FILARIASIS

DEPARTEMENT OF PARASITOLOGY

CLINICAL CASE
2

A 28-year old male came to Community Health

Centre with complaints swelling of right leg from
thigh to toes. The swelling occurred once every 5-6
months. It started 4 years ago along with hardness
and swelling of inguinal lymph nodes. He also
developed chills and fever. About 4-5 days later the
fever stopped, but the swelling of the leg increased.
At this stage he had chills with severe pain in the
right leg. This lasted for 10-12 days, after which the
pain subsided. During this time he had ulcers on the
swollen leg with bleeding and a yellow discharge.
This remained for 2 days. Later the swelling
decreased and the ulcers started healing.

Learning issues
4

1.
2.
3.

Agents of the disease

Pathogenesis
Diagnosis

References
5

King, C.L. 2001. Transmission intensity and human immune responses

to lymphatic filariasis. Parasite Immunology 23 (7): 363371

Melrose, W.D. 2002. Lymphatic filariasis: new insights into an old

disease. International Journal for Parasitology 32(8), 947-960

Muller, R. and Wakelin, D. 2002. Worm and Human Disease. 2 th edition.

London. CABI Publishing

Palumbo, E. 2008. Filariasis: diagnosis, treatment and prevention. Acta

biomedical. 79. 106-109

Rahmah, N., Lim, B. H., Khairul Anuar, A., et al. 2001. A recombinant
antigen-based igg4 ELISA for the specific and sensitive detection of
brugia malayi infection. Transactions of the royal society of tropical
medicine and hygiene 95(3): 280-284

World Health Organization. 1999. Collaborative global programme to

eliminate lymphatic filariasis: Programmes backround and overview
towards initiating a National programme to eliminate lymphatic filariasis .
WHO/CEE/FIL World Health Organization, Geneva, 1-25

Lymphatic Filariasis

Causative agents
7

1.
2.
3.

Brugia malayi
Wuchereria bancrofti
Brugia timori

Wuchereria bancrofti
8

The larva was found by Demarquay

(1863) and Wucherer (1866)
The adult was first found by Bancroft in
1876
Nocturnal periodicity
Vector: Culex and Aedes

Wuchereria bancrofti
9

Morphology

Adults look like thin and long threads

Female is 80-100 mm, male is 25-45 mm
with spiral-shaped tail
Fertilized eggs is 30-40 x 20-25 m, the
egg cell develops rapidly to form a larva
while in the uterus

Wuchereria bancrofti
10

Morphology

Microfilaria is sheated and smoothshaped, 0.24-0.35 mm long

Regular nucleus, no terminal nucleus
Cephalic space: the length is equal with
the width

Wuchereria bancrofti
11

Morphology

12

L3 enter human body

13

The L3 enter the skin of the

human host through the
puncture site of the mosquito
when it takes its second blood
meal.

Details of larvae molting and

development in humans are
largely unknown, but it is
thought the larvae almost a
year to:

Migrate to the lymphatics

Mature undergoing two molts

and to become an adult

Mate

Produces microfilariae

Brugia malayi
14

The larva was first observed from a

native Sumatera by Brug (1927)
Nocturnal periodicity
Vector: Mansonia uniformis (rural) and
Anopheles spp. (urban)

Brugia malayi
15

Morphology

Adult resembles that of W bancrofti

Female is 43-55 mm, male is 13-23 mm
with spiral-shaped tail

Brugia malayi
16

Morphology

The larva is sheated and slightly winding

(kinky), 0.18-0.23 mm long
Irregular nucleus, 2 terminal nucleus
Cephalic space: the length is twice as the
width

Brugia malayi
17

Morphology

18

Pathogenesis
19

Inflammation occurs when worms die, either druginduced or spontaneously.

Granulomas arise around those worms,
characterized by macrophages which develop into
giant cells: as plasma cells, eosinophils and
neutrophils.
Clinical symptom is filarial fever starting when the
worm died and leads to retrograde lymphangitis
(painful with swelling), and lymphadenitis, which
lasts for 1 week.

Pathogenesis
20

Lymph vessels dilation, not obliteration, is probably

the early event following antigenic stimulation,
which spring larvae are being released. These larvae
are degenerate and will be taken up by phagocytic
cells.
These accompanied by triggering of the innate
immune system, release proinflammatory cytokines
and molecules that promote lymphangiogenesis.
The enlarge lymph vessels become less efficient at
transporting lymph from the periphery, which in the
legs is always oriented against gravity, more
vulnerable to exogenous microorganisms.

Pathogenesis
21

Insufficient fluid transport will lead to fluid

extravasations, particularly in the lower limbs, and
eventually to lymphoedema.
L3 preferentially stimulate IL-4 and IL-13 release
from basophils as well as histamine release. In
addition, basophils comprise approximately 1% of
cells in PBMC and their contribution to the
observed cytokine production can be substantial.
Therefore mast cells and basophils may play an
important role in regulating the host response to
filarial infection by affecting T-cell differentiation,
local blood flow, lymphocyte proliferation or by
release of histamine or other prostanoids.

Management
24

Diagnosis

Clinical manifestations
Laboratory diagnosis

Microscopic
Immunodiagnosis
Molecular technique
Ultrasonography

Clinical Manifestations
25

Acute filariasis
Chronic filariasis
Atypical presentation
Asymptomatic carrier

26

Lymphatic vessel dilatation, valve

incompetency, lymphatic back flow,
pooling & oedema

27

Adult worms in the

lymphatic system

Microscopy for Filaria

28

Nucleopore membran
(Knotts concentration)
Staining thick blood film
with Giemsa
Specific but not sensitive,
depends on:

Timing of sampling
(periodicity)
Volume of blood (volume
increase sensitivity
increase)
Nucleopore membrane (knotts
concentration)
Staining of the blood film

Morphological
characteristics

Periodicity

Definition:
Relative density of microfilaria in peripheral
circulation
> 24 hours per cycle
Nocturnal periodic: peak microfilaria at
around mid-night but very low or absence
during the day
Diurnal periodic: peak microfilaria during the
day but low or absence at night
Nocturnal subperiodic: peak microfilaria
density at night with lower density during
the day

Periodicity

Microfilariae stay in the lung during the

daytime and come rarely out to the
peripheral vessels, but soon after sunset
they begin to appear in the peripheral
blood, increasing in number from 10 p.m.
until 6 a.m. (nocturnal periodicity)
There are a number of theories
Photodynamic substance theory by Masuya
Fluorescent substances in the microfilarias
body are injured by the sunlight (W
bancrofti and B malayi)
Microfilaria of Loa loa has no fluorescent
substance at all

Ultrasonography
31

Detect the motile adult worms within the

lymphatics, scrotum and breast (term filarial
dance signs). Detecting W bancrofti only.

Immunodiagnosis
32

Brugia rapid
Antibody
detection assay
Detects IgG4

Immunodiagnosis
33

Antigen detection
assay
For bancroftian
filariasis

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