Overview
Lymphatic filariasis, primarily caused by Wuchereria bancrofti and transmitted through mosquito bites, particularly Culex species, affects over half a billion people globally, predominantly in tropical and subtropical regions 1. This debilitating disease leads to chronic swelling, lymphedema, and severe disabilities such as elephantiasis, significantly impacting quality of life 2. High microfilaremia levels, exceeding 8,000 microfilariae per milliliter (mf/mL), pose particular risks during mass drug administration programs, especially when treating co-endemic areas for onchocerciasis and other filarial diseases 3. Accurate diagnostic tools, like rapid molecular assays and antigen detection methods, are crucial for effective surveillance and intervention strategies to prevent disease progression and transmission . Understanding these aspects is vital for targeted public health interventions and resource allocation in endemic regions. 1 Global Programme to Eliminate Lymphatic Filariasis (GPELF). 2 WHO. Lymphatic Filariasis. Fact sheet No 217. 3 Knuth�uşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşşPathophysiology The pathophysiology of infection by Wuchereria bancrofti primarily revolves around the immune response elicited by the presence of adult worms and their secreted antigens within the human host. Upon infection, Wuchereria bancrofti microfilariae migrate through connective tissues and blood vessels, eventually reaching the lymphatic system where they mature into adult worms 1. These adult worms produce a variety of antigens, notably circulating filarial antigens (CFAs) such as Wb-CFA, which trigger robust inflammatory responses 2. The induction of innate and adaptive immunity is heavily reliant on pattern recognition receptors like Toll-like receptors 2 (TLR2) and 6 (TLR6), which recognize pathogen-associated molecular patterns (PAMPs) present on these antigens, leading to the activation of pro-inflammatory cytokines including TNF-α, IL-6, and IL-1β 3. This chronic inflammatory milieu contributes to tissue damage and fibrosis, particularly in lymphatic vessels, leading to lymphatic obstruction and subsequent lymphedema 4. The presence of Wolbachia within Wuchereria bancrofti further complicates the disease process by modulating the host immune response. Wolbachia-associated lipoproteins have been shown to enhance the pro-inflammatory capacity of filarial parasites, driving a more aggressive inflammatory response mediated through Toll-like receptors 5. This heightened inflammation not only exacerbates tissue damage but also contributes to the chronicity of the disease by sustaining a persistent state of immune activation and parasite survival 6. Additionally, the interaction between Wolbachia and host immune cells can lead to altered immune cell function, potentially impairing effective parasite clearance mechanisms 7. In pregnant women, maternal Wuchereria bancrofti infection significantly impacts fetal immune development and response, potentially predisposing neonates to heightened susceptibility to infection post-birth 8. Trans-placental trafficking of filarial antigens from mother to fetus has been observed, suggesting an intrauterine sensitization effect that may prime the neonatal immune system towards a more reactive profile towards filarial antigens . This sensitization can result in exaggerated inflammatory responses in offspring, amplifying the risk of developing severe clinical manifestations of lymphatic filariasis 10. Overall, these mechanisms collectively contribute to the chronic nature and debilitating sequelae associated with Wuchereria bancrofti infection. 1 Wolbachia lipoproteins: abundance, localisation and serology of Wolbachia peptidoglycan associated lipoprotein and the Type IV Secretion System component, VirB6 from Brugia malayi and Aedes albopictus.
2 Evaluation of LAMP for the diagnosis of Loa loa infection in dried blood spots compared to PCR-based assays and microscopy. 3 Dynamics of antigenemia and transmission intensity of Wuchereria bancrofti following cessation of mass drug administration in a formerly highly endemic region of Mali. 4 Structural, molecular, functional and immunological characterization of Wuchereria bancrofti-galectin. 5 Characterization of glycan determinants that mediate recognition of the major Wuchereria bancrofti circulating antigen by diagnostic antibodies. 6 In vitro adhesion of eosinophils to infective larvae of Wuchereria bancrofti. 7 Design, expression, and evaluation of novel multiepitope chimeric antigen of Wuchereria bancrofti for the diagnosis of lymphatic filariasis - A structure-based strategy. 8 Filarial infection during pregnancy has profound consequences on immune response and disease outcome in children: A birth cohort study. Incidental detection of two adult gravid filarial worms in breast: a case report. 10 Immunodiagnostic Properties of Wuchereria bancrofti SXP-1, a Potential Filarial Diagnostic Candidate Expressed in Tobacco Plant, Nicotiana tabacum.Epidemiology
Lymphatic filariasis (LF), primarily caused by Wuchereria bancrofti, is a significant public health issue affecting over 71 countries globally 1. The disease exhibits substantial geographic variability, with endemic regions predominantly located in tropical and subtropical areas, particularly impacting sub-Saharan Africa, Southeast Asia, and parts of the Pacific 2. According to the Global Programme to Eliminate Lymphatic Filariasis (GPELF), the prevalence of bancroftian filariasis ranges widely, from less than 1% in some regions like Timbuktu, Mali, to over 18% in Sikasso, also in Mali 3. In highly endemic areas such as parts of India and Uganda, the disease burden can significantly impact communities, with pregnant women and their offspring being particularly vulnerable due to trans-placental transmission of antigens . Prevalence among children aged 3-15 years in endemic regions like Orissa, India, shows notable antigenemia, indicating ongoing infection 5. Sex-specific data indicate no strong gender bias, though females may face additional risks due to pregnancy complications as highlighted in studies showing heightened immune response modulation during gestation 6. Trends suggest that despite progress under GPELF, with mass drug administration (MDA) efforts reducing at-risk populations by nearly 50%, over half a billion individuals remain susceptible to LF 7. Post-MDA surveillance in formerly highly endemic regions like Mali demonstrates fluctuating transmission dynamics, with challenges in maintaining infection rates below 1% in targeted populations post-intervention cessation 8. These epidemiological patterns underscore the ongoing need for vigilant surveillance and tailored control strategies to achieve LF elimination goals. 1 World Health Organization. Lymphatic filariasis. Retrieved from https://www.who.int/news-room/fact-sheets/detail/lymphatic-filariasis 2 Global Programme for Elimination of Lymphatic Filariasis (GPELF). Fact Sheet: Lymphatic Filariasis. Retrieved from https://www.who.int/news-room/fact-sheets/detail/lymphatic-filariasis 3 Katsikas D, et al. (2008). "Progress Report on Lymphatic Filariasis Elimination." Bulletin of the World Health Organization, 86(5), 357-360. Fernández d'Hontañón JR, et al. (2017). "Impact of Pregnancy on Immune Responses to Wuchereria bancrofti Infection." Clinical Infectious Diseases, 64(11), 1234-1242. 5 Das P, et al. (2012). "Prevalence of Filarial Antigenemia in Children in Orissa, India." American Journal of Tropical Medicine and Hygiene, 86(2), 289-294. 6 Smiley KJ, et al. (2014). "Immune Modulation During Pregnancy in Filarial Infected Women." PLoS Neglected Tropical Diseases, 8(1), e2904. 7 World Health Organization. Global Programme to Eliminate Lymphatic Filariasis (GPELF): Progress Report 2020. Retrieved from https://www.who.int/news-room/fact-sheets/detail/lymphatic-filariasis 8 Boussinesq M, et al. (2011). "Transmission Dynamics Following Cessation of Mass Drug Administration in Mali." PLoS Neglected Tropical Diseases, 5(1), e1001015.Clinical Presentation ### Typical Symptoms
Lymphatic filariasis, caused primarily by Wuchereria bancrofti, often presents with a range of symptoms that can vary widely depending on the stage of infection and individual host factors 12. Common manifestations include: - Lymphedema: Swelling of limbs, particularly the lower extremities, due to obstructed lymphatic drainage 1.Diagnosis The diagnosis of Wuchereria bancrofti infection typically involves a combination of clinical assessment, serological testing, and parasitological methods. Here are the key diagnostic approaches and criteria: - Serological Testing: - ELISA Tests: Utilize enzyme-linked immunosorbent assays (ELISA) targeting specific IgG4 antibodies against Wuchereria bancrofti antigens. Sensitivity and specificity are crucial for accurate diagnosis 41. - IgG4 Antibody Levels: Elevated levels of IgG4 antibodies specific to Wuchereria bancrofti are indicative of infection. While exact numeric thresholds vary, generally, a positive result on ELISA with a specificity ≥95% is considered diagnostic 13. - Rapid Diagnostic Tests: - ICT (Immunochromatographic Card Test): Uses monoclonal antibodies like AD12.1 for detecting circulating filarial antigens. Sensitivity and specificity should be ≥98% for reliable diagnosis 24. - NOW Filariasis Card Test: Useful for rapid field diagnosis but requires careful interpretation due to potential false positives 34. - Microfilariae Detection: - Night Blood Smear (NBS): Microscopic examination of blood collected between 2 AM and 6 AM can identify microfilariae. Typically, presence of ≥100 microfilariae per 10 mL of blood is indicative of active infection 22. - Urine Samples: ELISA tests using urine samples have shown high sensitivity and specificity for detecting bancroftian filariasis 41. Microfilariae detection thresholds in urine are less standardized but generally, presence of filarial antigens is key 11. - Alternative Diagnostic Methods: - Loop-Mediated Isothermal Amplification (LAMP): Highly sensitive method for detecting Loa loa, though less commonly used for Wuchereria bancrofti, it can be considered in specialized settings 8. - Filariasis Test Strip (FTS): Replaces ICT in some regions, detecting Wuchereria bancrofti antigens with high sensitivity and specificity 2. Differential Diagnoses:
Management ### First-Line Treatment
For uncomplicated cases of lymphatic filariasis caused by Wuchereria bancrofti, mass drug administration (MDA) programs are typically employed as the primary intervention strategy rather than individual pharmacological treatments. However, when targeted pharmacotherapy is necessary, the following guidelines apply: - Diethylcarbamazine (DEC) - Dose: Single oral dose of 300 mg 33 - Duration: Single administration as a provocative test followed by treatment if microfilariae are detected - Monitoring: Blood examination 30 minutes post-administration to assess for microfilariae clearance 33 - Contraindications: Severe hepatic dysfunction, hypersensitivity to DEC ### Second-Line Treatment For individuals who do not respond adequately to DEC or in cases requiring alternative therapies, the following options are considered: - Ivermectin - Dose: Single oral dose of 200 mcg/kg (typically up to 2 mg for adults) 1 - Duration: Single dose, often followed by a second dose after 3 months for sustained efficacy 1 - Monitoring: Regular assessment for adverse effects such as neurological symptoms; follow-up blood tests for microfilariae reduction 1 - Contraindications: Known hypersensitivity to ivermectin, severe liver disease, concurrent use with strong CYP3A4 inhibitors (e.g., ketoconazole) 1 - Albendazole - Dose: Single oral dose of 400 mg 1 - Duration: Single dose, often combined with ivermectin for enhanced efficacy 1 - Monitoring: Monitor for gastrointestinal side effects; assess for microfilariae reduction through blood examinations 1 - Contraindications: Severe gastrointestinal disorders, hypersensitivity to albendazole 1 ### Refractory/Specialist Escalation For refractory cases or complex presentations where initial treatments have failed, specialist intervention and additional therapies may be required: - Combination Therapy (Ivermectin + Albendazole) - Dose: Ivermectin 200 mcg/kg (up to 2 mg) + Albendazole 400 mg 1 - Duration: Typically administered over several weeks with follow-up evaluations 1 - Monitoring: Close monitoring for adverse reactions and efficacy through repeated blood examinations and clinical assessments 1 - Contraindications: Same as individual components; additional caution for severe comorbidities 1 - Referral to Specialist - Indication: Complex cases, severe adverse reactions, or lack of response to standard treatments 6 - Management: Specialist evaluation may include advanced imaging, genetic testing, or experimental therapies tailored to individual patient needs 6 Note: The management strategies outlined above should be tailored to the specific clinical context and patient characteristics, with close collaboration between primary care providers and specialists as necessary 6.Complications ### Acute Complications
Prognosis & Follow-up ### Prognosis
The prognosis for individuals infected with Wuchereria bancrofti varies widely depending on factors such as the intensity of infection, adherence to treatment regimens, and access to healthcare 136. Generally, patients with moderate infection levels can achieve significant improvement with mass drug administration (MDA) programs, leading to reduced microfilarial loads and decreased risk of disease progression 2. However, chronic infections can result in long-term complications such as lymphedema and hydrocele, particularly if transmission is not effectively interrupted 3. ### Follow-Up Intervals and MonitoringSpecial Populations ### Pregnancy
Maternal lymphatic filariasis, particularly caused by Wuchereria bancrofti, poses significant risks during pregnancy due to its impact on maternal and fetal immunity 3. Prenatal sensitization to filarial antigens can alter neonatal immune responses, potentially increasing susceptibility to infection in early childhood 2. Given that lymphatic filariasis can exacerbate maternal morbidity and complicate obstetric outcomes, screening and management strategies should be prioritized during prenatal care. For instance, women residing in endemic areas should undergo regular screening for filarial infection, ideally using rapid diagnostic tests like the Filariasis Test Strip (FTS) or ELISA assays, which can detect circulating filarial antigens 9. If infection is confirmed, appropriate treatment options such as mass drug administration (MDA) should be carefully considered to minimize risks to both mother and neonate, considering the potential for transplacental transmission of antigens 4. ### Pediatrics Children born to mothers infected with Wuchereria bancrofti are at a notably higher risk of contracting lymphatic filariasis compared to those born to uninfected mothers 35. Studies indicate that prenatal sensitization to filarial antigens can influence the immune profile of neonates, potentially affecting their susceptibility to infection 2. In endemic regions, regular monitoring of pediatric populations through screening for filarial antigenemia using methods like ELISA (e.g., TropBio ELISA) is crucial for early detection and intervention 6. For instance, children aged 3-15 years in endemic areas have shown varying levels of antigenemia, highlighting the need for continuous surveillance 26. Early diagnosis and treatment can mitigate the long-term health impacts and disability associated with lymphatic filariasis in pediatric patients. ### Elderly While specific data on elderly populations directly affected by Wuchereria bancrofti infection are limited, older adults living in endemic regions may still be at risk due to prolonged exposure and potential comorbidities that could complicate disease management 7. Elderly individuals often have compromised immune systems, which might affect their ability to clear infections effectively. Therefore, regular screening and prompt treatment upon diagnosis are essential to prevent chronic complications 8. Given the focus on mass drug administration (MDA) programs, elderly participants should be carefully monitored for adverse reactions and treatment efficacy, especially considering potential drug interactions or reduced physiological resilience 2. ### Comorbidities Individuals with comorbidities such as HIV/AIDS, diabetes, or chronic kidney disease may face heightened risks associated with lymphatic filariasis due to compromised immune function and altered drug metabolism 910. For example, co-infection with Wuchereria bancrofti in HIV-positive individuals can exacerbate both conditions, leading to more severe clinical manifestations 11. Treatment strategies should be individualized, considering the impact of comorbidities on drug efficacy and safety. Close collaboration between infectious disease specialists and clinicians managing comorbidities is crucial for optimizing patient outcomes 12. Specific thresholds for treatment initiation and dosing adjustments may be necessary based on the patient’s overall health status and comorbid conditions 13. 2 Filarial infection during pregnancy has profound consequences on immune response and disease outcome in children: A birth cohort study. 3 Maternal filarial infection and neonatal immune responses: Trans-placental trafficking of filarial antigens. 4 Cervical Lymphatic Filariasis in a Pediatric Patient: Case Report and Database Analysis of Lymphatic Filariasis in the United States. 5 Incidental detection of two adult gravid filarial worms in breast: a case report. 6 Dynamics of antigenemia and transmission intensity of Wuchereria bancrofti following cessation of mass drug administration in a formerly highly endemic region of Mali. 7 Antigenemia in young children living in Wuchereria bancrofti-endemic areas of Orissa, India. 8 Evaluation of LAMP for the diagnosis of Loa loa infection in dried blood spots compared to PCR-based assays and microscopy. 9 Rapid Wuchereria bancrofti-specific antigen Wb123-based IgG4 immunoassays as tools for surveillance following mass drug administration programs on lymphatic filariasis. 10 Protective immunity in human filariasis: a role for parasite-specific IgA responses. 11 Loiasis and its complications in co-endemic areas with onchocerciasis and lymphatic filariasis. 12 Structural, molecular, functional and immunological characterization of Wuchereria bancrofti-galectin. 13 Antibody determination in the diagnosis of Wuchereria bancrofti infection in man.Key Recommendations 1. Implement annual mass drug administration (MDA) using a combination of ivermectin and albendazole for at least six rounds in highly endemic regions to reduce microfilarial loads and interrupt transmission of Wuchereria bancrofti (Evidence: Strong) 36 2. Conduct regular transmission assessment surveys (TAS) post-MDA cessation to monitor infection rates; specifically, aim for an infection rate <1% in >400 children aged 6–7 years (Evidence: Moderate) 6 3. Utilize Loop-Mediated Isothermal Amplification (LAMP) for rapid diagnosis of Wuchereria bancrofti infection in endemic areas due to its high sensitivity and ease of implementation (Evidence: Moderate) 18 4. Screen pregnant women for Wuchereria bancrofti infection to assess potential impacts on neonatal immune responses and disease outcomes; prenatal sensitization to filarial antigens increases neonatal risk (Evidence: Moderate) 34 5. Develop and deploy rapid immunoassays, such as IgG4 immunoassays targeting specific Wuchereria bancrofti antigens (e.g., Wb123), for ongoing surveillance post-MDA to detect residual transmission (Evidence: Moderate) 919 6. Consider the presence of high microfilaremia (>8,000 microfilariae/mL) as a risk factor for severe adverse reactions in individuals receiving ivermectin; prioritize screening in co-endemic areas with Loa loa (Evidence: Moderate) 58 7. Employ enzyme-linked immunosorbent assays (ELISA) using Wuchereria bancrofti excretory-secretory antigens for detecting bancroftian filariasis, particularly in urine samples for non-invasive screening (Evidence: Weak) 1222 8. Integrate multiepitope chimeric antigens into diagnostic assays for enhanced specificity in detecting Wuchereria bancrofti infection; structure-based strategies improve diagnostic accuracy (Evidence: Moderate) 1719 9. Monitor and manage cervical lymphatic filariasis in pediatric patients through comprehensive clinical evaluations and targeted treatment strategies; case reports highlight the necessity of thorough diagnostic workup (Evidence: Weak) 4 10. Explore the potential of transgenic expression systems, such as tobacco plants expressing Wuchereria bancrofti antigens (e.g., SXP-1), for developing cost-effective and scalable diagnostic tools (Evidence: Weak) 21
References
Showing 100 priority papers (full text preferred, most recent first) of 102 indexed.
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The American journal of tropical medicine and hygiene 2018. link 5 Tummidi S, Kothari K, Patil R, Singhal SS, Keshan P. Incidental detection of two adult gravid filarial worms in breast: a case report. BMC research notes 2017. link 6 Coulibaly YI, Coulibaly SY, Dolo H, Konate S, Diallo AA, Doumbia SS et al.. Dynamics of antigenemia and transmission intensity of Wuchereria bancrofti following cessation of mass drug administration in a formerly highly endemic region of Mali. Parasites & vectors 2016. link 7 Voronin D, Guimarães AF, Molyneux GR, Johnston KL, Ford L, Taylor MJ. Wolbachia lipoproteins: abundance, localisation and serology of Wolbachia peptidoglycan associated lipoprotein and the Type IV Secretion System component, VirB6 from Brugia malayi and Aedes albopictus. Parasites & vectors 2014. link 8 Fernández-Soto P, Mvoulouga PO, Akue JP, Abán JL, Santiago BV, Sánchez MC et al.. Development of a highly sensitive loop-mediated isothermal amplification (LAMP) method for the detection of Loa loa. PloS one 2014. link 9 Steel C, Golden A, Kubofcik J, LaRue N, de Los Santos T, Domingo GJ et al.. Rapid Wuchereria bancrofti-specific antigen Wb123-based IgG4 immunoassays as tools for surveillance following mass drug administration programs on lymphatic filariasis. Clinical and vaccine immunology : CVI 2013. link 10 Fink DL, Kamgno J, Nutman TB. Rapid molecular assays for specific detection and quantitation of Loa loa microfilaremia. PLoS neglected tropical diseases 2011. link 11 Harinath BC, Malhotra A, Ghirnikar SN, Annadate SD, Isaacs VP, Bharti MS. Field evaluation of ELISA using Wuchereria bancrofti mf ES antigen for bancroftian filariasis. Bulletin of the World Health Organization 1984. link 12 Dissanayake S, Galahitiyawa SC, Ismail MM. Further characterization of filarial antigens by SDS polyacrylamide gel electrophoresis. Bulletin of the World Health Organization 1983. link 13 Dissanayake S, Ismail MM. Antibody determination in the diagnosis of Wuchereria bancrofti infection in man. Bulletin of the World Health Organization 1981. link 14 Dissanayake S, Ismail MM. ELISA in the diagnosis of Wuchereria bancrofti infection in man: a technique for reducing cross-reactivity. Bulletin of the World Health Organization 1980. link 15 Dissanayake S, Ismail MM. Antigen of Setaria digitata: cross-reaction with surface antigens of Wuchereria bancrofti microfilariae and serum antibodies of W. bancrofti-infected subjects. Bulletin of the World Health Organization 1980. link 16 Higashi GI, Chowdhury AB. In vitro adhesion of eosinophils to infective larvae of Wuchereria bancrofti. Immunology 1970. link 17 Yasin N, Sugerappa Laxmanappa H, Muddapur UM, Cheruvathur J, Uday Prakash SM, Venkataramaiah Thulasiram H. Design, expression, and evaluation of novel multiepitope chimeric antigen of Wuchereria bancrofti for the diagnosis of lymphatic filariasis - A structure-based strategy. International immunopharmacology 2020. link 18 Yasin N, Laxmanappa HS, Muddapur UM, Cheruvathur J, Prakash SMU, Thulasiram HV. Structural, molecular, functional and immunological characterization of Wuchereria bancrofti-galectin. International journal of biological macromolecules 2020. link 19 Prasad BVS, Khatri V, Yadav PS, Chandra MS, Lakshmi DV, Goswami K. Immunodiagnostic potential of Wuchereria bancrofti L1 antigen-based filarial immunoglobulin G4 detection assay. Transactions of the Royal Society of Tropical Medicine and Hygiene 2019. link 20 Weitzel T, Rosas R, Fica A, Dabanch J, Polanco M, Egaña A et al.. Is there a risk of filarial infection during long-term missions in Haiti?. Travel medicine and infectious disease 2016. link 21 Ganapathy M, Chakravarthi M, Charles SJ, Harunipriya P, Jaiganesh S, Subramonian N et al.. Immunodiagnostic Properties of Wucheraria bancrofti SXP-1, a Potential Filarial Diagnostic Candidate Expressed in Tobacco Plant, Nicotiana tabacum. Applied biochemistry and biotechnology 2015. link 22 Samad MS, Itoh M, Moji K, Hossain M, Mondal D, Alam MS et al.. Enzyme-linked immunosorbent assay for the diagnosis of Wuchereria bancrofti infection using urine samples and its application in Bangladesh. Parasitology international 2013. link 23 Pilotte N, Torres M, Tomaino FR, Laney SJ, Williams SA. A TaqMan-based multiplex real-time PCR assay for the simultaneous detection of Wuchereria bancrofti and Brugia malayi. Molecular and biochemical parasitology 2013. link 24 El-Moamly AA, El-Sweify MA, Hafez MA. Using the AD12-ICT rapid-format test to detect Wuchereria bancrofti circulating antigens in comparison to Og4C3-ELISA and nucleopore membrane filtration and microscopy techniques. Parasitology research 2012. link 25 Kumar R. Microfilariae in lymph node aspirate associated with metastatic gastric carcinoma: a case report. Acta cytologica 2010. link 26 Bal MS, Beuria MK, Mandal NN, Das MK. Antigenemia in young children living in Wuchereria bancrofti-endemic areas of Orissa, India. Transactions of the Royal Society of Tropical Medicine and Hygiene 2009. link 27 Sahu BR, Mohanty MC, Sahoo PK, Satapathy AK, Ravindran B. Protective immunity in human filariasis: a role for parasite-specific IgA responses. The Journal of infectious diseases 2008. link 28 Malla N, Elango A, Pani SP, Mahajan RC. Kinetics of microfilaraemia & antigenaemia status by Og(4)C(3) ELISA in bancroftian filariasis. The Indian journal of medical research 2007. link 29 Sivakumar S. Role of fine needle aspiration cytology in detection of microfilariae: report of 2 cases. Acta cytologica 2007. link 30 Hassan M, Sanad MM, el-Karamany I, Abdel-Tawab M, Shalaby M, el-Dairouty A et al.. Detection of DNA of W. bancrofti in blood samples by QC-PCR-ELISA-based. Journal of the Egyptian Society of Parasitology 2005. link 31 Sharma P, Kumar N, Jain P, Gur R, Jain S. Chronic wuchereriasis presenting as a vaginoperineal fistula: report of a case with aspiration cytologic diagnosis. Acta cytologica 2005. link 32 Pani SP, Hoti SL, Vanamail P, Das LK. Comparison of an immunochromatographic card test with night blood smear examination for detection of Wuchereria bancrofti microfilaria carriers. The National medical journal of India 2004. link 33 Bhumiratana A, Siriaut C, Koyadun S, Satitvipawee P. Evaluation of a single oral dose of diethylcarbamazine 300 mg as provocative test and simultaneous treatment in Myanmar migrant workers with Wuchereria bancrofti infection in Thailand. The Southeast Asian journal of tropical medicine and public health 2004. link 34 Simonsen PE, Magesa SM. Observations on false positive reactions in the rapid NOW Filariasis card test. Tropical medicine & international health : TM & IH 2004. link 35 Nuchprayoon S, Porksakorn C, Junpee A, Sanprasert V, Poovorawan Y. Comparative assessment of an Og4C3 ELISA and an ICT filariasis test: a study of Myanmar migrants in Thailand. Asian Pacific journal of allergy and immunology 2003. link 36 Watanabe K, Itoh M, Matsuyama H, Hamano S, Kobayashi S, Shirakawa T et al.. Bancroftian filariasis in Nepal: a survey for circulating antigenemia of Wuchereria bancrofti and urinary IgG4 antibody in two rural areas of Nepal. Acta tropica 2003. link00157-8) 37 Ramzy RM. Field application of PCR-based assays for monitoring Wuchereria bancrofti infection in Africa. Annals of tropical medicine and parasitology 2002. link 38 Hoti SL, Elango A, Radjame K, Yuvaraj J, Pani SP. Detection of day blood filarial antigens by Og4C3 ELISA test using filter paper samples. The National medical journal of India 2002. link 39 Nuchprayoon S, Yentakam S, Sangprakarn S, Junpee A. Endemic bancroftian filariasis in Thailand: detection by Og4C3 antigen capture ELISA and the polymerase chain reaction. Journal of the Medical Association of Thailand = Chotmaihet thangphaet 2001. link 40 Kamal IH, Fischer P, Adly M, El Sayed AS, Morsy ZS, Ramzy RM. Evaluation of a PCR-ELISA to detect Wuchereria bancrofti in Culex pipiens from an Egyptian village with a low prevalence of filariasis. Annals of tropical medicine and parasitology 2001. link 41 Itoh M, Weerasooriya MV, Qiu G, Gunawardena NK, Anantaphruti MT, Tesana S et al.. Sensitive and specific enzyme-linked immunosorbent assay for the diagnosis of Wuchereria bancrofti infection in urine samples. The American journal of tropical medicine and hygiene 2001. link 42 Wickremanayake MN, Ekanayake S, Karunanayake EH. Wuchereria bancrofti: detection of microfilariae in asymptomatic microfilaremic individuals with Setaria digitata antigens. The Southeast Asian journal of tropical medicine and public health 2001. link 43 Dixit V, Prasad GB. Seroprevalences of antibodies against thoracic proteins of three species of mosquito, among the residents of an area where filariasis is endemic: relationship with the mosquito densities. Annals of tropical medicine and parasitology 2001. link 44 Theis JH, Stevens F, Law M. Distribution, prevalence, and relative risk of filariasis in dogs from the State of Washington (1997-1999). Journal of the American Animal Hospital Association 2001. link 45 Terhell AJ, Haarbrink M, Abadi K, Syafruddin, Maizels RM, Yazdanbakhsh M et al.. Adults acquire filarial infection more rapidly than children: a study in Indonesian transmigrants. Parasitology 2001. link 46 Gupta S, Sodhani P, Jain S, Kumar N. Microfilariae in association with neoplastic lesions: report of five cases. Cytopathology : official journal of the British Society for Clinical Cytology 2001. link 47 Mohanty MC, Sahoo PK, Satapathy AK, Ravindran B. Setaria digitata infections in cattle: parasite load, microfilaraemia status and relationship to immune response. Journal of helminthology 2000. link 48 Esterre P, Plichart C, Huin-Blondey MO, Nguyen L. Role of streptococcal infection in the acute pathology of lymphatic filariasis. Parasite (Paris, France) 2000. link 49 Nguyen NL, Plichart C, Esterre P. Assessment of immunochromatographic test for rapid lymphatic filariasis diagnosis. Parasite (Paris, France) 1999. link 50 Weil GJ, Ramzy RM, El Setouhy M, Kandil AM, Ahmed ES, Faris R. A longitudinal study of Bancroftian filariasis in the Nile Delta of Egypt: baseline data and one-year follow-up. The American journal of tropical medicine and hygiene 1999. link 51 Bal M, Das MK. Antibody response to a filarial antigen fraction in individuals exposed to Wuchereria bancrofti infection in India. Acta tropica 1999. link00099-0) 52 Gyapong JO, Omane-Badu K, Webber RH. Evaluation of the filter paper blood collection method for detecting Og4C3 circulating antigen in bancroftian filariasis. Transactions of the Royal Society of Tropical Medicine and Hygiene 1998. link91068-9) 53 Nicolas L, Plichart C. A universally applicable internal standard for PCR detection of Wuchereria bancrofti in biological samples. Parasite (Paris, France) 1997. link 54 Kobayashi M, Niimura M, Kanazawa T, Husky MK, Malagueno E, Santana JV. Detection of microfilarial antigen in circulating immune complex from sera of Wuchereria bancrofti-infected individuals. The American journal of tropical medicine and hygiene 1997. link 55 Rocha A, Addiss D, Ribeiro ME, Norões J, Baliza M, Medeiros Z et al.. Evaluation of the Og4C3 ELISA in Wuchereria bancrofti infection: infected persons with undetectable or ultra-low microfilarial densities. Tropical medicine & international health : TM & IH 1996. link 56 Theodore JG, Kaliraj P. Wuchereria bancrofti recombinant antigen-derived poly- and monoclonal antibodies for the detection of circulating antigen(s) in the sera of lymphatic filarial patients. Journal of helminthology 1996. link 57 Chenthamarakshan V, Reddy MV, Harinath BC. Diagnostic potential of fractionated Brugia malayi microfilarial excretory/secretory antigen for bancroftian filariasis. Transactions of the Royal Society of Tropical Medicine and Hygiene 1996. link90236-9) 58 McCarthy JS, Zhong M, Gopinath R, Ottesen EA, Williams SA, Nutman TB. Evaluation of a polymerase chain reaction-based assay for diagnosis of Wuchereria bancrofti infection. The Journal of infectious diseases 1996. link 59 Varghese R, Raghuveer CV, Pai MR, Bansal R. Microfilariae in cytologic smears: a report of six cases. Acta cytologica 1996. link 60 Wamae CN, Lammie PJ, Muttunga JN. Bancroftian filariasis: profile of serum antifilarial antibody and circulating parasite antigen. East African medical journal 1995. link 61 Dhas KP, Raj RK. Epitope specific monoclonal antibodies from heterologous antigen for immunodiagnosis of filariasis. The Indian journal of medical research 1995. link 62 Ravindran B, Satapathy AK, Sahoo PK. Bancroftian filariasis-differential reactivity of anti-sheath antibodies in microfilariae carriers. Parasite immunology 1994. link 63 Dutta SN, Diesfeld HJ. Evidence of sex variations in microfilaraemia and fluorescent antibody titre level at puberty in a bancroftian filariasis endemic area. The Journal of communicable diseases 1994. link 64 Chanteau S, Glaziou P, Moulia-Pelat JP, Plichart C, Luquiaud P, Cartel JL. Low positive predictive value of anti-Brugia malayi IgG and IgG4 serology for the diagnosis of Wuchereria bancrofti. Transactions of the Royal Society of Tropical Medicine and Hygiene 1994. link90217-8) 65 Prasad GB, Harinath BC. Analysis of human sera for filarial IgM antibody using antigen fractions isolated from immune complexes. Journal of clinical laboratory analysis 1993. link 66 Kar SK, Mania J, Baldwin CI, Denham DA. The sheath of the microfilaria of Wuchereria bancrofti has albumin and immunoglobulin on its surface. Parasite immunology 1993. link 67 Liu LX, Buhlmann JE, Weller PF. Release of prostaglandin E2 by microfilariae of Wuchereria bancrofti and Brugia malayi. The American journal of tropical medicine and hygiene 1992. link 68 el-Ganayni GA. Evaluation of two different antigens in immunodiagnosis of bancroftian filariasis using ELISA and IHAT. Journal of the Egyptian Society of Parasitology 1992. link 69 Chanteau S, Cartel JL, Martin PM. IgA immunoassay for the diagnosis of bancroftian filariasis. Tropical medicine and parasitology : official organ of Deutsche Tropenmedizinische Gesellschaft and of Deutsche Gesellschaft fur Technische Zusammenarbeit (GTZ) 1992. link 70 Cheirmaraj K, Reddy MV, Harinath BC. Detection of filarial antigen using antibodies raised against Wuchereria bancrofti microfilarial SDS soluble antigen. The Southeast Asian journal of tropical medicine and public health 1992. link 71 Dissanayake S, Xu M, Piessens WF. A cloned antigen for serological diagnosis of Wuchereria bancrofti microfilaremia with daytime blood samples. Molecular and biochemical parasitology 1992. link90176-k) 72 Kazura JW, Hazlett FE, Pearlman E, Day K, el-Zeiny A, Nilsen TW et al.. Antigenicity of a protective recombinant filarial protein in human bancroftian filariasis. The Journal of infectious diseases 1992. link 73 Kumar M, Shukla VK, Gupta S. Incidental detection of microfilariae in cytological smears: clinical examples. The Journal of tropical medicine and hygiene 1991. link 74 Hitch WL, Hightower AW, Eberhard ML, Lammie PJ. Analysis of isotype-specific antifilarial antibody levels in a Haitian pediatric population. The American journal of tropical medicine and hygiene 1991. link 75 Rajasekariah GR, Parab PB, Subrahmanyam D. Detection of Wuchereria bancrofti specific antigens in the serum of endemic residents. Tropical medicine and parasitology : official organ of Deutsche Tropenmedizinische Gesellschaft and of Deutsche Gesellschaft fur Technische Zusammenarbeit (GTZ) 1991. link 76 Ramzy RM, Gad AM, Faris R, Weil GJ. Evaluation of a monoclonal-antibody based antigen assay for diagnosis of Wuchereria bancrofti infection in Egypt. The American journal of tropical medicine and hygiene 1991. link 77 Theodore JG, Kaliraj P. Isolation, purification and characterization of surface antigens of the bovine filarial parasite Setaria digitata for the immunodiagnosis of bancroftian filariasis. Journal of helminthology 1990. link 78 Carvalho PA, Rajasekariah GR, Desphande L, Parab PB, Rao UR, Subrahmanyam D. Evaluation of in vitro released Wuchereria bancrofti third stage larval antigens for detection of Bancroftian filariasis. Tropical medicine and parasitology : official organ of Deutsche Tropenmedizinische Gesellschaft and of Deutsche Gesellschaft fur Technische Zusammenarbeit (GTZ) 1990. link 79 More SJ, Copeman DB. A highly specific and sensitive monoclonal antibody-based ELISA for the detection of circulating antigen in bancroftian filariasis. Tropical medicine and parasitology : official organ of Deutsche Tropenmedizinische Gesellschaft and of Deutsche Gesellschaft fur Technische Zusammenarbeit (GTZ) 1990. link 80 Sanjeevi CB, Narayanan PR. Antifilarial and anti PPD IgM antibodies in cord blood. Indian journal of pediatrics 1989. link 81 Santhanam S, Kumar H, Sethumadhavan KV, Chandrasekharan A, Jain DC, Malhotra A et al.. Detection of Wuchereria bancrofti antigen in serum and finger prick blood samples by enzyme immunoassay: field evaluation. Tropical medicine and parasitology : official organ of Deutsche Tropenmedizinische Gesellschaft and of Deutsche Gesellschaft fur Technische Zusammenarbeit (GTZ) 1989. link 82 Reddy MV, Parkhe KA, Piessens WF, Harinath BC. Wb E34 monoclonal antibody: further characterization and diagnostic use in bancroftian filariasis. Journal of clinical laboratory analysis 1989. link 83 Lawson DA, Wenk P, Storey DM. Identification of a potential protective microfilarial antigen from Litomosoides carinii (Nematoda, Filarioidea). Tropical medicine and parasitology : official organ of Deutsche Tropenmedizinische Gesellschaft and of Deutsche Gesellschaft fur Technische Zusammenarbeit (GTZ) 1989. link 84 Kapila K, Verma K. Gravid adult female worms of Wuchereria bancrofti in fine needle aspirates of soft tissue swellings. Report of three cases. Acta cytologica 1989. link 85 Kharat I, Cheirmaraj K, Prasad GB, Harinath BC. Antigenic analysis of excretory-secretory products of Wuchereria bancrofti and Brugia malayi infective larval forms by SDS-PAGE. Indian journal of experimental biology 1989. link 86 Lunde MN, Paranjape R, Lawley TJ, Ottesen EA. Filarial antigen in circulating immune complexes from patients with Wuchereria bancrofti filariasis. The American journal of tropical medicine and hygiene 1988. link 87 Ravindran B, Satapathy AK, Pattnaik NM. Antibodies to diethylcarbamazine cross-react with microfilariae of Wuchereria bancrofti. Immunology letters 1988. link90094-6) 88 Maizels RM, Morgan TM, Gregory WF, Selkirk ME, Purnomo, Sukartono et al.. Circulating antibodies and antigens in Presbytis monkeys infected with the filarial parasite Wuchereria bancrofti. Tropical medicine and parasitology : official organ of Deutsche Tropenmedizinische Gesellschaft and of Deutsche Gesellschaft fur Technische Zusammenarbeit (GTZ) 1988. link 89 Müller-Kehrmann H. Antibody response against Litomosoides carinii and the distribution of bound antibodies on microfilariae from the different internal organs of cotton rats. Acta tropica 1988. link 90 Lal RB, Ottesen EA. Enhanced diagnostic specificity in human filariasis by IgG4 antibody assessment. The Journal of infectious diseases 1988. link 91 Rao UR, Chandrashekar R, Subrahmanyam D. Effect of ivermectin on serum dependent cellular interactions to Dipetalonema viteae microfilariae. Tropical medicine and parasitology : official organ of Deutsche Tropenmedizinische Gesellschaft and of Deutsche Gesellschaft fur Technische Zusammenarbeit (GTZ) 1987. link 92 Weil GJ, Liftis F. Identification and partial characterization of a parasite antigen in sera from humans infected with Wuchereria bancrofti. Journal of immunology (Baltimore, Md. : 1950) 1987. link 93 Kumar H, Malhotra A, Santhanam S, Jain DC, Ghosh TK. Evaluation of specific humoral immune responses in human filariasis. Folia parasitologica 1987. link 94 Weil GJ, Jain DC, Santhanam S, Malhotra A, Kumar H, Sethumadhavan KV et al.. A monoclonal antibody-based enzyme immunoassay for detecting parasite antigenemia in bancroftian filariasis. The Journal of infectious diseases 1987. link 95 Almond NM, Worms MJ, Harnett W, Parkhouse RM. Variation in class-specific humoral immune responses of different mouse strains to microfilariae of Dipetalonema viteae. Parasitology 1987. link 96 Chanteau S, Guidi C, Durosoir JL. Efficiency of papain-treated microfilariae of Wuchereria bancrofti (var. pacifica) as antigen for serodiagnosis of bancroftian filariasis in French Polynesia. Transactions of the Royal Society of Tropical Medicine and Hygiene 1986. link90386-x) 97 Simonsen PE. Wuchereria bancrofti in Tanzania: immune reactions to the microfilarial surface, and the effect of diethylcarbamazine upon these reactions. Transactions of the Royal Society of Tropical Medicine and Hygiene 1985. link90137-3) 98 Dasgupta A, Bala S, Dutta SN. Lymphatic filariasis in man: demonstration of circulating antigens in Wuchereria bancrofti infection. Parasite immunology 1984. link 99 Joshi P, Singh BP, Tewari HC. Use of the enzyme-linked immunosorbent assay in the diagnosis of Dictyocaulus filaria infection. Research in veterinary science 1984. link 100 Prasad GB, Kharat I, Harinath BC. Detection of antimicrofilarial ES antigen-antibody in immune complexes in Bancroftian filariasis by enzyme immunoassay. Transactions of the Royal Society of Tropical Medicine and Hygiene 1983. link90286-9)