Lymphatic filariasis, a mosquito-transmitted disease commonly known as Bancroftian filariasis, is characterized by debilitating pathology linked to the progression of lymphoedema to a chronic state of elephantiasis. We performed longitudinal measurements of endothelial adhesion and angiogenic molecules in 63 Polynesian patients living in an hyperendemic focus of Wuchereria bancrofti. Decreased serum concentrations of soluble (s-) L selectin (CD62L) were noticed in sera of of patients with chronic conditions (hydrocele and elephantiasis). Chyluria was associated with increased vascular endothelial growth factor (VEGF) levels, whereas elephantiasis presented a high endothelin-1 (ET-1) profile. By contrast, increased serum concentrations of soluble intercellular (sICAM-1, CD54), but not of vascular cell (sVCAM-1, CD106), adhesion molecules were observed in sera of patients with bacterial lymphangitis used as controls. These trends are consistent with the increased permeability of vascular structures, a major clinical feature observed in acute lymphatic pathology (of bacterial or filarial origin), and of fundamental differences in the pathogenesis of hydrocele and elephantiasis. Using markers correlated with the clinical status (high ET-1 and VEGF levels for elephantiasis and chyluria, respectively; low CD62L levels for hydrocoele and elephantiasis) it should be possible to monitor disease progression in lymphatic filariasis.

Summary:Growing evidence suggest that secondary bacterial, mainly streptococcal, infections contribute significantly to recurrent episodes of acute adenolymphangitis (ADL| of filarial origin. We examined the role of group A streptococci in the progression of lymphedema in Polynesian patients with filariasis-related ADL (22 cases) or chronic pathology (10 cases), or with erysipela (10 patients) and, as controls, in 20 healthy adults. Antistreptolysin O (ASLO) and anti-streptodornase B (ASDB) titers were systematically determined in parallel to parasitological and biochemical tests. ASLO and ASDB assays were positive in 100 % of erysipela, 75 % of filarial ADL as compared to 50 % of chronic pathology and 39 % of healthy controls. Interestingly, by opposition to ASLO titers which were not significantly different between the four groups, ASDB titers were higher in ADL (p = 0.019) and erysipela (p = 0.002) than in controls. These results support the hypothesis that recurrent streptococcal infections may have an important role in the pathogenesis of ADL in lymphatic filariasis.KEY WORDS : lymphatic filariasis, Wuchereri a bancrofti, group A streptococci, acute adenolymphangitis, French Polynesia. (Fan et al., 1995). The acute form of bancroftian filariasis involves lymphadenitis and lymphangitis, generally called adenolymphangitis (ADL) and is supposed to be, at least partly, a local immunological response to adult worms associated to mechanical damages of the lymphatic vessels made by these motile parasites. Repeated lymphatic damages related to adult worms activity is supposed to result in increased susceptibility to secondary bacterial infections, leading to progression of lymphoedema and elephantiasis (Olszewski et al., 1993(Olszewski et al., , 1994Schacher & Sahyoun, 1967;Shenoy et al, 1995 et al, 1998) associated morbi dity. The present study examined serologically infec tions with group AB hemolytic streptococci, one of the main common pathogenic bacteria in tropical areas with a marked affinity for the lymphatics, in ADL of filarial and bacterial (erysipela, see clinical definition in Chattier &Grosshans, 1990, andVincent et al, 1998) origins, compared to controls with the same eth nological and social conditions. MOTS CLES MATERIAL AND METHODS SERUM SAMPLESP rospective patients, examined by an experienced medical staff (Clinical Research Unit, Institut Malarde, Papeete, French Polynesia), were care fully questioned for a clinical history of recurrent epi sodes of ADL (Suma et al, 1997;Vincent et al, 1998). The selected population consisted of 22 patients with filarial ADL, 10 patients with chronic pathology (six hydroceles, two elephantiasis and two chyluria) and 10 with typical erysipelas and 20 endemic healthy controls of the same ethnological (Polynesian) and social (life-long residents of Tahiti island, Society archi pelago) conditions. After informed consent, diligent cli nical and laboratory investigations (complete hemogram, serum biochemistry and detection of microfilariae by Nucleopore® membrane fi...

Summary :We measured the concentrations of several circulating fibrosis markers (type I collagen I, type III procollagen, hyaluronan) and eosinophil granule proteins (ECP and EPX) in lymphatic filariasis patients to investigate their relationship with clinical, parasitological and immunological data. This study was conducted in Polynesian patients with various stages of the disease (acute lymphangitis, chyluria, hydrocoele, elephantiasis), a closely related microbial lymphangitis and endemic controls. We observed modifications of the different markers in this pathology. Serum type I collagen and PIIINP were decreased. Serum hyaluronan, linked to perilymphatic granulomatous inflammation, was significantly increased in acute lymphangitis and elephantiasis patients. Serum ECP was also increased, at the limit of significance in our sample, in elephantiasis patients. These two last markers, already validated in another helminth disease, schistosomiasis, have potential interest in terms of follow-up of morbidity in these parasitic diseases. Résumé : MARQUEURS DE FIBROSE ET PROTÉINES DE L'ÉOSINOPHILE DANS LA FILARIOSE LYMPHATIQUE