Lymphatic

Filariasis /
Wuchereria bancrofti
Elephantiasis
& Brugia malayi
Dr. Tjatur Winarsanto SpPD

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

+
+

=?

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
species
B.malayi is transmitted by
Anopheles and Mansonia species.

Mansonia

Aedes

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 atrisk 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)

Albendazole

reduces microfilariae concentrations

kills adult worms
kills adult worms

Ivermectin

kills the microfilariae produced by adult worms

And more drugs!

The disease is usually treated with singledose 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