Management of disability in lymphatic filariasis - an update.

The global lymphatic filariasis elimination programme incorporates disability management along with transmission control, to ensure 'a visible impact' on those who are already affected by the disease. The common manifestations of lymphatic filariasis like lymphoedema; elephantiasis and hydrocele result from irreversible damage caused to the lymphatics by the adult worms. Only palliative treatment in the form of physical methods and surgery is available for lymphoedema and elephantiasis. Hydrocele can be corrected by surgery. The most distressing aspect of lymphatic filariasis is the attacks of acute adenolymphangitis, which cause considerable short-term and also long-term disability by worsening the lymphoedema. Since each episode prevents the person from attending his work for several days, the economic loss is substantial. The precipitating cause of these attacks is secondary infection, the bacteria entering the tissues through 'entry lesions' in the skin. These episodes can very well be prevented by proper 'local-hygiene' of the affected limbs, which is a simple, effective, cheap and sustainable method that can be carried out even in the patient's house. These subjects and the providers of 'home care' should be trained in foot-hygiene programme, so that the message percolates to various levels in the affected communities, ultimately benefiting the patient.