Lymphatic Filariasis / Elephantiasis

Wuchereria bancrofti & Brugia malayi

What is it?

Wuchereria bancrofti and Brugia malayi are filarial nematodes Spread by several species of night feeding mosquitoes Causes lymphatic filariasis, also known as Elephantiasis

Commonly and incorrectly referred to as Elephantitis

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Definitive Host

Humans are the definitive host for the worms that cause lymphatic filariasis There are no known reservoirs for W.bancrofti. B.malayi has been found in macaques, leaf monkeys, cats and civet cats

Anopheles

Intermediate Host

W.bancrofti is transmitted by Culex, Aedes, and Anopheles species B.malayi is transmitted by Anopheles and Mansonia species.

Aedes

Mansonia

Culex

Geographic Range

Lymphatic filariasis occurs in the tropics of India, Africa, Southern Asia, the Pacific, and Central and South America.

Lymphatic Filariasis by the numbers

Endemic in 83 countries 1.2 billion at risk More than 120 million people infected More than 25 million men suffer from genital symptoms More than 15 million people suffer from lymphoedema or elephantiasis of the leg

Morphology - W.bancrofti

W.bancrofti is a sexually dimorphic species. The adult male worm is long and slender, between four and five centimeters in length, a tenth of a centimeter in diameter, and has a curved tail. The female is six to ten centimeters long, and three times larger in diameter than the male. Microfilariae are sheathed, and approximately 245 to 300 m in length.

Morphology - B.malayi

B.malayi microfilariae are slightly smaller than those of W.bancrofti. Microfilariae are sheathed, and about 200 to 275 m. Not much is known about the adult worms, as they are not often recovered One distinctive feature of B.malayi is that the microfilarial nuclei extends to the tip of the tail

Wuchereria Life Cycle

Symptoms

1. Asymptomatic: patients have hidden damage to the lymphatic system and kidneys. 2. Acute: attacks of filarial fever (pain and inflammation of lymph nodes and ducts, often accompanied by fever, nausea and vomiting) increase with severity of chronic disease. 3. Chronic: may cause elephantiasis and hydrocoele (swelling of the scrotum) in males or enlarged breasts in females.

Diagnosis

The standard method for diagnosing active infection is the identification of microfilariae by microscopic examination However, microfilariae circulate nocturnally, making blood collection an issue A card test for parasite antigens requring only a small amount of blood has been developed

Does not require laboratory equipment Blood drawn by finger stick

Control

As with malaria, the most effective method of controlling the spread of W.bancrofti and B.malayi is to avoid mosquito bites The CDC recommends that anyone in atrisk areas:

Sleep under a bed net Wear long sleeves and trousers Wear insect repellent on exposed skin, especially at night

Vector control

Covering water-storage containers and improving waste-water and solid-waste treatment systems can help by reducing the amount of standing water in which mosquitoes can lay eggs. Killing eggs (oviciding) and killing or disrupting larva (larviciding) in bodies of stagnant water can further reduce mosquito populations.

Treatment

Treatment of filariasis involves two components: Getting rid of the microfilariae in people's blood Maintaining careful hygiene in infected persons to reduce the incidence and severity of secondary (e.g., bacterial) infections.

Drugs, Drugs, Drugs!

Anti-filariasis medicines commonly used include: Diethylcarbamazine (DEC)

reduces microfilariae concentrations kills adult worms kills adult worms

Albendazole

Ivermectin

kills the microfilariae produced by adult worms

And more drugs!

The disease is usually treated with singledose regimens of a combination of two drugs, one targeting microfilariae and one targeting adult worms (i.e.,either diethylcarbamazine and albenadazole, or ivermectin and albendazole In some areas, DEC laced table salt is used as a prophylactic

Treatment 2: Manchester United 0

If a high enough coverage of anti-filariasis drug treatment can be achieved (treating greater than 80% of the people in a community), the disease can be eradicated from an area. Attempts to eliminate the disease are being helped considerably by Merck and Co., which is donating ivermectin to treatment efforts, and Smith Kline Beecham, which is donating albendazole. The Gates Foundation has also donated millions towards eliminating lymphatic filariasis

Elimination programs

Finally

http://youtube.com/watch?v=SkIryQ6Paqg