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FILARIASIS

BLOOD AND LYMPHATIC SYSTEM

ISNA INDRAWATI

Department of Microbiology-Parasitology

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FILARIA

• Tissue nematodes (round worms)

• Family Filarioidea

• Adult worms live in the lymphatic,subcutaneous tissue & body cavities

• Transmitted by infected biting arthropods

during a blood meal.

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Morphology

• Adult worms : whitish and thread like

• Female : viviparous microfilaria

•

Microfilaria : sheated/ unsheated

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Periodicity of microfilaria:

• the circadian rhythm observed in the

appearance of filarial microfilaria in the

peripheral blood.•  Nocturna,

•  diurna

•  sub periodic

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• Basis of mf periodicity : >> unknown

• Influenced by :

 –Circadian rhythm of the host

 –p O2 and N2 in the blood

 –Strain of parasite

 –Feeding habit of the vectors

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 lymphatic

FILARIA

non-lymphatic

(sub cutaneous)

Wuchereria bancrofti

Brugia malayi

Brugia timori

Loa-loa

Onchocerca volvulus

Mansonella

NEMATODE 

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Global distribution of lymphatic filariasis and

onchocerciasis.

(Adapted from WHO, http://who.int/tdr/)

Source : www.neb.com

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Life cycle

Infected stage

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LYMPHATIC FILARIASIS

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Prevalence (WHO, 2015)

• ± 120 million people are infected withlymphatic filariasis;

• 25 million men have genital disease ( >>>

hydrocele)

• 15 million,(>> women), have lmphoedema or

elephantiasis of the leg.

•  ± 66% of those at risk of infection live in theWHO South-East Asia and 33% in the African

Region.

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Geographic distribution

W.bancrofti  : 90 % of the cases

B. malayi : most of the remainder cases

B. timori : also causes diseases

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Morphology

•

Adult worms : minute and thread like; whitish,smooth cuticula

•   ♂: 40 mm x 0,1 mm, posterior end curved

sharply

•   ♀: 80-100mm x 0.2- 0.3 mm

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Species Type/varians Mf periodicity Definitive

host

Wuchereria

bancrofti

Urban type Nocturnal Human

Rural type Nocturnal Human

Brugia malayiantropophilic Nocturnal Human

zoophilic

Subperiodic

Nocturnal

Human,

Monkey, Cat

Brugia timori Nocturnal Human

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Clinical symptoms

• Males >> females• The incubation period: 8 to 16 months.

(http://www.icm.tn.gov.in/seminar/filariasis.htm)

• >> infected people have no symptoms

• Acute :

•

episodes attacks of local inflammationinvolving the skin, lymph nodes and lymphaticlymphangitis retrograde & lymphadenitis

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• Filarial fever

• Orchitis, epididimitis, funiculitis ( filariasis

bancrofti)

Chronic

• << of persons will develop lymphedema

>> these symptoms years after beinginfected

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Filariasis bancrofti Filariasis brugia

• lymphatic system of

genitalia and breast

• 10 –50% of men suffer

genital damage,• hydrocele or swelling of

the scrotum

•

Chyluria•  Elephantiasis of the

entire leg or arm

• Ulcer

• Never affected

lymphatic system of

genitalia and breast• Elephantiasis of lower

part of the extremities

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Clinical symptoms

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Clinical symptoms

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Diagnosis

• Microscopic examination:

 –identification of microfilariae in a

blood smear obtained at night (10 pm

 –2 am)

Specific diagnosis (species)

•

Serologic enzyme immunoassay tests :antibody IgG4

• DNA probe ( PCR)

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Microfilaria

W. bancrofti

B. malayi

B.timori

http://www.dpd.cdc.gov/dpdx/HTML/Frames/A-F/Filariasis/body_Filariasis_mic1.htm

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Diagnosis( cont’d) 

• ultrasonography : allows visualization of adult

worms filarial dance sign (W.b)

• ICT( Immunochromatographic Tes): detection

of circulating filarial antigen detect antigens

released by adult filarial worms may

be positive even in amicrofilaremic individuals

(Filariasis bancrofti)

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The left ICT card displays negative results for LF infection, while the

right card displays positive results

Immuno Chromatographic Test

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Diagnosis (cont’d) 

• Biopsy :

• lymphoscintigraphy imaging Of lymphaticsystem

Lymphatic Filariasis

(diagnosis)

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Therapy

•DEC (Diethyl Carbamazine)

• Combination with albendazole

• Surgery :

 –The treatment for hydrocele is surgery(hydrocelectomy). 

 – lymphedema 

• lymphedema: patients can be educated aboutbasic principles of care ( such as hygiene,exercise, elevation, and treatment of woundsand infections)

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Tropical pulmonary

eosinophilia

•Etiology : Filarial worms

• typically found in persons living with thedisease in Asia.

•

Men 20 to 40 years old are most commonlyaffected.

• Symptoms : cough, shortness of breath, andwheezing.

• Hypereosinophilia is often accompanied byhigh levels of IgE and antifilarial antibodies.

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Epidemiology

• The Global Goal of Elimination of LymphaticFilariasis as a Public Health problem by The

Year 2020

•strategy :

•  (i) to stop the spread of infection

(interrupting transmission); and

• (ii) to alleviate the suffering of affectedpopulations (controlling morbidity).

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 • Mass drugs administration (MDA) :

 – 6 mg/kg of body weight diethylcarbamazine

citrate (DEC) + 400 mg albendazole;

 – Once a year for at least 5 years

 – coverage of at least 65% of the total at-risk

population:

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Source: http://www.wpro.who.int/southpacific/pacelf/about/en/

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Prevention

• Protecting oneself from being bitten by amosquito:

 – sleeping in a bed-net or screened bedroom

 – Insecticide spraying

 – using mosquito repellent.

• Controlling and reducing mosquito

populations