Filarial Worms

Rumala Morel Dept. of Parasitology Peradeniya

Y2S2

Teaching Learning Objectives: Name the major tissue nematodes of humans indicating their location in the human body. List the major characteristics of the filarial parasites of humans indicating those found in Sri Lanka Name the vectors of those parasites found in Sri Lanka Outline the life cycle of a typical filarial parasite Describe the life cycle of Wuchereria bancrofti Describe the phenomenon Periodicity of microfilaria
State the stages that cause pathogenic effects Identify stages of diagnostic importance Outline laboratory methods of visualization/identification of parasites/products

Identify points in the life cycle where preventive measures

are applicable

FILARIAL WORMS: Filariasis

tissue nematodes
adults thread like; female embryos (early first stage larvae)
microfilariae (mf)

transmitted by insect vectors

adults in different habitats in body mf in blood/ subcutaneous tissue

Human filarial parasites grouped according to HABITAT of the ADULT WORM in man

Lymphatic filariae
Subcutaneous filariae filarial infections of the body cavities
& associated tissue

LIFE CYCLE

MAN 2 moults Adults Infective larva-L3

INSECT VECTOR 2-moults NO multiplication

mf in blood /
subcutaneous tissue

Microfilaria- periodicity In some species mf in peripheral blood only during certain times during 24 h period.

Non periodic
- nocturnally - diurnally Sub periodic- mf present at all times but peak nocturnally or during daytime Periodic

Periodicity of microfilaria physiological adaptation to biting habits of vector

Diurnally periodic Mf bld

patency

Non periodic Sub periodic

6h

12h

Nocturnally periodic 24h 2h 6h

LYMPHATIC FILARIAE
mosquito borne adults in lymphatics / mf in blood Wuchereria bancrofti-widespread tropics Brugia malayi- SE Asia, India Brugia timori- Timor island,
other islands nearby

Lymphoedema

Hydrocoele

Distribution of lymphatic filariae

Sub periodic W. b

Filarial infections of Man in Sri Lanka Bancroftian filariasis- W bancrofti (nocturnally periodic) Dog filarial worm Dirofilaria repens- zoonosis in Sri Lanka

Wuchereria bancrofti (nocturnally periodic)

High prevalence in hot,humid, tropics. associated with poor urbanization Vector-common urban mosquito Culex quinquefasciatus

In E Africavector rural-Anopheles gambiae Pacific islandsdiurnally sub periodic vector day biting -Aedes spp

life span 7-16 yrs

Larva developing in the mosquito thoracic muscle

Infective larvae L3 emerging from proboscis of mosquito

Adults of Wuchereria bancrofti are long and threadlike. MALES (left) measure up to 40 mm long and FEMALES (right) are 80-100 mm long.

Wuchereria bancrofti -mf

Brugia malayi

head space

tail nuclei

300 x10 m Lie- graceful curves head space- short nuclei- countable,

260 m kinked (acute angles) long overlapping,tail nuclei+

Laboratory Diagnosis of Filariasis:

Direct Detection of mf in blood Thick film- 10pm-2 am (20-60l) wet mount/ stain Giemsa ConcentrationKnotts method-1ml blood +2% formalin, centrifuge, examine deposit for mf Membrane filtration- pore size 5m Detection of adults in biopsy- rare

Indirect Detection of Filarial Specific Ab Detection of Circulating Filarial Ag.

INDIRECT TESTS
A). Detection of filarial antibodies in serum
Indirect immunofluorescent test- IFA/FAT Antigen used - microfilariae of W bancrofti sections of adult worms (cattle filariae) ELISA (enzyme linked immunosorbent assay)

Disadvantage: Ab long lasting

B). Detection of Circulating Filarial Ag
Antigen detection ELISA Immunochromatographic [ICT] Card Test

Antigen detection strip (card) tests- RDTs

polyclonal Ab + colloidal gold Sample origin (whole blood serum/plasma) Mab W bancrofti absorbent pad

T
test

C
control

RDT = Rapid Detection Tests = Immunochromatographic Card Test

Immunochromatographic Card Test

Ag detection ELISA plate

ICT card test

Immunochromatographic card testdetects specific circulating W bancrofti Ag in serum/whole blood using monoclonal Ab IgG4

simple, no equipment required

quick results <15 min no need for night blood 100% sensitive in mf +s Not quantitative (+/-) But disease severity not dependant on mf density
Disadvantage: High cost > Rs. 1600/test

Filariasis in Sri Lanka1937-39: Brugia malayi predominant 1947: Anti Filariasis Campaign 1960s: Brugian filariasis eradicated
control of larval breeding residual action of DDT on adults treatment with DEC

Bancroftian filariasis is the ONLY lymphatic filariasis in SL now

LF is endemic in eight of the 25 districts.

Confined to urbanized coastal belt: 9.5 million (50%) population exposed

inland foci: Gampaha, Warakapola Veyangoda

Global Elimination of Lymphatic Filariasis

Global Programme to Eliminate Lymphatic Filariasis WHO 1998 Global Alliance to Eliminate Lymphatic Filariasis - 2000 public-private partnership WHO, national Ministries of Health, Private drug companies donating albendazole & ivermectin (Mectizan) NGOs 1 billion at risk population > 120 million people are already infected > 40 million incapacitated or disfigured

Bancroftian filariasis control in Sri Lanka

vector control:
prevent mosquito breeding clear drains, cess pits, sealing of septic tanks larviciding with insecticides, larvivorous fish

Selective treatment of mf + cases

with 2-week DEC (6 mg/kg)

Mass chemotherapy- eradication of parasite by

killing mf and disrupting transmission- continued for 4-5 years

Morbidity control clinics disability management

training

Culex quinquefasciatus breeding sites

Dirty water in blocked drains, cess pits etc.

Brugia malayi - Confined to Asia

Not detected in Sri Lanka since 1962
Adults in lymphatics of lower limbs, groin. Rare in genitalia. Mf sheathed, characteristic morphology Pre patent period- 1-3 months

Ba malayi- nocturnally periodic Vector: Mansonia species d

u
Female mosquito of Mansonia spp lays eggs on the under surface of leaves of water plants eg. Pistia, Salvinia, Eichonia

Sub periodic form - SE Asia-zoonoses (monkeys,dogs & cats)

Subcutaneous filariasis of humans

different fly vectors mf in blood / subcutaneous tissue biting habits of vector Onchocerca volvulus- Onchocerciasis Major public health problem - tropical Africa vector- black flies, mf subcutaneous Loa loa- Tabanids, mf in blood

Body cavities: Mansonella spp- culicoides, mf in blood

Dirofilaria repens - Dirofilariasis

Zoonotic filariasis in Sri Lanka a common subcutaneous filarial infection of dogs in Sri Lanka Transmitted by several species of mosquitoes Aedes, Armigeres & Mansonia spp. Human disease common Causes subcutaneous nodules due to granulomatous reaction to adult worm but not known to produce microfilariae in humans

D.repens adult

100x

200x

Cross-sections of Dirofilaria sp. from a subcutaneous nodule stained with hematoxylin and eosin (H&E).

Onchocerciasis = River Blindness

fast flowing rivers

River Volta-W Africa

Simulium (black fly)

mff causes eye lesions:

blindness

In skin: itching, depigmentation

loss of elasticity

Adults cause subcutaneous nodules

Loa loa- loasis

Adults in subcutaneous tissue Mf in blood- diurnally periodic transmitted by blood sucking day-biting flies Vectors: Tabanid flies

Confined to Tropical Africa where vectors are found

Mf in blood

Transient swellings-days

Adult worm under the conjunctiva- 10 mm

Tabanid fly adult worm under the conjunctiva

Filarial worms
Lymphatic filariae

- Wucheraria bancrofti [SRI LANKA]

Brugia malayi Subcutaneous filariae Onchocerca volvulus [River blindness] Loa loa Dirofilaria repens [ZOONOSIS in SRI LANKA] filarial infections of the body cavities & associated tissue