Microscopy

Lymphatic filariasis is usually identified by the finding of microfilaria in peripheral blood smears (thick or thin) stained with Giemsa or hematoxylin-and-eosin. For increased sensitivity, concentration techniques can be used. These include centrifugation of the blood sample lysed in 2% formalin (Knott's technique), or filtration through a Nucleopore® membrane. Microfilariae of Wuchereria and Brugia exhibit a nocturnal periodicity and an accurate diagnosis is best achieved on smears collected at night (10 PM-2 AM). Adults may be identified in biopsy specimens of lymphatic tissue.

Antigen Detection

Antigen detection using an immunoassay for circulating filarial antigens constitutes a useful diagnostic approach because sensitivity for detection of microfilariae can be low and variable. Unlike microfilariae with nocturnal periodicity, filarial antigens can be detected in blood samples collected at any time of day. A rapid format immunochromatographic test has been shown to be a useful and sensitive tool for the detection of Wuchereria bancrofti antigen and is being used widely by lymphatic filariasis elimination programs. Currently, this test is not licensed for use in the United States and cannot be used for patient diagnosis.

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