Lymphatic filariasis in children: Adenopathy and its evolution in two young girls

Lymphatic filariasis is a widespread infectious disease of children in ende mic areas, but little is known about the early lymphatic damage in children and its evolution, either with or without treatment. Two girls (ages 6 and 12 years) from a Wuchereria bancrofti endemic region of Brazil presented w ith chronic inguinal adenopathy. Neither had microfilaremia. By ultrasound both were shown to have living adult worms in their enlarged inguinal nodes and had occult local lymphatic damage (lymphangiectasis). One girl spontan eously developed acute adenitis in the affected node prior to any intervent ion; this adenitis resolved within 10 days and was associated with the prog ressive disappearance over 45-90 days of all local abnormalities detectable by ultrasound. In the other child, after treatment with a single dose of d iethylcarbamazine (DEC), the same clinical picture of transient adenitis an d resolving abnormalities (detectable by ultrasound) occurred. These findin gs demonstrated filariasis as the cause of adenopathy in children, and also both spontaneous and treatment-induced worm-death, with subsequent reversa l of lymphatic abnormalities.