Lymphatic Filariasis in a Tertiary Hospital in South-East Nigeria: A Tale of Neglect, Low Social Class and Disability

Background: Lymphatic filariasis (LF) is a neglected tropical disease affecting over 40 million people globally. It is associated with profound disfigurement /disability, pain, and social stigma partly due to late presentation. We described the socio-demographic, clinical and laboratory characteristics of patients with confirmed LF in order to improve the case detection/management in resource-constrained settings. Methods: A retrospective cohort study of patients referred /presenting to the Infectious /Tropical Diseases unit of the University of Nigeria Teaching Hospital with a provisional diagnosis of LF from October 2012 to September 2017. Data was extracted from medical records. Laboratory confirmation of LF was based on Giemsa -stained blood film for microfilaria. Results: Of 50 patients with a provisional diagnosis of LF, 18 (36%) had microfilaria confirmation. The mean age among the confirmed cases was 48.3 ± 9.5 years, women were in the majority 12 (66.7%), 7 (38.9%) had primary or no formal education, and 5 (27.8%) were widowed. They were predominantly rural dwellers 12 (66.7%), farmers 8 (44.4%), and of low social class13 (72.2%). The mean duration of lymphoedema was 6.5 ± 2.3 years. Wuchereria bancrofti was identified in 17 (94.4%) cases. Limitation of movement and secondary skin/soft tissue infections were evident in 14 (77.8%) and 15 (83.3%) patients, respectively. Anaemia 4 (22.2%) and depression 2 (11.1%) were co-morbidities. A combination of filaricidal therapy/supportive care led to noticeable reduction in lymphoedema and resolution of skin infections in 10/17 (58.8%) and 13/14 (92.9%) patients, respectively. Conclusions: LF remains a tale of neglect, low social class and disability. Surveillance and active case search in endemic regions is needed for prompt diagnosis and improved outcomes