• 1

    Seim AR, Dreyer G, Addiss DG, 1999. Controlling morbidity and interrupting transmission: twin pillars of lymphatic filariasis elimination. Rev Soc Bras Med Trop 32 :325–328.

    • Search Google Scholar
    • Export Citation
  • 2

    Addiss DM, Mackenzie C, 2004. LF diseease—clinical management. Am J Trop Med Hyg 71 (5suppl):12–15.

  • 3

    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 :72–74.

    • Search Google Scholar
    • Export Citation
  • 4

    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. SE Asian J Trop Med Public Health 26 :301–305.

    • Search Google Scholar
    • Export Citation
  • 5

    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.

    • Search Google Scholar
    • Export Citation
  • 6

    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.

    • Search Google Scholar
    • Export Citation
  • 7

    Dreyer G, Medeiros Z, Netto MJ, Leal NC, deCastro LG, Piessens WF, 1999. ADLA 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.

    • Search Google Scholar
    • Export Citation
  • 8

    Ananthakrishnan S, Das LK, 2004. Entry lesions in bancroftian filarial lymphoedema patients—a clinical observation. Acta Trop 90 :215–218.

    • Search Google Scholar
    • Export Citation
  • 9

    Burri H, Loutan L, Kumaraswami V, Vijayasekaran V, 1996. Skin changes in chronic lymphatic filariasis. Trans R Soc Trop Med Hyg 90 :671–674.

    • Search Google Scholar
    • Export Citation
  • 10

    Cheville AL, McGarvey CL, Petrek JA, Russo SA, Thiadens SR, Taylor ME, 2003. The grading of lymphedema in oncology clinical trials. Semin Radiat Oncol 13 :214–225.

    • Search Google Scholar
    • Export Citation
  • 11

    Ryan TJ, 2004. A search for consensus on the staging of lymph-edema. Lymphology 37 :180–181.

  • 12

    Suma TK, Shenoy RK, Varghese J, Kuttikkal VV, Kumaraswami V, 1997. Estimation of ASO titer as an indicator of streptococcal infection precipitating acute adenolymphangitis in brugian lymphatic filariasis. SE Asian J Trop Med Public Health 28 :826–830.

    • Search Google Scholar
    • Export Citation
  • 13

    Pani SP, Srividya A, 1995. Clinical manifestations of bancroftian filariasis with special reference to lymphoedema grading. Indian J Med Res 102 :114–118.

    • Search Google Scholar
    • Export Citation
  • 14

    Olszewski WL, Jamal S, Manokaran G, Pani S, Kumaraswami V, Kubicka U, Lukomska B, Tripathi FM, Swoboda E, Meisel–Mikolajczyk F, Stelmach E, Zaleska M, 1999. Bacteriological studies of blood, tissue fluid, lymph and lymph nodes in patients with acute dermatolymphangioadenitis (DLA) in course of ’filarial’ lymphedema. Acta Trop 73 :217–224.

    • Search Google Scholar
    • Export Citation
  • 15

    Dreyer G, Addiss D, Dreyer P, Noroes J, 2002. Assessment of chronic lymphoedema. Basic Lymphoedema Management: Treatment and Prevention of Problems Associated with Lymphatic Filariasis. Hollis, NH: Hollis Publishing Company.

  • 16

    Dreyer G, Addiss D, Dreyer P, Noroes J, 2002. Individual sheet evaluation—entry lesions. Appendix. Basic Lymphoedema Management: Treatment and Prevention of Problems Associated with Lymphatic Filariasis. Hollis, NH: Hollis Publishing Company.

  • 17

    Dreyer G, Addiss D, Bettinger J, Dreyer P, Noroes J, Rio F, 2001. Lymphoedema Staff Manual: Treatment and Prevention of Problems Associated with Lymphatic Filariasis. Part 1: Learner’s Guide. Geneva: World Health Organization (WHO/CDS/CPE/CEE), 73 pages.

  • 18

    Fay MP, 2005. Random marginal agreement coefficients: rethinking the adjustment for chance when measuring agreement. Biostatistics 6 :171–180.

    • Search Google Scholar
    • Export Citation
  • 19

    Bloch DA, Kraemer HC, 1989. 2x2 kappa coefficients: measures of agreement or association. Biometrics 45 :269–287.

  • 20

    Landis JR, Koch GG, 1977. The measurement of observer agreement for categorical data. Biometrics 33 :159–174.

  • 21

    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.

    • Search Google Scholar
    • Export Citation
  • 22

    McPherson T, Persaud S, Singh S, Fay MP, Addiss D, Nutman TB, Hay R, 2005. Interdigital lesions and frequency of acute dermatolympangioadenitis in filarial lymphœdema in a filariasis-endemic area. Br J Dermatol: in press.

  • 23

    Fox LM, Wilson SF, Addiss DG, Louis-Charles J, DE Rochars MV, Lammie PJ, 2005. Clinical correlates of filarial infection in haitian children: an association with interdigital lesions. Am J Trop Med Hyg 73 :759–765.

    • Search Google Scholar
    • Export Citation
  • 24

    Hope YM, Clayton YM, Hay RJ, Noble WC, Elder–Smith JG, 1985. Foot infection in coal miners: a reassessment. Br J Dermatol 112 :405–413.

    • Search Google Scholar
    • Export Citation
  • 25

    Williams HC, Burney PG, Pembroke AC, Hay RJ, 1994. The UK Working Party’s diagnostic criteria for atopic dermatitis. II. Observer variation of clinical diagnosis and signs of atopic dermatitis. Br J Dermatol 131 :397–405.

    • Search Google Scholar
    • Export Citation
  • 26

    Lison E, Clayton Y, Hay RJ, Hope Y, Midgley G, Moore M, Noble WC, 1986. The microbiology of foot infection. Mykosen 29 :147–152.

  • 27

    Hart R, Bell–Syer SE, Crawford F, Torgerson DJ, Young P, Russell I, 1999. Systematic review of topical treatments for fungal infections of the skin and nails of the feet. Br Med J 319 :79–82.

    • Search Google Scholar
    • Export Citation
  • 28

    Vaqas B, Ryan TJ, 2003. Lymphoedema: pathophysiology and management in resource-poor settings—relevance for lymphatic filariasis control programmes. Filaria J 2 :4.

    • Search Google Scholar
    • Export Citation
  • 29

    Byrt T, Bishop J, Carlin JB, 1993. Bias, prevalence and kappa. J Clin Epidemiol 46 :423–429.

  • 30

    Murdoch ME, Hay RJ, Mackenzie CD, Williams JF, Ghalib HW, Cousens S, Abiose A, Jones BR, 1993. A clinical classification and grading system of the cutaneous changes in onchocerciasis. Br J Dermatol 129 :260–269.

    • Search Google Scholar
    • Export Citation
  • 31

    Fletcher CL, Hay RJ, Smeeton NC, 2004. Onychomycosis: the development of a clinical diagnostic aid for toenail disease. I. Establishing discriminating historical and clinical features. Br J Dermatol 150 :701–705.

    • Search Google Scholar
    • Export Citation

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

HEALTH WORKERS’ AGREEMENT IN CLINICAL DESCRIPTION OF FILARIAL LYMPHEDEMA

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  • 1 National Institute of Allergy and Infectious Diseases, National Institutes of Health,Bethesda, Maryland and Pan American Health Organization/World Health Organization, Georgetown, Guyana; Biostatistic Research Branch, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland; Ministry of Health, Georgetown, Guyana; School of Nursing and Midwifery, University of Southampton, Southampton, United Kingdom; Queen’s University, Belfast, Northern Ireland, United Kingdom

Severity of lymphedema and presence of entry lesions are risk factors for acute bacterial dermatolym-phangioadenitis (ADLA) in those with filarial lymphedema. Recurrent ADLA causes acute morbidity and progression of lymphedema severity; however, there is little work assessing the ability of health workers to reliably stage disease severity and identify risk entry lesions. This knowledge is important in initiation of management and assessing interventions. We evaluated inter-rater reliability with two independent health workers rating both legs of 17 patients using a questionnaire and the Dreyer classification of lymphedema. The health workers could reliably stage lymphedema with high agreement (RMAC weighted kappa of 0.89) and identify nail, interdigital, and other skin lesions. However, there was less consistency in identifying the clinical nature of skin lesions. This indicates that the Dreyer classification can be a replicable way to stage lymphedema and a questionnaire can deliver high observer agreement on the presence of risk lesions.

Author Notes

Reprint requests: Michael P. Fay, Biostatistics Research Branch, National Infectious Diseases, Bethesda, MD 20892-7609, E-mail: mfay@niaid.nih.gov.
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