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Filariasis
Filariasis
B.Ganesh
Regional Filaria Training & Research Centre
National Institute of Communicable Diseases
Kozhikode.
Lymphatic Filariasis
Infection with 3 closely related Nematodes
Wuchereria bancrofti
Brugia malayi
Brugia timori
* Transmitted by the bite of infected mosquito
responsible for considerable sufferings/deformity
and disability
* All the parasites have similar life cycle in man
* Adults seen in Lymphatic vessels
* Offsprings seen in peripheral blood during night
Disease Manifestation
Disease manifestation range from
None
Acute-Filarial fever
Chronic-Lymphangitis, Lymphadenitis,
Elephantiasis of genitals/legs/arms
Tropical Pulmonary Eosinophilia (TPE)
Filarial arthritis
Epididimoorchitis
Chyluria, etc.
Distribution
Prevalent world wide in the Tropics
and Sub-tropical regions of
Africa
Asia
Western Pacific
Parts of Central & South America
Lymphatic Filariasis Endemic Countries & Territories
Endemic Countries
Swelling not
reversible at night
Skin folds-Absent
Appearance of skin-
Smooth, Normal
Stages of Lymphoedema of the
Leg (Stage III)
Swelling not
reversible at night
Skin folds-Shallow
Appearance of skin-
Smooth, Normal
Stages of Lymphoedema of the
Leg (Stage IV)
Swelling not
reversible at night
Skin folds-Shallow
Appearance of skin
- Irregular,
* Knobs, Nodules
Stages of Lymphoedema of the
Leg (Stage V)
Swelling not
reversible at night
Skin folds-Deep
Appearance of skin –
Smooth or Irregular
Stages of Lymphoedema of the
Leg (Stage VI)
Swelling not
reversible at night
Skin folds-Absent,
Shallow, Deep
Appearance of skin
*Wart-like lesions on
foot or top of the toes
Stages of Lymphoedema of the
Leg (Stage VII)
Swelling not
reversible at night
Skin folds-Deep
Appearance of skin-
Irregular
Needs help for daily
activities - Walking,
bathing, using bathrooms,
dependent on family or
health care systems
Pathology of Lymphatic Filariasis
The pathology associated
with lymphatic filariasis
results from a complex
interplay of the
pathogenic potential of
the parasite, the tissue
response of the host and
external bacterial and
fungal infections. Most of
the pathology associated
with LF is limited to the
lymphatics.
The damage to the lymphatic
vessels is mediated both by an
immune response to the adult
worms as well as by a direct action
of the parasite or the product
released by them. In the absence of
inflammation, marked lymphatic
dilation with lymphoedema is seen
in experimental animals with
immune deficiency and when
immuno competent cells are
induced, it results inflammatory
granuloma reactions around the
parasite and subsequent
obstructions of the lymphatic vessel
occurs leading to lymphoedema.
Lymphatic Filariasis
Management
Twin Pillars of Lymphatic Filariasis
Elimination
Interrupt transmission
Control Morbidity (relief of suffering)
# Community-level care of those with
disease
• Lymphoedema
• Acute inflammatory attacks
• Hydrocele repair
Management of Lymphatic Filariasis
Lymphatic Filariasis
Control
Lymphatic Filariasis Control Programme
The current strategy of filariasis control
(Elimination) is based on:
1. Interruption of transmission
2. Control of Morbidity
Interruption of the transmission can be achieved through:
a. Chemotherapy
b. Vector control
An integrated programme is in place for the
control of lymphatic filariasis. Earlier, vector
control was the main method of control. There
are three main reasons why filariasis never
causes explosive epidemics
1. The microfilariae does not multiply in the vector
2. Infective larvae do not multiply in man
3. Life cycle of the parasite is relatively long (>15 )
Case detection and treatment in low
endemic areas are suitable for preventing
transmission and controlling the disease.
In high endemic areas, Mass chemotherapy
is the approach.
DEC medicated salt is also a form of Mass
treatment using low dose of drug over a
long period of time (1-2 gm /Kg of Salt).
Vector Control
Vector control involves anti larval measures,
anti adult measures, personal prophylaxis. An
integrated method using all the vector control
measures alone will bring about sustained vector
control.
I. Anti larval measures:
1. Chemical control
a. Mosquito larvicidal oil
b. Pyrosene oil
c. Organo phosphorous compounds such as
Temephos, Fenthion,
2. Removal of pistia plants
3. Minor environmental measures
Vector Control
II. Anti adult measures:
Anti adult measures as indoor residual spay
using DDT, HCH and Dieldrin. Pyrethrum
as a space spray is also followed.
III. Personal Prophylaxis:
Reduction of man mosquito contact by
using mosquito nets, screening of houses,
etc.
Morbidity Management