Non Lymphatic Filaria

Infection
PARASITOLOGY DEPARTMENT
MEDICAL FACULTY
UNIVERSITY OF SYIAH KUALA
 Other Filarial Infection
Sub cutaneous/ cutaneous filariasis:
• Onchocerciasis
• Loasis
• Mansonelliasis (M.ozzardi & M.streptocerca)

Body cavity filariasis:

M. perstan
 Onchocerciasis
• Causative agent: Onchocerca volvulus
• Insect vector: Black flies, Simulium sp.
• Also known as “River blindness” – 5%
infected are blind (2 million)
• Distribution: Tropical Africa, Central
America, spread to Arabian Peninsula.
 Title
• Text
Clinical manifestations
• Pathology: cause by
microfilariae
• Dermatitis
– Reactive form (Sowda):
• single limb,
hyperpigmentation,
pruritus, papules,
lympadenitis
• Yemen
• Few microfilariae
– Non-reactive form:
• Symmetric involvement of
limb/trunk
• Tropical Africa & Latin
America
• Numerous microfilariae
Clinical manifestations
• Hanging groin
– Adenolymphocoele
– Loss of skin elasticity
• Sub-cutaneous nodules
(onchocercomata)
– Firm, movable, non-tender
– Over bony prominences
– Abscess with secondary
bacterial infection.
 Clinical manifestations
• Blindness
– Any part of the eye –
punctate keratitis,
sclerosing keratitis,
chorioretinitis, optic
atrophy.
– Most often in savanna
Africa & Guatemala
– Punctate keratitis is most
common – snowflake
opacities due to inflamatory
reaction to dying
microfilariae
 …continue
• Nakalanga syndrome (dwarfism)
– Associated with onchocerciasis in Uganda
– Short stature, low body weight, absence of
secondary sexual characteristics, skeletal
deformities & mental retardation.
 Clinical manifestations
• Visitors from non endemic areas:-
– Dermatitis most common
– No onchocercomata
– No occular lesion
– Absent or low density microfilaria
– Antibody response to O. volvulus
• Pathology cause by microfilaria
 Diagnosis & Treatment
• Diagnosis
– Histologic examination of
skin snip
– Smear of aspirate from
skin incision
– Slit-lamp examination
– Serological method
– PCR has role in
monitoring chemotherapy
• Treatment
– DEC is contarindicated
– Ivermectin is the drug of
choice
– Single dose of 150ugm/kg
– Microfilaricidal, need to
repeat dose
– nodulectomy
 Loiasis

• Caused by the eye worm of Africa, Loa loa

• Transmitted by mango flies, Chrysops sp.
• Endemic only in rainforest areas of central and west Africa
– Nigeria, Cameroon, Zaire (Congo), Angola, Gabon, Chad
& Sudan
• Mf in peripheral blood shows diurnal periodicity.
• Mf has been shown in primate but has nocturnal
periodicity, probably a different species
 Clinical manifestations
• Result from migration of adult worm in sub-cutaneous
tissue.
• Transient visual & anxiety – migrates across bulbar of the
eye and bridge of the nose.
• Calabar swelling – pathognomonic of the disease
– Migratory swelling
– Painful & itchy
– Redness (erythema) & creeping sensation
– Allergic response & migration of the worm
– Resolve spontaneously
Calabar swelling pada conjunctiva
 Clinical manifestations
– Endemic patient
• Hypo-responsiveness
• 90% positive for Mf
• Lower eosinophilia, parasite-specific IgG & lymphocyte
proliferation
– Non-endemic population
• Hyper-responsiveness
• Low positivity for Mf (10%)
• Higher level of eosinophilia (60-80%), parasite-specific IgG &
lymphocyte proliferation
• More severe & recurrent calabar swelling
 Diagnosis & Treatment
• Diagnosis
– Blood smear for Mf (mid-day sample)
– Biopsy
– Serological test (ELISA, IFA
• Treatment
– Ivermectin
 Mansonelliasis
• Caused by Mansonella ozzardi, M. perstan & M.
streptocerca.
• Transmitted by biting midges (Culicoides) or
blackflies (Simulium)
• M. ozzardi – Central America, central South
America & Caribbean islands
• M. perstan – central Africa & South America
(Panama to Argentina)
• M. streptocerca – confined to Central & West
Africa
 Clinical manifestations
• Majority asymptomatic
• Various allergic manifestations
– Joint paint, pruritus, papules, vertigo
– More serious in non-endemic patients
– Bung-eye (Uganda) nodule in the conjunctive & eyelid
producing proptosis
 Comparison between species
M. Ozzardi M. Perstan M. streptocerca

Insect Vector Culicoides sp. Culicoides sp. Culicoides sp

Simulium sp.
Location of Body cavities Body cavities Skin
adult
Location of Mf Blood, skin Blood Skin

Diagnosis Blood, skin snip Blood Skin snip or

or biopsy biopsy
Treatment Ivermectin Mebendazole DEC
M. streptocerca
 Dracunculiasis
• Caused by Dracunculus medinensis, guinea worm, Medina worm or
fiery serpent.
• It is NOT filarial worm!!!!!!!!!!!
• Endemic in Asia and Africa, affecting 10-40 million
– Asia: India, Turkey, Arabian Peninsula
– Africa: Nile valley, central equatorial Africa, west coast of Africa
• Transmitted by copepods (Cyclops sp.)
• Female worm measures 70-120 cm, usually in the limbs, releasing free
living larvae in the water.
• Cyclops ingest the larvae & taken up by human during drinking of un-
boiled water.
 MORPHOLOGICAL DIFFERENCES OF NON-
LYMPHATIC MICROFILARIAE (GIEMSA
STAIN)
Specimen: Blood smear Specimen: Skin snip

L. loa M. M. ozzardi O. M.
perstan volvulus streptocerca
Sheath +ve -ve -ve -ve -ve
(unstained)
Cephalic 1:1 1:1 1:2 1:2 1:1
space
Body nuclei overlap overlap Overlap Discrete Discrete

Terminal Absent Absent Absent Absent Absent

nuclei
Tail Tapered Blunt Slender & Tapered Tapered &
pointed & flexed coiled
Clinical, Diagnosis & Treatment
• Clinical
– Allergic manifestation due to female worms
– Erythema, generalised urticaria, giddiness, fainting, asthma like
attack, vomiting and diarrhoea
– Local lesion of blister which rupture upon contact with water
– Palpable, tortuous tract of the worm
• Diagnosis
– Blister with the worm extruding
• Treatment
– Manual removal of the worm