Filaria, Capillaria, Trichinella Flashcards
Medically important filarial species in the Philippines
Wuchereria bancrofti
Brugia malayi
Usually in Mindanao and Bicol
Common names of
Wuchureria
Brugia
Wuchureria: Bancrofti’s Filarial worm
Brugia: Malayan Filarial Worm
Intermediate host of
Wuchureria bancrofti:
Brugia malayi:
Wuchureria bancrofti: Anopheles, Aedes, Culex
Brugia malayi:
Mansonia bonneae, M. uniformis
Habitat of adult:
Wuchureria bancrofti:
Brugia malayi:
Wuchureria bancrofti: Lower lymphatic
Brugia malayi: upper lymphatic
Infective stage of
Wuchureria bancrofti:
Brugia malayi:
IS to FH: L3
IS to IH: Microfilariae
MOT of
Wuchureria bancrofti:
Brugia malayi:
both skin penetration
Periodicity of
Wuchureria bancrofti:
Brugia malayi:
Wuchureria bancrofti: nocturnal (10pm - 2am)
Brugia malayi:
Periodic-nocturnal / Subperiodic
Cephalic space of (length : width)
Wuchureria bancrofti:
Brugia malayi:
Wuchureria bancrofti: 1:1
Brugia malayi: 2:1
longer than its width
Sheath affinity to Giemsa:
Wuchureria bancrofti:
Brugia malayi:
Wuchureria bancrofti: Unstained
Brugia malayi: Stained-pink
Body/somatic nuclei of
Wuchureria bancrofti:
Brugia malayi:
Wuchureria bancrofti: regularly shaped
Brugia malayi: overlapping / irregular
Terminal nuclei of
Wuchureria bancrofti:
Brugia malayi:
Wuchureria bancrofti: NO TERMINAL NUCLEI
Brugia malayi: two nuclei
Appearance of
Wuchureria bancrofti:
Brugia malayi:
Wuchureria bancrofti: Graceful curve
Brugia malayi: Kinky / stiff
Pathology of
Wuchureria bancrofti:
Brugia malayi:
Wuchureria bancrofti: Bancroftian Filariasis
Brugia malayi: Malayan Filariasis
Lymphatic Filarial worms can cause
Elephantiasis
Elephantiasis habitat
Scrotal area, legs
stage released in the bloodstream
seen in blood smears
Microfilariae
Staining of Wuchereria bancrofti in
H&E stain:
Giemsa stain:
H&E stain: slightly /lightly stained
Giemsa stain: darkly stained
WUCHERERIA BANCROFTI
● Periodicity
Nocturnal (10pm-2am)
8 pm – 4 am (Belizario)
▪Only seen at night unless DEC is administered (pinainom)
▪ tablet para lumabas anytime or during day time
Vectors of WUCHERERIA BANCROFTI
Mosquitoes – Anopheles flavirostris, Aedes poecilus, Culex
Vector of WUCHERERIA BANCROFTI that
▪ Causes dengue (same species)
▪ Breeds in water or axils of abaca and banana
Aedes poecilus
Vector of WUCHERERIA BANCROFTI that
▪ Principal vector for malaria, too
Anopheles flavirostris
Vector of WUCHERERIA BANCROFTI that
▪ Major vectors in urban areas
▪ Breeds in drains, sewage, beaches
Culex
Vectors of Brugia malayi
Mansonia bonnae
Mansonia uniformis
Vector of Brugia malayi that
Breeds in freshwater swamps
Mansonia bonnae
Vector of Brugia malayi that
Breeds in rice fields
Mansonia uniformis
TRUE OR FALSE
Vectors of Brugia malayi are noght biters
TRUE
Both are night biters (5 pm – 11 pm)
Periodicity of Brugia malayi
Subperiodic
o Seen in the bloodstream any time of the day
Diagnosis
●Microscopy of Giemsa-Stained Blood Smears (Recommended)
● Knott’s Concentration Technique
● Filtration using Millipore
● DEC Provocative Test
o paiinumin iyan ng tablet 100 mg then 20-50 minutes pede mo na kunan ng blood
● Antigen Detection Test
Lymphatic filariasis is commonly known as
Elephentiasis
Manifestations of Elephantiasis
Malaki legs Convolutions Enlargement of breast Lymph edema Hydrocele (fluid in scrotum)
Procedure of Knott’s concentration technique
Collect blood Mix with 2% formalin Centrifuge Decant the supernatant Put sediment with parasite in slide Air dry Apply Giemsa stain (or wright stain) Observe
What should be considered in observing parasites in Knott’s concentration technique
differentiate: nuclei, color ng sheath, anterior portion, cephalic space
Adult male worm ahs characterized with chitinized spicule and long spicule sheath.
C. philippinensis
o spicule for copulation
o counterpart ng spicule ay penis of the male
o unique with Capillaria is that spicule is sheathed
o take note sheath is gne body coffin
The habitat of C. philippinensis
Small intestine
TRUE OR FALSE: Cooking meat to 170F or freezing
for 20 days at 50F will kill larvae
TRUE
o Raw food (like sushi) – has high chance to acquire
parasitic infection from eating contaminated meat.
o A way to kill parasite without cooking (like sushi) is
freezing them
o Freezing will kill parasites
Xenodiagnosis can be used to diagnose infection with.
Trichinella spiralis
o what is the other protozoan that can be use to
diagnosed Xenodiagnosis? trypanosoma cruzi
o Xenodiagnosis is procedure to use animals to
diagnose certain infection
TRUE OR FALSE: Trichinella spiralis can infect human muscle.
TRUE
Trichinella spiralis is also known as muscle worm
because it can infect the muscles
Capillaria Philippinensis was discovered in
Pudoc, Ilocos Sur, Philippines
Before, Capillaria Philippinensis was called
Mystery worm, the agent of the mystery disease Because the egg of capillaria
philippinesis resembles the egg of trichuris trichura (due to the bipolar plugs)
Capillaria Philippinensis egg is mistaken as
Trichuris trchiura
who discovered Capillaria Philippinensis
Nelia Salazar (1963 –UP manila)
Common name of Capillaria philippinensis
Pudoc worm
Final host of Capillaria philippinensis
birds and humans
Incidental / accidental hosts of Capillaria
Humans but we still harbor the sexual stage / adult stage
Intermediate hosts of Capillaria philippinensis
brackish and freshwater fish (small fishes)
People in northern region acquired this parasite because
they are fond of kinilaw (uncooked fish soaked in vinegar)
TRUE OR FALSE
Vinegar can kill bacterias and parasites
FALSE
Vinegar can kill bacteria but not parasite
habitat of Capillaria philippinensis
small intestine of birds and humans
diagnostic stage of Capillaria philippinensis
ova (egg) in the stool
in severe cases egg, larvae and adult stages are also seen
Infective stage of Capillaria philippinensis
Larva in intermediate host (no specific name)
Source of infection of Capillaria philippinensis
Food borne
Mode of Transmission of Capillaria philippinensis
ingestion
portal of entry of Capillaria philippinensis
mouth
What are the intermediate hosts of Capillaria philippinensis
● guppy – Poecilia reticulata ● Bukto – Chonophotus melanocephalus ● Bagsang – ambassis miops ● Ipon – sicyopterus sp, ●Birut?
TRUE OR FALSE
a dried fish can no longer harbor larva stage and is therefore not infectious
TRUE
TRUE OR FALSE
The larvae is still viable even though the fish has been
caught for several days.
TRUE
TRUE OR FALSE
Morphology of adult male has a curved tail
FALSE
you will not see a curved posterior tail.
Morphology of adult male includes
Chitinous Spicule
Spicule sheath (unique in C. philippinensis)
Presence of Stichocytes
– accessory reproductive structure
in male nematodes; useful in identification of species.
▪ usually found in the posterior portion
HAS A LONG SPICULE
Copulatory spicule
Chitinous spicule
Esophageal gland that contains stichocytes
stichosome
What differentiates Capillaria from other nematodes is the
presence of
stichosome
Morphology of adult female includes
Eggs
Stichosome
The spicule of an adult male is made up of
chitin which is why it is also termed as Chitinous spicule
2 types of capillaria female
typical female (oviparous)
atypical female (oviviparous / larviparous)
typical female (oviparous) has eggs of around
8-10 or more in a single row
atypical female (oviviparous) has eggs that are
segmented eggs / embryonated eggs
40-45 eggs
Which of the two is capable of autoinfection wherein you are the source of your own infection?
Atypical demale
the larva that is laid continues the cycle making the larva mature again
Capillaria philippinensis egg
thick, striated egg shell
flattened bipolar plugs
Peanut / guitar-shaped
Diagnostic tests of Capillaria philippinensis
●DFS
●Concentration technique (FECT)
● examination of duodenal aspirate
● Kato-Katz
● ELISA test
o we detect the Capillaria coproantigen. However,
this coproantigen cross-reacts with Trichinella spiralis which means they (the antigens) are almost the same
Coproantigens of Capillaria philippinensis cross-reacts with that of the
Trichinella spiralis
Pathology of Capillaria Philippinensis
Pudoc disease, Mystery disease
●microulceration, depression of intestinal villi ● Borborygmi / Borborygmous ● Abdominal pain ● Diarrhea (main pathology) ● Weight loss ● Malabsorption ● Low plasma electrolyte concentration
Treatment
Albendazole and Mebendazole
Common name of the Trichinella spiralis
Trichina worm / muscle worm
Final host of the Trichinella spiralis
Swine and other vertebrates (secondary hosts)
others are bears, boars, oso
common among carnivores
Habitat of Trichinella spiralis
adult - small intestine
larvae - striated muscle
Diagnostic stage of Trichinella spiralis
Encysted larvae (muscle tissue)
sample used in diagnosis of Trichinella spiralis
muscle tissue - muscle biopsy
Infective stage of Trichinella spiralis
Encysted larvae (muscle tissue)
Sources of infection in Trichinella spiralis
Food-borne / zoonotic
TRUE OR FALSE
Trichinella spiralis cannot be transferred via human-to-human transmission (would only be possible through cannibalism)
TRUE
Accidental hosts of the Trichinella spiralis
Humans
T. spiralis is also called the ____ of infection
end alley
Who are the dead-end host / accidental host
humans
the larva in our muscle cannot be acquired by another mammal
can be observed assisting the larva
nurse cells
Life cycle of the trichinella spiralis
- ingestion of undercooked meat
- Encysted larva will be released into the small intestine where maturation will happen
- Male and female will undergo reproduction (female will become gravid and it will migrate to the submucosal limning of the small intestine and lay larva)
- Laid larva will proceed to the bloodstream and once it reaches a crtain tissue, it will undergo encystation and will become encysted larva
Laboratory diagnosis of the Trichinella spiralis
●Muscle tissue biopsy (Deltoid & gastrocnemius)
●Ultrasound / Radiographic procedure
●Chemical assays (check isoenzyme CK-MM found in skeletal muscle)
High CK-MM=destruction muscle but this is not specific
● Species identification (PCR, Western blot assay)
● Beck’s Xenodiagnosis (no longer performed)
● Serological tests (detects antibodies against T. spiralis antigen)
Bentonite Flocculation Test
▪ in-vitro (outside the body) test
▪ collect serum then add reagent
▪ positive result: presence of clumping / flocculation
●Bachman intradermal test
Female trichinella spiralis are
a. oviparous
b. larviparous
b. larviparous
TRUE OR FALSE
There is no egg stage in this life cycle
TRUE
Why do we make use of radiographic procedure or X-rays in detection of trichinella spiralis?
because hyperinfection of T.spiralis larva can be calcified in the striated muscle
Skin test for trichinosis
Indirect method
bachman intradermal test (in vivo test)
1:5000 or 1:10000 dilution of larval antigen
trichinella larva is suspended in saline, saline is injected intradermally. observe of hypersensitive reaction whcich is triggered if we are re-exposed
Wheal (redness) and flare (swelling) = type 1 hypersensitivity reaction (immediate reaction)
Phases of clinical conditions (pathology) of trichinella spiralis
o Enteric phase
o Invasion phase
o Convalescent phase
What phase of clinical conditions includes
corresponds to the incubation and intestinal invasion
➢ In human digestion, the meat you eat will release
the Trichinella spiralis larva into the intestine and will mature rapidly to become an adult.
➢ Adult female (larviparous) will migrate to your
intestinal mucosa which will lay the larva into
submucosa.
Enteric phase
What phase of clinical conditions includes
corresponds to larval migration and muscle invasion
➢ The intent larva will enter the bloodstream. It will encyst in the striated muscle.
➢ We can see this through the microscopic
examination of tissue biopsy.
■ Muscle fiber will contain our coiled larva
■ Nurse cell will provide nutrition to your
encysted larva in the striated muscle
➢ Over time, it will form granuloma due to reaction of immune cell and it will be calcified around this cell
Invasion phase
Role of the nurse cell
assists the encysted larva by providing nutrition
What phase of clinical conditions includes
corresponds to encystment and encapsulation
➢ Humans are not traditional hosts as compared to
swine or bears. Life cycle does not occur and
cycle ceases with encystation of the larva.
➢ This type of parasite is just waiting to be eaten
by another mammal to continue its cycle.
➢ It usually happens in swine and wild bears that
can continue the cycle.
Convalescent phase
Pathologies of Trichinella spiralis
●Meningitis and Meningoencephalitis ●can also cause intestinal disorder ●Encysting and encapsulating eosinophilia ●Periorbital swelling ●Muscle tenderness, pain - common ●Edema generalized weakness ●Diarrhea (may be rare)
What are the muscle enzymes
Lactate dehydrogenase (LD)
Aldolase
Creatine phosphokinase (CK)
TRUE OR FALSE
Filarial worms are tissue nematodes
TRUE
Anthropod-transmitted parasite of the circulatory and lymphtic system
Filarial worms
How many larval molts in the life cycle of the filarial infection
5 larval molts
3 in insect vector
2 in human host
adult filarial worms reside in
lympathic system
life cycle of filarial worms
- Infective L3 is deposited in blood and would reach the lymphtic system
- a 6 or 12 months perior is required for sexual maturity. The parasite undegoes 2 molts and the adult worm develops (L5). Adult worms reside in lymphatics or lymph nodes
- Adult female worm gives birth to L1 larvae called microfilariae
How many microfilariae can a filarial worm lay
50,000 per day
sample for diagnosis for filarial infection
blood or lymphatic fluid
Drug of choice for filarial infection
If the patient is presenting tropical pulmonary eosinophilia and it could be caused by a filarial worm
Diethylcabamazine
Caused by Larva which is found at lymphatic and
circulatory system
Tropical pulmonary eosinophilia
TRUE OR FALSE
Lymphatic filariasis is the second leading cause or permanent and long term disability, affecting both physical and psychological aspect of the patient
TRUE
What are the two most common causes of the lymphatic filariasis (etiologic agent)
Wuchereria bancrofti
Brugia malayi
TRUE OR FALSE
The adult females of B. malayi and W. bancrofti are distinguishable
FALSE
The adult females of B. malayi and W. bancrofti are indistinguishable
Hydrocele / chylocele is a common chronic manifestation of
Bancroftian filariasis
Trichinella spiralis female is viviparous and lives for ___ and can lay ___ larvae in its lifetime
30 days
1,500 larvae
superfamily of Capillaria philippinensis is
Trichinelloidea
to which trichuris and trichinella belong
superfamily of Trichinella spiralis is
Trichinelloidea
