Patient selection: A person who has lived or had extensive exposure in a region endemic for microfilaria.
Clinical features of an episode:
(1) fever
(2) lymphadenitis with pain
(3) lymphangitis that evolves in a centrifugal pattern
(3a) lymphatics becoming tender and palpable
(3b) blotchy, erythematous rash over lymphatics
Variable findings:
(1) headache
(2) nausea and vomiting
(3) sweating (diaphoresis)
(4) constipation
(5) abdominal pain
(6) urticaria
(7) rigors
(8) mild eosinophilia between attacks, which decreases during an episode
An episode lasts up to 10 days then remits spontaneously.
Differential diagnosis:
(1) bacterial lymphangitis (which evolves in an centripetal pattern)
The diagnosis may need to be made on clinical findings alone since the microfilaria can be hard to demonstrate.
Antibiotics are not effective during an episode, Diethylcarbamazine or other antifilarial agent can reduce the frequency of episodes.
