note: Corticosteroids or antihistamines may be needed to treat allergic reactions that develop as a consequence of dying microfilariae.
  • Preferred regimen (2): Albendazole 400 mg PO single dose regimen AND (Ivermectin 200 mcg/kg PO OR Diethylcarbamazine 6mg/kg) may reduce or suppress microfilariae; however, this will not affect adultworms.::: Note :::: Diagnosis 1.serological-antigen detection by commercially available card test ; IgG4 antibody (not filaria species specific and may cross react with other helminths);:::: Diagnosis 2.special maneuvers DEC provocative days test (induce microfilaremia with dose of DEC); polymerase chain reaction.:::: Diagnosis 3.skin snips (detect Onchocerca volvulus, Mansonella streptocerca). Ultrasonography can detect adult W.bancrofti worms in scrotal lymphatics.
  1. ↑ Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.
  2. ↑ Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.
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