Surgical approaches to the urogenital manifestations of lymphatic filariasis

Overview

Lymphatic filariasis is currently endemic in 80 countries, in the tropics and sub-tropics. The disease has been targeted for global elimination by 2020. Transmission control and disability alleviation are the two pillars of the elimination strategy under the Global Programme for Elimination of Lymphatic Filariasis (GPELF).

Interruption of transmission is being achieved by mass annual administration of diethylcarbamazine (DEC) or ivermectin to entire communities at risk of infection. When community drug consumption rates are adequate, this is expected to result in reduction of transmission of lymphatic filariasis to low levels, and ultimately in elimination of filariasis, preventing new infections from occurring and protecting future generations from the disease.

Recognizing the physical suffering, gross disfigurement and consequent socioeconomic impact due to lymphoedema (particularly limbs), and the fact that simple foot hygiene can result in prevention of repeated attacks of acute adenolymphangitis (ADL) and progression of lymphoedema, efforts are being taken to teach patients and their families skin care and simple measures of hygiene.

It is realized that a disability alleviation strategy needs to be evolved for lymphatic filariasis patients who suffer from several urogenital manifestations, the burden of which is larger than that due to lymphoedema of limbs. In view of this, the WHO unit for Strategy Development and Monitoring for Eradication and Elimination (CEE) called for an informal consultation meeting of surgeons to address the issue of surgical management of urogenital manifestations of filariasis.