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Trop Med > Filariasis > Flashcards

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
Q

∆∆ onchocercaisis

A

Furuncular myiasis
Subcut cysticercosis

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26
Q

What causes this in severe cases?

A

O.Volvulus

Leopard skin, severe dermatitis

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27
Q

Skin biopsy of a patient with dermatitis. Which filarial worm is this?

A

O.Volvulus

No sheath, nuclei not to the end of the tail

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28
Q

What is nocturnal periodicity?

A

Filarial worms, the microfilariae only circulate in blood at night

29
Q

What is Sowda?

A

Localised oncodermatitis

Hyperimmune response to microfilariae

30
Q

What is the classic presentation of onchcerca in a returning expat?

A

Lightly infected skin, no eye disease

31
Q

What investigations can be done for O.Volvulus?

A

Skin snip
PCR is GOLD STANDARD
Mazotti test is an option
Eye exam
Bx of nodule

32
Q

What is the Mazotti test?

A

Administration of small dose of DEC and get significant exacerbation of itching due to dying larvae?

33
Q

What is the Rx of O.Volvulus mono infection?

A

1 week of ivermectin
6 weeks of doxycycline
1 dose of ivermectin

In that order

34
Q

What causes the mazotti reaction?

A

Wolbachia present in O. volvulus cause inflammation - do not give DEC for this reason

35
Q

What is the purpose of ivermectin and doxy in Rx of onchocerca?

A

Doxy - sterilises adult females - does not kill microfilariae

Ivermectin kills microfilariae

36
Q

What is used for mass chemotherapy?

A

Ivermectin (microfilarcidal)

37
Q

Where in the Americas is onchocerca volvulus still a problem?

A

Venezuela

38
Q

What is the vector for Loa Loa?

A

Chrysops
Injects L3

39
Q

What is the classical presentation of Loa Loa?

A

Transient subcutaneous nodules
Urticaria
Migrate through conjunctiva - irritation in eye

40
Q

What is different about the pattern of microfilarial release in Loa Loa?

A

Microfilaria released in day not night!

Optimal time to test - 4pm

41
Q

Where do Chrysops breed?

A

Mud below rainforest canopy

42
Q

What is a calabar swelling?

A

Transient itchy nodules caused from Loa Loa

43
Q

How do you test for Loa Loa?

A

Blood microfilarial smear

Adults live subcutaneously
Microfilaria in blood

44
Q

How do you treat Loa Loa?

A

Depends on microfilarial count and mono infection or co infection

45
Q

How do you treat mono infection Loa Loa?

A

<2500 microfilaria/ml
DEC
Not if have onchocerca
>2500 apheresis and expert input or albendazole until <2500
Then DEC

46
Q

How do you Rx Loa and O.Volvulus?

A

Onchocerca Rx first - ivermectin single dose
Wait 6-12 months
Rx LoaLoa with DEC

47
Q

Why do you not give DEC if microfilarial count is very high?

A

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
Q

How do you Rx LF and Loa?

A

Both are Rx with DEC however same rules apply re: microfilarial count of Loa

49
Q

How do you Rx Onchocerca and LF?

A

Onchocerca Rx first - ivermectin single dose
Wait 1 month
Rx for LF: Give DEC

50
Q

What is this?

A

Sheath
Nuclei not to the end

Therefore W.Bankrofti

51
Q

What is this? Skin snip.

A

Unsheathed
Nuclei not to the end
Found in skin therefore O.Volvulus

52
Q

What is this?

A

Sheath
Nuclei to the end (low)

Therefore Loa Loa

53
Q

What is this?

A

Sheath
Terminal nucleus
Therefore B.Malayi

54
Q

What is this?

A

No sheath
Nuclei to the end
Therefore Mansonella Persians

55
Q

What is this? Skin Bx.

A

No sheath
Hooked tail
Nuclei to the end
Therefore M.Streptocerca

56
Q

What is this? Blood smear

A

No sheath
Nuclei not to the end of the tail
Therefore M.Ozzardi (wizard of Oz does not exist)

57
Q

What is this?

A

W.Bankrofti

58
Q

What other test can you do for W.Bankrofti?

A

Circulating antigen test using ELISA
Also used in rapid test
Secreted by adult worm

Not for B.Malayi

59
Q

What is the Biplex test?

A

Rapid test for W.Bankrofti and Onchocerca

60
Q

What is this? Tissue biopsy?

A

O.Volvulus

61
Q

What is this?

A

B.Malayi

62
Q

What is this?

A

M.perstans

63
Q

What is this?

A

Loa Loa
Elongated nuclei pathopneumonic

64
Q

What is this?

A

W.Bankrofti

65
Q

What is this?

A

M.Streptocerca

66
Q

What is this?

A

W.Bankrofti

67
Q

What is this?

A

Loa Loa

68
Q

What is this?

A

B.Malayi

Trop Med (49 decks)

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