Filariasis: Pathogenesis & Epidemiology

PATHOGENESIS & EPIDEMIOLOGY
FILARIASIS
 “filaria” derived from: “filar” (thread-like)
 First disease proved to be transmitted
through insects
 Caused by: nematodes belonging to the
superfamily Filaroidea AKA Filariae
STATISTICS
 About 1 billion of the world population
 Endemic in at least 80 countries
 31 million microfilaraemics, 23 million
symptomaticfilariasis, & about 473
million individuals at risk
 170 million people in the tropics &
subtropics
HISTORY
 4000 yrs ago
 The first clear reference- ancient Greek culture
 First documentation- Jan Huyghen van Linschoten,
16th century.
 1866, Beatriz Perez: established the course of
disease
 1876, Joseph Bancroft: discovered adult worm
 1877, Patrick Manson: presence of worms in
mosquitoes
 1900, George Carmichael: presence of worms in
proboscis of the mosquito vector
GEOGRAPHIC
DISTRIBUTION
 Global
 Tropics of India, Africa, Southern Asia,
the Pacific, & Central and South
America
 Largest fraction: Southeast Asia
 2nd largest: Africa
 Frequency increased with expansion of
urbanization
3 types of Filariasis
 Lymphatic filariasis
 Subcutaneous filariasis
 Serous cavity filariasis
LYMPHATIC FILARIASIS
 Caused by 3 filarial worms:
 Wuchereria bancrofti
 Brugia malayi
 Brugia timori
Wuchereria bancrofti
kingdom Animalia
Phylum Nematoda
Class Secernentea
Order Spirurida
Suborder Spirurina
Family Onchocercidae
Genus Wuchereria
 Named after Otto Wucherer & Joseph
Bancroft
 Whitish, translucent, thread-like worms
with smooth cuticle & tapering ends
 Female larger than male (sexual
diamorphism)
 Ovoviviparous & can produce thousands
of juveniles known as microfilaria
 2 hosts: human being (definitive) &
mosquito (intermediate)
 Primary vector: Culex quinquefasciatus
Brugia malayi
Kingdom Animalia
Phylum Nematoda
Class Secernentea
Order Spirurida
Genus Brugia
species malayi
 Lichentenstein & Brug first recognized it
as distinct pathogen in 1927
 Long, thread-like
 Move in S-shape motion
 Primary vector: Mansonia spp.
Brugia timori
Kingdom Animalia
Phylum Nematoda
Class Secernentea
Order Spirurida
Genus Brugia
Species timori
 Disease is called “Timor filariasis”
 Identified as causative agent in 1977
 Has cephalic space length-to-width ratio
of about 3:1
 Only found in the Lesser Sunda Islands
of Indonesia
 Primary vector: Anopheles barbirostris
microfilariae
 Embryo of the filarial worms
 Egg membrane remains enveloping the larvae like
a sheath
 Sheath is retained until it is digested in the
mosquito midgut
 About 290 μm in length, 6-7 μm in breadth
 Very active, move both with & against the blood
stream
SUBCUTANEOUS
FILARIASIS
 Worms live in the subcutaneous tissues of
the skin, in the fat layer
 Set up temporary foci of inflammation,
which appear as swellings (up to 3 mm)
 Called calabar or fugitive swelling
 Vectors:
Chyrops spp. (night feeder)

Simulium spp. (day biting female black flies)
Culicoides spp.
Caused by:
 Loa loa (African eye worm)
 Onchocerca volvulus
 Mansonella streptocerca
 Dracunculus medinensis (guinea worm)
SEROUS CAVITY
FILARIASIS
 Worms occupy serous cavity of the
abdome
 Peritonial & pleural region
 Cause:
Mansonella ozzardi
Mansonella perstans
 Principal vector: Culicoides
LIFE CYCLE
Factors affecting pathogenesis:
 The quantity of accumulating adult worm
antigen in the lymphatics
 The duration & level of exposure to
infective insect bites
 The number of secondary bacterial &
fungal infections
 The degree of host immune response
3 clinical phases
1. Incubation or asymptomatic phase
2. Acute or inflammatory phase
3. Obstructive or chronic phase
Disease manifestations
 Lymphangitis
Inflammation of lymphatic vessels
 Lymphadenitis
inflammation of the lymph nodes
 Lymphangiovarix
dilation of lymph vessels
Obstruction of lymph flow in the lymph
nodes
Nodes become enlarged, but are soft in
consistency, leading to pressure
 Lymphorrhagia
Rupture of lymph vessels
 Hydrocoele
Obstruction of the lymph vessels
Accumulation of fluid in tunica vaginalis
 Lymph leakage
Rupture of swollen lymphatics into the renal pelvis can

cause chyluria (milk-like pale pink urine)
 Chylocoele
Lymph leakage into the area of the tunica vaginalis

(long-term extensive chyluria results in
hypoproteinaemia)
(rupture of numerous small skin lymphatics in the
scrotum can lead to a constantly wet, sticky scrotum)
 Chylous diarrhoea: chyle with the faeces
 Chylous ascitis: accumulation in the
peritoneal cavity
 Chylothorax: in the pleural chamber
 Tropical pulmonary eosinophilia
AKA weingartner’s sydrome/ eosinop
Pulmonary symptoms are predominant
Chest X-rays show patchy infiltrates
Sometimes splenomegaly occurs
 Acute dermato-lymphangio-adenitis
(ADLA)
Usually associated with fever, chiills,
headache, pain in the involved region, &
vomitting
Toxemia, altered sensorium & urinary
incontinence
Affected area extremely painful, warm, red,
swollen, & tender
Abscess formation
In higher grades, fungal infections occur in
the webs of the toes
 Elephantiasis
The chronic cases of lymphatic filaria leads to
elephantiasis
Swelling increases in size with subsequent
attacks & become thickened with abundant
fibrosis under it
Skin surface becomes uneven with warty
growths
Occurs at the scrotum, penis, lower limb, arms,
breasts & vulva
 Occult filariasis
Filarial infections in which mf are not found
in the peripheral blood although they
may be seen in the tissues
Rare
EPIDEMIOLOGY
 Spread through vectors or intermediate
hosts
 Either blood-sucking insects or copepod
crustaceans
 Mainly seen in developing countries
 Associated with urbanization,
industrialization, illiteracy, poverty& poor
sanitation
 Source: sick human
 Frequency:
 Mortality/ morbidity: rarely fatal, but cause
personal & socioeconomic hardship
 Race: no racial predilection
 Sex: both sexes are equally susceptible
 Age: Individuals of all the ages are susceptible
(mf rates increase with age)
Acute filariasis usually occurs only after years of

repeated exposure to infected vectors
The Father of tropical medicine
 Suspected night-biting mosquitoes are
responsible for transmission
 Allowed mosquitoes to bite his filaria-infected
gardner,
 Dissected the insects,
 & detected microfilariae
 He followed the metamorphosis of the parasites
in the insects
 However, he assumed that drinking water
contaminated with dead mosquitoes was
responsible
 It was later discovered that filaria is
transmitted through infected
mosquitoes, primarily by the night biting
Culex & Anopheles mosquitoes
 Mf have remarkable periodicity
 The density of parasites is greatest at
the time when the chance of
transmission is greatest (at night)
 Also transmitted via some day-biting
types like Aedes
Climate & filaria
 climate has significant effect on the endemicity
of filaria
 Optimum conditions needed:
Humidity above 60%

Temp. 60F-90F (15.5*C-32.2*C)
Physical factors such as Rainfall also is
considered
 It is known that, patients when proceed to a cold
climate, their troubles abate & in course of time
even cease
 Thus, a place nearer to the seacoast, as
also the equqtor, will have favorable
breeding & transmission conditions for
the greater part of the year
 India lies in the tropical area
 Thus, one would naturally expect the
South of India & the coastal areas to
have higher endemicity

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PATHOGENESIS & EPIDEMIOLOGY

Chyrops spp. (night feeder)

Rupture of swollen lymphatics into the renal pelvis can

Lymph leakage into the area of the tunica vaginalis

(mf rates increase with age)

Acute filariasis usually occurs only after years of

Humidity above 60%

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