Assessment & Management of Chronic Lymphatic Filariasis Morbidity among Endemic Populations Open Access

Mues, Katherine Elizabeth (2014)

Permanent URL: https://etd.library.emory.edu/concern/etds/ns064649f?locale=en
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Abstract

Lymphatic filariasis (LF) is a neglected tropical disease characterized by lymphedema. The first clinical manifestation is usually an episode of adenolymphangitis (ADL). These recurrent episodes are characterized by swelling, lymphatic inflammation, high fever, and general malaise. The objectives of this dissertation were to 1) determine how a lymphedema management program and compliance to the program affects the rate of ADL episodes, 2) to estimate the effect of a regimen of anti-fungal cream use on ADL episodes, and 3) to estimate the proportion of ADL episodes attributed to specific pathogens measured through antibody levels.

Data for studies one and two are from a cohort of lymphedema patients enrolled in a morbidity management program in Odisha State, India. Data for study three are from a subset of a group of lymphedema patients enrolled in a morbidity management program in Léogâne, Haiti. Correlated Poisson and logistic models were used to estimate the efficacy of the program on the frequency of ADL episodes over time. Marginal structural Poisson models were used to estimate the effect of a regimen of anti-fungal cream on the frequency of ADL episodes. Absolute and relative changes of antibody levels for different antigens were calculated for study three.

Patients enrolled in the lymphedema management program in India experienced a 35% lower rate of ADL episodes at 24 months compared to baseline. Compliance to soap was associated with a decrease in the rate of ADL episodes in all disease groups except among those with entry lesions and early lymphedema. Study two suggests that an increase in the number of times one uses anti-fungal cream was associated with a slight decrease in the frequency of ADL episodes at 12, 18, and 24 months. Among the cohort of 41 lymphedema patients in Haiti, the Strep A antigen had the highest prevalence of antibody response.

Findings suggest that community-based lymphedema programs are effective in decreasing the frequency of ADL episodes and use of anti-fungal cream to treat entry lesions may decrease the frequency of ADL episodes. Study three provides evidence for infection with Streptococcus A as a potential contributing factor to ADL episodes.

Table of Contents

Chapter 1: Overview 1

Chapter 2: Literature Review: Lymphatic Filariasis 14

Chapter 3: Impact of a Community-Based Lymphedema Management Program 42

on Episodes of Adenolymphangitis (ADL) and Lymphedema Progression

- Odisha State, India

Chapter 4: Marginal Structural Models 81

Chapter 5: The Effect of a Regimen of Anti-fungal Cream use on Episodes 89

of Acute Adenolymphangitis (ADL) among Lymphedema Patients:

an Application Using Marginal Structural Models.

Chapter 6: Appendix: The Effect of a Regimen of Anti-fungal Cream use 130

on Episodes of Acute Adenolymphangitis (ADL) among Lymphedema

Patients: an Application Using Marginal Structural Models.

Chapter 7: Changes in Antibody Levels during and following an Episode of 174

Acute Dermatolymphangioadenitis (ADL) among Lymphedema Patients

in Léogâne, Haiti

Chapter 8: Summary, Future Directions, and Implications 205

References 217

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