Bancroftian filariasis accounts for 90% of the lymphatic filariasis cases and is one of the most common causes of acquired lymphedema. Usually, this disease is commonly known as elephantiasis. Its physical sign is a disfigurement alongside a lack of movement. The symptoms of this disease, notwithstanding the physical nature of it, do not show signs in its early stages or non-specific symptoms.
But deep in the person, the lymphatic system has been damaged. This stage can span for several years. However, long-term reaction symptom is a painful swollen limb. It has been known to be the second leading infectious cause of disability worldwide after leprosy.
Its chief signs feature in the lymphatic system alongside clinical signs including acute adenolymphangitis, filarial fever, and tropical pulmonary eosinophilia to chronic, such as hydrocele, lymphedema, and elephantiasis in the most severe of cases.
In the case of filariasis, there is severe inflammation, resulting in fibrosis that ends up leading to lymphedema. While the legs are involved in most cases, the lymphedema can also involve the genitals, arms, and breasts. Despite the symptoms, it is important that while exploring bancroftian filariasis disease, one should consider the causes.
The major causative agent of the disease is the Wuchereria bancrofti also known as the roundworm or Brugia malayi and is spread by mosquito species, Culex quinquefasciatus and Mansonia annulifera / M.uniformis respectively.
Anopheles mosquitoes serve as vectors for Wuchereria bancrofti in the transmission of the disease. The vector, Mansonia, and Anopheles mosquitoes transmit the parasite Brugia malayi, which also causes filariasis.
When it enters the body, it multiplies in the human lymphatics while releasing immature larvae known as microfilariae into the bloodstream. Mosquitoes, in turn, ingest these larval forms when they feed on infected human blood and disperse the disease to the other people through their bite.
When an infected mosquito bites a healthy person, the larvae called microfilariae move into the lymphatics and lymph nodes. At this stage, they develop into adult worms and may persist for years. The adult parasite then produces more microfilariae. These go into the exterior blood usually in the night and are sucked by the mosquitoes during a bite.
The same exercise is then repeated in another healthy individual. Filariasis is caused by several round, coiled and thread-like parasitic worm that belongs to the family filaridea. These parasites, oftentimes, find their way into the skin either via their own or through the opening created by mosquito bites to get to the lymphatic system.
The signs are also important while exploring bancroftian filariasis disease. Generally, some people with filariasis have no symptoms, yet the symptoms could involve the following:
• Bancroftian filariasis affects both the legs and the genitals. The Malayan variety affects the legs below the knees.
• Some people with filariasis have abnormally high levels of certain white blood cells (eosinophilia) during acute episodes of symptoms. When the inflammation resolves, these levels return to normal.
• Filariasis may cause chronic lymph node swelling (lymphadenopathy) even in the absence of other symptoms. Long-lasting blockade of the lymphatic vessels may lead to several other conditions. These include accumulation of fluid in the scrotum (hydrocele), the presence of lymphatic fluid in the urine (chyluria), and/or abnormally enlarged lymphatic vessels (varices). Other symptoms may include progressive edema (elephantiasis) of the female external genitalia (vulva), breasts, and/or arms and legs. Chronic edema may result in skin that is abnormally thick and has a “warty” appearance.
• The disease generally identified with the symptoms like swelling of legs, and hydrocele and can cause a raft of societal stigma.
• Lymphatic filariasis infection involves asymptomatic, acute, and chronic conditions. A plethora of these infections are asymptomatic, showing no external signs of infection, although their blood is positive for microfilaria. This stage may last for months.
• Acute episodes of local inflammation involving the skin, lymph nodes, and lymphatic vessels.
• Its chronic condition shows edema with thickening of the skin and underlying tissues (the classical symptom of filariasis).
• It usually affects the lower extremities. However, the arms, vulva, breasts, and scrotum (causing hydrocele formation) can also be affected. The edema in the extremities, breast, or genital area can result in the part becoming several times its normal size and is due to blockage of the vessels of the lymphatic system.
It is known that the microfilariae that cause this disease circulates in the blood at night (called nocturnal periodicity). This is why blood collection is done at night to coincide with the appearance of the microfilariae, and a thick smear should be made and stained with Giemsa or hematoxylin and eosin. For increased sensitivity, concentration techniques can be used.
Serologic techniques provide an alternative to microscopic detection of microfilariae for the diagnosis of lymphatic filariasis. Patients with active filarial infection naturally have elevated levels of antifilarial IgG4 in the blood and these can be detected using routine assays.
• Avoiding mosquito bites is the best form of prevention. The mosquitoes that carry the microscopic worms usually bite between the hours of dusk and dawn. Nevertheless, if one is to live in or travel to an area with lymphatic filariasis:
• Sleep under a mosquito net.
• Wear long sleeves and trousers.
• Use mosquito repellent on exposed skin between dusk and dawn.
• Carefully wash and dry the swollen area with soap and water every day.
• Elevate the swollen arm or leg during the day and at night to move the fluid.
• Perform exercises to move the fluid and improve lymph flow.
• Disinfect any wounds. Use antibacterial or antifungal cream if necessary.
• Wear shoes adapted to the size of the foot to protect the feet from injury.
• Men with hydrocele can undergo surgery to reduce the size of the scrotum.
Finally, though lymphatic filariasis is treated with medicines, there is a continual abnormal enlargement of body parts leading pain and severe disability. This is further aggravated by the social stigma that makes patients suffer mentally, socially, and financially. Eliminating this disease is possible by disrupting the spread of infection with mass drug administration (MDA) and protection from mosquito bites and vector control methods. In exploring bancroftian filariasis disease further, it is important to consider age, travel history, family history, endemicity, and socioeconomic status when trying to work out a diagnosis.
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