L2: Bancroftian filariasis Flashcards

1
Q

What is the definition of Bancroftian filariasis?

A
  • It is caused by a slender “thin” white filarial worm called Wuchereria bancrofti, transmitted by mosquitoes bite, lives in lymphatics, periodically shedding larvae into peripheral bloodstream
  • often causes elephantiasis by blocking lymphatic drainage.
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2
Q

What is the morphology of adult of wuchereria bancrofti?

“Female is double the male”

A
  • Male: 4 cm long, curved posterior end.

- Female: 8 cm long, tapered tail.

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3
Q

What is the morphology of the microfilaria of wuchereria bancrofti?

A
  • About 300 x 10 μ.

- Has lose sheath, rounded anterior end, and tapered posterior end devoid of nuclei.

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4
Q

What is the lifecycle of wuchereria bancrofti?

A
  • Habitat: adults live in lymph vessels and lymph nodes especially those draining lower part of the body, and microfilariae are in peripheral blood.
  • Definitive host (D.H.): man.
  • Intermediate host (I.H., vector): mainly female Culex, also female Anopheles and Aedes mosquitoes.
  • Infective stage: infective filariform larvae in mosquito mouth.
  • Mode of infection: through the skin, during the bite of infected female mosquito.
  • Infected insect bites human→infective filariform larvae actively enter through bite wound→migrate to lymphatics→transform to adult worms.
  • Fertilized females lay microfilariae→migrate to peripheral blood→ sucked by insect vector.
  • In the insect midgut, microfilariae moult “peel” →infective filariform larvae →migrate to the mosquito mouth.
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5
Q

And what causes the clinical manifestations of wuchereria bancrofti?

“Like entamoeba”

A

❑ Results from a complex interplay of:

  1. Pathogenic potential of the parasite.
  2. Tissue response of the host.
  3. External bacterial and fungal infections.
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6
Q

what are the types of pathology caused by wuchereria bancrofti ?

A

Classical filarias

Occult filariasis

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7
Q

Compare between classical filariasis and occult filariasis according to:-

Cause
Lesions
Pathology C/P
MF in blood
Diagnosis

“Adult in lymphatics —–> microfilaria in peripheral blood ——-> infective filariform larva in mosquito midgut”

A

Cause:

  • Adult worm
  • Microfilaria (Microfilaria usually non-pathogenic)

Lesions:

  • LNs & Lymphatics
  • Lung, Liver and Spleen

Pathology C/P:

  • Inflammation, Fibrosis ands classical manifestations
  • esinophilic granuloma, cough, Dyspnea and asthma

MF in blood:

  • Present
  • Pbsent in blood (present in affected tissues)

Diagnosis:

  • Blood film - Serology is less effective
  • Serology
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8
Q

What is the incubation period of wuchereria bancrofti??

A

8 - 16 months

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9
Q

What are the clinical manifestations of wuchereria bancrofti?

A

Asymptomatic filariasis

Symptomatic filariasis

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10
Q

What are the characteristics of asymptomatic Filariasis?

A
  • in people living in endemic areas, and they are source of infection
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11
Q

What are the types of symptomatic filariasis?

A

Acute inflammatory manifestations “in nearly 6 months”

Chronic obstructive manifestations (10-15 years)

Tropical pulmonary eosinophilia (TPE, diffuse filarial lung disease)

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12
Q

What are Acute inflammatory manifestations of lymphatic filariasis?

A
  • Lymphangitis
  • Lymphadenitis
  • Filarial fever
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13
Q

What are the characteristics of lymphangitis in lymphatic filariasis?

A
  • dilated, inflamed and thickened lymphatic vessels.
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14
Q

What are the symptoms of lymphangitis of lymphatic filariasis?

A
  • red, tender & swollen.
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15
Q

What are the causes of lymphangitis of lymphatic filariasis?

A

a. Mechanical irritation by moving worms.
b. Metabolites of living worms.
c. Toxic products of living and dead worms.
d. Secondary bacterial infection.

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16
Q

What are the symptoms of lymphadenitis of Lymphatic filariasis?

A
  • enlarged, tender and matted lymph nodes
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17
Q

What causes lymphadenitis of Lymphatic filariasis?

A
  • due to fibrosis and necrosis & obstruction of proximal lymphatic vessels.
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18
Q

What is the site of lymphadenitis of lymphatic filariasis?

A

inguinal lymph nodes.

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19
Q

What are the symptoms of filarial fever?

A
  • high fever, chills and excess sweating.
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20
Q

What are chronic obstructive manifestations of lymphatic filariasis?

A
  • Dilatation of lymphatic (Varicosity)
  • Lymphorrhagia
  • Lymphedema
  • Elephantiasis
21
Q

Where does dilatation of lymphatics mainly occur?

A
  • occurs mainly in genital organs (hydrocele & lymphatic varices)
22
Q

What causes lymphorrhagia? And what are examples for it?

A
  • rupture of lymph varices release lymph, e.g. chyluria, chylous diarrhea, chylothorax and chyluria.
23
Q

What is lymphedema in lymphatic filariasis?

A
  • abnormal accumulation of lymph in tissues, swelling, mainly of lower limb & genitalia,
24
Q

What are the characteristics of lymphedema of lymphatic filariasis?

A
  • A hard and non-pitting area starts at ankle, then spreads to affect foot & leg.
  • It can also affect scrotum, vulva, arms and breast.
25
Q

What causes lymphedema of lymphatic filariasis?

A
  • dilatation of lymphatic vessels due to inflammation caused by worms.
26
Q

What causes elephantitis of lymphatic filariasis?

A
  • due to obstruction and fibrosis of lymph nodes & lymph vesselS
27
Q

What are the characteristics of the affected parts with elephantitis of lymphatic filariasis?

A
  • Affected parts are edematous & tender
28
Q

What are the characteristics of the skin covering the affected parts by elephantitis of lymphatic filariasis?

A
  • hard, stretched, thick and rough skin covering
29
Q

What are the mainly affected parts with elephantiasis of lymphatic filariasis?

A
  • It mainly affects leg, genitalia, arm and breast.
30
Q

What are the causes of obstruction of lymph flow in lymphatic filariasis?

A

a. Worms blocking the lumen of lymphatic vessels.
b. Endothelial proliferation and thickening of lymphatic vessels.
c. Fibrosis of lymphatic vessels and lymph nodes.
d. Recurrent secondary bacterial lymphangitis.

31
Q

What is the site of tropical pulmonary eosinophilia?

A

lung tissues

32
Q

What is the cause of tropical pulmonary eosinophilia?

A
  • hypersensitivity reaction to microfilarial antigens
33
Q

What is the pathology of tropical pulmonary eosinophilia?

A
  • chronic interstitial fibrosis with destruction of microfilariae in the pulmonary vasculature
34
Q

What is the clinical picture of tropical pulmonary eosinophilia?

A
  • Clinically there is dyspnea, cough & asthma.
35
Q

What is the treatment of tropical pulmonary eosinophilia?

A

Hetrazan

36
Q

How is Wuchereria bancrofti diagnosed?

A

❑ Clinical diagnosis: by good history taking.

❑ Laboratory diagnosis: Direct and indirect

37
Q

What is the direct diagnosis of Wuchereria bancrofti?

A
  1. Detection of microfilariae in peripheral blood
  2. Provocative test
  3. Detection of microfilariae
  4. Detection of adult worms
  5. Immunological tests for detection of filarial antigens
38
Q

What is the indirect diagnosis of Wuchereria bancrofti?

A

1- Immunological tests for detection of filaria-specific antibodies

2- Blood examination

3- X-ray

39
Q

How is Microfilaria detected in peripheral blood?

A

a. Fresh smear.
b. Giemsa-stained thick blood film.
c. Concentration of microfilariae (Knott s method).

40
Q

What are important points that should be concerned about Microfilaria in Peripheral Blood?

A
  • Appear year/s after infection.
  • Rarely found in obstructed lymphatic.
  • More in capillary than venous blood.
  • More in ear lobe than finger blood.
  • Blood must be collected at night (10 PM-2 AM).
41
Q

What is provocative test done to microfilaria?

A
  • 2mg/Kg of diethylcarbamazine are given to the patient microfilaria enters peripheral blood in day time within 30 - 45 min of administration.
42
Q

What are other sites where microfilaria could be detected?

A
  • chylous urine and other chylous fluid.
43
Q

How are adult worms of Wuchereria bancrofti detected?

A

a. Lymph node biopsy.
b. X-ray to detect dead calcified worm.
c. Ultrasonography: can visualize movement of living worms in lymphatics.

44
Q

How is Wuchereria bancrofti treated?

A
  1. Chemotherapy
  2. Surgical
  3. Foot care programme for lymphedema.
45
Q

What is the chemotherapy to Wuchereria bancrofti?

A

a. Diethyl carbamazine citrate (Hetrazan):
- Drug of choice, effective against microfilariae and tropical pulmonary eosinophilia.
- Repeated courses can kill adult worms.

b. Ivermectin: effective against microfilariae, but no effect on tropical pulmonary eosinophilia.
c. Albendazole: efficacy against microfilariae and its action on adults is under research.

46
Q

What is the surgical treatment for Wuchereria bancrofti?

A
  • Hydrocele.

- Elephantiasis.

47
Q

How is lymphedema treated?

A

Foot care programme

48
Q

How is Wuchereria bancrofti prevented and controlled?

A
  1. Detection & treatment of patients.
  2. Vector control.
  3. Health education in endemic areas.
  4. Environmental sanitation.
49
Q

What is indirect diagnosis of wuchereria bancrofti?

A
  1. Immunological tests for detection of filaria-specific antibodies: ELISA, indirect immunofluorescence assay test (IFAT) & complement fixation test (CFT).
  2. Blood examination: for detection of eosinophilia.
  3. X-ray: for diagnosis of tropical pulmonary eosinophilia.