Evaluation of Antiwolbachial Treatment in Pathogenesis of Lymphedema Development

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Globally, filarial LE affects more than 16 million individuals. Registered antifilarial drugs do little to mitigate the pathology. Currently, there is no definite drug for treating subjects who develop the pathology because the Global Programme to Eliminate Lymphatic Filariasis (GPELF) relies only on hygiene management practices as the only source of relieve for this group. Antiwolbachial therapy is therefore believed to be the most promising approach for treating lymphedema. To elucidate the efficacy of anti-wolbachial treatment with antibiotics in lymphedema, 180 individuals were recruited from 25 endemic communities of the Nzema East and Ahanta West Districts of the Western Region of Ghana for a double blind placebo-controlled trial. In all, 119 patients were stratified according to circulating filarial antigen (CFA) status, randomized to receive 200mg/d of doxycycline (n=46), 1000mg/d of amoxicillin (n=36) and placebo (n=38) for 42days in a daily observed treatment. Although minimal significant improvements were seen for almost all parameters measured in the CFA-positive treated with doxycycline, there were remarkable improvement in the CFA-negative doxycycline-treated patients particularly in the area of decreased mossy lesions, healed sores, reduced knobs, regressed leg stage, decreased ultrasound measurements (p=0.0001), reduced filarial acute attacks, halt of disease progression, significant reduction in antigenaemia levels (p=<0.00). In the majority of the patients who received 6 weeks doxycycline treatment, there was a highly significant improvement (43.9%) in the leg stage at the end of the study. Although there was halt of disease progression (61.9%) as well as decreased filarial attacks in the amoxicillin treated group, there was no significant improvement in the amoxicillin as well as the placebotreated patients regarding all other parameters assessed. The study suggests that doxycycline as the first therapy for treating lymphedema and recommends its use as individual drug administration.
A Thesis Presented to the Department of Clinical Microbiology, School of Medical Sciences, College of Health Sciences, Kwame Nkrumah University of Science and Technology Kumasi, in Partial Fullfillment of the Requirement for the Award of M’phil. Clinical Microbiology.