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DUPLEX DOPPLER SONOGRAPHIC ASSESSMENT OF THE EFFECTS OF DIETHYLCARBAMAZINE AND ALBENDAZOLE THERAPY ON ADULT FILARIAL WORMS AND ADJACENT HOST TISSUES IN BANCROFTIAN FILARIASIS

We used duplex Doppler sonography to assess effects of diethylcarbamazine and albendazole therapy (DEC/ALB) on adult Wuchereria bancrofti in vivo. The study was performed in clinically normal Egyptian adults with blood microfilaria counts > 80/mL. Motile adult worms were observed before treatment in dilated scrotal lymphatic vessels in 28 of 36 men (78%) and over the proximal extremities in 5 of 22 women (23%). Most worm nests were inactivated in the months following treatment (90% at 12 months). Circulating filarial antigen levels (a marker for living adult worms) also fell dramatically following treatment. Some men had intrascrotal calcifications and/or non-palpable hydroceles detectable by ultrasound before they were treated. New hydroceles and intrascrotal calcifications appeared after treatment in many cases. However, most of these were transient and of no clinical significance. Prevelance rates for hydrocele and intrascrotal calcifications 24 months after treatment were essentially the same as those prior to treatment. These results show that DEC/ALB is highly active against adult W. bancrofti. They also suggest that host responses to dying adult worms are important in the pathogenesis of filarial hydroceles.

Received April 15, 2004. Accepted for publication June 16, 2004.

Acknowledgments: We are grateful for technical assistance provided by the field research teams and laboratory staff at the Research and Training Center on Vectors of Diseases at Ain Shams University. The late Professor Rifky Faris helped to plan this study.

Financial support: This work was supported by National Institutes of Health grant AI-35855.

Authors’ addresses: Omar Hussein and Maged El Setouhy, Faculty of Medicine, Ain Shams University, Abbassia, Cairo, Egypt. Telephone and Fax: 20-2-683-9622. Ehab S. Ahmed, Amr M. Kandil, Reda M. R. Ramzy, and Hanan Helmy, Research and Training Center on Vectors of Diseases, Faculty of Science Building, Ain Shams University, Abbassia, Cairo, Egypt, Telephone and Fax: 20-2-6839622. Gary J. Weil, Infectious Diseases Division, Department of Internal Medicine, Washington University School of Medicine, Campus Box 8051, 660 South Euclid Avenue, St. Louis, MO 63110, Telephone: 314-454-7782, Fax: 314-454-5293, E-mail: gweil{at}im.wustl.edu.

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