Epidemiology of epizootic lymphangitis of carthorses in northern Ethiopia using conventional diagnostic methods and nested polymerase chain reaction.

BACKGROUND: Epizootic lymphangitis (EL), caused by Histoplasma capsulatum variety farciminosum (HCF) is a contagious, chronic disease of equines, characterized by development of nodular lesions in the lymph nodes, lymphatic vessels and skin. It is one of the most important diseases of equines in Ethiopia, causing significant economic loss, particularly in the livelihood of carthorse owners. To date there is neither effective diagnostic nor control measure implemented in the country. Furthermore, there is a shortage of data on the epidemiology of the disease in different regions of this country. The aim of this study was to investigate epidemiology of EL in northern Ethiopia, using the conventional methods as well as nested polymerase chain reaction (PCR). RESULTS: The presence of HCF genetic material was confirmed in 44% (84/191) of the carthorses. Subclinical infection was observed in 18.2% (22/121) of the apparently healthy carthorses. Considering the nested PCR as a gold standard, sensitivity and specificity of clinical examination were 74% and 92.5%, respectively, while the area under the ROC curve (AUR) was 0.83 (95% confidence interval, 0.77, 0.896). Moreover, a moderate (k = 0.675) agreement observed between the nested PCR and clinical examination. CONCLUSIONS: This study demonstrated widespread occurrence of EL in northern Ethiopia, and the advantage of the nested PCR in detecting infection of HCF, even before the clinical symptoms became apparent.

The socioeconomic impact of equine epizootic lymphangitis in working equids in low and middle-income countries: A scoping review.

Equine epizootic lymphangitis (EEL) is a very infectious and contagious fungal disease that, with its ocular, respiratory and skin forms, causes severe effects on the health and welfare of working equids. Treatment is expensive and rarely available in low and middle-income countries (LMICs). Epidemiological data is lacking in most countries where the disease is known to exist. The purpose of this scoping review is to identify the current knowledge on the socioeconomic impact of EEL in working equids in LMICs, to highlight knowledge gaps and provide recommendations for future research. Seven eligible papers were obtained from the search of four databases and backward citation searching. The review showed that the available research on this subject is very scarce and restricted to Ethiopia. From the results it emerged that EEL causes detrimental socioeconomic effects on working equids' owners, compromising their health and livelihood. Its economic consequences were attributed to the reduced working capacity and loss of sick animals. Among the social impacts, authors highlighted the stigma around sick equids and their owners. Further studies on the socioeconomic impact of EEL conducted in endemic areas are highly required. The integration of epidemiological data with socioeconomic impact studies from LMICs may promote funding allocation for the development of cost-effective treatments and vaccines and for implementing disease prevention and control programmes. Future research would gain from applying the One Health approach to better examine the multiplicity of the disease socioeconomic effects, therefore increasing the potential of research to orientate policy.

Prevalence and risk factors for epizootic lymphangitis among equids in ethiopia during 2002-2023: A systematic review and meta-analysis.

In Sub-Saharan Africa (SSA), particularly in Ethiopia, Epizootic Lymphangitis (EL) is the most prevalent fungal disease of equids, which causes significant economic losses as well as a decrease in equid populations. Therefore, this systematic review and meta-analysis were designed to pool the results of individual studies and estimate the prevalence of EL among equids in Ethiopia. A systematic search of research articles on the prevalence and risk factors of EL among equids in Ethiopia was conducted in registers, databases, and other sources. Cochrane's Q, inverse variance (I2), sensitivity analysis, funnel plot, Begg's, and Egger's regression tests were used to check heterogeneity and publication bias. A random-effects model was used to calculate the pooled burden of EL among equids. For this meta-analysis, a total of 7217 equids were included in the 14 eligible studies. The overall pooled prevalence of EL among equids in Ethiopia was 20.24% (95% CI: 16.27, 24.21). According to the subgroup analysis, the highest prevalence was observed in cart horses (20.98%), the Amhara region (21.46%), and studies conducted using sample sizes of 384 equids or greater (24.67%) and from 2002 to 2018 (25.52%) study periods. Harness-inflicted wounds, sharing stables or yards with harnesses, and the presence of preexisting wounds were identified as factors significantly associated with EL magnitude. Early diagnosis and proper medication, as well as implementing appropriate prevention and control measures, are necessary for the management of EL in equids.

[Lymphangitis-associated rickettsiosis caused by Rickettsia sibirica mongolitimonae]. / "Lymphangitis-associated rickettsiosis" due à Rickettsia sibirica mongolitimonae.

Rickettsia sibirica mongolitimonae was first isolated 20 years ago in Asia but has now been identified on three continents. Hyalomma spp. and Rhipicephalus pusillus ticks are vectors but only a small number of cases have been reported to date, mainly on the Mediterranean coast. This bacterium induces the lymphangitis-associated rickettsiosis, a still unfamiliar rickettsiosis that is mainly characterized by fever with a rope-like lymphangitis and/or lymphadenopathy and skin eschar occurring after tick bites. These features are especially evocative if they occur in spring. Sequellae are very rare and treatment with doxycycline is recommended.

Study on prevalence and associated risk factors of epizootic lymphangitis in equine in Nagele Arsi town, southeastern Ethiopia.

Epizootic lymphangitis is a contagious, chronic and overwhelming disease of equids, characterized by chronic discharging skin nodules. This study was aimed to investigate the prevalence and associated risk factors of epizootic lymphangitis in equines at Nagele Arsi town, southeastern Ethiopia. A cross-sectional study using a random sampling technique was employed from December 2021 to June 2022 via clinical and microscopic examinations of the lesions. The overall prevalence of epizootic lymphangitis was 4.37% with a prevalence of 6.69%, 0.72%, and 0% in horses, donkeys, and mules, respectively. The sex, species, harness type, season, and body condition scores of equids have shown statistically significant differences (p < 0.05) with the prevalence of epizootic lymphangitis. Macroscopically, the lesions revealed varying degrees of nodule to ulcer on the sternum, limbs, face, and cervical region of the equine. Upon giemsa stain, fungal hyphae with a halo (unstained capsule-like) structure were observed. Histologically, pyogranulomatous inflammation with fibroplasia was appreciated. In conclusion, epizootic lymphangitis was rampant in the study area. This requires a detailed investigation incorporating a large sample size using fungal culture and other molecular techniques including PCR.

Lymphoedema management to prevent acute dermatolymphangioadenitis in podoconiosis in northern Ethiopia (GoLBeT): a pragmatic randomised controlled trial.

BACKGROUND: Podoconiosis (also known as endemic, non-filarial elephantiasis) affects about 4 million subsistence farmers in tropical Africa. Poor awareness of the condition and inadequate evidence for the efficacy of treatment mean that no government in an endemic country yet offers lymphoedema management for patients with podoconiosis. Among patients with filarial lymphoedema, trials suggest that limb care is effective in reducing the most disabling sequelae: episodes of acute dermatolymphangioadenitis. We aimed to test the hypothesis that a simple, inexpensive lymphoedema management package would reduce the incidence of acute dermatolymphangioadenitis in adult patients with podoconiosis in northern Ethiopia. METHODS: We did a pragmatic randomised controlled trial at health posts and health centres in 18 sub-districts of Aneded woreda (district) in Amhara, northern Ethiopia. Participants were adults aged 18 years and older, had a diagnosis of at least stage 2 podoconiosis (persistent lymphoedema) and a negative antigen test for filariasis, and intended to remain within Aneded woreda for the duration of the trial. Patients were randomly assigned (1:1) to either receive a package containing instructions for foot hygiene, skin care, bandaging, exercises, and use of socks and shoes, with support by lay Community Podoconiosis Agents at monthly meetings (intervention group) or to receive no intervention (control group). Participants were aware of their group assignment, but researchers doing all analyses were masked to treatment group. The primary outcome was incidence of acute dermatolymphangioadenitis episodes in the total period of observation of each participant, measured by use of validated patient self-reported pictorial diaries. This trial was registered with the International Standard Randomised Controlled Trials Number Register, number ISRCTN67805210. FINDINGS: Between Dec 1, 2014, and June 30, 2015, 1339 patients were screened, and 696 patients were enrolled and randomly allocated to treatment groups. We allocated 350 patients to the intervention group and 346 patients to the control group. 321 (92%) patients from the intervention group and 329 (95%) patients from the control group provided follow-up results at 12 months. During the 12 months of follow-up, 16 550 new episodes of acute dermatolymphangioadenitis occurred during 765·2 person-years. The incidence of acute dermatolymphangioadenitis was 19·4 episodes per person-year (95% CI 18·9-19·9) in the intervention group and 23·9 episodes per person-year (23·4-24·4) in the control group. The ratio of incidence rate in the intervention group to that of the control group was 0·81 (0·74 to 0·89; p<0·0001), with a rate difference of -4·5 (-5·1 to -3·8) episodes per person-year. No serious adverse events related to the intervention were reported. INTERPRETATION: A simple, inexpensive package of lymphoedema self-care is effective in reducing the frequency and duration of acute dermatolymphangioadenitis. We recommend its implementation by the governments of endemic countries. FUNDING: Joint Global Health Trials scheme (from the Wellcome Trust, the UK Medical Research Council, and UK Aid).

The Effect of a Regimen of Antifungal Cream Use on Episodes of Acute Adenolymphangitis (ADL) among Lymphedema Patients: An Application Using Marginal Structural Models.

Episodes of adenolymphangitis (ADL) are a recurrent clinical aspect of lymphatic filariasis (LF) and a risk factor for progression of lymphedema. Inter-digital entry lesions, often found on the web spaces between the toes of those suffering from lymphedema, have been shown to contribute to the occurrence of ADL episodes. Use of antifungal cream on lesions is often promoted as a critical component of lymphedema management. Our objective was to estimate the observed effect of antifungal cream use on ADL episodes according to treatment regimen among a cohort of lymphedema patients enrolled in a morbidity management program. We estimated this effect using marginal structural models for time varying confounding. In this longitudinal study, we estimate that for every one-unit increase in the number of times one was compliant to cream use through 12 months, there was a 23% (RR = 0.77 (0.62, 0.96)) decrease in the number of ADL episodes at 18 months, however the RR's were not statistically significant at other study time points. Traditionally adjusted models produced a non-significant RR closer to the null at all time points. This is the first study to estimate the effect of a regimen of antifungal cream on the frequency of ADL episodes. This study also highlights the importance of the consideration and proper handling of time-varying confounders in longitudinal observational studies.

Evaluating the Burden of Lymphedema Due to Lymphatic Filariasis in 2005 in Khurda District, Odisha State, India.

BACKGROUND: Over 1.1 billion people worldwide are at risk for lymphatic filariasis (LF), and the global burden of LF-associated lymphedema is estimated at 16 million affected people, yet country-specific estimates are poor. METHODOLOGY/PRINCIPAL FINDINGS: A house-to-house morbidity census was conducted to assess the burden and severity of lymphedema in a population of 1,298,576 persons living in the LF-endemic district of Khurda in Odisha State, India. The burden of lymphedema in Khurda is widespread geographically, and 1.3% (17,036) of the total population report lymphedema. 51.3% of the patients reporting lymphedema were female, mean age 49.4 years (1-99). Early lymphedema (Dreyer stages 1 & 2) was reported in two-thirds of the patients. Poisson regression analysis was conducted in order to determine risk factors for advanced lymphedema (Dreyer stages 4-7). Increasing age was significantly associated with advanced lymphedema, and persons 70 years and older had a prevalence three times greater than individuals ages 15-29 (aPR: 3.21, 95% CI 2.45, 4.21). The number of adenolymphangitis (ADL) episodes reported in the previous year was also significantly associated with advanced lymphedema (aPR 4.65, 95% CI 2.97-7.30). This analysis is one of the first to look at potential risk factors for advanced lymphedema using morbidity census data from an entire district in Odisha State, India. SIGNIFICANCE: These data highlight the magnitude of lymphedema in LF-endemic areas and emphasize the need to develop robust estimates of numbers of individuals with lymphedema in order to identify the extent of lymphedema management services needed in these regions.

Assessing numbers and faces: a prerequisite for improving access to lymphatic filariasis morbidity care.

Concerted efforts to eliminate lymphatic filariasis worldwide have registered success; multiple rounds of mass drug administration have led to the interruption of transmission in many previously endemic areas. However, the management of patients with established clinical disease (e.g., lymphoedema, hydrocoele and acute dermatolymphangioadenitis) has not been addressed sufficiently. Two recent studies from Malawi underscore the need for accurate epidemiological and clinical data, and comprehensive morbidity assessments across various domains of daily life. Addressing these issues will guide the implementation of programmes to improve access to treatment and disability prevention for affected individuals in Malawi and beyond.

Lymphocutaneous syndrome. A review of non-sporothrix causes.

The lymphocutaneous syndrome can be caused by a number of diverse microorganisms requiring very different antimicrobial therapy for resolution. The epidemiology and geographic occurrence of the infection often can provide important first clues to the microbiologic etiology. Accurate diagnosis can be accomplished usually by punch or wedge biopsy of a primary lesion or proximal subcutaneous nodule submitted for histopathologic examination and culture. The microbiology laboratory staff should be alerted to the diagnostic possibilities so that appropriate cultural and incubation techniques, procedures, and precautions can be initiated. Provision of a correct microbiologic diagnosis and institution of appropriate antimicrobial therapy will result in a complete cure in almost all instances. Adjunctive surgical debridement may be required for certain organisms such as Nocardia or Mycobacterium chelonae.

Epidemiological and clinical features of Brugia timori in a newly established village. Karakuak, West Flores, Indonesia.

The epidemiological and clinical features of Brugia timori filariasis in a newly established village, Karakuak, West Flores, is described. The microfilarial rate by finger stick and Nuclepore filtration was 24% and 30%, respectively, and the disease rate 64%. Infected persons were found in every family and household with no predominant age or sex preference. Development of elephantiasis in the population was associated with residence in the new village of Karakuak, where extensive rice field cultivation was initiated soon after arrival. The irrigated fields provided excellent breeding sites for the vector, Anopheles barbirostris. People with no previous exposure to the parasite developed elephantiasis earlier and more frequently than those originating from other endemic areas.

The epidemiology of acute adenolymphangitis due to lymphatic filariasis in northern Ghana.

A study to investigate the socioeconomic impact of lymphatic filariasis was conducted in a rural community in northern Ghana. The incidence, severity, and duration of acute adenolymphangitis (ADL), as identified by local terminologies and confirmed using World Health Organization diagnostic criteria, were investigated. Local terminologies were found to be highly specific and sensitive for diagnosing ADL (sensitivity = 0.978, specificity = 0.980). The incidence of ADL was 95.9 per 1,000 per annum among adults more than 10 years of age, being much higher in females than in males. Among those with elephantiasis and other chronic filarial symptoms, there was no clear relationship between the stage of chronic lymphedema and the incidence of ADL. The incidence of ADL was found to be closely related to the rainfall pattern. The design of the study, its findings, and the public health implications of the findings are discussed in this paper.

The relationship between infection and disease in Wuchereria bancrofti infection in Ghana.

The relationship between infection and clinical disease in Wuchereria bancrofti infection was investigated in a community-based study in different endemic areas in Ghana. At the individual level, there was no association between acute adenolymphangitis and infection (microfilaraemia) status. There was a negative association between infection status and lymphoedema/elephantiasis, but a positive association with hydrocele; however, the intensity of infection was negatively associated with both elephantiasis and hydrocele. The community prevalence of infection was strongly associated with the prevalence of clinical filariasis (especially hydrocele). There was a strong positive association between the prevalence of infection in males and the odds of a case of hydrocele being microfilaraemic, suggesting that there is no acquired immunity to reinfection in cases of hydrocele. The pathophysiologies of elephantiasis and hydrocele may therefore differ from one another, and require further investigation.

Descriptive epidemiology of lymphatic filariasis in Ghana.

A national filariasis survey was conducted to determine the prevalence and distribution of Wuchereria bancrofti microfilaraemia and clinical disease associated with lymphatic filariasis in Ghana. Multi-stage systematic sampling was used to select households to be examined in all 10 administrative regions of the country. The results showed a high prevalence of microfilaraemia and disease with considerable regional variation in all the quantities investigated. In general, the disease was more prevalent in the northern guinea savannah and the southern coastal savannah, while the middle forest belt was relatively free. Even within the regions, there was considerable variation in the distribution of the disease. The disease is of potentially major public health significance, particularly in the northern and coastal savannahs, and requires the design and implementation of a control programme.

Acute adenolymphangitis due to bancroftian filariasis in Rufiji district, south east Tanzania.

A longitudinal prospective surveillance for acute adenolymphagitis (ADL) was carried out in three villages in Rufiji district. A sample population of 3000 individuals aged 10 years and above was monitored fortnightly for a period of 12 months. The annual incidence of ADL was found to be 33 per 1000 population and was significantly higher in males than females (52.7/1000 and 18.7/1000 respectively). ADL episodes were more frequent in the age group of 40 years and above. Individuals with chronic manifestations seemed to be more vulnerable to ADL attacks with 62.2% of the total episodes occurring in this group. Furthermore, individuals with lymphoedema experienced more frequent acute episodes compared to those with hydrocele and 'normal exposed'. ADL episodes ranged from one to five per annum and the majority of the affected (60.4%) experienced a single episode. The average duration of an ADL episode was 8.6 days and in 72.5% of the episodes the affected individuals were incapacitated and unable to do their normal activities for an average duration of 3.7 days. The physical incapacitation associated with ADL episodes emphasizes the significance of lymphatic filariasis as a major public health problem of substantial socio-economic consequences.

[NMR tomographic diagnosis with Gd-DTPA in HIV-associated diseases in the head-neck area]. / Kernspintomographische Diagnostik mit Gd-DTPA bei HIV-assoziierten Erkrankungen im Kopf-Hals-Bereich.

In a prospective study 21 patients suffering from HIV-1 infection underwent MR imaging. The following tumours were found: eight Kaposi's sarcomas, four lymphomas, two squamous-cell carcinomas, and three cases of lymphoid hyperplasia. Furthermore, three cases with lymphoepithelial cysts and one case of inflammatory changes of the parotid glands were studied. Optimal diagnostic results were obtained by using T1- and T2-weighted sequences plain and Gd-DTPA enhanced. Different signal intensities enabled the differentiation of lesions such as inflammation, lymphomas and lymphoid hyperplasia. Besides clinical examination modalities, MR imaging proves to be an important tool in investigating solid, cystic or inflamed processes in HIV-positive patients in the head and neck area.

A cross-sectional study of epizootic lymphangitis in cart-mules in western Ethiopia.

A cross-sectional study was conducted to determine the prevalence of epizootic lymphangitis (EL) in 309 cart-mules (cart-pulling mules) in Bako and Ejaji towns, Western Ethiopia using clinical and microbiological examinations, between November 2002 and April 2003. The overall prevalence was 21% (CI=16.6-26%). The clinical, histological and mycological characteristics of EL in a cart-mule were similar with those in a horse. There was significant (chi2=133.5, P=0.001) association between tick infestation and EL lesions in study cart-mules. Amblyoma coherence and Boophilus genera were the ticks collected from lesions of cases of EL, and thus played a predisposing role. In conclusion, our results showed that EL has high prevalence in cart-mules in the two towns.

Seasonal fluctuations of incubation, healing delays, and clinical presentation of cutaneous leishmaniasis in French Guiana.

An investigation was conducted to determine whether seasonal variations affected the development of cutaneous leishmaniasis. Data from 499 cases treated between July 1994 and December 1998 were analyzed. The interval between infection and consultation and between treatment and clinical cure varied significantly between cases with an incubation period during the dry season compared with the rainy season (P < 0.001). When the incubation period occurred during the dry season, the standard pentamidine isethionate treatment seemed to be less effective (i.e.. the odds ratio for failure was 1.9 [1.1-3.4], P = 0.01). The presence of lymphangitis was more frequent during the dry season (i.e., the odds ratio was 0.26 [0.15-0.45], P < 0.001). These results suggested that the observed seasonal variations were due to variations in the host/parasite balance. Converging indirect elements that suggest a role for variations in solar ultraviolet radiation are discussed.

Episodic dermatolymphangioadenitis (DLA) in patients with lymphedema of the lower extremities before and after administration of benzathine penicillin: a preliminary study.

Dermatolymphangioadenitis (DLA) is a common and serious complication of obstructive peripheral lymphedema. The clinical characteristics of acute DLA are local tenderness and erythema of the skin, sometimes red streaks along the distribution of the superficial lymphatics and enlarged inguinal lymph nodes. Systemic symptoms include malaise, fever and chills. In its subacute or latent form, only skin involvement is observed. Each episode of DLA is commonly followed by worsening of leg swelling. Numerous clinical studies suggest that administration of antibiotic drugs interrupt the acute episodes and prevent their recurrence. We investigated the clinical course of lymphedema with respect to the prevalence of DLA in patients receiving injections of long-acting penicillin (benzathine penicillin). Forty-five randomly selected patients with obstructive lymphedema of the lower limbs were included in an open clinical trial. The inclusion criteria was stage II-IV lymphedema of postsurgical, posttraumatic, and postdermatitis type with at least 3 previous episodes of DLA. Benzathine penicillin (PCN) was given after the last presenting episode of DLA in a dose of 1,200,000 u, intramuscularly at 3-week intervals, for at least one year. Each patient was reevaluated at 3-month intervals. They were instructed in early diagnosis of DLA and reported promptly to the responsible senior surgeon with prodrome symptoms of recurrent DLA. The duration of lymphedema before initiation of therapy was 7 months to 40 years and the frequency of DLA was 1-6 episodes per year. PCN administration lasted for at least one year but was extended in all patients because of the tendency for recurrence of DLA after cessation of PCN injections. In 26 of these patients, PCN administration extended to over 5 years and in 2 over 10 years. Recurrent episodes of DLA occurred in the PCN-treated group during one year follow-up in only 4 of the 45 patients (9%). The frequency episodes in 3 patients with recurrent DLA was 1-2/year; in one patient, no positive effect of PCN therapy was observed. There were no apparent side effects of long-term PCN therapy. These data, although evaluated without a placebo group, suggest that long-term PCN administration decreases the frequency of DLA attacks and furthermore provide justification for carrying out a double-blind randomly placebo-controlled clinical trial of the efficacy of prophylactic antibiotic drug treatment in forestalling DLA episodes.

A preliminary study of filariasis related acute adenolymphangitis with special reference to precipitating factors and treatment modalities.

Episodic adenolymphangitis (ADL) is one of the important clinical manifestations of lymphatic filariasis. Recurrent ADLs contribute to the progress of the disease and also have important socioeconomic implications since they cause significant loss of man days. The present study was conducted in order to identify the precipitating factors responsible for ADL attacks and also to examine the different modalities of treatment. Sixty-five individuals with filariasis related ADL attacks, who are residents of Alleppey district (endemic for Brugia malayi) were studied. All efforts were taken to identify the precipitating factors for ADLs in these individuals. They were hospitalized for a period of five days or more. All of them received symptomatic antipyretic/antiinflammatory therapy and topical antibiotic/antifungal treatment of the affected limbs. They were then randomly allocated to one of the following four regimens: group I - symptomatic alone; group II - symptomatic plus antibiotics; group III - symptomatic followed by diethylcarbamazine citrate (DEC) and group IV - symptomatic plus antibiotic followed by DEC. Patients in groups III and IV received DEC every three months up to one year. There was a significant relationship between the number of ADL attacks and the grade of edema. Presence of focus of infection in the affected limb could be identified in 28 of the 65 patients. In the majority of patients (48) response to treatment was rapid (resolution in less than five days). Neither antibiotics nor DEC (given at intervals of three months) appeared to alter the frequency of ADL attacks. On the otherhand simple hygienic measures combined with good foot care and local antibiotic/antifungal cream application (where required), were effective in reducing the number of ADL attacks.