5.2. filariasis darah & limfatik

7/21/2019 5.2. Filariasis Darah & Limfatik

http://slidepdf.com/reader/full/52-filariasis-darah-limfatik 1/30

FILARIASIS

BLOOD AND LYMPHATIC SYSTEM

ISNA INDRAWATI

Department of Microbiology-Parasitology



FILARIA

• Tissue nematodes (round worms)

• Family Filarioidea

• Adult worms live in the lymphatic,subcutaneous tissue & body cavities

• Transmitted by infected biting arthropods

during a blood meal.



Morphology

• Adult worms : whitish and thread like

• Female : viviparous microfilaria

•

Microfilaria : sheated/ unsheated



Periodicity of microfilaria:

• the circadian rhythm observed in the

appearance of filarial microfilaria in the

peripheral blood.• Nocturna,

• diurna

• sub periodic



• Basis of mf periodicity : >> unknown

• Influenced by :

–Circadian rhythm of the host

–p O2 and N2 in the blood

–Strain of parasite

–Feeding habit of the vectors



lymphatic

FILARIA

non-lymphatic

(sub cutaneous)

Wuchereria bancrofti

Brugia malayi

Brugia timori

Loa-loa

Onchocerca volvulus

Mansonella

NEMATODE



Global distribution of lymphatic filariasis and

onchocerciasis.

(Adapted from WHO, http://who.int/tdr/)

Source : www.neb.com



Life cycle

Infected stage



LYMPHATIC FILARIASIS



Prevalence (WHO, 2015)

• ± 120 million people are infected withlymphatic filariasis;

• 25 million men have genital disease ( >>>

hydrocele)

• 15 million,(>> women), have lmphoedema or

elephantiasis of the leg.

• ± 66% of those at risk of infection live in theWHO South-East Asia and 33% in the African

Region.



Geographic distribution

W.bancrofti : 90 % of the cases

B. malayi : most of the remainder cases

B. timori : also causes diseases



Morphology

•

Adult worms : minute and thread like; whitish,smooth cuticula

• ♂: 40 mm x 0,1 mm, posterior end curved

sharply

• ♀: 80-100mm x 0.2- 0.3 mm



Species Type/varians Mf periodicity Definitive

host

Wuchereria

bancrofti

Urban type Nocturnal Human

Rural type Nocturnal Human

Brugia malayiantropophilic Nocturnal Human

zoophilic

Subperiodic

Nocturnal

Human,

Monkey, Cat

Brugia timori Nocturnal Human



Clinical symptoms

• Males >> females• The incubation period: 8 to 16 months.

(http://www.icm.tn.gov.in/seminar/filariasis.htm)

• >> infected people have no symptoms

• Acute :

•

episodes attacks of local inflammationinvolving the skin, lymph nodes and lymphaticlymphangitis retrograde & lymphadenitis



• Filarial fever

• Orchitis, epididimitis, funiculitis ( filariasis

bancrofti)

Chronic

• << of persons will develop lymphedema

>> these symptoms years after beinginfected



Filariasis bancrofti Filariasis brugia

• lymphatic system of

genitalia and breast

• 10 –50% of men suffer

genital damage,• hydrocele or swelling of

the scrotum

•

Chyluria• Elephantiasis of the

entire leg or arm

• Ulcer

• Never affected

lymphatic system of

genitalia and breast• Elephantiasis of lower

part of the extremities

http://localhost/var/www/apps/conversion/tmp/scratch_3/Filariasis%20klinik.pptx






Clinical symptoms



Diagnosis

• Microscopic examination:

–identification of microfilariae in a

blood smear obtained at night (10 pm

–2 am)

Specific diagnosis (species)

•

Serologic enzyme immunoassay tests :antibody IgG4

• DNA probe ( PCR)



Microfilaria

W. bancrofti

B. malayi

B.timori

http://www.dpd.cdc.gov/dpdx/HTML/Frames/A-F/Filariasis/body_Filariasis_mic1.htm



Diagnosis( cont’d)

• ultrasonography : allows visualization of adult

worms filarial dance sign (W.b)

• ICT( Immunochromatographic Tes): detection

of circulating filarial antigen detect antigens

released by adult filarial worms may

be positive even in amicrofilaremic individuals

(Filariasis bancrofti)



The left ICT card displays negative results for LF infection, while the

right card displays positive results

Immuno Chromatographic Test



Diagnosis (cont’d)

• Biopsy :

• lymphoscintigraphy imaging Of lymphaticsystem

Lymphatic Filariasis

(diagnosis)



Therapy

•DEC (Diethyl Carbamazine)

• Combination with albendazole

• Surgery :

–The treatment for hydrocele is surgery(hydrocelectomy).

– lymphedema

• lymphedema: patients can be educated aboutbasic principles of care ( such as hygiene,exercise, elevation, and treatment of woundsand infections)

http://localhost/var/www/apps/conversion/tmp/scratch_3/Filariasis%201.pptx


http://localhost/var/www/apps/conversion/tmp/scratch_3/Elephantiasis%201.pptx

http://localhost/var/www/apps/conversion/tmp/scratch_3/Elephantiasis%201.pptx







Tropical pulmonary

eosinophilia

•Etiology : Filarial worms

• typically found in persons living with thedisease in Asia.

•

Men 20 to 40 years old are most commonlyaffected.

• Symptoms : cough, shortness of breath, andwheezing.

• Hypereosinophilia is often accompanied byhigh levels of IgE and antifilarial antibodies.



Epidemiology

• The Global Goal of Elimination of LymphaticFilariasis as a Public Health problem by The

Year 2020

•strategy :

• (i) to stop the spread of infection

(interrupting transmission); and

• (ii) to alleviate the suffering of affectedpopulations (controlling morbidity).



• Mass drugs administration (MDA) :

– 6 mg/kg of body weight diethylcarbamazine

citrate (DEC) + 400 mg albendazole;

– Once a year for at least 5 years

– coverage of at least 65% of the total at-risk

population:



Source: http://www.wpro.who.int/southpacific/pacelf/about/en/



Prevention

• Protecting oneself from being bitten by amosquito:

– sleeping in a bed-net or screened bedroom

– Insecticide spraying

– using mosquito repellent.

• Controlling and reducing mosquito

populations

5.2. filariasis darah & limfatik

Documents