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THE FILARIAE
 Tissue Nematodes comprises 8 species of filariae:1. Wuchereriria bancrofti2 Brugia malayi3. Brugia timori4. Onchocerca volvulus5. Loa Loa6. Mansonella perstans7. Mansonella streptocerca8. Mansonella ozzardi9. Dracunculus medinensis = not a filarial worm butmorphologically similarCharacteristic features:(1) the adults live in the tissues(2) female worms give birth to larvae known as microfilariaethat circulate in the blood and lymph or are present in tissues(3) transmission requires the ingestion of the microfilariae bya bloodsucking arthropod, which in turn, transmits theinfection to another human
Wuchereria bancrofti
Syn : Filaria BancroftiDisease : Bancroftian FilariasisAdult Worm= long, hair-like & transparent w/ smooth cuticle= filiform shape w/ both ends tapering but terminatebluntly rounded= head slightly swollen w/ 2 rings of small sessilepapillae= mouth unarmedMale= measures 40 mm. L X 0.1 mm. in diameter= copulatory spicule distinctly unequal & dissimilar= gobernaculum cresent – shaped= caudal end curved & sharply ventradFemale = measures 8-100 mm. X 0.24 – 0.3 mm.= vulva cervical in position= post. end narrow & abruptly pointedMicrofilaria= elongate, bluntly rounded anteriorly & pointedcaudally= hyaline sheath extends beyond the ant. & post endof the embryo= single stylet at the ant. end= cephalic space is long & broad & devoid of granules or nuclei= central column of nuclei discrete & do not extenddown to the tip of the tail= has graceful sweeping curveLife Cycle :Epidemiology := widely distributed in the tropics & subtropics= 2 types of filarial infection in the Phil.A) urban type most prevalent in abaca raising areasmosquito vector – Aedes poecilusB) rural type occurs away from houses towards mountain andhillMosquito vector – anopheles minimus= both are night biter but may also bite during the day andbreeds in clear running mountain stream Endemic Provinces( Phil ) Camarines Norte & Sur Albay, Sorsogon, Quezon,Mindoro, Masbate, Romblon, Bohol, Leyte and Samar. Allprovinces of Mindoro, Mountain Province ( Bontoc ) Sulu &Palawan= Anopheles minimus & Flavirostris are vectors in Mt.Province, Sulu & Palawan= Aedes Poecilus in the rest of provincesPathology := pathology prod. by parasite is centered in lymph vessel& lymph glands= inflammation, edema & fibrosis gives rise as a result of obstruction of lymph flow resulting to lymphangitis, edema&chyluria= clinical manif. includes: hydrocoele, chylocoele,elephantiasis of scrotum & vulva
 
Dx: 1) Blood smear (peripheral smear at night time 8:00PM. to 4:00 AM.) because of nocturnal periodicity= peak hours 10:00 PM. to 2:00 AM2) Biopsy of material important for confirmatorydiagnosisRx: 1. Diethyl carbamazine ( Hetrazan )-2mg/kg TID X 2-4wks2. Surgical procedures3. CorticosteroidsPrevention and Control :1) All abaca workers should wear long sleeve-shirt2) Use of mosquito net3) Insect repellant4) Spray house w/ insecticide
Brugia Malayi
Disease : Malayan FilariasisGeog. Distribution : Southeast Asia includes the Phil.Morphology :Adult worm both male & female resembles that of W.BancroftiMale = measures 23 mm. x 0.09 mm. in diameterFemale = measures 55 mm. x 0.16 mm. in diameterMicrofilaria:= measures 170-260 u= smaller than W. bancrofti= sheathed= appears knob-like= double stylets found at anterior end= cephalic space longer than broad= 2 discrete nuclei at the tail end portionLife Cycle := similar with W. Bancrofti except for the species of mosquitoes as its intermediate host (mansonia bonnae &mansonia uniformis) 
↓ ↓
 found fresh H
2
Ofound in ricefield swampsPathogenesis and Pathology := pathological changes similar w/ Bancrofti filariasis= it has been observed that malayan filariasis affectthe lower extremities with lymphatic obstruction morefrequent than in W. Bancrofti.Symptomatology := similar w/ W. BancroftiEpidemiology :1) Endemic provinces ( Phil.) Palawan, Sulu, Agusan, EasternSamar2) Mosquito vector are night biter (Nocturnal periodicity) bitesusually start 5:00 PM – 11:00 PM.3) Cat is an important reservoir host and may transmit theworm to man by means of Cat – Mosquito cycleDx: = Blood smear ( appearance of sheathed filaria isnocturnal or maybe taken also) during daytime Treatment : The same withPrevention & Control :W. Bancrofti
Brugia Timori
= 1
st
reported from island of Timor in 1964= island of lesser Punda group in Indonesia= closely resembles bancroftian filariasis= high rate of abscess formation= predominance of elephantiasis of the legsMicrofilariae= longer than B. malayi (ave. 310um)= cephalic space has a length-width ratio of 3:1compared to B. malayi 2:1= sheath does not stain with Giemsa stain= exhibit a nocturnal periodicity= vector: Anopheles barbirostris= humans: only definitive host
 
 Treatment:= DEC = used for mass treatment= 5mg/kg/yr. for 10 days= In adenolymphangitis = additional course of DEC= 300mg daily for 20 days(150mg daily for children younger than 10 years)In ELISA: drop in filarial antigen levelSide effects: headache, generalized body malaise,chills, dizziness, anorexia
→
peak on 2
nd
day
→
proveneffective
♦
Weekly administration of DEC at Low dosage
→
proveneffective over 18 months= children <10 year old = 25mg>10 year old = 50mg= swelling disappears within 1 year= elephantiasis clears up 2-4 years
♦
Elephantiasis involving 1 extremity or affecting anarm rather than a leg proved easier to treat
♦
It proved that Timoran filariasis responds better totherapy than the other lymphatic filariasis
Loa – Loa
Syn : Eye wormDisease : Loasis / Calabar Swelling / Fugitive SwellingGeog. Distribution := West & Central Africa esp. Nigeria, Cameroonand ZaireMorphology :Adult worm = threadlike cylindrical= cephalic end provided w/ papillae= body had cuticular bossesMale = measures 32 mm. in length x 0.3-0.4 mm. indiameterFemale = measures 50-70 mm. X 0.5 mm. in diameterMicrofilaria = measures 250-300 u X 6-8 u in diameter= sheathed= nuclei of the body are extended tothe tipLife Cycle := similar w/ that of W. Bancrofti= intermediate host are day-biting (diurnalperiodicity) flies of the genus chrysop (C. dimidiata & C.silacea)Pathology & Symptomatology:= transitory inflammation of the subcutaneous tissueusually in the head (swelling may attain a hens egg size) w/cis tender & painful= swelling usually disappear w/ in 2-3 days afteroccurrence thus the name fugitive swellingDx:= Surgical exploration of the swelling for presence of worm= Blood smear (recover microfilaria in the blood)= Serological test
Onchocerca volvulus
( convoluted filaria )Disease : Onchocerciasis / River Blindness / Blinding filariasis /Divers BlindnessGeog. Distribution := Endemic Central & South America & AfricaMorphology :Adult worm= threadlike or wire-like white, opalescenttransparent= measures 19-42 mm. x 130-210 u= both ends blunt= cuticula possess distinct transverse striation= habitat – subcutaneous connective tissue as atumor-like lesionMale = measures 19-42 x 130-210 u= provided w/ perianal & caudal papillae=post. end tightly recurved ventradFemale = measures 33.5-50 cm. in length x 270-400 u inwidth= vulva opens slightly behind the post end of esophagusMicrofilaria:= measures 150-368 u X 5-9 u in diameter= unsheathed w/ tail end pointed & nuclei free= ant end bluntly rounded & enlarged= post end narrow= no stylets seen at ant. endLife Cycle := similar w/ W. Bancrofti= arthropod vector: genus simulium (black fly) whichbreeds in river & stream= microfilaria in subcutaneous tumors migrate toother site but do not enter to the bloodstream= periodicity (non-periodic) no statistical significancein the appearance of infective stagePathology := encapsulation & proliferation as a result of migration of larva to the other part of body & elaboration of metabolitesthere is multiple nodular swelling of subcutaneous tissue (esp.head, chest &joints) presence of urticarial rashes anditchiness
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