Interdigital skin lesions involving bancroftian filariasis.

Wuchereria bancrofti vespid, Immune response, Serum immune complexes diagnosis, Diethylcarbamazine (DEC), Wolbachia in filarial parasites, Interdigital skin lesions, Urban Filariasis, Doxycycline, mass drug administration program, Filarial Lymphedema Care, Detection of filarial parasites, Albendazole, research abstracts

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Interdigital skin lesions involving bancroftian filariasis.

Postby patoco » Fri Sep 01, 2006 8:57 am

Interdigital skin lesions of the lower limbs among patients with lymphoedema in an area endemic for bancroftian filariasis.

Trop Med Int Health. 2006 Sep;11(9):1475-81

Dreyer G, Addiss D, Gadelha P, Lapa E, Williamson J, Dreyer A.
Nucleo de Ensino, Pesquisa e Assistencia em Filariose-NEPAF, Universidade Federal de Pernambuco, Recife, Brazil.

An estimated 15 million persons suffer from lymphoedema of the leg in filariasis-endemic areas of the world. A major factor in the progression of lymphoedema severity is the incidence of acute dermatolymphangioadenitis (ADLA), which is triggered by bacteria that gain entry through damaged skin, especially in the toe web spaces ('interdigital skin lesions').

Little is known about the epidemiology of these skin lesions or about patients' awareness of them. We interviewed and examined 119 patients (89% women) with lymphoedema of the leg in Recife, Brazil, an area endemic for bancroftian filariasis. We detected 412 interdigital skin lesions in 115 (96.6%) patients (mean, 3.5 lesions per patient, range 0-eight). The number of interdigital skin lesions was significantly associated with lymphoedema stage (P < 0.001) and frequency of ADLA (P < 0.0001). Only 20 (16.8%) patients detected their own interdigital skin lesions or considered them abnormal.

Patients reported a mean of 3.6 ADLA episodes during the previous 12 months (range, 0-20); reported ADLA incidence was associated with lymphoedema stage (P < 0.0001) and the number of interdigital skin lesions detected by the examining physician (P < 0.0001). These data suggest that interdigital skin lesions are a significant risk factor for ADLA and that persons with lymphoedema in filariasis-endemic areas are unaware of their presence or importance.

Prevention of ADLA through prompt recognition and treatment of interdigital skin lesions will require that patients be taught to identify lesions, especially between the toes and to recognize them as abnormal.

PMID: 16930270 [PubMed - in process]

http://www.ncbi.nlm.nih.gov/entrez/quer ... med_docsum

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Interdigital lesions and frequency of acute dermatolymphangioadenitis in lymphoedema in a filariasis-endemic area.

McPherson T, Persaud S, Singh S, Fay MP, Addiss D, Nutman TB, Hay R.
Department of Mycology, St John's Institute of Dermatology. King's College, London, UK.

BACKGROUND:

Lymphatic filariasis (LF) is a mosquito-borne nematode infection that causes permanent lymphatic dysfunction in virtually all infected individuals and clinical disease in a subset of these. One major sequel of infection is lymphoedema of the limbs. Lymphoedema of the leg affects an estimated 15 million persons in LF-endemic areas worldwide. Acute dermatolymphangioadenitis (ADLA) in people with filarial lymphoedema causes acute morbidity and increasingly severe lymphoedema. Episodes of ADLA are believed to be caused by bacteria, and it has been shown that entry lesions in the skin play a causative role. Clinical observations suggest that interdigital skin lesions of the feet, often assumed to be fungal, may be of particular importance.

OBJECTIVES:

To investigate the epidemiology and aetiology of interdigital lesions (IDL) of the feet in filarial lymphoedema.

METHODS:

The frequency and mycological aetiology of IDL in 73 patients with filarial lymphoedema were compared with 74 individuals without lymphoedema in a region of Guyana highly endemic for Wuchereria bancrofti.

RESULTS:

More than 50% of patients with lymphoedema had one or more IDL (odds ratio 2.69; 95% confidence interval 1.31-5.66; P<0.005 compared with controls). The number of lesions was the strongest predictor of frequency of ADLA. Only 18% of the lesions had positive microscopy or culture for fungi (dermatophytes and Scytalidium).

CONCLUSIONS:

These findings highlight the importance of interdigital entry lesions as risk factors for episodes of ADLA and have implications for the control of morbidity from filarial lymphoedema.

PMID: 16634898 [PubMed - indexed for MEDLINE]

http://www.ncbi.nlm.nih.gov/entrez/quer ... s=16634898

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Entry lesions in bancroftian filarial lymphoedema patients--a clinical observation.

April 2004

Ananthakrishnan S, Das LK.
Vector Control Research Center (Indian Council of Medical Research), Medical Complex, Indira Nagar, Pondicherry 605-006, India. vcrc@vsnl.com

The prevalence of entry lesions in limbs was significantly higher in limbs with filarial lymphoedema (80.88%) than in normal limbs (42.86%, P = 0.000012). Among the various entry lesions in the lymphoedematous limbs, the prevalence of web space intertrigo was significantly higher in those who had acute dermatolymphangioadenitis (ADLA) than those who did not have ADLA (P = 0.04). Entry lesions were present only in 25% of those not using footwear, while 84.3% of those using footwear regularly or irregularly had these lesions (P = 0.01). None of the patients with good limb hygiene had ADLA, while 64% of those with fair to poor limb hygiene had ADLA (P = 0.02). Since the majority of the entry lesions were asymptomatic, training of patients and health care givers to specifically look for and treat these along with advice for good limb hygiene practices should form an important component of foot care programme for optimum filarial morbidity management. Copyright 2004 Elsevier B.V.

PMID: 15177149 [PubMed - indexed for MEDLINE]

http://www.ncbi.nlm.nih.gov/entrez/quer ... s=15177149
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