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    Filariasis: Dr. Suhaemi, SPPD, Finasim

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    Erreli K. Khusumawerdanie
    Filariasis, also known as elephantiasis, is caused by parasitic roundworms transmitted by mosquitoes. It causes swelling and deformity of body parts like the legs. The parasites Wuchereria bancrofti and Brugia malayi live and breed in the lymphatic vessels, causing blockages and swelling. Symptoms include fever, coughing, and swelling of limbs. Diagnosis involves finding microfilariae in blood smears. Treatment aims to eliminate microfilariae and adult worms using a combination of drugs like diethylcarbamazine, ivermectin and albendazole. Vector control through mosquito nets and reducing standing water can also help control transmission.

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    Filariasis: Dr. Suhaemi, SPPD, Finasim

    Uploaded by

    Erreli K. Khusumawerdanie
    162 views30 pages
    Filariasis, also known as elephantiasis, is caused by parasitic roundworms transmitted by mosquitoes. It causes swelling and deformity of body parts like the legs. The parasites Wuchereria bancrofti and Brugia malayi live and breed in the lymphatic vessels, causing blockages and swelling. Symptoms include fever, coughing, and swelling of limbs. Diagnosis involves finding microfilariae in blood smears. Treatment aims to eliminate microfilariae and adult worms using a combination of drugs like diethylcarbamazine, ivermectin and albendazole. Vector control through mosquito nets and reducing standing water can also help control transmission.

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    Filariasis (2)

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    Filariasis, also known as elephantiasis, is caused by parasitic roundworms transmitted by mosquitoes. It causes swelling and deformity of body parts like the legs. The parasites Wuchereria bancrofti and Brugia malayi live and breed in the lymphatic vessels, causing blockages and swelling. Symptoms include fever, coughing, and swelling of limbs. Diagnosis involves finding microfilariae in blood smears. Treatment aims to eliminate microfilariae and adult worms using a combination of drugs like diethylcarbamazine, ivermectin and albendazole. Vector control through mosquito nets and reducing standing water can also help control transmission.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    162 views30 pages

    Filariasis: Dr. Suhaemi, SPPD, Finasim

    Uploaded by

    Erreli K. Khusumawerdanie
    Filariasis, also known as elephantiasis, is caused by parasitic roundworms transmitted by mosquitoes. It causes swelling and deformity of body parts like the legs. The parasites Wuchereria bancrofti and Brugia malayi live and breed in the lymphatic vessels, causing blockages and swelling. Symptoms include fever, coughing, and swelling of limbs. Diagnosis involves finding microfilariae in blood smears. Treatment aims to eliminate microfilariae and adult worms using a combination of drugs like diethylcarbamazine, ivermectin and albendazole. Vector control through mosquito nets and reducing standing water can also help control transmission.

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    FILARIASIS

    Dr. Suhaemi, SpPD, Finasim

    Filariasis
    commonly known as elephantiasis
    caused by a parasite transmitted by mosquito
    Signs and Symptoms
    Pain and swelling of the breast, vagina, scrotum, legs
    and arms Fever Cough Chills Wheezing
    Wuchereria bancrofti and Brugia malayi are filarial
    nematodes
    Spread by several species of night - feeding mosquitoes
    Causes lymphatic filariasis, also known as Elephantiasis
    Commonly and incorrectly referred to as Elephantitis
    Humans are the definitive host for the worms that cause
    lymphatic filariasis
    There are no known reservoirs for W.bancrofti.
    B.malayi has been found in macaques, leaf monkeys,
    cats and civet cats

    Intermediate Host
    W.bancrofti is transmitted by Culex, Aedes,
    and Anopheles species
    B.malayi is transmitted by Anopheles and
    Mansonia species.
    Endemic in 83 countries
    1.2 billion at risk
    More than 120 million people infected
    More than 25 million men suffer from
    genital symptoms
    More than 15 million people suffer from
    lymphoedema or elephantiasis of the leg
    Adult: White and thread-like. Two rings of
    small papillae on the head.
    Female:5~10cm in length
    Male: 2.5~4cm and a curved tail with two
    copulatory spicules.

    Anopheles

    Aedes

    Culex

    Mansonia

    Microfilaria: 177~296 m in length, a sheath with free endings.


    Bluntly rounded anteriorly and tapers to a point posteriorly. A
    nerve ring with no nuclei at anterior 1/5 of the body.

    Wuchereria bancrofti

    Brugia malayi

    B. Malayi
    B.malayi microfilariae are slightly smaller than those of
    W.bancrofti.
    Microfilariae are sheathed, and about 200 to 275 m.
    Not much is known about the adult worms, as they are not
    often recovered
    One distinctive feature of B.malayi is that the microfilarial
    4
    nuclei extends to the tip of the tail

    The morphological differences between two microfilaria


    W.bancrofti

    Size
    Cephalic space
    Nuclei

    Terminal nucleus

    244~296 m
    Shorter
    Equal sized
    clearly
    countable
    No

    B. malayi
    177~230 m
    Longer
    Unequal sized
    coalescing
    uncountable
    Two

    Characteristic of life cycle


    Host: Mosqutoes (intermediate host)
    Human (final host)
    Location: Lymphatics and lymph nodes
    Infective stage: Infective larvae
    Transmission stage: Microfilariae
    Diagnostic stage: Microfilariae
    para-lab by l. wafa menawi

    Life cycle
    para-lab by l. wafa menawi

    Wuchereria Life Cycle

    para-lab by l. wafa menawi

    para-lab by l. wafa menawi

    Nocturnal periodicity
    Phenomen which the number of microfilariae in
    peripherial blood is very low density during daytime,
    but increase from evening to midnight and reach the
    greatest density at 10p.m to 2 a.m.May be related to
    cerebral activity and vasoactivity of pulmonary
    vessels.
    Larva deposited by mosquito bite
    Travel through dermis to lymphatic vessels
    Growth (approx 9 months) to mature worms(20-100mm
    long)
    Worms live 5-7 years (occasionally up to15 years)
    Mate->Microfilariae (1st stage larva)
    Females->release up to 10,000 microfilariae/day into
    bloodstream
    by l. wafa menawi
    9
    Microfilarie taken up para-lab
    by mosquito
    bite

    Lymphatic System
    Network of vessels that collect
    fluid that leaks out of the blood
    into tissues (lymph)
    Redirects lymph back into the
    blood stream

    Clinical Course

    Initially asymptomatic
    Symptoms develop with increasing numbers of
    worms
    Less than 1/3 of infected individuals have acute
    symptoms
    Clinical Course is 3 phases:
    Asymptomatic Microfilaremia
    10
    Acute Adenolymphangitis (ADL)

    Acute ADL
    Presents with sudden onset of fever and painful
    lymphadenopathy
    Retrograde Lymphangitis
    Inflammation spreads distally away from lymph node
    group
    Immune mediated response to dying worms
    Most common areas: Inguinal nodes and Lower
    extremities
    o Inflammation spontaneously resolve after 4-7 days but
    can recur frequently
    o Recurrences usually 1-4 times/year with increasing
    severity of lymphedema
    o Secondary bacterial infections in
    edematous(elephantatic) areas
    o Filarial fever (fever w/o lymphangitis)
    11
    o Tropical Pulmonary Eosinophilia

    Chronic Manifestations
    o Lymphedema

    o Mostly LE and inguinal, but can affect UE and breast


    o Initially pitting edema, with gradual hardening of
    tissues hyperpigmentation & hyperkeratosis
    o GenitaliaHydroceles
    o Renal involvement

    o Chylurialymph discharge into urine


    o Loss of fat and protein hypoproteinemia & anemia
    o Hematuria, proteinuria from immune complex nephritis
    o Secondary bacterial/fungal infections
    o Elephantiasis: accumulation of lymph in extremeties, fibrosis,
    and thickening of skin.

    12

    Onchocerciasis (river blindness)


    Debilitates millions of humans
    by scarring eyes & causing
    permanent blindness
    Affects people along rivers
    in West & Central Africa
    (native) & South America
    (introduced via slavery)
    Caused by Onchocerca
    volvulus
    Adult females are up to
    500mm long & males up to
    40mm long
    Adults live up to 14 years
    Restricted to humans (no
    known animal reservoirs)

    13

    Onchocerciasis (river blindness)

    Black flies ingest microfilariae from blood


    Move from gut to flight muscles & mature into
    infective larvae (L3)
    L3 larvae migrate to head & enter humans via
    bite wound; mature into adults (2-4 months)
    Adults accumulate in subcutaneous nodules
    (1cm diameter) which dont cause much
    damage
    Mating in nodules produces microfilariae
    Live under skin causing rashes & wrinkles
    Cause blindness when invade eyes tissues &
    die there
    14

    para-lab by l. wafa menawi

    15

    Onchocerciasis (river blindness)


    Early stages of eye damage can be reversed by
    drug treatment
    Parasiticide ivermectin is most popular
    Transfer of worms affected by feeding behaviour
    of flies
    Waggle mouth parts during biting to increase
    wound size & create pool of blood (pool
    feeders)
    Main vector = Simulium damnosum
    Complex of >40 sibling species in West &
    East Africa
    Not all sibling species transmit worms
    Insecticide applications used to control larvae
    in rivers
    16

    Loiasis
    Caused by infection with Loa loa
    Adult worms move under human skin
    Observed beneath skin or passing through
    conjunctiva of eyes (eye worms)
    Worms = 2 races (attack humans or arboreal
    primates)
    Transmitted by horse flies (Tabanidae) in genus
    Chrysops
    Day-feeding & forest-dwelling
    Rare case of Tabanidae = biological vectors
    Disease endemic to rain forest regions of West &
    Central Africa
    Generally mild & painless (chronic) with 10-15
    year incubation period
    para-lab by l. wafa
    17
    May cause swellings
    ofmenawi
    skin (Calabar
    swelling)

    para-lab by l. wafa menawi

    18

    Diagnosis
    The standard method for diagnosing active
    infection is the identification of microfilariae by
    microscopic examination
    However, microfilariae circulate nocturnally,
    making blood collection an issue
    A card test for parasite antigens requring only
    a small amount of blood has been developed
    Does not require laboratory equipment
    Blood drawn by finger stick
    Urinalysis, CBC and Comprehensive Chemistries
    Foot Biopsy: Normal Skin with areas of chronic
    inflammation
    19

    Microfilariae are seen in blood


    smears and are DIAGNOSTIC

    para-lab by l. wafa menawi

    20

    Blood Smear Microfilaria


    Note wavy
    microfilarial
    worm in the
    thick part of
    blood film.
    Dark blue
    structures are
    nuclei
    Tail end tapering
    (no nuclei)
    Sheath covering
    worm.
    para-lab by l. wafa menawi

    21

    Blood Smear Microfilaria


    Note wavy
    microfilarial
    worm in the
    thick part of
    blood film.
    Head end of the
    worm rounded
    (no nuclei)
    (Sheath is not
    clearly seen)
    para-lab by l. wafa menawi

    22

    Blood Smear Microfilaria


    Note wavy
    microfilarial worm
    in the thick part of
    blood film.
    Dark blue
    structures are
    nuclei
    Tail end - tapering
    sheath (no nuclei)
    para-lab by l. wafa menawi

    23

    Hydrocele fluid cell


    block.
    Note wavy
    microfilarial
    worms.
    Inflammatory
    cells
    lymphocytes.
    Hemorrhagic
    fluid sediment

    para-lab by l. wafa menawi

    24

    Hydrocele fluid cell


    block.
    Note wavy
    microfilarial
    worms.
    Inflammatory
    cells
    lymphocytes.
    RBC

    para-lab by l. wafa menawi

    25

    Hydrocele fluid cell


    block.
    Note wavy
    microfilarial
    worms.
    Inflammatory
    cells
    lymphocytes.
    RBC

    para-lab by l. wafa menawi

    26

    Hydrocele fluid cell


    block.

    Inflammatory
    cells
    Microfilaria.
    lymphocytes.
    RBC

    para-lab by l. wafa menawi

    27

    Control

    Vector control

    Covering water-storage
    As with malaria, the most
    containers and improving
    effective method of
    controlling the spread of
    waste-water and solidW.bancrofti and B.malayi is
    waste treatment systems
    to avoid mosquito bites
    can help by reducing the
    The CDC recommends that
    anyone in at-risk areas:
    amount of standing water
    Sleep under a bed net
    in which mosquitoes can
    Wear long sleeves and
    lay eggs.
    trousers
    Wear insect repellent on Killing eggs (oviciding) and
    exposed skin, especially
    killing or disrupting larva
    at night
    (larviciding) in bodies of
    stagnant water can further
    reduce mosquito
    populations.
    28

    Treatment
    Treatment of filariasis involves two
    components:
    Getting rid of the microfilariae in
    people's blood
    Maintaining careful hygiene in
    infected persons to reduce the
    incidence and severity of secondary
    (e.g., bacterial) infections.
    para-lab by l. wafa menawi

    29

    Drugs, Drugs, Drugs!


    Anti-filariasis medicines commonly used include:
    Diethylcarbamazine (DEC)
    reduces microfilariae concentrations
    kills adult worms
    Albendazole
    kills adult worms
    Ivermectin
    kills the microfilariae produced by adult worms

    The disease is usually treated with single-dose


    regimens of a combination of two drugs, one targeting
    microfilariae and one targeting adult worms (i.e.,either
    diethylcarbamazine and albenadazole, or ivermectin
    and albendazole
    In some areas, DEC laced table salt is used as a
    30
    prophylactic

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