Sasha Anne L.

Valdez
OUTLINE FOR MODULE 9 (Part 3):

1. Wuchereria bancrofti
2. Brugia malayi
3. Onchocerca volvulus
4. Loa loa
5. Dracunculus medinensis
Module 10 : Nematodes Part 2

Module Objectives:

1. Identify the major morphological differences of

blood and tissue nematodes.
2. Familiarize the significant blood and tissue
nematodes that infect humans (morphology, life
cycle, symptoms, diagnosis, treatment, control and
prevention.
The major blood and tissue parasites of man are
microfilaria. These include Wuchereria bancrofti and
Brugia malayi, Onchocerca volvulus, Loa loa (eye worm)
Trichinella spiralis and Dracunculus medinensis.

https://pt.slideshare.net/HazelMarieBarcela/introduction-to-tissue-nematodes-and-filarial-worms/10
https://www.scribd.com/presentation/329 https://slideplayer.com/slide/9986023/
416619/Blood-and-Tissue-Nematodes

reproduction https://slideplayer.com/slide/3461483/
 • named for Otto
Wucherer, who
discovered the
microfilariae, & Joseph
Bancroft who 1st found
the adult worms.

• is one of the three

parasites that cause
lymphatic filariasis.

Humans serve as
https://www.mcdinternational.org/trainings/malaria/english/DPDx5/H
the definitive host.
TML/ImageLibrary/A-F/Filariasis/body_Filariasis_il1
• common name = Bancroft’s filaria

• it affects over 120 million people,

primarily in Africa, South America, and
other tropical and sub-tropical
countries.
• found throughout the tropics as in the
Figi Islands, Samoa, China, Japan, Korea,
Thailand, Malaysia, Philippines & others.

• Bancroftian filariasis, Elephantiasis

https://www.medicalnewstoday.com/articles/321797
https://www.wikidoc.org/index.php/Filariasis_epidemiology_and_demographics
• The parasite is carried from person to person by
mosquitoes.

• 120 million people are infected in subtropical and tropical

Asia (mostly in India), Africa, the Pacific and the
Americas (mostly in Brazil, Haiti, Guyana and the
Dominican Republic).

• Lymphatic filariasis is the leading cause of permanent

disability worldwide.

• Out of the 120 million more than 30 % are severely

incapacitated by the disease.

• Over one billion people in over 80 countries are at risk of

getting infected.
•W.bancrofti has a larger distribution :
Asia (China, India, Indonesia, Japan,
Malaysia, Philippines, South-East
Asia, Sri Lanka, Tropical Africa,
Central and South America, Pacific
Islands.
https://www.slideshare.net/HazelMarieBarcela/wuchereria-bancrofti-57456676
➢ Bluntly round
anteriorly and
pointed caudally
body.

➢ Graceful , sweeping
curves appearance.

➢ Pale sheath.

➢ Note : The absence

of terminal nuclei.
https://www.onlinebiologynotes.com/wuchereria-bancrofti-
morphology-life-cycle-and-epidemiology/
Microfilaria of Wuchereria bancrofti. The microfilaria is
sheathed, with eosinophil in left corner.(H&E,40x)

https://www.researchgate.net/figure/Microfilaria-of-Wuchereria- https://www.jaypeedigital.com/book/97893525
bancrofti-The-microfilaria-is-sheathed-with-eosinophil-
in_fig1_269521396 00185/chapter/ch61
https://www.researchgate.net/figure/Microfilaria-of-
Wuchereria-bancrofti-in-a-thick-film_fig7_277944110
The microfilariae can be found
free in the fluid within the
nodules and in the dermal
layers of the skin spreading
centrifugally from the area
where an adult lies.

Microfilariae also can be

found in the blood and eye
during heavy infections.

first stage larvae are known as MICROFILARIAE. The

microfilaria are present in the circulation. The
microfilaria migrate between the deep and the peripheral
circulation. During the day they are present in the deep
veins and during the night the migrate to the peripheral
circulation.
The microfilariae are found mainly in the
peripheral blood and can be found at peak
amounts from 10p.m. to 2 a.m. The cause
of this periodicity remains unknown but
the advantages of the microfilariae being
in the peripheral blood during these hours
may ensure that the vector, the night time
mosquito, will have a higher chance of
transmitting them elsewhere.

https://www.slideshare.net/HazelMarieBarcela/wuchereria-bancrofti-57456676
➢ The adult male worm is long &
slender, between 4 & 5 cms. in
length, a tenth of a centimeter
in diameter, & features a
curved tail.

➢ The female is 6-10 cms. long, is

ovoviviparous (gives birth to
microfilariae), & three times
larger in diameter than the
male. This size deviation can
be attributed to the vast
numbers of microfilariae
that the female produces each
day. Posterior end
is narrow & abruptly pointed.

https://thebiologynotes.com/wuchereria-
bancrofti-habitat-morphology-and-life-cycle/
 ➢ Elongate,
bluntly
rounded
anteriorly &
pointed
caudally.

➢ measures
244-96 micra
in length.

https://alchetron.com/Wuchereria-bancrofti
• Different species of the following genera of
mosquitoes (IHs) are vectors of W. bancrofti
filariasis depending on geographical distribution.
• Among them are: Culex (C. annulirostris, C.
bitaeniorhynchus, C. quinquefasciatus, & C.
pipiens); Anopheles (A. arabinensis, A.
bancroftii, A. farauti, A. funestus, A. gambiae,
A. koliensis, A. melas, A. merus, A. punctulatus
& A. wellcomei); Aedes (A. aegypti, A. aquasalis,
A. bellator, A. cooki, A. darlingi, A. kochi, A.
polynesiensis, A. pseudoscutellaris, A. rotumae,
A. scapularis, and A. vigilax); Mansonia (M.
pseudotitillans, M. uniformis); Coquillettidia (C.
juxtamansonia).
 They infect their fly vectors while the flies are
feeding on the human host and mature into stage
three infective larvae in the flies flight muscles (in
about 10 days).

A mosquito is the intermediate host and

carrier. The most common vectors/carriers
are:
in Africa: Anopheles species
in the Americas: Culex quinquefasciatus
in the Pacific and in
Asia: Mansonia and Aedes species. https://irac-online.org/pests/anopheles-spp/

http://entnemdept.ufl.edu/creatures/aqu https://www.researchgate.net/figure/Adult-Mansonia-
https://www.caryinstitute.org/news-
atic/southern_house_mosquito.htm titillans-Photo-r-Sean-McCann_fig4_280638351 insights/podcast/who-needs-aedes-mosquitoes
https://mectizan.org/news-resources/life-cycle-lymphatic-filariasis/
2 types of Disease:

1. Urban – abaca raising areas (water

accumulated in abaca axils)
• Bicol region, Quezon, Masbate,
Mindoro, Mindanao & Sulu.

2. Rural – clear running mountain streams

• Bontoc, Mt. Province, Palawan & Sulu.

The pathogenesis of W. bancrofti infection is
dependent on the host's immune system and
inflammatory responses.

1. Asymptomatic Phase

https://www.slideshare.net/alubajessabeth/wuchereria-bancrofti-39245224
https://www.slideshare.net/alubajessabeth/wuchereria-bancrofti-39245224

2. Inflammatory (Acute Phase)

The individual will exhibit fever, chills,

skin infections, painful lymph nodes,
The antigens from the female adult worms and tender skin of the
elicit inflammatory responses. lymphedematous extremity.
https://www.slideshare.net/SyedMohammad14/microfilariae-wuchereria-bancrofti

https://www.globalcitizen.org/en/content/ntds-
explainer-lymphatic-filariasis/ https://twitter.com/who/status/1049259349519060992
 These symptoms often lessen after 5-7 days.
Other symptoms that may occur include:

Orchitis -inflammation of the testes, which

is accompanied by painful
immediate enlargement. It can be
caused by either a bacterial or viral
infection.

Epididymitis - which is the inflammation of

the spermatic cord.

Typically, the roundworms travel to lymph vessels, mate, then the female
produces millions of offspring called microfilariae, into the blood.The
adult worms typically survive for 5–7 years. This infection most commonly
results in lymphedema (or lymphatic obstruction which is a long-term
condition where excess fluid collects in tissues causing swelling/ edema).
3. Obstructive (Chronic) Phase

- marked by lymph varices, lymph

scrotum, hydrocele, chyluria* (lymph in
urine), and elephantiasis.

- Microfilariae are not normally present in this

phase.

- A key feature of this phase is scar formation

from affected tissue areas.
*a milky bodily fluid consisting of lymph and emulsified fats, or free fatty
acids (FFAs). It is formed in the small intestine during digestion of fatty
foods, and taken up by lymph vessels.
a type of swelling in the scrotum that occurs when
fluid collects in the thin sheath surrounding a
testicle.
https://www.slideshare.net/rajud521/filarial-nematodes
 In women, the
legs and arms are
https://www.goldjournal.net/article/S0090-
affected. Some
4295(04)01048-9/fulltext on their breasts.

Elephantiasis affect men

mainly on the legs, arms,
and scrotum.
https://www.sciencephoto.com/media/257034/view/woman-with-
a-breast-enlarged-by-elephantiasis
PATHOLOGY
Sequence of events:
1. biological incubation period lasts 1 year
or more.
2. Patent (evident, obvious) symptomless
period.
3. Acute stage w/ lymphangitis,
lymphadenitis, “filarial fever” as the
conspicuous symptoms.
4. Chronic stage develops w/ the
enlargement of the involved organ.
https://www.researchgate.net/figure/Symptoms-of-Lymphatic-Filariasis-23-25_fig1_312053588
Figure: Clinical classification of filariasis. * = Hydrocele results from accumulation of straw coloured fluid in sac covering the
testicles; # = Rupture of dilated lymph vessels causes lymph to accumulate in affected body site called chyluria.

https://pubs.rsc.org/en/content/articlehtml/2017/ra/c7ra01857f
 Treatment

The severe symptoms caused by the parasite can be

avoided by cleansing the skin, surgery, or the use of
therapeutic drugs, such as Diethylcarbamazine (DEC)
, ivermectin, or albendazole.

The drug of choice however, is DEC, which can eliminate

the microfilariae from the blood and also kill the adult
worms with a dosage of 6 mg/kg semiannually or annually.

A polytherapy treatment that includes ivermectin with DEC

or albendazole is more effective than each drug alone.
It has some side effects which include: dizziness, fever,
headache, nausea and muscle and joint pain.

DEC should only be used, if Wuchereria bancrofti has been

identified. This is because most people with lymphedema
are not infected with parasites.

In some cases lymphedema can be prevented from getting

worse by exercising the swollen leg or arm to improve the
lymph flow. The swollen skin is vulnerable to bacterial
infections because immune defences cannot work properly
due to the impaired flow of fluids. That is why the skin
must be kept clean by washing it with soap and water daily.

According to some new studies Wolbachia bacteria are in

symbiosis with Wuchereria bancrofti. The bacteria live
inside the worm. If the bacteria are killed with
antibiotics, Wuchereria bancrofti dies, too.
 https://link.springer.com/chapter/10.10
07/978-3-319-14493-1_26

https://www.slideshare.net/mainwi_k/trends-in-the-management-of-lymphedema-presentation

Modified Charles’ Procedure and

Its Combination with Lymph Node
Flap Transfer for Advanced
Lymphedema

Charles operation (total lymphangiectomy*) The leg is

normal size but has become hyperkeratotic.
*Excision of a lymphatic vessel.
 UNICEF is supporting a mass
distribution of mosquito nets

https://www.unicef.org/sudan/stories/why-mosquito-nets-are-affective

Avoiding and controlling the disease vector, mosquito, is the most effective prevention.

Sleep under a mosquito net in endemic areas

Use insect repellent between dusk and dawn or other peak vector hours

Eliminating vector habitat (i.e. puddles and stagnant pools of water)

Insecticide-impregnated materials

Taking a yearly preventative dose of ivermectin or DEC can also kill any circulating
worms before clinical symptoms develop. This should only be practiced in “at risk”
populations in endemic areas.
Prognosis, in the absence of elephantiasis, is
good.

Eradication

The WHO is coordinating an effort to eradicate

filarisis. The main stay of this programme is the
mass use of antifilarial drugs on a regular basis for
at least 5 years.

In April 2011 Sri Lanka was certified by the WHO

as having eradicated this disease.
 Kingdom: Animalia
Phylum: Nematoda
Class: Secernentea
Order: Spirurida
Family: Onchocercidae
Genus: Brugia
Species: B. malayi
(Brug 1927)

https://web.stanford.edu/group/parasites/ParaSites2009/JuliaLiebner_
Brugiamalayi/JuliaLiebner_Brugiamalayi.htm
 • Identified by
Lichtenstein

• formerly
known asFilaria
malayi

Common Name : Malayan filarial worm,

producing malayan
filariasis
https://web.stanford.edu/group/parasites/ParaSites2009/JuliaLiebner_
Brugiamalayi/JuliaLiebner_Brugiamalayi.htm
 https://web.stanford.edu/group/parasites/ParaSites2006/Lymphatic_filariasis/Epidemiology.htm

Geographical occurence of agents of lymphatic filariasis:

•Wuchereria bancrofti is encountered in tropical areas worldwide

•Brugia malayi is limited to Asia
•Brugia timori is restricted to some islands of Indonesia

Geographical occurence of other agents causing filariasis:

•Onchocerca volvulus (river blindness) occurs mainly in Africa, with
additional foci in Latin America and the Middle East
•Loa loa and Mansonella streptocerca are found in Africa
•Mansonella perstans occurs in both Africa and South America
•Mansonella ozzardi occurs only in the American continent
B. malayi infects 13 million people in south and southeast
Asia and is responsible for nearly 10% of the world’s total
cases of lymphatic filariasis.

B. malayi infection is endemic or potentially endemic in 16

countries, where it is most common in southern China and
India, but also occurs in Indonesia, Thailand, Vietnam,
Malaysia, the Philippines, and South Korea.

The distribution of B. malayi overlaps with W. bancrofti in

these regions.
• infects a # of wild & domestic animals
& is restricted to South-East Asia
(Indonesia, Borneo, New Guinea, China,
Korea, India & the Phils.

• Mosquitoes are vectors. (Mansonia)

• found in Quezon, Palawan, Bongao, Sulu,

Agusan, Eastern Samar.

• appears that the disease is endemic in

areas where fresh water swamps exist.

https://www.wrbu.si.edu/vectorspecies/genera/mansonia
 https://www.researchgate.net/figure/Schematic-drawing-the-anatomy-of-adult-stage-B-malayi-and-distribution-of-Wolbachia_fig2_51181525

Adult worms resemble the classic nematode roundworm.

Long and threadlike, B. malayi and other nematode possess only longitudinal
muscles and move in an S-shape motion.

Adults are typically smaller than adult W. bancrofti, though few adults
have been isolated. Female adult worms (50 mm) are larger than male
worms (25 mm).
 https://www.cdc.gov/dpdx/lymphaticfilariasis/index.html

• 200-275 um in length and have a

round anterior end and a pointed
posterior end.

•The microfilariae are sheathed,

which stains heavily with Giemsa.

•The sheath is actually the egg shell,

a thin layer that surrounds the egg
shell as the microfilariae circulates in
the bloodstream.

•The microfilariae retain the sheath

until it is digested in the mosquito
midgut.
 Microfilaria of B.malayi. Like W.bancrofti,
this species has a sheath. Differently
from Wuchereria, the microfilariae in
this species are more tightly coiled,
& the nuclear column is
more tightly packed,
preventing the
visualization
of individual cells.

https://web.stanford.edu/group/parasites/ParaSites2009/JuliaLiebner_
Brugiamalayi/JuliaLiebner_Brugiamalayi.htm
 https://web.stanford.edu/group/parasites/ParaSites2009/JuliaLie
bner_Brugiamalayi/JuliaLiebner_Brugiamalayi.htm

Detail from the microfilaria of Brugia malayi

showing the tapered tail, with a subterminal
& a terminal nuclei (seen as swellings at the
level of the arrows), separated by a gap
without nuclei. This is characteristic of
B. malayi.
https://web.stanford.edu/group/parasites/ParaSites2006/Lymphatic_filariasis/Introduction.htm
Brugia malayi, which
infects humans and
animals, as well as other
zoonotic species.
 They migrate
to the lymphatics,
where they
develop into
adults, a slow
process that
can require
up to 18 months.

Inside the mosquito,

the microfilariae develop in 1
to 2 weeks into infective
filariform (third-stage) larvae.

https://www.cdc.gov/parasites/lymphaticfilariasis/biology_b_malayi.html
https://pubs.rsc.org/en/content/articlehtml/2017/ra/c7ra01857f
• Pathology similar to W.bancrofti.

• observed symptoms are allergic in

nature such as asthmatic attacks,
adenopathy, eosinophilia & in
advanced cases, elephantiasis of the
groin & upper extremities instead of
the lower as observed in W.bancrofti.
Treatment

➢ same as for bancroftian filariasis. Diethylcarbamazine (DEC) has

been used in mass treatment programs in the form of DEC-medicated
salt, as an effective microfilaricidal drug in several locations, including
India.

➢ While DEC tends to cause adverse reactions like immediate

fever and weakness, it is not known to cause any long-term
adverse drug effects.

➢ DEC has been shown to kill both adult worms and microfilariae.
Microfilariae numbers slowly return many months after treatment,
thus requiring multiple drug doses over time in order to achieve long-
term control. However, it is not known how many years of mass drug
administration is required to eliminate transmission. But currently,
there have been no confirmed cases of DEC resistance.