Lymphatic

Filariasis /
Elephantiasis

Wuchereria bancrofti
& Brugia malayi
What is it?
Wuchereria bancrofti and Brugia malayi
are filarial nematodes
Spread by several species of night -
feeding mosquitoes
Causes lymphatic filariasis, also known
as Elephantiasis
Commonly and incorrectly referred to as
Elephantitis
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Definitive Host
Humans are the definitive
host for the worms that
cause lymphatic filariasis
There are no known
reservoirs for W.bancrofti.
B.malayi has been found in
macaques, leaf monkeys,
cats and civet cats
 Anopheles

Intermediate Host
W.bancrofti is transmitted by
Culex, Aedes, and Anopheles Aedes
species
B.malayi is transmitted by
Anopheles and Mansonia species.

Mansonia Culex
Geographic Range
Lymphatic filariasis occurs in the tropics of
India, Africa, Southern Asia, the Pacific,
and Central and South America.
Lymphatic Filariasis by the
numbers
Endemic in 83 countries
1.2 billion at risk
More than 120 million people infected
More than 25 million men suffer from
genital symptoms
More than 15 million people suffer from
lymphoedema or elephantiasis of the leg
 Morphology - W.bancrofti
W.bancrofti is a sexually
dimorphic species.
The adult male worm is long and
slender, between four and five
centimeters in length, a tenth of a
centimeter in diameter, and has a
curved tail.
The female is six to ten
centimeters long, and three times
larger in diameter than the male.
Microfilariae are sheathed, and
approximately 245 to 300 m in
length.
Morphology - B.malayi
B.malayi microfilariae are slightly
smaller than those of W.bancrofti.
Microfilariae are sheathed, and
about 200 to 275 m.
Not much is known about the adult
worms, as they are not often
recovered
One distinctive feature of B.malayi
is that the microfilarial nuclei
extends to the tip of the tail
Wuchereria Life Cycle
 Symptoms
1. Asymptomatic: patients have hidden
damage to the lymphatic system and kidneys.
2. Acute: attacks of filarial fever (pain and
inflammation of lymph nodes and ducts, often
accompanied by fever, nausea and vomiting)
increase with severity of chronic disease.
3. Chronic: may cause elephantiasis and
hydrocoele (swelling of the scrotum) in males
or enlarged breasts in females.
Diagnosis
The standard method for diagnosing active
infection is the identification of microfilariae by
microscopic examination
However, microfilariae circulate nocturnally,
making blood collection an issue
A card test for parasite antigens requring only a
small amount of blood has been developed
Does not require laboratory equipment
Blood drawn by finger stick
Control
As with malaria, the most effective method
of controlling the spread of W.bancrofti and
B.malayi is to avoid mosquito bites
The CDC recommends that anyone in at-
risk areas:
Sleep under a bed net
Wear long sleeves and trousers
Wear insect repellent on exposed skin, especially
at night
Vector control
Covering water-storage containers and
improving waste-water and solid-waste
treatment systems can help by reducing the
amount of standing water in which
mosquitoes can lay eggs.
Killing eggs (oviciding) and killing or
disrupting larva (larviciding) in bodies of
stagnant water can further reduce mosquito
populations.
Treatment
Treatment of filariasis involves two
components:
Getting rid of the microfilariae in people's
blood
Maintaining careful hygiene in infected
persons to reduce the incidence and
severity of secondary (e.g., bacterial)
infections.
Drugs, Drugs, Drugs!
Anti-filariasis medicines commonly used include:
Diethylcarbamazine (DEC)
reduces microfilariae concentrations
kills adult worms
Albendazole
kills adult worms
Ivermectin
kills the microfilariae produced by adult worms
And more drugs!
The disease is usually treated with single-
dose regimens of a combination of two
drugs, one targeting microfilariae and one
targeting adult worms (i.e.,either
diethylcarbamazine and albenadazole, or
ivermectin and albendazole
In some areas, DEC laced table salt is
used as a prophylactic
Treatment 2: Manchester United 0
If a high enough coverage of anti-filariasis drug
treatment can be achieved (treating greater than
80% of the people in a community), the disease
can be eradicated from an area.
Attempts to eliminate the disease are being
helped considerably by Merck and Co., which is
donating ivermectin to treatment efforts, and
Smith Kline Beecham, which is donating
albendazole.
The Gates Foundation has also donated millions
towards eliminating lymphatic filariasis
Elimination programs
Finally
http://youtube.com/watch?v=SkIryQ6Paqg