FILARIASIS

Dr. Saida Sharmin

MBBS, MPH (Epidemiology)
FILARIASIS
Lymphatic filariasis considered globally as a
neglected tropical disease.
Lymphatic filariasis commonly known as
elephantiasis, is caused by thread-like
parasitic worms that live in the human
lymphatic system and lay the grounds of
grotesque swelling of the scrotum, male
genitalia, breast and limb.
 FILARIASIS

Lymphatic filariasis :
Infection with 3 nematode worm.
 W.bancrofti

 B.malayi

 B.timori

Manifestation : Acute and chronic.

Lymphigitis, lymphadenitis, elephantiasis of
legs and arms, and tropical eosinophilia.
FILARIASIS
FILARIASIS
EPIDEMIOLOGICAL DETERMINANTS
Agent factors
There are at least 8 species of filarial parasites
that are specific to man. They are Wuchereria
bancrofti, Brugia malayi, B.timori
Onchocerca volvulus, Loa loa, T. perstans,
T. streptocerca, Mansonella ozzardi. Out of
these, the first 3 cause lymphatic filariasis.
Periodicity : Nocturnal periodicity.
HOST
Wucheria Bancrofti completes its life cycle in
two hosts :

Definitive host = Man

Intermediate host = Female mosquito
(mostly Culex , sometimes Aedes and
Anopheles )
DEFINITIVE HOST
Human are the definitive host for the worms
that cause lymphatic filariasis There are no
known reservoirs for W.bancrofti.
Intermediate Host

W.bancrofti is transmitted by Culex .

B.malayi and B.Timori is transmitted by
Anopheles and Mansonia species.
WUCHERERIA LIFE CYCLE
 HOST FACTORS
• Man is natural host.
• All age are susceptible to infection.
• Filarial disease appears in a small
percentage of infected individuals.
• Mf(microfilaria) is higher in men.
• Migration of people helps in spread of
disease in non endemic area.
 HOST FACTORS
• Man develop immunity after years of
infection.
• Lymphatic fileriasis is associated with
urbanization, industrialisation ,poverty
and poor sanitation.
Environmental factors: Lymphatic filariasis
is associated with bad drainage. vector breed
profusely in polluted water.
MODE OF TRANSMISSION

Filariasis is transmitted by the bite of

infected vector mosquitoes. The dynamics
of transmission depends upon the man-
mosquito contact(e.g. Infective biting
rate).
INCUBATION PERIOD

Pre patent period: Interval between

inoculation of infective larvae and the first
appearance of detectable mf(microfilaria).
Clinical incubation period:
Time interval from invasion of infective
larvae to the development of clinical
manifestation. It is about 8-16 months.
 CLINICAL MANIFESTATIONS
They are of 2 types:
a) Lymphatic Filariasis
b) Occult Filariasis
Lymphatic Filariasis:
Caused by the parasite in the lymphatic system.
Occult Filariasis
Due to immune hyper responsiveness of the
human host.
 CLINICAL MANIFESTATIONS

Lymphatic filariasis has following stages

1. Asymptomatic amicrofilaraemia:
Exposed people in endemic area do not
show Mf(microfilaria) or clinical
manifestation of disease although they
have same degree of exposure to infected
larvae as those who become infected.
Cont....

2. Asymptomatic microfilaraemia:
Blood is positive for Mf(microfilaria), but
no symptoms. They are an important
source of infection in the community,
these carriers are usually detected by night
blood examination.
Cont....
3. Stage of acute manifestation:
Recurrent episode of acute inflammation in
lymph gland and vessels. Manifested as
filarial fever, lymphangitis , lymphadenitis,
lymphoedema and epididymoorchitis..
Cont....

4. Stage of chronic obstructive lesion:

Develops 10- 15 years from the onset of
the 1st acute attack. Due to fibrosis and
obstruction of lymphatic vessel,
causing permanent structural change.
Hydrocele, elephantiasis and chyluria.
Cont....
Occult Filariasis :
The term Occult Filariasis refers to a
condition which is caused by a
hypersensitivity reaction to microfilaria
antigens and is characterized by massive
eosinophilia (30-80%) hepatosplenomegaly
and absence of Microfilaraemia.
Cont....
Adult female produces microfilaria in
lymph node but they do not reach
peripheral blood as they are destroyed in
the tissues.
Cont....
Tropical Pulmonary Eosinophilia (TPE):
This is a manifestation of occult filariasis
and is characterized by low grade fever ,loss
of weight, paroxysmal cough with scanty
sputum(may be blood-tinged) and
splenomegaly.
 CONTROL MEASURE

Two pillar of filariasis elimination or

control measure:
The current strategy is based on
1. Chemotherapy
2. Vector control
Chemotherapy :
a) Diethylcarbamazine
b) Filaria control in the community
 CONTROL MEASURE

a) Diethylcarbamazine : 6mg/kg body

wt/day orally for 12 days given in divided
does after meal . Effective in killing
Mf(microfilaria).
b) Filaria control in the community:
Three reason why filariasis never causes
explosive epidemic.
 CONTROL MEASURE

i. Parasite does not multiply in the insect

vectors.
ii. Infective larvae do not multiply in the
human host.
iii. Life cycle of the parasite is relatively long,
15 years or more.
 CONTROL MEASURE

The administration of DEC can be carried

out in various ways
1. Mass therapy: DEC is given to everyone
in the community irrespective of whether
they have microfilaraemia, disease
manifestation or no signs of infection;
except children under 2years, pregnant
women and seriously ill patients.
 CONTROL MEASURE
2. Selective treatment:
DEC given only to those who are
Mf(microfilaria) positive. More suitable in
low endemicity areas .
Dose: 6mg DEC per kg body weight daily
for 12 doses.
In endemic areas, it should be repeated
every 2 years.
CONTROL MEASURE
3. DEC-medicated salt:
Use of DEC medicated salt is a very special
from of mass treatment using very low
doses of drug over a long period of time.
Common salt medicated with 1-4gm of
DEC/kg has been used for filaria control in
endemic areas. Rx(treatment)should be
continue for at least 6-9 month.
IVERMECTIN

It is a semi-synthetic macrolide antibiotic

with broad spectrum activity against
nematodes and ectoparasites.
Single oral does 20-400mg/kg body wt were
effective in completely clearing blood
microfilaria in all treated cases within
weeks, but by 3 month microfilaria
recurrent in most patient.
VECTOR CONTROL

Where mass treatment with DEC is

impracticable, the control of filariasis must
depend upon vector control. Vector control
is beneficial when used in conjunction with
mass treatment. The most important step is
to reduce the target mosquito population to
stop or reduce the transmission.
VECTOR CONTROL

It consists of:
i. Anti-larval measures
ii. Anti-adult measures
iii. Personal prophylaxis
VECTOR CONTROL

i. Anti-larval measure
It consists of
a. Chemical control
1. Mosquito larvicidal oil
2. Pyrosene oil-E
3. Organophosporous larvicide.
 VECTOR CONTROL

b. Removal of Pistia plant

- To control breeding of Mansonia
mosquitoes
c. Minor environmental measures
It includes:
• Drainage of stagnant water
• Adequate maintenance of septic tanks
 VECTOR CONTROL

ii. Anti-adult measures

 Previously, DDT, HCH & dieldrin was
used. But, it has been discontinued.
 Pyrethrum is now used as a space spray.
iii. Personal prophylaxis
• Avoidance of mosquito bites by using
mosquito nets.
• Repellents
QUESTIONS
 Name the vector and parasites of
Filaria?
 What is elephantiasis?
 Mention the control measures of
filaria.
 Filariasis is prevalent in northern parts
of Bangladesh – justify.