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China was once one of the most heavily endemic for lymphatic filariasis (LF), with a heavy disease burden. Due to decades of sustained efforts, LF was eliminated from China in 2007. The historical tales in the control and elimination of LF in China and current post-elimination surveillance are reviewed and concluded. In the course of LF control and elimination, National Technical Steering Group for Filariasis Control and Research, and Collaborating Research Group on the Transmission Threshold of Filariasis, led by the National Institute of Parasitic Diseases, carried out researches, developed control measures, and applied in practical control and surveillance. The main of the results include: in theoretical study, (1) formulating the microfilaria rate below 1% as the transmission threshold of filariasis, (2) developing anti-filarial drugs and establishing animal model for drug screening, (3) studying the vectorial capacity of mosquitoes transmitted filariasis; in clinical diagnostic and therapy, (1) developing antigens for serological diagnostics, (2) studying different administration regimes for alleviating the side-response of diethylcarbamazine (DEC), (3) studying on the recurrence of acute adenolymphangitis and lymphadenitis of malayan filariasis, (4) observing lymphoedema of the lower extremity using lymphangiography; in practical control and surveillance, (1) establishing the control strategy taking elimination of infection source as the major focus, (2) formulating safe, feasible and effective DEC-mass drug administration, (3) revealing the transmission pattern of filariasis at the post-control phase, (4) establishing comprehensive active surveillance system, (5) formulating the criteria of basic elimination and elimination of filariasis. In the post-elimination surveillance phase, special monitoring and investigation in key areas were conducted for clearing way potential residual infection sources. Two schemes on LF surveillance in the post-elimination phase and caring for chronic filariasis patients were issued to maintain the diagnosis and treatment skills of filariasis all levels of disease control and prevention workers in future. Also, the Notifiable Diseases Reporting System, which included LF in 2004, plays an important role in LF post-elimination surveillance to prevent LF resurgence in China. The strategies and measures of LF control, elimination and post-elimination surveillance in China provide valuable practical experience and promote the progress of Global Programme of Elimination of Lymphatic Filariasis in worldwide. [ABSTRACT FROM AUTHOR]

Lymphatic filariasis, caused by lymphatic filarial parasites, Wuchereria bancrofti, and Brugia malayi, causes significant morbidity and disability to 120 million people in the tropics and subtropics. Chitin has an important role for embryogenesis in adult worms and is a component of microfilaria sheath. Human chitotriosidase (CHIT1) is a chitin-degrading enzyme which provides a protective role against chitin-containing pathogens. Here, we determined the association of CHIT1 polymorphisms with susceptibility to bancroftian filariasis (BF) in 88 individuals at the Thai–Myanmar border. Two common polymorphisms of CHIT1, contributing inactive CHIT protein, including 24 base pair (24 bp) duplication in exon 10, and p. G102S in exon 4 were genotyped by allele-specific Polymerase Chain Reaction (PCR) and PCR sequencing, respectively. Unexpectedly, genotype frequencies of 24 bp duplication insertion homozygous (INS/INS) were significantly higher in endemic normal (EN) (40.0%) than BF patients (31.4%). In contrast, genotype frequencies of p. G102S homozygous (A/A) in BF patients (21.6%) was higher than in EN (19.0%) without statistical difference. Mutant allele frequencies of 24 bp duplication were 0.6125 (98/160) and p. G102S were 0.392 (69/176). Genotype and allele frequencies of CHIT1, 24 bp duplication, and p. G102S, showed no association with BF patients. [ABSTRACT FROM AUTHOR]

Chronic lower limb swelling is frequently encountered in clinical practice. Secondary lymphoedema and chronic venous insufficiency are two frequent causes of chronic lower limb swelling. The most common form of secondary lymphoedema worldwide is filariasis, due to Wuchereria bancrofti. Chronic inflammation and fibrosis are histological hallmarks of lymphoedema. Chronic venous insufficiency refers to venous dilation and venous reflux of long duration. The classical signs include minimal superficial dilation with associated skin changes and ulceration. Both the conditions mimic each other although the treatment is different. The diagnosis need to be confirmed prior to institution of treatment. We present below two cases of chronic lower limb swelling with a review of literature.

Chronic lower limb swelling is frequently encountered in clinical practice. Secondary lymphoedema and chronic venous insufficiency are two frequent causes of chronic lower limb swelling. The most common form of secondary lymphoedema worldwide is filariasis, due to Wuchereria bancrofti. Chronic inflammation and fibrosis are histological hallmarks of lymphoedema. Chronic venous insufficiency refers to venous dilation and venous reflux of long duration. The classical signs include minimal superficial dilation with associated skin changes and ulceration. Both the conditions mimic each other although the treatment is different. The diagnosis need to be confirmed prior to institution of treatment. We present below two cases of chronic lower limb swelling with a review of literature. [ABSTRACT FROM AUTHOR]

Lymphatic filariasis, caused by lymphatic filarial parasites, Wuchereria bancrofti, and Brugia malayi, causes significant morbidity and disability to 120 million people in the tropics and subtropics. Chitin has an important role for embryogenesis in adult worms and is a component of microfilaria sheath. Human chitotriosidase (CHIT1) is a chitin-degrading enzyme which provides a protective role against chitin-containing pathogens. Here, we determined the association of CHIT1 polymorphisms with susceptibility to bancroftian filariasis (BF) in 88 individuals at the Thai–Myanmar border. Two common polymorphisms of CHIT1, contributing inactive CHIT protein, including 24 base pair (24 bp) duplication in exon 10, and p. G102S in exon 4 were genotyped by allele-specific Polymerase Chain Reaction (PCR) and PCR sequencing, respectively. Unexpectedly, genotype frequencies of 24 bp duplication insertion homozygous (INS/INS) were significantly higher in endemic normal (EN) (40.0%) than BF patients (31.4%). In contrast, genotype frequencies of p. G102S homozygous (A/A) in BF patients (21.6%) was higher than in EN (19.0%) without statistical difference. Mutant allele frequencies of 24 bp duplication were 0.6125 (98/160) and p. G102S were 0.392 (69/176). Genotype and allele frequencies of CHIT1, 24 bp duplication, and p. G102S, showed no association with BF patients.

Introduction The aim of this work was to identify possible lymphatic filariasis foci in the western Brazilian Amazonian that could be established from the reports of Rachou in the 1950s. The study was conducted in three cities of the western Brazilian Amazon region - Porto Velho and Guajará-Mirim (State of Rondônia) and Humaitá (State of Amazonas). Methods For human infection evaluation thick blood smear stained with Giemsa was used to analyze samples collected from 10pm to 1am. Polymerase chain reaction (PCR) was used to examine mosquito vectors for the presence of Wuchereria bancrofti DNA. Humans were randomly sampled from night schools students and from inhabitants in neighborhoods lacking sanitation. Mosquitoes were collected from residences only. Results A total 2,709 night students enrolled in the Program for Education of Young Adults (EJA), and 935 people registered in the residences near the schools were examined, being 641 from Porto Velho, 214 from Guajará-Mirim and 80 from Humaitá. No individual examined was positive for the presence of microfilariae in the blood stream. A total of 7,860 female Culex quinquefasciatus specimens examined were negative by PCR. Conclusions This survey including human and mosquito examinations indicates that the western Amazon region of Brazil is not a focus of Bancroftian filariasis infection or transmission. Therefore, there is no need to be included in the Brazilian lymphatic filariasis control program.

A falta de conhecimento do impacto socioeconômico das diversas doenças é, geralmente, um dos maiores obstáculos para a obtenção de verbas para investimentos em pesquisa aplicada, assim como para iniciar a implementação de programas de controle necessários aos países em desenvolvimento. Os autores analisam e ressaltam aspectos relevantes da complexidade de quantificação do impacto socioeconômico da filariose linfática e enfatizam as lacunas existentes em algumas áreas do conhecimento, que ainda não foram devidamente exploradas para os portadores da doença. Aos dados de literatura aliam os ecos do aprendizado adquirido através do atendimento de pacientes portadores de infecção e doença bancroftiana em serviço terciário de referência do Núcleo de Ensino Pesquisa e Assistência em Filariose (NEPAF), Recife, Brasil. O impacto social, no seu sentido mais abrangente, mostra indícios fortes de perdas na qualidade de vida dos pacientes, infelizmente ainda pouco documentadas e, até certo ponto, de muito difícil contabilização, pelo tão peculiar abandono social das comunidades endêmicas.Lack of knowledge of the socioeconomic impact of various diseases is generally one of the biggest obstacles to obtaining funds for investment in applied research and for starting to implement control programs that are needed in developing countries. The authors analyze and emphasize important aspects of the complexity of quantifying the socioeconomic impact of lymphatic filariasis. They highlight the gaps that exist within some fields of knowledge and that these gaps have still not been properly explored with regard to individuals with this disease. They bring together the data in the literature and echoes from their own experience gained through caring for patients with Bancroftian infection and disease at a tertiary referral service (NEPAF - Filariasis Care, Research and Teaching Center, Recife, Brazil). The social impact, in its broadest sense, consists of strong indications of losses of quality of life among patients. Unfortunately, this is still poorly documented and, up to a certain point, very difficult to quantify because of the very particular social abandonment of the endemic communities.

Os autores abordam aspectos da realidade social de crianças e adolescentes residentes em Jaboatão dos Guararapes/PE, diagnosticados como portadores de infecção filarial bancroftiana e tratados no Núcleo de Ensino, Pesquisa e Assistência em Filariose da Universidade Federal de Pernambuco (Centro de Ciências da Saúde), um serviço terciário de referência para filariose. Quantificam e classificam as condições de moradia como subumanas, estando em relação direta com a manutenção da transmissão da bancroftose, e alertam para a necessidade de decisão política quanto à implementação de obras de saneamento básico.The authors report on aspects of the social realities of children and adolescents living in Jaboatão dos Guararapes, State of Pernambuco, who were diagnosed with Bancroftian filariasis infection and were treated at the Filariasis Teaching, Research and Care Center of the Federal University of Pernambuco (Health Sciences Center), which is a tertiary-level reference service for filariasis. The patients’ housing conditions were quantified and classified as subhuman, with a direct relationship with the maintenance of Bancroftian filariasis transmission, and the authors highlight the need for political decisions regarding the implementation of basic sanitation projects.

A Filariose linfática é uma parasitose endêmica em Pernambuco desde 1918, com focos persistentes e em expansão na Região Metropolitana do Recife, tornando-se um desafio premente a ser encarado tanto pelas autoridades de saúde pública, como pela população e escolas de áreas de risco. Como subsídio para o planejamento de estratégias pedagógicas que estimulem os alunos a vivenciarem medidas preventivas para controle da doença, identificamos modelos mentais de cinqüenta alunos (nove-dez anos), residentes em áreas endêmicas da região metropolitana. Os resultados indicaram que as crianças: (a) acreditam que a filariose é evitável, tratável, causada por fator externo, e que o cumprimento das recomendações médicas é fundamental para o sucesso do tratamento; (b) têm dificuldades em identificar os sintomas e as etapas do processo de adoecimento; (c) apóiam seus modelos no que podem observar, o que possibilita a estruturação de ações pedagógicas que simulem, na escola, situações reais vividas pelas crianças em sua comunidade.Bancroftian filariasis has been an endemic parasite in Pernambuco since 1918 expanding into the metropolitan region of Recife, and becoming a permanent challenge to be faced by the public health authorities as well as by the population and schools in the risk areas. As support in creating pedagogic strategies that stimulate pupils to put into practice preventative measures against the disease, we identified the mental models of 50 pupils aged from 9 to 10, living at endemic areas of the Recife Metropolitan Region. The results indicated that the children: (a) believe that the filariasis can be avoided and treated, that it is caused by external factors and that the observance of medical recommendations is fundamental to the success of the treatment; (b) have difficulties in identifying the symptoms and phases of the disease; (c) they based their models on features they can see. This makes it possible to build pedagogical activities that simulate, in school, real situations lived by the children in its community.

Em 1997, a Organização Mundial de Saúde anunciou um ambicioso projeto de eliminação global da filariose linfática como problema de saúde pública. Esse projeto baseia-se em dois pilares: interrupção da transmissão e controle da morbidade. Experiência em Recife-Brasil, área endêmica de filariose bancroftiana, mostrou que a criação pioneira de Clubes da Esperança pode contribuir, a baixo custo, como terapia coadjuvante importante na melhoria da qualidade de vida dos portadores de linfedema e de quilúria. Os pacientes compreendem os fundamentos básicos e os utilizam na prevenção dos episódios agudos bacterianos de pele (erisipelas) e na manutenção da urina sem o componente quiloso. Eles sentem que não estão sós e, através de ações especializadas e do trabalho em grupo, readquirem o potencial para o trabalho produtivo, realizando também mudanças substancialmente positivas dentro de suas comunidades, agindo, assim, como amplificadores do processo.In 1997 the World Health Organization announced an ambitious project called the Global Program to Eliminate Lymphatic Filariasis, as a Public Health Problem. The program is based on two pillars: interruption of transmission and morbidity control. Experience in Recife, Brazil, an endemic area for bancroftian filariasis, showed that an innovative approach called Hope Clubs, can equip lymphedema patients with the skills, motivation, and enthusiasm to sustain effective, low-cost and convenient self-care to prevent acute skin bacterial episodes and milky urine in the case of chyluria carriers. They feel they are not alone, they regain their potential for productive work and are able to amplify these activities throughout filariasis-endemic communities.

This study evaluated the whole blood immunochromatographic card test (ICT card test) in a survey performed in Northeastern Brazil. 625 people were examined by the thick blood film (TBF) and ICT card test. Residents of a non-endemic area were also tested by the whole blood card test and Og4C3. The sensitivity of the ICT card test was 94.7% overall, but lower in females than males, based on the reasonable assumption that TBF is 100% specific. However, since TBF and other methods have unknown sensitivity, the true specificity of the card test is unknown. Nevertheless, it is possible to estimate upper and lower limits for the specificity, and relate it to the prevalence of the disease. In the endemic area, the possible range of the specificity was from 72.4% to 100%. 29.6% of the card tests performed in the non-endemic area exhibited faint lines that were interpreted as positives. Characteristics of the method including high sensitivity, promptness and simplicity justify its use for screening of filariasis. However, detailed information about the correct interpretation in case of extremely faint lines is essential. Further studies designed to consider problems arising from imperfect standards are necessary, as is a sounder diagnostic definition for the card test.

Culex quinquefasciatus is known to be an efficient insect host of Wuchereria bancrofti. In Brazil Cx. quinquefasciatus is widely distributed throughout the country and is often abundant in and around human habitations. In contrast, Bancroftian filariasis is limited to three foci in Brazil. Experiments were undertaken to compare the vector capacities of Cx. quinquefasciatus originating from Maceió (Alagoas), one of the endemic areas of W. bancrofti infection in Brazil, and Belo Horizonte (Minas Gerais), a non endemic area. Laboratory-reared Cx. quinquefasciatus were dissected 20 days after blood feeding on microfilaraemic patients. Survival rates and the number of infective larvae that developed did not differ in female mosquitoes of different origins. Thus both populations of Culex were susceptible to infection with W. bancrofti

Bancroftian filariasis is spreading in towns of endemic areas as in Recife, northeastern Brazil, where it is a major public health problem. This paper deals with the prevalence of microfilaraemia and filarial disease in two urban areas of Recife, studying their association with individual characteristics and variables related to the exposure to the vectors. The parasitologic survey was performed through a "door-to-door" census and microfilaraemia was examined by the thick-drop technique using 45µl of peripheral blood collected between 20:00 and 24:00 o' clock. 2,863 individuals aged between 5 and 65 years were interviewed and submitted to clinical examination. Males aged between 15 and 44 years old presented the greatest risk of being microfilaraemic. Microfilaraemia was also significantly associated with no use of bednet to sleep. The risk of being microfilaraemic was greater among those who had lived in the studied areas for more than 5 years. The overall disease prevalence was 6.3%. Males presented the greatest risk of developing acute disease. The risk of developing chronic manifestations was also greater among males and increased with age. We found no association between time of residence, bednet use, microfilaraemia and acute and chronic disease. We may conclude that in endemic areas there are subgroups of individuals who has a higher risk of being microfilariae carriers due to different behaviours in relation to vector contact.A Filariose bancroftiana está se disseminando em áreas urbanas de regiões endêmicas como no Recife, nordeste do Brasil, onde se constitui em um problema de saúde pública. Este artigo descreve a prevalência de microfilaremia e doença filarial em duas áreas urbanas do Recife, estudando sua associação com características individuais e variáveis relacionadas ao contacto com vetores. O inquérito parasitológico foi realizado através de um censo "porta-a-porta" e a pesquisa de microfilárias foi efetuada pela técnica da gota espessa utilizando 45µl de sangue capilar entre 20:00 e 24:00 horas. Homens com idade entre 15 e 44 anos apresentaram o maior risco de microfilaremia. Microfilaremia esteve também associada com o não uso de mosquiteiros para dormir e um maior tempo de residência nas áreas de estudo. A prevalência total de doença filarial foi 6,3%. Os homens apresentaram o maior risco de desenvolver doença aguda. O risco de manifestações clínicas crônicas foi também maior entre os homens e aumentou com a idade. Não encontramos associação entre tempo de residência nas áreas, uso de mosquiteiros, microfilaremia e doença filarial aguda e crônica. Podemos concluir que em áreas endêmicas existem subgrupos de indivíduos que têm um maior risco de serem portadores de microfilárias devido a comportamentos diferentes em relação ao contato com o vetor.

For the past four decades, Belém has been considered to be the largest focus of Bancroftian filariasis in the Amazon region and one of the most important ones in Brazil. In 1952, practically one-fifth of the population was infected and it was estimated that there were 2,500 cases of Bancroftian elephantiasis. The major factor considered to be responsible for this situation was the high density of the main vector species: it was calculated that in April 1943 there was a mean of 67 infected mosquitoes per house. A control campaign was initiated in 1952, involving treatment of patients with diethylcarbamazine, as well as control of the vector. In 1956, vector control was discontinued because of a lack of efficient insecticides and financial limitations. Even so, the campaign was very successful and the incidence was reduced from 19.9% to 0.03%. Total eradication could be achieved if new methods of vector control were introduced, such as the use of Reiter's expanded polystyrene balls in cesspits and pit latrines, biological control using pathogenic bacteria, and improvement of basic sanitation.Há mais de quatro décadas Belém é considerada o maior foco de bancroftose da região amazônica e um dos mais importantes do Brasil. Em 1952, praticamente um quinto de sua população apresentava microfilárias no sangue, estimando-se em 2.500 os casos de elefantíase. O fator considerado o maior condicionante de tão extraordinária freqüência era a alta densidade local do principal vetor, Culex quinquefasciatus. Em abril de 1943 calculava-se uma média de 67 fêmeas da espécie infectadas por domicílio. Uma campanha de controle foi deflagrada em 1952, incluindo busca ativa e tratamento dos casos com dietilcarbamazina, além medidas de combate ao vetor. Estas foram abandonadas em 1956, por força da ineficácia ou do alto custo dos inseticidas. Ainda assim, a campanha foi muito bem sucedida, reduzindo a incidência de 19,9 para 0,03%. Hoje, a erradicação poderia ser de pronto lograda, se novos métodos de combate ao vetor fossem adotados, tais como o emprego das bolinhas expandidas de poliestireno nas fossas sépticas e privadas estanques não-inundáveis e o controle biológico com microrganismos entomopatogênicos nos criadouros naturais, sobretudo se acompanhados de um incremento de obras de saneamento.

Since the World Health Assembly's (Resolution WHA 50.29, 1997) call for the elimination of lymphatic filariasis by the year 2020, most of the endemic countries identified have established programmes to meet this objective. In 1997, a National Lymphatic Filariasis Elimination Plan was drawn up by the Ministry of Health of Brazil, creating local programs for the elimination of Bancroftian filariasis in areas with active transmission. Based on a comprehensive bibliographic search for available studies and reports of filariasis epidemiology in Brazil, current status of this parasitic infection and the outlook for its elimination in the country were analysed. From 1951 to 1958 a nationwide epidemiological study conducted in Brazil confirmed autochthonous transmission of Bancroftian filariasis in 11 cities of the country. Control measures led to a decline in parasite rates, and in the 1980s only the cities of Belém in the Amazonian region (Northern region) and Recife (Northeastern region) were considered to be endemic. In the 1990s, foci of active transmission of LF were also described in the cities of Maceió, Olinda, Jaboatão dos Guararapes, and Paulista, all in the Northeastern coast of Brazil. Data provide evidence for the absence of microfilaremic subjects and infected mosquitoes in Belém, Salvador and Maceió in the past few years, attesting to the effectiveness of the measures adopted in these cities. Currently, lymphatic filariasis is a public health problem in Brazil only in four cities of the metropolitan Recife region (Northeastern coast). Efforts are being concentrated in these areas, with a view to eliminating the disease in the country. [ABSTRACT FROM AUTHOR]

An 18-year-old man presented with multiple subcutaneous nodules over the anteromedial aspect of his right lower arm. Based on findings of sonography, histopathology, circulating filarial antigen test, and therapeutic response to diethylcarbazine, a diagnosis of filarial lymphadenopathy affecting mid-arm nodes and epitrochlear lymph nodes was made. [ABSTRACT FROM AUTHOR]

Background & objectives: Goa is one of the filariasis endemic states of India. However, information on density, pattern and resting behavior of Culex quinquefasciatus Say, the principal vector of filariasis in Goa is lacking. Therefore, current longitudinal study was undertaken to investigate these aspects. Methods: Panaji was divided into six zones and a total of 240 man hours were spent in 60 fixed catching sites to collect the adult Cx. quinquefasciatus mosquitoes on fortnightly basis from indoor resting sites during 2005-06. The female mosquitoes were classified as unfed, fed, semi-gravid and gravid to ascertain the resting behavior of Cx. quinquefasciatus adults. The data were analysed to evaluate the spatio-temporal variations in adult density, abdominal status and indoor resting sites and linked to meteorological variables like temperature, relative humidity, rainfall and number of rainy days. Results: Cx. quinquefasciatus adults were prevalent perennially in Panaji with highest per man hour density of females (48.6) in February and the lowest density (6.6) in September. Monthly variations in the densities between different months was significant (F=15.3; P<0.05). Rainfall significantly influenced the population of Cx. quinquefasciatus (t=2.63; P<0.05). Fed group and semi-gravid group showed a strong correlation with the relative humidity (P<0.05), rain fall (P<0.05) and number of rainy days (P<0.05). 62.4 per cent of females and 65.1 per cent of males preferred to rest on hanging objects. Spatio-temporal variations in the number of Cx. quinquefasciatus females and males resting on different sites and also the variations in different sites (P<0.05) were significant. Interpretation & conclusion: The density of female Cx. quinquefasciatus encountered in all the months was higher than the estimated tolerated level of density of 34 per ten man hours up to which there is no risk of filariasis transmission. The strong correlation between the abdominal conditions and relative humidity, rainfall and number of rainy days imply that these meteorological variables significantly influenced the feeding and fecundity of the species. 85.3 per cent of the indoor resting population comprising of fed, semi-gravid and gravid females confirmed the endophilic nature of the species. The preferential resting behavior of both females and males on hanging objects suggest that use of insecticide treated long-lasting bed nets as personal protective measure can be exploited to reduce the density of the vector species. [ABSTRACT FROM AUTHOR]

Abstract: Malaria and lymphatic filariasis are two of the most common mosquito-borne parasitic diseases worldwide which can occur as concomitant human infections while also sharing common mosquito vectors. This review presents the most recent available information on the co-transmission of human Plasmodium species and Wuchereria bancrofti by Anopheles mosquitoes. Important biological and epidemiological aspects are also described including the lifecycle of each parasite species and their specificities, the geographical biodiversity of each pathogen and their vectors where the parasites are co-endemic, and biological, environmental and climatic determinants influencing transmission. The co-transmission of each disease is illustrated from both a global perspective and a country level using Thailand as a study case. Different diagnostic methods are provided for the detection of the parasites in biological samples ranging from traditional to more recent molecular methods, including methodologies employing concomitant detection assays of W. bancrofti and Plasmodium spp. parasites. The relevant issues of combined malaria and Bancroftian filariasis control strategies are reviewed and discussed. [Copyright &y& Elsevier]

Thioredoxin is a low molecular weight redox-active protein of filarial parasite that plays a crucial role in downregulating the host immune response to prolong the survival of the parasite within the host body. It has the ability to cope up with the oxidative challenges posed by the host. Hence, the antioxidant protein of the filarial parasite has been suggested to be a useful target for immunotherapeutic intervention of human filariasis. In this study, we have designed a multi-epitope peptide-based vaccine using thioredoxin of Wuchereria bancrofti. Different MHC-I and MHC-II epitopes were predicted using various web servers to construct the vaccine model as MHC-I and MHC-II epitopes are crucial for the development of both humoral and cellular immune responses. Moreover, TLRs specific adjuvants were also incorporated into the vaccine candidates as TLRs are the key immunomodulator to execute innate immunity. Protein-protein molecular docking and simulation analysis between the vaccine and human TLR was performed. TLR5 is the most potent receptor to convey the vaccine-mediated inductive signal for eliciting an innate immune response. A satisfactory immunogenic report from an in-silico immune simulation experiment directed us to propose our vaccine model for experimental and clinical validation. The reverse translated vaccine sequence was also cloned in pET28a(+) to apply the concept in a wet lab experiment in near future. Taken together, this in-silico study on the design of a vaccine construct to target W. bancrofti thioredoxin is predicted to be a future hope in saving human-being from the threat of filariasis. • Multi-epitope-based vaccine has been developed using the B- and T-cell epitopes of filarial thioredoxin. • The vaccine candidate binds to human Toll like receptors (TLRs) to the induce innate immune-response. • Protein-protein interaction and molecular dynamic simulation studies postulated a high efficacy of the vaccine candidate. • The designed vaccine can be easily cloned and expressed within bacterial system. [ABSTRACT FROM AUTHOR]

Summary: Clinical examinations were conducted in an effort to provide baseline data for a pilot filariasis elimination programme implemented in a Wuchereria bancrofti-endemic focus in Malindi district, Kenya. Of 186 males aged 15 years and above examined, 64 individuals (34.4%) had hydrocele, and the prevalence of the manifestation in those above 40 years old was 55.3%. The prevalence of leg lymphoedema in persons aged 15 years and above was 8.5%, with a higher rate in males (12.6%) than in females (5.7%). The overall prevalence of inguinal adenopathy was 8.6%, and males had a significantly higher (12.9%) prevalence of adenopathy than females (5.1%) (P <0.001). The data in the present study provided support for consideration of filarial infection as a possible cause of inguinal lymphadenopathy in bancroftian filariasis-endemic areas. The results of this study also indicate that lymphatic filariasis is a serious public health problem in the northern coastal areas and morbidity control programmes should be implemented to alleviate the suffering of those affected. [Copyright &y& Elsevier]

Abstract: The impact of single dose mass drug administration of diethylcarbamazine (DEC), DEC with albendazole (ALB), and ivermectin (IVR) with albendazole, was examined on the human bancroftian filarial infections in village scale trials in south India, from a follow-up study after 2 years. The treatment arms administered with DEC alone and DEC+ALB demonstrated long-term benefits in reducing microfilaraemia significantly (P <0.05), while antigenaemia reduction was negligible. The arm with ALB+IVR did not show such reductions. Among the antigenaemic and microfilaraemic individuals, 87% became amicrofilaraemic in DEC+ALB arm, which were higher than that observed in the other 2 treatment arms. Among amicrofilaraemics (but Ag+), nearly 35% cleared of infection in DEC+ALB, while 26% and 6% in DEC alone and IVR+ALB arms, respectively. The drug combination DEC+ALB was observed to demonstrate a significant impact in reducing filarial infection even after 2 years post treatment. [Copyright &y& Elsevier]

Objectives An estimated 15 million persons suffer from lymphoedema of the leg in filariasis-endemic areas of the world. A major factor in the progression of lymphoedema severity is the incidence of acute dermatolymphangioadenitis (ADLA), which is triggered by bacteria that gain entry through damaged skin, especially in the toe web spaces (‘interdigital skin lesions’). Little is known about the epidemiology of these skin lesions or about patients’ awareness of them. Methods We interviewed and examined 119 patients (89% women) with lymphoedema of the leg in Recife, Brazil, an area endemic for bancroftian filariasis. Results We detected 412 interdigital skin lesions in 115 (96.6%) patients (mean, 3.5 lesions per patient, range 0–8). The number of interdigital skin lesions was significantly associated with lymphoedema stage ( P < 0.001) and frequency of ADLA ( P < 0.0001). Only 20 (16.8%) patients detected their own interdigital skin lesions or considered them abnormal. Patients reported a mean of 3.6 ADLA episodes during the previous 12 months (range, 0–20); reported ADLA incidence was associated with lymphoedema stage ( P < 0.0001) and the number of interdigital skin lesions detected by the examining physician ( P < 0.0001). Conclusions These data suggest that interdigital skin lesions are a significant risk factor for ADLA and that persons with lymphoedema in filariasis-endemic areas are unaware of their presence or importance. Prevention of ADLA through prompt recognition and treatment of interdigital skin lesions will require that patients be taught to identify lesions, especially between the toes and to recognize them as abnormal. [ABSTRACT FROM AUTHOR]

Summary: Diethylcarbamazine/albendazole (DEC/ALB) therapy is widely used in mass drug administration (MDA) programmes aimed at eliminating lymphatic filariasis. We studied the effects of repeated annual treatments with DEC/ALB on Wuchereria bancrofti microfilaraemia, filarial antigenaemia and IgG4 antibodies to Bm14 antigen. Fifty-seven subjects with asymptomatic microfilaraemia were treated with one or seven daily doses of DEC/ALB at time zero. All subjects were re-treated with single-dose DEC/ALB 12, 24 and 36 months later. The two treatment groups had comparable pre-treatment microfilaria counts. Multidose treatment cleared microfilaraemia more effectively than single-dose treatment. Filarial antigen levels decreased equally in both treatment groups. Total antigen clearance was observed in 29.6%, 52.0%, 63.6% and 79.5% of subjects at 12, 24, 36 and 48 months. These clearance rates are much higher than those observed in prior treatment trials with DEC or ivermectin. Antibody levels increased 4 weeks after treatment and then slowly decreased in most subjects. Antibody tests turned negative in 20%, 35%, 39.4% and 52.5% of treated subjects at 12, 24, 36 and 48 months post treatment. These results show that the studied parameters decline at different rates and to differing degrees following DEC/ALB treatment. These findings have important implications regarding strategies for monitoring the effects of MDA in populations. [Copyright &y& Elsevier]

As part of the Global Programme for Elimination of Lymphatic Filariasis (GPELF), India is implementing mass drug administration (MDA) with annual single dose of diethylcarbamazine (DEC) with and without albendazole (ALB). The impact of MDAs on filarial infections and soil-transmitted helminth (STH) infections was assessed during a 3-year period in two communities, one with DEC + ALB and the other with DEC alone. Prior to each MDA (during 2001, 2002 and 2003), filarial indices (microfilaraemia and antigenaemia) were assessed from blood samples of 450–650 persons aged 2–25 years and STH infections in stool samples (Kato–Katz method) from 325 to 500 children aged 9–10 years. Mosquitoes resting indoors were collected to determine the filarial infection status. The microfilaraemia prevalence decreased significantly ( P < 0.05) in both arms, with the highest decline in the DEC + ALB arm (72% vs. 51%). Decline in micrefilaria intensity was also higher in the DEC + ALB arm (81.4% vs. 48.5%). In this arm alone, the antigenaemia prevalence was reduced significantly (62%; P < 0.001). The reduction in STH prevalence was lower in the DEC alone arm (6.5%; NS) than in the DEC + ALB arm (70.9%; P < 0.001). Also, the egg reduction in DEC alone arm was only half that of DEC + ALB arm (49% vs. 97%). Our community-based follow-up study showed higher and sustained benefits with regard to filarial and STH infections for the two-drug arm over the DEC alone arm. The trends suggest that at least 10 MDAs may be necessary to achieve the goal of elimination. [ABSTRACT FROM AUTHOR]