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NATURAL COURSE OF LYMPHATIC FILARIASIS: INSIGHTS FROM EPIDEMIOLOGY, EXPERIMENTAL HUMAN INFECTIONS, AND CLINICAL OBSERVATIONS

Lymphatic filariasis has been described as a "spectral disease". Analysis of the natural course of infection in nonendemic individuals as well as experimental infections of "volunteers" suggests that the filarial parasites are not inherently aggressive infectious agents. Experimental infections of humans with infective larvae result in transient, low-level microfilaremia, if at all. Nonendemic individuals with limited exposure show no evidence of persistent infection or pathology. Nonendemic individuals exposed to repeated infections show accelerated pathology. It is tempting to speculate that normal, immunocompetent residents in an endemic area show either (a) no pathology (endemic normals) because they are subject to the relatively low levels of infection or (b) chronic pathology if they are repeatedly infected. It would appear that only those individuals rendered immunologically tolerant to filarial parasites become productively infected with the filarial parasites. The intensity of transmission may underlie the differences in clinical presentation seen in diverse global pockets of endemicity.

Received May 30, 2005. Accepted for publication July 1, 2005.

^* Address correspondence to T. V. Rajan, MD, PhD, Boehringer-Ingelheim Professor of Immunology, Professor and Interim Chairman, Department of Pathology, 263 Farmington Avenue, Farming-ton, CT 06032. E-mail: rajan{at}neuron.uchc.edu

Author’s address: T.V. Rajan, MD, PhD, Boehringer-Ingelheim Professor of Immunology, Professor and Interim Chairman, Department of Pathology, University of Connecticut Health Center, 263 Farmington Avenue, Farmington, CT 06032, E-mail: rajan{at}neuron.uchc.edu.

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