FILARIASIS AND ERISIPELA IN SANTO-DOMINGO

This study examined acute-convalescent changes in diagnostic anti-stre ptococcal antibodies by the anti-streptolysin O (ASO) and anti-DNAase B (ADAB) tests among patients (n = 28) with lymphedema and recurrent e risipela of the lower limb, comparing them with endemic normal control residents (n = 25). The study was based in Villa Francisca, an urban focus of Bancroftian filariasis in eastern Santo Domingo, capital of t he Dominican Republic. The acute signs and symptoms of erisipela were consistent with a diagnosis of bacterial cellulitis. The ASO test was especially successful at demonstrating a rise in mean titer during con valescence, whereas the ADAB produced about the same frequency of sign ificant increases (0.2 log titer) as did the ASO. When subjects were s cored as responders if mounting a minimal titer increase by either les t, patients were found more frequently positive than were controls (X- 2 = 5.3, P = 0.02). About half (54%) of all patients mounted at least a minimal antibody increase. Filaria-specific IgG(4) antibodies were a bsent from all sera of 20 residents of a nonendemic Dominican mountain town but appeared in about two-thirds of the sampled residents of the endemic barrio. Notably however, levels did not change between the ac ute phase and convalescence. These findings are consistent with the hy pothesis that recurrent streptococcal invasion of the lymphatics may b e a significant factor triggering or amplifying lymphedema and elephan tiasis in patients with chronic filariasis.