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DEPARTEMENT OF PARASITOLOGY
FACULTY OF MEDICINE
USU
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LEARNING ISSUES:
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References
• King, C.L. 2001. Transmission intensity and human immune
responses to lymphatic filariasis. Parasite Immunology 23 (7),
363–371
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Lymphatic Filariasis
Caused by worms:
- Brugia malayi
Wuchereria
- Wuchereria bancrofti
bancrofti
Brugia
- Brugiamalayi
timori
Brugia timori
Vector: Mansonia sp
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B.malayi
- Wrinkled body
curve
- Sheath stained
pinkish-red
- Overlapping body
nuclei
- Presence of sub-
terminal and
terminal nucleus
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Wuchereria bancrofti
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Brugia timori
- Overlapping body
nuclei
- Sheath does not
stain pinkish (bluish)
- Tapered tail
- Presence of sub-
terminal and terminal
nucleus
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Pathogenesis
Inflammation occurs when worms die, either drug-
induced or spontaneously.
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Pathogenesis
Lymph vessels dilation, not obliteration, is probably the
early event following antigenic stimulation, which
spring larvae are being released. These larvae are
degenerate and will be taken up by phagocytic cells.
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1. Clinical manifestations:
a). Acute filariasis
b). Chronic filariasis
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1.a). Acute manifestations
- Characterised by recurrent
attacks of
fever associated with inflammation
of lymph nodes (adenitis) and /or
lymph vessels adenolymphangitis, ADL)
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- Involvement of genitalia lymphatic in male –
funiculitis, epididymitis or orchitis (specific on
parasite W. bancrofti)
- Lasting for 4-5 days
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Acute manifestation: ADL
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ADL with secondary bacterial infection
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1.b). Chronic manifestation
Major signs
Hydrocoele
Swelling of
scrotum due to
collection of
lymph fluid
Chyluria
Lymphoedema
Elephantiasis
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Chronic manifestation
Major signs:
Hydrocoele
Chyluria
- rupture of lymphatic lining
the bladder leading to passage
of lymph in the urine
- may resolve spontaneously
- lymphocytes in urine
Lymphoedema
Elephantiasis
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Chronic manifestation
Major signs
Hydrocoele
Chyluria
Lymphoedema
Swelling due to
collection of lymph
fluid in soft tissue
Pitting oedema, may
or may not be
reversible
Thickened skin
Elephantiasis
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Chronic manifestation
• Major signs
– Hydrocoele
– Chyluria
– Lymphoedema
– Elephantiasis
• Irreversible, non-pitting
oedema with fibrotic and
verrucous skin changes
(thickening, folding,
hyperkeratosis,
pigmentation, ulceration)
• Skin & soft tissue infection
common
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Chronic manifestation
• Rarely develop before 15 years
• Only a small proportion of filarial-infected
population affected
• Immigrants tend to develop chronic manifestation
more often and sooner than indigenous people
• Occurrence of major signs differ between places
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Lymphatic vessel dilatation, valve incompetency,
lymphatic back flow, pooling & oedema
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Adult worm in the lymphatic
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2. a) Microscopy for microfilaria
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2.b) Immunodiagnosis:
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Volume of blood: standardisation
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2.c). Molecular techniques (PCR)
- DNA radioactive and non radioactive probes Hha 1,
capable detecting B. malayi in blood samples
- PCR amplifies DNA using specific primers. Detecting
B. malayi and W.bancrofti
2.d). Ultrasonography
Detect the motile adult worms within the
lymphatics, scrotum and breast (term as “filarial
dance” signs). Detecting W. bancrofti only.
.
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Ultrasonagraphy & Doppler’s Technique in
Filariasis
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Treatment
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- Ivermectin. Dose: single dose 120 µg/kg
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Side effect of DEC:
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PROGNOSIS
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