BLOOD AND TISSUE NEMATODES Flashcards
BLOOD AND TISSUE NEMATODES aka
Filarial worms
• Infective stage to man:
filariform/filiform/3rd stage microfilariae
• Infective stage to vector:
microfilariae (adult worm lays eggs in the circulation; ingested by mosquito)
• Pathogenic stage to man:
adult worm (pain is felt; disease occurrence)
Diagnostic stages
Microfilariae: blood
Adult larvae: lymphatics
MOT
Arthropod transmitted/mosquito-borne parasites
- threadlike, creamy, white, varies in length (2-50 cm)
- Adult
- snake-like with a column of cells in the anterior to the posterior portion (develops in the vector)
- larval stage
-pre-larval stage, embryos produced by filarial worms usually found in the blood or tissues of patients with filariasis, highly motile and threadlike
- Microfilaria
Location of Microfilariae in man:
peripheral blood and lymph spaces of the skin
a thin, translucent egg shell remnant covering the body of the microfilaria and past the head and tail
Sheath
SHEATHED Microfilariae
- Wuchereria bancrofti
- Brugia malayi
- Loa loa
UNSHEATHED Microfilariae
- Onchocerca volvulus
- Dipetalonema perstans/Mansonella perstans
- Dipetalonema streptocerca/Mansonella streptocerca
- Mansonella ozzardi
rhythmical appearance of microfilariae in the peripheral blood; maximum biting activity of the vector/active/helps in the PBS
Periodicity
Periodicity Types:
- Periodic
- Subperiodic
- Non-periodic
- Periodic:
➢ Nocturnal –
➢ Diurnal –
10pm to 2am
10am to 2pm
- Subperiodic:
➢ Nocturnally –
➢ Diurnally –
peak count during night time
peak count during day time
- Non-periodic:
during night time and day time
Disease caused by
Lymphatic Filariasis
: swelling in the scrotum that occurs when fluid collects in the thin sheath surrounding a testicle.
a) Hydrocele
: swelling that generally occurs in one of the arms or legs
b) Lymphedema/Lymphangitis
: condition characterized by gross enlargement of an area of the body, especially the limbs
c) Elephantiasis
: rare condition in which lymphatic fluid leaks into the kidneys and turns the urine milky white
d) Chyluria
✓ Asymptomatic microfilaremia
✓ Lymphangitis (inflammation) and lymphadenitis (enlargement)
✓ Orchitis (inflammation of testicle) and epididymitis; hydrocoele (swelling of scrotum)
✓ Elephantiasis
✓ Tropical pulmonary eosinophilia & allergic reaction (microfilariae)
✓ Chyluria (milky white urine)
Laboratory Diagnosis for Filariae
- Microscopic Examination
- Capillary tube method
- Immunoassay
- Identification of adult worms
• Stains:
Wrights; Giemsa; Delafield Hematoxylin
• Negative results:
low intensity of infection; dead worms; obstructed lymphatics
provocative tests 3mg/kg single dose)- stimulates microfilariae to come out to the peripheral circulation
DEC (Diethylcarbamazine)
➢ 1 ml WB + 10 ml 2% formalin
KNOTT’S method
➢ Centrifuge at 500 x for 10 minutes
KNOTT’S method
➢ Sediment- thick and thin smears: Microfilariae & WBCs
KNOTT’S method
➢ Centrifugation of the blood sample lyzed in 2% formalin
KNOTT’S method
➢ 1 ml of fresh or anticoagulated blood is drawn up into a syring
c) Filtration: Nucleopore or Millipore membrane (5 µm pore)
➢ Lyze by adding 10 ml distilled water then pass through the Swinney filter membrane
c) Filtration: Nucleopore or Millipore membrane (5 µm pore)
➢ Examine filter membrane
c) Filtration: Nucleopore or Millipore membrane (5 µm pore)
➢ Use corneal-scleral punch, or a scalpel and needle
Skin snips: microfilariae of O.volvulus and M. streptocerca
➢ Incubate sample for 30 minutes to 2 hours in saline or culture medium then examine for microfilariae that would have migrated from the tissue to the liquid phase of the specimen
Skin snips: microfilariae of O.volvulus and M. streptocerca
➢ Use heparinized capillary tube; examine buffy coat layer
- Capillary tube method
➢ Antigen detection- circulating filarial antigens
- Immunoassay
➢ Molecular diagnosis using PCR- differentiation of filarial species and stage
- Immunoassay
➢ Ultrasonography- demonstrate live worms in the lymphatics
- Identification of adult worms
➢ Contrast lymphangiography & lymphscintigraphy using radiolabeled albumin or dextran
- Identification of adult worms
➢ Tissue samples collected during nodulectomies (onchocerciasis)
- Identification of adult worms
➢ Subcutaneous biopsies or worm removal from the eye (loiasis)
- Identification of adult worms
Prevention
Abaca workers-wear [?]
Use of mosquito repellants and/or mosquito nets; vector control (?)
long sleeves shirts
insecticides
Treatment
- DEC (Diethylcarbamazine)/Hatrazan
- Ivermectin (single dose of 200-400 µg/kbw for 12 days)
➢ A filaricidal piperazine derivative that kills both microfilariae and some adult worms of Wuchereria bancrofti and Brugia malayi
DEC (Diethylcarbamazine)/Hatrazan
➢ Periodic mass treatment: Single dose for 6 months
DEC (Diethylcarbamazine)/Hatrazan
➢ 6 mg/kg body weight for 12 days (bancroftian filariasis)
DEC (Diethylcarbamazine)/Hatrazan
➢ 3 – 6 mg/kg body weight up to a total dose of 36-72 mg/body weight (brugian filariasis)
DEC (Diethylcarbamazine)/Hatrazan
( 0.1% DEC or 0.3% DEC for 3-4 month )
Use of DEC fortified tablet salt
More effective if used in combination with DEC
Ivermectin (single dose of 200-400 µg/kbw for 12 days)
Relief of pain- cool the affected area
Ivermectin (single dose of 200-400 µg/kbw for 12 days)
Bancroft’s filarial worm
Wuchereria bancrofti
Malayan filarial worm
Brugia malayi
Eye worm, Loa worm
Loa loa
Bancroftian filariasis, elephantiasis of lower extremeties, lymphatics of scrotum; wuchereriasis
Wuchereria bancrofti
Malayan filariasis, elephantiasis of upper extremeties
Brugia malayi
-Loasis, fugitive swelling, calabar
Loa loa
-swelling(diameter:5- 10 cm)
Loa loa
-migration rate under the skin: 1 inch/2 mins
Loa loa
-does not cause blindness
Loa loa
- persists for 4 to 7 days and disappears
Loa loa
MALE: 4 cm in length by 0.1 mm
Wuchereria bancrofti
FEMALE: viviparous, 8- 10 cm in length by 0.2- 0.3 mm
Wuchereria bancrofti
MALE: 13-23 mm in length
Brugia malayi
FEMALE: 43-55 mm
Brugia malayi
MALE: 30-34 mm by 0.35 -0.43 mm (35mm)
Loa loa
FEMALE: 40-70 mm by 0.5 mm (60 mm)
Loa loa
➢ Microfilaria: 300 µm
Loa loa
➢ infective larvae: 200 µm
Loa loa
MOSQUITO: 6-20 days
Wuchereria bancrofti
VESSELS OF MAN: 6 mons
Wuchereria bancrofti
LIFE SPAN: 5 years
Wuchereria bancrofti
MOSQUITO: 2 weeks
Brugia malayi
VESELS: 3-9 mons
Brugia malayi
MOSQUITO: 10-12 days
Loa loa
SUBCUTANEOUS TISSUES: 1 year
Loa loa
LIFE SPAN: 1-15 years
Loa loa
Lymph vessels and lymph glands (lower)
Wuchereria bancrofti
Lymph vessels and lymph glands (upper)
Brugia malayi
Subcutaneous/Cutaneous and muscular tissues
Loa loa
blood
Wuchereria bancrofti
Brugia malayi
Loa loa
Culex pipiens quinquefasciatus
Wuchereria bancrofti
Mansonia spp
Anopheles spp
Brugia malayi
Chrysops spp (Deer fly /Mango fly)
Loa loa
In the Philippines, the province endemic for [?] are: Camarines Norte & Sur, Bohol, Samar, Albay, Leyte, Sorsogon, all provinces in Mindanao, Quezon, Mindoro, Mt. Province, Sulu, Masbate, Palawan, Romblon
W. bancrofti
– rural type
- Anopheles minismus var, flavirostris
- urban type of bancroftian filariasis (both breed in the axils of abaca & banana)
- Aedes poecillus
(in fresh water)
- Mansonia bonnae
(rice fields)
-Mansonia uniformis
- Endemic in the Philippines (Palawan)
B. malayi
- Abaca trees accumulates stagnant water, serving as reservoir/breeding sirte for the vector mosquito
B. malayi
Tropics & subtropics
Wuchereria bancrofti
Eastern & Southwestern Pacific islands, parts of India
Brugia malayi
Tropical Africa
Loa loa
200-300 µm
Wuchereria bancrofti
220-250 µm
Brugia malayi
250- 300 µm
Loa loa
6 µm
Brugia malayi
8 µm
Wuchereria bancrofti
Loa loa
Stains slightly w/ Giemsa
Wuchereria bancrofti
Stains deeply w/ Giemsa
Brugia malayi
Almost colorless w/Giemsa
Loa loa
Regular smoothly curved
Wuchereria bancrofti
Graceful sweeping
Wuchereria bancrofti
Irregular and twisted
Brugia malayi
Stiff w/secondary kinks
Brugia malayi