filariasis by dr.t.v.rao md
TRANSCRIPT
-
8/20/2019 Filariasis by Dr.T.V.Rao MD
1/62
FilariasisDr.T.V.Rao MD
-
8/20/2019 Filariasis by Dr.T.V.Rao MD
2/62
WHAT IS
Filariasis•Filariasis (or philariasis) is a parasiticdisease caused by an infection with
roundworms of the Filarioidea type. These are spread by blood-feedingblack ies and mosquitoes. Thisdisease belongs to the group of
diseases called helminthiasis.•Eight known larial nematodes usehumans as their deniti!e hosts.
-
8/20/2019 Filariasis by Dr.T.V.Rao MD
3/62
Epidemiology-
International•"#$ million in %$ countries•
" billion at risk•&$' - ucherariaancrofti
•*emainder + rugia ,alayi
-
8/20/2019 Filariasis by Dr.T.V.Rao MD
4/62
-
8/20/2019 Filariasis by Dr.T.V.Rao MD
5/62
Parasites• hite slender roundworms• Three types uchereriabancrofti rugia malayi rugiatimori
• /i!e for 0-1 years produce
millions of o2spring•lock the lymphaticsystem•3etwork of channels andlymph nodes that helpmaintain uid le!els in thebody
•lockage leads to edema(collection of uid in tissues)
-
8/20/2019 Filariasis by Dr.T.V.Rao MD
6/62
Mosquitos are Vectorsand spread the
Inection•4 mosquito is the intermediatehost and carrier. The most
common !ectors5carriers are•in 4frica 4nopheles species•in the 4mericas 6ule7
quinquefasciatus•in the 8acic and in 4sia,ansonia and 4edes species.
-
8/20/2019 Filariasis by Dr.T.V.Rao MD
7/62
Millions are Inected
!ith "lariasis•9ne hundred and twenty million people inat least %$ nations of the world ha!elymphatic lariasis 9ne billion people are
at risk of getting infected. 3inety percentof these infections are caused byuchereria bancrofti and most of theremainder by rugia malayi. For .
bancrofti humans are the e7clusi!e hostand e!en though certain strains of .malayi can also infect some felines andmonkeys.
-
8/20/2019 Filariasis by Dr.T.V.Rao MD
8/62
Wucheraria
#ancroti• 8rimary causati!e agent of lymphaticlariasis
• 9!ert bancroftian lariasis ""0 millioncases worldwide (:0.0 million ;ndia :$million sub-il)
-
8/20/2019 Filariasis by Dr.T.V.Rao MD
9/62
-
8/20/2019 Filariasis by Dr.T.V.Rao MD
10/62
-
8/20/2019 Filariasis by Dr.T.V.Rao MD
11/62
-
8/20/2019 Filariasis by Dr.T.V.Rao MD
12/62Micro"laria o Mansonella ozzardi.
-
8/20/2019 Filariasis by Dr.T.V.Rao MD
13/62
%haracters o the Adult
Parasites•4n 4dult femaleuchereriabancrofti is about%$+"$$ mm longand $.#:+$.?$mm in diameterwhereas a male isabout :$ mm longand $." mm indiameter.
-
8/20/2019 Filariasis by Dr.T.V.Rao MD
14/62
Ho! the )ar*a Appear
•4 microlaria is about #:$+?$$@m (micrometers) long and 1.0+"$
@m thick. ;t is sheathed and hasnocturnal periodicity e7cept the
-
8/20/2019 Filariasis by Dr.T.V.Rao MD
15/62
Ho! the )ar*a
Appear• The nuclearcolumn (the cellsthat constitute itsbody) is looselypacked. The cellscan be seenindi!idually undera microscope anddo not e7tend tothe tip of the tail.
-
8/20/2019 Filariasis by Dr.T.V.Rao MD
16/62
Filarial )ar*ae
-
8/20/2019 Filariasis by Dr.T.V.Rao MD
17/62
-
8/20/2019 Filariasis by Dr.T.V.Rao MD
18/62
Impact o Filariasis
•with the disease can su2er fromlymphedema and elephantiasis and inmen swelling of the scrotum called
hydrocele. /ymphatic lariasis is aleading cause of permanent disabilityworldwide. 6ommunities frequently shunand reAect women and men disguredby the disease. 42ected peoplefrequently are unable to work becauseof their disability and this harms theirfamilies and their communities.
-
8/20/2019 Filariasis by Dr.T.V.Rao MD
19/62
)ie %ycle(•;nfecti!e lar!ae aretransmitted by infected biting
mosquitoes during a bloodmeal. The lar!ae migrate tolymphatic !essels and lymph
nodes where they de!elopinto microlariae-producingadults.
-
8/20/2019 Filariasis by Dr.T.V.Rao MD
20/62
)ie %ycle(• The adults dwell inlymphatic !essels and
lymph nodes where theycan li!e for se!eral years.
The female worms producemicrolariae whichcirculate in the blood
-
8/20/2019 Filariasis by Dr.T.V.Rao MD
21/62
Micro"lariae• The microlariae infect bitingmosquitoes. ;nside the mosquito themicrolariae de!elop in " to # weeksinto infecti!e lariform (third-stage)lar!ae. Buring a subsequent bloodmeal by the mosquito the lar!aeinfect the human host. They migrate tothe lymphatic !essels and lymphnodes of the human host where theyde!elop into adults.
-
8/20/2019 Filariasis by Dr.T.V.Rao MD
22/62
)ie cycle o Brugia that also
applies to Wuchereria #y %+%
-
8/20/2019 Filariasis by Dr.T.V.Rao MD
23/62
-
8/20/2019 Filariasis by Dr.T.V.Rao MD
24/62
-
8/20/2019 Filariasis by Dr.T.V.Rao MD
25/62
Multiplication and
)ie %ycle•4dult female worms producemicrolariae. Feeding !ectormosquitoes ingest microlariae fromthe bloodstream. ;n the mosquito themicrolariae mature to infecti!elar!ae which migrate to the
mosquitoCs mouth-parts enter a newhost !ia the !ectorCs puncture woundmigrate to the lymphatics matureand mate.
-
8/20/2019 Filariasis by Dr.T.V.Rao MD
26/62
Why %linical
Maniestations•Bisease manifestations aredue to lymphatic dysfunction
resulting from the presence ofli!ing and dead worms lymphthrombi inammation and
immune reactions to wormsand worm products.
-
8/20/2019 Filariasis by Dr.T.V.Rao MD
27/62
Pathogenesis and
Pathology •6omple7 interplay of thepathogenic potential of the
parasite the immune response ofthe host and e7ternal(CcomplicatingC) bacterial andfungal infections.
•,ost recogni>able + Denitaldamage ( =ydroceles ) and/ymphoedema5elephantiasis
-
8/20/2019 Filariasis by Dr.T.V.Rao MD
28/62
Clinical features.There are chronic, acute and
asymptomatic presentations oflymphatic larial disease, as well
as some syndromes associated with
these infections. Among chronicmanifestations, h ydrele, even
though found only with W.
bancrofti infections not in Brugia infections is the most commonclinical manifestation of lymphatic
lariasis.
-
8/20/2019 Filariasis by Dr.T.V.Rao MD
29/62
Bisease ,anifestations
•4lthough the parasite damagesthe lymph system most infected
people ha!e no symptoms andwill ne!er de!elop clinicalsymptoms. These people do notknow they ha!e lymphatic
lariasis unless tested. 4 smallpercentage of persons will de!eloplymphedema.
-
8/20/2019 Filariasis by Dr.T.V.Rao MD
30/62
+isease
Maniestations• This is caused by uid collectionbecause of improper functioning
of the lymph system resulting inswelling. This mostly a2ects thelegs but can also occur in thearms breasts and genitalia. ,ostpeople de!elop these symptomsyears after being infected.
-
8/20/2019 Filariasis by Dr.T.V.Rao MD
31/62
What is elephantiasischaracteri,ed #y
• Thickening and hardening of theskin
•6orrect.• ) ;ncreased body si>e due tomasses of worms all o!er the
body especially in the nose• 6) Eosinophilia heart failureand breathing diculty
-
8/20/2019 Filariasis by Dr.T.V.Rao MD
32/62
What causes
elephantiasis•4) Becrease of blood ow dueto worms inside blood !essels
• ) lockage of lymph uiddue to worms inside lymph!essels• 6) ,asses of microlaria inskin tissue
-
8/20/2019 Filariasis by Dr.T.V.Rao MD
33/62
Tropical pulmonaryeosinophilia .TPE/
• Bistinct syndrome in some indi!iduals
• 8aro7ysmal cough and whee>ing
•
eight loss low grade fe!erpronounced blood eosinophilia
• Total serum ;gE and antilarial 4btitres raised
• *esponds well to treatment but in itsabsence progressi!e pulmonarydamage
-
8/20/2019 Filariasis by Dr.T.V.Rao MD
34/62
SymptomsFe!erGidney damage
-
8/20/2019 Filariasis by Dr.T.V.Rao MD
35/62
Social Impact o
+isease
-
8/20/2019 Filariasis by Dr.T.V.Rao MD
36/62
Clinical features.There are chronic, acute and
asymptomatic presentations oflymphatic larial disease, as well
as some syndromes associated with
these infections. Among chronicmanifestations, h ydrele, even
though found only with W.
bancrofti infections not in Brugia infections is the most commonclinical manifestation of lymphatic
lariasis.
-
8/20/2019 Filariasis by Dr.T.V.Rao MD
37/62
-
8/20/2019 Filariasis by Dr.T.V.Rao MD
38/62
-
8/20/2019 Filariasis by Dr.T.V.Rao MD
39/62
Pathogenesis
•,en can de!elop hydrocele or swelling of thescrotum due to infection with one of theparasites that causes /F specically .bancrofti.
•Filarial infection can also cause tropicalpulmonary eosinophilia syndrome althoughthis syndrome is typically found in personsli!ing with the disease in 4sia. ing. The eosinophilia is oftenaccompanied by high le!els of ;gE(;mmunoglobulin E) and antilarial antibodies.
-
8/20/2019 Filariasis by Dr.T.V.Rao MD
40/62
•=istologically - dilatation and
proliferation of lymphaticendothelium H abnormallymphatic function•
Cnon-inammatory pathwayC•Iinammatory pathwayI - adenitisand retrograde lymphangitis•bacterial and fungalsuperinfections
-
8/20/2019 Filariasis by Dr.T.V.Rao MD
41/62
6linical Features•Chronic manifestations: =ydrocoele (mostcommon ) elephantiasis 6hyluria
• Acute manifestations: 4cute inammatoryepisodes CB/4C(dermatolymphangioadenitis)
Clarial fe!erC tropical pulmonaryeosinophilia acute inammatory reaction• Asymptomatic Presentations•Other Syndromes: arthritis (typically
monoarticular) endomyocardial brosistenosyno!itis thrombophlebitisglomerulonephritis lateral popliteal ner!epalsy and others.
-
8/20/2019 Filariasis by Dr.T.V.Rao MD
42/62
While lymphedema can develop in theabsence of overt inammatoryreactions and in the early stages beassociated with microlaremia, the
development of elephantiasis (eitherof the limbs or the genitals) is mostoften associated with a history ofrecurrent inammation. The early
pitting edema gives rise to a stronger
-
8/20/2019 Filariasis by Dr.T.V.Rao MD
43/62
-
8/20/2019 Filariasis by Dr.T.V.Rao MD
44/62
Diagnosis.ntil very recently, diagnosinglymphatic lariasis had been
e!tremely di"icult, since parasites
had to be detected microscopicallyin the blood, and in most parts ofthe world, the parasites have a
nocturnal periodicity that restrictstheir appearance in the blood toonly the hours around midnight.
-
8/20/2019 Filariasis by Dr.T.V.Rao MD
45/62
+iagnosisJntil recently !ery dicultto diagnose3octurnal periodicity Theworms can only be detected in
the blood of those infectedaround the hour of midnight.
3ew specic card testBetects parasites using onlynger prick blood tests any
time of day.Jltrasound can identifyrapidly mo!ing adult worms.
-
8/20/2019 Filariasis by Dr.T.V.Rao MD
46/62
BiagnosisJntil recently diagnosisdepended on the direct
demonstration of the parasite Antigen detection: 6irculatinglarial antigen (6F4) - CgoldstandardC for diagnosing
Wuchereria bancrofti infections.6linical Biagnosis
-
8/20/2019 Filariasis by Dr.T.V.Rao MD
47/62
S l
-
8/20/2019 Filariasis by Dr.T.V.Rao MD
48/62
Serology
•
-
8/20/2019 Filariasis by Dr.T.V.Rao MD
49/62
Treatment.Communities where
lariasis is endemic. Theprimary goal of treating thea"ected community is to
eliminate microlariae
-
8/20/2019 Filariasis by Dr.T.V.Rao MD
50/62
Management •Treating the infection: BE6 (K mg5kgper day) for "# days in bancroftianlariasis and for K days in brugianlariasis repeated at "-K monthlyinter!als if necessary
•;!ermectin
•4lbenda>ole
•
-
8/20/2019 Filariasis by Dr.T.V.Rao MD
51/62
Treatment andManagement o
Elephantiasis8re!ention,osquito nets insect repellents
Loodoo healing techniques
Ele!ate and e7ercise a2ected body part
-
8/20/2019 Filariasis by Dr.T.V.Rao MD
52/62
Management andTreatment o )ymphatic
Filariasis•6urrently Jsed• 4ntilarial drugs (BE6 and i!ermectin)are useful against lar!al o2spring
• Testing• Bo7ycycline
• Tested on a Tan>anian !illage.
• Found to almost completely eliminate adultworms ": months after treatment.
•
-
8/20/2019 Filariasis by Dr.T.V.Rao MD
53/62
8re!ention
•y decreasing contact betweenhumans and !ectors or bydecreasing the amount of infection
the !ector can acquire•Population: through reducing thenumbers of mosquito !ectors
•#-drug treatment regimens(selecting among albenda>ole andeither i!ermectin ordiethylcarbama>ine MBE6N)
-
8/20/2019 Filariasis by Dr.T.V.Rao MD
54/62
Ho! to pre*ent the Filarialinection
•Individuals: personalrepellents bednets or
insecticide-impregnatedmaterials.•8rophylactic regimen ofBE6 (K mg5kg per day 7 #days each month)
Ho! can I pre*ent
-
8/20/2019 Filariasis by Dr.T.V.Rao MD
55/62
Ho! can I pre*entinection
•=ow can ; pre!ent infectionO
•4!oiding mosquito bites is the best form ofpre!ention. The mosquitoes that carry the
microscopic worms usually bite betweenthe hours of dusk and dawn. ;f you li!e in ortra!el to an area with lymphatic lariasis
•
-
8/20/2019 Filariasis by Dr.T.V.Rao MD
56/62
Treating theindividual.
•$oth albenda%ole and &' havebeen shown to be e"ective in
illing the adult*stage larialparasites. +t is clear that thisantiparasite treatment can resultin improvement of patients
elephantiasis and hydrocele(especially in the early stages ofdisease)
WHO's Strategy toWHO's Strategy to
-
8/20/2019 Filariasis by Dr.T.V.Rao MD
57/62
WHO s Strategy to WHO s Strategy toliminate !ym"haticliminate !ym"hatic
#ilariasis#ilariasis
•The strategy of the World -ealthrgani%ation (W-) of the /lobal0rogramme to 'liminate1ymphatic 2ilariasis has 3 aims4 a)to stop the spread of infection(interrupt transmission), and
secondly b) to alleviate thesu"ering of a"ected individuals.
-
8/20/2019 Filariasis by Dr.T.V.Rao MD
58/62
Mass Treatments orPre*ention
•To interrupt transmission, districts in whichlymphatic lariasis is endemic must beidentied, and then community*wide (5masstreatment5) programs implemented to treatthe entire at ris population. +n mostcountries, the program will be based on once* yearly administration of single doses of 3drugs given together4 albenda%ole plus either
diethylcarbama%ine (&') or ivermectin, thelatter in areas where either onchocerciasis,loiasis or another may also be endemic.
i
-
8/20/2019 Filariasis by Dr.T.V.Rao MD
59/62
%ommunity
Treatments•To alleviate the su"ering caused by thedisease, it will be necessary to implementcommunity education programmes to
raise awareness in a"ected patients.This would promote the benets ofintensive local hygiene and the possibleimprovement, both in the damage that hasalready occurred, and in preventing thedebilitating and painful, acute episodes ofinammation.
International communities
-
8/20/2019 Filariasis by Dr.T.V.Rao MD
60/62
International communitieshelp or elimination o
+isease•The pledge in 6778 by/la!co9mith:line to collaborate withthe W- in its elimination e"orts
included the donation of numerousresources, but especially albenda%olefree of charge, for as long asnecessary. This donation, coupled
with the recent decision by ;erc toe!pand its wellnown ;ecti%an
-
8/20/2019 Filariasis by Dr.T.V.Rao MD
61/62
conomic and Socialconomic and Social$m"act.$m"act.
-
8/20/2019 Filariasis by Dr.T.V.Rao MD
62/62
• Program %reated and+esigned #y +r'T'V'0ao M+
or Medical and Paramedicalstudents on glo#al Educationon %ommunica#le diseases
• Email• doctort!raoPgmail.com