Lymphatic filariasis17102023 for MBBS students.pptx
- 1. Lymphatic filariasis Dr. Suman Saurabh Associate Professor, Department of Community and Family Medicine
- 4. Organisms and vectors Disease Causative organism Vector Malaria Protozoal parasite: P. vivax P. falciparum Mosquito anopheles Lymphatic filariasis Nematode: Wuchereria bancrofti Brugia malayi Mosquito Culex species (mainly Culex quinquefasciatus) Kala-azar Protozoal parasite: Leishmania donovani Sandfly (Phlebotomus Argentipes) Dengue Dengue virus (4 serotypes) Aedes aegypti mosquito Chikungunya Chikungunya virus Aedes aegypti mosquito Japanese encephalitis JE virus Culex species (mainly Culex tritaeniorhynchus)
- 5. Malaria An. culicifacies, An. fluviatilis, An. minimus An. sundaicus, An. stephensi, An. dirus Dengue Ae. Aegypti, Ae. Albopictus Filariasis Cx. quinquefasciatus, Ma. annulifera and uniformis Japanese Encephalistis Cx. vishnui, Cx. tritaeniorhyncus etc. Kala azar--- Sand fly Disease Vector species in India Malaria ,Kala-azar and Filaria in Elimination mode
- 6. National programme • The malaria control programme • Lymphatic Filariasis • Kala-azar • Japanese Encephalitis • Dengue • Chikungunya Integrated under National Vector Borne Disease Control Programme (NVBDCP) in Year 2002
- 8. GLOBAL BURDEN OF LF • Population at risk : 1.23 Billion • No. of countries: 73 • Hydrocele : 25 Million • Lymphoedema : 15 Million
- 10. NATIONAL BURDEN OF LF RAJASTHAN ORISSA GUJARAT MAHARASHTRA MADHYA PRADESH BIHAR KARNATAKA UTTAR PRADESH JAMMU & KASHMIR ASSAM TAMIL NADU TELANGANA CHHATTISGARH ANDHRA PRADESH PUNJAB JHARKHAND WEST BENGAL ARUNACHAL PR. HARYANA KERALA UTTARAKHAND HIMACHAL PRADESH MANIPUR MIZORAM MEGHALAYA NAGALAND SIKKIM GOA A&N ISLANDS D&N HAVELI PONDICHERRY LAKSHADWEEP TRIPURA DELHI CHANDIGARH DAMAN & DIU N E W S Endemic Non-Endemic Uncertain 21 states/UTs 257 districts 650 millions Hydrocele- 0.38 million Lymphoedema-0.84 million
- 11. Economic Impact of LF • Globally >2 billion USD lost per year • Approx. 5 million DALYs lost annually • Direct costs – ‘Out-of-pocket’ payments for care – Costs to health system • Indirect costs – Lost productivity (↓30%) – Social and Psychological impact
- 12. LIFE CYCLE OF FILARIAL PARASITE
- 13. Video courtesy District vector control unit, Kerala
- 14. Photo courtesy District vector control unit, Kerala
- 15. The parasite • Three parasites causing human filariasis: W. bancrofti B. malayi B. timori • In India W. bancrofti and B.malayi • W. bancrofti – Vector: Culex quinquefasciatus (Breeds in polluted water) - Contributes 99.4% LF in India - Distribution both urban & rural • B.malayi - Seven states – Kerala, Orissa, Tamil Nadu ( Rural areas) AP, MP, Assam, West Bengal in pockets - Vector: Mansonia sp (Breeding associated with aquatic plants, viz Pistia)
- 16. Filariasis vectors and their breeding spots Culex quinquefasciatus Mansonia annulifera Culex quinquefasciatus breeding spot Mansonia breeding places in Pistia plants
- 17. Natural History of Lymphatic Filariasis Un infected individuals Disease free microfilarial carrier state Acute disease manifestation Patients with chronic pathology
- 18. Lymphatic Filariasis Disease Manifestation Asymptomatic Symptomatic Acute • Adenolymphangitis • Acute epididymo- orchitis • funiculitis Chronic • Lymphoedema • Hydrocele • Elephantiasis • Chyluria
- 19. Clinical spectrum • Man-Natural host. • All ages and genders- susceptible to infection - Youngest age recorded with infection – 6 months - Peak age of infection= 20 – 25 yrs. • While infection occurs in child hood diseases manifests later. • Disease spectrum: – Endemic normal – Asymptomatic micro filarimia ● Sub clinical lymphatic pathology . – Acute manifestation – Chronic disease – Occult clinical manifestation » Tropical pulmonary Eosinophilia
- 20. Acute manifestation Acute Filarial lymphangitis (AFL): • Characterised by presence of dilated, inflammed and thickened lymphatic vessels associated with erythema, oedema,tenderness and pain. • Cause: Parturition of adult, release of diffusible toxin or death of adult worm. Dermato lymphangio adenitis (ADLA) * Entry lesion-Reticular lymphangitis and adenitis * Bacterial/Fungal infection GRADE II LYMPHEDEMA LEFT LEG WITH ACUTE LYMPHANGITIS
- 23. Entry lesions
- 24. Acute attack
- 25. Post - Acute attack
- 26. GRADE II LYMPHEDEMA LEFT LEG GRADE III LYMPHEDEMA BOTH LEGS WITH SKIN PIGMENTATION GRADE 1 LYMPHEDEMA LEFT LEG
- 28. Leg
- 29. Breast
- 32. Strategies for ELF Interruption of transmission of filariasis by Annual MDA for 5 years or more to the population except: children below 2 years pregnant women seriously ill persons (DEC + Albendazole ) Morbidity Management Home based management of lymphoedema cases up-scaling of hydrocele operations in the identified CHCs / District hospitals/ medical colleges.
- 33. How does MDA work ?
- 34. Elimination of Lymphatic Filariasis MDA Success depends on • High coverage (>65% of total population) • Sustained coverage over 5-7 years
- 35. 1 •Pre MDA 2 •During MDA 3 •Post MDA Activities for MDA
- 36. Doses of Albendazole and DEC according to age Medicine Eligible population Dose Albedazole-400 mg All persons above 2 years of age 1*400 mg DEC (100 mg) 2-5 years of age 1*100 mg DEC (200 mg) 6-15 years of age 2*100 mg DEC (100 mg) Above 15 years of age 3*100 mg
- 40. Advances in mass treatment • TRIPLE DRUG combination therapy • Small scale clinical trials & safety studies completed • More effective than two-drug therapy, very promising • Recently recommended by WHO for MDA • Rolled out in selected districts in India DEC + Ivermectin (12 mg adult dose) + Albendazole
- 41. Inaugural Ceremony DC Mr. Jatashankar Chaudhary inaugurated the Ceremony by consuming Anti Filarial Drug 45
- 42. Bhag Filaria Bhag- A School programme launched by the DC, Simdega in all Govt. & Pvt. Schools (approx. 377 in nos.) in mission mode for awareness regarding MDA. Filaria Rally & Media Sensitization Workshop 46
- 43. IEC Material Hoarding Banner Poster Wall Painting Broshure Handbill News Paper Advt. 47
- 44. Flag hoisting of Miking Van by MLA Sensitization of local leaders by DC Nukkar Natak in Village & Haat Awareness through Jhanki IEC Activities 48
- 45. Local Dose Pole Prepared by District Drug Compliance in School Local Leaders Meeting Field Monitoring by State Team 49
- 49. Morbidity Management Alleviation of Suffering & Disability Prevention
- 50. MORBIDITY MANAGEMENT Scope: a. Lymphoedema / Elephantiasis b. Hydrocele & other Genitourinary manifestations c. Acute ADL episodes Strategy: 1. Treatment & Prevention of acute episodes 2. Management of Lymphoedema 3. Appropriate surgery 3. Prevention of disease progression
- 51. • Twice-daily washing of the affected parts with soap and water • Raising the affected limb at night • Regularly exercising the affected limb to promote lymph flow • Keeping the nails clean • Wearing shoes • Use of antiseptic or antibiotic creams to treat small wounds or abrasions. Management Regimens
- 52. LOCAL HYGIENE Care of affected limb: Wash with soap & water. If infected wounds or entry lesions in deep folds, use anti septic Keep skin dry & clean Care of nails Entry lesions Topical antifungals Topical antibiotics
- 62. Hydrocele surgery • Hydrocelectomy is usually done in CHCs, district hospitals or medical colleges free of cost. • Programme emphasises to intensify the hydrocele operations in camp mode for more operations • The incentives to promote such activities are provided @ Rs.750 per case • Some states pay more out of state resources but it varies from state to state
- 63. THANK YOU
Editor's Notes
- #10: The learning objectives for this session are the following: To describe the difference between probability and non-probability sampling To list the advantages & disadvantages of various types of probability and non-probability samples, and To differentiate between sampling error and bias
- #26: Acute attack This slide illustrates the limb during an acute attack. Note the swelling, redness and the shiny skin. In the second picture you can clearly see the entry lesions that occurred during the acute attack.
- #27: Post - Acute attack This clinical photograph illustrates the events that are seen after the acute attack. These include blistering of the skin and the separation of the dead skin as seen over the sole.