Filariasis now

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  • National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland

“Filariasis without microfilaremia” was the title Paul Beaver chose for his presidential address to the American Society of Tropical Medicine and Hygiene nearly 20 years ago. It was a title reflecting his long-standing personal interest in occult or cryptic helminthic infections that cause syndromes such as visceral larva migrans, tropical pulmonary eosinophilia, human dirofilariasis and the like. The address was much more than a description of aberrant clinical syndromes, for by concentrating on filariasis, he both consolidated and codified concepts he and his colleagues had fashioned over the years and brought into focus issues that have proven to be absolutely critical to our understanding of filarial infection and disease today. As such, his address provides an excellent blueprint for this discussion of filariasis now.

The central concept underlying Dr. Beaver's “Filariasis without microfilaremia” was stated very simply: “It is, presumably, … (the) range of fit and non-fit in the worm-man relationships which accounts for clinical differences seen …,” a conclusion based on 3 sets of observations so important that they deserve to be reviewed here again.