Compiled by: EFREN II C.

DEOCADES, RMT

Module
9

Module
9
MTPC 124
CLINICAL
PARASITOLOGY
EFREN II C. DEOCADES, RMT

JMJ Marists Brothers

Notre Dame of Marbel University

NOTRE DAME OF MARBEL UNIVERSITY
College of Arts and Sciences Medical Technology Department
MEDICAL TECHNOLOGY DEPARTMENT
 Compiled by: EFREN II C. DEOCADES, RMT

MODULE IX:

The filariae AND MISCELLANEOUS NEMATODES

`

Learning Outcomes

At the end of the session, the students must be able to:

1. thoroughly explain the pathogenesis, epidemiology, prevention and control, treatment,

and diagnosis of clinically-relevant filariae and other miscellaneous nematodes;
2. exemplify mastery of the concept through passing the online assessment.

Introduction

In this module, we will discuss the remaining blood and tissue nematodes. Filarial worms will
be discussed first followed by other nematodes that are of high clinical relevance. These groups of
parasites are important because they can cause debilitating diseases to humans, causing
immobility and unproductiveness especially the group of filariae. The filariae are also characterized
with the presence of biological vectors that are necessary for the development and transmission
of the parasites.

Activity/ Application

The students will be tasked to watch documentaries regarding Nematode cases.

NOTRE DAME OF MARBEL UNIVERSITY

Medical Technology Department

The Filariae
Filarial Species
1. Wuchereria bancrofti – Bancroft’s filaria
2. Brugia malayi – Malayan filaria
3. Loa loa – Eyeworm (African)
4. Onchocerca volvulus – Blinding filaria
5. Mansonella ozzardi – New World filaria
6. Mansonella perstans – Perstans filaria
KEY DEFINITIONS
Filaria (pl. filariae)
− A group of nematodes (roundworms) in which the
adult worms live in tissue or the lymphatic system
Elephantiasis
− Enlargement of skin and subcutaneous tissue
Microfilaria (pl. microfilariae)
− The larval stage of the filariae
Periodicity
− The phenomenon whereby parasites present in
the bloodstream during a specific time period
Sheath
− Delicate, transparent covering found on select
microfilariae
GENERAL CHARACTERISTICS
Adults
− Creamy white; threadlike appearance
− Males often half the size of females
Microfilariae
− Slender, vary and overlap in size
− Key distinguishing features
1. Distribution of nuclei within tip of tail
2. Presence or absence of sheath
TRE DAME OF MARBEL UNIVERSITY
Compiled by: EFREN II C. DEOCADES, RMT
Requires arthropod vector
− mosquito, midge, or fly
− Infective larvae injected into humans during
feeding
− Larvae migrate to appropriate tissues and
complete development in adults (process
may take up to a year).
− Fertilized adult female worms lay live larvae
(microfilariae).
− Microfilariae take up residence in blood or
dermis.
− Vector ingests microfilariae during blood
meal.
− Larval development in vector – cycle repeats.
LABORATORY DIAGNOSIS
1. Specimen collection time important due to
parasite periodicity
2. Types of periodicity:
1. Nocturnal – occurs at night
2. Diurnal – occurs during the day
3. Subperiodic – timing of occurrences not
clear-cut
1. Wuchereria bancrofti
− Aka Bancroft’s Filarial Worm
− Most prevalent
− The most common in the Philippines
− causes bancroftian filariasis and elephantiasis
Two Forms:
1. Nocturnal Periodic Form
− found in the peripheral blood during the night
between 10 p.m. and 4 a.m.
2. Second Form
− found only in the Pacific Islands and is
present in the blood at all times, but more
frequently during the day in the afternoon
hours.
Medical Technology Department
NOTRE DAME OF MARBEL UNIVERSITY
Medical Technology Department

Life Cycle Notes
− Vector: Mosquito (Culex fatigans, Anopheles, or
Aedes spp.)
− Humans are the definitive host and the
reservoir for W. bancrofti.
− Adult worms reside in lymphatics.
− Microfilariae live in the blood and lymphatics.
Epidemiology
− Subtropical and tropical areas
− Mosquito breeding occurs in contaminated water
in these areas.
− Indigenous inhabitants are at greater risk of
contracting parasite than non-indigenous
individuals living in these areas.
Clinical Symptoms
A. Asymptomatic
− adults who as children were likely exposed
become infected but experience no
symptoms
− Microfilariae and eosinophilia usually
recovered in blood samples
− Physical exam reveals enlarged lymph
nodes, particularly in inguinal region/groin
area
− Typically self-limiting
B. Symptomatic bancroftian filariasis
• General symptoms: Fever, chills,
eosinophilia
• Additional possible symptoms
TRE DAME OF MARBEL UNIVERSITY
Compiled by: EFREN II C. DEOCADES, RMT
− ADLA (acute dermatolymphangioadenitis): the
most common acute manifestation of LF, defined
as localized pain, lymphadenitis and/or
lymphangitis and/or cellulitis and local warmth,
with or without systemic manifestations of fever,
nausea, and vomiting.
− Lymphedema most often occurs in the lower
extremities.
− Elephantiasis of lower extremities (especially
the legs)
− Genitals and breasts may also be involved
− Hydrocele: fluid-filled sac within the scrotum, may
occur when adult worms block the retroperitoneal
or subdiaphragmatic lymphatic vessels
− Chyluria: a result of lymphatic rupture and fluid
entering the urine
− Tropical Pulmonary Eosinophilia (TPE):
elevated serum immunoglobulin E (IgE) level,
weight loss, low-grade fever, cough and wheezing
at night, and lymphadenopathy; occult filariasis
− On the death of the adult worm, calcification or
formation of abscesses may occur
− Endosymbiont:
Wolbachia spp.: increases the risk of chronic
infection; obligate intracellular organism; bacterial
antigens enhance the host inflammatory
response, leading to increased scarring and
damage within the host lymphatic system
Right Leg Elephantiasis
Right Leg Elephantiasis
and Hydrocele
Medical Technology Department
NOTRE DAME OF MARBEL UNIVERSITY
Medical Technology Department
 Compiled by: EFREN II C. DEOCADES, RMT

Laboratory Diagnosis
Method of choice: fresh Giemsa-stained blood, fluid,
or tissue smear

Other techniques:
1. Filter heparinized blood using nucleopore filter;
examine filter contents
2. Knott technique
3. Serologic tests and PCR have been developed.

Patient symptoms and history often serve as primary

means of diagnosis in endemic areas.

Treatment
1. Diethylcarbamazine (DEC)- choice
2. Ivermectin (Stromectol)
3. Surgical removal Life Cycle Notes
4. Unna’s paste boots
− Vectors: Aedes, Anopheles, or Mansonia species
5. Elastic bandages
of mosquitoes
6. Simple elevation
− Anopheles mosquito can also transmit W.
bancrofti, which may result in a coinfection with
Prevention and Control
both filariae.
1. Use of personal protection when entering known
endemic areas − Adult worms reside in lymphatics.
2. Destroying mosquito breeding grounds − Microfilariae live in the blood and lymphatics.
3. Insecticides
4. Educating inhabitants of endemic areas Epidemiology
5. Mosquito netting/insect repellants − Found in numerous locations around the world
including:
1. Philippines
2. Brugia malayi 2. Sri Lanka
− Aka Malayan Filarial Worm 3. Vietnam
− B. timori is limited to the two islands of Timor, an 4. Specific regions of Japan, China
island of Indonesia − Felines and monkeys at risk for contracting
parasite even though humans are considered to
Two Forms: be the primary definitive host
1. The Nocturnal Form
− is the most common and is located near Clinical Symptoms
areas of coastal rice fields − Often asymptomatic
2. The Nonperiodic Form − Fevers may take months to years to develop after
− associated with infections in areas near initial infection.
swampy forests. − Other symptoms include:
1. Granulomatous lesions
2. Chills
3. Lymphadenopathy
4. Lymphangitis
5. Elephantiasis of legs
TRE DAME OF MARBEL UNIVERSITY
Medical Technology Department
NOTRE DAME OF MARBEL UNIVERSITY

Medical Technology Department


6. Elephantiasis of genitals less common
7. Clinical disease progresses faster after
infection with B. malayi than with W. bancrofti
8. Microfilariae may appear in the blood in as
little as 3 to 4 months
Laboratory Diagnosis
− Method of choice: Fresh Giemsa-stained blood
smear
− Periodicity: typically nocturnal; Subperiodic
organisms are possible.
− Knott technique and serologic methods have
been developed and are available.
Treatment
− Diethylcarbamazine (DEC)
− Anti-inflammatory drugs may be necessary due
to inflammatory reactions that may occur after
treatment.
Prevention and Control
− Use of personal protection when entering known
endemic areas
− Destroying mosquito breeding grounds
− Insecticides
− Educating inhabitants of endemic areas
− Mosquito netting
− Insect repellants
3. Loa loa
− Aka Eye worm
− Causes Calabar Swelling, Fugitive Swelling
TRE DAME OF MARBEL UNIVERSITY
Compiled by: EFREN II C. DEOCADES, RMT
Life Cycle Notes
− Vector: Chrysops fly
− Adults live and multiply throughout the
subcutaneous tissues.
− Microfiliariae appear in the blood years after
initial infection.
− can persist in the human host for up to 17 years
Epidemiology
− Africa – especially in rainforest belt
− Infection rates estimated at over 70% in areas of
known vector population existence
Clinical Symptoms
A. Loiasis
1. Pruritus or itchiness and localized pain at bite
site
2. Adult worms may be noticeable when seen
migrating under the conjunctiva of the eye or
crossing under the skin of the bridge of the
nose
3. Calabar swellings
Laboratory Diagnosis
− Method of choice: Fresh Giemsa-stained blood
smear
− Knott technique
− Periodicity: diurnal {between 10:15 a.m. and
2:15 p.m.}
− Presence of eosinophilia and Calabar or transient
subcutaneous swellings aids in diagnosis
− Serologic testing is available
− Adult worm extraction {such as from the eye}
Medical Technology Department
NOTRE DAME OF MARBEL UNIVERSITY
Medical Technology Department

Worm Removal from the Eye of an Infected Person
Treatment
− Surgical removal of adult worms
− Diethylcarbamazine (DEC)
Prevention and Control
− Personal protection
− Destroying vector breeding grounds
− The prophylactic use of DEC
4. Onchocerca volvulus
− Aka Blinding Worm, Convoluted Filaria
− Causes River Blindness
Life Cycle Notes
− Vector: Black fly genus Simulium
− Adults encapsulate in subcutaneous fibrous
tumors and mate.
TRE DAME OF MARBEL UNIVERSITY
Compiled by: EFREN II C. DEOCADES, RMT
− Resulting microfilariae migrate throughout
infected nodules, subcutaneous tissues, skin, and
into the eye; rarely seen in peripheral blood.
Epidemiology
− Equatorial Africa and Central America:
1. Includes East Africa, Mexico, Brazil, and
others
− Vector breeds in running water, particularly along
streams and rivers.
− There are known animal reservoir hosts.
Clinical Symptoms
− Onchocerciasis: river blindness
1. Usually results in chronic, non-fatal condition
2. Localized symptoms caused by infected
nodule development
3. Secondary bacterial infections due to
scratching
4. Eye involvement may lead to blindness
Laboratory Diagnosis
− Multiple Giemsa-stained slides of tissue biopsies
known as skin snips
1. To obtain uncontaminated sample (with other
microfilariae), skin snips are collected with as
little blood as possible.
− Adults may be seen during opthalmic exam.
− Serologic and PCR methods are available.
Treatment
− Ivermectin for treatment of microfilariae
− No known effective medication that treats both
microfilariae and adults without some toxic effects
or complications
− Long-term treatment may be necessary because
of long life span of adult worms
− Surgical removal of adult worms
Prevention and Control
− Personal protection
− Controlling vector breeding grounds and areas
where adults reside with insecticides
Medical Technology Department
NOTRE DAME OF MARBEL UNIVERSITY
Medical Technology Department
 Compiled by: EFREN II C. DEOCADES, RMT

5. Mansonella ozzardi 2. Diethylcarbamazine (DEC) is treatment of choice.

Prevention and Control

1. Controlling vector populations
2. Because of small size of vectors, nets and
screening equipment ineffective prevention and
control measures

6. Mansonella perstans

Life Cycle Notes

− Vector: Culicoides sucking midge or Simulium
black fly
− Microfilariae found in blood and capillaries and
intravascular spaces of the skin.
− Emerging adults may reside in body cavities,
visceral fat, and mesenteries, but this is still
undocumented.

Epidemiology Laboratory Diagnosis

− Found exclusively in the Western Hemisphere − Blood
1. North, Central, and South America − Periodicity: non-periodic
2. West Indies and Caribbean
Life Cycle Notes
Clinical Symptoms − Vector: Culcoides sucking midge
A. Asymptomatic − Eye involvement common
B. Symptomatic − Humans primary definitive hosts
1. Urticaria − Incubation period once inside host – unknown
2. Lymphadenitis
3. Skin itching Epidemiology
4. Arthralgias − Africa, Caribbean Islands (select areas)
5. Eosinophilia − Panama
6. Adult worms cause minimal damage to − Northern South America
areas they inhabit − Primates thought to be reservoir hosts
Laboratory Diagnosis Clinical Symptoms
− Giemsa-stained peripheral blood smears − Infections with single worm are common and
− Periodicity: non-periodic cause little if any damage to affected tissue;
symptoms are minimal as well.
Treatment − Asymptomatic
1. Asymptomatic cases are usually not treated.
TRE DAME OF MARBEL UNIVERSITY
Medical Technology Department
NOTRE DAME OF MARBEL UNIVERSITY

Medical Technology Department

 Compiled by: EFREN II C. DEOCADES, RMT

− Symptomatic Life Cycle Notes

1. Minor allergic reactions Natural Hosts/Definitive Host: Rats
2. Moderate eosinophilia Intermediate Hosts:
− Other symptoms Mollusks- Snail
1. Calabar swellings Pila luzonica- Kuhol
2. Headache Brotia asperata- Suso
3. Edema MOT: Ingestion of IH
4. Lymphatic discomfort Migrate to the brain and spinal cord causing
5. Evidence suggests a connection to joint and Eosinophilic Meningoencephalitis
bone pain and liver enlargement and pain
Characteristics
Treatment Female Worm: Barber’s Pole Appearance (whitish
− Asymptomatic infections usually not treated uterus, red digestive tract)
− Diethylcarbamazine (DEC), may involve multiple
treatments Female Worm of
− Alternative medication – mebendazole Barber’s Pole Parastrongylus
cantonensis
Prevention and Control
− Vector population control measures
− Personal protection from insect bites

Miscellaneous Nematodes
1. Parastrongylus cantonensis
− previously known as Angiostrongylus sp.,
− Aka Rat Lung Worm
− Causes: Cerebral Angiostrongyliasis
− Parastrongylus costaricensis: Abdominal
Angiostrongyliasis 2. Dirofilaria immitis
− Common Name: Dog Heart Worm
− Very common filarial parasite of dogs
− Clinical manifestations are characterized by
solitary, peripheral nodules in the lung (coin
lesions) or as subcutaneous nodule

TRE DAME OF MARBEL UNIVERSITY

Medical Technology Department
NOTRE DAME OF MARBEL UNIVERSITY

Medical Technology Department

 Compiled by: EFREN II C. DEOCADES, RMT

3. Anisakis
− Common Name: Herring’s Worm
− Causes: Herring’s Disease
− Common in Japan

Definitive Host: Whales/ Dolphins

1st IH: Copepods
2nd IH: Smaller Fishes
3rd IH: Larger Fishes (Salmon)
MOT: ingestion of raw fish infected with larvae
Pathology: Abdominal Pain and Granuloma around
Migrating Larvae in Intestinal Wall

4. Toxocara spp.
A. Toxocara canis
− Visceral Larva Migrans
− intestinal ascarid of dogs

B. Toxocara cati
− Ocular Larva Migrans
− intestinal ascarid of cats

References
Belizario Jr., V. Y., & de Leon, W. U. (Eds.). (2015). Medical Parasitology in the
Philippines (3rd ed.). University of the Philippines Press.

Tille, P. M. (2017). Bailey and Scott’s diagnostic microbiology (14th ed.). Elsevier Inc.

Zeibig, E. A. (2013). Clinical Parasitology: A Practical Approach (2nd ed.). Saunders Elsevier.

Assessment
An online, 50-item quiz will be given and will be accessed using the Learning
Management System.
TRE DAME OF MARBEL UNIVERSITY
Medical Technology Department
NOTRE DAME OF MARBEL UNIVERSITY

Medical Technology Department