Acute attacks in the extremities of persons living in an area endemic for bancroftian filariasis: differentiation of two syndromes

The natural history of lymphatic disease in human filariasis remains unclea r, but recurrent episodes of acute lymphangitis are believed to constitute a major risk factor for the development of chronic lymphoedema and elephant iasis. Prospective analysis of 600 patients referred to the filariasis clin ic of the Centro de Pesquisas Aggeu Magalhaes/FIOCRUZ in Recife, Brazil, in dicated that 2 distinct acute syndromes accompanied by lymphangitis occur i n residents of this filariasis-endemic area. One syndrome, which we call ac ute filarial lymphangitis (AFL), is caused by the death of adult worms. It is relatively uncommon in untreated persons, usually is asymptomatic or has a mild clinical course, and rarely causes residual lymphoedema. The second syndrome, of acute dermatolymphangioadenitis (ADLA), is not caused by fila rial worms per se, but probably results from secondary bacterial infections . ADLA is a common cause of chronic lymphoedema and elephantiasis in Recife as well as in other areas of Brazil where lymphatic filariasis is not pres ent. The syndromes of AFL and ADLA can be readily distinguished from each o ther by simple clinical criteria.