Addiss David G, Brady Molly A
WHO Collaborating Center for Control and Elimination of Lymphatic Filariasis in the Americas, Division of Parasitic Diseases, Centers for Disease Control and Prevention, Mailstop F-22, 4770 Buford Highway, Atlanta, Georgia, 30341, USA.
Filaria J. 2007 Feb 15;6:2. doi: 10.1186/1475-2883-6-2.
The Global Programme to Eliminate Lymphatic Filariasis (GPELF) has two major goals: to interrupt transmission of the parasite and to provide care for those who suffer the devastating clinical manifestations of the disease (morbidity control). This latter goal addresses three filariasis-related conditions: acute inflammatory episodes; lymphoedema; and hydrocele. Research during the last decade has confirmed the importance of bacteria as a cause of acute inflammatory episodes in filariasis-endemic areas, known as acute dermatolymphangioadenitis (ADLA). Current lymphoedema management strategies are based on the central role of ADLA as a trigger for lymphoedema progression. Simple intervention packages are in use that have resulted in dramatic reductions in ADLA rates, a lower prevalence of chronic inflammatory cells in the dermis and subdermis, and improvement in quality of life. During the past decade, the socioeconomic impact of ADLA and lymphoedema in filariasis-endemic areas has received increasing attention. Numerous operational research questions remain to be answered regarding how best to optimize, scale up, monitor, and evaluate lymphoedema management programmes. Of the clinical manifestations targeted by the GPELF, hydrocele has been the focus of the least attention. Basic information is lacking on the effectiveness and complications of hydrocele surgery and risk of post-operative hydrocele recurrence in filariasis-endemic areas. Data on the impact of mass administration of antifilarial drugs on filarial morbidity are inconsistent. Several studies report reductions in acute inflammatory episodes, lymphoedema, and/or hydrocele following mass drug administration, but other studies report no such association. Assessing the public health impact of mass treatment with antifilarial drugs is important for programme advocacy and morbidity control strategies. Thus, although our knowledge of filariasis-related morbidity and its treatment has expanded in recent years, much work remains to be done to address the needs of more than 40 million persons who suffer worldwide from these conditions.
全球消除淋巴丝虫病规划（GPELF）有两个主要目标：阻断寄生虫传播以及为罹患该疾病严重临床表现的患者提供治疗（疾病控制）。后一目标针对三种与丝虫病相关的病症：急性炎症发作、淋巴水肿和鞘膜积液。过去十年的研究证实，在丝虫病流行地区，细菌作为急性炎症发作（称为急性皮肤淋巴管腺炎，ADLA）病因的重要性。当前的淋巴水肿管理策略基于ADLA作为淋巴水肿进展触发因素的核心作用。正在使用的简单干预方案已使ADLA发病率大幅降低，真皮和皮下组织中慢性炎症细胞的患病率降低，生活质量得到改善。在过去十年中，ADLA和淋巴水肿在丝虫病流行地区的社会经济影响受到越来越多的关注。关于如何最好地优化、扩大规模、监测和评估淋巴水肿管理方案，仍有许多业务研究问题有待解答。在GPELF针对的临床表现中，鞘膜积液受到的关注最少。在丝虫病流行地区，缺乏关于鞘膜积液手术的有效性和并发症以及术后鞘膜积液复发风险的基本信息。关于大规模服用抗丝虫药物对丝虫病发病率影响的数据并不一致。几项研究报告称，大规模药物服用后急性炎症发作、淋巴水肿和/或鞘膜积液有所减少，但其他研究报告没有这种关联。评估大规模服用抗丝虫药物对公共卫生的影响对于项目宣传和疾病控制策略很重要。因此，尽管近年来我们对丝虫病相关发病率及其治疗的了解有所扩展，但要满足全球4000多万患有这些病症的人的需求，仍有许多工作要做。
