Filariasis has been identified by who as one among the 6 major tropical diseases , there are 120 million cases of filariasis in the world out of which 90 million cases are of lymphatic forms of filariasis and around 900 million people are exposed to filarial infection . Filariasis is a disease produced by certain nematode worms , we are mainly concerned here with Wuchereria bancrofit and Brugle malayi which are prevalent in India .
W. Bancrofit is a parasite found in man . It has two biologically different forms .one periodic with nocturnal periodically of microfilariae transmitted by night biting mosquitoes i.e, Culex Fatigans and this is the urban variety . The second sub periodical with diumal periodicity of the microfilariae adopted by the day mosquitoes . the adult worms can survive from 10 –18 years and mainly remain in lymphatics or lymph nodes of human being only . human being is the definitive host where as mosquito ,the intermediate host . B. malayi is predominatly an infection of tae rural population in contrast to the urban , w. bancrofit and is transmitted by open swamp species of mansonia and some anopheliness . it is a parasite of man and no natural infections have been found in animals . Bancroftial filariasis is a disease widely spread in tropics and sub tropics . In India , it is distributed usually in coastal zones ,through other states are not free from the disease . In India usually Bancrofit and Malayan infections are found ,Bancrofitian filariasis is more towards southern India ,mixed infections are observed in Orissa . W.malayi causes lymphangitis lympho cdema and “elephantiasis “ particularly in the legs and virtually spares the genitourinary system
Infection and diseases : Many diseased show no microfilario and all infected people disease . The micro filario and all infected people show disease . The microfilario rate is greatest in males in most countries and it has been suggested that hormones influence the level of parasitaemia , the rate is at speak in 15-20 age groups , where as sings of filarial disease become apparent in the 20-29 age group
Pathology ; in most cases of filarial infection , the parasite does not exercise or manifest any injurious influence on the host and in endemic areas of filariasis , here are many people with microfilaraemia who show no clinical or pathological signs of
filarial infection i.e, asymptomatic carriers , healthy , fully formed microfilariae are usually harmless except in case of tropical pulmonary eosinophilia . An infected mosquito when bites , discharges the 3rd stage larva (infective form of the larva)into the skin from where it enters local lymphatic channels from this infective larva matures and becomes adult worm .
Male and female adult worm conjugate for production of microfilariae , the injurious influence produced by the adult worm as well as microfilariase in the lymphangitis . this leads to either lymphadenitis or lymphangitis . The pathogenic effects are mainly due to mechanical obstruction as well as irritation by the adult worms . The patient first develops rigor with allergic fever before the development of lymphangitis or lymphadenitis . the damage to the endothelical layer of lymphatics invite bacterial infection ,caused mainly by streptococci ,because of the local oedema of lymphnodes and lynphatics due to inflammation and infections , the conchrned lymphnode is nonstretchable but sensitive , a constant pain is felt due to increased tension inside the capsule . the lymphnodes and lymphatic channel are obliteraied in the early stage due to mechanical obstruction caused by bolus of adult worms and microfilaria ,inflammatory oedema , proliferation ,endothelium in response to toxic inflammation , this deprives the area of lymphatic drainage and leads to local oedema due to collection of lymph in dependent parts , this is the pitting stage . As the lymph is rich in carbohydrate and protein it invites local infection by etrepto and staphylocci leading to cellutities , which spread to enc in gangrene or septicaemia or may be localized in the form of an abscess or ulcer . The cellutities subsides treatment is started . There is hypereorinophilia due to local infection , later on there is lymphocytoris as the cellular immunity comes to play a role .
In late stage of this disease ,fibrosis develops surrounding lymphatics and in lymphnodes , this and obliterative endolymphangitis causes complete obstruction of lymphatic channels and in abnormal pattern of dermal back flow development of lymphoedema . The adult worms may become calcified ,due to repeated infection ,there is local fibrosis and coagulation of lymph , there transduction into the tissues of lymph rich in protein which causes cellular proliferation in the connective tissue and the production of elephantiasis .
Gradation of oedema : Grade –1: lymphoedema with slight increase in limb size mostly pitting oedema , some fibrosis , spontaneously reversible on elevation.
Grade –11 : lymphoedema with obvious increase in limb size but without deformities mostly non-pitting oedema , much fibrosis ,not spontaneously reversible on elevation .
Grade – 111 : Elephantiasis , the affected limb being deformed with local bulging and with chronic skin abnormalities of grade-11 oedema with much dermatoslerosis , regarding scrotal and penile oedema gradation beard no clinical importance at all .
Clinical filariasis : The incubation period is usually from 5-15 months as ineffective (3rd stage) larva takes about one year to mature into adult worm . In early filariasis , the onset is manifested by painful swellings of the scrota contents , acute swelling of the lymph glands of the inguinal , femoral, axillary or epitrochlear region is common , lymphangitis and filarial fever are less common in the earliest stage .
Acute presentation : acute lymphangitis , lymphadenitis .orchitis , epididymo-orchitis , funiculitis , myositis , acute urinary tract infection , abscess formation.
Chronic presentation :1. Lymphatic block with distal dilatation lamphagiectaris (lymphvarix) , hydrocele of scrotum , hydrocele of breast .2. Lymphatic block with distal dilatation and rupture , chyluria , chyloyhorax , chylous ascitis and lymphorthoea . 3. Lymphatic block with lymphstasis , elephantiasis of upper limb, lower limb , breast , scrotum with without ramhorn penis, vulvae .
Diagnosis ;–Microfilaria blood : The diagnosis is best made on clinical manifestation , the absence of micrifilariae does not exclude filarial disease as this is found in a small percentage of cases and only in early filariasis .
Eosinophilia : A moderate eosinophilia 33.50 % is found in most early cases of filariasis .
Symptomatic treatment : Recurrent adenolymphangitis and filarial fever . Treatment should consist of removing and cause of irritation , rest m avoiding undue exertion , elevation of the affected part , cooling lotions, relief of pain and subsequent elevation and bandaging of the part .
Elephantiasis : prolonged firm bandaging , the patient is put to bed and firm bandaging is started from the foot upwards . sponge rubber is used to protect the tissue from too tight bandaging , the bandages are removed evey day and replaced a little tighter .
Abscess : caused by filarial must be opened and drained .
Moderate Improvement of Attacks Subsided : When the patient remains free from attacks for a period ranging from 1-2 years depending upon the frequency of attacks , as above .
Therapy : some of the remedies which are most useful in filarial cases —-these are
“Homoeopathic remedies “
Rhus tox, Bryonia alba , Apis mellifica and sulphur and these drugs alone cover 60 % of cases and roughly 45 % of cases respond to these drugs only , other important drugs are —–“ Natrum muriaticum , Pulsatilla , Lycopodium , Rhododendron “ next in the lists are “Belladonna , calcarea carbonicum , Lachesis , Mercurius solubilus ,” etc.and “Thuja , Medorrhinum , and Sulphur” act as effective intercurrents when applicable.
Here I would like to mention that drugs like –“Anthracinum , Tarentula cubensis , and some times Veratrum viride” act very well in acute adendym poangitis . Specially one with severe cellulites associated with burning similarly sue of thiosinaminum in oedema to some extent , use of cooling lotions and ointments help relieve the pain and burning and gives much soothing effect . these are —“Hydrocotyle , Echinacea , Calendula and arnica lotions and ointments . observations in respect of some important reliable indications of drugs .
Apis mellifica : Glossy oedema , burning amel , cold application , scanty thirst .
Belladonna : acute congestion, sudden onset , sensitiveness , throbbing pain .
Bryonia alba : Hot patient , profuse thirst agg. , motion, pressure , local oedema of all types especially fibrotic .
Lycopodium : chilly patient , desire for warm food , sweets , suppurative tendency ,
Natrum muriaticum : Intolerance to sun’s heat , desire for cold, salt, mental irritability
Pulsatilla : Hot patient , desire for cold , thirst scanty , mild disposition .
Rhododendran : affections of male genitalia , hydrocele .
Rhus tox : All cases of recent origin or acute over chronic, frequent episodes of adendym phangitis agg : exertion cord like swelling
Sulphur : Local or genaralised burning cold amel , desire for swets , cold , accompanied by gastric or skin disorders .
Most useful potencies
The best potencies are 200 and 1000 . We should like to know if the blood examinaton at the end of treatment is negative for the microfilaria .
Hydrocotyle asiatica 3-5 drops twice daily over long period and in some cases given along with “Calcarea flouricum” 6x has reduced and almost normalized Elephantiasis of legs and arms , especially the other skin troubles that come along . “Rhus tox , Pulsatilla , and Rhododendran have cured most of my cases of Hydrocele , all in 6th or 30th potency repeated daily .
Silicea has in 1000 ,1000th potency done wonderful work on glandular enlargement and hardening .
30th potency once or twice a day continuously for a month or two , 200th potency few doses per month ,
1M case of 50M or CM —one month to six months interval .
During acute paroxysms :
Low to medium potency at 3-4 hours interval . Rhus tox emerges as singularly the most useful remedy . It is applicable in all forms of clinical filariasis .
Filariasis has confirmed the efficacy of “Rhus tox , Bryonia alba , Apis mellifica in this disease and these drugs have been recommended to be included in the national control program of filariasis .