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BY: RUBIAN, ROEYLENE JOYCE G.

Filariasis is caused by several round, coiled and thread-like parasitic


worms that belongs to the family filaridea. These parasites penetrate the
skin either their own or through the opening created by mosquito bites
to reach the lymphatic system.

Lymphatic Filariasis is commonly known as elephantiasis. It is a


disfiguring and disabling disease, which is generally aquired in
childhood. In the early stages,though there are either no symptoms or
non-specific symptoms, the lymphatic system is damaged. Infected
persons sustain the transmission of the disease. The long term physical
consequences are painful swollen limbs. Hydrocele in males is also
common in endemic areas.

Filariasis is prevalent in tropical Africa, South East Asia, Papua New


Guinea, Philippines, and Thailand. B. malayi is spread over South and
South East Asia. B. timori is localized in Lesser Sunda Islands of Eastern
Indonesia (WHO 2010).
Causative agent - nematode parasites Wucherera bancrofti, Brugia
Malayi, B. timori
• Parasites live in the lymphatic vessels and lymph nodes; microfilarae
are found in the blood.
• Lifespan of adult parasites is 10 years; microfilariae for a year at the
most.

Incubation period - from the entry of the infective larvae to the


development of symptoms ranges from 8-16 months.

Mode of transmission - through bites from an infected female


mosquito, the Aedes poecillus, at night.
Clinical Manifestations:
• Fever repeatedly for 3-5 days every 1-2 months
• On the thighs and underarms swelling of the lymph nodes that looked
redness, heat and pain
• Swelling of the legs or arms, breasts, testicles that look red and feel hot
because the lymph fluid unstoppable

1. Asymptomatic stage- for years or event a lifetime; characterised only by


presence of microfilariae in the blood.

2. Acute stage
• Lymphadenitis (inflammation of lymph nodes)
• Lymphangitis (inflammation of lymph vessels)
Male genitalia: funiculitis, epidydimits, orchitis (red, painful and tender scrotum)

3. Chronic stage- develop 10-15 years from the onset of the first attack
• Hydrocoele (swelling of the scrotum)
• Lymphedema- temporary swelling of the upper and lower extremities
• Elephantasis- enlargement and thickening of the skin of the lower and.or
upper extremities, scrotum and breasts.
Phatogenesis:

The pathogenesis of the characteristic lymphatic damage is thought to involve three


components:

• mechanical damage by motile parasites


• bacterial superinfection in previously damaged vessels
• local immunological responses to parasite antigen

Lymphatic dilation (lymphangiectasia) is present in all patients who harbor living


adult worms. It can remain subclinical for undetermined periods of time, or involve
into chronic disease. The death of adult worms can cause episodes of acute filarial
lymphangitis or may result in subclinical (without complaints from patient)
infection. However, lymphangiectasia in the skin (legs arms, penis, scrotum, breasts)
further impairs lymphatic function and predisposes to secondary bacterial and fungal
infections. Recurent infections are an essential cofactor in the development of
lymphedema and it progression to elephantiasis that’s why personal hygiene is very
important for prevention most severe complications of filarial infection.
Diagnostic Procedure:

1. Nocturnal Blood Exam (NBE)- done after 8:00 p.m.

2. Immunochromatographic Test (ICT) - antigen test done at


daytime.
Nursing Management and Treatment:

• Selective treatment with DEC (Diethylcarbamazine Citrate) is given


to people with clinical manifestations of the disease.
• Mass treament of the people living in established endemic areas.
• Medicines (DEC and albendazole) are given once a year for 5
years.
• Surgery for elephantiasis and hydrocoele

• Nursing care is primarily aimed at preventing the potential


complications that may develop. If possible, elastic stockings or
bandages are applied to the affected limbs, to assist venous
return and prevent excessive edema. Bedrest may be required in
more severe cases, with elevation of the involved extremities.
Suspensory bandages or scrotal supports may provide comfort in
the event of hydrocele.
Prevention and Control

• Trying to avoid mosquito bites by:


> Sleep-wear mosquito nets
> The holes / ventilation houses covered with fine mesh wire
> Do not let the mosquitoes nesting in or around the home
> Killing mosquitoes with mosquito sprays

• Wash water or sewer plants to eliminate mosquito breeding places

The World Health Organization recommends limiting any outdoor


activities during nighttime, especially if living in rural areas or
jungles; wearing long sleeves and long pants; avoiding dark-
colored clothing which is attractive to mosquitoes; not wearing
scents like perfume or cologne
Nursing Diagnosis

• Impaired Skin Integrity


• Impaired Comfort
• Impaired Physical Immobility
• Disturbed Body Image