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Filariasis, Onchocerchiasis

Filarial infections in humans are primarily caused by four species: Wuchereria bancrofti, Brugia malayi, Onchocerca volvulus, and Loa loa, with W. bancrofti being the most widespread. Lymphatic filariasis can lead to severe complications such as lymphedema and hydrocele, while onchocerciasis, known as 'river blindness', can cause significant ocular damage and skin lesions. Diagnosis involves identifying microfilariae in blood or skin samples, and treatment options include medications like diethylcarbamazine and ivermectin.

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3 views15 pages

Filariasis, Onchocerchiasis

Filarial infections in humans are primarily caused by four species: Wuchereria bancrofti, Brugia malayi, Onchocerca volvulus, and Loa loa, with W. bancrofti being the most widespread. Lymphatic filariasis can lead to severe complications such as lymphedema and hydrocele, while onchocerciasis, known as 'river blindness', can cause significant ocular damage and skin lesions. Diagnosis involves identifying microfilariae in blood or skin samples, and treatment options include medications like diethylcarbamazine and ivermectin.

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demissdan2010
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We take content rights seriously. If you suspect this is your content, claim it here.
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FILARIASIS

Azeb Kebede (MD)


Introduction
• Filarial worms are nematodes that stay in the
subcutaneous tissues and the lymphatics
• Eight filarial species infect humans of these, four are
responsible for most serious filarial infections
– Wuchereria bancrofti,
– Brugia malayi,
– Onchocerca volvulus, and
– Loa loa
• The first two affect the limphatics
• The others affect subcutaneous tissue
Lymphatic Filariasis

• Lymphatic filariasis is caused by Wuchereria


bancrofti, Brugia malayi or Brugia timori.
• W. bancrofti is the most widely distributed
filarial parasite of humans.
• Filariasis is due to the presence of adult
W.bancrofti in the lymphatic system or
connective tissues of man.
• Many species of mosquito (Anopheles, Culex,
Mansonia and Aedes )are vectors.
• W. bancrofti larvae are in lesser number
(scarce) in the peripheral blood by day and
increase at night
Pathology
• The principal pathologic changes result from
inflammatory damage to the lymphatics
• Damaged or incompetent lymph valves---
– Lymphedema and chronic stasis changes with hard
or brawny edema develop in the overlying skin
• These consequences of filarial infection are
due both to the direct effects of the worms
and to the host's inflammatory response to
the parasite
Clinical features
• Hydrocele
• Acute adenolymphangitis
• Chronic lymphatic disease
• Microscopic hematuria and/or proteinuria
• Scrotal lymphangiectasia
• Scrotal lymphedema and scrotal elephantiasis
• Fissuring of the skin develops, hyperplastic
changes.
Diagnosis

• Difficult because microfilaria may not easily be


identified.
• Definitive diagnosis is by demonstration of
microfilaria from blood, hydrocele fluid or
other body fluids at night.
• ELISA
• PCR
• Ultrasound /Doppler of the testis
Treatment
• Diethylcarbamazine [(DEC), 6 mg/kg daily for
12 days],
• Albendazole 400mg twice daily for 21 days
• Hydroceles drained repeatedly or managed
surgically
• Hygiene, prevention of secondary bacterial
infections, and physiotherapy to decrease the
lymphedema
Onchocerciasis

• Onchocerciasis ("river blindness") is caused by


the filarial nematode Onchocerca volvulus.
• Onchocerciasis is the second leading cause of
infectious blindness worldwide.
• Infection in humans begins with deposition
infective larvae on the skin by the bite of an
infected black fly.
• The blackfly vector breeds along free-flowing
rivers and streams
Pathology
• Onchocerciasis primarily affects the skin, eyes,
and lymph nodes.
• Neovascularization and corneal scarring lead
to corneal opacities and blindness
• Inflammation in the anterior and posterior
chambers frequently results in anterior uveitis,
chorioretinitis, and optic atrophy.
Clinical Features

• Subcutaneous nodules (onchocercomata) are


the most characteristic lesions of onchocerciasis
• Pruritus and rash
• Eczematous dermatitis and pigmentary changes
are more common in the lower extremities.
• Photophobia, sclerosing keratitis & blindness
• Enlarged inguinal lymph nodes
DX & Rx
• Diagnosis-- demonstration of the microfilariae
in the skin snip or nodules
• Rx--Ivermectin orally in a single dose of
150mg/kg, yearly or semiannually is the
treatment of choice.
– No agent so far eradicates the adult worm.
– The drug is microfilaricidal
– Prevents blindness due to optic nerve disease by
50%

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