filariasis

(Lymphatic)

 Filariasis is a parasitic disease that is caused by an African worm, a microscopic thread-like worm, a filarial nematode worms in the family Filarioidea, also known as "filariae". This nematodes uses human as a host.

It is divided into three groups according to the body part they accupy which are : Lymphatic Filariasis, Subcutaneous Filariasis and Serous Cavity Filariasis.

 Serous Cavity Filariasis is caused by the worms Mansonella perstans and Mansonella ozzardi, which occupy the serous cavity of the abdomen. In all cases, the transmitting vectors are either blood sucking insects or Copepod crustaceans in the case of Dracunculus medinensis.

 Subcutaneous Filariasis is caused by Loa loa (the African eye worm), Mansonella streptocerca, Onchocerca volvulus, and Dracunculus medinensis (the guinea worm). These worms occupy the subcutaneous layer of the skin, the fat layer.

 Lymphatic Filariasis is the most common of this group that has three causative organisms which are Wuchereria bancrofti (most common worldwide) a 4-5 cm long thread-like worm that affects the lymph nodes and lymph vessels, Brugia malayi and Brugia timori (most common in Asia) that occupies also the lymphatic system which maintains the body's fluid balance and fights infections, and in chronic cases these worms lead to the disease lymphedema and elephantiasis (the skin hardens and thickens) and in men, swelling of the scrotum, called hydrocele while in women is enlargement of the breasts.

 It is considered one of the neglected tropical disease and is a leading cause of permanent disability worldwide. Communities frequently shun and reject women and men disfigured by the disease. Affected people frequently are unable to work because of their disability, and this harms their families and their communities.

 According to CDC, a wide range of mosquitoes can transmit the parasite, depending on the geographic area. In Africa, the most common vector is Anopheles and in the Americas, it is Culex quinquefasciatus. Aedes and Mansonia can transmit the infection in the Pacific and in Asia. Many mosquito bites over several months to years are needed to get lymphatic filariasis

 People living for a long time in tropical or subtropical areas where the disease is common are at the greatest risk for infection. Shortterm tourists have a very low risk. Programs to eliminate lymphatic filariasis are under way in more than 50 countries. These programs are reducing transmission of the filarial parasites and decreasing the risk of infection for people living in or visiting these communities.

 According to the World Health Organization, nearly 1.4 billion in 73 countries worldwide are threathened by lymphatic filariasis commonly known as elephantiasis. Over 120 million people are currently infected with about 40 million disfigured and incapacitated by the disease. Approximately 65 million people worldwide have symptoms and many others are asymptomatic. Lymphatic filariasis causes approximately 300 deaths each year.

 In the Philippines, the neglected tropical diseases are among the poorest of the poor in Rural areas. It tends to be neglected by the NGOs because it doesnt cause instant death. According to the WHO, there are already 645,232 Filiponos infected and twenty million are at risk in getting lymphatic filariasis also known as tibak in local language affecting 44 of the 80 provinces of the country.

 As of year 2011, elephantiasis have been eliminated in provinces namely Agusan del Sur, Biliran, Bukidnon, Campostella valley, Cotabato Province, Dinagat Island, Romblon, Sorsogon and Southern Leyte. Sorsogon with the highest rank was declared filaria-free after 7 years of MDA. November 2012 when Marinduque, Albay and Western Samar was declared as filarial free. In the year 2018, a Filariasis-free Philippines is the target of the Department of Health (inquirer.net, aug 14, 2012). The program MDA or Mass Drug Administration distributing albendazole and diethylcarbamazine is to treat the disease and given once a year to eliminate it (Joy C. Quito).

PATHOPHYSIOLOGY OF THE DISEASE

When a mosquito bites a person, microscopic worms in the blood enter and infect the mosquito. The microscopic worms pass from the mosquito through the skin and travel to the lymph vessels where they grow into adults. The adult worm lives in the human lymph vessels for seven years, mates, and produces millions of microscopic worms, also known as microfilariae.

 Microfilariae circulate in the person's blood and picked up by the mosquito when it bites a person who is infected microfilariae grow and develop in the mosquito then transmitted via larvae. They grow again into adult worms, a process that takes 6 months or more.

 An adult worm lives for about 57 years. The adult worms mate and release millions of microfilariae into the blood. People with microfilariae in their blood can serve as a source of infection to others. A person needs many mosquito bites over several months to years to get filariasis.

 at first most people do not know they have it and do not feel any symptoms until after the the adult worm dies. The common symptoms are acute recurrent fever, chills, headache, swelling of the limbs breasts and scrotum.

 Symptoms vary depending on the type of the parasitic worm caused the infection but usually all infections begin with chills headache and fever between three months and one year after the insect bite. There may also be swelling, redness, pain in the arms, leg and scrotum. Areas of abscesses may appear as a result of dying worms or secondary bacterial infection. Circulating Fialarial Antigen test is performed on a finger-prick blood droplet taken anytime of the day and gives result in a few minutes. A larvae may found in the blood but mosquitoes are active at night usually between 10pm-2am.

 Pattern of inflammation ad signs of lymphatic obstruction must be observed. The medication to be used are ivermectin, albendazole or diethylcarbamazapine to eliminate the larvae, to impair the worms ability to reproduce and to kill the adult worms. Medications should be started at low doses to prevent the reactions of the dying parasites. Surgery may be used to remove surplus or excess tissues and provide way to drain the fluid around the damaged lymphatic vessels.

 surgery is also used to minimize the massive enlargement of the scrotum. Elephantiasis can also be eased up by elevating the legs and providing support with elastic bandages.

III. REACTIONS
Filariasis is one of the communicable diseases that are endemic in the Philippines. The news was right that some tropical cases like this were neglected since it doesnt cause instant death. Sometimes lack of knowledge about the disease is a factor of having it. For the people doesnt know how to prevent it and didnt give importance on the health teachings given to them. Or maybe because it usually happens in rural areas wherein they really cant be seen or examine by the doctors and didnt even get the proper treatment necessary for them. As a student nurse it is good to know that there is what so called mass drug administration to eliminate the said disease and to treat those asymptomatic ones.

 There are programs launched by the Department of Health that can be very helpful in reducing the morbidity and mortality rate of the disease. The fact that mosquitoes cannot be eradicated means that there were still cases wherein it was said that a person needs many mosquito bites over several months to years to get filariasis. If ever a person got infected again, the annual mass drug administration could be very helpful hoping that the government will still find time and budget for it.

 Assessment of the knowledge of the client regarding the disease is important. Health teachings are very important also in this case such as using mosquito net, insect repellant when available and take yearly dose of medicine that kills the worm circulating in the body. Still proper diet and exercise is needed provided that the client will use bandages to the affected limb. Lymphatic Filariasis has also impact on physical, mental and social life of the client so counseling is also needed to manage psychosocial problems caused by this.

 Identified Areas of responsibilities are: Safe and Quality Nursing Care is to be able to identify the health needs of the client, group or community. Proper assessment is needed not to explain totally the pathophysiology of the disease but sometimes these client needs further explanation on how they get it or how to prevent it for they are most often lack of knowledge about it and also to give the holistic care to the client. Communication is to be able to identify and respond to the needs of the client and the family in all aspects and lastly through Health Education, the most important of all the areas of responsibility the disease could be prevented, reduced and eliminated.