Current Advances in the Diagnosis, Immunopathology, Treatment and Elimination of Lymphatic Filariasis

Abstract

Lymphatic filariasis is a mosquito-borne neglected tropical disease caused by Wuchereria bancrofti, Brugia malayi and Brugia timori, and remains an important public health problem in endemic regions. This review summarises current advances in the diagnosis, immunopathogenesis, treatment and elimination of lymphatic filariasis. The disease has a wide clinical spectrum, ranging from asymptomatic infection to recurrent inflammatory episodes and chronic manifestations such as lymphoedema, hydrocele and chyluria. Its pathogenesis reflects prolonged parasite survival in the lymphatic system, host immune regulation, inflammatory responses associated with Wolbachia endosymbionts, and progressive lymphatic damage. Diagnostic methods have expanded from nocturnal blood microscopy to antigen-detection tests, antibody-based assays and molecular techniques. Rapid antigen tests have improved field-based mapping and surveillance, while ELISA and PCR-based methods provide greater sensitivity in low-transmission or post-treatment settings, although their operational use remains limited by cost and infrastructure. Treatment has also advanced through the use of mass drug administration and triple-drug ivermectin, diethylcarbamazine and albendazole regimens, with doxycycline offering an additional approach through depletion of Wolbachia. Morbidity management, including lymphoedema care and hydrocele surgery, remains essential for affected individuals and should be considered alongside transmission interruption. Global elimination efforts have achieved measurable progress, but persistent transmission foci, incomplete treatment coverage, diagnostic limitations, population movement, funding constraints and environmental change continue to challenge elimination in several endemic settings. The manuscript emphasises that elimination depends on both biological effectiveness and operational feasibility. Sustained integrated strategies combining effective treatment, sensitive surveillance, morbidity management, vector control and health-system strengthening are required to consolidate gains and support long-term interruption of transmission.