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 Aedes
species
 B.malayi is transmitted by
Anopheles and Mansonia species.

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 µm in
length.
Morphology - B.malayi
 B.malayi microfilariae are slightly
smaller than those of W.bancrofti.
 Microfilariae are sheathed, and
about 200 to 275 µm.
 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 at-
risk 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
 Albendazole
 kills adult worms
 Ivermectin
 kills the microfilariae produced by adult worms
…And more drugs!
 The disease is usually treated with single-
dose 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