Q: My grandmother is suffering from filariasis. She has light swelling in her left leg. Since it was not treated properly, the swelling remains as it is. But even after 2-3 years, she gets fever with shivering and red swelling in the leg. Doctor gives medicine and all becomes normal. Is there any permanent cure for this disease? Will this be inherited by other members of the family too? My grandmother was diagnosed positive 20 years back but no one in the family has shown any symptoms. Do we all need to take any vaccination to prevent this disease? We have read about DEC tablets for filariasis. Is it safe to take these? Will it kill any bacteria/virus in our body? Do I need to consult a doctor for taking the medicine or can I buy and take it directly?

A:Filariasis is an infective disease caused by filarial parasites (Wuchereria bancrofti, Brugia malay and Brugia timori) transmitted by the bite of Culex quinquefasciatus (bancroftian filariasis) and Mansonia mosquitoes. Wuchereria bancrofti is responsible for over 98% cases. The infective stage larvae are transmitted to human host through mosquito bites and within the human host, the larvae develop into adult worm. The disease is not transmitted from one patient to other except by mosquito bite. India is the largest filariasis endemic country in the world with nine states (Andhra Pradesh, Bihar, Gujarat, Kerala, Maharastra, Orissa, Tamil Nadu, Utter Pradesh and West Bengal) contributing to about 95% of total burden of the disease. The key treatment modalities available include drug treatment (oral or parenteral) and surgical excision. Bed rest, limb elevation, and compression bandages have traditionally been used to treat chronic lymphedema. Steroids can be used to soften and reduce the swelling of lymphedematous tissues. Patients with chronic lymphatic filariasis are encouraged to mobilize (with compression bandage support) the affected limb. The most important local treatments are those measures that prevent superficial bacterial and fungal infection. Additionally, patients should use limb elevation, special massage techniques, and elastic stockings to protect the affected extremity. Diethylcarbamazine (DEC) is the drug of choice for use in lymphatic filariasis though Ivermectin is an equally potent alternative, and the combination of these 2 drugs provides significant synergism. Recent studies have shown the advantage of the use of single-dose regimens of ivermectin and DEC or albendazole for large-scale control and elimination programs and treatment. Aggressive treatment of chronic lymphoedema and elephantiasis can lead to reversal of symptoms. This entails long-term, low-dose DEC (to eradicate persistent or new filarial infections) with diligent attention to the local area of the lymphedematous extremity. Patients with severely damaged extremities may benefit from surgery (decompression of the lymphatic system by nodo-venous shunt) followed by excision of redundant tissue. In case of gross limb elephantiasis, correction with surgery is less successful and may require multiple procedures and skin grafting.