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Sitti Wahyuni, MD, PhD wahyunim@indosat.net.id Department of Parasitology Medical Faculty Hasanuddin University
6/18/2012
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Lymphatic Filariasis
a vector born disease of lymphatic system caused by: Wuchereria bancrofti Brugia malayi Brugia timori not lethal but can be seriously y debilitating g causing an economic burden on infected individuals
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Clinical manifestation
It is i an old ld disease. di
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Epidemiology
affect 120 million people over 80 tropics & subtropics countries 44 million have visible signs of disease 76 million have preclinical infection WHO has considered as one of the six potentially eradicable diseases WHO: global elimination of filariasis by 2020
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Prevalence in Indonesia
extensive surveys since 1970: prev. prev 0-70% Health Minister & UI (1983): mf prev. has declined to 0 0-19,6% 19 6% WHO (2000) stated: - endemic in 22 of 27 provinces -150 150 million people at risk of infection - the highest prev. in South East Asia
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Adult
creamy creamy-white,
minute, thread like nematodes with smoth cuticula tapering toward both end,& terminations are bluntly rounded head: slighty swollen, surmounted by 2 rings of small papillas , no buccal Mouth: unarmed, vestibule
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Adult
Live in lymph nodes Can stay alive for 15 years Vivipar & produce microfilaria Causes clinical manifestation (febrile, extremitas oedema, hidrochele & elephanthiasis Can only be seen if it circulate in hidrocele/incision of lymph y p nodes
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Thick blood smears stained with Giemsa can not demonstrate the sheath
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Microfilaria B Brugia i
Shape: more tightly coiled nuclear l column: l more tightly packed, individual nuclei can not be visualize Sheath: slightly stained with hematoxylin. y
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Microfilaria B Brugia i
Host
Definitive: -humans: humans: W. W bancrofti and B. B timori -human & animals: B. malayi Intermediate: masquitos q - urban W.bancrofti: Culex quenquefasciatus - rural W.bancrofti: A. farauti & A. punctulatis - nocturnally B. malayi (Sulawesi): Anopheles barbirostris - sub-periodic sub periodic B.malayi B malayi (Sumatra & Kalimantan): Mansonia spp. - nocturnal B timori : A. barbirostris
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Breeding site
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Breeding site
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Acute l lymphangitis/lymphadenitis h i i /l h d ii
Often occur in chronic patients Caused C db by d dying i or d degenerating ti adult d lt worms Bacterial or fungal superinfections in limbs with compromised lymphatic dysfunction play a significant role
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Chronic obstructive
Bancroftion filariasis -main clinical manifestation: hydrocele
can be accompanied by lymphoedema -can (elephantiasis) of the whole arm/leg enlargement of vulve/breast -enlargement
Diagnosis
Detection of microfilariae A ti Antigen detection d t ti assays Molecular Diagnosis USG detection of adult worms Antibody assays
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Detection of microfilariae
Classic diagnosis of lymphatic Still the golden standard The time accord to the periodicity Two methods: finger prick & whole blood filtration
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Molecular Diagnosis g
Characterization of filaria species-specific DNA using PCR-based assays primers for both W.bancrofti & B malayi y have been designed successfully Positive only in the presence of circulating mf Problem for diagnosis of cryptic infections PCR is an expensive assay Requires well-equipped laboratories & personnel 6/18/2012 S. Wahyuni, Parasitology Dept, Medical Faculty, Unhas 29
Antibody y assays y
Anti-filarial lgG4 : have high specificity & sensitivity iti it Anti-filarial lgG4 correlate strongly with the presence of mf Can discriminate active from p past infection
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Management
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Dosage g of DEC
Standard : 12-14 day y course of 6 mg/kg g g BW Meta-analysis of studies : a single dose/a year for several years equivalently reduce mf f levels l l New opplications : mass administration of DEC fortified salt Combination therapy ivermectin /albendozole can give 10% better results results. Have a long-term effects
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