[Rational for morbidity management in bancroftian filariasis endemic areas]

Selection of the most appropriate therapy for the patient with bancroftian filariasis requires a knowledge of the diverse clinical characteristics of filarial disease and their pathogenesis. As a result of new diagnostic tests and clinical advances, our understanding of bancroftian filariasis has changed rapidly, as have our ideas about treatment. In the past, it was believed that elephantiasis was caused by an immunologic reaction of the host to the filarial parasite. From this perspective, elephantiasis was seen as the endpoint of an unalterable relationship between the host and the parasite, and given the absence of effective medication or procedures, affected individuals were considered "immunologically predisposed" to this end-stage disease. In the last few years, however, new evidence has suggested that lymphedema and elephantiasis have another etiologic agent. Namely, the principal factor in the evolution of lymphedema and elephantiasis is the involvement of recurrent secondary bacterial infections. Today, it is clear that other forms of supportive therapy (including education and psychological counseling) are necessary and are often more important than antiparasitic drugs.