The Acute clinical manifestations of lymphatic filariasis are characterized by episodic attacks of lymphadenitis and lymphangitis associated with fever and malaise.Sometimes fever precedes the adenolymphangitis by a few days.Although the fever sometimes precedes adenolymphangitis, fever alone, in the absence of adenolymphangitis, should not be ascribed to filariasis, even when microfilaraemia is present.
Filarial fever is an acute recurrent fever with haedache, malaise, chills, rigors, low to high grade (38-40°),subsiding with sweating and it may closely resemble malaria.Fever persists for 3-5 days. It is usually accompanied by symptomatic lymphangitis and other early signs of filariasis but may occur as fever alone.
Acute lymphadenitis and lymphangitis are characteristic of Bancroftian and Malayan filariasis.
The onset is acute, involving a single
gland or group of glands within the inguinal, axillary, cervical or epitrochlear regions.
This is accompanied by fever; 6-8 hours later retrograde (centrifugal) lymphangitis starts
in the glands and spreads peripherally.
The lymphatic trunks become painful and cord-like with characteristic red streaks running down the arms or legs. The distal affected limb becomes swollen and oedematous during the attack which may continue for several days accompanied by the fever.
Lymphangitis may be confined to the groin glands, testis, spermatic cord (endemic funiculitis) or abdominal varix ruptures, symptoms of peritonitis rapidly develop and may be fatal (abdominal filariais)
This is an acute painful inflammation of the spermatic cord and epididymis. This is usually associated with fever and inflammation of testis and painful glands in the groins. Lymphangitis of the spermatic cord gives rise to funiculitis which has been called 'endemic funiculitis'.It is usually accompanied by filarial fever and orchitis.
Fluid aspirated from the runica vaginalis is cloudy and contains a number of polymorphonuclear cells and occasional red cells, together with microfilariae. The acute symptoms last a few days but recur at intervals. In sections dead and efferentia causing extensive fibrotic change are found and it is possible, although not yet proved, that this may result in sterility. The end result is a thickened spermatic cord.
Epididymo-orchitis is an acute painful condition involving the testis and epididymis resulting in some degree of scrotal swelling and redness. It is usually associated with fever, funiculitis and lymphnode elargement in the groin. The onset is sudden with pain radiating to the groin and tendernesss of the testis which may swell to twice its usual size with a boggy feeling on palpation. Orchitis is associated with filarial fever,and recurrent attacks lead sooner or later to hydrocele.
Filarial abscesses develop within superficial lymphatics on the limbs or scrotum and at first the symptoms resemble an attack of lymphangitis but the pain and swelling continue, to be followed after some weeks by rupture and a discharge of pus. Pus may be sterile or contain bacteria particularly Beta haemolytic streptococci. Fragments of dead adult worms may be discharged.