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Filariasis Flashcards

1
Q

Infective stage for W.Bancrofti/B.Malayi?

A

L3 larvae

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2
Q

Name the vector for W.Bancrofti/B.Malayi

A

Aedes agypti, anopheles, manonia, culex - a mix of night or day biting mosquitos

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3
Q

Which stage of the lifecycle do mosquitos take up during a blood meal in W.Bancrofti/B.Malayi?

A

pre-L1 larvae - microfilaria

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4
Q

Where do L3 larvae mature to adults in the human body (W.Bancrofti/B.Malayi)?

A

Lymphatics

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5
Q

What are the symptoms of W.Bancrofti/B.Malayi?

A

Lymphadenitis, lymphedema, fever, hydrocele

Chyluria - renal lymphatics get blocked - get chyle in urine

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6
Q

What causes tropical pulmonary eosinophilia?

A

W.Bancrofti/B.Malayi
Microfilariae released into blood from mating adult worms in lymph nodes - IgE response

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7
Q

Where in the world is lymphatic filariasis?

A
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8
Q

What are the symptoms of tropical pulmonary eosinophila?

A

Presents with paroxysmal nocturnal asthma + pulmonary infiltrates + eosinophilia >3000/ml, raised IgE, rapid response to Rx

bilateral lower lobe interstitial disease. Mostly young males in India.

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9
Q

What are the key clinical differences between B.Malayi to W.Bankrofti?

A

Bankrofti - more common (90%) vs Malayi 10%

Malayi - Elephantiasis usually
lower leg, Cold filarial abscesses

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10
Q

What other tests can you do for W.Bankrofti and what would you see?

A

Ultrasound
”Filaria dance sign”

Can also see adult worms

Lymphoscintigraphy to see extent of damage to anatomy

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11
Q

Investigation of choice in lymphatic filariasis?

A

Blood sample and smear to look for microfilariae

Taken night time - microfilariae circulate at night!

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12
Q

Drug of choice for lymphatic filariasis?

A

DEC followed by 6 weeks of doxy

Diethylcarbamazine

Single dose is microfilaricidal but can be given longer to kill adult

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13
Q

Alternatives to Rx of lymphatic filariasis in control programmes?

A

Single dose of ivermectin or albendazole - microfilaricidal therefore prevent transmission

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14
Q

Another alternative Rx for lymphatic filariasis?

A

Kill the Wolbachia bacteria which allows the worm to exist

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15
Q

What must you check before Rx?

A

No onchocerciasis

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16
Q

What is the mass Rx strategy?

A

IDA
Ivermectin
DEC
Albendazole

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17
Q

Alternative tests for lymphatic filariasis species?

A

Serology
IgG or antigen test

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18
Q

What is the vector for onchocerca volvulus?

A

Simulium fly

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19
Q

Infective stage for onchocerca volvulus?

A

L3 larvae

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20
Q

Where do larvae develop into adults in onchocerca volvulus?

A

Subcutaneous nodules

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21
Q

What is different about onchocerca volvulus to W.Bankrofti and B.Malayi?

A

Adults develop in subcut nodules and migrate through SKIN AND EYE not blood

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22
Q

What are the symptoms of O.Volvulus?

A

-Pruritus, dermatitis
-Punctate and sclerosing keratitis, blindness
-Encapsulated nodules in skin
- leopard skin- hypopigmentation

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23
Q

Which species causes ‘river blindness’?

A

onchocerca volvulus

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24
Q

Where do the Simulium flies breed?

A

Fast flowing rivers

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25
∆∆ onchocercaisis
Furuncular myiasis Subcut cysticercosis
26
What causes this in severe cases?
O.Volvulus Leopard skin, severe dermatitis
27
Skin biopsy of a patient with dermatitis. Which filarial worm is this?
O.Volvulus No sheath, nuclei not to the end of the tail
28
What is nocturnal periodicity?
Filarial worms, the microfilariae only circulate in blood at night
29
What is Sowda?
Localised oncodermatitis Hyperimmune response to microfilariae
30
What is the classic presentation of onchcerca in a returning expat?
Lightly infected skin, no eye disease
31
What investigations can be done for O.Volvulus?
Skin snip PCR is GOLD STANDARD Mazotti test is an option Eye exam Bx of nodule
32
What is the Mazotti test?
Administration of small dose of DEC and get significant exacerbation of itching due to dying larvae?
33
What is the Rx of O.Volvulus mono infection?
1 week of ivermectin 6 weeks of doxycycline 1 dose of ivermectin In that order
34
What causes the mazotti reaction?
Wolbachia present in O. volvulus cause inflammation - do not give DEC for this reason
35
What is the purpose of ivermectin and doxy in Rx of onchocerca?
Doxy - sterilises adult females - does not kill microfilariae Ivermectin kills microfilariae
36
What is used for mass chemotherapy?
Ivermectin (microfilarcidal)
37
Where in the Americas is onchocerca volvulus still a problem?
Venezuela
38
What is the vector for Loa Loa?
Chrysops Injects L3
39
What is the classical presentation of Loa Loa?
Transient subcutaneous nodules Urticaria Migrate through conjunctiva - irritation in eye
40
What is different about the pattern of microfilarial release in Loa Loa?
Microfilaria released in day not night! Optimal time to test - 4pm
41
Where do Chrysops breed?
Mud below rainforest canopy
42
What is a calabar swelling?
Transient itchy nodules caused from Loa Loa
43
How do you test for Loa Loa?
Blood microfilarial smear Adults live subcutaneously Microfilaria in blood
44
How do you treat Loa Loa?
Depends on microfilarial count and mono infection or co infection
45
How do you treat mono infection Loa Loa?
<2500 microfilaria/ml DEC Not if have onchocerca >2500 apheresis and expert input or albendazole until <2500 Then DEC
46
How do you Rx Loa and O.Volvulus?
Onchocerca Rx first - ivermectin single dose Wait 6-12 months Rx LoaLoa with DEC
47
Why do you not give DEC if microfilarial count is very high?
In patients with >2,500 Loa loa microfilaria/ml of blood, treatment of onchocerciasis with Ivermectin or Moxidectin can result in facilitation of Loa loa entry into the CNS with severe encephalopathy and even death.
48
How do you Rx LF and Loa?
Both are Rx with DEC however same rules apply re: microfilarial count of Loa
49
How do you Rx Onchocerca and LF?
Onchocerca Rx first - ivermectin single dose Wait 1 month Rx for LF: Give DEC
50
What is this?
Sheath Nuclei not to the end Therefore W.Bankrofti
51
What is this? Skin snip.
Unsheathed Nuclei not to the end Found in skin therefore O.Volvulus
52
What is this?
Sheath Nuclei to the end (low) Therefore Loa Loa
53
What is this?
Sheath Terminal nucleus Therefore B.Malayi
54
What is this?
No sheath Nuclei to the end Therefore Mansonella Persians
55
What is this? Skin Bx.
No sheath Hooked tail Nuclei to the end Therefore M.Streptocerca
56
What is this? Blood smear
No sheath Nuclei not to the end of the tail Therefore M.Ozzardi (wizard of Oz does not exist)
57
What is this?
W.Bankrofti
58
What other test can you do for W.Bankrofti?
Circulating antigen test using ELISA Also used in rapid test Secreted by adult worm Not for B.Malayi
59
What is the Biplex test?
Rapid test for W.Bankrofti and Onchocerca
60
What is this? Tissue biopsy?
O.Volvulus
61
What is this?
B.Malayi
62
What is this?
M.perstans
63
What is this?
Loa Loa Elongated nuclei pathopneumonic
64
What is this?
W.Bankrofti
65
What is this?
M.Streptocerca
66
What is this?
W.Bankrofti
67
What is this?
Loa Loa
68
What is this?
B.Malayi

Trop Med (49 decks)

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