MICROBIOLOGY & PARASITOLOGY 2nd Semester

2. WUCHERERIA BANCROFTI
IL O I L O D O C T O R S ’ CO L L E G E OF ME D I C I N E
Molo, Iloilo City  Bancroftian filariasis, wuchereriasis ,
S.Y. 2018-2019
elephantiasis

BATCH 2021 A. LIFE CYCLE

DISCIMUS SAPIENCIA UT VIRTUS
 Humans are the only known definitive host-
survive for 5 years
 Adult worms- lymphatics, microfilia- blood and
MICROBIOLOGY lymph
BLOCK 3
LECTURER: DR. SOMBILLA
 Microfilaria in the mosquito(muscle)
larvae in 6-20days proboscis  enter
BLOOD AND TISSUE
MAIN TOPIC: NEMATODES II - new host during a blood meal  vessels
NEMATODES: FILARIAL PARASITES OF and nodes  adult in 6 months
HUMAN BEINGS lymphatic vessels of the lower extremities,
groin in males, labia in females
microfilaria carried in the lymphatics
1. FILARIAE circulation to the bloodstream  blood
meal
FILIFORM
B. EPIDEMIOLOGY
 Creamy white worm
 2-50cms in length F 2xM  Worldwide distribution, tropical and subtropical
 Mouth has no lips, esophagus is cylindrical, countries
cardiac bulbus, divided into anterior muscular  Prevalence: density of population, poor
and posterior grandular portion sanitation
 Male has caudate alae 2,copulatory spicules  Vector: Culex quinquenfasciatus; Aedes
 polynesiensis
MICROFILARIA
 Close-fitting membrane C. PATHOLOGY
 Contain a column of cell with deeply –staining
nuclei  Granulomatous reaction around the trapped
 Appears in the blood 6 months after infection worms
via the lymphatics  Vascular and lymphatic hyperplasia
 Period of the microfilariae in the lymp blood  Fibroblastic proliferation
varies with the species  Caseation
 Biological adaptation of the parasite to the  Absorption and replacement of the parasite by
time of maximum biting activity of the hyalinised or calcified scar tissue
parasite vector
D.CLINICAL MANIFESTATIONS
 Periodicity of the microfilaria in the blood varies
with the species  Asymptomatic Filariasis
 Nocturnal periodicity – W. bancrofti  Moderate generalized enlargement of
 Due to increase: increase 02 pressure by the lymph nodes- inguinal region
hyperventilation or exercise O2 pressure  Blood- mircrofilaria, low grade
by hyperventilation or exercise eosinophilia
 Diurnal periodicity - Loa Loa  Remain asymptomatic until the adult
worm die
A. LIFE CYCLE
 Inflammatory filariasis
 Ingestion of the microfilaria from the blood or  Immunologic,10-20 years old
tissue by blood sucking insect In 1-3weeks  Caused by sensitization to the product of
 Infective larva infect the skin of the new host living and dead worms
 Immune response to filarial infection  Funiculitis, epididymitis, orchitis, scrotal
 Humoral and cellular immune response edema, retrograde lymphangitis of the
 Lymphatics inflamtion- lymphagitis, extremities, swelling and redness of arm
lymphatic obstruction collagen deposition, and legs
elephantiasis  Fever, chills, headache, vomiting malaise
 Immediate hypersensitivity- high IgE levels,  Overgrowth of fibrous tissue around the
eosinophil a, bronchoconstriction dead worms lymphatics
obstruction,lymphangitis elephantiasis
 Leukocytosis - 10,000 eosinophilia - 6-26%

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 Obstructive filariasis
 Elephantiasis is the dramatic end result,
>30yo
 Develop slowly years after filarial infection
 Preceded by chronic edema
 High protein content of lymphs growth of
dermal and collagenous connective tissue
obstruction elephantiasis
 Thoracic duct, median abdominal lymph
vessels scrotum and penis in males,
external genetalia in females
 Rupture of lymphatics of the kidney
chyluria - hydrocele or chylous ascitis
 Prognosis Poor
 Tropical Pulmonary Eosinophilia
 A syndrome of filarial etiology in which
microfilaria are found in found are found in
lungs and lymph nodes but not in the blood
stream
 Persons who live in endemic places
 20-30 years old
 Paroxysmal nocturnal cough, dyspnea,
fever, weight loss, fatigue
 (+) rales and rhonchi
 Increased bronchovascular markings,
opacities in chest x-ray
 Eosinophilia > 2,000u/L, inc IgE >1,000
IU/ml, inc titer of antimicrobial Ab, (-)
microfilaria in blood.
D. DIAGNOSIS
 Microfilaria in the blood – thin or thick blood
smears or urine
 Detection of circulating antigen
 Serologic tests are also useful
E. TREATMENT
 Diethylcarbamazine (DEC)
 Effective in killing microfilaria, adults
 2 mg/kg tid X 12 days; 50 mg D1, 50 mg
D2, 100 mg D3, 6mkd tid D4- 14 (1 mkd
PO D1, 1 mk tid D2, 1-2 mk tid D3, 6 mkd
tid D4-14)
 Pruritus, fever, arthralgias, adenopathy,
headache
 Ivermectin
 Single oral doseI
 Supportive
 Elevation of the affected limb, use of
elastic stockings, and pressure bandages,
boots
 Surgery
E. PREVENTION
 Control of mosquitoes
 Mass treatment with DEC
 Protection of individuals – screened quarters,
bed nets, mosquito repellents, protective
clothing
MICROBIOLOGY & PARASITOLOGY 2nd Semester
3. BRUGIA (WUCHERERIA) MALAYI, B.
TIMORI
 Malayan filariasis
 Morphology
 Female – 55 X 0.16 mm
 Male – 23 X 0.09 mm(-) person-to-person
transmission
A. LIFE CYCLE
 Human is the only known definitive host
 Intermediate hosts: Mansonia, Anopheles,
Aedes, Armigeres
B. EPIDEMIOLOGY
 Sri Lanka, Indonesia, Philippines, India, China,
Korea
 Mansonia – rural in distribution, Anopheles –
urban in distribution
 B. timori – Indonesian islands
C. CLINICAL MANIFESTATION
 Lymphangitis, lymphadenopathy, abscess
formation of the inguinal nodes
 Elephantiasis confined to distal extremities
 Involvement of the male genitalia is uncommon
D. TREATMENT
 Similar to W. bancrofti
E. PREVENTION
 Control of mosquitoes
 Herbicides
4. ONCHOCERCA VOLVULUS
 Onchocerciasis, onchocercosis, river blindness
A. LIFE CYCLE
 Humans are the only known definitive host
 Habitat: subcutaneous tissues, encapsulated in
fibrous tumors – (+) adult worms and
microfilaria > migrate to eye, rare in the blood
 Vector: black flies – Simulium
 Infective larvae in black flies > mature in 6-10
days > proboscis > blood meal >migrate to the
connective tissue
B. EPIDEMIOLOGY
 West Africa, Central and East Africa
 Areas of rapidly flowing streams where insects
breed
 M>F
B. CLINICAL MANIFESTATION
 Subcutaneous tissues, skin, eyes
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 MICROBIOLOGY & PARASITOLOGY 2nd Semester

 (+) nodules – 5-25 mm size > trunk, thighs,
arms, head (3-6 in number > 150)
 (+) pruritus > depigmentation, thickening of the
epidermis xeroderma, lichenification,
atrophy
 “hanging groin” – redundant folds of the skin in
the inguinal area
 Chronic onchocercal dermatitis – “lizard skin”
or “leopard skin’
 Ocular involvement – photophobia, lacrimation,
foreign body sensation, conjunctivitis
 Cornea – superficial punctuate keratitis >
opacities infiltration of leukocytes
 Iritis – thickening, atrophy, depigmentation
loss of vision
C. DIAGNOSIS
 History and physical examination
 Demonstration of microfilaria in skin snips, eye
by ophthalmologic examination
 Serologic studies – ELISA
 Mazotti test
C. TREATMENT
 Ivermectin 150uk/kg PO, repeated at 3-6
months interval
 Fever, urticaria, pruritus
 Eye involvement – DEC is contraindicated
D. PREVENTION AND CONTROL
 Vector control
 Personal protection – wearing protective
clothing, insect repellent
 Treatment of infected persons
5. LOA LOA
 Loiasis, eye worm infection, fugitive swelling,
Calabar swelling
A. LIFE CYCLE
 Humans (and monkeys) are the only known
definitive hosts
 Microfilaria matures in 10-12 days in flies
(Chrysops) > blood meal > migrate to skin,
subcutaneous tissues, subconjunctiva where
the mature to adult form
 Microfilaria is present in diurnal periodicity
B. EPIDEMIOLOGY
 Africa
 Rain forests of West and Central Africa were
Chrysops flies live
C. CLINICAL MANIFESTATION
 Calabar swellings – localized subcutaneous
edema which are non-erythematous, slightly
painful, pruritic, 10-20 cm in diameter, common
in joints, wrist, knee, eye > resolve over days to
weeks > recur
 Eye – irritation, congestion, pain, impaired
vision
 (+) eosinophilia
D. DIAGNOSIS
 Microfilaria in the blood
 History of calabar swellings
 (+) eosinophilia
 (+) antifilarial antibodies in serum
E.TREATMENT
 DEC – adults 50 mg D1, 50 mg tid D2, 100 mg
tid D3, 9 mkd tid D4-21 (children 1 mkd PO D1,
1 mk tid D2, 1-2 mk tid D3, 9 mkd tid d4-21)
 Albendazole X 3 weeks to reduce microfilarial
levels
 Antihistamines and corticosteroids
F. PREVENTION
 Personal protective measures
 DEC 300 mg PO weekly – travellers
6. MANSONELLA PERSTANS
 Perstans filariasis
A. LIFE CYCLE
 Habitat: mesentery, retroperitoneal tissues,
pleural cavity, pericardium (adult); peripheral
blood and capillaries of the lungs (microfilaria)
 Human is the only definitive host
 Intermediate host: blood sucking midges
Culicoides
B. EPIDEMIOLOGY
 West and Central Africa, Northern South an
Islands
C. CLINICAL MANIFESTATION
 Allergic reactions
 Edema, swelling, lymphatic varices
 (+) moderate eosinophilia
E. DIAGNOSIS
 Microfilaria in the blood
G, TREATMENT
 DEC
 Mebendazole 100 mg bid X 7 days
F. PREVENTION
 Vector control, herbicides
 Individual protection
7. MANSONELLA OZZARDI
 Mansonelliasis ozzardi, Ozzard’s filariasis
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 Adult worm inhabits body cavities, mesentery,
visceral fat
 Humanity is the only known definitive host
 Found in Central and Northern South America
 Asymptomatic lymphadenitis, urticaria,
arthralgia
 Ivermectin 150 u/k single dose
8. DIROFILARIA IMITIS
 Parasite of dogs, dog heartworm
A. CLINICAL MANIFESTATION
 (+) solitary peripheral nodules in the lung –
“coin lesion” or subcutaneous nodules
 Surrounding central necrosis with giant cells,
lymphocytes, macrophages, eosinophils
 Cough, chest pain, hemoptysis
 (-) blood eosiinophilia
9. DRANCUCULUS MEDINENSIS
 Draconthiasis, dracunculosis, guinea worm
A.LIFE CYCLE
 Copecods  ingested by humans 
released in the stomach  intestinal
mucosa, mature mate  adult after 1 year
 migrates and emerges through the skin,
legs  release larva  ingested by
crustaceans
B. EPIDEMIOLOGY
 Africa, sudan
 Humans acquire infection by drinking
contaminated stagnant water containing
immature forms of the parasite in copecods
(Cyclops)
C. CLINICAL MANIFESTATION
 Stinging papule, urticaria  vesicle
ruptures forms an ulcer
 Nausea, vomiting, diarrhea, dyspnea
D. DIAGNOSIS
 Clinical
 Microscopic examination demonstrating larvae
E. TREATMENT
 Metronidazole 25 mg/kg/day tid PO X 10 days,
max 750 mg
 Topical corticosteroids
 Topical antibiotics
E. PREVENTION
 Boiling or chlorinating water
MICROBIOLOGY & PARASITOLOGY 2nd Semester
10. GNASTHOSTOMA SPINIGERUM
 Gnathostomiasis
A. EPIDEMIOLOGY
 Dog and cat nematode
 Endemic in Southeast Asia, Japan, China,
India
B. MODE OF TRANSMISSION
 Ingestion of freshwater fish, frog, snails
containing larvae; or chicken, duck, pigs
 Penetration of the skin by larvae also occurs
C. CLINICAL MANIFESTATION
 Malaise, fever, urticaria, anorexia, nausea,
vomiting, diarrhea, epigastric pain occurs 24-
48 hours after ingestion
 Cutaneous gnathostomiasis – localized pitting
edema with pain, pruritus, erythema
 CNS: focal neurologic findings – paralysis,
change in mental status
D.DIAGNOSIS
 Clinical
 History and PE
E. TREATMENT
 Albendazole 400 mg PO bid X 21 days
11. ANGIOSTRONGYLUS CANTONENSIS
 Eosinophilic meningitis
A. LIFE CYCLE
 Rat – adult female worms discharge eggs in
the pulmonary vessels  break into the
respiratory tract  migrate to the trachea
 swallowed  feces  molluscan hosts
eat larvae  molt several times 
infective 3rd stage larvae  eaten by rats or
humans CNS, brain
B. EPIDEMIOLOGY
 Rat lungworm
 Southeast Asia, South Pacific, Taiwan, Africa,
Australia, North America
 Humans acquire infection by ingestion of third
stage larva in raw snails or slugs, freshwater
prawns, frog or fish;
 of the parasite in copecods (Cyclops)
C. CLINICAL MANIFESTATION
 2-35 days after ingestion
 Severe headache, neck pain or nuchal rigidity,
hyperesthesias, fatigue, fever, rash, pruritus,
nausea, vomiting, cranial nerve palsies
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 MICROBIOLOGY & PARASITOLOGY 2nd Semester

 Heavy infections  coma  death

E. DIAGNOSIS

 Peripheral blood eosinophilia – peaks in the

5th week
 CSF – pleocytosis > 10% (+) eosinophils,
mildly elevated protein, normal glucose levels
 History of travel, diet history, clinical
 ELISA

E. TREATMENT

 Supportive
 Analgesics for headache
 LP to relieve hydrocephalus
 Cerebral decompressants
 Corticosteroids

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