Filariasis

TROPMED BLOCK
Faculty Medicine USU
2016
EPIDEMIOLOGY
 Agent of Disease

*Manson’Tropical Disease 4thEd Chapter 54th

Lymphatic filariasis
Wuchereria bancrofti
Morphology

The larva was found by Demarquay (1863) and

Wucherer (1866)

The adult was first found by Bancroft in 1876

Nocturnal periodicity

Vector: Culex and Aedes

Wuchereria bancrofti
Morphology

Adults look like thin and

long threads

Female is 80-100 mm, male

is 25-45 mm with spiral-
shaped tail
Fertilized eggs is 30-40 x 20-
25 μm, the egg cell
develops rapidly to form a
larva while in the uterus
Wuchereria bancrofti
Morphology
Microfilaria is sheated
and smooth-shaped,
0.24-0.35 mm long

Regular nucleus, no
terminal nucleus
Cephalic
space 1:1

Cephalic space: the

length is equal with the
width *modified from Manson’Tropical Disease 4thEd Chapter 54th
Brugia malayi
Morphology
The larva was first observed from a native
Sumatera by Brug (1927)
Nocturnal periodicity
Vector: Mansonia uniformis (rural) and
Anopheles spp. (urban)
Adult resembles that of W bancrofti
Female is 43-55 mm, male is 13-23 mm with
spiral-shaped tail
 Brugia malayi
Morphology
The larva is sheated and
Cephalic
slightly winding (kinky), space 1:2
0.18-0.23 mm long

Irregular nucleus, 2
terminal nucleus

Cephalic space: the length

is twice as the width (1:2)

*modified from Manson’Tropical Disease 4thEd Chapter 54th

Brugia timori
Morphology
The Larva is sheated but
does not stain pinkish Cephalic
space 1:3
but (bluish)
Irregular nucleus; 2
terminal nucleus

Cephalic space is
elongated, ratio 1:3

Adult resembles that of

W bancrofti
*modified from Manson’Tropical Disease 4thEd Chapter 54th
 The karvae migrate to the
lymphatic system, where
they grow, mate and form Female worms produce
nests. The nests cause microfilariae in lymphatic
blockages resulting swelling system, and live more than
and fever 20 years

An infected mosquito deposits Microfilariae (mf) appear in blood

larvae on the skin while biting after minimum 8 months in
and the larvae enter the skin W.bancrofti and 3 months in
B.malayi and lifespan mf is ± 1 year.

Migrate to the head and

mouthparts of the mosquito Microfilariae is ingested by
as infective larvae (L3) vector

Development in vector: Migrate

to the thoracic muscles where
*modified from they molt twice (L1-L3); 10-12
Manson’Tropical days
Disease 4thEd
Chapter 54th
 Pathogenesis

Inflammation occurs when worms die, either drug-

induced or spontaneously.

Repeat attacks of inflammation lead to dilation &

thickening of the affected lymphatics (lymphedema)
Chronic lymphedema: hyperplasia of connective
tissue, infiltration of plasma cells, macrophages and
eosinophils
Eventual thickening and verrucous changes:
elephantiasis
 Pathogenesis

Initial Acute response: parasite specific local

inflammatory reaction (cell mediated and humoral
components). Inflammatory infiltrate surrounds and
attacks worm

Granulomatous reaction: Release of endosymbiotic

intracellular bacteria (wolbachia) as worm is
digested. TNF-α (tumor necrosis fector =) is induced
follow by a granulomatous inflammatory response
 Management Diagnosis
Clinical manifestations

Laboratory diagnosis

Microscopic

Immunodiagnosis

Molecular technique

Ultrasonography
 Clinical manifestation

Acute filariasis

Chronic filariasis

Atypical presentation

Asymptomatic carrier
 Lymphatic vessel
Lymphatic vessel dilatation,
dilatation, valve incompetency,
valve incompetency,
lymphatic back flow, pooling & oedema
lymphatic back flow, pooling & oedema
25
Adult worms in the lymphatic system

Picture:
showing segment of necrotic
partly calcified adult filaria
with surrounding fibrosis and
inflammatory reaction in a
section epididymis and
contigous tissue.
 Microscopy for Filaria

Nucleopore membran (Knott’s concentration)

Staining thick blood film with Giemsa

Specific but not sensitive, depends on:

• Timing of sampling (periodicity)
• Volume of blood (volume increase à sensitivity increase)
• Staining of the blood film
• Morphological characteristics
 Periodicity
Definition: Relative density of microfilaria in peripheral
circulation > 24 hours per cycle

Nocturnal periodic: peak microfilaria at around mid-

night but very low or absence during the day

Diurnal periodic: peak microfilaria during the day but

low or absence at night

Nocturnal subperiodic: peak microfilaria density at night

with lower density during the day
 Pathophysiology

Acute filariasis

Chronic filariasis

Atypical presentation

Asymptomatic carrier
 Management Diagnosis
Clinical manifestations

Laboratory diagnosis

Microscopic

Immunodiagnosis

Molecular technique

USG
Imunodiagnosis

Serologi untuk deteksi

antibodi W.bancrofti &
B.malayi
 Education and avoidance

Avoidance of musquito bites

DEC can kill developing forms of filarial parasite and useful as a

prophylactic agent in humans

Community-based intervention is the current approach to elimination of

lymphatic filariasis

Community education and clinical care for persons already suffering from
the chronic sequelae of li=ymphatic filariasis are important
components......