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Trop. Med. Infect. Dis. 2017, 2(4), 50; https://doi.org/10.3390/tropicalmed2040050

Lymphatic Filariasis Increases Tissue Compressibility and Extracellular Fluid in Lower Limbs of Asymptomatic Young People in Central Myanmar

1
Division of Tropical Health and Medicine, James Cook University, Townsville 4811, Australia
2
Division of Tropical Health and Medicine, James Cook University, Cairns 4870, Australia
3
Department of Health, Myanmar Ministry of Health and Sports, Nay Pyi Taw 15011, Myanmar
4
World Health Organization, Country Office, Yangon 11201, Myanmar
5
College of Nursing & Health Sciences, Flinders University, Bedford Park 5042, Australia
*
Author to whom correspondence should be addressed.
Received: 15 August 2017 / Revised: 13 September 2017 / Accepted: 17 September 2017 / Published: 27 September 2017
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Abstract

When normal lymphatic function is hampered, imperceptible subcutaneous edema can develop and progress to overt lymphedema. Low-cost reliable devices for objective assessment of lymphedema are well accepted in clinical practice and research on breast-cancer related lymphedema but are untested in populations with lymphatic filariasis (LF). This is a cross-sectional analysis of baseline data in a longitudinal study on asymptomatic, LF antigen-positive and -negative young people in Myanmar. Rapid field screening was used to identify antigen-positive cases and a group of antigen-negative controls of similar age and gender were invited to continue in the study. Tissue compressibility was assessed with three tissue tonometers, and free fluids were assessed using bio-impedance spectroscopy (BIS). Infection status was confirmed by Og4C3 antigen assay. At baseline (n = 98), antigen-positive cases had clinically relevant increases in tissue compressibility at the calf using a digital Indurometer (11.1%, p = 0.021), and in whole-leg free fluid using BIS (9.2%, p = 0.053). Regression analysis for moderating factors (age, gender, hydration) reinforced the between-infection group differences. Results demonstrate that sub-clinical changes associated with infection can be detected in asymptomatic cases. Further exploration of these low-cost devices in clinical and research settings on filariasis-related lymphedema are warranted. View Full-Text
Keywords: neglected tropical disease; lower extremity; lymphatic filariasis; tissue tonometry; bio-impedance spectroscopy; lymphedema neglected tropical disease; lower extremity; lymphatic filariasis; tissue tonometry; bio-impedance spectroscopy; lymphedema
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Douglass, J.; Graves, P.; Lindsay, D.; Becker, L.; Roineau, M.; Masson, J.; Aye, N.N.; Win, S.S.; Wai, T.; Win, Y.Y.; Gordon, S. Lymphatic Filariasis Increases Tissue Compressibility and Extracellular Fluid in Lower Limbs of Asymptomatic Young People in Central Myanmar. Trop. Med. Infect. Dis. 2017, 2, 50.

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