# Lymphatic Filariasis (Elephantiasis) - Category: chronic - Review status: reviewed (every claim checked against a document named on this page) - Sources: Bancroftian Filariasis(Archived) - StatPearls - NCBI Bookshelf - https://www.ncbi.nlm.nih.gov/books/NBK547682/ · ICPC-3 (WONCA International Classification of Primary Care, 3rd edition) class AD24.08 - condition scope only, no dose · Egyptian National Drug Formulary - Antimicrobial 2023 (diethylcarbamazine monograph, p28) - Verified date: 2026-08 ## Verified against - Lymphatic Filariasis (Elephantiasis) - disease-level clinical article (lymphatic-filariasis-clinical.txt) - Egyptian National Drug Formulary - Antimicrobial 2023 (diethylcarbamazine monograph, p28) ## Treatment metadata - Diethylcarbamazine — 100 mg — oral.solid - Referral & safety-netting (no drug therapy) ## Complete treatment card ```text LYMPHATIC FILARIASIS (ELEPHANTIASIS) Sources: Bancroftian Filariasis(Archived) - StatPearls - NCBI Bookshelf - https://www.ncbi.nlm.nih.gov/books/NBK547682/ · ICPC-3 (WONCA International Classification of Primary Care, 3rd edition) class AD24.08 - condition scope only, no dose · Egyptian National Drug Formulary - Antimicrobial 2023 (diethylcarbamazine monograph, p28) Review status: REVIEWED against Lymphatic Filariasis (Elephantiasis) - disease-level clinical article (lymphatic-filariasis-clinical.txt), Egyptian National Drug Formulary - Antimicrobial 2023 (diethylcarbamazine monograph, p28) (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (9) - Acute adenolymphangitis brings repeated sudden bouts of painful groin lymph node swelling with inflamed testis, spermatic cord, and epididymis [lymphadenopathy] - Patients can have 1 to 4 episodes a year, each resolving after 4 to 7 days - Filarial fever is fever occurring without associated lymph node inflammation [fever] - Tropical pulmonary eosinophilia causes dry, nocturnal cough, wheeze, and breathlessness [breathlessness · cough · wheeze] - Acute dermatolymphangioadenitis presents with painful inflamed skin plaques, fever, chills, and headache [chills · fever · headache · plaques · redness] - Calabar swellings are transient non-red skin swellings, usually on the face or limbs, that resolve in 2 to 4 days - Patients may report a sensation of a worm migrating across the eye, which lasts 10 to 20 minutes - It is usually caught in childhood and stays silent for years while quietly damaging the lymphatic system and the kidneys and weakening immunity - Years of repeated inflammation end in chronic lymphoedema and elephantiasis, with permanent oedema of the limbs, the breasts, the vulva and the scrotum [oedema] SIGNS - what you find (3) - Chronic lymphedema progresses from pitting edema to firm, non-pitting swelling with thickened, darkened skin [leg swelling] - Unilateral or bilateral hydrocele is a common chronic finding, most often from W. bancrofti infection - Subcutaneous dirofilariasis presents as a tender, red nodule near the eye, groin, or a limb, sometimes with an abscess [abscess] TESTS (6) - Eosinophil counts often exceed 3000/µL, along with raised IgE, proteinuria, and hematuria - Newer rapid IgG4 antibody tests use recombinant antigens and are more sensitive than older crude-antigen serology - Circulating filarial antigen testing can give false positives for W. bancrofti when L. loa microfilaria levels are high - Blood for smear should be drawn between 10 pm and 2 am for Bancroftian and Brugian filariasis because of nocturnal periodicity - A worm needs 9 to 15 months to mature enough to shed detectable microfilariae, so skin snips can miss early infection - Ultrasound can show live adult worms moving inside lymphatic vessels, the filarial dance sign IF NOT THIS - what else fits (5) - Leprosy is a differential diagnosis for lymphatic filariasis - Lymphoma is a differential diagnosis for lymphatic filariasis - Podoconiosis - Primary lymphedema - Testicular malignancy Source StatPearls "Filariasis" - disease-level clinical article Status traced to the source above Rx: Antiparasitic | Main treatment ANTIPARASITIC 1. DIETHYLCARBAMAZINE [1st line] Adult 6 mg/kg/day, as a single dose or in 3 divided doses x 1 or 12 days; 14 to 21 days where there is tropical pulmonary eosinophilia Peds 6 mg/kg/day (6 mg/kg/day, given as one dose or split into three, for 1 or 12 days; 14 to 21 days where there is tropical pulmonary eosinophilia.) 3kg -> 18 mg/day 4kg -> 24 mg/day 5kg -> 30 mg/day 6kg -> 36 mg/day 7kg -> 42 mg/day 8kg -> 48 mg/day 9kg -> 54 mg/day 10kg -> 60 mg/day 11kg -> 66 mg/day 12kg -> 72 mg/day 13kg -> 78 mg/day 14kg -> 84 mg/day 15kg -> 90 mg/day 16kg -> 96 mg/day 17kg -> 102 mg/day 18kg -> 108 mg/day 19kg -> 114 mg/day 20kg -> 120 mg/day 21kg -> 126 mg/day 22kg -> 132 mg/day 23kg -> 138 mg/day 24kg -> 144 mg/day 25kg -> 150 mg/day 26kg -> 156 mg/day 27kg -> 162 mg/day 28kg -> 168 mg/day 29kg -> 174 mg/day 30kg -> 180 mg/day 31kg -> 186 mg/day 32kg -> 192 mg/day 33kg -> 198 mg/day 34kg -> 204 mg/day 35kg -> 210 mg/day 36kg -> 216 mg/day 37kg -> 222 mg/day 38kg -> 228 mg/day 39kg -> 234 mg/day 40kg -> 240 mg/day 41kg -> 246 mg/day 42kg -> 252 mg/day 43kg -> 258 mg/day 44kg -> 264 mg/day 45kg -> 270 mg/day 46kg -> 276 mg/day 47kg -> 282 mg/day 48kg -> 288 mg/day 49kg -> 294 mg/day 50kg -> 300 mg/day Source Egyptian National Drug Formulary - Antimicrobial 2023 (diethylcarbamazine monograph, p28) Why The formulary names treatment of lymphatic filariasis as an indication for diethylcarbamazine and gives 6 mg/kg/day for it - a different and lower regimen from the 8-10 mg/kg/day it gives for loiasis, which is why the two cards do not carry the same row. The cited article says every patient should be treated even when free of symptoms, because early treatment may reverse the lymphatic damage. Caution TEST FOR CO-INFECTION FIRST. The cited article is explicit: anyone from a region where onchocerciasis or loiasis is endemic must be checked before this drug is started. Diethylcarbamazine triggers a severe inflammatory reaction in onchocerciasis, and both it and ivermectin can cause a fatal encephalopathy in loiasis. CONTRAINDICATED IN ONCHOCERCIASIS - the formulary's only listed contraindication. WHERE MICROFILARIAE ARE IN THE BLOOD the formulary offers a dose-escalating start: 50 mg once on day 1; 50 mg three times on day 2; 100 mg three times on day 3; then 6 mg/kg/day in 3 divided doses from day 4. Treating the worm does not undo established lymphoedema. Limb hygiene, skin care and management of the swelling continue regardless. Egypt no Egyptian brand matched - prescribe by generic name MAIN TREATMENT 2. REFERRAL & SAFETY-NETTING (NO DRUG THERAPY) [1st line] Adult Wuchereria bancrofti infection causing lymphoedema/elephantiasis and hydrocele. Historically endemic in Nile Delta governorates, but Egypt reached WHO elimination status in 2013, so new transmission is very unlikely. A GP today mainly manages chronic lymphoedema (hygiene, compression) and treats acute adenolymphangitis attacks, referring for confirmation rather than prescribing antifilarial drugs directly. - Refer, with advice Peds Children follow the same pathway: recognise and refer. No primary-care medicine is implied. Source No dose - referral pathway, no medicine given in primary care Why Wuchereria bancrofti infection causing lymphoedema/elephantiasis and hydrocele. Historically endemic in Nile Delta governorates, but Egypt reached WHO elimination status in 2013, so new transmission is very unlikely. A GP today mainly manages chronic lymphoedema (hygiene, compression) and treats acute adenolymphangitis attacks, referring for confirmation rather than prescribing antifilarial drugs directly. Caution Rare in Egyptian primary care. The drug rows above are what the treating service gives. They are here so that the referral is an informed one and so the GP can recognise the regimen the patient comes back on - not as permission to start it without the referral. RED FLAG - Before starting treatment, test patients from endemic regions for onchocerciasis or loiasis coinfection because DEC can cause severe inflammatory reactions in onchocerciasis and DEC or ivermectin can cause fatal encephalopathy in loiasis. RED FLAG - Fever with painful ascending lymphangitis (an acute attack) is treated as bacterial superinfection, and progressive limb or scrotal swelling needs referral to rule out other causes (malignancy, venous disease) as well as filariasis. Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)