 Slender, filiform, creamy white worms

 Range from 2 to 50 cm. long (adult)

 Females are 2x the size of males
 Arthropod transmitted
 Affect the circulatory, lymphatic and
muscular systems, connective tissues and
serous cavities
 Bancroftian filariasis, wuchereriasis
 Elephantiasis
 Humans are the only known definitive host
 Adult worms are located in the lymphatics
 Microfilaria (larval stage) are found in the blood
and lymph
 Microfilariae are sheathed
 Adults are tightly coiled in the nodular dilations
of the lymphatic vessels and sinuses of lymph
nodes
 Nocturnal periodicity is very distinct
 Causative agent of malayan filariasis
 Adult and microfilaria closely resembles that
of W. bancrofti
 Nocturnal periodicity is less distinct
POSTERIOR ANTERIOR
 Adult females are viviparous
 Microfilariae migrate into the bloodstream and are
ingested by mosquitoes during blood meal
 Microfilariae migrate to the muscles of the mosquito
 Larvae develop 6 – 20 days and force their way out of
the muscles and migrate to the proboscis
 Developed larvae are transferred to another human
host during blood meal
 Larvae pass to the lymphatic vessels and nodes and
mature (6 months or more)
 Adults frequent the lymph vessels of the lower
extremities, groin glands, epididymis or labial glands
 Aedes polynesiensis
Brush mosquito
Day biter, nondomesticated, rural, sylvatic

Culex quinquefasciaticus
Night biter, domesticated, urban
mosquito
 ANOPHELES AEDES
(URBAN OR SUB-URBAN) (BRUSH MOSQUITO)
MANSONIA PISTIA
NIGHT BITERS (BREEDING SITE OF MANSONIA)
 Tropical and subtropical
 Africa, Asia, Philippines
 Correlated with the population density,
presence of vector, and poor sanitation
 Sri Lanka, Indonesia, Philippines, China,
Korea, Japan and other Asian countries
 Correlated with the population density,
presence of vector, and poor sanitation
 Bancroftian filariasis
 Malayan filariasis
 Caused mainly by living, dead and
degenerating adult worms
 Microfilariae cause less pathologic response
 Pseudotubercular The walled
Adult worms in the granulomatous degenerating
lymph reaction around worm occludes the
the trapped adult lymphatics
worm

Lakes of lymph Dead worm is

fluids develop in Lymphatics absorbed and
the lymph sinuses become varicose replaced with
and lymph nodes hyalinized or
calcified scar tissue
 Asymptomatic filariasis
 Inflammatory filariasis
 Obstructive filariasis
 When children are exposed to infection at an
early stage
 Adults exhibit microfilariae in the blood
without symptoms
 Moderate to general enlargement of the lymph
nodes during physical examination
 Blood examination shows numerous
microfilariae
 Adults die and microfilariae disappear without
symptoms
 Immunologic phenomenon caused by sensitization
to the product of living and dead adult worms
 Characterized by funiculitis, epididymitis, orchitis,
retrograde lymphangitis of extremities, localized
swelling and redness of arms and legs
 May be accompanied by fever, headache, vomiting
and malaise
 Most patients do not have microfilaremia
 Elephantiasis
 End result of filariasis
 Develops slowly usually following years of continuous
filarial infection
 Preceded by chronic edema and repeated
inflammatory attacks
 Cellular reaction and edema are replaced by
fibroblastic hyperplasia
 High protein content of the lymph stimulates the
growth of dermal and collagenous connective tissue
 Over a period of time, the enlarged areas harden
EPI DYDIMITIS HYDROCELE
 Lymphangitis, lymphadenopathy, abcess
formation in the inguinal nodes occur more
frequently with B. malayi
 Elephantiasis in B. malayi is generally
confined to the distal extremities
 Involvement of the male genitalia (funiculitis
and orchitis) is more common in W. bancrofti
 Rupture of the lymphatics of the kidney can
occur in W. bancroftie resulting in chyluria
 Identification of microfilariae in the blood
 History of exposure to endemic areas
 Place a drop of blood on a slide and examine
under LPO for actively moving microfilariae
 Recommended time to collect blood: 8pm. – 4am.
Best time: 10pm. – 2 am.
 To determine the species: stain thick or thin blood
smear with Wright’s or Giemsa to bring about the
differential characteristics
 W. bancrofti microfilariae may be present in urine
KNOTT’S CONCENTRATION NUCLEOPORE

 Used to detect light  Slightly more sensitive

infection  Filtration of 1 – 5 ml. of
 1ml. of night blood is laked heparinized blood through
in 10ml. of 2% formalin a 5µ of Nucleopore filter
solution  The stained filter is placed
 Sediment is examined on a slide and examined
directly or may be dried
and stained.
 Approximately 6-12 months may elapse from
time of infection until worm matures and
produce microfilariae
 Late in the disease (elephantiasis), adult
worms and microfilariae may both have died
 The standard drug for treatment of most filariasis
 Dosage is 2 mg. per kg t.i.d. for 12 days
 Clears the blood of microfilariae but is also
believed to affect adult worms
 Has the important disadvantage of producing
significant/severe side effects
 Fever, arthralgia, adenopathy, headache,
prostration
 May be the effect of the sudden death of large
number of microfilariae
 Exact mechanism of side effects still unknown
 Found to be almost equally effective as 12 days
of DEC in rapid clearance of microfilaremia
 Unlike DEC, it is given in single dose only
 10% to 20% recurrence occurs 3 to 6 months
after treatment
 Has approximately the same side effects as DEC.
 Mechanical devices can be used to reduce edema
 Surgery to remove excess connective tissues in
elephantiasis give short term benefits but long
term complications
 Control of mosquitoes and human sources of
infection
 Spraying of houses with insecticides and
larvicides are effective for domesticated
mosquitoes only
 Protection of individual by screened quarters,
bed nets, mosquito repellant and protective
clothing (educational and economic problem)
 Human loiasis is confined to the rain forest
and swamp forest areas of West Africa. It is
especially common in Cameroon and on the
Ogowe river.
 Loiasis is caused by the filarial nematode Loa
loa which is transmitted to humans by day-
biting Chrysops flies
 Once inside the body the infective larvae
develop slowly into a mature adult (the process
takes about a year).
 During this period it lives and moves around the
fascial layers of the skin.
 Loa loa often makes frequent excursions
through the subdermal connective tissues.
 Once they reach maturity (measuring 3-3.4 cm x
0.35-0.43 mm for males and 5.7 x 0.5 mm for
females) the adults mate and produce sheathed
microfilariae 298 x 7.5 micrometers in size.
 Damage is usually caused by migrating worm
 Worm may migrate to the eye and damage the
cornea
 Immune reactions to the worm may cause
inflammation called Calabar swelling: painful
swelling usually in the extremities
 Recurrent swelling can lead to the formation of cyst
like enlargements of the connective tissues around
the tendon sheaths.
 Dying worms can also cause chronic abscesses
followed by granulomatous reactions and fibrosis.
 Detection of the microfilariae
 May be found in the blood, urine, sputum,
and spinal fluid
 Human onchocerciasis is found in both the Old and
New World but about 95% of all cases are in Africa.
 Caused by the filarial parasite Onchocerca volvulus.
The infective larvae are normally transmitted by the
bite of Simulium flies
 Simulium flies can only breed in well oxygenated water
because their larvae have an obligatory aquatic stage
during which they require high oxygen tension
 Accordingly onchocerciasis and the blindness it can
lead to are associated with fast flowing rivers with
rapids and onchocerciasis is often referred to as 'river
blindness'
 The infective larvae of Onchocerca enter the body through the
wound made by the bite of its host fly.
 The larvae then move to the subcutaneous tissues where they
become encapsulated nodules and mature into adults in
approximately one year
 After mating the female vivipariously gives birth to
microfilariae 300 mm in length and 0.8 mm in diameter. The
microfilariae are sheathless with sharply pointed recurved
tails.
 The microfilariae can be found free in the fluid within the
nodules and in the dermal layers of the skin spreading
centrifugally from the area where an adult lies.
 Microfilariae also can be found in the blood and eye during
heavy infections. They infect their fly vectors while the flies
are feeding on the human host and mature into stage three
infective larvae in the flies' flight muscles
 One of the earliest signs of infection with Onchocerca is the
raised nodules that can be seen under the skin around areas
over bony prominence. It is suggested that this
phenomenon occurs because the larvae are immobilized in
these locations (while the host is sleeping) long enough for
them to be trapped by the body's cellular defense
mechanisms
 Reactions to dead microfilariae around these nodules can
lead to several unpleasant conditions. In the skin there is
destruction of the elastic tissues and the formation of
redundant folds.
 There is also often a loss of pigmentation and the
histological appearance of advance cases often resemble the
skin of very old normal subjects
 The microfilariae can also enter the eye by
passing along the sheaths of the ciliary vessels
and nerves from under the bulbar conjunctiva
directly into the cornea, via the nutrient vessels
into the optic nerve, and via the posterior
perforating ciliary vessels into the choroid.
 Dead microfilariae in the eye lead to an
inflammatory immune response and the
eventual formation of secondary cataracts and
ocular lesions. Because of this, heavy infections
often lead to progressive blindness.
 The microfilariae can also cause inflammation
of regional lymph glands which remove
foreign material from the distal skin.
 This inflammation along with the loss of
tissue elasticity can lead to protruding lymph
glands enfolded in pockets of skin.
 This condition is especially prominent in the
areas around the scrotum (often called the
'hanging groin' effect) and in severe cases is
classified as minor elephantiasis
RAISED NODULES HANGING GROIN
 Mansonella ozzardi
 Mansonella streptocerca
 Mansonella perstans
 Causative agents of mansonelliasis
 Cilicoides flies serve as vectors
 Only filarial worm parasitizing humans in South
America
 Adult worms are found in the mesenteries and visceral
fats
 Microfilaria are found in the blood and sometimes in
the capillaries and intravascular spaces of the skin
 Usually asymptomatic
 May cause adenopathy, pruritic and maculopapular
skin lesions, arthritis, fever, and marked eosinophilia
 Simulium fly may also become a vector
 Infects both humans and monkeys in Africa
(Congo)
 Microfilariae are found primarily in the skin,
sometimes in the blood
 Posterior end of microfilaria resembles a
shepherd’s crook
 Causes pruritic dermatitis with
hypopigmented macules ans inguinal
adenopathy
 Common parasite of humans and apes in
Africa
 May also be found in Latin and South America
 Adult worms are found in deep connective
tissues
 Microfilariae are found in the blood, and in
the skin
 Periodicity is not exhibited
 Majority of infections are benign
 May cause Calabar-like swellings, pruritis,
hives, fever, and headache
 Causes Ugandan or Kampala eye worm
condition when adult worms invade the
conjunctiva and periorbital connective tissue
 Humans are accidental hosts
 Usually infect rodents
 Migrates to the CNS of humans
 Humans get the infection by ingesting the
intermediate host snail (Achitina fulica)
 No effective treatment