FILARIASIS
Dr. Ajay Poudel
Lecturer
Department of Microbiology,
CMC
• Filariasis parasitic disease caused by an infection with roundworms of the Filarioidea type.
•Includes nematodes inhabiting the blood vessels, lymphatic system, connective tissues and
serous cavity of Man and animals
•spread by blood-feeding mosquitoes and black flies.
•Life cycle in two hosts: Man and a certain blood-sucking insect
Microfilar of W. bancrofti, from a patient seen
in Haiti - the thick blood smears are stained
with hematoxylin
Different types of filariasis
• Lymphatic filariasis
– caused by the worms Wuchereria bancrofti, Brugia malayi, and Brugia timori.
– Adult worm occupy the lymphatic system; Microfilaria in blood
– In chronic cases, these worms lead to the syndrome of elephantiasis.
• Subcutaneous filariasis
– Loa loa (the eye worm), Mansonella streptocerca and Onchocerca volvulus.
– Adult worms occupy the subcutaneous layer of the skin
– microfilara of L. loa found in blood
– microfilaria of M. streptocera and O. Volvulus, found in skin
– L. loa causes Loa loa filariasis, while O. volvulus causes river blindness.
• Serous cavity filariasis
– caused by the worms Mansonella perstans and Mansonella ozzardi,
– Adult occupy the serous cavity of the abdomen and microfilaria in blood
Wuchereria bancrofti
Geographic distribution
• Largely confined to tropics and subtropics,
• India, Southern China, Japan, pacific islands, West and Central
Africa and south America
Habitat:
• Adults worms in lymphatic vessels and lymph nodes of man only
• Not zoonotic disease
Morphology
Adult worm
Long hair-like transparent nematodes (often creamy-white color)
Life span long (5-10 years)
Male:
•2.5- 4 cm length and 0.1 mm in thickness.
•Tail-end curved ventrally and contains two spicules of unequal length
Female:
•8-10 cm in length and 0.2-0.3 mm in thickness.
•Tail- end is narrow abruptly pointed.
•Although liberating active embryos, are really ovo-viviparous ( laying eggs with
well developed embroys)
Embryos (Microfilariae)
•When unstained, colourless and transparent bodies with blunt heads and rather
pointed tails
•290 μm in length and 6-7 μm in breadth
•Larval form do not undergo further development in human body
A hyaline sheath :
• a sac projected slightly beyond the terminal of embryo.
• Larva can move forwards and backwards within it
Somatic cells or Nuclei
• granules in central axis of body and extended from head to the tail end
No nuclei in the tip of tail
Periodicity of W. bancrofti
• Microfilariae in Oriental countries ( India, Nepal, China) are not constantly present in
peripheral blood
• But appear periodically at night mostly between 10 PM to 4 PM (nocturnal periodicity)
• It has been suggested that during day time retire principally inside capillaries of lungs,
kidney, heart and big arties
• Mechanism of nocturnal periodicity not known but presumed to be in some way related
with night-feeding habitat of its intermediate host , mosquito
Definitive host: Man (Adult in lymphatic system)
Life cycle Intermediate host: Mosquito (microfilariae further development)
Mode of infection of Wucheria bancrofti
Transmitting agent:
• female mosquitoes (Culex, Aedes and Anopheles)
• India/ China: Culex pipiens fatigans (C. p. quinquefasciatus)
• Pacific Island such as Fiji and New Caledonia: Anopheles puctulatus
• Infective satge: 3rd stage larvae
Typical vector for Brugia malayi filariasis are mosquito species from the
genera Mansonia and Aedes
Adult worms B. malayi
• Resemble those of Wuchereria bancrofti but are smaller.
• Female worms measure 43 to 55 mm in length by 130 to 170 μm in
width,
• Males measure 13 to 23 mm in length by 70 to 80 μm in width.
Microfilariae
• 177 to 230 μm in length and 5 to 7 μm in width
• Sheathed and have nocturnal periodicity
Pathogenicity of
Wuchereria bancrofti:
• Pathogenic effects due to living or dead adult worms.
• Living microfilaria in blood circulation not produce any pathogenic effect ( except in
occult filariasis)
• Injurious influence by adult worm on host is an inflammatory reaction of lymphatic
system, lymphangitis
• Lesion in occult filariasis is by microfilaria in lymphnodes and lungs and liver,
spleen
Symptoms
• Lymphatic filariasis infection involves asymptomatic, acute, and chronic conditions.
The majority of infections are asymptomatic,
• still cause damage to the lymphatic system and the kidneys, and alter the body's immune system.
When lymphatic filariasis develops into chronic conditions
• leads to lymphoedema (tissue swelling) or elephantiasis (skin/tissue thickening) of limbs and
hydrocele (scrotal swelling).
• Involvement of breasts and genital organs is common.
• Such body deformities often lead to social stigma and sub-optimal mental health, loss of income-
earning opportunities and increased medical expenses for patients and their caretakers.
Acute episodes of local inflammation involving skin, lymph nodes and lymphatic vessels
• often accompany chronic lymphoedema or elephantiasis.
• Some of these episodes by the body's immune response to the parasite.
• Most are the result of secondary bacterial skin infection where normal defences
have been partially lost due to underlying lymphatic damage.
• acute attacks are debilitating, may last for weeks
PC
Diagnosis
1. Direct
A. Microfilaria in thin or thick film of blood- Most common
Blood collection should be done at night
Microfilaria Not found in peripheral blood:
• In case of elephantiasis, due to lymph obstruction
• After attack of lymphangitis , due to the death of adult worm
• During early allergic manifestation
• In occult filariasis
B. Detection of Adult in biopsy lymph node- rare
C. Calcified worm by X-ray
C) PCR
Lyphamtic filariasis is caused by
Entamoeba histolytica
Giardia lamblia
Onchocera volvulus
Difilaria conjunctivae
Wucheria bancrofti
Loa loa
Brugia malayi
