EXTRA INTESTINAL AND BLOOD
NEMATODES
FILARIAL NEMATODES
• Arthropod transmitted
nematodes
• Mostly night - feeding
mosquitos
• The sheathed group (retain the
embryonic sheath)
• Wuchereria bancrofti, Brugia
malayi and Loa loa
• The unsheathed group (do not
retain the embryonic sheath)
• Onchocerca volvulus,
Dipetalonema perstans,
Manzonella perstans
• Adult worms are thread-like, they
have simple mouth which is
circular or slightly elongated
dorsoventrally and is surrounded
by papillae
• Adult worms live in the
lymphatics, subcutaneous tissues,
connective tissues, muscle and
body cavities of the host
• Female adult worms are
viviparous. Larvae are called
microfilaria
• Humans are the key definitive
host
• Filarial worms are transmitted
through the bite of arthropod
• Periodicity - refers to the
rythmical appearance of the
microfilaria in the peripheral
blood
• Nocturnal - appears
during the night (10 pm - 2 am)
• Diurnal - appears during
day (10 am - 2 pm)
• Subperiodic - appears
during day and night
• Nocturnal subperiodic -
count is peak during night
time
• Diurnal subperiodic -
count is peak during day time
• Non-periodic - no
difference in count
Wuchereria bancrofti
Common name: Brancroft’s
filarial worm
MORPHOLOGY
• Wuchereria bancrofti
• Adult: minute, whitish and
thread-like and are filariform in
shape with a smooth surface. Both
anterior and posterior portion are
tapering.
• Male - tail is sharply curved
ventrally
• Female - Viviparous, longer
than male
LIFE CYCLE
• INTERMEDIATE HOSTS
• Aedes poecilus
•Anopheles minismus
flavirostris
• Culex quinquefasciatus
PATHOLOGY
• Elephanthiasis of lower
extremeties with chylocele and
Chyluria
• Tropical pulmonary
Eosinophilia
DIAGNOSIS
• Blood smear
• Nocturnal in periodicity
• Presence of Sheathed
microfilariae free from nuclei at the
tip
• Graceful appearance
Brugia malayi
Common name:
Brugian/Malayan filarial worm
• B. malayi
• Malayan filarial worm
• HABITAT: Upper lymph gland
• INTERMEDIATE HOST: Mansonia,
Culex
• SAMPLE: Peripheral blood
• PERIODICITY: Subperiodic
nocturnal
MORPHOLOGY

• Sheathed microfilariae
• 2 discrete nuclei on the tip
• Kinky appearance
PATHOLOGY
• “ELEPHANTHIASIS OF UPPER
EXTREMETIES”
• The clinical manifestation of
Malayan Filariasis and Bancroftian
Filariasis nearly the same but with
only few differences
• The common sites of
elephanthiasis include the legs
below the knee and less frequently
the arm below the elbow. Genital
involvement and chyluria are
absent.
• The diagnosis and treatment
are the same as described in
Bancroft’s filariasis.
DIAGNOSIS
• Same as W. bancrofti
• Standard method: Peripheral
Blood Smear
• wet smear - unstained;
motile mf could be seen
• DISADV: cannot be
kept for future reference
• Stained smear -
differentiation of species; can
be stored for future reference
• Venous Blood Sample
• Knott’s Concentration
Technique: used for low
intensity of infection
• *** Microfilariae circulate
nocturnally, making blood
collection an issue
• Card Tes: Antigen detection:
parasite specific
• requiring only a small
amount of blood has been
developed
• Does not require laboratory
equipment
• Blood drawn by finger stick
• Ultrasonography -
demonstrate live worms in the
lymphatics
• Foot Biopsy - Normal skin
with areas of chronic
inflammation
Loa loa
Common name: Eye worm
• Adult worms move under
human skin
• Observed beneath skin or
passing through conjunctiva of
eyes (‘eye worms’)
• Sheathed Microfilaria
• Nuclei irregularly spaced to the
Continuous to the tip
• Diurnal in periodicity
• Intermediate host
• Chrysops
• Pathology
• Callabar swelling
• Disease endemic to rain
forest regions of West and
Central Africa
• Generally mild and painless
(chronic) with 10-15 year
incubation period
• May cause swellings of skin
(Calabar swelling)
Onchocerca volculus
Common name: River Blinding
worm
• Adults accumulate in
subcutaneous nodules (1cm
diameter) which don’t cause
much damage
• Mating in nodules produces
microfilariae
• Live under skin causing
rashes and wrinkles
• Cause blindness when invade
eyes tissues
• Early stage of eye damage
can be reversed by drug
treatment
• Parasiticide ivermectin is
most popular
• Transfer of worms affected
by feeding behaviour of flies
• Waggle mouth parts during
biting to increase wound size
and create pool of blood (‘pool
feeders’)
• MORPHOLOGY
• Unsheathed FILARIASIS
• Free from nuclei
• DIAGNOSIS: Skin snips • Control and Prevention
biopsy/Mazzoti test • Most effective methid: avoid
mosquito bites (for W.
• PATHOLOGY bancrofti and B. malayi)
• RIVER BLINDNESS • Sleep under a bed net
• Wear long sleeves and
LET’S REVIEW trousers
Filarial nematode • Wear insect repellent on
exposed skin, especially at
• Wuchereria bancrofti night
- Sheathed without caudal • Vector Control:
nuclei • Killing eggs (oviciding) and
- Nuclei are distinct and killing or disrupting larva
arranged in 2-3 rows (larviciding) in bodies of
• Brugia malayi stagnant water can further
- Sheathed with 2 caudal nuclei reduce mosquito populations.
- Nuclei are indistinct and
confluent Treatment of filariasis involves
• Loa loa two components:
- Sheathed - Getting rid of the
- Caudal nuclei continuous with microfilariae in people’s blood
those of the trunk - Maintaining careful
• Onchcerca volvulus hygiene in infected persons to
- Unsheathed reduce the incidence and
- Both anterior and posterior severity of secondary (e.g.,
end are nuclei free bacterial) infections.

Mansonella species Anti-filariasis medicines

• Mansonella perstans
• Mansonella streprocerca
• Mansonella ozzardi
• Mansonella perstans
- Unsheathed
- Nuclei extending up to the tip
of the blunt tail
• Mansonella ozzardi
- Unsheathed
- Tail tapers to a thin filament
containing column of 4-6 ovoid
nuclei
• Mansonella streprocerca
- Unsheathed
- Posterior end is strongly bent
commonly used include:
Diethylcarbamazine (DEC)
- Reduces microfilariae
concentrations
- Kills adult worms
*** Table salt maybe
fortified with DEC.
Albendazole
- Kills adult worms
Ivermectin
- Kills the microfilariae
produced by adult worms.

Mansonella species
• Unsheathed

• Intermediate hosts = biting

midge