Documente Academic
Documente Profesional
Documente Cultură
Lymphatic
filariasis,
also
known
as
elephantiasis, is causedby parasitic worms of the
Filarioidea type. Many cases of thedisease have no
symptoms. Some however, develop largeamounts of
swelling of the arms, legs, or genitals. The skinmay also
become thicker, and pain may occur. The changesto the
body can cause social and economic problems for
theaffected person.
The worms are spread by the bites of infected mosquitos.
Infections usuallyThere arethree types of worms that
cause the disease: Wuchereria bancrofti, Brugia
malayi,and Brugia timori. Wuchereriabancrofti is the most
common. The disease is diagnosed bylooking, under a
microscope, at blood collected during the night. The
blood should be in the form of a thick smear and stained
with Giemsa . Testing the blood for antibodies against the
diseasemay also be used.
HISTORY
Lymphatic filariasis is thought to have affected humans
for about 4000 years. Artifacts from ancient Egypt and the
Nok civilization in West Africa show possible
elephantiasis symptoms. The first clear reference to the
disease occurs in ancient Greek literature, wherein
scholars differentiated the often similar symptoms of
lymphatic filariasis from those of leprosy.
The first documentation of symptoms occurred in the 16th
century, when Jan Huyghen van Linschoten wrote about
the disease during the exploration of Goa. Similar
symptoms were reported by subsequent explorers in areas
of Asia and Africa, though an understanding of the this
did not begin to develop until centuries later.
In 1866, Timothy Lewis, building on the work of JeanNicolas Demarquay and Otto Henry Wucherer, made the
DISTRIBUTION
Prevalent worldwide in the Tropics and Sub-tropical
regions of
Africa
Asia
Western Pacific
Parts of Central & South America
CAUSES
Elephantiasis occurs in the presence of microscopic,
thread-like parasitic worms such as Wuchereria
bancrofti (the most common), Brugiamalayi, and
Brugia timori (also known as B. timori), all of which
Host Factors
Man Natural Host
Age All age (6 months) Max: 20-30 years
Sex Higher in men
Migration leading to extension of infection to nonendemic areas
Immunity may develop after long year of exposure
(Basis of immunity-not known).
Agent Factors
Laboratory Diagnosis
1. Demonstration of microfilarae in the peripheral
blood
a. Thick blood smear: 2-3 drops of free flowing
blood by finger prick method, stained with JSB-II
b. Membrane filtration method: 1-2 ml intravenous
blood filtered through 3m pore size membrane
filter
c. DEC provocative test (2mg/Kg):After consuming
DEC, mf enters into the peripheral blood in day
time within 30 - 45 minutes.
2. Immuno Chromatographic Test (ICT): Antigen
detection assay can be done by Card test and through
ELISA. Circulating Filarial Antigen detection is regarded
as Gold Standard for diagnosing Wuchereria bancrofti
infection. Specificity is near complete, sensitivity is
greater than all other parasite detection assays, will detect
antigen in amicrofilaraemic as well as with clinical
manifestations like lymphoedema, elephantiasis.
3. Quantitative Blood Count (QBC):QBC will identify
the microfilariae and will help in studying the
morphology. Though quick it is not sensitive than blood
smear examination.
Prevention
The World Health Organization recommends treating
entire groups of people who are at risk with a single
annual dose of two medicines, namely albendazole in
combination with either ivermectin or diethylcarbamazine
citrate. Transmission of the infection can be broken when
a single dose of these combined oral medicines is
consistently maintained annually for a duration of four to
six years.
Lymphoedema Management
Basic Components and Benefits
Basic Components
1. Hygiene
2. Prevention & cure of entry lesions
3. Exercise
4. Elevation of foot
5. Use of proper footwares
Lymphoedema management helps
to eliminate the bad odour
to prevent & heal entry lesion
to help patients self-confident
to reduce the size of the lyphoedema
to prevent disability
to prevent economic loss
Treatment
Treatments for lymphatic filariasis differ depending on
the geographic location of the endemic area. In sub-
Surgical Treatment
Hydrocele: Excision
Scrotal Elip: Surgical removal of Skin & Tissue,
preserving penis and testicles.
Lymphoedema (Elephantiasis): Excision of redundant
tissue, Excision of subcutaneous and fatty tissues,
postral drainage and physiotherapy
2. Control of Morbidity
Interruption of the transmission can be achieved through:
a. Chemotherapy
b. Vector control
An integrated programme is in place for the control of
lymphatic filariasis. Earlier, vector control was the main
method of control. There are three main reasons why
filariasis never causes explosive epidemics
1. The microfilariae does not multiply in the vector
2. Infective larvae do not multiply in man
3. Life cycle of the parasite is relatively long (>15 )
4. Case detection and treatment in low endemic areas
are suitable for preventing transmission and
controlling the disease.
5. In high endemic areas, Mass chemotherapy is the
approach.
6. DEC medicated salt is also a form of Mass treatment
using low dose of drug over a long period of time (12 gm /Kg of Salt).
Vector Control
Vector control involves anti larval measures, anti adult
measures, personal prophylaxis. An integrated method
using all the vector control measures alone will bring
about sustained vector control.
I. Anti larval measures:
1. Chemical control
a. Mosquito larvicidal oil
b. Pyrosene oil
c. Organo phosphorous compounds such as Temephos,
Fenthion,
2. Removal of pistia plants
3. Minor environmental measures
II. Anti adult measures:
Anti adult measures as indoor residual spay using
DDT, HCH and Dieldrin. Pyrethrum as a space spray is
also followed.
III. Personal Prophylaxis:
Reduction of man mosquito contact by using
mosquito nets, screening of houses, etc.
Prevention of filariasis
Exercise
Elevation of Foot
Elevation of Foot