M 110 LEC RE 9: BLOOD AND I E a ae b e f he b e he f he e a

de g a
NEMA ODE
Af e a a a dc a ( a fe a e) de
TRICHINELLA SPIRALIS larva into the mucosa, where it penetrates and circulates until it
reaches the striated muscles (where it grows and develops)
A. GENERAL CHARACTERISTICS Encapsulation is then completed after 4-5 weeks from infection

Trichinella was first described by Tiedemann in 1822. In D. PATHOGENESIS AND CLINICAL

1835, James Paget and Richard Owen demonstrated
Trichinella in human cadavers in London.
German investigators were able to prove that raw or
insufficiently cooked meat (i.e., pork) was responsible for
trichinellosis in humans.
Habitat: Muscle fiber
Infective Stage: Encysted larva
Mode of Transmission: Ingestion of raw meat with
encysted larva
B. STAGES
Adult Male
0.6 to 1.5 mm long
Single testis near the posterior end of the body &
joined in the midbody by the genital tube which
extends back to the cloaca
Posteriorly-located cloaca:
o Pair of caudal appendages
o Two pairs of papillae which clasps the
female during copulation
Adult Female
1.26 to 3.35 mm
Single ovary located posteriorly
Presence of oviduct, seminal receptacle, coiled
uterus, vagina and vulva
o Vulva is located in the anterior-fifths on
the ventral side of the body
Viviparous female: Lifespan- 30 days; Produce 1,500
larva
Larva
A b h ( he e ded b ad fe a e): 80 120
b 6
o In the muscle fiber: can reach 0.65 to
1.45 mm
o Spear-like burrowing anterior tip which
aids its penetration on the muscle fiber.
o Digestive tract of the mature larva
encysted in the muscle fiber resembles
an adult worm
o Reproductive organs are not yet fully
developed
C. LIFE CYCLE
Humans, rats, pigs, or any
other carnivores or omnivores serves
as both the final and intermediate host
by harboring both the adult and the
larva stages. Infective larva are
usually encysted in the muscle fibers
of the host.
Starts from ingestion of
undercooked meat with encysted
a ae d ge ed he ach
through gastric acid and pepsin.
Larvae is
e ea ed/e c ed e ed
MANIFESTATIONS
Light infection (up to 10 larvae): Asymptomatic
2 days post-infection: Gastroenteritis, diarrhea,
abdominal pain
TRICHINELLOSIS HAS 3 PHASES & 3 STAGES:
1. Enteric phase- Incubation and intestinal invasion
Resembles acute food poisoning (diarrhea or
constipation, vomiting, abdominal cramps, malaise, and
nausea)
2. Invasion phase- Larval migration and muscle invasion
Immunological, pathological, and metabolic reactions
Inflammatory reactions to the infection results in
eosinophilia, which results in the release of histamines
Histamine contribute to an increase in the vascular
permeability which results to tissue edema.
Signs and symptoms:
Severe myalgia, periorbital edema, and eosinophilia
High remittent fever and chills, headache, dyspnea, dysphagia
and difficulty in chewing
Paralysis and splenomegaly
Gastric and intestinal hemorrhages
Pericardial pain, tachycardia, and electrocardiogram
abnormalities
Pericardial effusion, congestive heart failure
3. Convalescent phase- Encystment and encapsulation
Signs and symptoms:
Fever, weakness, pain and other symptoms start to abate (less
intense/symptoms starts to diminish)
Full recovery is expected since trichinellosis is a self-limiting
disease. Neurologic signs arising from brain damage may
persist.
E. DIAGNOSIS
Muscle biopsy (most definitive)- done during serologic
examination
Digestion of muscle samples with pepsin and HCl-
done to determine the number of larvae per gram of
muscle, or to isolate larvae for molecular characterization
Non-specific lab tests to detect eosinophilia, muscle
enzymes (creatine phosphokinase, lactate
dehydrogenase, and myokinase), total IgE in serum may
be useful in diagnosis
ELISA: recommended for diagnosis
Western blot technique: confirmatory of ELISA-positive
samples
Latex agglutination technique may be utilized for rapid
confirmation
F. TREATMENT
Mebendazole
Albendazole
A treatment cycle may be repeated 5 days after the initial
cycle in case of severe infection.
Thiabendazole is no longer used due to its associated
adverse drug reactions.
 Other supportive treatment to control symptoms Adults lodge in the lymphatic system causing
o Supportive treatment through analgesics and lymphedema, lymphangitis, and elephantiasis
antipyretics is commonly used to control
Blood-feeding arthropod vectors: mosquitoes and
symptoms.
black flies
o Corticosteroids may be given with anthelminthics
to control hypersensitivity reactions to the larvae,
and may also be given to treat acute vasculitis and LYMPHATIC FILARIASIS (LF)
myositis. One of the most debilitating diseases plaguing
many tropical countries.
G. EPIDEMIOLOGY
Next to psychiatric illness, LF is the second leading
Documented in 55 countries worldwide, 10,000 cases cause of permanent and long term disability,
reported each year, 0.2% mortality affecting both physical and psychological aspects
Human trichinellosis occurs wherever meat is a part of the of the victim.
diet. The social stigma and associated economic
Outbreaks: Argentina, Bosnia-Herzegovina, China, consequences result in a poor quality of life to the
France, Laos, Romania, Spain, Sweden, Thailand, afflicted.
Turkey, Ukraine, Uzbekistan, and Vietnam. Mosquito-borne causative agents: Wuchereria bancrofti
Trichinella infection has never been documented in a ( Ba c f f a a ; ca a e age f Ba c f a
small number of island countries, including the Philippines. filariasis) and Brugia malayi (or Malayan filarial worm;
Primarily a zoonosis; Humans get infected after causes Malayan filariasis)
ingestion of raw or insufficiently cooked meat from
Wuchereria bancrofti Brugia malayi
infected animals.
The infection is usually maintained in a pig-to-pig or pig- A. GENERAL CHARACTERISTICS
to-rat-to-pig cycle. Causative agent of Causative agent of Brugian
Bancroftian filariasis, filariasis, Upper lymphatic
H. PREVENTION AND CONTROL Elephantiasis in lower elephantiasis
Health education- important component of prevention and extremities Definitive Host: Man
control measures against this parasitic infection Definitive Host: Man Intermediate Host: Mansonia
Meat cooked at a minimum 77°C (170°F) Intermediate Host: Female bonnae, Mansonia uniformis,
Freezing- storage at -15°C for 20 days or -30°C for 6 days is Culex mosquito (Culex and Anopheles spp.
suggested. Smoking, salting, or drying meat is not effective. fatigans) and Aedes poecilus Habitat: Lymphatic system
Habitat: Lymphatic tissues of Infective Stage: Stage 3
Regular animal monitoring (meat inspection or detection of
lower limbs & external genitalia Filariform larva
circulating antibodies)
Infective Stage: Stage 3 Diagnostic Stage: Microfilaria
Keeping pigs in rat-free pens, and proper disposal of Filariform larva Mode of transmission:
suspected carcasses. Diagnostic Stage: Microfilaria Repeated bite of the vector
Mode of transmission: during blood meal
FILARIAL NEMATODES Repeated bite of the vector Periodicity: Anytime
Tissue dwelling worms during blood meal
All have intermediate host (usually an arthropod) Periodicity: Nocturnal
Filarial worms are transmitted through the bite of an insect
B. STAGES
vector
Subdivided into 3 groups based on its anatomic location Adult Adult
from where they cause pathology o Creamy white, long and filiform o Creamy white, long and filiform
o Male: 20-40 mm o Male: 13-23 mm
Subcutaneous Serous cavity Lymphatic o Female: 80-100 mm o Female: 45-55 mm
Loa loa (African Mansonella Wuchereria bancrofti Microfilaria Microfilaria
eyeworm) perstans o Fresh specimens appear as o 111-230
Onchocerca volvulus Mansonella Brugia malayi minute snake-like o 2 nuclei at the tip of tail
ozzardi organisms constantly o 2 rows of indistinct and
Brugia timori moving among the red blood confluent nuclei
cells. o In stained blood smears, seen
Differentiated as sheathed microfilaria and unsheathed
o 270-290 be seen enclosed in a sheath
microfilaria
o Enclosed in a hyaline and having angular
Sheathed Microfilaria Unsheathed Microfilaria sheath which is much longer curvatures w/secondary kinks
Parasite Habitat Parasite Habitat than the microfilaria itself.
Wuchereri Lower Onchocerc Subcutaneous tissue o Dark-staining nuclei in
a bancrofti lymphatics a volvulus central axis (important
Brugia Upper Mansonella Body cavities identifying feature)
malayi lymphatics perstans (peripheral tissue) o Nuclei arranged in 2 or 3
Loa loa Subcutaneou Mansonella Body cavities rows and distinctly
s tissue ozzardi (mesenteric fats) conspicuous
MICROFILARIA o Several curvatures and a
Hatched embryonated eggs graceful appearance
Diagnostic stage
Can be sheathed or unsheathed
Snake-like appearance with column cells and can be seen
in the peripheral/blood circulation (except Onchocerca
volvulus)
 C. LIFE CYCLE - Lymphedema and Elephantiasis
- Genito-urinary lesions (hydrocele)
WUCHERERIA - Tropical pulmonary eosinophilia (TPE)
BANCROFTI
Mosquito (Genus Asymptomatic Microfilaremia
Aedes, Culex, and - Individuals with thousands to millions of vigorously motile
Anopheles) takes a microfilariae in peripheral blood often shows no obvious
blood meal with an clinical signs of disease.
infected person and - Serves as main reservoir for mosquitoes which acquire
picked up a microfilariae during a blood meal.
microfilariae. - Characterized by several immune regulatory processes
Microfilariae driven by living parasites to ensure their long-term survival.
ingested by the - Co-infection with other parasites and infectious disease is
ce common, and the suppressive immunomodulatory
develop into 1st, 2nd, mechanisms by the worm can modulate protective immune
and 3rd stage larvae. responses for malaria and tuberculosis.
After 6-20 days of - Endemic normal
development, 3rd stage o Asymptomatic
larvae forces their way out of the muscles, causing o Harbors parasite antigen in the blood instead of in
c de ab e a da age head a d the microfilariae
proboscis
In another blood meal, larvae emerges from the Acute Dermatolymphangioadenitis (ADLA)
b c f he ce b e h penetrates the - Most common acute manifestation of LF
ha c e e a d de de e ad - Localized pain, lymphadenitis and/or lymphangitis
worms and/or cellulitis and local warmth
Localized in the lymph vessels of the lower extremities, - With or without systemic manifestations of fever, nausea,
inguinal lymph nodes, epididymis of males, labia of females, and vomiting
c f a ae g a e ( a e ha c - Lymphatic insufficiency leads to increase susceptibility to
neighboring blood vessel) opportunistic infections, and result in ADLA.
- Amount of exposure to secondary bacterial infections
BRUGIA MALAYI and the magnitude of host immunity to infective or
Same pattern developing larvae, or exposure to Wolbachia (a potent
with Wuchereria inducer of inflammation released by dead/dying worms)
bacrofti with a few increase the risk of development of chronic disease.
exceptions: - Clinical descriptions are remarkably similar to those of
o Mosquito vector erysipelas and cellulitis. The attacks are recurrent, and
belongs to the genus among patients in LF-endemic areas, the mean annual
Mansonia reported incidence ranges from 1.5 to more than 7 episodes
o Development of the per patient.
of the microfilariae to the - Current evidences shows that ADLA is of bacterial etiology,
infective stage in the based on clinical signs and symptoms
mosquito takes about 2 weeks and the maturation - Isolation of bacteria at the time of the acute episode
time for the 3rd stage larva to become adult takes includes Group A Streptococcus, although other bacteria are
about 3-9 months thereafter microfilaria are often found in cultures, including non-pathogenic strains.
produced may be seen in the circulation. - Secondary bacterial infections from neglected skin lesions
precipitate attacks of ADLA, and repeated ADLA episodes
D. PATHOGENESIS AND CLINICAL are deemed the most important factor in lymphedema
MANIFESTATIONS progression.
LF is characterized by a wide spectrum of clinical
manifestations, with signs and symptoms different from one Acute Filarial Lymphangitis (AFL)
host to another. - Rare manifestation directly caused by adult worms that died
The infection is usually acquired in childhood but may take spontaneously, or commonly observed following treatment
years to manifest itself. The clinical course may be divided with diethylcarbamazine citrate (DEC), the latter is
into asymptomatic, acute, and chronic stages, generally c de ed e de ce f he d g ac f a c da eff cac .
progressing in that order. - Characterized by lymphangitis that progresses distally along
Individuals who grew up outside regions endemic for these the lymphatic vessel, producing a palpable cord.
filarial parasites and who get infected by them after migration - May be accompanied by mild fever, headache, and malaise.
to the endemic regions may clinically present with “Expatriate Distal lymphedema may occur, but it is usually mild and
Syndrome.” reversible. The symptoms are self-limited or generally subside
without treatment.
Expatriate Syndrome:
- Clinical and immunologic hyper-responsiveness to the Lymphedema and Elephantiasis
mature or maturing worms - Live filarial parasites or filarial antigens induce lymphatic
- Lymphadenitis, lymphangitis endothelial cell proliferation and differentiation leading to
- Allergic reactions (hives, rashes, and blood eosinophilia) collateralization.
- Clinical Spectrum - These lymphatic dysfunctions have been shown to predispose
- Asymptomatic microfilaremia infected individuals to secondary bacterial infections which
- Acute dermatolymphangioadenitis (ADLA) trigger inflammatory reactions in the skin and subcutaneous
- Acute filarial lymphangitis (AFL) tissue, leading to lymphedema and elephantiasis.
- Most common chronic manifestation of lymphatic lymphangitis and lymphadenitis with localized
filariasis: lymphedema, which on progression leads to pain and swelling.
elephantiasis.
- Many autho e he e e e ha a f a f f Wuchereria bancrofti Brugia malayi
lymphedema. Dreyer et al. in 2002 proposed a staging system Hydrocele or chylocele Enlargement of
for chronic lymphedema. Localization in scrotal o Epitrochlear
lymphatics o Inguinal
Stage 1: Swelling increases during the day but is reversible
Chronic epididymitis, o Axillary lymph nodes
once the patient lies flat in bed o Elephantiasis below the
funiculitis, scrotal sac
Stage 2: Irreversible swelling and patient may still experience elbow/knee
lymphedematous
acute attacks. thickening
Stage 3: Shallow skin folds (folds where the base can still be Vulva lymphedema
ee he he a e e he eg f a d he f d e Lower extremities Upper extremities
. L e c ea e ee he a eg a e a ead
considered shallow folds.) E. DIAGNOSIS
Stage 4: Knobs present in the affected area (lumps or Microscopic finding (Peripheral blood smear) of
protrusions in the skin that predispose the area to trauma) characteristic microfilaria in the blood is the traditionally
Stage 5: Has deep skin folds, where the base can no longer accepted procedure.
be seen when the patient moves the leg, but only when the Due to the nocturnal periodicity of most W. bancrofti
folds are actively “opened” by hand. strains, wet smears or thick blood smears are taken
Stage 6: Mossy lesions are present, brought about by the between 8PM and 4 AM. Time is not a problem for B.
clustering of small elongated or rounded growths. These usually malayi.
leak translucent fluid, putting the area at risk for secondary Knott’s method
bacterial infection. - Filtration using a nucleopore filter
Stage 7: Patient is unable to adequately or independently - 1mL of EDTA blood + 9mL of Formalin
perform activities of daily living due to the extent of the Diethycarbamazine (DEC) provocative test
pathology. The infected area is foul-smelling and the affected - Stimulates microfilariae into coming out to the
individual frequently experiences acute attacks. peripheral circulation, allowing blood smear collection
even during daytime.
Genito-urinary lesions (hydrocele) - Although these methods are still widely used, their low
- Obstruction in lymphatics of tunica vaginalis sensitivity and poor acceptability necessitate
- Clear or straw-colored hydrocele fluid typically accumulates alternative approaches that fulfill the requirements.
in the closed sac of the testis, and rarely, the fluid may have Detection of circulating filarial antigens (CFA)
a milky appearance caused the presence of lymph- a - Preferred method; detects latent infection
condition known as chylocele. - Mainly done with immunochromatographic (ICT) card
- Hydrocele is a common chronic disease manifestation of tests.
Bancroftian filariasis since W. bancrofti worms have been - These simple card tests that detect CFAs are very
shown ultrasonographically to prefer localization in scrotal sensitive and specific, thus eliminating the need for
lymphatics. These cases usually occur after puberty, and laboratory facilities.
the prevalence increases with age.
F. TREATMENT
Tropical Pulmonary Eosinophilia (TPE) 1. Diethycarbamazine
- Classic example of occult filariasis in which the typical - Drug of choice
clinical manifestations are not present, and microfilaria are - Effective on adult and microfilaria
not found in the blood but may be found in the tissues. - Better if executed for 12 consecutive days
- The syndrome, brought about by immunologic hyper- - For TPE: 3-4 weeks
responsiveness to filarial infection, is characterized by: 2. Ivermectin
Paroxysmal nocturnal cough
- Highly effective
Hypereosinophilia
- Reduce microfilaremia up to 1 year
Increased ESR
- Slower parasite clearance
Diffuse miliary lesions/increased bronchovascular
3. Albendazole
markings
Extremely high titers of filarial antibody (IgE) ADLA Treatment
Good therapeutic response to DEC. Bed rest, cooling the affected area to relief pain
- In most cases, lung function is impaired, with a reduction in
Analgesics and antipyretics
vital capacity, total lung capacity, and residual volume.
Hygiene education program
- Commonly misdiagnosed as asthma or tuberculosis.
Chronic symptoms may delay diagnosis, and if untreated, Footcare Program
TPE progresses to chronic pulmonary fibrosis and Washing the affected limb twice a day with soap
respiratory failure. and water especially the webs of toes and skin
- Patent Infection: Parasite-induced lymphatic dilatation folds, and drying with a clean cloth to remove
(lymphangiectasia) moisture
- Fibrosis and Cellular hyperplasia Clipping nails often and keeping them clean
o These changes are postulated to render Preventing and promptly treating local injuries
lymphatic endothelial cells less effective at and infections with topical agents
transporting interstitial fluid, thereby contributing Regular use of properly fitting footwear
to the edema and collagen accumulation. Raising the affected limb at night to reduce the
o Dead and decalcifying adult worms elicit immune swelling.
responses leading to lymphatic blockage and
gross pathological lesions; it invokes
 G. EPIDEMIOLOGY Microfilaria
- Does not invade bloodstream; Unsheathed
WUCHERERIA BANCROFTI - 250 325 long
Widespread in tropical and subtropical regions globally - Both anterior end and tail are free of nuclei
but control measures have reduced its geographic range - Seen in the dermis and chambers of eye
Endemic throughout Sub-Saharan Africa excluding
C. LIFE CYCLE
southern portion, Madagascar, several western pacific
island nations and territories, and parts of the As the black fly bites an infected person, larvae ingested by
Caribbean. he b ac f f gh ce a ae de e de he
black fly and becomes infective f h a ab 1 ee
Bancroftian filariasis accounts for 90% of cases in 83
biting parts of fly (can be transmitted back to humans when it
endemic countries bites again)
About 120 million people worldwide are affected by the Humans become infected when black flies deposits infective
disease, and more than 1 billion people are at risk larvae into the skin when biting to extract blood.
BRUGIA MALAYI Once inside the human body, the larvae matures into adults in
Geographically limited and occurs only in Southeast approximately 12 to 18 months.
Asia Most adult female worms live in fibrous nodules and these
Responsible for the remaining 10% of cases of adult male worms usually found near the female worms.
lymphatic filariasis and 13 million cases worldwide These nodules form around the worms as part of the
interaction between the parasite and its human host.
Considered neglected tropical disease and control
Inside the nodules, the worms are relatively safe from the
measures have reduced its endemic range human immune response, so the larvae becomes detectable
H. PREVENTION AND CONTROL in the skin 12-18 months after the initial infection and these
adult worms can live approximately 10-15 years.
Global program to eliminate lymphatic filariasis
(GPELF) has been established by the WHO and has 2 D. PATHOGENESIS AND CLINICAL
major goals: MANIFESTATIONS
o Interrupt transmission of the parasite via preventive Itchy skin rashes, nodules under the skin, and vision
chemotherapy changes
o Provide care through hygiene education programs Formation of nodules (adult worms surrounded by fibrous
DEC-medicated cooking/table salt has been used material)
successfully in eliminating LF in some endemic areas. Pigmentary changes called “Leopard skin” caused by
inflammation in the skin and long-term damage
ONCHOCERCA VOLVULUS Thinning of the skin with loss of elasticity that gives the
skin a cigarette paper appearance and can contribute to
A. GENERAL CHARACTERISTICS conditions such as hanging groin.
Common name: Blinding filarial, Blinding worm, Ocular manifestations (river blindness)
Convoluted filarial o Inflammation caused by larva in the eye results
Disease: Onchocerciasis, River blindness, Costal initially in reversible lesion on the cornea that
erysipelas, Robles disease without treatment will progress to permanent
o Another neglected tropical disease clouding of the cornea.
o Called river blindness because the black fly
(intermediate host) lives and breathes near fast flowing E. DIAGNOSIS:
streams and rivers, mostly near the remote rural Shaving of skin nips, Biopsy of nodules, and Slit-lamp
villages, the infection can result in visual impairment examination
and sometimes blindness.
o Onchocerciasis can cause skin disease which F. TREATMENT:
includes intense itching, rashes, and nodules under
the skin. Ivermectin, Doxycycline
Intermediate Host: Black flies (Simulium damnosum)
G. PREVENTION AND CONTROL
Habitat: Subcutaneous tissue
Infective Stage: Stage 3 Filariform larva Personal protection against biting insects (insect repellant, long
Diagnostic Stage: Microfilaria sleeves and pants, and permethrin-treated clothing)
Mode of transmission: Repeated bite of blackflies of the
LOA LOA
genus Simulium

B. STAGES A. GENERAL CHARACTERISTICS

Adult worms Common name: African eye worm
- Distinct annular striations of the cuticula Disease/Manifestation: Loiasis, Calabar swelling
- Anteriorly: 8 small papillae in 2 circles and pair of (repeated episodes of itchy swellings in the body)
large oval papilla Intermediate Host: Deer flies (Chrysops dimidiate and
- Lives more than 11 years Chrysops silacea)
- Produce onchocercoma Habitat: Subcutaneous tissue
Male: Infective Stage: Stage 3 Filariform larva
- 2-4 cm Diagnostic Stage: Microfilaria
- Tightly curved tail with 2 spicules Mode of transmission: Repeated bite of deer flies of the
Female: genus Chrysops
- 10x larger than male Knowing whether someone has Loa loa infection has
- Anterior vulva become more important in Africa because the presence of
 people with Loa loa infection has limited programs to MANSONELLA PERSTANS AND MANSONELLA
control or eliminate onchocerciasis (river blindness) and
OZZARDI
lymphatic filariasis (elephantiasis).
There may be more than 29 million people who are at risk
A. GENERAL CHARACTERISTICS
of getting loaisis in affected areas of Central and West
Africa. Intermediate Host/ Vectors:
1. Culicoides austeni (Midges): Both
B. STAGES 2. Simulium amazonicum (Black fly): M. ozzardi only
Adult worm 3. Leptoconops bequaerti (Midges): M. ozzardi only
- White thread-like Habitat: Body cavities
- Chitinous wart-like nodules Infective Stage: Stage 3 Filariform larva
- Female: 6 cm Diagnostic Stage: Microfilaria
- Male: 3 cm (males are shorter) Mode of transmission: Repeated bite of small flies of the
- Tapered and curved with 2 unequal spicules genus Culicoides
Microfilaria Rare parasite in man
- Angular, ungraceful curves, tapered tail with nuclei
on tip B. STAGES
- Diurnal periodicity Mansonella perstans Mansonella ozzardi
- Closely resembles that of Wucheria bancrofti Adult female: 70-80 mm long Adult female: 49 mm long by
b 120 150
C. LIFE CYCLE Adult male: 45 b 60 Adult male: 26 b 70
When a deer fly Microfilaria: unsheathed, Microfilaria: unsheathed, non-
(genus Chrysops) takes subperiodic periodic
a bloodmeal from an
fec ed e C. LIFE CYCLE
larvae taken up by the During a blood meal, an infected midge introduces 3rd stage
fly undergoes 3 stages a ae he f he h a h e e ae he b e
(stage 1 larvae, stage 2 d de e ad ha e de b d ca e ,
larvae, and stage 3 commonly the peritoneal cavity, or pleural cavity, and less
infective larvae) frequently he e ca d d ce hea hed,
As the fly bites subperiodic microfilariae (M. perstans), non-periodic
another suspected c f a ae (M. a d ) e e e he a c c a
pe d ce 3 d Amidge vector ingests microfilariae during another blood
age a ae he f he fec ed h e e ae ea c f a ae g a e f he dge dg h gh
he b e d a ae de e ad ha he he c e he h ac c c e f he a h d
c e de bc a e e ad d ce microfilariae develop into 1st stage larvae and subsequently into
sheathed microfilariae that are found in spinal fluid, urine, 3rd stage infective larvae
sputum, peripheral blood, and in the lungs

D. PATHOGENESIS AND CLINICAL

MANIFESTATIONS
Calabar swelling- localized, non-tender swelling in arms and
legs near joints
Itching occurs around area of swelling or all over the
body.
Eye worm- visible movement of adult worm on eye surface;
causes eye congestion, itching, pain, light sensitivity
Eosinophilia

E. DIAGNOSIS
D. PATHOGENESIS AND CLINICAL
Identification of adult worm after removal from the eye MANIFESTATIONS
Blood smear taken between 10 am to 2 pm
Most infections are believed to be asymptomatic. When
Serological test
symptoms occur, they appear related to migration of adult
Biopsy of calabar swelling
worms and include
Knotts technique
o Transient subcutaneous swellings (similar to those
F. TREATMENT caused by Loa loa)
o Pericarditis and pleuritis
Diethylcarbamazine citrate (DEC): drug of choice, Albendazole o Ocular symptoms (e.g., impaired visual acuity) if
microfilariae enter the eye
G. PREVENTION AND CONTROL Fever, pruritus, arthralgias, abdominal pain
No programs to control/eliminate Loiasis in affected areas Headache and neuropsychiatric symptoms
Avoiding areas where deer flies reside- muddy, shaded areas
along rivers E. DIAGNOSIS
Personal protection against biting insects- insect repellant (w/ Microscopy
DEET), long sleeves and pants, and permethrin-treated a. Wet smears: skin snips
clothing b. Thick blood smear: Giemsa stain
c. Knott’s concentration technique
Molecular detection
 Serological testing: ICT detects filarial antigens 3. The worm is then wrapped around a rolled piece of
DEC provocative test gauze or a stick to maintain some tension on the worm
Ultrasonography and encourage more of the worm to emerge. This also
prevents the worm from slipping back inside.
F. TREATMENT 4. Then, gentle traction is applied to the worm to slowly pull
Diethylcarbamazine citrate (DEC), Ivermectin it out. Pulling stops when resistance is met to avoid
breaking the worm. Because the worm can be as long as
DRACUNCULUS MEDINENSIS one meter in length, full extraction can take several days
to weeks.
A. GENERAL CHARACTERISTICS 5. Afterwards, topical antibiotics are applied to the wound to
prevent secondary bacterial infections.
Common Name: Guinea worm, Dragon worm, Worm of Medina
6. The affected body part is then bandaged with fresh
Intermediate Host/Vector: Copepods
gauze to protect the site. Medicines, such as aspirin or
Habitat: Body cavities
ibuprofen, are given to help ease the pain of this process
Infective Stage: Stage 3 Filariform larva and reduce inflammation.
Mode of transmission: Ingestion of copepods with larva 7. These steps are repeated every day until the whole worm
Longest nematode of man is successfully pulled out.
B. LIFE CYCLE E. EPIDEMIOLOGY
Humans become Remote parts of Africa
infected by drinking unfiltered P e 10% f he d a h acce f
water containing copepods safe drinking water (both disease of poverty and cause of
(small crustaceans) which are poverty)
fec ed h a ae
copepods die and release the F. PREVENTION AND CONTROL
a ae e e a e he h Guinea Worm Eradication Program (GWEP)
stomach and intestinal wall a. Surveillance and case containment
and enter the abdominal cavity b. Provision of safe drinking water
After maturation c. Vector control
ad a dc a ae d e a d he fe a e d. Health education and community mobilization (important
migrate in the subcutaneous tissues towards the skin surface aspects of Guinea worm disease eradication)
A ae e ea af e fec he fe a e
induces a blister on the skin, generally on the distal lower Teaching communities about the disease and how it is
extremit , h ch e he c ac h a e , a spread
c ac ha he a e ee e e e he ca d c f Helping villagers take action against the disease
fe a e e e ge a d e ea e a ae a ae a e
Helping villagers understand the need for safe chemical
ge ed b a c e d af e ee (a d ), he
treatment in the water supplies
have developed into infective larvae

C. PATHOGENESIS AND CLINICAL

MANIFESTATIONS
Asymptomatic for 1 year
Slight fever, itchy rash, nausea, vomiting, diarrhea, dizziness
Blister forms anywhere on the skin burning pain (mostly on
lower body parts, 80-90% of cases), bigger over several
da ca e b g a e e a e ,e g
the worm
o Infected body part→ cool water to ease symptoms
or may enter water to perform tests such as fetching
or drinking
o Upon contact with water→ worm discharges
hundreds of thousands of larvae into the water
Complications
a. Cellulitis
b. Boils
c. Generalized infection (sepsis)
d. Septic arthritis
e. Lock jaw (tetanus)
Disability- 8.5 weeks or permanent (common outcome)

D. TREATMENT
No specific drug/vaccine to treat and prevent it
Removing the worm and caring for the wound
1. First, the infected person is not allowed to enter drinking
water sources.
2. Next, the wound is cleaned. The affected body part may
be immersed or soaked in water to encourage the worm
to contract and release larvae. Emptying the worm of
larvae may make removing the worm easier.