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Tissue Nematodes

II BPT
Dr Ekta Chourasia
Microbiology
Classification – Tissue
Nematodes
Lymphatic Wuchereria bancrofti
Brugia
malayi
Brugia timori

Subcutaneo Loa loa (african eye


us worm)
Onchocerca volvulus
(blinding filaria)
Dracunculus medinensis
(thread worm)

Conjunctiva Loa loa

08/04/09 Dr Ekta, Microbiology


Wuchereria bancrofti (Filarial worm)

Definitive host Man

Intermediate host Female Culex, Aedes or


Anopheles mosquito

Infective form Third stage larva

Mode of transmission Inoculation – bite of mosquito

Site of localization Lymphatics / lymph nodes of


man

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Life cycle

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Clinical features
 Infection - Wuchereriasis/ Lymphatic filarisis/ Bancroftian
filariasis

 Pathogenic states are produced only by adult worm


(living/ dead) – classical filariasis
Occult filariasis – lesions produced by microfilaria

 Clinical states in classical filariasis can be classified as:


 Asymptomatic ( in endemic areas)
 Inflammatory – lymphadenitis, lymphangitis, fever, lymphoedema
 Obstructive – elephantiasis, lymphangiovarix, chyluria, hydrocele
 Tropical pulmonary eosinophilia

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Obstructive stage

 Lymphatic obstruction – occurs with the


death of worms

 Causes of obstruction –
 Blocking of lumen by dead worms
 Excessive proliferation & thickening of walls
of lymphatic vessels
 Fibrosis of lymphatic vessels

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Consequences of Lymphatic Obstruction

 Elephantiasis of organs like leg, scrotum,


penis, vagina, breast, arm etc – fibrotic
thickening of skin & subcutaneous tissue

 Lymphangiovarix – dilatation of afferent


lymphatics.

 Rupture of Lymphangiovarix into urinary tract


– chyluria

 Hydrocele

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Lymphatic filariasis

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chyluria

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Classical v/s Occult filariasis

Classical filariasis Occult filariasis

Cause Developing worms & adults Microfilariae

Basic lesions Acute inflammation followed An eosinophilic granuloma


by an epitheloid granuloma (hypersensitivity reaction)
surrounding the adult worm &
a fibrous scar
Organs involved Lymphatic system Lymphatic system, lungs,
liver & spleen

Microfilaria Present in Blood Present in affected tissues


not in blood

Therapeutic No response to any drug Responds to


response microfilaricidal drug, DEC.

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Laboratory diagnosis
 Specimen - blood collected at
night, preferably capillary blood
from ear lobes, chylous urine,
hydrocele fluid, exudate from
lymphangiovarix

 Microscopic examination – wet


mount or stained with giemsa:
sheathed microfilaria with no
nuclei at tail tip

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Laboratory diagnosis
 Concentration techniques – for capillary
blood, venous blood (Knott’s technique)

 DEC provocation test – 100 mg of DEC


orally, examine peripheral blood smear after
30 to 45 minutes

 Serology – using non specific Ags


1. Passive hemagglutination test
2. Fluoresecent ab test
3. ELISA

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Treatment Prevention

 DEC (Diethylcarbamazine) –  Destruction of


microfilaricidal: 6mg/ kg/day mosquitoes
for 2-3 weeks
 Protection against
 Elevation of the affected mosquito bites
limbs, use of elastic bandages
& local foot care – reduces  Treatment of carriers
symptoms of lymphatic
obstruction

 Surgical treatment of
hydrocele

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Brugia sps
 Two species infect humans : B.malayi & B.timori

 Causes lymphatic filariasis

 Transmitted by Mansonia & Anopheles species of mosquitoes

 Life cycle, pathogenesis, clinical features, diagnosis &


treatment – similar to W. bancrofti, with a following differences
 Children commonly affected
 Rapid development of signs & symptoms
 Elephantiasis affect lower extremities
 Chyluria & hydrocele rare

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Onchocerca volvulus
(Blinding filaria – 2nd most common cause of infectious blindness)

Definitive host Man

Intermediate host Black flies (simulium)

Infective form Larva

Mode of transmission Inoculation

Site of localization Subcutaneous tissue, dermis


& eye
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Clinical features
 Incubation period - 10 to 12
months

 Eosinophilia and urticaria.

 Nodular and erythematous


lesions (Onchocercomata) in the
skin and subcutaneous tissue

 Photophobia, lacrimation, keratitis


and blindness – due to trapping
of microfilaria in the cornea,
choroid, iris and anterior
chambers.

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Diagnosis & Treatment
 Nodular biopsy – adult
worm

 Skin snip – unsheathed


microfilaria with no
nuclei

 Treatment – Ivermectin,
surgical removal, DEC in
non ocular
onchocercosis

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Loa loa (African eye worm)

Definitive host Man

Intermediate host Chrysops


(deer fly)
Infective form Larva

Mode of transmission Inoculation

Site of localization Subcutaneous & deep


connective tissue
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Clinical features
 Subcutaneous swelling
– Calabar or fugitive
swelling, measuring 5
to 10 cm, marked by
erythema and
angioedema, usually in
the extremities

 Migrating worm in
subconjunctival tissue

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Diagnosis & Treatment
• Peripheral blood smear - Sheathed
microfilaria with nuclei upto rounded
tail tip

• Isolation of worms from the


conjunctiva or subcutaneous biopsy

• Treatment - Ivermectin, surgical


removal, DEC (effective against adult
& microfilaria)

08/04/09 Dr Ekta, Microbiology


Dracunculus medinensis (Guinea Worm)

Adult worms Male 2 to 4 cm


Female 70 –120 cms, viviparous

Definitive host Human

Intermediate host Cyclops

Infective form Larva inside Cyclops

Mode of transmission Ingestion of water contaminated


with cyclops

Site of localization Subcutaneous tissue

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Clinical Features
 Disease – Dracunculosis

 Clinical features develop an year


after infection following the migration
of worm to the subcutaneous tissue
of the leg

 Blister formation – rupture of blister


when in contact with water -
ulceration – release of larvae by
adult female worm

 Secondary bacterial infection of ulcer


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Diagnosis & Treatment
 Detection of adult worm – when it
appears at the surface of skin

 Detection of larva – in milky fluid


released by worm on exposure to
water

 Radiology – calcified worm in deeper


tissues

 Treatment –
1. Thiabendazole/ Metronodazole –
symptomatic relief, easy removal of
worm
2. Gradual extraction of worm by
winding of a few cms on a matchstick
per day, over 3 to 4 weeks
3. Surgical excision
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Prevention
 Provision of safe water
supply

 Education to discourage
people from entering water
source

 Filtering water through a


double folded cloth

 Boiling water before drinking

 Discouraging the use of step


wells
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