Case 3 Case 4

Brugia malayi Pathophysio

• its life cycle follows the same course with that of W. bancrofti • Sarcoptes scabiei burrows through the skin, invading the stratum corneum
• Adult worms in LV/LN mate → sheathed microfilariae released by gravid to the boundary of S. granulosum (3rd) by releasing a kerolytic substance
female → microfilariae enters circulation → mosquito (Mansonia) ingests M (lyses keratin content of skin)
from blood → sheds → penetrates midguts → migrate to muscle → larva • Body develops an immune response by sensitization of the mites and their
develops (L1, 2, 3 — 2 weeks) → move to proboscis → enter man via blood and secretions by IgG and IgM antibodies
meal → penetrates skin via bite wound → reach lymphatic sys → mature • Asymptomatic (6 weeks) followed by:
(3-9 months L3) o intense pruritus (itching) - intensifies at night and after hot showers
o immediate hypersensitivity reaction (re-infestation)
Diagnosis filariasis § burrow inflammation (infiltrates: eosino, lympho, macro)
• extracting history of travel or lives in endemic areas (India, SEA, Africa, § forms generalized hypersensitive rashes
PH: Palawan, Samar, Agusan, Sulu) § This immunity + scratching mechanism limits to <15
• physical examination: look into clinical manifestations depending on stage mites/person
of filariasis • Hyper-infestation (1000+ mites) is called crusted scabies (Norwegian
o pxt in acute stages: SKIN - presents with urticarial rashes, fever, scabies) if:
headache, adenolymphangitis — swell, red, tender lesions usually in § glucocorticoid use
legs, arms and genitals § immunodeficiency
o GIT - vomiting § neuro or psychiatric illness that limits itching/scratch
o GUT - hydrocoele, lesions in epididymis, funiculitis, scrotum, mechanism
spermatic cord; areola or vulva in females (in chronic stages)
• CBC: eosinophilia (parasitic infection) with or without leukocytosis MOT:
(superimposed bacterial infection) • close personal (skin to skin) contact - prime route of transmission
• definitive diagnosis: detection of parasite • sexual contact (thus sometimes considered an STD) - lesions are in groin,
o difficult to detect adult since sequestered in LV/LN genitals and areolar region
o Microfilariae in blood:
• transmission via inanimate object - is rare as they die within 2-3 days; best
§ Time of blood collection should be based on the endemic seen in crusted scabies where mites are seen in dusts from floor, chairs,
region involved usually nocturnal (in others, may be curtains and couches
subperiodic)
§ EXTENT and DURATION of physical contact - determines
§ samples (blood or body fluids) are usually taken the likelihood of spread of scabies (infection intensity)
at 8pm to 3 am
§ 24 hours after treatment, transmission ceases
§ Thick smear — fringer prick; stain with giemsa or JSB to
demo worms
§ Wet smear preparation — sample inoculated to KOH 1. W. bancrofti
§ Diethylcarbamazepine (DEC) prevocative test a. Discuss / morph
o hetrazan provocative method b. MOT and life cycle
o 2mg/kg DEC is admin orally c. Epidemiology
o Induces MF to circulate in peri blood (30-45 mins) 2. B. malayi
o Examine mx/conc method a. Discuss / morph
b. MOT and life cycle
§ Knot’s concentration method c. Epidemiology
o blood mixed with formalin 10 min stand: lyse RBC so 3. Pathogenesis of filariasis
MF is visible 4. Clinical Manifestation of filariasis
o blood is filtered through nucleopore membrane filter (3 a. Asymptomatic
µm size) b. Acute
o Only for low intensity infections c. Chronic
5. Diagnosis of filariasis
a. History to CBC
b. Biopsy to Ag detection
6. Prevention of filariasis
7. Treatment of filariasis