IMMUNE DYNAMICS IN THE PATHOGENESIS OF HUMAN LYMPHATIC FILARIASIS

Despite the longstanding recognition of the spectral nature of human d isease due to lymphatic filariasis, immunologists interested in pathog enesis have mostly examined patients classified as being at either one extreme pole or the other. While the clinically asymptomatic individu als with microfilaremia who sit at one pole always have active infecti on, it has been difficult to define who else on the clinical spectrum is actively infected with living adult worms. In this review, David Fr eedman discusses how the ability to measure circulating filarial antig en in patient serum has advanced our ability to understand the immunop athogenesis of lymphatic filariasis by improving the precision of pati ent classification. Recent work suggests that the presence (or absence ) of antigenemia, rather than overt clinical manifestations of disease , is closely associated with specific cytokine responses. A framework for patient classification based on these findings is proposed.