CLINICAL PARASITOLOGY I

TOPIC: FILARIAL WORMS

By: Dr. Ayii G. Ayii

MBBS, DMLS & CMLS

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 FILARIAL WORMS
OUTLINES
1. Introduction of Filarial worms

2. Define Filariasis

3. Explain the Wuchereria bancrofti

4. Discuss the epidemiology, and lifecycle of W.bancrofti

5. Describe Clinical features, Diagnosis and treatment

6. Explain the prevent and control

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The filariae are thread-like parasitic nematodes
(roundworms) that are transmitted by arthropod
vectors.

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The adult worms inhabit specific tissues where they
mate and produce microfilariae, the characteristic
tiny, thread-like larvae.
The microfilariae infect vector arthropods, in which
they mature to infective larvae.

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 Introduction cont.…..

The female worm gives rise to a young worm called

microfilaria.
The microfilariae, when taken by the arthropod
intermediate host during biting, develop into
filariform larvae, which are the infective stages.
Humans get infected when bitten by the infected
arthropod intermediate host.

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 Introduction cont.…..

Eight species of filarial worms infect humans,

who are the definite hosts.
Of them 6 are pathogens
• Wuchereria bancrofti, Brugia malayi, and
B.timori cause lymphatic filariasis
• Loa loa causes calabar swellings and allergic
lesions;

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 Introduction cont.…..

• Onchocerca volvulus causes eye lesions and

dermatitis
• Mansonella streptocerca leads to skin diseases
• Mansonella ozzardi and M. perstans are virtually
nonpathogenic

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 FILARIASIS
Infection with any of the filarial worms may be
called filariasis, but traditionally, the term filariasis
refers to lymphatic filariasis caused by Wuchereria
or Brugia species.

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 Classification of Filariasis

1. Lymphatic filariasis

2. Subcutaneous filariasis

3. Serous cavity filariasis

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According to the normal habitat of the adult worm,
human filarial infections can be classified as follows.
1. Lymphatic filariasis caused by; W.bancrofti
B.malayi and B.timori.
2. Subcutaneous filariasis caused by; Loa loa,
Onchocerca volvulus and Mansonella streptocerca.
3. Serous cavity filariasis caused by; Mansonella
ozzardi and Mansonella perstans.

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 LYMPHATIC FILARIASIS

WUCHERERIA BANCROFTI
History
o Filariasis has been known from antiquity.
o Elephantiasis had been described in India by
Sushrutha (circa 600 BC) and in Persia by Rhazes
and Avicenna.

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o The term ‘Malabar leg’ was applied to the condition
by Clarke in 1709 in Cochin.
o Microfilaria was first observed by Demarquay (1863)
in the hydrocoele fluid of a patient from Havana, and
Cuba.

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o The genus is named after Wucherer, a Brazilian
physician who reported microfilariae in chylous urine
in 1868.
o Microfilaria was first demonstrated in human blood in
Calcutta by Lewis (1872), who called it Filaria
sanguinis hominis.

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o The female adult worm was described by
Bancroft (1876) in Brisbane, Australia and the
male worm by Bourne (1888).

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o Manson (1878) in China identified the Culex
mosquito as the vector.
o This was the first discovery of insect transmission
of a human disease.
o Manson (1879) also demonstrated the nocturnal
periodicity of microfilariae in peripheral blood

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 Distribution

 W. bancrofti is distributed widely in the tropics and

subtropics of Asia, Africa and South America
 About 120 million people in 80 countries suffer
from lymphatic filariosis caused by Wuchereria
bancrofti
 1.1 billion people are at infection risk (WHO, 2000)

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 Humans are the only natural final hosts of W.
bancrofti and the most widely disseminated Brugia
strains.
 There are, however, other Brugia strains using also
animals as final hosts (cats, dogs, and monkeys).

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Mode of transmission
Humans are infected when the female mosquito
(especially Anopheles and Culex species)
deposits infective larvae on the skin while biting.

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 Life cycle

• Humans are infected when the female mosquito

(especially Anopheles and Culex species) deposits
infective larvae on the skin while biting.
• The larvae penetrate the skin, enter a lymph node,
and, after 1 year, mature to adults that produce
microfilariae.

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• These circulate in the blood, chiefly at night, and are
ingested by biting mosquitoes.
• Within the mosquito, the microfilariae produce
infective larvae that are transferred with the next bite.
• Humans are the only definitive hosts.

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 PATHOGENESIS

Adult worms in the lymph nodes cause inflammation

that eventually obstructs the lymphatic vessels, causing
edema.
Massive edema of the legs is called elephantiasis

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 Elephantiasis

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 Clinical Findings

 Asymptomatic infection, but with microfilaremia

that can persist for years.

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  Acute symptomatic infection
• Swelling of lymph nodes
• Lymphangitis
• Intermittent recurrent febrile episodes
• General malaise
• Swellings on legs, arms, and scrotum

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 Chronic symptomatic infection
• Dilatation of the lymphatic vessels (“lymphatic varices”)
• Legs, “elephantiasis
• Lymphuria,
• Chyluria,
• Chylocele etc.
NB: This clinical picture develops gradually in indigenous
inhabitants over a period of 10–15 years.

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 Tropical, pulmonary eosinophilia
Syndrome with coughing, asthmatic pulmonary
symptoms, high-level blood eosinophilia, lymph node
swelling and high concentrations of serum antibodies
(including IgE) to filarial antigens.
This is an allergic reaction to filarial antigens.

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 Diagnosis

1. Clinical diagnosis
2. Laboratory Diagnosis
BS: Thick blood smears taken from the patient at
night reveal the microfilariae.
CBC : Eosinophilia

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 Microfilariae in peripheral blood smear

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o ELISA TEST: For filarial antigens detection
o ICT :ICT filariosis card test
o PCR : DNA analysis
o U/S : Adult worms are detectable by ultrasonography

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Treatment
Diethylcarbamazine (DEC) is effective only
against microfilariae.
Doxycycline to kill Wolbachia.

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 Prevention and Control

1. Mosquito control with insecticides

2. The use of protective clothing.
3. Mosquito netting, and repellents.
4. Mass treatment of populations in endemic areas
with microfilaricides.

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 Prevention and Control
Concurrent single doses of two active substances
(albendazole with either diethylcarbamazine or
ivermectin) are 99% effective in removing microfilariae
from the blood for one Year after treatment.

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 ONCHOCERCA OUTLINES

1. Introduction of Onchocerca

2. Define Onchocerciasis.
3. Explain the clinical features of Onchocerciasis.
4. Mention the investigations of Onchocerciasis.
5. Describe the management of Onchocerciasis.
6. Explain the prevent and control of Onchocerciasis.

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 ONCHOCERCA
Disease
Onchocerca volvulus causes onchocerciasis.
Also called River blindness.

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 ONCHOCERCA VOLVULUS

History and Distribution

Onchocerca volvulus, the ‘convoluted filaria’, or the
‘blinding filaria’ producing onchocerciasis or ‘river
blindness’ was first described by Leuckart in 1893.

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It affects about 40 million people, mainly in tropical
Africa, but also in Central and South America.
A small focus of infection exists in Yemen and south
Arabia.
Onchocerciasis is the second major cause of blindness
in the world.

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Mode of transmission
Humans are infected when the female blackfly,
Simulium, deposits infective larvae while biting.

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Life Cycle

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 Life Cycle
Humans are infected when the female blackfly,
Simulium, deposits infective larvae while biting.
The larvae enter the wound and migrate into the
subcutaneous tissue, where they differentiate into adults,
usually within dermal nodules.

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 Life Cycle
The female produces microfilariae that are ingested
when another blackfly bites.
The microfilariae develop into infective larvae in the
fly to complete the cycle.
Humans are the only definitive hosts.

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Epidemiology
• Millions of people are affected in Africa and
Central America.
• The disease is a major cause of blindness.
• It is called river blindness, because the blackflies
develop in rivers and people who live along those
rivers are affected.
• Infection rates are often greater than 80% in areas
of endemic infection.

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 Clinical manifestations.

• Fibrous nodules(Onchocercomas)
• Pruritus
• Loss of skin elasticity
• Papules
• Depigmentation
• Swelling of lymph nodes

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Eye changes: “snowflake” corneal opacities, in
later stage sclerosing keratitis, the main cause of
blindness, chorioretinitis and ocular nerve atrophy;
tendency toward bilateral damage.

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 Laboratory Diagnosis
SKIN SNIP: (in blood specimens sampled during
the day!
Biopsy of the affected skin reveals microfilariae
CBC: Eosinophilia is common.

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 Treatment

The drug of choice is diethylcarbamazine that

kills microfilariae.
Suramin kills adult worms but is quite toxic and
is used particularly in those with eye disease.

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Prevention and Control
In 1974, WHO launched a control programme in
West Africa using aerial larvicide for vector
control and treatment of patients with ivermectin.
This is believed to have prevented blindness in
millions of children.

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The ends,

Thank you for active attention.

Next lecture will be Loa loa and Guinea

Worm

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ANY QUESTIONS

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