Background Approximately 14 million persons living in areas endemic for lymphatic filariasis have lymphedema of the leg. Clinical studies indicate that repeated episodes of bacterial acute dermatolymphangioadenitis (ADLA) lead to progression of lymphedema and that basic lymphedema management, which emphasizes hygiene, skin care, exercise, and leg elevation, can reduce ADLA frequency. However, few studies have prospectively evaluated the effectiveness of basic lymphedema management or assessed the role of compressive bandaging for lymphedema in resource-poor settings. Methodology/Principal Findings Between 1995 and 1998, we prospectively monitored ADLA incidence and leg volume in 175 persons with lymphedema of the leg who enrolled in a lymphedema clinic in Leogane, Haiti, an area endemic for Wuchereria bancrofti. During the first phase of the study, when a major focus of the program was to reduce leg volume using compression bandages, ADLA incidence was 1.56 episodes per person-year. After March 1997, when hygiene and skin care were systematically emphasized and bandaging discouraged, ADLA incidence decreased to 0.48 episodes per person-year (P<0.0001). ADLA incidence was significantly associated with leg volume, stage of lymphedema, illiteracy, and use of compression bandages. Leg volume decreased in 78% of patients; over the entire study period, this reduction was statistically significant only for legs with stage 2 lymphedema (P = 0.01). Conclusions/Significance Basic lymphedema management, which emphasized hygiene and self-care, was associated with a 69% reduction in ADLA incidence. Use of compression bandages in this setting was associated with an increased risk of ADLA. Basic lymphedema management is feasible and effective in resource-limited areas that are endemic for lymphatic filariasis.
References
[1]
Michael E, Bundy DAP, Grenfell BT (2001) Re-assessing the global prevalence and distribution of lymphatic filariasis. Parasitology 112: 409–428. doi: 10.1017/S0031182000066646
[2]
Ottesen EA (2001) The global programme to eliminate lymphatic filariasis. Trop Med Internat Health 5: 591–594. doi: 10.1046/j.1365-3156.2000.00620.x
[3]
Seim A, Dreyer G, Addiss D (1999) Controlling morbidity and interrupting transmission: twin pillars of lymphatic filariasis elimination. Revista da Sociedade Brasileira de Medicina Tropical 32: 325–328. doi: 10.1590/S0037-86821999000300022
[4]
Dreyer G, Medeiros Z, Netto MJ, Leal NC, de Castro LG, et al. (1999) Acute attacks in the extremities of persons living in an area endemic for bancroftian filariasis: differentiation of two syndromes. Trans R Soc Trop Med Hyg 93: 413–417. doi: 10.1016/S0035-9203(99)90140-2
[5]
Pani SP (1995) Clinical manifestations of bancroftian filariasis with special reference to lymphoedema grading. Indian J Med Res 102: 114–118.
[6]
Pani S, Yuvaraj J, Vanamail P, Dhanda V, Michael E, et al. (1995) Episodic adenolymphangitis and lymphoedema in patients with bancroftian filariasis. Trans R Soc Trop Med Hyg 89: 72–74. doi: 10.1016/0035-9203(95)90666-5
[7]
Shenoy RK, Sandhya K, Suma TK, Kumaraswami V (1995) A preliminary study of filariasis related acute adenolymphangitis with special reference to precipitating factors and treatment modalities. Southeast Asian J Trop Med Public Health 26: 301–305.
[8]
Babu BV, Nayak AN, Dhal K (2005) Epidemiology of episodic adenolymphangitis: A longitudinal prospective surveillance among a rural community endemic for bancroftian filariasis in coastal Orissa, India. BMC Public Health 5: 50. Available: http://www.pubmedcentral.nih.gov/article？render.fcgi?tool=pubmed&pubmedid=1590453？7.
[9]
Suma TK, Shenoy RK, Kumaraswami V (2002) Efficacy and sustainability of a footcare programme in preventing acute attacks of adenolymphangitis in Brugian filariasis. Trop Med Int Health 7: 763–766. doi: 10.1046/j.1365-3156.2002.00914.x
[10]
McPherson T (2003) Impact on the quality of life of lymphoedema patients following introduction of a hygiene and skin care regimen in a Guyanese community endemic for lymphatic filariasis: A preliminary clinical intervention study. Filaria J 2: 1. Available: http://www.filariajournal.com/content/2/？1/1.
[11]
World Health Organization (2004) Lymphatic filariasis: Progress of disability prevention activities. Wkly Epidemiol Rec 79: 417–424.
[12]
Kerketta AS, Babu BV, Rath K, Jangid PK, Nayak AN, et al. (2005) A randomized clinical trial to compare the efficacy of three treatment regimens along with footcare in the morbidity management of filarial lymphoedema. Trop Med Int Health 10: 698–705. doi: 10.1111/j.1365-3156.2005.01442.x
[13]
Shenoy RK, Kumaraswami V, Suma TK, Rajan K, Radhakuttyamma G (1999) A double-blind, placebo-controlled study of the efficacy of oral penicillin, diethylcarbamazine or local treatment of the affected limb in preventing acute adenolymphangitis in lymphoedema caused by brugian filariasis. Ann Trop Med Parasitol 93: 367–377. doi: 10.1080/00034989958366
[14]
Joseph A, Mony P, Prasad M, John S, Srikanth , et al. (2004) The efficacies of affected-limb care with penicillin diethylcarbamazine, the combination of both drugs or antibiotic ointment, in the prevention of acute adenolymphangitis during bancroftian filariasis. Ann Trop Med Parasitol 98: 685–696. doi: 10.1179/000349804225021451
[15]
Beau de Rochars M, Kanjilal S, Direny AD, Radday J, Lafontant JG, et al. (2005) Lessons learned: The filariasis elimination project in Leogane after three years of mass drug administration. Am J Trop Med Hyg 73: 888–894.
[16]
Lammie PJ, Addiss DG, Leonard G, Hightower AW, Eberhard ML (1993) Heterogeneity in filarial-specific immune responsiveness among patients with lymphatic obstruction. J Infect Dis 167: 1178–1183. doi: 10.1093/infdis/167.5.1178
[17]
Eberhard ML, Walker EM, Addiss DG, Lammie PJ (1996) A survey of knowledge, attitudes, and perceptions of lymphatic filariasis, elephantiasis, and hydrocele among residents of an endemic area in Haiti. Am J Trop Med Hyg 54: 290–303.
[18]
Addiss DG, Dimock KA, Eberhard ML, Lammie PJ (1995) Clinical, parasitologic and immunologic observations of patients with hydrocele and elephantiasis in an area with endemic lymphatic filariasis. J Infect Dis 171: 755–758. doi: 10.1093/infdis/171.3.755
[19]
Dreyer G, Addiss D, Dreyer P, Noroes J (2002) Basic lymphoedema management: Treatment and prevention of problems associated with lymphatic filariasis. Hollis, NH: Hollis Publishing Co. 112 p.
[20]
Foldi E, Foldi M, Weissleder H (1985) Conservative treatment of lymphoedema of the limbs. Angiology - Journal of Vascular Diseases 36: 171–180. doi: 10.1177/000331978503600306
[21]
SAS Institute, Inc (1999) SAS/STAT User's Guide, Version 8 . Cary, NC: SAS Institute, Inc..
[22]
Ramaiah KD, Kumar KNV (2000) Effect of lymphatic filariasis on school children. Acta Trop 76: 197–199. doi: 10.1016/S0001-706X(00)00102-9
[23]
Kumari AK, Harichandrakumar KT, Das LK, Krishnamoorthy K (2005) Physical and psychosocial burden due to lymphatic filariasis as perceived by patients and medical experts. Trop Med Int Health 10: 567–573. doi: 10.1111/j.1365-3156.2005.01426.x
[24]
Harichandrakumar KT, Krishnamoorthy K, Kumari AK, Kas LK (2006) Health status of lymphatic filariasis assessed from patients using seven domains five levels (7D5L) instrument. Acta Trop 99: 137–143. doi: 10.1016/j.actatropica.2006.07.009
[25]
Coreil J, Mayard G, Louis-Charles J, Addiss D (1998) Filarial elephantiasis among Haitian women: Social context and behavioural factors in treatment. Trop Med Int Health 3: 467–473. doi: 10.1046/j.1365-3156.1998.00238.x
[26]
Suma TK, Shenoy RK, Kumaraswami V (2003) A qualitative study of the perceptions, practices and socio-psychological suffering related to chronic brugian filariasis in Kerala, southern India. Ann Trop Med Parasitol 97: 839–845. doi: 10.1179/000349803225002435
[27]
Chandrasena TG, Premaratna R, Muthugala MA, Pathmeswaran A, deSilva NR (2007) Modified Dermatology Life Quality Index as a measure of quality of life in patients with filarial lymphoedema. Trans Roy Soc Trop Med Hyg 101: 245–249. doi: 10.1016/j.trstmh.2006.08.012
[28]
Person B, Addiss DG, Bartholomew LK, Meijer C, Pou V, van den Borne B (2006) Health-seeking behaviors and self-care practices of Dominican women with lymphoedema of the leg: implications for lymphoedema management programs. Filaria J 5: 13. Available: http://www.filariajournal.com/content/5/？1/13.
[29]
World Health Organization (2006) Informal consultation on preventing disability from lymphatic filariasis, WHO, Geneva, August 2006. Wkly Epidemiol Rec 81: 373–84.
[30]
Coreil J, Mayard G, Addiss D (2003) Support groups for women with lymphatic filariasis in Haiti. Social, Economic and Behavioral (SEB) Research report series No. 2. TDR/STR/SEB/RP/03.1. Geneva: World Health Organization.
[31]
Dreyer G, Addiss D, Gadelha P, Lapa E, Williamson J, et al. (2006) Interdigital skin lesions of the lower limbs among patients with lymphoedema in an area endemic for bancroftian filariasis. Trop Med Internat Health 11: 1475–1481. doi: 10.1111/j.1365-3156.2006.01687.x
[32]
McPherson T, Persaud S, Singh S, Fay MP, Addiss D, et al. (2006) Interdigital lesions and acute dermatolymphangioadenitis in filarial lymphedema. British J Dermatol 154: 933–941. doi: 10.1111/j.1365-2133.2005.07081.x
[33]
Wilson SF, Guarner J, Valme AL, Louis-Charles J, Jones T, et al. (2004) Histopathologic improvement with lymphedema management, Léogane, Haiti. Emerg Infect Dis J 10: 1938–1946. doi: 10.3201/eid1011.040548
[34]
Tretbar LL, Morgan CL, Lee BB, Simonian SJ, Blondeau B (2007) Lymphedema: Diagnosis and Treatment. New York, NY: Springer. 78 p.
[35]
Bockarie MJ, Tisch DJ, Kastens W, Alexander ND, Dimber Z, et al. (2002) Mass treatment to eliminate filariasis in Papua New Guinea. N Engl J Med 347: 1841–1848. doi: 10.1056/NEJMoa021309
[36]
March HN, Laigret J, Kessel JF, Bambridge B (1960) Reduction in the prevalence of clinical filariasis in Tahiti following adoption of a control program. Am J Trop Med Hyg 9: 180–184.
[37]
Partono F, Maizels RM, Purnomo (1989) Toward a filariasis-free community: Evaluation of filariasis control over an eleven year period in Flories, Indonesia. Trans R Soc Trop Med Hyg 83: 821–826. doi: 10.1016/0035-9203(89)90343-X
[38]
Addiss DG, Brady MA (2007) Morbidity management in the Global Programme to Eliminate Lymphatic Filariasis: A review of the scientific literature. Filaria J 6: 2. Available: http://www.filariajournal.com/content/6/？1/2.
[39]
Gyapong JO, Gyapong M, Adjei S (1996) The epidemiology of acute adenolymphangitis due to lymphatic filariasis in northern Ghana. Am J Trop Med Hyg 54: 591–595.
