Chapter 6

Filarial nematodes
(Helminthology)
Filarial nematodes
General Characteristics is same with Nematodes (Chapter 5)

+++

Have complex life cycles & require an arthropod (insect)

=> for development and transmission

Inhabit lymphatic system or subcutaneous tissues of man

The female worm gives rise to a young worm = Microfilaria

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 Conti… General Characteristics
The microfilariae develop into filariform larvae (infective) in

arthropod (intermediate)
Humans get infected when bitten by the infected arthropod

intermediate host
Adult worms are long-lived > microfilarial

Infection is established if the exposure to infective larva is

intense and prolonged

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A. Wuchereria bancrofti
GeogD: Periodic form in Asia, Africa, America, including Ethiopia
(Gambella at Baro River)

=> Sub-periodic form in Eastern Pacific, Thailand and Vietnam

Habitat: Adults: Coiled in lymphatic vessels of the lower limb

=> or Wondering in retroperitoneal tissues

Microfilariae: In lymphatic vessels & peripheral blood @ night

=> in lung & other internal organs @ day time
 Infective larvae: In the vector mosquitoes
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 Conti… W. bancrofti

Morphology: Adults: Creamy white, smooth surface & curved tail

=> Microfilaria: Smooth cuticle & pointed tail

Life Cycle:
filari-form larvae (Infective) →Adult worm → microfilariae

=>2 hosts: Man (definitive) & Anopheles/Aedes (intermediate)

Infection => during infected female mosquito takes a blood meal

 During arthropod takes blood meal deposit filariform (in skin)

=> filariform enter to the blood vessels & lymph nodes

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 Conti… life cycle of W. bancrofti

 In the lymphatics, Develop (in to adult) & mate then

=> produce microfilariae, then enter to blood stream

 Mosquito vector take microfilariae during blood meal

 In the insect vector, microfilariae develop to infective larvae

 Then, larvae are ready to be transmitted during blood meal

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 Conti… W. bancrofti

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 Conti… W. bancrofti
The Microfilariae (in human)=> in pulmonary circulation (day)

=> in peripheral circulation (night)

Reason for being periodic (Nocturnal) is

 Coincide with the biting habit of the vector

 body temperature, oxygen & sleeping habits (influence)

Pathology: infective larvae (deposited in skin) & wondering

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 Conti… W. bancrofti Pathology
Alive Adult worms =>lymphatic blockage & gross lymphedema

++ => host immunity response (damage self-lymph)

 Lymphatic filariasis or elephantiasis
=> @ upper limbs, genital organs & breasts
Dead worm => local necrosis & inflammation reaction (dead)

 lymphatic obstruction and filariasis

Symptoms => fever, thickening & blocking of lymphatic vessels,

swelling, fibrosis, elephantiasis & hydrocele of limbs, genital

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Lymphatic filariasis or elephantiasis (Conti… W. bancrofti)
@ upper limbs, genital organs, breasts & Hydrocele

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 Conti… W. bancrofti
Lab Diagnosis:
1. Microfilariae in wet or stained blood films
2. Microfilariae in aspirates of hydrocele and lymph gland fluid
3. Serological diagnosis Collection time of Blood for W. bancrofti
microfilariae
 Periodic: b/n 22.00-04.00 hrs (time of peak density is 24.00 hr)
 Nocturnal (night) sub-periodic: b/n 20.00-22.00 hrs (21.00 hr)
 Diurnal (day time) sub-periodic: b/n 14.00-18.00 hs (16.00 hr)

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 Conti… W. bancrofti
Non-filarial elephantiasis = Podoconiosis (Ethiopia)
Silicon, aluminium & iron (red clay soil)

=> Absorbed via skin abrasions (bare footed)

=> The minerals obstruct the lymphatics = Podoconiosis

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 Conti… W. bancrofti

Treatment:

=> Diethylcarbamazine

Surgery can be used to remove elephantoid

Prevention & Control:

Controlling mosquito vector & avoiding mosquitoes bite

Treatment & health education.

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B. Brugia malayi
GeogD: Malaysia, India, Philippines, Vietnam, China, Korea.
Peroidic: in open swamps & rice growing areas
 Sub-periodic: in fresh water swamp in forests along rivers
Habitat: Adult: In lymphatic Vessels of man (@ upper limb)
 Microfilariae: => in Lymph & peripheral blood (night)

=> in the lung & internal organs (day time)

 Infective filariform larvae: In the gut of mosquitoes
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 Conti… B. malayi

Morphology: Adults: Male < Female (in size)

 Microfilariae: coiled & kinked (has small angular curves)

Life cycle: similar to W. bancrofti,

=> Man (definitive) & Female Anopheles/Mansoni (intermediate)
 Infection: bite of infected insect vector during blood meal

Pathology: Malayan filariasis or elephantiasis (lower limbs)

=> Symptoms develop rapidly & children are more affected

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 Conti… B. malayi

Lab Diagnosis: Microfilariae in wet or stained blood films

Collection Time for B. malayi Microfilariae

 Periodic: b/n 22.00-04.00 hrs (24.00 hr)

 Subperiodic: b/n 20.00-22.00 hrs (21.00 hr)

Treatment: Diethylcarbamazine

Prevention & Control:

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similar method to W. bancrofti 16
C. Onchocerca volvulus (River blindness)

GeogD: fast running rivers in the forests & Savannah areas of west

& central Africa (Ethiopia)

Habitat: Adults: Subcutaneous nodules & in skin

 Microfilariae: Skin, eye & other organs of the body,

 Infective larvae: In the gut of Simulium (black fly)

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 Conti… O. volvulus

Morphology: Adults: Male < Female (in size); curved tail

=>Microfilariae: thick with long & pointed tail

Life Cycle: 2 hosts: Man (definitive) & Simulum (intermediate)

Infective larvae are deposited on the skin during blood meal by

infected vector

 Enter to subcutaneous tissue & develops to Adult worm

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 Conti… O. volvulus Life Cycle

 After mate => viviparous female produce microfilaria

=> microfilaria found below skin surface in the lymph

spaces, connective tissues & fluid of nodules

=> also migrates to the eye

 Simulum vector takes microfilariae during blood meal

 Develop into infective larvae

Then transmitted @ the next blood meal

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 Conti… O. volvulus
Pathogenicity: Onchocerciasis (river blindness)

=>Symptoms are by inflammatory rxns around dead microfilaria

 Skin loses elasticity & becomes wrinkled(aged)=Elephant skin

 Skin of Groin=>hanging groin develops (spotted depigmentation)

= Leopard skin

 Symptoms: formation of nodules, dermatitis & inflammatory

reactions in the eye

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chapter 6 to blindness 20
 Conti… O. volvulus

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Conti… O. volvulus
In many parts of Africa, the sighted young are responsible
for leading the older blind adults

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 Conti… O. volvulus
Lab Diagnosis: Finding Microfilariae in skin snips

Treatment: Diethylcarbamazine

Prevention & Control

Destruction of black files in rivers & streams

 Avoiding the vector bites

Treatment of communities (mass treatment) & health education

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 D. Loa loa (Eye worm)
GeogD: restricted to the equatorial rain forest area of west &
central Africa
Habitat: Adults: In connective tissues under the skin &
in sub-conjunctiva tissue of the eye or
in thin skinned areas
Microfilariae: In peripheral blood of man during day time.

Infective larvae: In the gut of Tabanide flies (horsefly)

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 Conti… Loa loa

Morphology: Adults: Cylinderical and transparent

Male < Female (in size)
Microfilariae: has several curves & kinks

Life cycle: Similar to the life cycle of W. bancrofti but

=>Adult worms inhabit (freely moving) the subcutaneous tissues

Man & Monkeys (natural Definitive), Simian (reservoir) &

horsefly (intermediate)
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 Conti… Loa loa
Pathology: form swelling (Calabar swellings) @ arms

Adult worms migrate in

sub-conjunctiva tissues

=> cause inflammation &

irritation but not blindness

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 Conti…. Loa loa
Lab Diagnosis
Finding microfilariae in stained blood films taken during day time

Occasionally the microfilariae can be found in joint fluid

Treatment: => Diethylcarbamazine

=> Surgical removal of adult worms in the eye

Prevention & Control: similar method like W. bancrofti

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