Wuchereria Bancrofti

Common name: Bancroft’s Filarial worm

Disease:

 Bancroftian filariasis
 Wuchereriasis
 Elephantiasis
 Filariasis
 Filariasis bancrofti

Geographical distribution:
• Tropics
• Philippines: Camarines Norte, Camarines Sur, Albay, Sorsogon, Mindoro, Masbate, Romblon,
Marinduque, Bohol, Samar, Leyte, Palawan.
• All provinces of Mindanao Bontoc, Mt. Province

Vectors:
• Anopheles minismus flavirostris (rural)
• Aedes poecillus (urban)

Other important features

 Adult females of W. bancrofti and B. malayi are indistinguishable.
 Elephantiasis is greatly due to bacterial or fungal superinfection in the
affected area.
 Rupture of lymphatics in the kidney may produce CHYLURIA (milky urine- chyle in urine)
 Hematuria also occurs
 Site of lymphatic obstruction determines the parts of the body affected.

Clinical Manifestations
Are caused mainly by adult worms either living, dead, or degenerating. Symptomatology depends upon:
1. The number of infective stages present.
2. Number of exposures to infection or to bite.
3. Sensitivity of the individual to the toxin produced by the parasite

Stages of Clinical Manifestations

1. Period of incubation – asymptomatic; the patient may manifest low-grade fever & regional
lymphadenitis for 1-3 weeks
2. Inflammatory stage- characterized by lymph ad itis and lymphangitis, pain on the affected portion,
fever, and chills.
3. Obstructive stage- production of elephantiasis, usually involves the lower extremities and genitalia
Diagnosis
1. Wet smears or thick blood smears
Factors where this may fail:
a.) low intensity of infection
b.) dead worms
c.) obstructed lymphatics
2. Filtration using a nucleopore filter or Knott’s method for concentration-in cases of low-intensity
infection
3. Antigen detection technique-use to detect circulating filarial antigens (CFA)
-Immunochromatography for W. bancrofti antigens
4. PCR- Polymerase Chain Reaction
- Detects filarial DNA
5. Ultrasound- demonstrate live worm in the lymphatics
6. Contrast Lymphangiography (uses radiolabeled albumin and dextran)- demonstrate obstructed
lymphatics. This is invasive and may lead to lymphatic damage.
7. Lymphoscintigraphy- demonstrate obstructed lymphatics. Can be performed repeatedly w/o harm.
serial studies of individuals are possible.

Treatment
 Diethyl Carbamazine (DEC)
- 3mg/kg single dose
-it stimulates microfilariae to come out to peripheral circulation allowing blood smear even
during day time.

Management
For acute attacks
1. Initial steps- relieve the pain
-Cool the affected area- don’t use ice water, it damages the skin that causes secondary infection.
2. Frequent washing of affected area minimum 2x a day
3. Elevate affected extremity
4. Wear comfortable slippers to prevent skin breakage/ cuts
5. Abrasions- antiseptics
6. Prophylactic creams and antibiotics.

PREVENTION
The goal of WHO- elimination by 2020
1. DEC (Diethyl Carbamazine) medicated table or cooking salt endemic areas.
2. DEC + Ivermectin
DEC + Albendazole
*99% effective in endemic areas
Albendazole +Ivermectin
2. Personal protective measures (net, OFF Lotion, spray)

Brugia malayi

Disease: Malayan filariasis

Geographic distribution
  The Philippines, Indonesia, Sri Lanka, Vietnam, Thailand, China, Malaysia, and in specific parts of
Korea.
 The nocturnally periodic form is found in areas with rice fields and the nocturnally subperiodic form is
found in rural villages and plantations along the lower reaches of major rivers in swamp forests.

Morphology
 Adult- microfilaria possesses a sheath
 Has a round anterior end and numerous nuclei.
 The characteristic that distinguishes it from the other sheathed organisms is the presence of two
distinct nuclei on the tip of the pointed tail.
 Female 50㎜
 Male 25㎜
 Microfilariae, measuring 177-230 μm in length and 5-7 μm in width, which are sheathed (diagnostic).

Hosts
 Definitive Host:
 Prefers Humans
 Intermediate Host:
 Mosquito acts as a vector.
 Prefer humans as sole definitive hosts and have become highly adapted to our physiology.

Transmission
 Insect bites
 Mosquito
 Bloodborne
 Blood Transfusion of the recipient receiving the blood of a contaminated donor (only that of
L3 stage).

Symptoms
 Asymptomatic Phase: Upon initial infection, no symptoms may be present as microfilariae mature.
  Lymphadenitis: Causes swelling of the lymph nodes that may occur prior to maturation
 Lymphangitis: Inflammation of the lymphatic vessels usually after maturation.
 Abscess formation and ulceration of lymph nodes may also occur
 Secondary bacterial infections (lymph node failure caused by extended overstimulation).
 Lymph edema (elephantiasis):
 Enlargement of the limbs
 a late-onset condition caused by repeated inflammation of lymphatic vessels.
 Consistent irritation of lymphatic vessels leads to blockages caused by dead adult worms,
inflammatory fibrosis, or granulomatous reactions.
 Leads to scar formation of affected tissues.
 typically affects distal portions of the body such as arms and legs.

Diseases
 Elephantiasis
 Lymphangitis

Treatment
 Mass Treatment:
Diethylcarbamazine (DEC)- is effective at eliminating microfilariae. DEC-medicated salt is
commonly consumed in an effort to stop the spread of vectors and prevent new host infections or 6 mg/kg
weekly for 6 weeks.
 Tetracyclines used for secondary bacterial infections after lymph node damage.

Prevention
 Mosquito bed netting.
 Insect repellents/mosquito control (environmental treatment DDT).
 Diethylcarbamazine therapy would be considered as “preventative option).
 Cover exposed skin by loose clothing

LOA LOA

Common name:
-Loa worm
-African eye worm
Disease:
-Loaiasis
-Fugitive swelling
or Calabar swelling

Vector: Genus Chrysops

Morphology:
ADULTS:
Male:
-30 to 34 mm in length and 0.35 to 0.43 mm in diameter, the caudal end curve is ventrad and is provided
with narrow wings.
Female:
-40 to 70 mm in length and 0.5 mm in diameter, with the vulvar opening located in the cervical region.
*Adults live in the subcutaneous tissues of humans, where they mate and produce worm-like eggs called
microfilaria.
HABITAT- subcutaneous tissue

MICROFILARIAE:
 250 to 300 μm by 6 to 8 μm
 sheathed and have diurnal periodicity, optimum site during their active phase in the pulmonary
blood, the embryo appears in peripheral blood only during their passive phase.
 have been recovered from spinal fluid, urine, and sputum.
 During the day they are found in peripheral blood
 during the non-circulation phase, they are found in the lungs.

Clinical manifestation:
 Calabar swelling
 Migrating adult worms in the subcutaneous tissue provoke temporary inflammation.
 Swell develop rapidly and last for 1-3 days.
 Pain and swelling due to the host’s reaction to worm metabolites.
 Eosinophilia is a prominent finding.
 Nodular fibrosis occurs when there is encapsulation and calcification of the worm.

DIAGNOSTIC STAGE: Microfilaria

INFECTIVE STAGE: L3 stage

Diagnosis:
Blood smear:
Identification of the microfilaria on a blood smear made from blood taken from the patient between
10AM and 2PM.
Observing the worm under the conjunctiva, Calabar swelling, eosinophilia.

Treatment:
 Surgical removal
 Suramin betrazan
Prevention:
Diethylcarbamazine citrate
 shown as an effective prophylaxis for Loa loa infection.
 The recommended prophylactic dose is 300 mg DEC given orally once weekly.
 Detection and DEC treatment of human cases to destroy circulating microfilariae.
 Mosquito nets, repellents, screens

UNSHEATHED FILARIAL WORM

Onchocerca volvulus

Kingdom: Animalia
Phylum: Nematoda
Class: Secernentea
Order: Spirurida
Family: Filariidae
Genus: Onchocerca
Species: O. volvulus

Common name: convoluted filarial worm

DISTRIBUTION
 Tropical Africa between the 15° north and the 13° south (high endemicity in Burkina Faso and
Ghana)
 Foci are present in Southern Arabia, Yemen, and in America (Mexico, Guatemala, Colombia,
Ecuador, Brazil, and Venezuela)
 Predominantly located in rural agricultural villages located near rapidly flowing streams

Vector: Simulium blackfly

Disease:
Onchocerciasis is commonly known as river blindness
The world’s second-leading infectious cause of blindness
The World Health Organization (WHO) estimates the global prevalence is 17.7 million, of whom about
270,000 are blind
MORPHOLOGY
 helminths worm
 The male is usually 2-3 cm long; the female is usually 50 cm long
 Adults occur in the subcutaneous tissue and in nodules
 Microfilaria are usually 300 X 8 micrometers long
 An adult female worm can produce over 1000 microfilariae in a day, resulting in millions over a
lifetime
 Adult worms have a life span of 10-15 years
 Lips and a buccal capsule are absent

Infective stage: L3 larvae of O. volvulus

Diagnostic stage: Microfilariae

LIFE CYCLE
Onchocerciasis is linked with fast-flowing rivers where Simulium blackflies breed.
An infected female blackfly takes a blood meal from a host. The host’s skin is stretched by the fly’s apical
teeth and cut by its mandible.
The third stage larvae enter subcutaneous tissue, migrate, form and lodge in nodules, and slowly mature
into adult worms. New worms form new nodules or find existing nodules and cluster together.
The smaller male worms may travel through nodules and mate.
After mating, eggs form inside the female worm, develop into microfilariae and leave the worm one by one.
Thousands of microfilariae migrate in the subcutaneous tissue.
Some microfilariae die causing skin rashes, lesions, intense itching, or skin depigmentation
Microfilariae also can travel to the eye, causing blindness.
The infected host is bitten by another female fly. Microfilariae are transferred from the host to the blackfly,
where they develop into infective larvae.
Inside the fly, the larvae travel to the fly’s thoracic muscles and develop into third-stage larvae. The cycle
begins again…

ONCHOCERCIASIS
 The intensity of human infection (number of worms in an individual) is related to the number of
infectious bites endured by an individual.
 Blindness is almost always in persons with intense infection.
 An individual may be asymptomatic. Those with symptoms usually experience nodules, skin rashes,
eye lesions, and bumps under the skin. The eye lesions can manifest into blindness.
 Incubation periods last from nine to 24 months after the initial bite.
 The host’s white blood cells usually release cytokines that affect the infected tissue and thus kill the
microfilariae, which causes “lizard skin” (swelling and thickening of the skin) and “leopard skin” (loss
of pigment).

PATHOLOGY AND CLINICAL SYMPTOMS

 The adult worms induce a fibroblastic reaction in the host which causes the worms to become
enveloped in fibrous scars: onchocercal nodule or onchocercoma of firm, round, non-tender, and
varying in diameter of 0.5 to 10 cm or more.
 These nodules tend to occur on anatomic sites where the bone is superficial, such as the scalp,
scapulae, elbows, iliac crests, and knees. Heavy and long-term infections in an endemic area, can
make irreversible eye changes.
 Symptomatology of ocular onchocerciasis begins with photophobia and progresses through a
gradual blurring of vision to blindness.

DIAGNOSIS
 The most common is a fresh examination of blood-free skin snips; however, this does not always
show the presence of the parasite.
 Serologic testing for antibodies is available; however, a positive result doesn’t guarantee
onchocerciasis.
TREATMENT
 Ivermectin (mectizan) is administered as an oral dose of 150 micrograms per kilogram (maximum 12
mg) every 6-12 months.
 The drug paralyzes the microfilariae and prevents them from causing itching.
 Ivermectin does not kill the adult worm; it does prevent them from producing additional offspring.
 Surgical removal of the nodules is also available.
 There is no vaccine.

Prevention
 Using insecticides and personal insect repellent spray.
 Avoiding the haunts of Simulium by wearing clothing that reduces the area of skin exposed to bites
 There is no chemoprophylaxis.

Mansonella streptocerca
Formerly known as:
• Dipetalonema streptocerca
• Dipetalonema streptocercum

Intermediate host
• Culicoides grahamii and other culicoides species
Definitive hosts
• Humans and monkeys(chimpanzees)

Disease
• Streptocerciasis
• Subcutaneous filariasis
Geographical Distribution
• West-central Africa
• East and West Africa
Vector: Culicoides grahamii

Adult streptocercae
-Are thin, sinous worms
Location : Cutaneous connective tissue
Sizes:
Males: averaging 17x0.05mm
Females: 27x0.075 mm
Microfilaria- found only in human skin
Size : 180-240 μm x 2.5-5 μm
Characteristics:
• Unsheathed
• Body is in straight attitude.
• Nuclei extend to end of tail.
• Hooked tail
Rounded or forked tail tip("shepherd's crook")

Lice Cycle

Signs and symptoms

• Often asymptomatic
• Pruritic dermatitis (itchiness)
• Hypopigmented macules
• Papular eruption
• Enlarged axillary lymph glands

Diagnosis
• Skin snip
• collected from several sites, usually the shoulders and buttocks and sometimes the chest and
calves.
• placed immediately in 0.5ml of 0.9% sodium chloride in a microtiter plate and left for four hours to
allow the microfilaria to migrate out of the tissues
• the wells are examined using an inversion microscope after four hours

Treatment
• Diethylcarbamazine (DEC) - The drug of choice
• Ivermectin - needs further studies
Prevention
• Eradication of the vector
• Wearing of long sleeves and long pants
• Use of insect repellants
• Use of nets and screen

Manzonella ozzardi

• one of the three types of genus Mansonella (M. perstans, and M. streptocerca)
• first described and found in Guyana in the late 19th century.
• one of two that causes serous cavity Filariasis in humans

Common Name: Ozzard’s Filaria

Disease: Manzonelliasis ozzardi, ozzard’s filariasis

Geographic Distribution
• Endemic in tropical areas of the New world
• Central and South America (parts of Mexico, Panama, Brazil, Colombia, Argentina, Caribbean)

Definitive host: Humans

Intermediate host:
• biting midges (genus Culicoides)
-C. austeni and the day-biting C. grahamii
• blackflies (genus Simulium)

Periodicity: Non periodic

Habitat: serous cavity of the abdomen

MOT: bites of infected midges or black

Morphology
• cylindrical and bilaterally symmetrical worm, with a pseudocoel, or a false body cavity.
• Cuticle: protective layer
• have longitudinal muscles that run along the body wall. They also have dorsal, ventral, and
longitudinal nerve cords connected to these longitudinal muscles.
• Site of infection: peritoneal cavity
Adult Male
• 24–28 mm long by 0.07–0.08 mm
• It is coiled in one and a half to two turns and has two spicules and caudal alae.
• long and slender with reduced lips
Adult Female
• 32.2–61.5 × 0.13–0.16 mm
• Dioecious and ovoviviparous
• have a slender, clear, tapered tail called a "button hook”
• nuclei do not extend to the end of the tail
• has a vulva 0.76 mm from the caudal extremity
• The vagina leads to paired uteri filling the body cavity with highly coiled ovaries in the posterior part
of the body.

Note: Both male and female live in body cavities embedded in adipose tissues and in the mesentery
Microfilariae
• unsheathed
• 207–232 μm long by 3–4 μm
• The anterior end is round and they have an attenuated tail resembling M. perstans, but pointed,
clear and ending in a hook
• Found in blood

Mansonella perstans
No sheath, nuclei extending to the
tip of the tail

Mansonella ozzardi
No sheath, no nuclei in the tip of the
tail

Mansonella streptocerca (skin)

No sheath, nuclei extending to the tip
of the hooked tail

Microfilariae of M. ozzardi,
This microfilaria was identified with a blood smear.
The nuclei do not extend to the tip of the tail which has a pointed end.

Copulation
• the female is believed to release a pheromone to attract males. When the male finds the female, he
will coil around the female over the genital pore. The male's spicules are used to hold the female
during copulation.
Life Cycle

Signs and Symptoms

Infections caused by M. ozzardi are generally Asymptomatic

• Moderate fever
• Coldness in the legs
• Joint pains
• Headaches
• Pruritis (itchiness)
• Skin eruptions
• Pulmonary symptoms
• Lymphadenitis
• Adenopathy
• Hepatomegaly

Diagnosis
• Examination of blood for microfilaria (thick smear stained with Giemsa or hematoxylin and eosin may
be used)
 • Serum immunoglobulin concentrations
• Ultrasound
Note: Researchers are currently developing a polymerase chain reaction- method for detecting the
parasites in skin biopsies.

Treatment
• Ivermectin (Drug of Choice): Registered as a single dose of 14 mg/kg body weight
• Diethylcarbamazine citrate (DEC) in daily doses of 4.5 to 6 mg/kg is ineffective, at least in some
localities. Larger doses (6 m/kg three times daily for 10 days, are reported to be effective

Prevention
• wear long-sleeved shirts and pants to decrease the body parts exposed
• Insect repellents could also be applied to body parts that are not protected by clothing
• Communities should also maintain the natural vegetation around them to decrease the possible
breeding grounds for the biting midges.
• Individuals should also avoid the waterways whenever possible.
• apply insecticides specific for blackfly larvae in streams and rivers

DRACUNCULUS MEDINENSIS (“little dragon from medina”)

 Dracunculus medinensis is among the longest nematode infecting humans.

 The longest recorded adult female was 800 mm(31 in), while the male is only 40 mm(1.6 in).

COMMON NAME:
-Medina worm
-Guinea worm
-Dragon worm

DISEASE:
-Dracontiasis
-Dracunculiasis
-Dracunculosis (guinea worm ulcer)

Geographical distribution:
Central Africa, Saudi Arabia, Yemen, Iraq, Far East, and Central America (where communities use wells as
a source of water)

Mode of infection: man is infected by drinking water containing infective cyclops/ copepods
Incubation period: about 1 year
Definitive host: man
Reservoir host: dogs, cats, cattle and camels
Insect vector: cyclops (water flea)
Habitat: subcutaneous tissue especially parts that contact with water (foot, leg, shoulder back)
MORPHOLOGY:
Larvae/Embryo (diagnostic stage)
>comma shaped, non- sheathed, with round anterior end.
>larva has a rhabditiform esophagus and a long-pointed tail (= 1/3 body).
ADULT:
>adult worms are thread-like with smooth surfaces.
ADULT MALE
>12-29mm x 0.4 mm
ADULT FEMALE
>500-1200mm x 0.9-1.7mm

Life cycle:
Ingestion of water containing copepods/cyclops infected with D. medinensis larvae
Cyclops die and release stage 3 larvae w/c penetrates host’s duodenal wall
After the male and female copulate, the male dies
After 1-year, the female worm migrates to subcutaneous tissues causing blisters and ruptures in skin
When affected area contacts WITH water, the female protudes and skin ruptures, releases large number of
stage 1 larvae in water
Stage 1 larvae are ingested by cylops, after 2 weeks, stage 3 larvae become infectious
Ingestion of cyclops

Signs and Symptoms:

 As an adult female migrates to the skin, the patient develops allergic reactions in the form of
FEVER, NAUSEA, VOMITING, AND ASTHMA.
 A skin reaction, in the form of a red papule (blister that ulcerates)

 >2nd infection leads to an abscess, cellulitis, and septicemia

 >severe inflammatory, and allergic reactions(anaphylaxis)
 >high eosinophilia
Pathogenesis:
1) Local skin lesions (papule, blister)
2) Outline of the female may be seen under the skin
3) Worm may be felt by fingers; as a rolling string with a spiral course

Diagnosis:
1) X-ray = shows calcified females
2) Intradermal test
3) Serological test

TREATMENT:
1) Surgical removal
2) Forced parturition
1)Metronidazole: 250 mg 3 times daily for 7 days orally
2)Thiabendazole: 25 mg/ Kg twice daily for 2 days
3) Diethylcarbamazine citrate: 2 mg/Kg 3 times daily for 2-3 weeks orally.
Prevention and Control:
1) Filtering or boiling of drinking water
2) Destroying the Cyclops using copper sulfate or chlorine
3) Wells should be covered
4) Patients are not allowed to path or wade in water used for drinking