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Lymphatic Filariasis
Infection with 3 closely related Nematodes
Disease Manifestation
Disease manifestation range from Acute-Filarial fever Chronic-Lymphangitis, Lymphadenitis, Elephantiasis of genitals/legs/arms Tropical Pulmonary Eosinophilia (TPE) Filarial arthritis Epididimoorchitis Chyluria, etc.
Iqbal A Farooqui
Distribution
Prevalent world wide in the Tropics and Sub-tropical regions of Africa Asia Western Pacific Parts of Central & South America
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Endemic Countries
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Agent Factors
S.no
Parasite
Mosquito
Culex Mansonia Anopheles/ Mansonia Simulium flies
Disease
LF LF LF River Blindness
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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 non-endemic areas Immunity may develop after long year of exposure (Basis of immunity-not known)
Iqbal A Farooqui
Iqbal A Farooqui
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.
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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. 4. Ultrasonography:
Iqbal A Farooqui
Iqbal A Farooqui
Iqbal A Farooqui
Clinical Manifestations Manifestations are 2 types 1. Lymphatic Filariasis (Presence of Adult worms) 2. Occult Filariasis (Immuno hyper responsiveness) Clinical Spectrum
None
Asymptomatic microfilaremia Filarial fever Chronic pathology TPE
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Leg
Click to edit Master text styles Second level Third level Fourth level Fifth level
Iqbal A Farooqui
Arm
Click to edit Master text styles Second level Third level Fourth level Fifth level
Iqbal A Farooqui
Iqbal A Farooqui
Treating the infection Treatment and prevention of Acute ADL attacks Treatment and Lymphoedema prevention of
3.
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Chemotherapy of Filariasis
Drugs effective against filarial parasites
1. 2. 3.
4.
ADL
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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
Iqbal A Farooqui
Iqbal A Farooqui
Iqbal A Farooqui
Iqbal A Farooqui
Ivermectin
Mode of action: Directly acts on mf and no action on adults. Very effective against mf (Microfilariacidal) Lowers mf level even in single dose of 200g 400g/Kg body weight No action on TPE Drug of choice in Co-endemic areas of Onchocerciasis with LF. Adverse reactions are lesser but similar to that of DEC Microfilariae reappears faster than DEC
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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. b. c.
Mosquito larvicidal oil Pyrosene oil Organo phosphorous Temephos, Fenthion, compounds such as
Vector Control
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.
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Thank you
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