{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,16]],"date-time":"2026-01-16T05:07:34Z","timestamp":1768540054416,"version":"3.49.0"},"reference-count":49,"publisher":"American Society of Tropical Medicine and Hygiene","issue":"4_Suppl","license":[{"start":{"date-parts":[[2024,10,1]],"date-time":"2024-10-01T00:00:00Z","timestamp":1727740800000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,10,1]]},"abstract":"<jats:title>ABSTRACT.<\/jats:title>\n<jats:p>Filarial lymphedema (LE) remains a significant global problem despite the progress made toward elimination of lymphatic filariasis (LF). In Ghana, the main approach to LF is preventive chemotherapy, but this has minimal impact on individuals who have already developed LE. In 2018\u20132020, a 24-month randomized, double-blind, placebo-controlled trial was conducted to evaluate the efficacy of stringent hygiene measures using the Essential Package of Care with or without additional administration of doxycycline (DOX) to improve filarial leg LE. This study enrolled 356 participants with LE stages 1\u20133 from two districts in the Upper East Region of Ghana. In addition to regular training on appropriate care for their affected legs, participants were randomized to receive 6 weeks of either 200 mg\/day DOX (<jats:italic>n<\/jats:italic> = 117), 100 mg\/day DOX (<jats:italic>n<\/jats:italic> = 120), or matching placebo (<jats:italic>n<\/jats:italic> = 119). Participants were seen every 2 months, with clinical measurements done at 6, 12, 18, and 24 months to assess the status of affected legs. There was a trend toward later appearance of acute attacks after DOX, but surprisingly, DOX showed no effect on LE stage progression. In all groups, leg LE improvement was more common (DOX 200 mg: <jats:italic>n<\/jats:italic> = 23 [20%]; DOX 100 mg: <jats:italic>n<\/jats:italic> = 23 [19.5%]; placebo: <jats:italic>n<\/jats:italic> = 32 [27.4%]) than LE worsening (DOX 200 mg: <jats:italic>n<\/jats:italic> = 2 [1.7%]; DOX 100 mg: <jats:italic>n<\/jats:italic> = 3 [2.5%]; placebo: <jats:italic>n<\/jats:italic> = 2 [1.7%]). Overall, these data show a strong benefit from adherence to a strict hygiene protocol, with some added potential benefit for DOX in preventing acute attacks.<\/jats:p>","DOI":"10.4269\/ajtmh.24-0313","type":"journal-article","created":{"date-parts":[[2024,10,2]],"date-time":"2024-10-02T12:35:43Z","timestamp":1727872543000},"page":"66-82","source":"Crossref","is-referenced-by-count":5,"title":["Adherence to Hygiene Protocols and Doxycycline Therapy in Ameliorating Lymphatic Filariasis Morbidity in an Endemic Area Post-Interruption of Disease Transmission in Ghana"],"prefix":"10.4269","volume":"111","author":[{"given":"Linda Batsa","family":"Debrah","sequence":"first","affiliation":[{"name":"Kumasi Centre for Collaborative Research in Tropical Medicine (KCCR), Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana;"},{"name":"Department of Clinical Microbiology, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana;"},{"name":"German-West African Center for Global Health and Pandemic Prevention (G-WAC), partner site Kumasi, Ghana;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ute","family":"Klarmann-Schulz","sequence":"additional","affiliation":[{"name":"Institute for Medical Microbiology, Immunology and Parasitology (IMMIP), University Hospital Bonn, Bonn, Germany;"},{"name":"German Center for Infection Research (DZIF), partner site Bonn-Cologne, Germany;"},{"name":"Institute for Medical Biometry, Informatics and Epidemiology (IMBIE), University Hospital Bonn, Bonn, Germany;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jubin","family":"Osei-Mensah","sequence":"additional","affiliation":[{"name":"Kumasi Centre for Collaborative Research in Tropical Medicine (KCCR), Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana;"},{"name":"School of Veterinary Medicine, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Janina M.","family":"Kuehlwein","sequence":"additional","affiliation":[{"name":"Institute for Medical Microbiology, Immunology and Parasitology (IMMIP), University Hospital Bonn, Bonn, Germany;"},{"name":"German Center for Infection Research (DZIF), partner site Bonn-Cologne, Germany;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yusif","family":"Mubarik","sequence":"additional","affiliation":[{"name":"Kumasi Centre for Collaborative Research in Tropical Medicine (KCCR), Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jennifer","family":"Nadal","sequence":"additional","affiliation":[{"name":"Institute for Medical Microbiology, Immunology and Parasitology (IMMIP), University Hospital Bonn, Bonn, Germany;"},{"name":"Institute for Medical Biometry, Informatics and Epidemiology (IMBIE), University Hospital Bonn, Bonn, Germany;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nana Kwame","family":"Ayisi-Boateng","sequence":"additional","affiliation":[{"name":"Department of Medicine, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Arcangelo","family":"Ricchiuto","sequence":"additional","affiliation":[{"name":"Institute for Medical Microbiology, Immunology and Parasitology (IMMIP), University Hospital Bonn, Bonn, Germany;"},{"name":"Institute for Medical Biometry, Informatics and Epidemiology (IMBIE), University Hospital Bonn, Bonn, Germany;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vera Serwaa","family":"Opoku","sequence":"additional","affiliation":[{"name":"Kumasi Centre for Collaborative Research in Tropical Medicine (KCCR), Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sarah M.","family":"Sullivan","sequence":"additional","affiliation":[{"name":"Neglected Tropical Diseases Support Center, Task Force for Global Health, Decatur, Georgia;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Derrick Adu","family":"Mensah","sequence":"additional","affiliation":[{"name":"Kumasi Centre for Collaborative Research in Tropical Medicine (KCCR), Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana;"},{"name":"Department of Clinical Microbiology, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John","family":"Horton","sequence":"additional","affiliation":[{"name":"Tropical Projects, Hitchin, United Kingdom;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Abu Abudu","family":"Rahamani","sequence":"additional","affiliation":[{"name":"Kumasi Centre for Collaborative Research in Tropical Medicine (KCCR), Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana;"},{"name":"Department of Clinical Microbiology, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Philip J.","family":"Budge","sequence":"additional","affiliation":[{"name":"Washington University School of Medicine, St. Louis, Missouri;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stephen","family":"Gbedema","sequence":"additional","affiliation":[{"name":"Department of Pharmaceutics, Faculty of Pharmacy and Pharmaceutical Sciences, College of Health Sciences, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Patricia Jebett","family":"Korir","sequence":"additional","affiliation":[{"name":"Institute for Medical Microbiology, Immunology and Parasitology (IMMIP), University Hospital Bonn, Bonn, Germany;"},{"name":"German Center for Infection Research (DZIF), partner site Bonn-Cologne, Germany;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John","family":"Opoku","sequence":"additional","affiliation":[{"name":"Kumasi Centre for Collaborative Research in Tropical Medicine (KCCR), Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kenneth","family":"Pfarr","sequence":"additional","affiliation":[{"name":"Institute for Medical Microbiology, Immunology and Parasitology (IMMIP), University Hospital Bonn, Bonn, Germany;"},{"name":"German Center for Infection Research (DZIF), partner site Bonn-Cologne, Germany;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Derrick Boateng","family":"Kontoh","sequence":"additional","affiliation":[{"name":"Department of Pharmaceutics, Faculty of Pharmacy and Pharmaceutical Sciences, College of Health Sciences, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Angelika","family":"Kellings","sequence":"additional","affiliation":[{"name":"Clinical Study Core Unit Bonn (SZB), Institute of Clinical Chemistry and Clinical Pharmacology, University Bonn, Bonn, Germany;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Charles","family":"Gyasi","sequence":"additional","affiliation":[{"name":"Kumasi Centre for Collaborative Research in Tropical Medicine (KCCR), Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael Agyemang","family":"Obeng","sequence":"additional","affiliation":[{"name":"Kumasi Centre for Collaborative Research in Tropical Medicine (KCCR), Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Barbara","family":"Gruetzmacher","sequence":"additional","affiliation":[{"name":"Institute for Medical Microbiology, Immunology and Parasitology (IMMIP), University Hospital Bonn, Bonn, Germany;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fatima Amponsah","family":"Fordjour","sequence":"additional","affiliation":[{"name":"Department of Microbiology, University for Development Studies (UDS), Tamale, Ghana;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Inge","family":"Kroidl","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases and Tropical Medicine, Medical Center of the University of Munich (LMU), Munich, Germany;"},{"name":"German Center for Infection Research (DZIF), partner site Munich, Germany;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sacha","family":"Horn","sequence":"additional","affiliation":[{"name":"Division of 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Ghana"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"2795","reference":[{"key":"b1","series-title":"Lymphatic Filariasis","year":"2022"},{"key":"b2","series-title":"PLoS Negl Trop Dis","first-page":"e0009373","article-title":"New global targets for NTDs in the WHO roadmap 2021\u20132030","volume":"15","author":"Casulli","year":"2021"},{"key":"b3","series-title":"Control of Neglected Tropical Diseases","year":"2020"},{"key":"b4","series-title":"Lancet Infect Dis","first-page":"451","article-title":"Effectiveness of a triple-drug regimen for global elimination of lymphatic filariasis: A modelling study","volume":"17","author":"Irvine","year":"2017"},{"key":"b5","series-title":"Lancet Glob Health","first-page":"e1186","article-title":"The global distribution of lymphatic filariasis, 2000\u201318: A geospatial analysis","volume":"8","year":"2020"},{"key":"b6","series-title":"PLoS Negl Trop Dis","first-page":"e3319","article-title":"Progress and impact of 13 years of the 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Dis","first-page":"621","article-title":"Doxycycline improves filarial lymphedema independent of active filarial infection: A randomized controlled trial","volume":"55","author":"Mand","year":"2012"},{"key":"b11","series-title":"Basic Lymphoedema Management: Treatment and Prevention of Problems Associated with Lymphatic Filariasis","author":"Dreyer","year":"2002"},{"key":"b12","series-title":"PLoS Pathog","first-page":"e92","article-title":"Doxycycline reduces plasma VEGF-C\/sVEGFR-3 and improves pathology in lymphatic filariasis","volume":"2","author":"Debrah","year":"2006"},{"key":"b13","series-title":"Hum Genomics","first-page":"1","article-title":"Single nucleotide polymorphisms in the angiogenic and lymphangiogenic pathways are associated with lymphedema caused by Wuchereria bancrofti","volume":"11","author":"Debrah","year":"2017"},{"key":"b14","series-title":"Clin Infect Dis","first-page":"517","article-title":"Doxycycline leads to sterility and enhanced killing of female Onchocerca volvulus worms in an area with persistent microfilaridermia after repeated ivermectin treatment: A randomized, placebo-controlled, double-blind trial","volume":"61","author":"Debrah","year":"2015"},{"key":"b15","series-title":"Ann Trop Med Parasitol","first-page":"39","article-title":"The economic burden of lymphatic filariasis in northern Ghana","volume":"90","author":"Gyapong","year":"1996"},{"key":"b16","series-title":"Parasit Vectors","first-page":"1","article-title":"The design and development of a multicentric protocol to investigate the impact of adjunctive doxycycline on the management of peripheral lymphoedema caused by lymphatic filariasis and podoconiosis","volume":"13","author":"Horton","year":"2020"},{"key":"b17","series-title":"PLoS Negl Trop Dis","first-page":"e0010129","article-title":"Occurrence of lymphatic filariasis infection after 15 years of mass drug administration in two hotspot districts in the upper east region of Ghana","volume":"16","author":"Adu 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