F
il
a
ri
a
sis
N
o
.
ICPC
-
2
:
D
96
WOMS
/
O
th
e
r
Pa
r
a
sit
e
s
N
o
.
ICD
-
10
:
B
74
F
il
a
ri
a
sis
B
74
.
0
F
il
a
ri
a
sis
D
u
e T
o
W
u
c
h
e
r
e
ri
a Ba
n
c
rofti
B
74
.
1
F
il
a
ri
a
sis
D
u
e
to
B
rugi
a Ma
l
a
yi
B
74
.
2
F
il
a
ri
a
sis
D
u
e
to
B
rugi
a T
imori
Ab
ility l
e
v
e
l
:
4
A
Hea
lth pro
b
l
e
ms
F
il
a
ri
a
sis
(
e
l
e
ph
a
nt foot
d
is
ea
s
e
)
is
a
inf
ec
tious
d
is
ea
s
e ca
us
ed
b
y fil
a
ri
a
worms tr
a
nsmitt
ed b
y v
a
rious typ
e
s of mosquito
e
s
.
T
his
d
is
ea
s
e
c
hroni
c
(
c
hroni
c
)
a
n
d
if you
d
on
'
t g
e
t tr
ea
tm
e
nt
ca
n
ca
us
e
p
e
rsist
e
nt
de
f
ec
ts in th
e
form of
e
nl
a
rg
ed
l
e
gs
,
a
rms
a
n
d
g
e
nit
a
ls
b
oth wom
e
n
a
n
d
m
e
n
.
WHO
h
a
s
e
st
ab
lish
ed a
glo
ba
l
a
gr
ee
m
e
nt to
e
limin
a
t
e
fil
a
ri
a
sis
b
y
2020
(
T
h
e G
lo
ba
l
G
o
a
l of
E
limin
a
tion of
L
ymph
a
ti
c F
il
a
ri
a
sis
a
s
A
P
u
b
li
c Hea
lth
P
ro
b
l
e
m
B
y th
e Yea
r
2020
).
E
limin
a
tion progr
a
ms
a
r
e ca
rri
ed
out
through m
a
ss tr
ea
tm
e
nt with
Dec a
n
d A
l
be
n
da
zol
e
on
ce a
y
ea
r
for
5
y
ea
rs in th
e
lo
ca
tion th
a
t is
de
sp
e
n
de
nt
a
n
d
th
e ca
r
e
of
c
lini
ca
l
ca
s
e
s is goo
d
ac
ut
e a
n
d c
hroni
c
to pr
e
v
e
nt k
eca
p
a
t
a
n
da
n r
ed
u
ce
suff
e
ring
.
I
n
d
on
e
si
a ca
rri
e
s out
e
limin
a
tion of
e
l
e
ph
a
nt l
e
gs in st
a
g
e
s
h
a
s
bee
n st
a
rt
ed
sin
ce
2002
in
5
d
istri
c
ts
.
E
xp
a
nsion of th
e
r
e
gion will
h
e
l
d e
v
e
ry y
ea
r
.
E
l
e
ph
a
nt
'
s l
e
g
d
is
ea
s
e ca
us
ed b
y thr
ee
sp
ec
i
e
s of fil
a
ri
a
worms
,
n
a
m
e
ly
:
W
u
c
h
e
ri
a
Ba
n
c
rofti
,
B
rugi
a Ma
l
a
yi
a
n
d B
rugi
a T
imori
.
D
ig
e
st v
ec
tor in
I
n
d
on
e
si
a
up to
C
urr
e
ntly th
e
r
e a
r
e
27
sp
ec
i
e
s of mosquito
e
s from th
e
g
e
nus
A
noph
e
l
e
s
,
C
ul
e
x
,
Ma
nsoni
a
,
Aede
s
,
a
n
d A
rmig
e
r
e
s th
a
t
ca
n
ac
t
a
s
a
tr
a
nsmitt
ed
v
ec
tor
E
l
e
ph
a
nt
'
s l
e
g
d
is
ea
s
e
.
A
n
a
mn
e
sis
(
su
b
j
ec
tiv
e
)
r
e
sults
A c
ompl
a
int
S
ymptoms of
Ba
n
c
rofti
F
il
a
ri
a
sis
a
r
e
v
e
ry
d
iff
e
r
e
nt from on
e e
n
de
mi
c a
r
ea
with
O
th
e
r
e
n
de
mi
c a
r
ea
s
.
T
his might
be ca
us
ed b
y
d
iff
e
r
e
n
ce
s
T
h
e
int
e
nsity of
e
xposur
e
to inf
ec
tiv
e
v
ec
tors in th
e e
n
de
mi
c a
r
ea
.
Ac
ut
e
m
a
nif
e
st
a
tion
,
in th
e
form of
:
1
.
Fe
v
e
r r
e
p
ea
t
ed
ly for
3
-
5
da
ys
.
Fe
v
e
r
ca
n
be
lost wh
e
n r
e
st
Da
ntim
b
ul
a
g
a
in
a
ft
e
r working h
a
r
d
.
2
.
S
w
e
lling of lymph no
de
s
(
without injury
)
in th
e
fol
d a
r
ea
T
highs
,
a
rmpits
(
lymph
ade
ntitis
)
who look r
edd
ish
,
hot
,
a
n
d
si
c
k
.
3
.
I
nfl
a
mm
a
tion of th
e
lymph no
de
s th
a
t f
ee
l hot
a
n
d
si
c
k
spr
ead
from th
e ba
s
e
of th
e
l
e
g or
ba
s
e a
rm tow
a
r
d
s th
e
tip
(
r
e
trogr
ade
lymph
a
ngitis
).
4
.
F
ill
a
ri
a
l
ab
s
ce
ss
e
s
a
s
a
r
e
sult of fr
e
qu
e
nt suff
e
ring from sw
e
lling of th
e
s
a
p gl
a
n
d
C
l
ea
r
,
ca
n
b
r
ea
k
a
n
d
r
e
mov
e
pus
a
n
d b
loo
d
.
5
.
E
nl
a
rg
e
m
e
nt of
Le
gs
,
A
rms
,
B
r
ea
sts
,
Za
k
a
r
Ba
gs th
a
t look r
a
th
e
r
Red
n
e
ss
a
n
d
f
ee
l hot
(
Ea
rly
I
mpho
de
m
a
).
C
hroni
c
m
a
nif
e
st
a
tions
,
ca
us
ed b
y r
ed
u
ced
lymph
c
h
a
nn
e
l fun
c
tions o
cc
ur
s
e
v
e
r
a
l months to m
a
ny y
ea
rs from
ac
ut
e e
piso
de
s
.
C
hroni
c
symptoms
F
il
a
ri
a
sis in th
e
form of
:
e
nl
a
rg
e
m
e
nt th
a
t s
e
ttl
ed
(
e
l
e
ph
a
nti
a
sis
)
on
l
e
gs
,
a
rms
,
b
r
ea
sts
,
e
l
e
ph
a
nti
a
sis
(
e
l
e
ph
a
nti
a
sis skroti
)
ca
us
ed
b
y th
e
pr
e
s
e
n
ce
of
ad
ult worms on th
e
lymph
a
ti
c
syst
e
m
a
n
d b
y hippr
ec
ponsiv
e
r
eac
tions
I
n th
e
form of
Occ
ult
F
il
a
ri
a
sis
.
T
h
e
journ
e
y of th
e d
is
ea
s
e
is not
c
l
ea
r from on
e
st
ad
ium to th
e
n
e
xt st
a
g
e b
ut
W
h
e
n sort
ed
from th
e
in
c
u
ba
tion p
e
rio
d
it
ca
n
be d
ivi
ded
into
:
1
.
P
rim
a
ry p
e
rio
d
,
th
a
t is th
e
p
e
rio
d be
tw
ee
n inf
ec
tiv
e
l
a
rv
ae e
ntry to
T
h
e
o
cc
urr
e
n
ce
of mi
c
rofil
a
tion is
a
roun
d
37
months
.
J
ust p
a
rtly
from r
e
si
de
nts in
e
n
de
mi
c a
r
ea
s th
a
t
bec
om
e
mi
c
rofili
a
r
e
mi
c
s
,
a
n
d
from
this mi
c
rofil
a
r
e
mi
c
group is not
a
ll th
e
n shows
C
lini
ca
l symptoms
.
I
t
ca
n
be
s
ee
n th
a
t this group in
c
lu
de
s groups
A
symptom
a
ti
c a
mi
c
rophili
a
r
e
mi
c a
n
d a
symptom
a
ti
c
mi
c
rofil
a
m
e
nt
.
2
.
T
h
e
in
c
u
ba
tion p
e
rio
d
,
th
e
p
e
rio
d be
tw
ee
n th
e e
ntry of inf
ec
tiv
e
l
a
rv
ae
until it o
cc
urs
C
lini
ca
l symptoms r
a
ng
e
from
8
-
16
months
.
3
.
Ac
ut
e c
lini
c
symptoms
a
r
e
lymph
ade
nitis
a
n
d
lymph
a
ngitis
acc
omp
a
ni
ed b
y h
ea
t
a
n
d
m
a
l
a
is
e
.
T
h
e e
xpos
ed
gl
a
n
d
is usu
a
lly unil
a
t
e
r
a
l
.
Pa
ti
e
nt with
Ac
ut
e c
lini
ca
l symptoms
ca
n
be a
mi
c
rophili
a
r
a
n
d
mi
c
rofil
a
tion
.
4
.
C
h
a
t
S
ymptoms
,
o
cc
ur
10
-
15
y
ea
rs
a
ft
e
r th
e
first
ac
ut
e a
tt
ac
k
.
M
i
c
rofil
a
ri
a
s
e
s
a
r
e
r
a
r
e
ly foun
d a
t this st
a
g
e
,
wh
e
r
ea
s
Ade
nolimf
a
ngitis
ca
n still o
cc
ur
.
T
his y
ea
r
'
s
c
h
a
tty
ca
us
ed
th
e
o
cc
urr
e
n
ce
of
de
f
ec
ts th
a
t int
e
rf
e
r
e
with th
e ac
tiviti
e
s of suff
e
r
e
rs
a
n
d
w
e
igh on
f
a
mily
.
S
impl
e
physi
ca
l
a
n
d
supporting r
e
sults
(
o
b
j
ec
tiv
e
)
P
hysi
ca
l
e
x
a
min
a
tion
I
n
ac
ut
e
m
a
nif
e
st
a
tions
ca
n
be
foun
d
with lymph
a
ngitis
a
n
d
lymph
ade
nitis
whi
c
h l
a
sts
3
-
15
da
ys
,
a
n
d ca
n o
cc
ur s
e
v
e
r
a
l tim
e
s
a
y
ea
r
.
L
ymph
a
ngitis will
e
xp
a
n
d
th
e d
ist
a
l to th
e
gl
a
n
d
s
a
ff
ec
t
ed b
y th
e
pl
ace
T
his worm liv
e
s
.
L
ymph
a
ngitis
a
n
d
lymph
ade
nitis
de
v
e
lop mor
e
oft
e
n in
L
ow
e
r
e
xtr
e
miti
e
s r
a
th
e
r th
a
n
ab
ov
e
.
I
n
add
ition to th
e
lim
b
s
,
it
ca
n r
e
g
a
g
e
th
e
tool
Ge
n
de
r
, (
typi
ca
l sign of inf
ec
tion w
.
ba
n
c
rofti
)
a
n
d b
r
ea
sts
.
C
hroni
c
m
a
nif
e
st
a
tions
,
ca
us
ed b
y r
ed
u
ced
lymph
c
h
a
nn
e
l fun
c
tions
.
S
h
a
p
e
this m
a
nif
e
st
a
tion
ca
n o
cc
ur in s
e
v
e
r
a
l months to m
a
ny y
ea
rs from
Ac
ut
e e
piso
de
.
T
h
e
m
a
in
c
lini
ca
l sign is hy
d
ro
ce
l
e
,
lymf
ede
m
a
,
e
l
e
f
a
nti
a
sis
a
n
d
C
hyluri
a
is in
c
r
ea
sing
acc
or
d
ing to
a
g
e
.
Ge
nit
a
l m
a
nif
e
st
a
tions in m
a
ny
e
n
de
mi
c a
r
ea
s
,
c
hroni
c d
r
a
wings th
a
t o
cc
ur
is hy
d
ro
ce
l
e
.
I
n
add
ition
,
c
hroni
c e
p
ed
i
c
itis
ca
n
be
foun
d
,
funi
c
ulitis
,
ede
m
a
Beca
us
e
of th
e
thi
c
k
e
ning of th
e
skin of th
e
skin
,
whil
e
in wom
e
n
ca
n
be
foun
d
V
ulv
a
lymf
ede
m
a
.
L
imf
ede
m
a a
n
d E
l
e
f
a
nti
a
sis
E
xtr
e
miti
e
s
,
L
imf
ede
m
a E
piso
de
s
T
h
e e
xtr
e
miti
e
s will
ca
us
e e
l
e
f
a
nti
a
sis in th
e L
imf
e c
h
a
nn
e
l
a
r
ea
e
xpos
ed
in y
ea
rs
.
M
or
e
oft
e
n
e
xpos
ed
to low
e
r
e
xtr
e
miti
e
s
.
O
n w
.
ba
n
c
rofti
,
inf
ec
tion in th
e
thigh
a
n
d
low
e
r
e
xtr
e
mity
O
ft
e
n
,
whil
e B
.
Ma
l
a
yi is only
ab
out th
e
low
e
r lim
b
.
I
n th
e ac
ut
e
st
a
t
e
of
Ba
n
c
rofti fil
a
ri
a
sis inf
ec
tion
,
lymph v
e
ss
e
ls m
a
l
e
g
e
nit
a
ls
Me
n
a
r
e
oft
e
n
a
ff
ec
t
ed
,
follow
ed b
y funi
c
ulitis
,
e
pi
d
i
d
isitis
,
a
n
d
or
c
hitis
.
Ade
nolimf
a
ngitis
inguin
a
l or
a
xill
a
,
oft
e
n
a
long with lymph
a
ngitis r
e
trogr
ad
g
e
n
e
r
a
lly
c
ur
ed
its
e
lf in
3
-
15
da
ys
a
n
d a
tt
ac
ks o
cc
ur s
e
v
e
r
a
l tim
e
s
in
a
y
ea
r
.
I
n
B
rugi
a F
il
a
ri
a
sis
,
th
e
most fr
e
qu
e
nt lymph
ade
nitis r
e
g
a
r
d
ing
T
h
e
inguin
a
l gl
a
n
d
s oft
e
n o
cc
ur
a
ft
e
r working h
a
r
d
.
S
om
e
tim
e
s
acc
omp
a
ni
ed
Re
trogr
ad
lymph
a
ngitis
.
T
h
e
lymph v
e
ss
e
ls
bec
om
e
h
a
r
d a
n
d
p
a
in
a
n
d
oft
e
n o
cc
ur
L
imf
ede
m
a
on
a
nkl
e
s
a
n
d
l
e
gs
.
S
uff
e
r
e
rs
a
r
e
not
ab
l
e
to work
for s
e
v
e
r
a
l
da
ys
.
A
tt
ac
ks
ca
n o
cc
ur
12
x
/
y
ea
r to s
e
v
e
r
a
l
M
onthly tim
e
s
.
T
h
e a
ff
ec
t
ed
lymph gl
a
n
d ca
n
bec
om
e ab
s
ce
ss
,
b
r
ea
k
d
own
,
form
a
n ul
ce
r
a
n
d
l
ea
v
e a d
istin
c
tiv
e
gr
a
t
ed
,
a
ft
e
r
3
w
ee
ks
U
p to
3
months
.
I
n th
e ca
s
e
of th
e c
hroni
c
fil
a
ri
a
sis of th
e Ba
n
c
rofti
,
th
e
most foun
d
hy
d
ro
ce
l
e
.
L
imf
ede
m
a a
n
d e
l
e
f
a
nti
a
sis o
cc
ur in
a
ll upp
e
r lim
b
s
,
low
e
r lim
b
s
,
Sc
rotum
,
vulv
a
or
b
r
ea
sts
,
a
n
d
th
e
siz
e
of th
e e
nl
a
rg
e
m
e
nt in th
e
lim
b ca
n
be
3
tim
e
s
from th
e
origin
a
l siz
e
.
C
hyluri
a
o
cc
urs without
c
ompl
a
ints
,
b
ut on som
e
suff
e
r
e
rs
ca
us
e
w
e
ight loss
a
n
d
f
a
tigu
e
.
F
il
a
ri
a
sis
B
rugi
a
,
e
l
e
f
a
nti
a
sis o
cc
urs in th
e
low
e
r lim
b
un
de
r th
e
kn
ee a
n
d
th
e
for
ea
rm
,
A
n
d
th
e
siz
e
of
e
xtr
e
mity
e
nl
a
rg
e
m
e
nt is no mor
e
th
a
n
2
tim
e
s th
e
siz
e
of its origin
.
S
upport
1
.
Ide
ntify mi
c
rofil
a
ri
a
from
a b
loo
d
pr
e
p
a
r
a
tion
.
F
il
a
ri
a
worms
ca
n
be
foun
d
with thi
c
k or thin
b
loo
d e
xtr
ac
tion
a
t night
be
tw
ee
n
A
t
10
pm to
2
in th
e
morning
,
whi
c
h w
a
s post
ed
with
G
i
e
ms
a c
oloring
or
W
right
.
M
i
c
rofil
a
ri
a ca
n
a
lso
be
foun
d
on hy
d
ro
ce
l
e
flui
d
or
O
th
e
r
b
o
d
y flui
d
s
(
v
e
ry r
a
r
e
).
2
.
Ed
g
e b
loo
d c
h
ec
ks th
e
r
e a
r
e
l
e
uko
c
ytosis with
e
osinophili
a
until
10
-
30
%
with th
e
insp
ec
tion of
a
fing
e
r
b
loo
d
pr
e
p
a
r
a
tion t
a
k
e
n st
a
rting
a
t
20
.
00
lo
ca
l tim
e
.
3
.
I
f it is v
e
ry n
ece
ss
a
ry to
be d
on
e b
y
D
i
e
thyl
ca
r
ba
m
a
zin
e P
rovo
ca
tiv
e
t
e
st
.
D
i
a
gnosti
c E
nfor
ce
m
e
nt
(
A
ss
e
ssm
e
nt
)
C
lini
ca
l
d
i
a
gnosis
D
i
a
gnosis is
e
nfor
ced b
y
a
n
a
mn
e
sis
,
physi
ca
l
e
x
a
min
a
tion
a
n
d
I
nv
e
stig
a
tion of mi
c
rofil
a
ri
a
nt i
de
nti
ca
l support
.
I
n th
e e
n
de
mi
c a
r
ea
,
if th
e
r
e a
r
e
lymph
ede
m
e
s in th
e e
xtr
e
miti
e
s
acc
omp
a
ni
ed b
y m
a
l
e
g
e
nit
a
l
d
ist
a
n
ce
in suff
e
r
e
rs with mor
e a
g
e
th
a
n
15
y
ea
rs
,
if th
e
r
e
is no r
ea
son lik
e
tr
a
um
a
or
c
ong
e
stiv
e
h
ea
rt f
a
ilur
e
T
h
e
possi
b
ility of fil
a
ri
a
sis is v
e
ry high
.
D
i
a
gnosis of
A
pp
ea
l
1
.
Bac
t
e
ri
a
l inf
ec
tion
,
trom
b
ophl
eb
itis or tr
a
um
a ca
n
d
isrupt
ac
ut
e
fil
a
ri
a
sis
ade
nolimf
ade
nitis
2
.
T
u
be
r
c
ulosis
,
Le
prosy
,
Sa
r
c
oi
d
osis
a
n
d S
yst
e
mi
c D
is
ea
s
e G
r
a
nulom
a
tous
oth
e
r
.
C
ompli
ca
tions
E
nl
a
rg
ed
org
a
ns
(
l
e
gs
,
h
a
n
d
s
,
s
c
rotum or oth
e
r
b
o
d
y p
a
rts
)
L
imf
e c
h
a
nn
e
l o
b
stru
c
tion
.
C
ompr
e
h
e
nsiv
e Ma
n
a
g
e
m
e
nt
(
P
l
a
n
)
Ma
n
a
g
e
m
e
nt of
F
il
a
ri
a
sis th
e
r
a
py
a
ims to pr
e
v
e
nt or improv
e
tr
a
v
e
l
D
is
ea
s
e
,
a
mong oth
e
rs
b
y
:
1
.
Ma
int
a
in skin
c
l
ea
nlin
e
ss
.
2
.
P
hysioth
e
r
a
py is som
e
tim
e
s n
eeded
in
c
hroni
c
lymph
ede
m
e
s
.
3
.
T
h
e d
rug is
a D
i
e
thyl
Ca
r
ba
m
a
zin
e C
itr
a
t
e
(
DEC
)
a
n
d
iv
e
rm
ec
tin
(
T
his
d
rug is us
e
ful if giv
e
n in th
e ac
ut
e
ph
a
s
e
is wh
e
n th
e
p
a
ti
e
nt
e
xp
e
ri
e
n
ce
lymph
a
ngitis
).
4
.
Dec
or
ca
n kill mi
c
rofil
a
ri
a a
n
d ad
ult worms
.
I
v
e
rm
e
ktin
is
a
strong
a
ntimi
c
rophil
a
ri
a
,
b
ut h
a
s no
e
ff
ec
t
m
a
krofil
a
risi
da
.
5
.
D
os
a
g
e dec
6
mg
/
kg
bb
,
3
d
os
e
s
/
da
y
a
ft
e
r m
ea
ls
,
for
12
da
ys
,
on
T
ropi
ca
l
P
ulmon
a
ry
E
osinophyli
a
(
TPE
)
tr
ea
tm
e
nt is giv
e
n for thr
ee
w
ee
ks
.
6
.
S
i
de e
ff
ec
ts
ca
n o
cc
ur
a
s
a
r
eac
tion to
DEC
or r
eac
tion
a
g
a
inst
dead ad
ult worms
.
B
o
d
y r
eac
tion to th
e
prot
e
in
r
e
l
ea
s
ed
wh
e
n th
e
worms
d
i
e ca
n o
cc
ur s
e
v
e
r
a
l hours
A
ft
e
r tr
ea
tm
e
nt
,
2
forms m
a
y o
cc
ur
,
n
a
m
e
ly th
e
r
eac
tion
S
yst
e
mi
c a
n
d
lo
ca
l r
eac
tion
:
a
.
S
yst
e
mi
c
r
eac
tion in th
e
form of f
e
v
e
r
,
h
eadac
h
e
,
p
a
in
A
g
e
n
c
y
,
d
izzin
e
ss
,
a
nor
e
xi
a
,
m
a
l
a
is
e
,
da
nmunt
a
h
-
vomiting
.
S
yst
e
mi
c
r
eac
tion
t
e
n
d
to
be
r
e
l
a
t
ed
to th
e
int
e
nsity of inf
ec
tion
.
b
r
ea
kf
a
st
.
L
o
ca
l r
eac
tions in th
e
form of lymph
ade
nitis
,
ab
s
ce
ss
e
s
,
a
n
d
tr
a
nsi
e
nt
lymph
ede
m
e
s
.
L
o
ca
l r
eac
tions o
cc
ur slow
e
r
b
ut l
a
st long
e
r th
a
n
S
yst
e
mi
c
r
eac
tion
.
C
..
S
i
de e
ff
ec
ts of
dec
isiv
e dec
i
de
rs in on
c
hor
ce
r
c
isi
a
sis
,
so th
e d
rug is not giv
e
n in th
e
tr
ea
tm
e
nt progr
a
m
m
a
ss in th
e e
n
de
mi
c
fil
a
ri
a
sis with
c
o
-
e
n
de
mi
c
on
c
hor
ce
r
c
i
a
v
a
lvulus
.
7
.
O
v
e
r
eMec
tin is giv
e
n
a
singl
e d
os
e
of
150
UG
/
K
g
BB e
ff
ec
tiv
e
ly
a
g
a
inst
dec
r
ea
s
e
in th
e de
gr
ee
of mi
c
rophil
a
ri
a
w
ba
n
c
rofti
,
b
ut in fil
a
ri
a
sis
b
y
B
rugi
a
spp
.
T
h
e dec
r
ea
s
e
is gr
ad
u
a
l
.
I
v
e
rm
ec
tin si
de e
ff
ec
ts
e
qu
a
l to
Dec
,
th
e c
ontr
a
in
d
i
ca
tion of th
e
iv
e
rm
ec
tiv
e
n
e
ss is
a
pr
e
gn
a
nt wom
a
n
a
n
d
C
hil
d
r
e
n l
e
ss th
a
n
5
y
ea
rs
.
Beca
us
e
it h
a
s no
e
ff
ec
t on worms
Ad
ults
,
iv
e
rm
ec
tin must
be
giv
e
n
e
v
e
ry
6
months or
12
months for
Ma
int
a
ining th
e de
gr
ee
of mi
c
rofil
a
r
e
mi
a
r
e
m
a
ins low
.
8
.
P
rovision of
a
nti
b
ioti
c
s
a
n
d
/
or
a
ntifung
a
l will r
ed
u
ce a
tt
ac
ks
Re
p
ea
t
,
thus pr
e
v
e
nting
c
hroni
c
lymph
ede
m
e
s
.
9
.
A
ntihist
a
min
e
s
a
n
d c
orti
c
ost
e
roi
d
s
a
r
e
n
eeded
to
add
r
e
ss si
de e
ff
ec
ts
tr
ea
tm
e
nt
.
A
n
a
lg
e
si
c
s
ca
n
be
provi
ded
if n
eeded
.
10
.
O
p
e
r
a
tiv
e
tr
ea
tm
e
nt
,
som
e
tim
e
s
c
hroni
c
hy
d
ro
ce
ls r
e
quir
e ac
tion
O
p
e
r
a
tiv
e
,
a
s w
e
ll
a
s
C
hyluri
a
who
d
i
d
not improv
e
with th
e
r
a
py
c
ons
e
rv
a
tiv
e
.
C
ouns
e
ling
a
n
d ed
u
ca
tion
P
rovi
de
inform
a
tion to p
a
ti
e
nts
a
n
d
th
e
ir f
a
mili
e
s r
e
g
a
r
d
ing
d
is
ea
s
e
F
il
a
ri
a
sis
,
e
sp
ec
i
a
lly th
e
imp
ac
t of th
e d
is
ea
s
e a
n
d
th
e
w
a
y of tr
a
nsmission
.
Pa
ti
e
nt
a
n
d
Fa
mili
e
s must
a
lso un
de
rst
a
n
d
th
e
pr
e
v
e
ntion
a
n
d c
ontrol of
d
is
ea
s
e
T
h
e
s
e c
ont
a
gious through
:
1
.
E
r
ad
i
ca
tion of
ad
ult mosquito
e
s
2
.
E
r
ad
i
ca
tion of mosquito l
a
rv
ae
3
.
P
r
e
v
e
nt mosquito
b
it
e
s
F
ollow up pl
a
n
A
ft
e
r tr
ea
tm
e
nt
,
r
e
-
c
ontrol th
e
symptoms
a
n
d
mi
c
rofil
a
ri
a
,
if th
e
r
e a
r
e
still symptoms
a
n
d
mi
c
rofil
a
ri
a
s
e
s on th
e
ir
b
loo
d
t
e
sts
,
T
r
ea
tm
e
nt
ca
n l
a
st
6
months l
a
t
e
r
.
Re
f
e
r
e
n
ce c
rit
e
ri
a
Pa
ti
e
nts
a
r
e
r
e
f
e
rr
ed
to if op
e
r
a
tiv
e
tr
ea
tm
e
nt is n
eeded
or if symptoms
d
o not
I
mprov
ed
with
c
ons
e
rv
a
tiv
e
tr
ea
tm
e
nt
.
E
quipm
e
nt
Lab
or
a
tory
e
quipm
e
nt for mi
c
rofil
a
ri
a
nt
e
x
a
min
a
tion
.
P
rognosis
P
rognosis in g
e
n
e
r
a
l
d
o
e
s not thr
ea
t
e
n th
e
liv
e
s
.
Q
uo
ad
fun
c
tion
a
m is
D
u
b
i
a ad B
on
a
m
,
whil
e
quo
ad
s
a
n
a
tion
a
m is night
.
T
h
e
prognosis of this
d
is
ea
s
e de
p
e
n
d
s on
:
1
.
Ad
ult
Cac
ing
ad
ults
a
n
d
mi
c
rofil
a
ri
a
s
e
s in th
e
p
a
ti
e
nt
'
s
b
o
d
y
.
2
.
P
ot
e
nti
a
l worms to
b
r
eed
.
3
.
O
pportunity for r
e
-
inf
ec
tion
.
4
.
r
e
s
ac
tiviti
e
s
.
I
n
ea
rly
a
n
d
m
ed
ium
ca
s
e
s
,
th
e
prognosis is
e
ith
e
r
e
sp
ec
i
a
lly if th
e
p
a
ti
e
nt
M
ov
e
from th
e e
n
de
mi
c a
r
ea
.
T
h
e
sup
e
rvision of th
e e
n
de
mi
c a
r
ea ca
n
d
on
e b
y
ad
minist
e
ring
d
rugs
a
n
d e
r
ad
i
ca
ting v
ec
tors
.
O
n th
e
F
urth
e
r
ca
s
e
s
e
sp
ec
i
a
lly with
ede
m
a
in l
e
gs
,
mor
e
prognosis
bad
.
