BACTERIOLOGICAL STUDIES OF SKIN, TISSUE-FLUID, LYMPH, AND LYMPH-NODESIN PATIENTS WITH FILARIAL LYMPHEDEMA

Filarial lymphedema is complicated by frequent episodes of dermatolymp hangioadenitis (DLA). It is not certain whether DLA is of filarial or bacterial etiology. The frequency of episodic DLA does not depend on t he presence or absence of microfilariae. Antibiotic therapy is effecti ve in prevention and treatment of DLA. These observations point to the bacterial rather than filarial etiology of DLA. Skin and lymph node b iopsies, tissue fluid, lymph, and blood from patients with chronic fil arial lymphedema, and during acute episodes of DLA, were cultured for detection of bacteria. A high prevalence of bacterial isolates from th e tissue fluid (64%), lymph (75%), and inguinal lymph nodes (66%) of l imbs with filarial lymphedema was found. Bacillus cereus, Staphylococc us epidermidis, S. hominis, S. capitis, S. xylosus, and Micrococcus sp p. were the most common isolates. Bacteria were also isolated from the blood of patients with recent episodes of DLA, with strains of the sa me phenotype and antibiotic sensitivity in all specimens from patients with DLA. Bacterial strains of the same phenotype and antibiotic sens itivity were documented on the toe web surface and in tissue fluid (25 %), lymph (26%), or lymph nodes (41%). Increasing prevalence of bacter ial isolates in tissue fluid, lymph, and lymph nodes was observed in a dvanced stages of lymphedema. Bacilli and cocci were sensitive to gent amicin, tetracyline, rifampicin, vancomycin, kanamycin and cotrimoxazo le, and least sensitive to penicillin. Blood cultures of patients in t he periods between DLA attacks were negative. In healthy controls with out edema and episodes of DLA, tissue fluid did not contain bacteria. In lymph, only single colonies of Micrococcus and Acinetobacter were c ultured in 12% of the cases. Impaired lymph drainage and lack of elimi nation of penetrating bacteria may be responsible for progression of l ymphedema and recurrent attacks of DLA.