FILARIA & OTHER
SOMATIC
NEMATODES
Dr Pavithra Padmakumar
Department of Microbiology
PIMS
CLASSIFICATION OF PARASITES
NEMATODES
• Roundworms appears round when
viewed in cross section
• Cylindrical in structure & taper towards
anterior & posterior ends
• Bilaterally symmetrical
• Sexes are separate, few are
hermaphrodite.
• Commonly found in digestive & respiratory
tracts & circulatory system
FILARIAL NEMATODES
• Resides in lymphatics, skin, subcutaneous tissue, body cavities
• Types :
Cutaneous & ocular
Lymphatic filariasis: filariasis:
• Wuchereria bancrofti
• Loa loa
• Brugiya malai
• Onchocerca volvulus
• Brugiya timori
• Mansonella spp
MORPHOLOGY
• Adult worm
• Larvae 4 larval stages
Microfilariae – 1st stage DIAGNOSTIC FORM
Filariform larvae – 3rd stage INFECTIVE FORM
LYMPHATIC FILARIASIS
Chronic obstruction & fibrosis of lymphatics leading to lymphedema,
hydrocele, elephantiasis.
• Wuchereria bancrofti (90%)
• Brugiya malai
• Brugiya timori
BANCROFTIAN FILARIASIS
• Wuchereria bancrofti (90%)
• Microfilarial periodicity – Time when most of the microfilariae are
found in the peripheral blood.
• Nocturnal periodicity – 9pm – 4am
LIFE CYCLE
• 2 hosts : Man (Definitive) & Mosquito (Intermediate)
• Culex quinquefasciatus - Vector
• Incubation period : 8 to 16months
CLINICAL FEATURES
Lymphatic filariasis : 4 stages
• Endemic normal – people residing in endemic area not infected
(immunological resistance, insufficient exposure)
• Asymptomatic microfilaremia – microfilaria can be demonstrated in
blood
• Acute filariasis – Fever, Lymphatic inflammation, reversible pitting
edema
• Chronic filariasis – 10-15 years after infection
Chronic host immune responses against dead worm Granuloma
formation, fibrosis & obstruction of lymphatics
Features of filariasis :
• Elephantiasis – Swelling of lower limb, vulva, breast
• Hydrocele – fluid accumulation in tunica vaginalis
• Epididymitis
• Chyluria – excretion of milky white fluid(chyle) in urine rupture of
lymph vessels in urinary system
TROPICAL PULMONARY EOSINOPHILIA/ OCCULT FILARIASIS
• Hypersensitivity reaction to microfilaria antigen
• Microfilariae – cleared from bloodstream & lodged and destroyed in
lungs allergic response
• Microfilariae not detected in PBS
LAB DIAGNOSIS
• Sample collection : Blood collected as per periodicity of microfilariae
• Nocturnal periodicity : 9pm to 4am
• DEC (Diethylcarbamazine) Provocation test : To collect blood in daytime
• DEC tablet, orally nocturnal microfilariae are stimulated & come to
peripheral blood smear within 15min – 1 hour.
• Contraindication : Loa loa, Onchocerca
• Other samples – Hydrocele fluid, urine
1. Microscopy :
• Direct wet mount
• Thick & Thin peripheral blood smear – Giemsa stain
• Quantitative buffy coat (QBC)
Microfilariae in PBS - Diagnostic
W. bancrofti microfilaria :
• 260µm long, covered by hyaline sheath
• Head end – blunt, Tail end – pointed
• Cephalic space 1:1
• Nuclei – large, coarse, well separated, present
throughout except tail end
• Antigen detection : ELISA, ICT using monoclonal antibodies against
Og4C3 & AD12 antigen
• Antibody detection : Flowthrough assays IgG antibodies to WbSXP -1
Imaging :
• Ultrasound – Filarial dance serpentine movement of adult worms
within lymphatic vessels of scrotum
• Lymphocyntigraphy – abnormalities of lymphatics
• X ray – calcified worms
• Molecular methods – PCR , Realtime PCR detect low level parasites
• Treatment : Diethylcarbamazine (DEC) 6mg/kg daily x 12days
Kills adult worm & microfilariae
Albendazole
BRUGIAN FILARIASIS
• Brugia malai
• Kerala , Eastsern India
• Vector – Anopheles, Aedes
• Diagnosis – Microfilariae detection in PBS
ELISA, ICT
Brugia malai microfilariae :
• 220µm long, covered by sheath
• Cephalic space – 2:1
• Nuclei – large, coarse, darkly stained, overlapping
extends till tail
• Tail – blunt , 2 nuclei
Microfilarial periodicity
Nocturnal periodicity 9pm – 4am Wuchereria, Brugia
Diurnal periodicity 12pm – 2pm Loa loa
Non periodic Onchocerca
Sub periodic Peaks in afternoon 3-5pm Wuchereria caused by
or evening 7-9pm Aedes
Elimination of Lymphatic filariasis
• NVBDCP
• MDA regimen – Single dose DEC 6mg/kg + albendazole 400mg
• Triple drug regimen – IDA (Ivermectin + DEC + Albendazole)
THANK YOU
