FILARIASIS

BLOOD AND LYMPHATIC SYSTEM

ISNA INDRAWATI
Department of Microbiology-Parasitology

FILARIA
Tissue nematodes (round worms)
Family Filarioidea
Adult worms live in the lymphatic,
subcutaneous tissue & body cavities
Transmitted by infected biting
arthropods during a blood meal.

Morphology
Adult worms : whitish and thread like
Female : viviparous
microfilaria
Microfilaria : sheated/ unsheated

Periodicity of microfilaria:
the circadian rhythm observed in the
appearance of filarial microfilaria in
the peripheral blood.
Nocturna,
diurna
sub periodic

 Basis of mf periodicity : >> unknown

Influenced by :
Circadian rhythm of the host
p O2 and N2 in the blood
Strain of parasite
Feeding habit of the vectors

NEMATODE
Wuchereria bancrofti

lymphatic

FILARIA
non-lymphatic
(sub cutaneous)

Brugia malayi
Brugia timori
Loa-loa
Onchocerca volvulus
Mansonella

Global distribution of lymphatic filariasis and onchocerciasis.

(Adapted from WHO, http://who.int/tdr/)

Source : www.neb.com

Life cycle

Infected stage

LYMPHATIC FILARIASIS

Prevalence (WHO, 2015)

120 million people are infected with
lymphatic filariasis;
25 million men have genital disease ( >>>
hydrocele)
15 million,(>> women), have lmphoedema
or elephantiasis of the leg.
66% of those at risk of infection live in
the WHO South-East Asia and 33% in the
African Region.

Geographic distribution

W.bancrofti : 90 % of the cases

B. malayi : most of the remainder cases
B. timori : also causes diseases

Morphology
Adult worms : minute and thread like;
whitish, smooth cuticula
: 40 mm x 0,1 mm, posterior end curved
sharply
: 80-100mm x 0.2- 0.3 mm

Species
Wuchereria
bancrofti

Type/varians

Definitive
host

Urban type

Nocturnal

Human

Rural type

Nocturnal

Human

antropophilic

Nocturnal

Human

zoophilic

Subperiodic
Nocturnal

Human,
Monkey, Cat

Nocturnal

Human

Brugia malayi

Brugia timori

Mf
periodicity

Clinical symptoms
Males >> females
The incubation period: 8 to 16 months.
(http://www.icm.tn.gov.in/seminar/filariasis.
htm)
>> infected people have no symptoms

Acute :
episodes attacks of local inflammation
involving the skin, lymph nodes and
lymphatic
lymphangitis retrograde &
lymphadenitis

 Filarial fever
Orchitis, epididimitis, funiculitis ( filariasis
bancrofti)

Chronic
<< of persons will develop lymphedema
>> these symptoms years after being
infected

Filariasis bancrofti Filariasis brugia

lymphatic system of ge Ulcer
nitalia and breast
Never affected
1050% of men suffer
lymphatic system of
genital damage,
genitalia and breast
hydrocele or swelling Elephantiasis of lower
of the scrotum
part of the extremities
Chyluria
Elephantiasis of the
entire leg or arm

Clinical symptoms

Clinical symptoms

Diagnosis
Microscopic examination:
identification of microfilariae in a
blood smear obtained at night (10
pm 2 am)
Specific diagnosis (species)
Serologic enzyme immunoassay tests
: antibody IgG4
DNA probe ( PCR)

Microfilaria

B. malayi
W. bancrofti
B.timori
http://www.dpd.cdc.gov/dpdx/HTML/Frames/A-F/Filariasis/body_Filariasis_mic1.htm

Diagnosis( contd)
ultrasonography : allows visualization of
adult worms
filarial dance sign (W.b)
ICT( Immunochromatographic Tes):
detection of circulating filarial antigen
detect antigens released by adult filarial
worms
may be positive even in
amicrofilaremic individuals (Filariasis
bancrofti)

The left ICT card displays negative results for LF

infection, while the right card displays positive
results

Immuno Chromatographic Test

Diagnosis (contd)
Biopsy :
Lymphatic Filariasis
(diagnosis)

lymphoscintigraphy imaging Of
lymphatic system

Therapy
DEC (Diethyl Carbamazine)
Combination with albendazole
Surgery :
The treatment for hydrocele is surgery (
hydrocelectomy).
lymphedema
lymphedema: patients can be educated
about basic principles of care ( such as
hygiene, exercise, elevation, and treatment
of wounds and infections)

Tropical pulmonary
eosinophilia
Etiology : Filarial worms
typically found in persons living with the
disease in Asia.
Men 20 to 40 years old are most
commonly affected.
Symptoms : cough, shortness of breath,
and wheezing.
Hypereosinophilia is often accompanied by
high levels of IgE and antifilarial
antibodies.

Epidemiology
The Global Goal of Elimination of
Lymphatic Filariasis as a Public Health
problem by The Year 2020
strategy :
(i) to stop the spread of infection
(interrupting transmission); and
(ii) to alleviate the suffering of affected
populations (controlling morbidity).

 Mass drugs administration (MDA) :

6 mg/kg of body weight
diethylcarbamazine citrate (DEC) + 400
mg albendazole;
Once a year for at least 5 years
coverage of at least 65% of the total atrisk population:

Source: http://www.wpro.who.int/southpacific/pacelf/about/en/

Prevention
Protecting oneself from being bitten by a
mosquito:
sleeping in a bed-net or screened
bedroom
Insecticide spraying
using mosquito repellent.
Controlling and reducing mosquito
populations