FILARIASIS

DEFINITION
Lymphatic Filariasis also known as Elephantiasis
is a parasitic tropical disease that is caused by an
infection with a filarial nematodes (roundworms)
and is transmitted to humans through a mosquito
bite. It is considered a neglected tropical disease
and usually acquired in childhood and causes
damage in the lymphatic system.

ETIOLOGY
Lymphatic Filariasis is caused by infection with
nematodes (roundworms) of the family
Filariodidea. There as three types of thread-like
filarial worms including Wuchereria bancrofti,
which is responsible for 90% of the cases, Brugia
malayi, which causes most of the remainder of the cases and, Brugia timori, which also causes the
disease. Lymphatic filariasis is transmitted by three different mosquito vectors: Aedes mosquitoes that is
common in urban and semi-urban areas, Anopheles that is common in Rural areas, and Culex mosquitoes
in the Pacific Region.
Life Cycle
This begins with the introduction of
nematode larvae to the human host
during the blood meal by an infected
mosquito. The larvae then migrate to the
lymphatic system and mature into adult
worms over the course of 3 to 6 months.
Adult female subsequently release
microfilariae – pre larval form of the
filarial worm into the lymph and blood
vessels. In turn, unaffected mosquitoes
become vectors when they ingest these
microfilariae during a blood meal of an
infected human host. The microfilariae
penetrate through the mid gut of the
mosquito transform into larvae within the
thoracic muscles and then migrate to the
proboscis where it can be introduced into
its next host.

PATHOPHYSIOLOGY
Although L3 larvae are capable of causing infection, they do not exhibit any pathogenic effects. Likewise,
the presence of circulating microfilariae does not induce pathogenic effects.The pathogenic effects arise
from the presence of fourth stage larvae, as well as the moulting stage from L3 larvae and adult worms,
whether they are alive or dead, within the lymphatic vessels.
The following stage occur sequentially during the pathogenesis or lymphatic filariasis.

I. Dilation of lymph vessels

Inflammatory reactions are induced by the developing larva, metabolic products released during larval
moulting, unsheathing of microfilariae during moulting, and the presence of adult worms. During the
initial phase of infection, there is a notable increase in the inflammation of lymph vessels, resulting in
their growth. In addition to the presence of inflammation, the immune response of the host towards the
worms, as well as the toxic effects induced by the worms, contribute to the dilation of lymphatic vessels.
The dilation of lymphatic vessels results in an augmented release of proteinaceous substances from the
lymphatics into the adjacent tissue, which subsequently leads to the development of noticeable
lymphedema and thickening of the endothelium.

II. Infection of lymphatic vessels (lymphangitis)

The development of infection is characterized by the occurrence of lymphangitis. The condition is
distinguished by the existence of dilated, inflamed, and thickened lymphatic vessels accompanied by
erythema, edema, and tender and painful areas. The primary etiologies of lymphangitis include:
● The sensation of irritation arises as a result of the movement of the mature worm inside the
lymphatic system.
● The excretion of metabolic waste products by the larval stage
● The process of host cell absorption of toxic substances released by dead worms.
● The presence of secondary bacterial infection caused by streptococci is seen.

III. Obstructions of the lymph node

Lymphangitis is thereafter accompanied by necrosis, sclerosis, and blockage of lymphatic channels
located proximal to the lymph nodes. The obstruction of lymph flow may occur as a result of several
factors, including the;
● presence of parasitic worms inside the lymphatic vessels, thickening of the lymphatic vessels, and
the occurrence of localized necrosis.
● The blockage of lymphatic vessels occurs due to the growth of giant cells, fibrosis, and cellular
alterations.
● Elephantiasis, characterized by the conventional trait of obstructed lymph flow, occurs as a
consequence.
The progression of events in the development of lymphatic filariasis is diverse and dependent upon the
interplay between multiple factors involving the host and the parasite.

RISK FACTORS
● Residing in or visiting tropical or subtropical areas that have endemic filariasis commonly in
Africa, Asia, Carribean and parts of South America.
● Multiple bites of mosquitoes.
● Indivuaduals with a compromised immune system such as those afflicted with HIV/AIDS or
undergoing certain treatment regimens.
● Residing in crowded or poor sanitary conditions such as with standing water.
● Gender. Men are at slightly higher risk for filariasis infection than women.
● Age. Children and older adults has a higher risk of getting filariasis.

CLINICAL MANIFESTATIONS
The cause of Lymphatic Filariasis may be attributed to the presence of both juvenile and adult worms of
W. Bancrofti. The signs and symptoms depends on the several stages of the diseases as follows:
● Endemic Normal: No apparent clinical signs and symptoms
● Asymptomatic Stage: Individuals at this stage exhibit the presence of microfilariae in their
bloodstream, however do not have any apparent clinical manifestations of filariasis.
● Acute Filariasis: The inflammatory phase of acute filariasis is initiated by the release of antigens
from female adult worms.
- Filarial Fever: a low-grade fever but may sometimes become severe.
- Chills
- General Malaise
 - Headache
- Pain
- Lymphedema: condition characterized by the accumulation of lymphatic fluid
- Lymphadenitis: aka adeno-lymphangitis (ADL)
● Chronic Filariasis: The obstructive phase typically requires a period of 10-15 years for its
development.
- Lymph varices: pathological condition characterized by the restriction of lymphatic flow
and subsequent buildup of lymph inside the ducts, resulting in the dilatation of these
channels.
- Hydrocele: arises due to the blockage of lymph veins inside the spermatic cord, as well
as the exudation originating from the inflamed testis and epididymis.
- Elephantiasis: pathological disorder characterized by significant hypertrophy of a
specific region of the body, often in the limbs. The external genitalia are often impacted
in various circumstances. Elephantiasis is a medical condition that arises from the
blockage of the lymphatic system, leading to the buildup of lymph fluid in the affected
regions.
- Hypertrophy and hyperplasia are seen as outcomes of an overabundance of protein
within the lymph exudates, which then stimulates excessive development in the
connective tissue.
- Chronic elephantiasis is characterized by the manifestation of the condition in the
scrotum, legs, and arms of males, and in the legs and arms of females.
- The affected region undergoes significant enlargement, resulting in the formation of a
solid mass resembling a tumor.
- The epidermal layer of the integumentary system has a roughened texture, characterized
by the presence of papillomatous formations.
- The hair follicles undergo a transformation, resulting in a rough and diminished hair
thickness.
- A section of the epidermis resembles an immature pear in that it is fibrous, enlarged,
and dense.
- The subcutaneous tissue exhibits a bluish hue, revealing lymphatic vessels and veins
that have become dilated and distended.
- Typically, there is no observable change in the underlying musculoskeletal structures.
- A granuloma of the breast is distinguished by the existence of a solitary film-like mass
within the breast.
- Chyluria: The presence of chyle in the urine, along with blood and, at times,
microfilariae. This condition is attributed to the leakage of chyle into the urine as a result
of the rupture of varicose chyle veins inside the mucosal membrane of the urinary tract.

MEDICAL MANAGEMENT
1. Medical care involves the use of antiparasitic medications, such as diethylcarbamazine (DEC),
ivermectin, albendazole, or doxycycline which are prescribed to eliminate filarial worms
2. Antibiotics to treat secondary infections
3. The treatment of elephantiasis may include the implementation of several strategies to address
swelling, as advised by healthcare professionals. These strategies may include the elevation of the
affected limb or the use of compression therapy, massage.
4. Surgical intervention may be used to extract dead parasites from the system. In cases where
filariasis has resulted in the development of hydrocele, surgical intervention may be pursued as a
means to alleviate the accumulation of fluid inside the scrotum.
NURSING CONSIDERATIONS & MANAGEMENT
1. Monitor the patient’s vital signs and address if there are problems after vital signs monitoring.
2. Educate patient about the proper lymphedema care such as to properly clean and cover up or
bandage the wounds, to elevate the limbs that are swollen, like the arms or legs, to participate in
physical exercise as a means to improve lymphatic fluid circulation, suggesting that swollen parts
of the body be must be cleaned and dried out regularly, to wear the right footwear to lower the
risk of falling and getting injured.
3. Educate the patient about the disease, the cause, signs and symptoms, complications, and proper
treatment of the disease condition. Instruct the patient on how to take the medications prescribed
by the physician.

PREVENTION
● Mass Drug Administration (MDA): Distribution of antiparasitic drugs in endemic areas
● Lymphatic Filariasis Elimination Programs: Public health programs aim for disease
control of mosquito vector populations, conducting health education including hygiene
and sanitation practices.
● Use of mosquito nets
● Use of mosquito repellents (DEET ) and insecticides
● Use of long sleeves and pants
● Avoiding mosquito bites

REFERENCES

World Health Organization: WHO. (2023, June 1). Lymphatic filariasis.

https://www.who.int/news-room/fact-sheets/detail/lymphatic-filariasis
Bronze, M. S., MD. (n.d.). Filariasis: practice essentials, background, pathophysiology.
https://emedicine.medscape.com/article/217776-overview#a4'
Karki, G. (2020, May 19). Lymphatic filariasis (W. bancrofti): transmission, Pathogenesis, clinical
manifestation and treatment. Online Biology Notes.
https://www.onlinebiologynotes.com/lymphatic-filariasis-w-bancrofti-transmission-pathogenesis-
clinical-manifestation-and-treatment/
Lymphatic filariasis. (2021, September 1). CDC.
https://www.cdc.gov/parasites/lymphaticfilariasis/epi.html
https://my.clevelandclinic.org/health/diseases/21925sis-filaria