THE FILARIAE

Tissue Nematodes comprises 8 species of filariae:

1. Wuchereriria bancrofti
2 Brugia malayi
3. Brugia timori
4. Onchocerca volvulus
5. Loa Loa
6. Mansonella perstans
7. Mansonella streptocerca Life Cycle :
8. Mansonella ozzardi
9. Dracunculus medinensis = not a filarial worm but
morphologically similar

Characteristic features:
(1) the adults live in the tissues
(2) female worms give birth to larvae known as microfilariae
that circulate in the blood and lymph or are present in tissues
(3) transmission requires the ingestion of the microfilariae by
a bloodsucking arthropod, which in turn, transmits the
infection to another human Epidemiology :
= widely distributed in the tropics & subtropics
Wuchereria bancrofti = 2 types of filarial infection in the Phil.
Syn : Filaria Bancrofti A) urban type most prevalent in abaca raising areas
Disease : Bancroftian Filariasis mosquito vector – Aedes poecilus
Adult Worm B) rural type occurs away from houses towards mountain and
= long, hair-like & transparent w/ smooth cuticle hill
= filiform shape w/ both ends tapering but terminate Mosquito vector – anopheles minimus
bluntly rounded = both are night biter but may also bite during the day and
= head slightly swollen w/ 2 rings of small sessile breeds in clear running mountain stream Endemic Provinces
papillae ( Phil ) Camarines Norte & Sur Albay, Sorsogon, Quezon,
= mouth unarmed Mindoro, Masbate, Romblon, Bohol, Leyte and Samar. All
provinces of Mindoro, Mountain Province ( Bontoc ) Sulu &
Palawan
= Anopheles minimus & Flavirostris are vectors in Mt.
Province, Sulu & Palawan
= Aedes Poecilus in the rest of provinces

Pathology :
= pathology prod. by parasite is centered in lymph vessel
& lymph glands
= inflammation, edema & fibrosis gives rise as a result of
obstruction of lymph flow resulting to lymphangitis, edema&
chyluria
Male = measures 40 mm. L X 0.1 mm. in diameter = clinical manif. includes: hydrocoele, chylocoele,
= copulatory spicule distinctly unequal & dissimilar elephantiasis of scrotum & vulva
= gobernaculum cresent – shaped
= caudal end curved & sharply ventrad
Female = measures 8-100 mm. X 0.24 – 0.3 mm.
= vulva cervical in position
= post. end narrow & abruptly pointed
Microfilaria
= elongate, bluntly rounded anteriorly & pointed
caudally
= hyaline sheath extends beyond the ant. & post end
of the embryo
= single stylet at the ant. end
= cephalic space is long & broad & devoid of
granules or nuclei
= central column of nuclei discrete & do not extend
down to the tip of the tail
= has graceful sweeping curve
Dx: 1) Blood smear (peripheral smear at night time 8:00
PM. to 4:00 AM.) because of nocturnal periodicity
= peak hours 10:00 PM. to 2:00 AM
2) Biopsy of material important for confirmatory
diagnosis

Rx: 1. Diethyl carbamazine ( Hetrazan )-2mg/kg TID X 2-4wks

2. Surgical procedures
3. Corticosteroids
Prevention and Control :
1) All abaca workers should wear long sleeve-shirt
2) Use of mosquito net Epidemiology :
3) Insect repellant 1) Endemic provinces ( Phil.) Palawan, Sulu, Agusan, Eastern
4) Spray house w/ insecticide Samar
2) Mosquito vector are night biter (Nocturnal periodicity) bites
Brugia Malayi usually start 5:00 PM – 11:00 PM.
Disease : Malayan Filariasis 3) Cat is an important reservoir host and may transmit the
Geog. Distribution : Southeast Asia includes the Phil. worm to man by means of Cat – Mosquito cycle
Morphology : Dx: = Blood smear ( appearance of sheathed filaria is
Adult worm both male & female resembles that of W. nocturnal or maybe taken also) during daytime
Bancrofti Treatment : The same with
Male = measures 23 mm. x 0.09 mm. in diameter Prevention & Control : W. Bancrofti
Female = measures 55 mm. x 0.16 mm. in diameter
Brugia Timori
= 1st reported from island of Timor in 1964
= island of lesser Punda group in Indonesia
= closely resembles bancroftian filariasis
= high rate of abscess formation
= predominance of elephantiasis of the legs
Microfilariae

= longer than B. malayi (ave. 310um)

= cephalic space has a length-width ratio of 3:1
compared to B. malayi 2:1
Microfilaria:
= sheath does not stain with Giemsa stain
= measures 170-260 u
= exhibit a nocturnal periodicity
= smaller than W. bancrofti
= vector: Anopheles barbirostris
= sheathed
= humans: only definitive host
= appears knob-like
= double stylets found at anterior end
= cephalic space longer than broad
= 2 discrete nuclei at the tail end portion

Life Cycle :
= similar with W. Bancrofti except for the species of
mosquitoes as its intermediate host (mansonia bonnae &
mansonia uniformis)
↓ ↓
found fresh H2O found in ricefield swamps

Pathogenesis and Pathology :

= pathological changes similar w/ Bancrofti filariasis
= it has been observed that malayan filariasis affect
the lower extremities with lymphatic obstruction more
frequent than in W. Bancrofti.
Symptomatology :
= similar w/ W. Bancrofti
 Dx:
= Surgical exploration of the swelling for presence of
worm
= Blood smear (recover microfilaria in the blood)
Treatment: = Serological test
= DEC = used for mass treatment
= 5mg/kg/yr. for 10 days Onchocerca volvulus
= In adenolymphangitis = additional course of DEC ( convoluted filaria )
= 300mg daily for 20 days Disease : Onchocerciasis / River Blindness / Blinding filariasis /
(150mg daily for children younger than 10 years) Divers Blindness
In ELISA: drop in filarial antigen level Geog. Distribution :
Side effects: headache, generalized body malaise, = Endemic Central & South America & Africa
chills, dizziness, anorexia→ peak on 2nd day → proven Morphology :
effective Adult worm
♦ Weekly administration of DEC at Low dosage →proven = threadlike or wire-like white, opalescent
effective over 18 months transparent
= children <10 year old = 25mg = measures 19-42 mm. x 130-210 u
>10 year old = 50mg = both ends blunt
= swelling disappears within 1 year = cuticula possess distinct transverse striation
= elephantiasis clears up 2-4 years = habitat – subcutaneous connective tissue as a
tumor-like lesion
♦ Elephantiasis involving 1 extremity or affecting an
Male = measures 19-42 x 130-210 u
arm rather than a leg proved easier to treat = provided w/ perianal & caudal papillae
♦ It proved that Timoran filariasis responds better to =post. end tightly recurved ventrad
therapy than the other lymphatic filariasis Female = measures 33.5-50 cm. in length x 270-400 u in
width
Loa – Loa = vulva opens slightly behind the post end of
Syn : Eye worm esophagus
Disease : Loasis / Calabar Swelling / Fugitive Swelling Microfilaria:
Geog. Distribution : = measures 150-368 u X 5-9 u in diameter
= West & Central Africa esp. Nigeria, Cameroon = unsheathed w/ tail end pointed & nuclei free
and Zaire = ant end bluntly rounded & enlarged
Morphology : = post end narrow
Adult worm = threadlike cylindrical = no stylets seen at ant. end
= cephalic end provided w/ papillae
= body had cuticular bosses
Male = measures 32 mm. in length x 0.3-0.4 mm. in
diameter
Female = measures 50-70 mm. X 0.5 mm. in diameter
Microfilaria = measures 250-300 u X 6-8 u in diameter
= sheathed
= nuclei of the body are extended to
the tip
Life Cycle :
Life Cycle :
= similar w/ W. Bancrofti
= similar w/ that of W. Bancrofti
= arthropod vector: genus simulium (black fly) which
= intermediate host are day-biting (diurnal
breeds in river & stream
periodicity) flies of the genus chrysop (C. dimidiata & C.
= microfilaria in subcutaneous tumors migrate to
silacea)
other site but do not enter to the bloodstream
Pathology & Symptomatology:
= periodicity (non-periodic) no statistical significance
= transitory inflammation of the subcutaneous tissue
in the appearance of infective stage
usually in the head (swelling may attain a hens egg size) w/c
is tender & painful
Pathology :
= swelling usually disappear w/ in 2-3 days after
= encapsulation & proliferation as a result of migration of
occurrence thus the name fugitive swelling
larva to the other part of body & elaboration of metabolites
there is multiple nodular swelling of subcutaneous tissue (esp.
head, chest &joints) presence of urticarial rashes and
itchiness
= eye lesion may also occur accompanied w/ photophobia or = whenever ulcer of infected person is immersed in H2O →
may progress to complete blindness larva is liberated
= if copepods are swallowed → deep conn. Tissues maturation
(1 year)

Pathology and Symptomatology:

Dx: Skin biopsy (aspirate fluid from nodules) or scraping of the
skin where nodules are found
Rx: Diethyecarbomazine ( Hetrazan )
Antripol 100-200 mg initially then 1 mg. every week
Prednisolone ( as anti-inflammatory drug )
Prevention and Control ( similar w/ Loa-Loa )
= onset of symptoms occurs just previous to the local
eruption of the worm
= early manifestation:- urticaria, erythema, dyspnea,
vomiting, pruritus
= slight to moderate increase in Eosinophils
= if worm is broken during extraction and the larvae escape
into the subcutaneous tissue → severe inflammatory reaction
produced → pain → secondary bacterial infection and abscess
formation & sloughing of the tissues

Dracunculus medinensis
Disease: Dracontiasis, Dracunculosis, Dracunculiasis
= “the guinea worm”
Female: 500-1,200L x 0.9-1.7mm in diameter
Male: 12-29L x 0.4mm
= inhabits the cutaneous and subcutaneous tissues
= attains sexual maturity as early as 10 weeks
= female life span: 12-18 months
Diagnosis:
= made from the local lesion, worm or larvae
= outline of the worm under the skin revealed by
reflected light
= calcified worms may be located by roentgenologic
exam
= discharge of the larvae is stimulated by cooling the
Epidemiology:
ulcerated area
= Middle East Treatment:
= Central India; Pakistan
1) Metronidazole → DOC
= Africa
→ 200mg TID x 7 days
= parasite of dogs and other carnivores in
N. America → anti-inflammatory effect and action
upon the worm
Alternative:
Niridazole 25g/kg p.o. x 7 days
Thiabendazole 25g/kg BID 2 days
2) Surgical removal under anesthesia
Prevention:
1) Avoid bathing and washing in waters
2) Drinking water and wells; springs should be surrounded by
cement curbing
3) Boil drinking water
4) Treating water supplies with chlorine

= worms develop to maturity in the body cavity in deeper

connective tissues
= females migrate to the subcutaneous tissues when they
became gravid
= body of fully gravid female worm is completely filled with
uterus distended with larvae
= papule is produced in the skin where the head of the female
lies just under the dermis → vesicular→ ulcerate → exposure
of worm
= loop of uterus prolapses through the wall of the worm → lie
in ulcer opening → immersed in H2O → larvae discharged
= microfilariae have a well-developed digestive tract and
never found in the blood in tissues of host → discharged
directly into water → ingested by copepods → mature within 2
weeks