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Guidelines Filariasis Elimination India

Guidelines Filariasis Elimination India

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Published by egalivan
Guidelines Filariasis Elimination
Guidelines Filariasis Elimination

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Published by: egalivan on Oct 17, 2010
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Guidelines on Elimination of Lymphatic Filariasis India
1
1.INTRODUCTION
Filariasis is the common term for a group of diseases caused by parasitic nematodes belongingto superfamily Filarioidea. Adult worms of these parasites live in the lymphatic system, cutaneoustissues or body cavity of the humans and are transmitted through vectors. Filariasis caused bynematodes that live in the human lymph system is called
Lymphatic Filariasis (LF)2.CAUSATIVE ORGANISMS
Three nematode parasites causing LF in human are
Wuchereria bancrofti, Brugia malayi 
and
Brugia timori 
. Of these, only
Wuchereria bancrofti 
and
Brugia malayi 
are found in India. In mainlandIndia,
Wuchereria bancrofti,
transmitted by the ubiquitous vector,
Culex quinquefasciatus,
hasbeen the predominant infection contributing to 99.4% of the problem in the country. The infectionis prevalent in both urban and rural areas. The vector species breeds preferably in dirty andpolluted water.
Brugia malayi 
infection has been reported earlier from some rural areas in seven states viz.,Kerala, Orissa, Tamil Nadu, Andhra Pradesh, Madhya Pradesh, Assam and West Bengal. However,its prevalence is now reportedly restricted to rural areas of Kerala and the infection disappearedin some pockets in other states.
Mansonia (Mansonioides) annulifera 
is the principal vector while
M. (M). uniformis 
is the secondary vector for transmission of
B. malayi 
infection. The breeding ofthese mosquitoes is associated with aquatic plants such as
Pistia stratiotes, Salvinia auriculata,Salvinia molestes, Eichhornia speciosa,
 
E. crassipes,
etc
.
Both
W. bancrofti 
and
B. malayi 
infections in mainland India exhibit nocturnal periodicity ofmicrofilariae. In 1974-75, diurnal sub-periodic
W.bancrofti 
infection was detected among aborigines,inhabiting Nicobar Group of Andaman & Nicobar Islands.
Ochlerotatus 
 
(Finlaya) niveus 
group ofmosquitoes were incriminated as the vectors for this infection, formerly known as
Aedes (Finlaya) niveus 
.
3.LIFE CYCLE OF THE PARASITE
The adult parasite worms, male and female, live in the lymph vessels and lymph nodes by makingnest in the dilated lymphatics. The adult worms survive for about 5-8 years and sometimes for as longas 15 years. After mating, the female worm parturates millions of microfilariae which finally migrate
Filariasis Control in India & Its EliminationFilariasis Control in India & Its EliminationFilariasis Control in India & Its EliminationFilariasis Control in India & Its EliminationFilariasis Control in India & Its Elimination
CHAPTER 1
 
2
to blood circulation. The sheathed microfilariae begin to appear in the blood circulation in six monthsto one year after infection (prepatent period). The microfilariae remain in the arterioles of the lungsduring the day and emerge into the peripheral circulation at night (nocturnally periodic). The periodicityof mf coincides with the biting activity of the vector. The sexual cycle of the parasite takes place inthe human host, where the adult worms ultimately die. The life cycle of the parasite is cyclo-developmental in the vector where the parasites do not multiply.Microfilariae, (when picked up by the mosquito during blood meal) undergo development inmosquitoes (intermediate hosts) to form infective larvae which usually takes about 10 to 14 days. Theingested microfilariae first shed their sheaths, penetrate the stomach wall, migrate to the muscles ofthe thorax and develop there without multiplication. The slender and tiny microfilariae (mean lengthof mf in
Wb 
290 μ,
Bm 
222 μ and
Bt 
310 μ) transform into immobile and inactive sausage stage (L1)larva, which has a cuticle that forms a conspicuous slender tail with specific identification characters.The larvae grow rapidly in length and breadth after their first moult to become L2 or pre-infectivelarva, which is recognised by the presence of one or two papillae at its caudal end and by its shorttail. This L2 stage moults to become L3 which is infective. It is slender and thread like, measuringabout 1500-2000 microns in length. It is highly motile which is a unique phenomenon used foridentification (Fig.1).
Mf in mosquito vectorL 1 in mosquito vectorL 2 in mosquito vectorL 3 in mosquito vector
Fig 1: Different stages of larvae in mosquito
When the infective mosquitoes (harbouring L3 larvae) bite, some or all of the infective larvaeescape from the proboscis and actively enter the human host through the wound made by themosquito bite or penetrate the skin on their own and migrate into lymphatic system. In the lymphaticsystem of the infected persons, the infective larvae develop into adult male and female worms (Fig. 2).
4
.WOLBACHIA
ENDOSYMBIONT
Several recent studies have demonstrated presence of
Wolbachia 
, bacterial
 
endosymbiontsin the adult filarial worms and microfilariae of both
W. bancrofti 
and
B. malayi 
. This bacterium isnecessary for the development, viability and fertility of the adult parasites. Drug interventionsdirected against
Wolbachia 
cause deleterious effect on the survival of the adult worms.
5.CLINICAL SPECTRUM
Man is the natural host. All ages and genders are susceptible to infection. In endemic areas,the youngest age recorded with filarial infection was infant aged 6 months. The infection increaseswith age reaching a peak between 20 and 25 years. Disease manifestation appears in a small
Filariasis Control in India & Its Elimination 
 
Guidelines on Elimination of Lymphatic Filariasis India
3
proportion of infected individuals, commonly over 10 years of age. The disease spectrum of LFranges from the initial phase of asymptomatic microfilaraemia to the later stages of acute, chronicand occult clinical manifestations.
5.1Asymptomatic Parasite Carrier State
Some of the infected individuals continue to harbour the parasite for many years withoutany sign and symptoms of disease. Even at this stage subclinical changes like lymph vessel dilationand tortuosity are shown by ultrasonography and lymphoscintigraphy. Only some among theseinfected asymptomatic individuals progress to clinical disease in course of time.
5.2Acute Disease
Adenolymphangitis
:
oAcute dermato-adeno-lymphangitis (
ADLA)
oAcute filarial lymphangitis (
AFL
)
Acute epididymo-orchitis and funiculitis:
Fig 2: Life Cycle of Filarial Parasite

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