1. Wuchereria bancrofti 2. Brugia malayi

PREFI THE FILARIAE Flashcards by Sunwoo's Berry

blood feeding arthropod vector-borne nematodes

FILARIAE

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LYMPHATIC FILARIAE:

Wuchereria bancrofti
Brugia malayi

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SUBCUTANEOUS FILARIAE:

Loa loa
Onchocerca volvulus

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Filariae that causes infection in the
abdomen

SEROUS CAVITY

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Considered one of the most delabilating
diseases that is known in the man

LYMPHATIC FILARIAE

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 “BANCROFT’S FILARIAL WORM”
 Causative agent of BANCROFTIAN
FILARIASIS

Wuchereria bancrofti

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INFECTIVE STAGE OF Wuchereria bancrofti

L3 larvae

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DIAGNOSTIC STAGE OF Wuchereria bancrofti

SHEATHED microfilariae

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MOT OF Wuchereria bancrofti

vector-borne by a mosquito bite

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W. bancrofti DH (DEFINITIVE HOST)

HUMAN

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W. bancrofti IH (INTERMEDIATE HOST)

genus CULEX, Aedes, and Anopheles

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B. malayi IH

genus Aedes, Anopheles, MANSONIA

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Motility: minute snake-like constantly
moving among the RBCs
* Development: 3-9 months

MICROFILARIAE

Both W. bancrofti and B. malayi are SHEATHED

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W. bancrofti or B. malayi MICROFILARIAE

Mean length (um): 270-290 um
Cephalic space: breadth - 1:1
Tail: Single row of nuclei that DOES NOT REACH the tail’s end
TERMINAL NUCLEI: NONE
Sheath in Giemsa: unstained
- Blunt and round anterior end
Appearance in blood film: Smoothly curved
- Nuclei: conspicuous (dark staining nuclei); REGULARLY SPACED, separately situated
Innenkorper length (um): 34

W. bancrofti MICROFILARIAE

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W. bancrofti or B. malayi MICROFILARIAE

Mean length (um): 111-222 um
Cephalic space: breadth - 2:1
Tail: Single row of nuclei that REACH the tail’s end
TERMINAL NUCLEI: 2 NUCLEI, which bulge the cuticle, conspicuously placed
Sheath in Giemsa: pink
- Rounded anterior end
Appearance in blood film: Kinky
- Nuclei: indistinct and confluent; IRREGULARLY SPACED, and overlapping
Innenkorper length (um): 30.7

B. malayi MICROFILARIAE

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 White and threadlike in appearance
 Shape: filiform
 MALE: 20-40 mm in length
 FEMALE: 80-100 mm

ADULT WORMS

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W. bancrofti PERIODICITY
- can see in peripheral blood during NIGHTTIME

NOCTURNAL PERIODICITY

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 “MALAYAN FILARIAL WORM”
 Causes MALAYAN FILARIASIS

Brugia malayi

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DEFINITIVE HOSTS OF Brugia malayi

HUMANS

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PERIODICITY of Brugia malayi:
(microfilaria present in blood at all time
and the max. level is during afternoon)

NOCTURNAL and SUBPERIODIC

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Pathogenesis
- lymph nodes of the LOWER extremities

W. bancroft

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Pathogenesis
- lymph nodes of the UPPER extremities

B. malayi

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Pathogenesis
- millions of vigorously motile microfilariae in the peripheral blood show no obvious signs
o “endemic normals

a. Asymptomatic microfilaremia
b. Acute dermatolymphangioadenitis
c. Acute filarial lymphangitis
d. Lymphedema and elephantiasis

a. Asymptomatic microfilaremia

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Pathogenesis
- localized pain, lymphadenitis and/or
lymphangitis and/or cellulitis and local warmth
o Most common acute manifestation

a. Asymptomatic microfilaremia
b. Acute dermatolymphangioadenitis
c. Acute filarial lymphangitis
d. Lymphedema and elephantiasis

Study These Flashcards

b. Acute dermatolymphangioadenitis

Pathogenesis - lymphangitis progressing distally along the lymphatic vessel = palpable “cord” o Caused by spontaneous death of adult worms o Symptoms: self-limiting a. Asymptomatic microfilaremia b. Acute dermatolymphangioadenitis c. Acute filarial lymphangitis d. Lymphedema and elephantiasis

c. Acute filarial lymphangitis

Pathogenesis - most common chronic manifestation o Stage 1: SWELLING INCREASES during the day but is REVERSIBLE once patient lies flat in bed o Stage 2: SWELLING IS NOT REVERSIBLE overnight but experiences acute attacks o Stage 3: presence of SHALLOW SKIN FOLDS; legs “open up” o Stage 4: KNOBS ARE PRESENT in the affected area o Stage 5: DEEP SKIN FOLDS o Stage 6: presence of MOSSY LESIONS that leak translucent fluid o Stage 7: patient is PROSTATE a. Asymptomatic microfilaremia b. Acute dermatolymphangioadenitis c. Acute filarial lymphangitis d. Lymphedema and elephantiasis

d. Lymphedema and elephantiasis

production of hydrocele or chylocele o Chylocele: accumulation of milky hydrocele fluid in the closed sac of the testis due to the presence of lymph o Hydrocele: common chronic manifestation of Bancroftian filariasis

Genito-urinary lesions

classic example of occult filariasis o Hypereosinophilia: 3,000-5,000 cells per mm3 of blood o Elevated erythrocyte sedimentation rate o Extremely high titers of filarial antibody (IgE)

Tropical pulmonary eosinophilia

CLINICAL MANIFESTATION OF LYMPHATIC FILARIAE * One of the most debilitating diseases * Second leading cause of permanent and long-term disability * Acquired from childhood * Expatriate Syndrome: infection of people from outside regions after migration to the endemic area o Symptoms: hives, rashes, and blood eosinophilia

Lymphatic filariasis

CLINICAL MANIFESTATION OF LYMPHATIC FILARIAE  Most common chronic manifestation of LF  Most common affected: LOWER LIMBS (but upper limb and male genitalia can be affected also)  Progression to ELEPHANTIASIS  Formation of HYDROCELE (CHYLOCELE) – obstructions of the lymphatic in the tunica vaginalis

LYMPHEDEMA

CARDINAL SIGNS OF Lymphatic filariasis - lymph dilatation due to the tight coiling of adult worms in nodular dilated nests in lymph vessels and sinuses of lymph glands ▪ Common feature of patent infection A. Lymphangiectasia B. Lymphangiogenesis C. Chronic LF infection

A. Lymphangiectasia

CARDINAL SIGNS OF Lymphatic filariasis - live filarial parasites or antigens induce lymphatic endothelial cell proliferation and differentiation = collaterization ▪ Results to secondary bacterial infections and trigger inflammatory reactions in the skin and subcutaneous tissue ▪ Leads to lymphedema and elephantiasis A. Lymphangiectasia B. Lymphangiogenesis C. Chronic LF infection

B. Lymphangiogenesis

CARDINAL SIGNS OF Lymphatic filariasis - fibrosis and cellular hyperplasia in and around the lymphatic walls o Dead and calcifying adult worms = lymphangitis and lymphadenitis with localized pain and swelling A. Lymphangiectasia B. Lymphangiogenesis C. Chronic LF infection

C. Chronic LF infection

DIAGNOSIS OF LYMPHATIC FILARIAE

Microscopy using Giemsa-stained (wet) thick blood films o W. bancrofti: nocturnal o B. malayi: nocturnal & subperiodic * Knott’s technique: for low intensity infections * Immunochromatographic card test: detect circulating filarial antigens * Xenomonitoring

specimen collection for Microscopy of lymphatic filariae

between 8 pm to 4 am

Treatment for W. bancrofti:

- diethylcarbamazine - ivermectin with albendazole

Treatment for B. malayi:

- diethylcarbamazine

Subcutaneous Filariae “African eye worm”

Loa loa

Subcutaneous Filariae “blinding filaria”

Onchocerca volvulus

Subcutaneous Filariae Infective Stage:

L3 LARVAE

Subcutaneous Filariae Diagnostic Stage

MICROFILARIAE

Subcutaneous Filariae MOT

vector-borne by a fly bite

L. loa IH:

deerflies under genus Chrysops (DAY BITING FLY)

O. volvulus IH:

blackflies under genus Simulium

L. loa PERIODICITY - (they can be found during the day)

DIURNAL

MICROFILARIAE - 248-300 um - Has continuous row of nuclei EXTENDING TO THE TIP of the tail - Pointed tail - Sheathed Circulation: peripheral blood L. loa OR O. volvulus?

L. loa MICROFILARIAE

MICROFILARIAE - 150-355 um - Nuclei DOES NOT EXTEND to the tip of the tail - Somewhat pointed tail - Unsheathed Circulation: subcutaneous tissue L. loa OR O. volvulus?

O. volvulus MICROFILARIAE

L. loa OR O. volvulus ADULT WORMS? - White cylindrical threadlike  MALE: 28-35 mm  FEMALE: 38-72 mm

L. loa ADULT WORMS

L. loa OR O. volvulus ADULT WORMS? - Thin and wirelike - Coil up in knots inside skin nodules  MALE: 25-50 mm  FEMALE: up to 500 mm

O. volvulus ADULT WORMS

CM OF L.loa * Initial bite = pruritus and localized pain followed by Calabar swellings

Loiasis

Loiasis most common form of manifestation?

- CALABAR SWELLINGS - EYE WORM

: localized, nontender swellings on the arms and legs near the joint ▪ Occur anywhere on the body due to the migration and death of the microfilariae

CALABAR/FUGITIVE SWELLINGS

In loiasis adult worms may migrate into?

o CONJUNCTIVA o UNDER THE SKIN o BRIDGE OF THE NOSE

DIAGNOSIS OF L.loa?

BLOOD - MICROFILARIAE IN GIEMSA STAINED IN BLOOD (10:15 AM – 2:15 PM)  Extraction of adult worms on body locations  Serologic testing

TREATMENT FOR L.loa

 DEC (DIETHYLCARBAMAZINE)  SURGICAL REMOVAL/EXTRACTION

PERIODICITY of O. volvulus: (microfilaria circulate in the blood throughout 24 hour period)

NONPERIODIC

* Infection usually results in a chronic and non-fatal condition * Development of infected nodules causes localized symptoms * RIVER BLINDNESS: Development of lesions in the eye * Symptoms: loss of elasticity, location of nodules on the body, where the patient contracted the parasite (Eastern or Western Hemisphere)

Onchocerciasis

DIAGNOSIS OF O. volvulus:

 SKIN SNIPS - MICROFILARIAE IN GIEMSA STAINED TISSUE - Tissue biopsy in the infected area – SPECIMEN OF CHOICE - Obtained with little blood (to avoid contamination sample)  Extraction of adult worms on infected nodules  OPHTHALMOLOGIC EXAM - Uses SLIT LAMP  PCR AND SEROLOGIC METHODS

TREATMENT FOR O. volvulus:

 IVERMECTIN  THERAPY CAN BE LONG BECAUSE OF THE ADULT WORM LIFESPAN (15 YEARS

PREFI THE FILARIAE Flashcards

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