Volume 90, Issue 1
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645



We conducted a longitudinal analysis of 117 lymphedema patients in a filariasis-endemic area of Haiti during 1995–2008. No difference in lymphedema progression between those who received or did not receive mass drug administration (MDA) was found on measures of foot ( = 0.24), ankle ( = 0.87), or leg ( = 0.46) circumference; leg volume displacement ( = 0.09), lymphedema stage ( = 0.93), or frequency of adenolymphangitis (ADL) episodes ( = 0.57). Rates of ADL per year were greater after initiation of MDA among both groups ( < 0.01). Nevertheless, patients who received MDA reported improvement in four areas of lymphedema-related quality of life ( ≤ 0.01). Decreases in foot and ankle circumference and ADL episodes were observed during the 1995-1998 lymphedema management study ( ≤ 0.01). This study represents the first longitudinal, quantitative, leg-specific analysis examining the clinical effect of diethylcarbamazine on lymphedema progression and ADL episodes.


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  1. Talbot JT, Viall A, Direny A, de Rochars MB, Addiss D, Streit T, Mathieu E, Lammie PJ, , 2008. Predictors of compliance in mass drug administration for the treatment and prevention of lymphatic filariasis in Leogane, Haiti. Am J Trop Med Hyg 78: 283288. [Google Scholar]
  2. Shenoy RK, Suma TK, Kumaraswami V, Rahmah N, Dhananjayan G, Padma S, Abhilash G, Ramesh C, , 2007. Preliminary findings from a cross-sectional study on lymphatic filariasis in children, in an area of India endemic for Brugia malayi infection. Ann Trop Med Parasitol 101: 205213.[Crossref] [Google Scholar]
  3. Bernhard P, Magnussen P, Lemnge MM, , 2001. A randomized, double-blind, placebo-controlled study with diethylcarbamazine for the treatment of hydrocoele in an area of Tanzania endemic for lymphatic filariasis. Trans R Soc Trop Med Hyg 95: 534536.[Crossref] [Google Scholar]
  4. 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.[Crossref] [Google Scholar]
  5. Dreyer G, Medeiros Z, Netto MJ, Leal NC, de Castro LG, Piessens WF, , 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: 413417.[Crossref] [Google Scholar]
  6. McPherson T, Persaud S, Singh S, Fay MP, Addiss D, Nutman TB, Hay R, , 2006. Interdigital lesions and frequency of acute dermatolymphangioadenitis in lymphoedema in a filariasis-endemic area. Br J Dermatol 154: 933941.[Crossref] [Google Scholar]
  7. Pani SP, Srividya A, , 1995. Clinical manifestations of bancroftian filariasis with special reference to lymphoedema grading. Indian J Med Res 102: 114118. [Google Scholar]
  8. Pani SP, Yuvaraj J, Vanamail P, Dhanda V, Michael E, Grenfell BT, Bundy DA, , 1995. Episodic adenolymphangitis and lymphoedema in patients with bancroftian filariasis. Trans R Soc Trop Med Hyg 89: 7274.[Crossref] [Google Scholar]
  9. 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: 301305. [Google Scholar]
  10. 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.[Crossref] [Google Scholar]
  11. Ottesen EA, , 2000. The global programme to eliminate lymphatic filariasis. Trop Med Int Health 5: 591594.[Crossref] [Google Scholar]
  12. Dreyer G, Addiss DG, Dreyer P, Norões J, , 2002. Basic Lymphoedema Management: Treatment and Prevention of Problems Associated with Lymphatic Filariasis. Hollis, NJ: Hollis Publishing Co. [Google Scholar]
  13. Debrah AY, Mand S, Specht S, Marfo-Debrekyei Y, Batsa L, Pfarr K, Larbi J, Lawson B, Taylor M, Adjei O, Hoerauf A, , 2006. Doxycycline reduces plasma VEGF-C/sVEGFR-3 and improves pathology in lymphatic filariasis. PLoS Pathog 2: e92.[Crossref] [Google Scholar]
  14. Joseph A, Mony P, Prasad M, John S, Srikanth Mathai D, , 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: 685696.[Crossref] [Google Scholar]
  15. Shenoy RK, Suma TK, Rajan K, Kumaraswami V, , 1998. Prevention of acute adenolymphangitis in brugian filariasis: comparison of the efficacy of ivermectin and diethylcarbamazine, each combined with local treatment of the affected limb. Ann Trop Med Parasitol 92: 587594.[Crossref] [Google Scholar]
  16. 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: 367377.[Crossref] [Google Scholar]
  17. 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: 763766.[Crossref] [Google Scholar]
  18. 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.[Crossref] [Google Scholar]
  19. Wijesinghe RS, Wickremasinghe AR, Ekanayake S, Perera MS, , 2007. Efficacy of a limb-care regime in preventing acute adenolymphangitis in patients with lymphoedema caused by bancroftian filariasis, in Colombo, Sri Lanka. Ann Trop Med Parasitol 101: 487497.[Crossref] [Google Scholar]
  20. Kerketta AS, Babu BV, Rath K, Jangid PK, Nayak AN, Kar SK, , 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: 698705.[Crossref] [Google Scholar]
  21. Shenoy RK, Suma TK, Kumaraswami V, Rahmah N, Dhananjayan G, Padma S, , 2009. Antifilarial drugs, in the doses employed in mass drug administrations by the Global Programme to Eliminate Lymphatic Filariasis, reverse lymphatic pathology in children with Brugia malayi infection. Ann Trop Med Parasitol 103: 235247.[Crossref] [Google Scholar]
  22. Dreyer G, Addiss D, Roberts J, Noroes J, , 2002. Progression of lymphatic vessel dilatation in the presence of living adult Wuchereria bancrofti . Trans R Soc Trop Med Hyg 96: 157161.[Crossref] [Google Scholar]
  23. Freedman DO, Bui T, De Almeida Filho PJ, Braga C, Maia e Silva MC, Maciel A, Furtado AF, , 1995. Lymphoscintigraphic assessment of the effect of diethylcarbamazine treatment on lymphatic damage in human bancroftian filariasis. Am J Trop Med Hyg 52: 258261. [Google Scholar]
  24. 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: 180184. [Google Scholar]
  25. Partono F, Maizels RM, Purnomo, 1989. Towards a filariasis-free community: evaluation of filariasis control over an eleven year period in Flores, Indonesia. Trans R Soc Trop Med Hyg 83: 821826.[Crossref] [Google Scholar]
  26. Hewitt R, Kenney M, Chan A, Mohamed H, , 1950. Follow-up observations on the treatment of bancroftian filariasis with hetrazan in British Guiana. Am J Trop Med Hyg 30: 217237. [Google Scholar]
  27. Kenney M, Hewitt R, , 1949. Treatment of bancroftian filariasis with hetrazan in British Guiana. Am J Trop Med Hyg 29: 89114. [Google Scholar]
  28. Pani SP, Krishnamoorthy K, Prathibha J, Rao AS, , 1989. Diethylcarbamazine and supportive measures for the treatment of brugian filariasis. Natl Med J India 2: 260263. [Google Scholar]
  29. Moore TA, Reynolds JC, Kenney RT, Johnston W, Nutman TB, , 1996. Diethylcarbamazine-induced reversal of early lymphatic dysfunction in a patient with bancroftian filariasis: assessment with use of lymphoscintigraphy. Clin Infect Dis 23: 10071011.[Crossref] [Google Scholar]
  30. Bockarie MJ, Tisch DJ, Kastens W, Alexander ND, Dimber Z, Bockarie F, Ibam E, Alpers MP, Kazura JW, , 2002. Mass treatment to eliminate filariasis in Papua New Guinea. N Engl J Med 347: 18411848.[Crossref] [Google Scholar]
  31. Meyrowitsch DW, Simonsen PE, Makunde WH, , 1996. Mass diethylcarbamazine chemotherapy for control of bancroftian filariasis through community participation: comparative efficacy of a low monthly dose and medicated salt. Trans R Soc Trop Med Hyg 90: 7479.[Crossref] [Google Scholar]
  32. Ciferri F, Siliga N, Long G, Kessel JF, , 1969. A filariasis-control program in American Samoa. Am J Trop Med Hyg 18: 369378. [Google Scholar]
  33. Beye HK, Edgar SA, Mille R, Kessel JF, Bambridge B, , 1952. Preliminary observations on the prevalence, clinical manifestations and control of filariasis in the Society Islands. Am J Trop Med Hyg 1: 637661. [Google Scholar]
  34. Fan PC, Peng HW, Chen CC, , 1995. Follow-up investigations on clinical manifestations after filariasis eradication by diethylcarbamazine medicated common salt on Kinmen (Quemoy) Islands, Republic of China. J Trop Med Hyg 98: 461464. [Google Scholar]
  35. Das L, Subramanyam Reddy G, Pani S, , 2003. Some observations on the effect of Daflon (micronized purified flavonoid fraction of Rutaceae aurantiae) in bancroftian filarial lymphoedema. Filaria J 2: 5.[Crossref] [Google Scholar]
  36. Kessel JF, , 1957. An effective programme for the control of filariasis in Tahiti. Bull World Health Organ 16: 633664. [Google Scholar]
  37. Beau de Rochars MB, Kanjilal S, Direny AN, Radday J, Lafontant JG, Mathieu E, Rheingans RD, Haddix AC, Streit TG, Beach MJ, Addiss DG, Lammie PJ, , 2005. The Leogane, Haiti demonstration project: decreased microfilaremia and program costs after three years of mass drug administration. Am J Trop Med Hyg 73: 888894. [Google Scholar]
  38. World Health Organization, 2008. Lymphatic filariasis: progress report on mass drug administration in 2007. Wkly Epidemiol Rec 83: 333348. [Google Scholar]
  39. Won KY, Beau de Rochars M, Kyelem D, Streit TG, Lammie PJ, , 2009. Assessing the impact of a missed mass drug administration in Haiti. PLoS Negl Trop Dis 3: e443.[Crossref] [Google Scholar]
  40. Boyd HA, Waller LA, Flanders WD, Beach MJ, Sivilus JS, Lovince R, Lammie PJ, Addiss DG, , 2004. Community- and individual-level determinants of Wuchereria bancrofti infection in Leogane Commune, Haiti. Am J Trop Med Hyg 70: 266272. [Google Scholar]
  41. Addiss DG, Louis-Charles J, Roberts J, Leconte F, Wendt JM, Milord MD, Lammie PJ, Dreyer G, , 2010. Feasibility and effectiveness of basic lymphedema management in Leogane, Haiti, an area endemic for bancroftian filariasis. PLoS Negl Trop Dis 4: e668.[Crossref] [Google Scholar]
  42. Addiss DG, Michel MC, Michelus A, Radday J, Billhimer W, Louis-Charles J, Roberts JM, Kramp K, Dahl BA, Keswick B, , 2011. Evaluation of antibacterial soap in the management of lymphoedema in Leogane, Haiti. Trans R Soc Trop Med Hyg 105: 5860.[Crossref] [Google Scholar]
  43. Pani SP, Vanamail P, Yuvaraj J, , 1995. Limb circumference measurement for recording edema volume in patients with filarial lymphedema. Lymphology 28: 5763. [Google Scholar]
  44. Boyd A, Won KY, McClintock SK, Donovan CV, Laney SJ, Williams SA, Pilotte N, Streit TG, Beau de Rochars MV, Lammie PJ, , 2010. A community-based study of factors associated with continuing transmission of lymphatic filariasis in Leogane, Haiti. PLoS Negl Trop Dis 4: e640.[Crossref] [Google Scholar]
  45. Liang KY, Zeger SL, , 1986. Longitudinal data analysis using generalized linear models. Biometrika 73: 1322.[Crossref] [Google Scholar]
  46. Kazura JW, Bockarie M, Alexander N, Perry R, Bockarie F, Dagoro H, Dimber Z, Hyun P, Alpers MP, , 1997. Transmission intensity and its relationship to infection and disease due to Wuchereria bancrofti in Papua New Guinea. J Infect Dis 176: 242246.[Crossref] [Google Scholar]
  47. Rubin DB, , 1996. Multiple imputation after 18+ years. J Am Stat Assoc 91: 473489.[Crossref] [Google Scholar]
  48. Shi ZJ, Xie JZ, Hu XL, Li ZX, Ren YF, Sun DJ, Xu SR, Yuan YZ, Shen BG, , 2000. Studies on the recurrent attacks of acute adenolymphangitis due to Malayan filariasis [in Chinese]. Zhongguo Ji Sheng Chong Xue Yu Ji Sheng Chong Bing Za Zhi 18: 7983. [Google Scholar]
  49. Mathieu E, Direny AN, de Rochars MB, Streit TG, Addiss DG, Lammie PJ, , 2006. Participation in three consecutive mass drug administrations in Leogane, Haiti. Trop Med Int Health 11: 862868.[Crossref] [Google Scholar]
  50. Meyrowitsch DW, Simonsen PE, Makunde WH, , 1996. Mass diethylcarbamazine chemotherapy for control of bancroftian filariasis: comparative efficacy of standard treatment and two semi-annual single-dose treatments. Trans R Soc Trop Med Hyg 90: 6973.[Crossref] [Google Scholar]
  51. Ward LC, , 2006. Bioelectrical impedance analysis: proven utility in lymphedema risk assessment and therapeutic monitoring. Lymphat Res Biol 4: 5156.[Crossref] [Google Scholar]
  52. Shenoy RK, Suma TK, Kumaraswami V, , 2003. A qualitative study on the feasibility and benefits of foot hygiene measures practiced by patients with brugian filariasis. J Commun Dis 35: 916. [Google Scholar]

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  • Received : 03 Jun 2013
  • Accepted : 09 Oct 2013
  • Published online : 08 Jan 2014

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