BLOOD AND

TISSUE Prof. O.
NEMATODES Ojurongbe
 Filariae
• The filariae, members of the superfamily filariodea.

• These nematodes have a unique stage in their life cycle, the microfilaria, which
distinguishes them as a group.

• The adult worm lives in various tissues of the definitive host, including the body
cavities, subcutaneous tissues, and the lymphatic and vascular systems.

• The microfilariae produced by the female worm are motile, and those of some
species migrate into the blood stream; others accumulate in the skin.

• Host-to-host transmission is accomplished when a blood-sucking arthropod

intermediate host ingests the microfilaria.

• It develops to the infective stage in the tissue of the intermediate host

• When the infected arthropod again takes a blood meal, the larva invades the
tissues of the definitive host through the bite site and develops to the sexually
mature adult stage.
Species of Filaria

• Eight species of filariae are endemic in various parts of the

world
• Wuchereria bancrofti, Lymphatic filariasis
• Brugia malayi, B. temori,
• Loa loa,
• Onchocerca volvulus,
• Mansonella ozzardi, M. perstans, and M. streptocerca
Wuchereria bancrofti (Bancroftian filariasis)
• The disease is widely distributed through the
tropical area of Africa, Asia and Latin America.
• Man is the only natural definitive host. Intermediate
host is the female mosquitoes especially anopheles
and culex species.
Morphology
• Adult worms are found in the lymphatic vessels.
• They are small, thread like and have a smooth cuticle.
• Females are viviparous and they discharge motile
microfilaria.
• Microfilaria from peripheral blood measures 244-246 µm in
length by 75-100 µm in diameter.
• The anterior end is bluntly rounded, the posterior end is
tapered and the body is enclosed in large sheath.
• In a stained blood film the body appears to be composed of
no more than a column of dark–staining nuclei that do not
extend to the end of the tail.
• The motile microfilaria have a marked nocturnal periodicity,
and the number is high between 10 p.m-2 am
• They are scant, usually absent during daylight hours when
they tend to accumulate in the viscera and particularly in the
lungs.
Life Cycle of Wuchereria bancrofti
 Pathogenesis - Acute stage

• Adult worms are found in lymph vessels throughout

the body but principally in or around axillary,
epitrochlear, inguinal, and pelvic nodes and the
lymphatic distal, as well as in the testis, epididymis,
and cord.
• Symptoms are caused primarily by local and systemic
sensitization and tissue reaction to the parasite.
• There is an accumulation of histeocyte, epitheloid
cells, lymphocytes, plasma cells, giant cells, and
eosinophils in the vessel’s lumen around the worms.
Pathogenesis - Acute stage:
Elephantiasis
• Attacks of lymphangitis and lymphadenitis result
from reactions to the products of developing adult or
dying worms or bacterial or fungal infection.
• These attacks are marked by retrograde
lymphadenitis, funiculitis, epididymitis, and orchitis
with fever.
• Repeated attacks of lymphangitis lead to thickening
of the affected lymphatic vessels, which may become
incompetent, leading to lymphodema, and the
lymphatic vessels tend to become fibrosed after the
repeated attacks.
• In chronic lymphodema, there will be hyperplasia of
the connective tissue and infiltration of plasma cells,
macrophages, and eosinophils.
• Woody indurations of the tissues may occur with a
thick and verrucous change in the skin leading to
elephantiasis.
Clinical features:
Asymptomatic:
• Heavily infected, no signs of the disease other than large number of microfilariae in
the circulating blood.
• In some patients, the presence of even a few numbers of worms provokes severe
reactions seen in immunologically naïve patients.
Acute phase:
• characterized by fever, lymphangitis, and lymphodema,
• These attacks remain high for 1- 2 days and gradually subside over a 2-5 days.
Chronic phase:
• Repeated acute attacks lead to Odem and fibrosis of the leg and genitalia (scrotum)
lymphatic vessels.
• Elephantiasis occurs mainly in those with repeated attacks over a long period of time.
Tropical pulmonary eosinophilia
• characterized by coughing and wheezing, especially at night.
• Microfilariae cause these symptoms in the lung that elicit immediate hypersensitivity
reaction characterized by high IgE concentration and eosinophils.
• Parasites are not seen in Peripheral blood.
Diagnosis
• Thick blood smears taken from the patient at night reveal the
microfilariae.
• Antigen detection using an immunoassay for circulating filarial
antigens is a useful diagnostic approach, because microfilaremia
can be low and variable.
• A rapid format immunochromatographic test, for Wuchereria
bancrofti antigens, has been recently evaluated in the field.
• Molecular diagnosis using polymerase chain reaction is available
Treatment
• Diethylcarbamazine is effective only against
microfilariae
• Ivermectin is also effective against microfilariae
worms
• No drug therapy for adult worms is available.
• Combination of Albendazole and Ivermectin is also
very effective
Onchocerciasis
 Onchocerciasis

• It is transmitted by Onchocerca volvulus

• It is endemic in Africa, Central America and small area in Yemen.
• The disease is a major cause of blindness and called river
blindness because the black flies (vector) develop in rivers.
• People who live along those rivers are mostly affected.
• Infection rate are often greater than 80% in areas of endemic
infection
• The microfilaria lacks a sheath; the column of the nuclei doesn't
extend to the end of the tail.
• The microfilaria are typically found in the upper layers of the
dermis, frequently in the urine, in cytology smear and rarely in
blood.
Life cycle
Pathogenesis and symptomatology
• The presence of the adult worm causes a local cellular
reaction of a fibrotic nature, resulting in the encapsulation
of the worms.
• There may be only a single nodule or many.
• In Africa, the nodules are common in the pelvis (iliac
crest), trochanters, and the lateral chest wall.
• In America, nodules are more common on the head.
• The dispersal of microfilaria into the dermal layers of the
skin throughout the body causes various types of acute and
chronic skin lesions
• Sowda: localized onchocerciasis in Yemen
• Lymphadenopathy is commonly associated with
onchocerciasis.
• In some areas of Africa, hanging groin: a sac-like
projection of loose, atrophied skin containing a mass of
large, fibrotic lymph glands.
• Ocular complications are the most serious consequences
in some area of Africa and central America in which the
microfilaria invade all tissues of the eye, producing
congestion, hemorrhage and degeneration of the tissues as
well as degenerative changes in the optic nerve.
Leopard Skin in Onchocerciasis
Lizard Skin in Onchocerciasis
Diagnosis:
• Skin snip: Biopsy of the affected skin reveals
microfilaria.
Treatment
• Ivermectin against microfilaria but not the adult.
Suramin kills adult worms but is toxic and used
particularly in eye disease patients.
• Surgical removal of the nodules can be done
Control
• Mass treatment with Ivermectin co-ordinated by
African Program on Onchocerciasis Control (APOC)
• Larviciding formerly used in OCP countries
Loiasis
Co-endemicity of Loiasis and Onchocerciasis in Rain Forest Communities in
Southwestern Nigeria | PLOS Neglected Tropical Diseases
Loiasis
• The disease caused by Loa loa is endemic in tropical central and West
Africa
• The filarial worm migrates throughout the subcutaneous tissues of
humans, occasionally crossing into subconjunctival tissues where it
can be easily observed.
• This presentation led to the popular name the African eye worm.
• Several species of tabanid flies transmit Loa loa. the two prominent
vectors are from the Chrysops genus of tabanids—C. silicea and C.
dimidiate
• Adult Loa worms are sexual, with males considerably smaller than
females at 30-34mm long and 0.35-0.42mm wide compared to 40-
70mm long and 0.5mm wide.
• Adults live in the subcutaneous tissues of humans, where they mate
and produce worm-like called microfilaria.
• These microfilariae are 250-300mm long, 6-8mm wide, and can be
distinguished morphologically from other filariae—they are sheathed
and contain body nuclei that extend to the tip of the tail
Life cycle
Clinical Presentation
• Human infections with Loa loa is often
asymptomatic.
• When symptoms occur, it includes localized
angioedema (swelling of the deep dermis),
migration of the adult worm, producing
urticaria and pruritus, microfilaremia,
eosinophilia, and variable antibody levels.
• Localized angioedema, or Calabar
swellings (named for the coastal Nigerian
town where they were first noted), most
often affects the upper limbs (especially the
hands) or lower limbs, and sometimes the
face.
• They may be red and have associated
pruritus (itching).
• Loa loa worms are not necessarily in the
swellings when they become visible.
Diagnosis
• Physically, Calabar swellings are the primary tool for
diagnosis.
• Adult worms migrating across the eye are another potential
diagnostic, but the short timeframe for the worm’s passage
through the conjunctiva makes this harder to achieve
• Blood tests to reveal microfilaremia and eosinophilia are
useful in many, but not all cases, as one-third of loiasis
patients are amicrofilaremic
• The worm can also be seen in wet blood preparation under
the microscope
 Treatment
• Treatment of loiasis involves chemotherapy or, in some cases,
surgical removal of adult worms followed by systemic treatment
• The current drug of choice for therapy is diethylcarbamazine
(DEC) which kills the microfilariae and adult worms
• Certain people with heavy infections are at risk of brain
inflammation when treated with DEC.
• Albendazole is used in patients not cured with multiple DEC
treatments. Albendazole is believed to kill the adult worm
• Co-endemicity of Loa loa and onchocerciasis has to be
determined before treatment of onchocercisis
• Ivermectin is contraindicated in patients who are co-infected with
loiasis
• killing of massive numbers of microfilaria, some of which may be
near the ocular and brain region, can lead to encephalopathy
 Dracunculus medinensis
• Guinea fire worm, Dracunculiasis: The
disease occurs over large areas of
tropical Africa, the Middle East, and
India. Though it is sometimes classed
with filarial worms, Dracunculusis not a
true filaria.
• The adult female, which carries about 3
million embryos, can measure 600 to
800 mm in length and 2 mm in
diameter.
• The parasite migrates through the victim's subcutaneous tissues causing
severe pain, especially in the joints.
• The worm eventually emerges (from the feet in most of the cases), causing
an intensely painful oedema, a blister, and an ulcer accompanied by fever,
nausea and vomiting.
• Infected persons try to relieve the burning sensation by immersing the
infected part of their body in local water sources, usually ponds water.
• This also induces a contraction of the female worm at the base of the ulcer
causing the sudden expulsion of hundreds of thousands of first stage larvae into
the water.
• They move actively in the water, where they can live for a few days
• The larvae of D. medinensis subsequently infect Cyclops (small crustaceans)
• When a person drinks contaminated water from ponds or shallow open wells,
the cyclops is dissolved by the gastric acid of the stomach and the larvae are
released and migrate through the intestinal wall.
• After 100 days, the male and female meet and mate.
• The male becomes encapsulated and dies in the tissues while the female moves
down the muscle planes.
• After about one year of the infection, the female worm emerges usually from the
feet releasing thousands of larvae thus repeating the life cycle.
• No drug is available to prevent or heal this parasitic disease.
• Dracunculiasis is, however, relatively easy to eliminate and eventually eradicate.