Filariasis: Pathogenesis & Epidemiology
Filariasis: Pathogenesis & Epidemiology
Filariasis: 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
Family Onchocercidae
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
Family Onchocercidae
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:
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