title: Proposed panel of diagnostic criteria, including the use of ultrasound, to refine the concept of 'endemic normals' in lymphatic filariasis.
abstract: Although living adult Wuchereria bancrofti worms can be detected by ultrasound examination of the scrotal area in approximately 80% of men infected with this filarial parasite, the location of the adult worms in the remaining 20% remains unclear. To determine this, 32 individuals who had W. bancrofti microfilaraemia but no adult worms detectable on ultrasound were treated with diethylcarbarmazine (DEC), either with a single 6 mg/kg dose (n = 13) or with a 12-day course of 6 mg/kg per day (n = 19). They were then monitored with serial physical and ultrasound examinations. Thirteen (41%) subjects developed small, single scrotal nodules 12 h to 7 days after treatment; this rate was unaffected by the dose of DEC. No nodules were detected outside the scrotal area. All 5 men with lymphangiectasia suspected on ultrasound before treatment developed scrotal nodules, compared to 8 (29.6%) of 27 men without ultrasonographic evidence (P = 0.006). Thus, using both ultrasound and 'provocative' treatment with DEC, adult W. bancrofti can be detected in the scrotal area of an estimated 88% of infected men. Because no single diagnostic test for W. bancrofti infection is completely sensitive, a panel of tests, including ultrasound, is proposed to identify with greater accuracy 'endemic normals' for immunological and epidemiological studies.
authors.affiliation: Departamento de Parasitologia, Centro de Pesquisas Aggeu Magalhaes-FIOCRUZ, Universidade Federal de Pernambuco, Recife, Brazil.
authors.forename: G
authors.initials: G
authors.lastname: Dreyer
authors.forename: A
authors.initials: A
authors.lastname: Santos
authors.forename: J
authors.initials: J
authors.lastname: Noroes
authors.forename: D
authors.initials: D
authors.lastname: Addiss
mesh_terms: D000328:Adult; D000818:Animals; D004049:Diethylcarbamazine / Q000627:therapeutic use; D004605:Elephantiasis, Filarial / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000188:drug therapy; D005369:Filaricides / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D012611:Scrotum / Q000000981:diagnostic imaging / Q000469:parasitology; D012680:Sensitivity and Specificity; D014463:Ultrasonography; D014958:Wuchereria bancrofti / Q000302:isolation & purification*
chemical_list: D005369:Filaricides; D004049:Diethylcarbamazine