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Type of filariasis Worm species Vector

Clinical features

Diagnosis

Treatment

Prevention

Lymphatic filariasis Wucheria bancrofti Brugia malayi, Brugia timori Culex Mansonia spp. Anopheles spp. Aedes spp. Acute phase (inflammatory filariasis) Due to sensitization to products of living and dead worms Suffer from malaise, fever due to acute lymphagitis, lymphadenitis Males; acute epididumo-orchitis Chronic phase Lymphedema; grade 1 (pitting edema, reversible with limb elevation), grade 2 (nonpitting edema, irreversible on limb elevation), grade 3 (elephantiasis) Chyluria; often associated with gross hematuria, reflux of intestinal lymph node into renal lymphatic (LN obstruction below cysterna chili), rupture, chyle flow to urinary system. Urine white (morning), red (later in the day) Elephantiasis; large irregular folds of skin and subcutaneous tissue, affect limb, breast, scrotum, penis. Result of obstruction of lymph node, thickened with surrounding edema, inflammatory cell reaction. Some associated with phlebitis, capillaries inflammation and trauma by worms. Hydrocele; scrotal fluid accumulation, due to obstruction in retroperitoneum, not common in bancroftian but common in brugian. *mainly by adult worms Blood examination (to look for mf); wet mount prep, stained thick blood film, concentration technique Sheathed Sheathed Smooth body curve Kinky body curve Cephalic space 1:1 ratio Cephalic space 1:2 ratio countable body nucleus terminal nucleus Serology test; ICT, brugia rapid DiEthylcarbamazine Citrate (DEC) Ivermectin (Mectizan) Albandazole Vector control, protection from vector Host treatment Mass control program, education

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Types of filariasis Worm species Disease Vector Clinical features

Diagnosis

Subcutaneous filariasis Onchocerca volvolus Onchocerciasis, River Blindness Blackfly, Simulium spp Early infection; asymptomatic Blackfly bites are painful and may bleed, multiple bites result in urticaria and itching (intense with swelling, hyper pigmentation, diffuse popular eruption and regional lymphadenopathy) Caused by adult worm; onchocercoma (subcutaneous nodule containing adult worm) Flattened, firm, mobile and tender, 3 discrete layer Outer fibrous layer of granulation and scar tissue Middle inflammatory cells (eosinophil, plasma cells, foamy macrophages) Central core, contain adult male and female worms Caused by micro filarial Dermatitis; degeneratinf mf at upper half of body.skin pigmentation result in leopard spot, to skin thickening, progress to severe wrinkling. End is fibrosis Non tender lymphadenopathy, lymphedema and protrusion of superficial nodes (lymph node obstruction from migrating mf) Eye lesion; penetration by mf. Both portions. Anterior portion lead to punctate keratitis, common in young people and reversible. When chronic inflammation lead to sclerosing keratitis and iridocyclitis result in blindness. Posterior portion, chorioetinitis and optic nerve atrophy may cause blindness Skin examination (to look mf) Without sheath Anterior end; shape of spatula

Loa loa Loasis, Calabar swelling/ eyeworm Deerfly, Chysops spp Calabar swelling; focal angiodema located at extremities Cause is unknown but may represent an immune response to antigenic material where the worm has migrated Occur one site at a time, may recur sporadically More common in visitor to an endemic region than local inhabitants Fatigue and arthralgias not uncommon Adult worm wander at scrotal skin, spermatic cord, subconjunctival tissue of the eye Adult worm early visible and do not form nest

Blood examination (to look for mf) Kinky Posterior end always curl-up towards body

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Treatment Prevention

Posterior; body nucleus not present Drug; ivermectin Nodulectomy Reduction in human fly contact Treatment Vector control Individual control Education

With sheath Drug; DEC Removal of adult worm from conjunctiva Avoid the bites of Chrypsops flies Destruction of Chrypsops flies Treatment

Mansonella spp. Species Mansonella streptocerca Mansonella perstans Mansonella azzardi Adult Mf Just below the surface of the skin Serous cavity of the Peripheral blood abdomen and chest Live in mesenteric and Peripheral blood subperitoneal tissue Blood and skin Diagnosis Skin snip Blood examination Vector Cullicoides midges

Cullicoides midges and simulium blackfly

*cause allergic reaction *does not require treatment

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