FILARIASIS

BLOOD AND LYMPHATIC SYSTEM

ISNA INDRAWATI
Department of Microbiology-Parasitology

FILARIA
Tissue nematodes (round worms)
Family Filarioidea
Adult worms live in the lymphatic,
subcutaneous tissue & body cavities
Transmitted by infected biting arthropods
during a blood meal.

Morphology
Adult worms : whitish and thread like
Female : viviparous
microfilaria
Microfilaria : sheated/ unsheated

Periodicity of microfilaria:
the circadian rhythm observed in the
appearance of filarial microfilaria in the
peripheral blood.
Nocturna,
diurna
sub periodic

 Basis of mf periodicity : >> unknown

Influenced by :
Circadian rhythm of the host
p O2 and N2 in the blood
Strain of parasite
Feeding habit of the vectors

NEMATODE
Wuchereria bancrofti

lymphatic

Brugia malayi
Brugia timori

FILARIA
Loa-loa
non-lymphatic
(sub cutaneous)

Onchocerca volvulus
Mansonella

Global distribution of lymphatic filariasis and

onchocerciasis.
(Adapted from WHO, http://who.int/tdr/)

Source : www.neb.com

Life cycle

Infected stage

LYMPHATIC FILARIASIS

Prevalence (WHO, 2015)

120 million people are infected with
lymphatic filariasis;
25 million men have genital disease ( >>>
hydrocele)
15 million,(>> women), have lmphoedema or
elephantiasis of the leg.
66% of those at risk of infection live in the
WHO South-East Asia and 33% in the African
Region.

Geographic distribution

W.bancrofti : 90 % of the cases

B. malayi : most of the remainder cases
B. timori : also causes diseases

Morphology
Adult worms : minute and thread like; whitish,
smooth cuticula
: 40 mm x 0,1 mm, posterior end curved
sharply
: 80-100mm x 0.2- 0.3 mm

Species
Wuchereria
bancrofti

Type/varians

Mf periodicity

Urban type

Nocturnal

Human

Rural type

Nocturnal

Human

antropophilic

Nocturnal

Human

zoophilic

Subperiodic
Nocturnal

Human,
Monkey, Cat

Nocturnal

Human

Brugia malayi

Brugia timori

Definitive
host

Clinical symptoms
Males >> females
The incubation period: 8 to 16 months.
(http://www.icm.tn.gov.in/seminar/filariasis.h
tm)
>> infected people have no symptoms

Acute :
episodes attacks of local inflammation
involving the skin, lymph nodes and lymphatic
lymphangitis retrograde & lymphadenitis

 Filarial fever
Orchitis, epididimitis, funiculitis ( filariasis
bancrofti)

Chronic
<< of persons will develop lymphedema
>> these symptoms years after being
infected

Filariasis bancrofti Filariasis brugia

lymphatic system of
genitalia and breast
1050% of men suffer
genital damage,
hydrocele or swelling of
the scrotum
Chyluria
Elephantiasis of the
entire leg or arm

Ulcer
Never affected
lymphatic system of
genitalia and breast
Elephantiasis of lower
part of the extremities

Clinical symptoms

Clinical symptoms

Diagnosis
Microscopic examination:
identification of microfilariae in a
blood smear obtained at night (10 pm
2 am)
Specific diagnosis (species)
Serologic enzyme immunoassay tests :
antibody IgG4
DNA probe ( PCR)

Microfilaria

B. malayi

W. bancrofti
B.timori

http://www.dpd.cdc.gov/dpdx/HTML/Frames/A-F/Filariasis/body_Filariasis_mic1.htm

Diagnosis( contd)
ultrasonography : allows visualization of adult
worms
filarial dance sign (W.b)
ICT( Immunochromatographic Tes): detection
of circulating filarial antigen detect antigens
released by adult filarial worms
may
be positive even in amicrofilaremic individuals
(Filariasis bancrofti)

The left ICT card displays negative results for LF infection, while the
right card displays positive results

Immuno Chromatographic Test

Diagnosis (contd)
Biopsy :
Lymphatic Filariasis
(diagnosis)

lymphoscintigraphy imaging Of lymphatic

system

Therapy
DEC (Diethyl Carbamazine)
Combination with albendazole
Surgery :
The treatment for hydrocele is surgery
(hydrocelectomy).
lymphedema
lymphedema: patients can be educated about
basic principles of care ( such as hygiene,
exercise, elevation, and treatment of wounds
and infections)

Tropical pulmonary
eosinophilia
Etiology : Filarial worms
typically found in persons living with the
disease in Asia.
Men 20 to 40 years old are most commonly
affected.
Symptoms : cough, shortness of breath, and
wheezing.
Hypereosinophilia is often accompanied by
high levels of IgE and antifilarial antibodies.

Epidemiology
The Global Goal of Elimination of Lymphatic
Filariasis as a Public Health problem by The
Year 2020
strategy :
(i) to stop the spread of infection
(interrupting transmission); and
(ii) to alleviate the suffering of affected
populations (controlling morbidity).

 Mass drugs administration (MDA) :

6 mg/kg of body weight diethylcarbamazine
citrate (DEC) + 400 mg albendazole;
Once a year for at least 5 years
coverage of at least 65% of the total at-risk
population:

Source: http://www.wpro.who.int/southpacific/pacelf/about/en/

Prevention
Protecting oneself from being bitten by a
mosquito:
sleeping in a bed-net or screened bedroom
Insecticide spraying
using mosquito repellent.
Controlling and reducing mosquito
populations