Generally, filariasis refers to an extremely heterogeneous group of clinical manifestations associated with the presence of parasites from the superfamily Onchocercoidea in the human body. Specifically, lymphatic filariasis is caused by two different nematode parasites: Wuchereria bancroftii and Brugia malayi. These parasites, transmitted in their larval stage by various species of arthropods (Anopheles, Aedes togoi, Mansonia), develop inside the human body first as microfilariae and later, after about 90 days, into their adult form, which can persist for years. Their maturation occurs entirely within the subcutaneous tissue and in the lymphatic collectors. 


The clinical manifestations associated with this parasitic infection of the lymphatic structures can range from acute lymphangitis to lymphadenitis, and can progress to the development of chronic lymphedema and elephantiasis. The pathological process often occurs after the death of the parasite; a fibrosing granulomatous reaction is triggered by the remains of the microorganism or by products released during maturation, causing lymphatic thrombophlebitis with eosinophil invasion and subsequent mechanical occlusion of the affected collectors. This sets the physiological basis for the development of secondary post-infectious chronic lymphedema. 

Filariasis is endemic in India, China, Southeast Asia, and Korea. Diagnosis is primarily based on clinical evaluation and medical history (in particular and initial cases of W. bancroftii infection, microfilariae can be isolated from the blood during nighttime). Medical therapy for parasitic infection is mainly based on diethylcarbamazine and other antiparasitic drugs, while the treatment of any lymphological complications (such as secondary chronic lymphedema) is similar to the usual combined therapy used successfully for other secondary lymphedemas. 

In the image: Edema from a previous filarial infection in an Ethiopian patient (rear view). 

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