Filariasis

Filariasis (or philariasis) is a parasitic disease caused

by an infection with roundworms of the Filarioidea
type.[1] These are spread by blood-feeding black ies and
mosquitoes. This disease belongs to the group of diseases
called helminthiasis.

Elephantiasis aects mainly the lower extremities, while

the ears, mucous membranes, and amputation stumps
are aected less frequently. However, dierent species
of larial worms tend to aect dierent parts of the
body; Wuchereria bancrofti can aect the legs, arms,
Eight known larial nematodes use humans as their vulva, breasts, and scrotum (causing hydrocele formaBrugia timori rarely aects the genitals.
denitive hosts. These are divided into three groups ac- tion), while
Those
who
develop
the chronic stages of elephantiasis
cording to the niche within the body they occupy:
are usually amicrolaraemic, and often have adverse immunological reactions to the microlariae, as well as the
Lymphatic lariasis is caused by the worms
adult worms.[2]
Wuchereria bancrofti, Brugia malayi, and Brugia
timori. These worms occupy the lymphatic system, The subcutaneous worms present with rashes, urticarial
including the lymph nodes; in chronic cases, these papules, and arthritis, as well as hyper- and hypopigmentation macules. Onchocerca volvulus manifests itself in
worms lead to the disease elephantiasis.
the eyes, causing river blindness (onchocerciasis), one
Subcutaneous lariasis is caused by Loa loa (the eye of the leading causes of blindness in the world. Serous
worm), Mansonella streptocerca, and Onchocerca cavity lariasis presents with symptoms similar to subcuvolvulus. These worms occupy the subcutaneous taneous lariasis, in addition to abdominal pain, because
layer of the skin, in the fat layer. L. loa causes Loa these worms are also deep-tissue dwellers.
loa lariasis, while O. volvulus causes river blindness.
Serous cavity lariasis is caused by the worms 2 Cause
Mansonella perstans and Mansonella ozzardi, which
occupy the serous cavity of the abdomen.
Human larial nematode worms have complicated lifecycles, which primarily consists of ve stages. After the
The adult worms, which usually stay in one tissue, release male and female worms mate, the female gives birth to
early larval forms known as microlariae into the hosts live microlariae by the thousands. The microlariae are
bloodstream. These circulating microlariae can be taken taken up by the vector insect (intermediate host) during
up with a blood meal by the arthropod vector; in the vec- a blood meal. In the intermediate host, the microlariae
tor, they develop into infective larvae that can be trans- molt and develop into third-stage (infective) larvae. Upon
mitted to a new host.
taking another blood meal, the vector insect injects the
Individuals infected by larial worms may be described as infectious larvae into the dermis layer of the skin. After
either microlaraemic or amicrolaraemic, depend- about one year, the larvae molt through two more stages,
ing on whether microlariae can be found in their pe- maturing into the adult worms.
ripheral blood. Filariasis is diagnosed in microlaraemic
cases primarily through direct observation of microlariae in the peripheral blood. Occult lariasis is diagnosed 3 Diagnosis
in amicrolaraemic cases based on clinical observations
and, in some cases, by nding a circulating antigen in the
Filariasis is usually diagnosed by identifying microlarblood.
iae on Giemsa stained, thin and thick blood lm smears,
using the gold standard known as the nger prick test.
The nger prick test draws blood from the capillaries of
1 Signs and symptoms
the nger tip; larger veins can be used for blood extraction, but strict windows of the time of day must be obThe most spectacular symptom of lymphatic lariasis is served. Blood must be drawn at appropriate times, which
elephantiasisedema with thickening of the skin and un- reect the feeding activities of the vector insects. Examderlying tissueswhich was the rst disease discovered ples are W. bancrofti, whose vector is a mosquito; night is
to be transmitted by mosquito bites.[2] Elephantiasis re- the preferred time for blood collection. Loa loas vector is
sults when the parasites lodge in the lymphatic system.
the deer y; daytime collection is preferred. This method
1

of diagnosis is only relevant to microlariae that use the

blood as transport from the lungs to the skin. Some larial
worms, such as M. streptocerca and O. volvulus, produce
microlarae that do not use the blood; they reside in the
skin only. For these worms, diagnosis relies upon skin
snips, and can be carried out at any time.

5.1 Research teams

3.1

6 Other animals

Concentration methods

REFERENCES

In 2015 William C. Campbell and Satoshi mura were

Co-awarded half of that years Nobel prize in Physiology or Medicine for the discovery of the drug avermectin,
which in the further developed form ivermectin has come
to decrease the occurrence of lymphatic lariasis.[9]

Various concentration methods are applied: membrane

Filariasis can also aect domesticated animals, such as
lter, Knotts concentration method, and sedimentation
cattle, sheep, and dogs.
technique.
Polymerase chain reaction (PCR) and antigenic assays,
which detect circulating larial antigens, are also avail- 6.1 Cattle
able for making the diagnosis. The latter are particularly
Verminous haemorrhagic dermatitis is a clinical disuseful in amicrolaraemic cases. Spot tests for antigen[3]
ease in cattle due to Paralaria bovicola.
are far more sensitive, and allow the test to be done any
time, rather in the late hours.
Intradermal onchocercosis of cattle results in losses
Lymph node aspirate and chylus uid may also yield miin leather due to Onchocerca dermata, O. ochengi,
crolariae. Medical imaging, such as CT or MRI, may
and O. dukei. O. ochengi is closely related to hureveal larial dance sign in chylus uid; X-ray tests
man O. volvulus (river blindness), sharing the same
can show calcied adult worms in lymphatics. The DEC
vector, and could be useful in human medicine reprovocation test is performed to obtain satisfying numsearch.
bers of parasites in daytime samples. Xenodiagnosis is
now obsolete, and eosinophilia is a nonspecic primary
Stenolaria assamensis and others cause dierent
sign.
diseases in Asia, in cattle and zebu.

6.2 Horses

Treatment

Summer bleeding is hemorrhagic subcutaneous

nodules in the head and upper forelimbs, caused by
Paralaria multipapillosa (North Africa, Southern
and Eastern Europe, Asia and South America).[10]

The recommended treatment for people outside

the United States is albendazole (a broad-spectrum
anthelmintic) combined with ivermectin.[4][5] A combination of diethylcarbamazine and albendazole is also
eective.[4] All of these treatments are microlaricides; 6.3 Dogs
they have no eect on the adult worms. Dierent trials
Heart lariasis is caused by Dirolaria immitis.
were made to use the known drug at its maximum
capacity in absence of new drugs. In a study from India,
it was shown that a formulation of albendazole had better
anti-larial ecacy than albendazole itself.[6]
7 See also
In 2003, the common antibiotic doxycycline was suggested for treating elephantiasis.[7] Filarial parasites have
symbiotic bacteria in the genus Wolbachia, which live inside the worm and seem to play a major role in both its
reproduction and the development of the disease. Clinical trials in June 2005 by the Liverpool School of Tropical Medicine reported an eight-week course almost completely eliminated microlaraemia.[8]

Neglected diseases
Eradication of infectious diseases
Helminthiasis
List of parasites (human)

8 References
5

Society and culture

[1] Center for Disease Control and Prevention. Lymphatic

Filariasis. Retrieved 18 July 2010.

[2] Lymphatic lariasis. Health Topics A to Z. Source: The

World Health Organization. Retrieved 2013-03-24.
[3] Seva Fila (PDF). JB Tropical Disease Research Centre
& Department of Biochemistry, Mahatma Gandhi Institute of Medical Sciences.
[4] The Carter Center, Lymphatic Filariasis Elimination Program, retrieved 2008-07-17
[5] U.S. Centers for Disease Control, Lymphatic Filariasis
Treatment, retrieved 2008-07-17
[6] Gaur RL, Dixit S, Sahoo MK, Khanna M, Singh S, Murthy
PK (2007). Anti-larial activity of novel formulations of
albendazole against experimental brugian lariasis. Parasitology. PMID 17078904.
[7] Hoerauf A, Mand S, Fischer K, Kruppa T, MarfoDebrekyei Y, Debrah AY, Pfarr KM, Adjei O, Buttner
DW (2003), Doxycycline as a novel strategy against bancroftian lariasis-depletion of Wolbachia endosymbionts
from Wuchereria bancrofti and stop of microlaria production, Med Microbiol Immunol (Berl) 192 (4): 2116,
doi:10.1007/s00430-002-0174-6, PMID 12684759
[8] Taylor MJ, Makunde WH, McGarry HF, Turner JD,
Mand S, Hoerauf A (2005), Macrolaricidal activity after doxycycline treatment of Wuchereria bancrofti: a double-blind, randomised placebo-controlled
trial, Lancet 365 (9477): 211621, doi:10.1016/S01406736(05)66591-9, PMID 15964448
[9] Jan Andersson, Hans Forssberg, Juleen R. Zierath; The
Nobel Assembly at Karolinska Institutet (5 October
2015), Avermectin and Artemisinin - Revolutionary Therapies against Parasitic Diseases (PDF), retrieved 5 October
2015
[10] Pringle, Heather (3 March 2011), The Emperor and the
Parasite, retrieved 9 March 2011

Further reading
Special issue, Indian Journal of Urology 21 (1),
2005
Filariasis. Therapeutics in Dermatology. June
2012. Retrieved 24 July 2012.

10

External links

Filariasis Research at the University of Tuebingen

The Carter Center Lymphatic Filariasis Elimination
Program
UK Health Charity working to cure and prevent
Lymphatic lariasis
Brugia malayi Filarial worms. Video by R. Rao.
Washington University in St. Louis

Page from the Merck Veterinary Manual on

Paralaria multipapillosa in horses

11

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