03:50,17,Mar,2006 | (1282/0/0) | Original

about lymphatic filariasis


Diagnosis:
1. Filariasis epidemiology and clinical diagnosis must be combined with epidemiological history, the patients of endemic areas to farmers the most. Lymphangitis, lymphadenitis, elephantiasis-oriented features of the disease. Suffering from endemic areas and the spermatic cord inflammation, orchitis, chyluria who are mostly of filariasis.
Since the task of increasing foreign aid, foreign aid in recent years, returned in some patients were found to have filariasis, onchocerciasis and Ah-who need to pay attention to the time of diagnosis.
2. Laboratory diagnosis to find microfilaria in peripheral blood. Microfilaria found in blood, diagnosis can be established.
3. Therapeutic purposes of this Act is to diagnose the diagnosis of suspicious symptoms and signs of filariasis, but can not find microfilaria in the blood of patients. To the service diethylcarbamazine, some patients can appear 2 to 14 days of reaction the lymphatic system and lymphatic nodules. This is the drug evidence in the filarial adult. Nodules may be necessary, extraction, search filarial.
4. Lymphangiography filariasis patients often show expansion of the input the output of small lymphatic vessels and lymphatic vessels, lymph nodes develop a real defect phenomenon.
Laboratory tests:
1. WBC count and classification of the early patients are allergic to the total number of white blood cells increase in eosinophils, the former mostly in the (10 ~ 20) × 109 / L, the latter at 20% or more. If secondary bacterial infection, in addition to total number of foreign white blood cells, neutrophils also increased significantly.
2. The discovery of blood microfilaria microfilaria filariasis diagnosis depends on the discovery, usually in the peripheral blood examination, most of them from 22:00 to 2:00 next morning to find microfilaria most vulnerable, such as the blood out of the night 150 / 60μl, the day can be found.
(1) blood method: draw straws earlobe blood hemoglobin count 20μl, at low magnification under a microscope to find microfilaria. Microfilaria positive freedom can be seen swinging around the curl, is quite active.
(2) smear: earlobe three drops of blood (approximately 60μl) placed in glass center thickness and edge of the neatly painted rectangular or oval thick blood films, about 2cm × 3cm size. 80 years since the 20th century onwards, and unified regulations to 120μl, or six drops of double-disc method. Staining supplies or borax methylene blue staining blue, such as the identification of insect species are in trouble can Giemsa or hematoxylin staining. Acridine orange fluorescence staining pigments can also improve the detection rate of microfilaria.
(3) concentration methods: the concentrated method microfilaria many red blood cells are dissolved in the blood after centrifugation, drawing sediment, looking to be concentrated in the sediment within the microfilaria. Hemolytic agent commonly used for the distil
led water.
(4) microporous membrane filtration method: 5% sodium citrate containing 0.1ml of blood 1 m1 mixing 10ml syringe, then suck 10% teepol Liquid 9ml (or 2% Tween 80 0.1% sodium bicarbonate solution or liquid) mixing hemolysis, take the syringe 5μm pore size 25 mm diameter membrane filter, dissolving blood through the membrane filter, the microfilariae remain in the film, remove the film with 0.1% hematoxylin or 0.1% methylene blue staining microscopy.
(5) The trap-out method microfilaria day: the day after oral administration of diethylcarbamazine 100mg, 1h the microfilaria in the peripheral blood can be found. Law method unsuitable for screening of filariasis. In outpatient basis for reference.
3. Microfilaria examination of various body fluids hydrocele, chyluria, lymphatic or chylous ascites, pericardial effusion, anterior chamber, water and other liquids in checked microfilaria, can direct smear, staining, or centrifugal concentration method Check.
4. Immunological diagnosis at home and abroad immunological diagnostic methods commonly used are:
(1) skin test: 0.05ml injection of Dirofilaria immitis antigens in subjects within the forearm skin, 15min after the pimples    0.9 cm were positive. This test and found signs of filariasis patients was 73.6% ~ 96.6%, and blood microfilaria positive consistent with a rate of 86.2% to 94.1%, but with schistosomiasis may produce mild cross-reaction. Law is only a screening and diagnostic value, in the prevention and treatment should not be used to monitor late.
(2) indirect immunofluorescence antibody test: a gerbil animal model of such collection for adults and microfilaria antigen fluorescent antibody using goat anti-human IgG fluorescent antibody conjugates, with high sensitivity and specificity. The adult section as antigen, the sensitivity of 92% to 98%, specificity 95%; to slice for microfilaria antigen, a sensitivity of 92% ~ 96%, a specificity of 98%. This method can be used as filariasis diagnosis and seroepidemiological survey and site monitoring. Disadvantage is still the effect can not be used for evaluation, and the difference between patients belonging to past infection or active infection.
(3) enzyme-linked immunosorbent assay (ELISA): use of Brugia malayi, Dirofilaria immitis, finger-like abdominal microfilaria malayi and other soluble antigens, ELISA determination of antibodies, consistent with the positive rate of filariasis patients 85% to 100%, false positive 8.2% to 1.5%. Or adults with microfilaria microfilariae ES antigen were positive consistent hyperlipidemia 93% ~ 95%, non-endemic areas of intestinal nematode infection in healthy people and those who are negative. Law antibodies detect human filariasis, with high specificity and sensitivity for on-site investigation. This Law shall not be used to effect the same distinction between assessment and whether the patient is active infection.
(4) detection of circulating antigen: WHO recommended immuno chromatography (immunochromatographic, ICT) test card testing Wuchereria bancrofti antigen. It was reported that the sensitivity of the method was 90% to 98%, specificity of 99% to 100%.
With a monoclonal antibody enzyme-linked immunosorbent assay (McAb ELISA) and dot ELISA (Dot-ELISA) antigen detection of filariasis patients, the specificity was 94% and 96%, Dot-ELISA can be detected 0.055μg / L antigen, McAb ELISA detected only 10μg / L antigen. Active infection can be detected both as a post-monitoring of filariasis control, search and evaluation of residual source of infection prevention and control effects.
5. Molecular hybridization and DNA cloning and recombinant DNA technology is currently being used in filariasis diagnostic techniques with high sensitivity and specificity.
6. Chyluria and lymphatic urinary former milky white, can be extracted with ether to Sudan â…¢ staining seen under the microscope the red yellow oil point. Lymphatic visual inspection of urine is no different with normal urinary, and its content of protein-based, there are a few red blood cells, but no tube. Derived from the puncture chylous hydrocele fluid and lymph, and chyle and lymph urinary roughly the same, since its activities can be found in the precipitate microfilaria.
7. Biopsies to suspected lesions, such as lower extremity superficial lymph nodes, epididymis nodules were cut into small pieces, for pathological examination, can be found in adults and can be seen related to the pathological changes.
Other laboratory examinations: lymphatic filariasis patients often show expansion of imaging input the output of small lymphatic vessels and lymphatic vessels, lymph nodes develop a real defect phenomenon.
Differential Diagnosis
In addition to the three identification of lymphatic filariasis endemic area of residence based on history and clinical manifestations, mainly rely on pathogen morphology and immunological methods. Lymphatic filariasis in the acute phase of inflammation and bacterial lymphadenitis should go far identification of lymphatic vessels. Bacterial lymphatic vessels to regional lymph nodes is a bottom-up development, and can be found in local lesions, and severe symptoms, local pain and tenderness are more significant, blood neutrophils significantly increased. Spermatic cord and epididymis inflammation and tuberculosis epididymitis should be different. History of tuberculosis for reference, nodular enlargement of epididymal tuberculosis, hard, light tenderness. Necessary to do a biopsy.
Inguinal or femoral hernia should identify varicose lymph nodes. According to varicose lymphatic vessels, percussion-free air sound, no bowel sounds hyperthyroidism, with body position changes the size of less cough impulse does not exist, and the puncture in the lymph of lymph available can be found within the microfilaria and other identification.
Spermatic cord lymphatic varicocele varicose and difficult to distinguish, the latter wall thicker than the clear tube, if necessary, pumping fluid from the pipe inspection, are provided identification.
Although more common in filariasis chyluria, but should be tuberculosis, cancer, thoracic duct injury caused by stress or those to be identified.
Elephantiasis can also be found in recurrent bacterial lymphangitis after or because of local damage, tumor compression leaving lymphatic drainage blocked, after surgical removal of lymphoid tissue can cause, this time should be combined with a history of identification. In addition, the yet to congenital or familial elephantiasis identification. Non-endemic areas of filariasis in Zhejiang, has found that family for four generations, 14 were presented by hereditary elephantiasis. Treatment (see content)
1. Pathogen treatment
(1), diethylcarbamazine (diethylcarbamazine): namely, diethylcarbamazine citrate (sea Qunsheng, hetrazan), this product is no direct in vitro effect of killing microfilariae, but the person or animal filarial infection, is able to rapid clearance of microfilaria in the blood. The role of the Malay microfilariae more rapidly than Bancroft and completely. Use a larger dose or longer course of treatment, they can kill adults. After three courses of intermittent treatment, microfilaria negative rate, Bancroft 90% to 99.8%, Malay 96.3% ~ 100%; nodular appearance rate, Bancroft is 30% to 40%, Malay as the 50%. Diethylcarbamazine dose and type of treatment can be based on local filarial infection levels, the health status of patients with selected applications. ① 1.5g therapy: the treatment of filariasis for the Malays. Adult 1.5g, at Dayton clothing; or 0.75g / d, and even served 2 days; or 0.5g / d, even for 3 days. The weak low-dose incremental approach can be used, even for 10 days. ② 3g therapy: mainly used for Bancroftian filariasis, Malayan filariasis can also be used more and physical well microfilaria were. Adult daily afternoon 1.5g, and even served 2 days; or 0.75g / time, 2 times / d, and even served 2 days; or daily afternoon 1g, even for 3 days; or 3g sharing service 5 days. ③ 4.2g therapy: for the treatment of Bancroftian filariasis, adult 0.6g / d, 3 times service for 7 days. This method is more reliable to kill adults. ④ Intermittent therapy: In recent years, a small dose of diethylcarbamazine at home and abroad that the long-range treatment, negative conversion rate, reliable efficacy, side effects. Treatment of Bancroftian filariasis, diethylcarbamazine 0.5g / times, 1 times / week for 7 weeks, total 3.5g; or 0.3g (6mg/kg body weight), 1 / 15 days or 1 / 30 days, and even served 12 times, with a total dose of 3.6g. Malayan filariasis treatment, 0.3g (6mg/kg body weight), 1 times / week, and even served 6 times. Diethylcarbamazine treatment of filariasis over, regardless of blood microfilaria negative or not, three consecutive treatments, each treatment interval of 1 to 2 months. Negative for microfilaria not to continue treatment. ⑤ National diethylcarbamazine medicated salt consumption: the diethylcarbamazine medicated salt content of 0.3% (diethylcarbamazine 3g/kg salt), taking 6 months, each about the total dose of diethylcarbamazine service 9g [average salt 16.7g / (d? people), with diethylcarbamazine 50mg], can achieve better results.
Emperor Wen Si application of diethylcarbamazine treatment of echinococcosis, a dose of 5mg/kg body weight, 1 / d or 1 times / week, continuous or intermittent medication of 10 times. There is also a long course of treatment with low-dose therapy, adults 50 ~ 100mg, 1 times / week; 1 to 10-year-old children 25 ~ 50mg, 1 times / week. Intermittent medication, treatment for 18 months. Low toxicity of diethylcarbamazine itself. The main reason to react, because a large number of microfilariae produced by an allergic reaction death. Side effects and preventive measures are as follows: â‘  gastrointestinal symptoms: common are nausea, vomiting, as early as 15min after taking the drug appeared in more than 4h in medication, and can be symptomatic treatment. â‘¡ allergic reaction include: chills, fever, headache, muscle and joint pain, rash, skin itching and so on, even there may be laryngeal edema and bronchospasm. Most allergic reactions after taking 6 ~ 8h on there, but also occur as late as 24h or more, and more to symptomatic treatment. Occurred laryngeal edema, bronchospasm immediately injected epinephrine 1:1000 1ml (children reduce it), can quickly ease the symptoms. Corticosteroids can also be used. â‘¢ Local reaction: there may be lymphangitis, lymphadenitis, spermatic cord inflammation, epididymitis, and subcutaneous nodules, subcutaneous nodules usually in the six months to a year to go away. Lymphangitis, lymphadenitis, spermatic cord inflammation, epididymitis can be local hot, the scrotum care and services with painkillers and other symptomatic treatment. Diethylcarbamazine has driven the role of worms, a roundworm infection in patients with severe drug, may stimulate a large number of roundworm Ascaris drill into the appendix caused by intestinal obstruction or acute appendicitis and should be a timely manner.
Rule or taboo subjects ease severe heart, liver, kidney disease, active tuberculosis, acute infectious disease patients. Within 3 months of pregnancy or 8 months or more pregnant women and women's menstrual period.
(2) furan ethyl ketone (furapyrimidone): 1979, China's synthetic anti-filariasis drugs. Of Wuchereria bancrofti adult worms and microfilaria significant role in the killing, similar to side effects and diethylcarbamazine, This product is enteric-coated tablets, dose 20mg / (kg? D), 2 times or 3 times, and even served 7 days for a course of treatment.
(3) of ivermectin (ivermectin): can effectively remove Bancroftian microfilaria, adult 100 ~ 200 μg / kg body weight, single-dose or qd for 2 days of oral. Clear short-term effects of Bancroftian microfilaria better than diethylcarbamazine, but continued to report different results each time. Microfilaria on the role of the Malay poor, adverse reactions are headache, fever, anorexia
And so on.
2. Symptomatic treatment
(1), lymphangitis, lymphadenitis, spermatic cord inflammation, orchitis treatment: diethylcarbamazine treatment can refer to the local response to treatment. Patients with severe symptoms should rest in bed, raising the lower limbs. Prednisone or compound acetylsalicylic acid (aspirin compound) can also be applied. If secondary bacterial infection, use of antimicrobial drugs.
(2), like the skin of the treatment: the treatment of lower limb can be used as drying the skin tied therapy, limb by radiant heat or microwave diathermy. Drying after the treatment with the elastic bandage, 1 / d, the former 1h / times, 20 times as a course of treatment, rest half a month to the next course of treatment; latter 30min / times, 15 times as a course of treatment, rest and 2 months , the next course of treatment. During the drying treatment and rest during the day and need to be continuous with the elastic bandage bandaging limbs, treatment 2 to 3 courses. Both tinea pedis in patients with anti-fungal treatment to control infection. Tied during the drying treatment, while treatment with low-dose diethylcarbamazine treatment of long, can stop the Meteors attack. Lower limbs of a small number of giant elephantiasis, a large area can be full-skin graft surgery, and bandaged. Scrotal skin treatment as the main purposes of orthopedic surgery.
(3) the treatment of chyluria: chyluria onset should increase abdominal pressure with supine rest, and raise the pelvic and lower lymphatic pressure, may promote the formation of the channel has been closed. Patients need to drink plenty of water or weak tea, with fat and protein restriction diet. Available in the chain of oil (in the carbon chain triglycerides, MCT) instead of ordinary edible oils and fats. Long-long treatment by rest or medicine, is still ranked chyluria will be considered 1% to 2% silver nitrate infusion or surgical treatment. If chyle hematuria may at its discretion with hemostatic agents.
(4) the treatment of hydrocele: Currently, surgery and more therapy, efficacy is satisfactory. General 3g after diethylcarbamazine therapy should be given 1 to 2 courses of treatment, as the pathogen treatment.
Complications
Elephantiasis, lymphangitis, lymphadenitis, spermatic cord inflammation, orchitis, chylous arthritis.
about lymphatic filariasis

Lymphatic filariasis (lymphatic filariasis) from the Malay Dili Wensi Bancroft insects cause. The main clinical features of acute inflammation of the lymphatic vessels and lymph node inflammation, and chronic obstruction of the lymphatic vessels and also produced a series of symptoms does not appear obvious symptoms, but only within the microfilaria in the blood by the so-called
About filariasis endemic in China, 16 provinces (autonomous regions and municipalities) of the 864 counties, cities (not including Taiwan Province) before the survey, according to Prevention, there are 30,994,000 people filariasis, ranking first in the world at that time, many elephantiasis patients with hydrocele, chyluria and other symptoms and signs. After struggling against great achievements, as of 1994, after evaluation, 864 cities and counties have to meet the basic elimination of filariasis standards, effective control of filariasis transmission. Epidemiology 1. Geographic Distribution of Bancroftian filariasis are very widespread mainly in Asia, Africa, Oceania and Latin America in some areas than its predecessor Malay filariasis-endemic areas, only found in Asia, only the popular Emperor Wen Si echinococcosis South East Timor, the Indonesian Islands (Timor), Foluoleisi (Flores) and other islands
Lymphatic filariasis. According to WHO 1994 published in 73 countries endemic for lymphatic filariasis, there were 119 million, 1.1 billion people at risk of lymphatic filariasis leading to global 4300 as a permanent or long-term disabled people, WHO 1995 was listed as the second largest disability causes. The distribution of filariasis in Shandong Dezhou area north to the south of Sanya City, Hainan Province, the East until Zhejiang Zhoushan, west Sichuan Yaan County, a total of 16 provinces, municipalities and autonomous regions (Shandong, Henan, Jiangsu, Shanghai, Zhejiang, Anhui, Hubei, Hunan, Jiangxi, Fujian, Hainan, Guizhou, Sichuan, Guangdong, Guangxi and Chongqing) in 864 counties, cities (not including Taiwan Province) popular in the northwest of the Loess Plateau and the Qinling Mountains found no filariasis. In addition to only Bancroftian filariasis in Shandong Province, other provinces (municipalities and autonomous regions) at the same time there are two popular filariasis. 2. The source of infection with microfilariae in the blood of people is the source of infection of filariasis. In recent years, found in foreign Brugia malayi sub-periodic type can be parasitic on domestic animals such as cats and dogs as animal source of infection in mammals. 3. Filariasis media media in China for the mosquitoes. Bancroftian filariasis transmission main mosquito species Culex quinquefasciatus, followed by Anopheles sinensis. Malayan filariasis transmission is the main mosquito species Anopheles sinensis, Anopheles Anopheles blood Reye subspecies. Togo Aedes coastal and Malay also Bancroftian filariasis transmission, while Anopheles Bancroftian filariasis in Hainan Province mosquito species endemic areas of the media emperor Wen Si insects to be the main media bill Anopheles. Filarial larvae in 16.6 ℃ when the
Lymphatic filariasis slowly developed in the 25 ~ 32 ℃ Relative humidity 70% to 90%, the growth acceleration. Therefore, the main season filariasis infection of 5 to 10 months. However, year-round warm all year round infection and popular south. 4. Susceptibility of young and old people can be infected, 20 to 50 years old and incidence rate of infection among the highest in a few years of age. The incidence of men and women was no significant difference. Illness resulting from low immunity, can be repeated infection. According to the level of infection can be divided into ultra high prevalence of endemic areas, area (more than 30% infection rate), highly endemic areas (prevalence of 20% to 29%), moderate endemic area (prevalence of 5% to 19% ) and low endemic areas (prevalence of 5% or less). Cause 1. Adults, such as line ends in a slight white tip slender, smooth surface dioecious, but often tangled together. Wuchereria bancrofti male's body length is 28 ~ 42 mm, a width of 0.1 mm, the length and width is about female male 1 times. Brugia malayi little shorter. Wuchereria bancrofti and Brugia malayi females almost identical to the shape and internal structure, but also little difference between male main difference is the small male's anal hole Bancroft papillae on both sides of 8 to 10 pairs, after the anal hole there is a pair of papillae, anal hole between the sometimes visible to the end of the twelve pairs of papillae; Malay male anal holes on both sides of only four pairs of papillae, anal after a pair of holes, without the anal papilla between the end hole. The ultrastructure of various filarial have many similarities. Malay and Wuchereria bancrofti adult body wall ultrastructure of cortex visible angle, rope and cable between the subcutaneous layers, muscle and other body wall. Insect body has a broad-based membrane system so that all the structures apart and separated from the body cavity with the fake. Adult life span is estimated to live 10 to 15 years. 2. Microfilaria Department of viviparous, mainly in the peripheral blood, swimming like a snake. Bancroftian microfilaria is about 280μm, width of 7μm, Malay Bancroftian microfilaria microfilaria than shorter fine. Seen under the light microscope tip microfilaria blunt slender, tapered tail, the body outside the sheath has a round nucleus, a nuclear-free parts of the head, said head-end gap. Nerve ring in the worm first 1 / 5, followed by the excretory pore, excretory cell parasites rear G, R2, R
Lymphatic filariasis 3 and R4 have four cells ventral anal holes later, the caudate nucleus in the tail. Bancroftian microfilaria in the form of the Malay significantly different, the three main differences between microfilaria see (Table 1) and (Figure 1). Ultrastructure and light microscope microfilaria seen basically the same, similar to the body wall and adults, including multi-angle film skin, back, abdomen and lateral, the lower skin and muscle cells, etc, without differentiation of microfilaria leave the body cavity life, in the human body can live 2 to 3 months, even up to 3 years were. Wuchereria bancrofti microfilariae in experimental animals can live more than 9 months. 3. Life Shiban Shi and Brugia malayi life cycle includes two different stages: a stage in insects (mosquitoes) in the host or intermediate host, the other stages in the human body that is the final host (Figure 2). (1) in mosquitoes: When the mosquito bites microfilaria positive patients, the blood in the mosquito stomach sucked microfilaria about 2 ~ 7h shed the sheath through the stomach wall into the room by the abdominal muscle, chest immediately after arrival began to develop 6 to 14 days after becoming the third period or two peeling infectious larvae, mature later, left chest, lower lip migrate to mosquito kiss, enter the body when the mosquito blood meal. (2) in the human body: transmission of the larvae invade the human body within the organization, some of the larvae died during the migration and development, or eliminate some of the larvae reach the lymphatic vessels or lymph nodes develop into adults. Bancroft adults often stranger in the abdominal cavity, spermatic cord and lower extremity deep and superficial lymph system; Malay adults dwelling in the lower extremities often shallow lymphatic system. Since the transmission of microfilaria larvae into the human body to appear in the peripheral blood within the required 8 Wuchereria bancrofti Brugia malayi 12 months to be 3 to 4 months. 4.'s Biological characteristics and Brugia malayi of classes according to their biological characteristics, is now the night cycle type, the two filarial microfilariae are seen in the peripheral blood during the night periodicity. Microfilariae emerged from the dark night
Lymphatic filariasis microfilariae appeared between the peak of Bancroft microfilaria is 10 pm to 2 am next morning; Malay microfilaria is 20:00 to 4:00 next morning. Malay microfilaria periodicity as the rules of Bancroftian microfilaria appear in summer than in winter more than the number of insects. Microfilaria in the day hiding in the lung, heart and other organs within the capillary, mainly within the pulmonary capillary blood microfilaria when many, in the peripheral blood during the day, but also a small amount appears. In addition, in the South Pacific Buck Princeton line (Buxton's line) to the east of the South Pacific islands and some islands the Bay of Bengal the Wuchereria bancrofti prevalence is sub-cycle model for the day. Kanchanaburi in western Thailand is Asia region was the night cycle type, peripheral blood microfilaria during the night there during the day can be found (about 20% of the night.) Microfilaria periodicity principle there are many different interpretations. Many scholars use the theory to explain the biological rhythm that is the parasite and host (definitive host and intermediate host) between the long-term adaptation process to obtain the biological properties can also be affected by a variety of reasons, especially evident with the human body awareness and sleep habits. If the change in the day and sleep at night, wake up, after a few days later, day and night cycle that is periodic this can be changed with the vagus nerve on the regulation of systolic and diastolic pulmonary capillaries. In the wake when the vagus nerve in the suppression condition, pulmonary vasodilation remain poorly most of the microfilariae in the pulmonary capillaries; vagus nerve during sleep in the excited state, a significant expansion of the lung blood vessels, large microfilaria
The amount of blood flow into the lymphatic filariasis. But on the day sub-cycle-type is this view is difficult to explain. The experiment found that the lung and peripheral blood changes in the partial pressure of oxygen can change the periodicity of Bancroft microfilaria. Patients inhaled oxygen at night and reduce carbon dioxide, while the muscles in the microfilaria in the peripheral blood can be quickly reduced; was also observed in the evening, if the 80% increase in pulmonary partial pressure of oxygen can Bancroftian microfilaria leave the peripheral blood, and then hide in the lungs. In addition, host body temperature, respiration, blood glucose levels, and certain drugs such as diethylcarbamazine, inhibiting or exciting the vagus nerve drugs, can affect the microfilaria in blood volume and periodicity. The occurrence of filariasis in the pathogenesis and development depends on various factors, including filarial species, growth conditions, parasite location, the number of infected larvae invade the body's reaction, and secondary infections. Filariasis in the pathogenesis of the process, played a major role in the adult, infection of larvae in their maturation process and the incidence of some degree of relationship. When complicated by bacterial infection, filariasis, performance is more complex. Appeared in the peripheral blood microfilaria is little relationship with the disease. When the infected larvae bore into the skin and, after development of the lymphatic system to reach the body as well as mature at this developmental stage, larvae and adults as well as metabolites produced by adults in the womb of waste, can arouse systemic allergic reactions and the organization of the local lymphatic system response, manifested as a chronic lymphadenitis and lymphangitis filarial fever and other such acute lymphatic (node) is considered to be an inflammatory type Ⅰ or type allergy caused Ⅲ. Mostly late lymphatic obstructive disease, that is a type Ⅳ allergic reaction. Filariasis, the incidence of chronic symptoms and signs of filarial antigen by the host immune response and Malay due to Bancroftian filariasis in the presence of serum anti-filarial antibodies to adult and microfilaria, in the absence of blood microfilaria serum of patients, there are anti-microfilaria surface sheath antibodies. Filarial antibody-mediated or participate in elimination of circulating microfilaria. Hyperlipidemia are asymptomatic microfilaria low immune response, the lymphocytes in vitro usually do not react with the filarial antigen in serum nor anti-adult and anti-microfilaria antigen antibodies or antibody levels low. To the development of chronic obstructive filariasis, elephantiasis at this time is usually the formation of microfilaria-free viremia, but the characteristic pathological inflammatory immune response is due to a high degree of local inflammatory response due to injury leaving the formation of lymphedema may be immune mediated response is due to the occlusion of adult lymphatic endometritis results; also suggested that some factors due to the adult body fluids with the host - cell interactions and lead to inflammation poor lymphatic drainage. In short, the immune system is complex filariasis, has so far remained unclear. The pathological changes of filariasis is mainly in the lymphatic vessels and lymph nodes. 1. Lymphatic system diseases can be divided into acute, subacute and chronic stages. Mainly in the acute phase of acute exudative inflammation of lymph node-based congestion, lymphatic vessel wall edema, eosinophil infiltration as well as thickening of the lumen of protein full of pink liquid and eosinophils; sub-acute lymph nodes and lymphatic appeared hyperplastic granulomatous reaction, granuloma center variability of adults and eosinophils, surrounded by fibrous tissue and epithelioid cells around, in addition to a large number of lymphocytes and plasma cells together, similar to tuberculous nodules, severe tissue necrosis, liquefaction, and a large infiltration of eosinophils, eosinophilic abscess formation; chronic stage, the most obvious manifestation is a lot of hard fibrous tissue hyperplasia lymph nodes, lymphatic fibrosis, and even the formation of solid cellulose, is the occlusion of lymphatic meningitis. 2. Secondary lesions occur when the lymphatic vessels and lymphatic obstruction, the distal lymphatic vessels broke down when the block is located in varicose aortic lymph nodes, lymphatic vessels and other dry waist occurs when the lymphatic urinary and lymphatic ascites; when the obstruction in the spermatic cord and When testicular lymphatic vessels, lymphatic fluid scrotal hydrocele; when the block is located in the superficial inguinal lymph nodes or lymphatic vessels, the lymphatic scrotal swelling; when the block is located in the thigh and the trunk when the lymph nodes, swollen lymph lower extremity. Dangxiong catheter is blocked, you can make chyluria and scrotal hydrocele chylous effusion, chylous diarrhea and the emergence of chylous ascites. Inflammation of the lymphatic filarial damage to the wall, so that the weaknesses calyceal ulceration, one of the reasons is the formation of chyluria. Lymph long stay in the organization, because the protein composition of lymph is high (from the normal 0.69% 0.49% to 3.03%) continue to stimulate the proliferation of fibrous tissue of the large number of skin and subcutaneous tissue was significantly thicker thicker, wrinkled the formation of various types of clinical findings and various parts of elephantiasis poor blood circulation due to local skin sweat glands, sebaceous glands and hair follicles is impaired, reduced resistance and easy to secondary bacterial infection, the aggravation or deterioration of elephantiasis, or even formation of local ulcers. 3. Microfilaria generally considered a rare disease in human organs, but the response does not cause significant was found in the spleen and brain can occur within the granuloma caused by the microfilariae, by the large number of eosinophils, epithelial cells fibroblasts and foreign body giant cells are formed, and can find microfilaria In addition, there are the neck, chest, back, breast and other parts of filarial granuloma, pericarditis, etc., and filariasis. Clinical manifestations of the disease incubation period from infection to the blood of larvae into the human body so far found microfilaria, generally a year or so, but also as early as 4 months or as late as 1.5 years of Emperor Wen Si echinococcosis incubation period of 3 months. Examination of lymph nodes from the first body found in Wuchereria bancrofti adult to 3 months after infection. Varying severity of clinical manifestations of filariasis in endemic areas may have from 50% to 75% of the "asymptomatic," the infection. Major parasite Brugia malayi lymphatic system in the shallow limb lymphangitis and therefore elephantiasis is most obvious. Wuchereria bancrofti lymphatic vessels in the limbs is not only parasites, but also parasitic on the deep lymphatic system, urinary, reproductive organs, causing the spermatic cord, epididymis, testes, scrotum and other inflammation and nodules. Malayan filariasis has not been proved that patients with simple reproductive system disease. Emperor Wen Si sis and clinical manifestations of filariasis in Malaysia is similar to recurrent episodes of acute lymphangitis, lymphadenitis and fever; period of lymphedema and chronic elephantiasis. 1. Acute symptoms of this issue highlights lymphadenitis, lymphangitis, filarial fever is characterized by the spermatic cord periodic attacks go far, every 2 to 4 weeks or every few months, more than one episode to episode 1 in sports or fatigue after. Sometimes see the occasional attack. Attack in the summer and more than other seasons. (1) lymphadenitis and lymphangitis: Lymphadenitis may occur in isolation, but often at the same time with the onset of lymphangitis, common sites were the groin, thigh, elbow and arm after the other. However, if the deep abdominal, pelvic and so can be violated, and those are all common clinical lymphadenitis are physically groin and lower extremities especially the most common recurrent thigh and accompanied by retrograde lymphangitis in addition to its characteristic symptoms In addition, the local lymph nodes pain, the swelling degree of the severity of infection are related. Lymphangitis as the common symptoms of filariasis, Bancroftian Malays as compared with more good fat in the limbs, lower limbs than upper limbs for many, each attack may be accompanied by fever, mostly in the majority among the 38 ~ 39 ℃ for 1 ~ 3 days from retirement, a few up to 10 days, the symptoms associated with muscle and joint pain, headache, chills and so on. Can often occur in the affected parts of the skin from top to bottom, eccentric "red line", the so-called retrograde lymphangitis, generally has pain, tenderness, local with hot and so on, but not as good as those of bacterial weight. Emperor Wen Si sis most notable feature is left behind after acute purulent lymphadenitis of the skin scar. (2), erysipelas-like dermatitis: the skin caused by the micro-lymphangitis often secondary to lymphadenitis and lymphangitis, may also occur in isolation because of a attack of skin irritation, the shape of erysipelas, hence the term erysipelas-like dermatitis, commonly known as "Falling Star" and more with fever, the heat level and severity of attacks are generally more time on each episode lymphadenitis, lymphangitis last for long. Limb lymphadenitis, lymphangitis and erysipelas-like dermatitis often exist. (3) filarial fever: Periodic fever, and sometimes first, chills, body temperature can be as high as 40 ℃, 2 ~ 3 days from retirement, but also sustained for up to 1 week. Some only low heat, no chills no local lymphangitis or lymphadenitis can be seen sometimes with abdominal pain. Such attacks may be due to deep lymphadenitis and lymphangitis caused. (4) spermatic cord inflammation, epididymitis, orchitis: In order to Wuchereria bancrofti adult strangers in the spermatic cord, epididymis, testis caused by the neighboring lymphatic where lymphangitis and interstitial inflammation. Fever, pain in the side of the scrotum can be spread from the groin down to the scrotum, and radiation to the inner thighs, in some cases the performance of the cramps. Local examination in addition to reach the epididymis, and testicular swelling outside the main thing is the spermatic cord nodule mass, and has significant tenderness, sustained a few days later due to local inflammation subsided, the mass becomes smaller and harder, you can repeat the attack, local mass tandem Each episode is gradually increasing. Change the filariasis disease seldom causes the vas deferens and seminal fluid itself, there are still sperm there, so very few of filariasis in the scrotum cause infertility. (5) eosinophils lung disease: mainly as chills, fever, cough, asthma, lung cell infiltration was migratory; sputum eosinophil number and have Charcot - Leyden crystals, peripheral blood the total number of leukocytes up to 40 × 109 / L, eosinophils increased from 20% to 30%, and blood microfilaria mostly negative, with high titers of anti microfilaria, IgE level is high. Treatment with diethylcarbamazine effective treatment not only alleviate the symptoms, and death can occur due to adult nodules; there urticaria and other symptoms of angioneurotic edema. With the view that the disorder is a "insidious filariasis" (occult filariasis), the host's immune system can quickly clear the microfilaria in blood, so difficult to find pathogens in blood, but often can be found in the lung concentration and microfilaria the formation of focal point of eosinophils. Speculated that the disease pathogen is mainly caused by the non-human filarial. 2. Chronic recurrent inflammation of the lymph nodes, and finally, the proliferation of lymphatic tissue and fibrous tissue, granulation of the block, resulting in clinical symptoms and signs. (1) lymph nodes and lymphatic varices: means the lymph node varicose varicose lymphatic vessels to the heart and the expansion of lymphatic sinuses within the lymph node, the common in the groin and thigh, one side or both sides of palpation in like a sponge cyst hard core sense of varicose lymphatic vessels, common in the spermatic cord, scrotum and inner thighs, occasionally the upper limbs. Spermatic cord lymphatic vessels may also have varicose veins, varicose lymphatic scrotum scrotum with lymph node exist. Varicose lymphatic vessels can also occur in the deep, has been reported, engorgement thoracic duct diameter of 1.5cm. (2), hydrocele, lymph lymphatic urinary ascites: the spermatic cord and testicular lymphatic obstruction due to lymph flow sheath cavity. Scrotal skin and subcutaneous tissue often the Ministry of return due to the obstruction of lymph edema, lymphatic fluid to form the scrotum. Hydrocele light are asymptomatic, while those with more heavy fluid drape and even walking difficult. Examination shows the increase scrotum size, pear-shaped scrotal skin tumor often has tight folds disappear, shrinking penis, transmission test often has an extremely positive, such as sheath thickening and scrotal elephantiasis associated with those light test negative. Lymph can occur even in urine, urine with blood, containing lymph. If the lymph into the abdominal cavity, the formation of lymphatic ascites, there may be symptoms of acute peritonitis. (3) chyluria, hydrocele chylous effusion, chylous ascites, chylous diarrhea: Bancroftian filariasis chyluria is one of the common symptoms of late, the incidence rate of about 2%, the number of young adults the incidence of the total incidence of 78.3 %; a few days shorter duration of the longest up to 54 years to a maximum of 25 years. Chyluria Lymphatic broken parts, common in the calyx and ureter, not in the bladder.
Lymphatic filariasis chyluria attacks often occur suddenly, before the onset may be asymptomatic but may have chills, fever, lower back, pelvic and groin pain, etc., following the emergence chyluria. Often overworked and delivery factors for seizures, sometimes because of drinking, serving anthelmintic acute abdomen caused. Attack often has intermittent intervals for weeks, months or a few years but there are few cases were continuous, high-fat diet can aggravate symptoms. Chyluria milky white or with color standing divided into three layers, the upper fat, middle is white or white than clear liquids, usually a small clot suspension, the lower is red or pink sediment containing red blood cells, lymphocytes and white, and sometimes can be found microfilaria rate was 5% to 13.8%. Chylous effusion than hydrocele hydrocele is a rare lymphatic fluid. Sheath effusion chylous easy to find microfilaria in the domestic rate of 77.8% reported positive sheath is clearly higher than that of lymph fluid. Chylous ascites chylous diarrhea and is extremely rare. In chylous ascites may have symptoms of acute peritonitis, and easier to secondary bacterial peritonitis. Filariasis chylous arthritis, chylous pleural effusion occasionally seen (4) elephantiasis: elephantiasis late for the two most common symptoms of filariasis, since about 10 years after infection occurs. Due to different parts of the lymphatic obstruction, location has different body sites were occurring (Figure 3), scrotum (Figure 4), penis (Fig. 5), labia, clitoris and breasts (Fig. 6) and so on. The most common sites were lower extremity lower extremity of Bancroftian Filariasis in China reported 89.5% 1.2% upper extremity, other 9.3%, and composite parts, and lower extremities accounted for 99.6% of filariasis in Malaysia, simultaneous upper and lower extremities accounted for 0.3%. Emperor Wen Si sis limb elephantiasis occurred also many see. (5) Other: Eye filariasis is extremely rare, can cause iridocyclitis, keratitis, retinal hemorrhage, optic atrophy, increased intraocular pressure, aqueous turbidity can be detected in the eye such as microfilaria. Wuchereria bancrofti even ectopic parasites on the body can be any part of the lymphatic vessels within the tumor blocks the formation of similar objects can be located in the neck, pectoralis major, after the Ministry of the abdominal wall, spleen and other places. Bancroftian filariasis in Anhui, Guangdong endemic area, found in patients with filarial pericarditis. Complications: elephantiasis lymphangitis, lymphadenitis, spermatic cord inflammation, orchitis, chylous arthritis. Diagnosis 1. Filariasis epidemiology and clinical diagnosis must be combined with epidemiological history, the patients of endemic areas to farmers the most. Lymphangitis Lymphadenitis elephantiasis-oriented features of the disease from endemic areas suffering from testicular inflammation, orchitis, chyluria who are mostly of filariasis. As China's increasing foreign aid missions, foreign aid in recent years, returned in some patients were found to have filariasis, onchocerciasis and Ah-who need to pay attention to the time of diagnosis. 2. Laboratory diagnosis to find microfilaria in peripheral blood. Diagnosis of microfilaria in the blood can be found established. 3. Therapeutic purposes of this Act is to diagnose the diagnosis of suspicious symptoms and signs of filariasis, but can not find microfilaria in the blood of patients. To the service diethylcarbamazine, some patients can appear 2 to 14 days of reaction the lymphatic system and lymphatic nodules. This is the drug evidence in the filarial adult when necessary, extraction can be nodular, looking for filarial. 4. Lymphangiography filariasis patients often show expansion of the input the output of small lymphatic vessels and lymphatic vessels, lymph nodes develop a real defect phenomenon. Differential Diagnosis: Three in addition based on identification of lymphatic filariasis endemic area of living history and clinical manifestation, mainly rely on pathogen morphology and immunological methods. Lymphatic filariasis in the acute phase of inflammation and bacterial lymphadenitis should go far identification of lymphatic vessels. Bacterial lymphatic vessels to regional lymph nodes is a bottom-up development, and can be found in local lesions, and severe symptoms, local pain and tenderness are more significant, blood neutrophils significantly increased. Spermatic cord and epididymis inflammation and tuberculosis epididymitis should be different. History of tuberculosis for reference, nodular enlargement of epididymal tuberculosis, hard, light tenderness. Necessary to do a biopsy. Inguinal or femoral hernia should identify varicose lymph nodes. According to varicose lymphatic vessels, percussion-free air sound, no bowel sounds with body position changes the size of small hyperthyroidism cough impulse does not exist, and the puncture in the lymph of lymph available can be found within the microfilaria and other identification. Spermatic cord lymphatic varicocele varicose and difficult to distinguish, the latter wall thicker than the clear tube, if necessary, pumping fluid from the pipe inspection, are provided identification. Although more common in filariasis chyluria, but should be tuberculosis, cancer, thoracic duct injury caused by stress or those to be identified. Elephantiasis can also be found in recurrent bacterial lymphangitis after or because of local damage, tumor compression leaving lymphatic drainage blocked, after surgical removal of lymphatic tissue may also cause this time should be combined with a history of identification. In addition, the yet to congenital or familial elephantiasis identification. Non-endemic areas of filariasis in Zhejiang, has found that family for four generations, 14 were presented by hereditary elephantiasis. Check the laboratory tests: 1. White blood cell count and classification of early leukocyte count in patients with allergic reactions and increase in eosinophils, the former mostly in the (10 ~ 20) × 109 / L, the latter more than 20% of any bacteria In addition to the total number of secondary infections increase white blood cells outside of neutrophils also increased significantly. 2. The discovery of blood microfilaria microfilaria filariasis diagnosis depends on the discovery, usually in the peripheral blood examination, most of them from 22:00 to 2:00 next morning to find microfilaria most vulnerable, such as the blood out of the night 150 / 60μl, the day can be found. (1) blood method: draw straws earlobe blood hemoglobin count 20μl, at low magnification under a microscope to find microfilaria. Microfilaria positive freedom can be seen swinging around the curl, is quite active. (2) smear: earlobe three drops of blood (approximately 60μl) placed in glass center thickness and edge of the neatly painted rectangular or oval thick blood films about the size of 2cm × 3cm 80 years since the 20th century onwards, and Unity is defined as 120μl drop of six double-disc method. Staining blue or borax supplies, such as methylene blue staining of difficulty identifying insect species can be stained with Giemsa or hematoxylin. Acridine orange fluorescence staining pigments can also improve the detection rate of microfilaria (3) concentration method: concentration of microfilaria in the blood collection method many of which are dissolved within the red blood cells, centrifugation to find lessons to be concentrated sediment microfilaria within the sediment. Hemolytic agent commonly used for the distilled water. (4) microporous membrane filtration method: 5% sodium citrate containing 0.1ml of blood 1 m1 mixing 10ml syringe, then suck 10% teepol Liquid 9ml (or 2% Tween 80 0.1% sodium bicarbonate solution or liquid) mixing hemolysis, take the syringe 5μm pore size 25 mm diameter membrane filter, dissolving blood through the membrane filter, the microfilariae remain in the film, remove the film with 0.1% hematoxylin or 0.1% methylene blue staining microscopy. (5) The trap-out method microfilaria day: the day after oral administration of diethylcarbamazine 100mg within 1h microfilaria can be found in the peripheral blood. Law method unsuitable for screening of filariasis. In outpatient basis for reference. 3. Microfilaria examination of various body fluids hydrocele, chyluria, lymphatic or chylous ascites, pericardial effusion, anterior chamber, water and other liquids in checked microfilaria, can direct smear, staining, or centrifugal concentration method Check 4. immunological diagnostic immunology at home and abroad diagnostic methods commonly used are: (1) skin test: 0.05ml injection of Dirofilaria immitis antigens in subjects within the forearm skin, 15min after the pimples    0.9 cm were positive. This test and found signs of filariasis patients was 73.6% ~ 96.6%, and blood microfilaria positive consistent with a rate of 86.2% to 94.1%, but with schistosomiasis may produce only a slight cross-reactivity screening of this Law and auxiliary diagnostic value in the prevention and treatment should not be used to monitor late. (2) indirect immunofluorescence antibody test: a gerbil animal model of such collection for adults and microfilaria antigen fluorescent antibody using goat anti-human IgG fluorescent antibody conjugates, with high sensitivity and specificity. The adult section as antigen, the sensitivity of 92% to 98%, specificity 95%; to slice for microfilaria antigen, a sensitivity of 92% ~ 96%, specificity was 98%. This method can be used as filariasis diagnosis and seroepidemiological survey and site monitoring. Disadvantage is still the effect can not be used for evaluation, and the difference between patients belonging to past infection or active infection. (3) enzyme-linked immunosorbent assay (ELISA): use of Brugia malayi, Dirofilaria immitis, finger-like abdominal microfilaria malayi and other soluble antigens, ELISA determination of antibodies, consistent with the positive rate of filariasis patients 85% to 100%, false positive 8.2% to 1.5%. Or adults with microfilaria microfilariae ES antigen on hyperlipidemia were positive consistent rate of 93% to 95%, non-endemic areas of intestinal nematode infection in healthy people and those who are negative. Law antibodies detect human filariasis, with high specificity and sensitivity, the same law applies to on-site investigations and the difference can not be used for efficacy assessment whether patients with active infection (4) detection of circulating antigen: WHO recommended immuno chromatographic Technology (immunochromatographic, ICT) test card testing Wuchereria bancrofti antigen. It was reported that the sensitivity of the method was 90% to 98%, specificity of 99% to 100%. With a monoclonal antibody enzyme-linked immunosorbent assay (McAb ELISA) and dot ELISA (Dot-ELISA) antigen detection of filariasis patients, the specificity was 94% and 96%, Dot-ELISA can be detected 0.055μg / L antigen, McAb ELISA detected only 10μg / L antigen. Active infection can be detected both as a post-monitoring of filariasis control, search and evaluation of residual source of infection prevention and control effects. 5. Molecular hybridization and DNA cloning and recombinant DNA technology is currently being used in filariasis diagnostic techniques with high sensitivity and specificity. 6. Chyluria and lymphatic urinary former milky white, can be extracted with ether to Sudan â…¢ stained red and yellow in the microscopic point of lymphatic oil visual inspection of urine and the urine is no different from normal, and its content of protein-based, a small number of red blood cells, without the tube. Derived from the puncture chylous hydrocele fluid and lymph, and chyle and lymph urinary roughly the same, since its activities can be found in the precipitate microfilaria. 7. Biopsies to suspected lesions, such as lower extremity superficial lymph nodes, epididymis nodules were cut into small pieces, for pathological examination, can be found in adults and can be seen related to the pathological changes. Other laboratory examinations: lymphatic filariasis patients often show expansion of imaging input the output of small lymphatic vessels and lymphatic vessels, lymph nodes develop a real defect phenomenon. Treatment 1. Pathogen treatment (1) diethylcarbamazine (diethylcarbamazine): namely, diethylcarbamazine citrate (sea Qunsheng, hetrazan), this product has no direct killing in vitro microfilaria role, but people infected with filarial or animals, you can quickly clear the microfilaria in the blood. The role of the Malay microfilariae more quickly than the class's full course of treatment using higher doses or longer, they can kill adults. After three courses of intermittent treatment, microfilaria negative rate, Bancroft 90% to 99.8%, Malay 96.3% ~ 100%; nodular appearance rate, Bancroft is 30% to 40%, Malay as the 50%. Diethylcarbamazine dose and type of treatment can be based on local filarial infection level of the health status of patients choose to apply â‘  1.5g therapy: the treatment of filariasis for the Malays. Adult 1.5g, at Dayton clothing; or 0.75g / d, and even served 2 days; or 0.5g / d, even for 3 days. The weak low-dose incremental approach can be used, even for 10 days. â‘¡ 3g therapy: mainly used for Bancroftian filariasis, Malayan filariasis can also be used for the physical well microfilaria were more adult afternoon 1.5g per day and even served 2 days; or 0.75g / sub 2 / d and even served 2 days; or daily afternoon 1g, even for 3 days; or 3g sharing service 5 days. â‘¢ 4.2g therapy: for the treatment of Bancroftian filariasis, adult 0.6g / d, 3 times service for 7 days. This method is more reliable to kill adults. â‘£ Intermittent therapy: In recent years, a small dose of diethylcarbamazine at home and abroad that the long-range treatment, negative conversion rate of reliable efficacy, side effects. Diethylcarbamazine treatment of Bancroftian filariasis 0.5g / times, 1 times / week for 7 weeks, total 3.5g; or 0.3g (6mg/kg body weight), 1 / 15 days or 1 / 30 days , and even served a total dose of 3.6g 12 Malay filariasis treatment, 0.3g (6mg/kg body weight), 1 times / week for 6 or more times with diethylcarbamazine treatment of filariasis, whether negative microfilaria in blood or not, every course of treatment for three consecutive intervals of 1 to 2 months. Negative for microfilaria not to continue treatment ⑤ diethylcarbamazine medicated salt consumption of the whole people: drug diethylcarbamazine salt content of 0.3% (diethylcarbamazine 3g/kg salt), taking 6 months, each about service ethylamine The average total dose of hydrochloride salt 9g 16.7g / (d · people), with diethylcarbamazine 50mg, can achieve better results. Emperor Wen Si application of diethylcarbamazine treatment of echinococcosis, a dose of 5mg/kg body weight, 1 / d or 1 times / week, continuous or intermittent medication of 10 times there is also a long course of low-dose therapy, adults 50 ~ 100mg1 times / week; children aged 1 to 10 25 ~ 50mg, 1 times / week. Intermittent medication, treatment for 18 months. Low toxicity of diethylcarbamazine itself. React mainly due to the death for a large number of microfilariae produced by allergic reactions. Side effects and preventive measures are as follows: â‘  gastrointestinal symptoms: common are nausea, vomiting, as early as 15min after taking the drug appeared in more than 4h in medication, and can be symptomatic treatment. â‘¡ allergic reaction include: chills, fever, headache, muscle and joint aches, skin rash, itching, etc., even there may be allergic laryngeal edema and bronchospasm after taking most of the 6 ~ 8h appear, but also appear as late as 24h or more, mostly symptomatic treatment . Occurred laryngeal edema, bronchospasm immediately injected epinephrine 1:1000 1ml (children reduce) symptoms can rapidly relieve corticosteroids may also be used â‘¢ local reaction: there may be lymphangitis, lymphadenitis, spermatic cord inflammation, epididymitis, and subcutaneous nodules, subcutaneous nodules usually in the six months to a year to go away. Lymphangitis Lymphadenitis, spermatic cord inflammation, epididymitis can be local hot, the scrotum care and services with painkillers and other symptomatic treatment. Diethylcarbamazine has driven the role of worms, there are patients with severe roundworm infection can stimulate a lot of medication roundworm Ascaris drill into the appendix caused by intestinal obstruction or acute appendiciti
s and should be a timely manner. Rule or taboo subjects ease severe heart, liver, kidney disease active tuberculosis, acute infectious disease patients. Within 3 months of pregnancy or 8 months or more pregnant women and women's menstrual period. (2) furan ethyl ketone (furapyrimidone): 1979, China's synthetic anti-filariasis drugs. Of Wuchereria bancrofti adult worms and microfilaria significant role in the killing, similar to side effects and diethylcarbamazine, This product is enteric-coated tablets, dose 20mg / (kg · d), 2 times or 3 times, and even served 7 days for a course of treatment. (3) of ivermectin (ivermectin): can effectively remove Bancroftian microfilaria, adult 100 ~ 200 μg / kg body weight, single-dose or qd for 2 days of oral short term removals Bancroftian microfilaria effective than diethylcarbamazine Well, but sustained effect of the time each report vary. Microfilaria on the role of the Malay poor, adverse reactions are headache, fever, anorexia and so on.
Add a comment
  • Nickname [Register]
  • Password Optional
  • Site URI
  • Email
Enable HTML Enable UBB Enable Emots Hidden Remember