INTRODUCTION

• Wuchereria bancrofti- is a parasitic filarian nematode

(roundworm) spread by a mosquito bite.

• A filarial worm found in the lymph nodes of human causing a

lymphatic filariasis called Bancroft’s filariasis.

• Definitive host- Human

• It is indigenous in warm regions of the world and is found throughout Africa, southern, and
southeastern Asia, the Pacific Islands, and the tropical and subtropical regions of South America
and Caribbean.

Common name: Bancroft’s filaria

Disease: Wuchereriasis or Filariasis (commonly called elephantiasis)

Habitat:

 Adult worm- Lymph nodes of human

 Microfilariae- Bloodstream
 Infective larva- female mosquitoes (Genus Culex, Aedes, or Anopheles)

• Is a dreaded endoparasite of humans.

• It is a digenetic parasite completing its life cycle in 2 hosts. The final host is man harboring the
adult worms, while the intermediate host is blood-sucking insects, the female mosquitoes of
genus Culex, Aedes, or Anopheles.

• Adult worms live coiled up in the lymph glands and lymph passage of man, where they often
obstruct the flow of lymph.

• The microfilariae are found in the peripheral blood, occasionally they are also found in chylous
urine or in hydrocele fluid.

GEOGRAPHICAL DISTRIBUTION

Africa, Southern and Southeastern Asia, The Pacific Islands and the Tropical regions of South
America and the Caribbean.

MORPHOLOGY

ADULT WORM
• These are long hair-like, transparent, translucent, thread-like worms with smooth cuticle and
tapering ends.
• These are filiform and cylindrical in shape with both ends tapering.
• Sexes are separate with distinct sexual dimorphism.
• The female is larger (70-100 x 0.25 mm) than the male (25-40 x 0.1mm)
• The posterior end of the female worm is narrow and pointed that bears an anus, while that of
the male is curved vertically and contains numbers of genital papillae two copulatory spicules of
unequal length.
• Males and females remain coiled together usually in the abdominal and inguinal lymphatics and
in the testicular tissues.
• Female worm- viviparous and directly liberates sheathed microfilariae into the lymph.
• Adult worms live for many years, probably 10-15 or more.

MICROFILARIA
• The first stage larva
• They are colorless, transparent bodies with blunt anterior ends and pointed tails.
• They are very active and can move forward and backward within the sheath which is much
longer than the embryo.
• They are microscopic and measure about 250-300 um in length and 6-10um in thickness.
• Its body is covered with hyaline sheath followed by a cuticular being lined by flattened
subcuticular cells or epidermis and an inner column of cytoplasm containing nuclei. Its cuticle
has well-marked striations.
• Somatic cella or Nuclei appear as granules in the central axis of the body extended from head to
tail except for the 5% terminal end of the tip.
• They do not undergo further development in the human body unless they are taken up by their
suitable host (mosquitoes)
• Their life span in the human body is probably 70 days.
 PERIODICITY OF MICROFILARIAE (NOCTURNAL PERIODICITY)
• The microfilariae circulate in the bloodstream.
• In India, China, and many other Asian countries, they show a nocturnal periodicity in peripheral
circulation being seen in large numbers in peripheral blood only at night (between 10pm and
4pm), but they disappear inside during the rest of the day. It is believed that during the daytime
they retire inside the deeper blood vessel. This correlates with the night biting habit of the
vector. (Culex mosquito)

THIRD STAGE OF THE LARVA (INFECTIVE FORM)

• The third stage larva is the infective form of the parasite is found only in mosquitoes.
• They are elongated, filariform, measures 1.5mm in length, and 18-23um in diameter.

LIFE CYCLE
• Wuchereria bancrofti is digenetic. Its life history is completed in two hosts.
• Definitive host: Man
• Intermediate host: Female mosquitoes, belonging to genus Culex, Aedes, and Anopheles.
• Infective form: Actively motile third-stage filiform larva is infective to man.
• Mode of transmission: Humans get the infection by the bite of mosquito carrying a filaform
larva.
 PATHOGENESIS
• The disease is of two types:
1. Classical Filariasis
 Caused by adult worms
 Eg: lymphangitis, elephantiasis, lymphedema
2. Occult filariasis
 Caused by embryo
 Eg: eosinophilia, hepato-splenomegaly

EOSINOPHILIA
• It is a condition in which the eosinophil count in the peripheral blood exceeds 4.5x108/L
(450/uL). Eosinophils usually account for less than 7% of the circulating leukocyctes. A marked
increase in non-blood tissue eosinophil count noticed upon histopathologic examination is
diagnostic for tissue eosinophil. Several causes are known, with the most common being some
form of allergic reaction or parasitic infection.
Hepato-splenomegaly
• Hepatosplenomegaly (commonly abbreviated HSM) is the simultaneous enlargement of both
the liver (hepatomegaly) and the spleen (splenomegaly)

• In endemic areas, infection is mostly asymptomatic.

• In some person hypersensitivity to the antigen causes symptoms such as nausea, malaise,
headache, vomiting, and low-grade fever.
• Recurrent attacks or pruritus, and urticarial may occur.
• Some develop fugitive swelling, raised painless, tender, diffuse, red areas on the skin, this may
disappear and reappear at the same site or different site.
• The characteristic manifestations of filariasis is due to:
• Obstruction of lymph vessels and nodes
• The essential feature are lymphadenopathy, lymphangitis, lymphangiovarix, lymphorrhagia or
chylorrhagia, hydrocele, lymphedema and elephantiasis. These features depends on the site
affected.

LYMPHANGITIS
• Acute inflammation of lymph vessels seen red under the
skin.
• Acute lymphangitis is due to allergic or inflammatory
reaction to filarial infection.

Lymphadenitis
• Repeated episodes of acute lymphadenitis with fever, occur very
frequently
• The inguinal nodes are most affected and axillary nodes less
common.
• The swollen nodes may be painful

Lymphangiovarix
• Dilatation of lymph vessels commonly occur in the inguinal, scrotal, testicular and abdominal
site

Hydrocoele
• Is common manifestation of
filariasis
• Accumulation of fluid occurs due
to obstruction of lymph vessels of
the spermatic cord and also by
exudation from the inflamed tests
and epididymis.
• The hydrocele may be unilateral or
bilateral and is generally small in
size in the early stage.
• The largest reported hydrocele
weight over 100 kg.

Lymphedema
• Swelling around the ankle, spreading to the back of the foot and leg.
• It may affect the arms, breast, scrotum, vulva, or any other part of the
body.
• Initially the oedema is putting in nature, but in course of time becomes
hard and nonpitting

Elephantiasis
• This is delayed sequeal to repeat lymphangitis, obstruction, and
lymphoedema.
• The skin surface become course, with warty excrescences.
• Cracks and fissures develop with secondary bacteria infection
• Seen most in leg but may also involve other parts of the body including
the arm, breast, scrotum, penis and vulva.
 DIAGNOSIS
 Direct evidence:
• Demonstration of microfilariae in peripheral blood film, chylous urine, hydrocele fluid and lymph
varix.
• Microfilariae appear in large numbers in peripheral blood at night. Hence, blood film should be
made in night between 10PM-2AM
 Indirect evidence
• Serological test like ELISA, IFA and IHA can be used but these test have low sensitivity and
specifity

TREATMENT
 Antifilarial Drugs
• Diethylcarbamazine (DEC)- demonstrated to kill both adult worms and microfilariae of W.
bancrofti.
Dosage:6 mg/kg/day for 12 days
• Ivermectin- treatment for filariasis and eosinophilic (lungs)
Dosage:single oral dose of 150 ug/kg body weight
• Combination of 2
(BETTER RESULT)

 General Measures:
• Rest
• Antibiotics
• Antifungal
• Physiotherapy
• Bandaging
 Elephantiasis
• Elephantoid tissues can be corrected surgically

PREVENTION AND CONTROL

Avoiding mosquito bites is the best form of prevention. The mosquitoes that carry the
microscopic worms usually bite between the hours of dusk and dawn. If you live in or travel to
an area with lymphatic filariasis:
 Sleep under a mosquito net.
 Wear long sleeves and trousers.
 Use mosquito repellent on exposed skin between dusk and dawn.