Filariasis Cure Permanently

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Filariasis Cure Permanently
Is there a cure for lymphatic filariasis? – There’s no vaccine or cure for filariasis. Medication can kill many of the worms and keep you from spreading the infection to someone else. Treatment can also reduce filariasis symptoms.

How long does it take to cure filariasis?

Diethylcarbamazine (DEC) is the drug of choice in the United States. The drug kills the microfilariae and some of the adult worms. DEC has been used world-wide for more than 50 years. Because this infection is rare in the U.S., the drug is no longer approved by the Food and Drug Administration (FDA) and cannot be sold in the U.S.

  1. Physicians can obtain the medication from CDC after confirmed positive lab results.
  2. CDC gives the physicians the choice between 1 or 12-day treatment of DEC (6 mg/kg/day).
  3. One day treatment is generally as effective as the 12-day regimen.
  4. DEC is generally well tolerated.
  5. Side effects are in general limited and depend on the number of microfilariae in the blood.

The most common side effects are dizziness, nausea, fever, headache, or pain in muscles or joints. DEC should not be administered to patients who may also have onchocerciasis as DEC can worsen onchocercal eye disease. In patients with loiasis, DEC can cause serious adverse reactions, including encephalopathy and death.

  • The risk and severity of the adverse reactions are related to Loa loa microfilarial density.
  • In settings where onchoceriasis is present, Ivermectin is the drug of choice to treat LF.
  • Some studies have shown adult worm killing with treatment with doxycycline (200mg/day for 4–6 weeks).
  • People with lymphedema and elephantiasis are unlikely to benefit from DEC treatment because most people with lymphedema are not actively infected with the filarial parasite.

To prevent lymphedema from getting worse, patients should ask their physician for a referral to a lymphedema therapist so they can be informed about some basic principles of care such as hygiene, elevation, exercises,skin and wound care, and wearing appropriate shoes.

Can you cure filarial worms?

The standard method for diagnosing active infection is the identification of microfilariae in a blood smear by microscopic examination. Microfilariae can be detected microscopically on blood smears obtained at night (10 PM–2 AM) and a thick smear should be made and stained with Giemsa or hematoxylin and eosin. For increased sensitivity, concentration techniques can be used. Serologic enzyme immunoassay tests, including antifilarial IgG1 and IgG4, provide an alternative to microscopic detection of microfilariae for the diagnosis of lymphatic filariasis. Patients with active filarial infection typically have elevated levels of antifilarial IgG4 in the blood and these can be detected using routine assays. Assays for circulating parasite antigen of W. bancrofti are not presently approved by the US Food and Drug Administration. Other methods of diagnosis include: tissue specimens to visualize adult worms or microfilariae as well as ultrasonography which allows visualization of adult worms (ultrasonography demonstration can be found at http://www.filariajournal.com/content/2/1/3 external icon ). For questions regarding diagnostic considerations, contact the Division of Parasitic Diseases at [email protected] More on: Diagnostic Procedures The main goal of treatment of an infected person is to kill the adult worm. Diethylcarbamazine citrate (DEC), which is both microfilaricidal and active against the adult worm, is the drug of choice for lymphatic filariasis. The late phase of chronic disease is not affected by chemotherapy. Ivermectin is effective against the microfilariae of W. bancrofti, but has no effect on the adult parasite. Because lymphatic filariasis is rare in the United States, DEC is no longer approved by the Food and Drug Administration (FDA). Physicians can obtain the medication from CDC after confirmed positive lab results. Treatment of lymphatic filariasis in adults and children > 18 months of age involves either a 1 day or 12 day treatment course of DEC (6mg/kg/day). One day treatment is generally as effective as the 12-day regimen. For tropical pulmonary eosinophilia (TPE), a longer DEC treatment course of 14-21 days is generally recommended. DEC is generally well tolerated. Side effects are generally limited and depend on the number of microfilariae in the blood. The most common side effects are dizziness, nausea, fever, headache, or pain in muscles or joints. DEC is contraindicated in patients who may also have onchocerciasis. Prior to DEC treatment for lymphatic filariasis, onchocerciasis should be excluded in all patients with a consistent exposure history due to the possibility of severe exacerbations of skin and eye involvement (Mazzotti reaction). In addition, DEC should be used with extreme caution in patients with circulating Loa loa microfilarial levels > 2,500/mm 3 due to the potential for life-threatening side effects, including encephalopathy and renal failure. Neither steroids pre-treatment nor slow dose escalation prevents these complications. Consultation with a tropical medicine specialist is recommended in these scenarios, The drug ivermectin kills only the microfilariae, but not the adult worm; the adult worm is responsible for the pathology of lymphedema and hydrocele. Some studies have shown adult worm killing with treatment with doxycycline (200mg/day for 4–6 weeks).

Can filariasis be cured with surgery?

Filariasis, unfortunately, is a chronic condition in most of the cases. However, surgery is an option for people who don’t have it that serious.

What kills filarial worms?

Ivermectin – Ivermectin, the widely-used antifilarial drug, is a macrocyclic lactone with broad spectrum activity on filarial parasites. The drug interacts with postsynaptic glutamate-gated chloride channels (GluCl), which results in paralysis of the MFs.

  1. Interestingly, the targeted proteins (GluCl) are only encoded in the genome of Nematoda and Arthropoda, therefore restricting the effects of IVM to organisms belonging to these phyla,
  2. The blocking of the GluCl channels in nematodes by ivermectin inhibits the release of uterine microfilariae by female worms and immobilizes skin and ocular microfilariae.

Microfilariae are thus transported to the regional lymph nodes, where the immobilized larvae are killed by effector cells. In filarial infections, IVM exhibits profound microfilaricidal effects. However, observations in in vitro settings of the Acanthocheilonema viteae model system with IVM show a weaker activity compared to the potent killing patterns in other parasite-infected hosts, therefore, emphasizing the role of host immune responses in controlling the parasite.

  1. Although IVM acts primarily by rapid clearance of MF from the periphery, its role in suppressing the production of MF is remarkable.
  2. It has been hypothesized that paralysis of the pharynx of the adult female worm by IVM may lead to an absence of iron, which is a prerequisite for parasite growth and for production of MF.
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One important potential cause for immune responses against IVM is the genetic background of the host. Gene polymorphisms, particularly in cytokine genes associated with either immunosuppression to onchocerciasis (IL-10, TGF-β) or protection (IFN-γ, IL-4, IL-5), may contribute to varying therapeutic success of IVM in different parasite hosts.

There is evidence supporting the role of IL-13 in hyper-reactive onchocerciasis and TGF-β in lymphatic filariasis, An overreaction (sowda) of the immune system against these worms is associated with the same variant of the IL-13 gene that confers an IgE-independent risk for asthma and atrophy, Moreover, a TGF-β Single Nucleotide Polymorphism (SNP) known to be linked to reduced expression of the protein is associated with the lack of MF in the blood of patients with lymphatic filariasis,

Therefore, the contribution of the immune response to MF killing and genetic variation in the human population is interrelated.

Is filariasis permanent?

Parasites – Lymphatic Filariasis Lymphatic filariasis, considered globally as a, is a parasitic disease caused by microscopic, thread-like worms. The adult worms only live in the human lymph system. The lymph system maintains the body’s fluid balance and fights infections. Lymphatic filariasis is spread from person to person by mosquitoes.

People with the disease can suffer from lymphedema and elephantiasis and in men, swelling of the scrotum, called hydrocele. Lymphatic filariasis is a leading cause of permanent disability worldwide. Communities frequently shun and reject women and men disfigured by the disease. Affected people frequently are unable to work because of their disability, and this harms their families and their communities.

Images: Left: Microfilaria of Wuchereria bancrofti in thick blood smear stained with Giemsa. Center: Photograph of a female Aedes aegypti mosquito as she was in the process of obtaining a “blood meal.” Right: Microfilaria of Brugia malayi in a thick blood smear, stained with Giemsa.

How long does lymphatic filariasis last?

How is lymphatic filariasis spread? – The disease spreads from person to person by mosquito bites. When a mosquito bites a person who has lymphatic filariasis, microscopic worms circulating in the person’s blood enter and infect the mosquito. When the infected mosquito bites another person, the microscopic worms pass from the mosquito through the skin, and travel to the lymph vessels.

Is filaria reversible?

PATHOGENESIS – The infective larvae (L3) deposited on the skin of the human host penetrate the skin and enter the lymphatics where they develop into adult worms. In bancroftian infections, the preferred site where the adult parasites live is the scrotal lymphatics in the adult men or even in boys after puberty, made out on ultrasonography by the presence of ‘filarial dance sign’ (FDS),

Other common locations described in women and children are larger lymph vessels and lymph nodes draining to lower and upper limbs, In brugian filariasis also adult worms were detected by Doppler sonography in the lymphatics of the inguinal and axillary regions in children, The adult parasites live in these sites for 6-8 yr or more and are responsible for initiating the early pathology in LF.

It is now well known that the earliest structural change in LF is the dilation of lymph vessels where the adult worms live. This has been demonstrated in subjects who are clinically asymptomatic except for presence of microfilariae (mf) in blood, by ultrasound examination of the lymphatics of the spermatic cord; lymphoscintigraphy of the limbs and by direct examination of lymph vessels resected by surgery,

  1. Dilatation of the lymph vessels has been demonstrated by lymphoscintigraphy even in children with brugian filarial infection,
  2. It is believed that this damage to lymph vessels is caused by the adult parasites through mediators produced by them, which cause vessel dilatation or inhibit contractility,

In course of time this early pathology predisposes to lymphatic dysfunction. It should be remembered that during this early stage of LF infection, the subject harboring the adult parasites does not have any evidence of clinical filarial disease and this phase is termed asymptomatic microfilaremia.

  • It has been reported that once established this lymphatic pathology is irreversible even after treatment or death of the filarial parasite and promotes progression of the disease,
  • Once this lymphatic damage progresses, stasis of lymph tends to occur in the dilated vessels due to incompetence of the unidirectional valves in them.

This damage is aggravated by bacterial infections of the limb, prolonged standing or strenuous exertion. The transient lympho-paralysis that sets in during acute bacterial infections also abets the lymph stasis. Stagnation of lymph encourages growth of bacteria invading the region.

Any interference with the skin integrity of the affected region like injuries, fungal or bacterial infections, fissuring of the skin, and paronychia or eczema favor entry of pathogenic bacteria into the tissues, These bacteria, mainly streptococci and occasionally other pathogens, are responsible for the acute attacks of dermato-lymphangio-adenitis (ADLA) commonly seen in filarial limbs,

Bacteria have been cultured from the skin and lymph from the edematous limb, It is mostly an initial acute attack of ADLA that precipitates lymphedema for the first time in an affected limb, usually starting in childhood. Such repeated attacks later perpetuate and worsen the lymphedema leading to elephantiasis.

How do you get rid of worms permanently?

Treating threadworms – If you or your child has threadworms, everyone in your household will need to be treated as there’s a high risk of the infection spreading. This includes those who don’t have any symptoms of an infection. For most people, treatment will involve taking a single dose of a medication called mebendazole to kill the worms.

If necessary, another dose can be taken after 2 weeks. During treatment and for a few weeks afterwards, it’s also important to follow strict hygiene measures to avoid spreading the threadworm eggs. This includes regularly vacuuming your house and thoroughly washing your bathroom and kitchen. If you’re pregnant or breastfeeding, hygiene measures are usually recommended without medication.

This is also often the case for young children. Read more about treating threadworm infections,

How many people have filarial worms?

Key facts –

More than 120 million people are infected with lymphatic filariasis worldwide, and some 40 million are disfigured or disabled by the disease. In the Region of the Americas, the disease is caused exclusively by the parasite Wuchereria bancrofti (in other regions there are other forms of the disease caused by Brugia malayi and B. timori). Some 12.6 million people are still at risk of infection in the Americas, 90% of them in Haiti. Only four countries in the Region are endemic for lymphatic filariasis: Brazil, the Dominican Republic, Guyana, and Haiti. In Brazil there is only one remaining active focus limited to the metropolitan area of Recife, in Pernambuco state. An elimination plan based on the administration of the antiparasitic drugs has been implemented there, and the country is very close to elimination.

Can elephantiasis be cured completely?

Living with elephantiasis – Lymphoedema cannot be cured, but you can manage the swelling by:

keeping the area clean by washing it with soap and water every day elevating the limb to drain the fluid performing exercises that get the fluid moving using antibacterial or antifungal cream on any wounds if necessary

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Elephantiasis can be very upsetting, disabling and can stop you leading a normal life. It can contribute to stigma and poverty, but counselling and support groups may help. Talk to your doctor about this. For more information about lymphoedema, visit the Australasian Lymphology Association,

Can a person with filariasis donate blood?

Abstract – Microfilariae can be transmitted by blood transfusion and they may be circulated in the recipient’s blood but they do not develop into adult worms. Mortality associated with transfusion associated filarial infection is not documented but it may give rise to morbidity in transfusion recipients in terms of allergic reaction.

The present study was carried out to investigate the association of post transfusion reactions and filarial infections in an endemic area. About 11,752 transfusion recipients were followed up and in 15 months period, 47 (0.4%) post transfusion reactions (PTR) were reported. Routine investigations for post transfusion reaction were carried out in all 47 patients and their respective blood donor.

Moreover, blood culture, microfilaria detection by concentration technique, filarial antibody and antigen detection (both by ELISA) were done in all subjects. Out of 47 patients showing post transfusion reaction, 29 (61.7%) patients developed allergic reaction.

Eighteen (38.3%) patients having allergic reaction did not have previous history of blood transfusion and 14 (29.8%) of them received transfusion from blood donors who was either positive for microfilaria, filarial antigen or antibody. Microfilaremia was demonstrated in 4 (8.5%) patients and 5 (10.6%) blood donors.

Microfilaria was concurrently present in 2 patients and their respective donors. Filarial antibody was detected in 27 (56.5%) patients and 26 (55.3%) blood donors but microfilaria was detected in 3 (6.4%) and 4 (8.5%) subjects, respectively. Antigen detection test correlated with microfileraemic state of subjects.

  • The result shows that transfusion associated filarial infection may be a probable cause for transfusion-associated morbidity in endemic areas.
  • In 14 (29.8%) patients having allergic reactions, the probable cause was transfusion-associated filarial infection.
  • Filarial antigen detection test was found to be more useful in detecting infections.

Blood donors with active history of filarial infection should be deferred from donating blood. Filarial antigen detection test may be employed as screening test for blood donors, if possible.

Can antibiotics cure filariasis?

Practical application of antimicrobial drugs for filariasis in Africa: Antimicrobial resistance a common challenge in the population – Vector-borne diseases remain an important challenge for public health globally, and contribute to over 17% of the globally estimated burden of all infectious diseases ( WHO, 2017b ).

Reports have shown an encouraging progress in the control of some important mosquito borne diseases including malaria ( Cibulskis et al., 2016 ) and filariasis ( Cromwell et al., 2020 ). This notwithstanding, there remain certain challenges regarding the controlling of these diseases, with the evolution of resistance against anti-parasitic drugs being one of the most important ( Conrad and Rosenthal, 2019 ).

Anti-filarial resistance has become alarming in larger populations since the inception of GPEL, probably leading to the WHO’s inability to achieve target ( McCarthy, 2005 ). Ivermectin resistance has been reported in Ghana, with the widespread of benzimidazole resistance (such as albendazole) present due to specific mutations in the gene encoding β-tubulin associated with drug resistance ( Anderson and Jaenike, 1997 ).

Moreover, it has been shown that DEC susceptibility is not 100% for lymphatic filariasis treatment. A review of the mechanisms of resistance to these anti-helminthics is therefore imperative to optimize the treatment for human lymphatic filariasis. There has been data on the antimicrobial resistance (AMR) in Africa with high level of resistance to the commonly used antibiotics in the Sub-Saharan African region ( Leopold et al., 2014 ).

For example, 90% of Gram negatives have been shown to be resistant to chloramphenicol, a commonly used antibiotic. In contrast, resistance to third-generation cephalosporins (like ceftriaxone) was less common, recommending this group for use ( Leopold et al., 2014 ).

  • To design suitable local and global interventions, it is important to understand the status of AMR and identify knowledge gaps.
  • The discovery of drug resistance in veterinary parasitology indicates that the resistance to the treatment of lymphatic filariasis in human nematode parasites could also exist.

Although it is urgent to prove anti-helminthic resistance in filarial parasites ( W. bancrofti, Brugia spp, O. volvulus), it is difficult to investigate this because these parasites do not have free-living stages and therefore cannot be cultured in animal models ( Cobo, 2016 ).

This clearly shows that parasitological evidence of anti-helminthic drug resistance can only be available by demonstrating the persistence of parasites after treatment over a long period of time. Studies have shown that antimicrobials given in combinations have higher efficacies than those given singly ( Schwab et al., 2005 ).

Treatment with anti-filarial drugs through the MDA programme has proved to be significant in the reduction of infection and morbidity, although in some parts of Asia, the program over 50 years could not eradicate the disease ( Pichon, 2002 ). Nonetheless, the continual use of the three anti-helminthics used for filarial treatment increases the risk for the emergence and spread of drug resistance, which may be a threat to the set goals of the GPELF.

Since there is no available vaccine, and the vector control programs have failed, the short-term goal is to identify and develop new classes of drugs and alternative chemotherapeutic strategies. The Wolbachia bacteria has been identified in filaria parasites over some decades now ( Andre et al., 2002 ).

Many antibiotics but, above all doxycycline are known to be effective in the treatment of human filariasis through the depletion of Wolbachia ( mclaren et al., 1975 ; Gardon et al., 1997 ; Hoerauf et al., 2000 ). Despite the efficacy of doxycycline against filarial disease, there is contraindication of the drug in pregnant/breastfeeding women and children under 9 years, therefore there is the need for new drugs that will be safe for these populations ( Jammal et al., 2015 ; Jimah T, 2020 ).

Can ivermectin cure microfilaria?

Abstract – Ivermectin and diethylcarbamazine (DEC) are used in mass treatment programs for the elimination of lymphatic filariasis because of their strong effects on microfilaremia. However, the effects of treatment on adult worms and the degree of individual variation in efficacy are unclear.

  • We analyzed series of microfilaria (Mf) counts from individuals treated with a single dose of 400 microg/kg ivermectin or 6 mg/kg DEC (N = 23 in each group; 1 year follow-up).
  • For each individual, we estimated the microfilaricidal effect and the reduction in overall Mf production (e.g., caused by death or sterilization of worms, or inhibited Mf release from the female worm uterus).

Ivermectin on average killed 96% of Mf and reduced Mf production by 82%. DEC killed 57% of Mf and reduced Mf production by 67%, with some individuals responding very poorly. The strong reduction in overall Mf production is good news for control of lymphatic filariasis, but the prospects of elimination will be diminished if part of the population systematically responds poorly to treatment.

Can lymphatic filariasis be eliminated?

Key facts –

Lymphatic filariasis impairs the lymphatic system and can lead to the abnormal enlargement of body parts, causing pain, severe disability and social stigma. Over 882 million people in 44 countries worldwide remain threatened by lymphatic filariasis and require preventive chemotherapy to stop the spread of this parasitic infection. Lymphatic filariasis can be eliminated by stopping the spread of infection through preventive chemotherapy with safe medicine combinations repeated annually. More than 9 billion cumulative treatments have been delivered to stop the spread of infection since 2000. As of 2018, 51 million people were infected – a 74% decline since the start of WHO’s Global Programme to Eliminate Lymphatic Filariasis in 2000. Due to successful implementation of WHO strategies, 740 million people no longer require preventive chemotherapy. An essential, recommended package of care can alleviate suffering and prevent further disability among people living with disease caused by lymphatic filariasis.

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What should a person with filariasis eat?

Light diet consisting of older jowar, wheat, horse gram, green gram, drum stick, bitter gourd, radish, garlic and older red rice is beneficial. Milk and products, fish, jaggery, sweets and contaminated water must be avoided.

How long are filarial worms?

They develop in adults that commonly reside in the lymphatics. The female worms measure 80 to 100 mm in length and 0.24 to 0.30 mm in diameter, while the males measure about 40 mm by.1 mm.

How do you know if you have filaria?

Signs & Symptoms – Some people with filariasis have no symptoms. Other affected individuals may have episodes of acute inflammation of lymphatic vessels (lymphangitis) along with high temperatures, shaking chills, body aches, and swollen lymph nodes. Excessive amounts of fluid may accumulate (edema) in the affected areas (i.e., arms and/or legs), but the accumulation typically resolves after the other symptoms are gone.

Attacks may also be accompanied by acute inflammation of the genitalia leading, in males, to inflammation, pain and swelling of the testes (orchitis), sperm track (funiculitis), and/or sperm ducts (epididymitis). The scrotum may become abnormally swollen and painful. Bancroftian filariasis affects both the legs and the genitals.

The Malayan variety affects the legs below the knees. Some people with filariasis have abnormally high levels of certain white blood cells (eosinophilia) during acute episodes of symptoms. When the inflammation resolves, these levels return to normal. Filariasis may cause chronic lymph node swelling (lymphadenopathy) even in the absence of other symptoms.

  • Longstanding obstruction of the lymphatic vessels may lead to several other conditions.
  • These include accumulation of fluid in the scrotum (hydrocele), the presence of lymphatic fluid in the urine (chyluria), and/or abnormally enlarged lymphatic vessels (varices).
  • Other symptoms may include progressive edema (elephantiasis) of the female external genitalia (vulva), breasts, and/or arms and legs.

Chronic edema may result in skin that is abnormally thick and has a “warty” appearance.

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What should a person with filariasis eat?

Light diet consisting of older jowar, wheat, horse gram, green gram, drum stick, bitter gourd, radish, garlic and older red rice is beneficial. Milk and products, fish, jaggery, sweets and contaminated water must be avoided.

Can elephantiasis be cured completely?

Living with elephantiasis – Lymphoedema cannot be cured, but you can manage the swelling by:

keeping the area clean by washing it with soap and water every day elevating the limb to drain the fluid performing exercises that get the fluid moving using antibacterial or antifungal cream on any wounds if necessary

Elephantiasis can be very upsetting, disabling and can stop you leading a normal life. It can contribute to stigma and poverty, but counselling and support groups may help. Talk to your doctor about this. For more information about lymphoedema, visit the Australasian Lymphology Association,

Is lymphatic filariasis reversible?

PATHOGENESIS – The infective larvae (L3) deposited on the skin of the human host penetrate the skin and enter the lymphatics where they develop into adult worms. In bancroftian infections, the preferred site where the adult parasites live is the scrotal lymphatics in the adult men or even in boys after puberty, made out on ultrasonography by the presence of ‘filarial dance sign’ (FDS),

  1. Other common locations described in women and children are larger lymph vessels and lymph nodes draining to lower and upper limbs,
  2. In brugian filariasis also adult worms were detected by Doppler sonography in the lymphatics of the inguinal and axillary regions in children,
  3. The adult parasites live in these sites for 6-8 yr or more and are responsible for initiating the early pathology in LF.

It is now well known that the earliest structural change in LF is the dilation of lymph vessels where the adult worms live. This has been demonstrated in subjects who are clinically asymptomatic except for presence of microfilariae (mf) in blood, by ultrasound examination of the lymphatics of the spermatic cord; lymphoscintigraphy of the limbs and by direct examination of lymph vessels resected by surgery,

Dilatation of the lymph vessels has been demonstrated by lymphoscintigraphy even in children with brugian filarial infection, It is believed that this damage to lymph vessels is caused by the adult parasites through mediators produced by them, which cause vessel dilatation or inhibit contractility,

In course of time this early pathology predisposes to lymphatic dysfunction. It should be remembered that during this early stage of LF infection, the subject harboring the adult parasites does not have any evidence of clinical filarial disease and this phase is termed asymptomatic microfilaremia.

It has been reported that once established this lymphatic pathology is irreversible even after treatment or death of the filarial parasite and promotes progression of the disease, Once this lymphatic damage progresses, stasis of lymph tends to occur in the dilated vessels due to incompetence of the unidirectional valves in them.

This damage is aggravated by bacterial infections of the limb, prolonged standing or strenuous exertion. The transient lympho-paralysis that sets in during acute bacterial infections also abets the lymph stasis. Stagnation of lymph encourages growth of bacteria invading the region.

Any interference with the skin integrity of the affected region like injuries, fungal or bacterial infections, fissuring of the skin, and paronychia or eczema favor entry of pathogenic bacteria into the tissues, These bacteria, mainly streptococci and occasionally other pathogens, are responsible for the acute attacks of dermato-lymphangio-adenitis (ADLA) commonly seen in filarial limbs,

Bacteria have been cultured from the skin and lymph from the edematous limb, It is mostly an initial acute attack of ADLA that precipitates lymphedema for the first time in an affected limb, usually starting in childhood. Such repeated attacks later perpetuate and worsen the lymphedema leading to elephantiasis.

Is filariasis irreversible?

What is Lymphatic Filariasis? – Lymphatic filariasis is caused by thin worms transmitted to humans by the bites of mosquitoes in tropical and subtropical regions. These worms live in, and cause damage to, the lymphatic system that normally returns fluids in our extremities to the circulatory system.

Rahab Joshua, 45, watches as her daughter performs chores at their home in Mangu, Plateau state, Nigeria. Rahab’s right leg is severely swollen as a result of the parasitic disease lymphatic filariasis, but she has found support through a peer group. (Photo: The Carter Center)