Lymphatic Filariasis: A Neglected Disease

Manila Bulletin, May 25, 2003 | Go to article overview

Lymphatic Filariasis: A Neglected Disease


SARS, tuberculosis, HIV/AIDS, malaria, cancer, cardiovascular diseases: These are the current headline diseases. They are also the ones attracting action and resources. Well, rightly so, since these infirmities do cause death and disabilities to millions of people.

But I would like to introduce you to a forgotten disease that is the second biggest cause of disability in the world, next to mental illness. This is the disease called lymphatic filariasis, better known as elephantiasis, since it causes legs and arms to swell like elephant extremities.

Lymphatic filariasis or LF puts at risk more than one billion people worldwide, with over 120 million affected by it, with 40 million seriously incapacitated and disfigured by the disease in 80 endemic countries. In the Philippines, at least half a million Filipinos have developed the disease and around 20 million Filipinos are at risk of having the disease. Thirty six provinces have been recently surveyed and still found to have disease transmission. It is a disease of the poor, and the endemic provinces are mainly 4th to 6th class in socio-economic category. These are the main reasons why LF has been a neglected disease. The whole of Mindanao, the Bicol peninsula, Leyte-Samar, Negros Oriental, Mindoro and Romblon are the areas prevalent in lymphatic filariasis.

LF is transmitted by female mosquitoes that thrive mostly in the axils of the abaca and banana plants. These mosquitoes carry the microfilaria worm as they bite people infected with LF. These mircofilariare (or minute larvae) develop inside the mosquito for 7 to 21 days and migrate to the biting mouth parts, ready to enter the punctured skin following the mosquito bite.

The human physical consequences are pain, ugly swollen limbs and genitals (especially in men) and bad smelling skin. There is also damage to the inside of the body which is not seen: the lymphatic system and the kidneys are affected. Everyday life becomes difficult. Simple actions like walking and working become impossible. The more the disease progresses, the more sufferers are shunned by society. Thus those affected remain hidden in far villages and become unproductive.

When I was a medical student in the 70s, early diagnosis of LF was through a blood sample taken from midnight to 4 a.m. which was extremely difficult to implement. Within the last few years, a new easy diagnostic test has been developed using only finger-pricked blood droplets taken anytime of the day. This has transformed the approach to diagnosis and monitoring the progress and transmission of the disease.

Treatment has also been revolutionized. With the combination of two drugs, diethylcarbamazine (DEC) and albendazole, 99% of the microfilariae are removed from the blood for a full year after treatment.

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