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ASSESSMENT OF FAMILIES FOR EXCESS RISK OF LYMPHEDEMA OF THE LEG IN A LYMPHATIC FILARIASIS-ENDEMIC AREA

The influence of host genes on the distribution of lymphedema due to lymphatic filariasis is unknown. To assess this, pedigree and disease information were collected from lymphedema patients in a lymphatic filariasis-endemic area. These patients were female, with an average age of approximately 40 years, who were enrolled between June 1995 and July 1999 in a lymphedema treatment clinic, and from the rural Haitian community served by the clinic. Interviews were conducted between September 1998 and December 1999. Families with multiple lymphedema cases were of similar size, with an average of 15 members, as those families with only a single lymphedema case. We determined whether families observed to have multiple lymphedema cases had a higher prevalence of lymphedema than expected when stratified population estimates and family size were considered. Lymphedema of the leg was excessive in 15 of 43 families with multiple lymphedema cases. The number of families demonstrating excess disease was significantly different than was expected based on population estimates of lymphedema prevalence (P = 0.026). Families with multiple cases of lymphedema were not significantly larger in family size than families with a single lymphedema cases. Twelve of the 15 families had a male with lymphedema, which influenced the interpretation of the results. The significance of these results is discussed.

Received March 23, 2003. Accepted for publication November 6, 2003.

Acknowledgments: We extend special thanks to Jacky Louis-Charles, Antoine Florent Michelus, Carline Casseus, Yvrose Dumond, and Erick Leriche for their tireless efforts in interviewing community members; David Addiss and the staff of the Hôpital Ste. Croix and its Lymphedema Clinic for their assistance with the project; and Amanda R. Freeman and John J. Hanfelt for their assistance. We also thank Centers for Disease Control and Disease Prevention Genetics Working Group for providing funding that was essential for conducting the study.

Authors’ addresses: Karen T.Cuenco, Department of Epidemiology and Preventive Medicine, University of Maryland School of Medicine, 660 West Redwood Street, Baltimore, MD 21201, Telephone: 410-706-2229, Fax: 410-706-04425. M. Elizabeth Halloran, Department of Biostatistics, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA 30322, Telephone: 404-727-7647, Fax: 404-727-1370. Patrick J. Lammie, Division of Parasitic Diseases, National Center for Infectious Disease, Centers for Disease Control and Prevention, Mailstop F-13, 4770 Buford Highway Atlanta, GA 30341, Telephone: 770-488-4054, Fax: 770-488-4108, E-mail: pjl1{at}cdc.gov.