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Proposed panel of diagnostic criteria, including the use of ultrasound, to refine the concept of ‘endemic normals’ in lymphatic filariasis

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Although living adult Wuchereria bancrofti worms can be detected by ultrasound examination of the scrotal area in approximately 80% of men infected with this filarial parasite, the location of the adult worms in the remaining 20% remains unclear. To determine this, 32 individuals who had W. bancrofti microfilaraemia but no adult worms detectable on ultrasound were treated with diethylcarbarmazine (DEC), either with a single 6 mg/kg dose (= 13) or with a 12-day course of 6 mg/kg per day (= 19). They were then monitored with serial physical and ultrasound examinations. Thirteen (41%) subjects developed small, single scrotal nodules 12 h to 7 days after treatment; this rate was unaffected by the dose of DEC. No nodules were detected outside the scrotal area. All 5 men with lymphangiectasia suspected on ultrasound before treatment developed scrotal nodules, compared to 8 (29.6%) of 27 men without ultrasonographic evidence (= 0.006). Thus, using both ultrasound and ‘provocative’ treatment with DEC, adult W. bancrofti can be detected in the scrotal area of an estimated 88% of infected men. Because no single diagnostic test for W. bancrofti infection is completely sensitive, a panel of tests, including ultrasound, is proposed to identify with greater accuracy ‘endemic normals’ for immunological and epidemiological studies.
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Keywords: Wuchereria bancrofti; adult worm; diethylcarbamazine; filariasis; ultrasound

Document Type: Research Article

Affiliations: 1: Departamento de Parasitologia, Centro de Pesquisas Aggeu Magalhaes-FIOCRUZ and Hospital das Clinicas, Universidade Federal de Pernambuco, Recife, Brazil 2: Servico de Urologia, Hospital das Clinicas, Universidade Federal de Pernambuco, Recife, Brazil 3: Division of Parasitic Diseases, Centers for Disease Control and Prevention, Atlanta, USA

Publication date: 1999-08-01

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