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A diagnostic dilemma: aetiological diagnosis of lymphoedema patients at an Indian multidisciplinary meeting

Katie Riches, M van Zanten, Peter Mortimer, Sahar Mansour, Saravu Narahari, Terence Ryan, Vaughan Keeley
23 June 2019

Lymphatic filariasis (LF) is caused by a mosquito-transmitted infection. The morbidity of this infection can result in chronic, progressive lymphoedema. LF is recognised as one of the most common causes of lymphoedema worldwide with an estimated 40 million people affected. In India, LF is considered endemic with people at risk from across 250 districts. The clinical presentation of LF can have similarities to primary lymphoedema, which is a congenital abnormality of the lymphatic system. Differentiating between the two is challenging, but important for family planning, as well as related phenotypical morbidities. In Kasaragod, India, the Institute of Applied Dermatology (IAD) has developed a unique concept of integrative medicine combining Ayurvedic medicine and yoga with allopathy. The treatment for lymphoedema offered at IAD consists of conservative management with Indian manual lymphatic drainage, compression bandages, yoga, dietitian support, skin soaking and skin oils. During the ninth colloquium, organised by the IAD, an attending team from the UK discussed the application of genetic research, differential diagnosis ‘clues’ and discussion of research priorities. Correct diagnosis is important to understand and explain inheritance patterns, and to further investigate any other relevant comorbidities. Due to the complexity of these diagnoses, collaboration between these specialist centres across the world is highly valuable. 

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