FILARIAL WORMS

White, slender roundworms

Three types: Wuchereria bancrofti,
Brugia malayi, Brugia timori
Live for 5-7 years, produce
millions of offspring
Block the lymphatic system
Network of channels and lymph
nodes that help maintain fluid levels
in the body
Blockage leads to edema (collection
of fluid in tissues)
Adult worms: sexes are separate.
Female worms are long and males are short.
Females are ovo-viviparous- lays eggs containing
embryos(microfilaria).
Microfilaria: have colourless sheath within which the
microfilaria moves with characteristic motility.
Present in peripheral blood.
Contain many nuclei.
Route of entry: Skin penetration of the infective larvae
deposited by the mosquito.
Infection then occurs in lymphatic system and lymph
nodes.
Infective stage is the microfilariae after development in
the mosquito.
Microfilaria in peripheral blood of humans is not
infective to another even if a blood transfusion occurs.
Life cycle: Definitive host – humans
Intermediate host – mosquitoes
Adult worm live in the lymph nodes and lymphatic
system of humans.
Microfilaria are released by gravid female which
circulates in the peripheral bloodstream. Seen in large
numbers at night.
Mosquito during blood meal may also take up these
microfilaria – which undergo development in the
mosquito. Mosquito then becomes infective.
Pathogenesis:
Classical filariasis(Lymphatic Filariasis) : caused by
the adult worm causing block in the lymphatic
channels. Also known as elephantiasis – due to massive
enlargement of part of the body effected. It is a
disfiguring and disabling disease, which is generally
 aquired in childhood. In the early stages,though there
are either no symptoms or non-specific symptoms, the
lymphatic system is damaged.
This stage can last for several years. Infected persons
sustain the transmission of the disease. The long term
physical consequences are painful swollen limbs
(lymphoedema or elephantiasis).
Occult filariasis: called occult(hidden) – as
microfilaria are not present in the peripheral blood.
Primarily due to hypersensitivity reaction to the
microfilarial antigens.
Patient has esinophilia, enlarged spleen and
lymphnodes.
No enlargement of body parts.
Lab diagnosis
Direct: Demonstration of agent: Larval stage in
peripheral blood. Adult stage in lymph nodes.
Indirect: 1. Demonstration of the presence of
antibodies by serological tests by ELISA, IHA, IFA.
These are used to diagnose occult filariasis.
2. Eosinophilia: due to allergic reactions caused by
parasite.
Treatment
The recommended regimen for treatment of filariasis
is   a single dose of two medicines are given together -
albendazole with  either ivermectin or
diethylcarbamazine citrate