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Parasitology Lec > Lymphatic Filariasis > Flashcards

Lymphatic Filariasis Flashcards

1
Q

is one of the most debilitating diseases in tropical countries

A

Lymphatic filariasis

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2
Q

Second leading cause of permanent and long-term disability, affecting both physical and psychological aspects (next to psychiatric illness)

A

Lymphatic filariasis

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3
Q

Infective Stage

A

• Third stage larvae

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4
Q

Diagnostic Stage

A

• Microfilariae

• Adult worm

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5
Q

Two most common mosquito-borne causative agents

A

Wuchereria bancrofti
Brugia malayi

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6
Q

Wuchereria bancrofti

• Common name:

• Causing (disease)

A

Bancroft’s filarial worm

Bancroftian filariasis

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7
Q

Brugia malayi

• Common name:

• Causing (disease)

A

Malayan filarial worm

Malayan filariasis

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8
Q

Epidemiology

• Cosmopolitan parasitic infection

•_____ people affected worldwide,____ endemic countties

A

120M

83

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9
Q

Epidemiology

•______ affects 90% of cases

•______ affect 10%

A

Wuchereria bancrofti

Brugia spp

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10
Q

Biology: Adult

Morphology

A

• Creamy white, long, filiform in shape

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11
Q

Adult

Found tightly coiled in nodular dilated nests (______) in lymph vessels and sinuses of lymph glands

A

lymphangiectasis

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12
Q

• Minute, snake-like organisms constantly moving among RBC

• Several curvatures and graceful appearance

A

Microfilaria

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13
Q

Microfilaria

Enclosed in______ that is longer than the microfilaria

________Important to species identification

A

hyaline sheath

• Dark-staining nuclei

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14
Q

Kinky with secondary curves

A

Brugia

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15
Q

Smoothly Curved

A

Wuchereria

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16
Q

Terminal Nuclei of Wuchereria

A

Absent

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17
Q

Terminal Nuclei of Brugia

A

Present

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18
Q

Prevalence of Wuchereria

A

Widespread

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19
Q

Prevalence of Brugia

A

Southeast Asia only

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20
Q

Mosquito Vector of Wuchereria

A

Aedes
Anopheles
Culex

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21
Q

Mosquito Vector Brugia

A

Mansonia

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22
Q

Preference of Wuchereria

A

Scrotal lymphatics

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23
Q

Preference of Brugia

A

Limb lymphatics

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24
Q

Clinical Picture of Wuchereria

A

Hydrocele

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25
Clinical Picture of Brugia
Elephantiasis
26
Severity Wuchereria Brugia
More severe Less severe
27
Cephalic Space length to width ratio Wuchereria Brugia
Wuchereria 1:1 Brugia 2:1
28
Stylet at anterior end Wuchereria Brugia
Wuchereria - Single Brugia - Double
29
Excretory Pore Wuchereria Brugia
Wuchereria - Not prominent Brugia - Prominent
30
Nuclei column Wuchereria Brugia
Wuchereria - large course discrete Brugia - overlapping blurred
31
Tail Wuchereria Brugia
Wuchereria - pointed and free of nuclei Brugia - pointed with 2 distinct nuclei
32
Sheath Wuchereria Brugia
Wuchereria - faintly stained Brugia - well stained
33
Pre larval form of filariasis
Microfilaria
34
Mosquito takes a blood meal
L3 larvae enters skin or Mosquito ingests Microfilariae
35
Adults in
lymphatics
36
Adults produce sheathe microfilariae that migrate into
lymph and blood channels
37
Microfilariae shed sheaths. pentrate mosquito's____, and migrate to____ muscles
midgut thoracic
38
Inf stage to humans
Filariform
39
Inf stage to mosquitoes
Microfilaria
40
Diagnostic stage to humans
Microfilaria or adults
41
Infection usually acquired during____ • Take years to manifest Adult worms in the lymph nodes cause inflammation that obstructs lymphatic vessels ______
childhood LYMPHEDEMA
42
Clinical course:
1. Asymptomatic 2. Acute Stage 3. Chronic Stage
43
Clinical Spectrum of Lymphatic Filariasis
1. Asymptomatic Microfilaremia 2. Acute Dermatolymphangioadenitis 3. Acute Filarial Lymphangitis 4. Lymphedema and Elephantiasis 5. Genitourinary Lesion such as hydrocoele 6. Tropical Pulmonary Eosinophilia
44
Lymphatic Localization: • For parasitic survival • Lymph is less
Less aggressive than blood - no platelet, no complement system - incomplete coagulation system - no granulocytes, slow flow
45
Adult worm ___ (parasite-induced lymphatic dilatation
lymphangiectasis
46
: parasite induced endothelial cell proliferation and differentiation leading to collateralization
Lymphangiogenesis
47
• Predispose to secondary bacterial infections and inflammatory response to skin and subcutaneous tissue
Lymphangiectasis and Lymphangiogenesis
48
Acute Stage ___________ • Main reservoir for mosquito vectors • “Endemic Normals”
• Asymptomatic Microfilaremia
49
Worm has suppressive immunoregulatory mechanism • Individuals with thousands to millions motile microfilariae in PBS but no symptoms
Asymptomatic Microfilaremia
50
Asymptomatic Microfilaremia Outwardly healthy but may have hidden ____&_____ damage
lymphatic and kidney damage
51
________ • From non-endemic person who transferred to endemic region • Lymphadenitis, lymphangitis
Expatriate Syndrome
52
• Clinical and immunologic hyperresponsiveness to the mature or maturing worms manifesting as allergic reactions like hives, rashes, and blood eosinophilia
Expatriate Syndrome
53
_____________ • Most common acute manifestation of LF • Localized pain, lymphadenitis, lymphangitis, cellulitis, local warmth • Same lesion as erysipelas, cellulitis
Acute Dermatolymphangioadenitis (ADLA)
54
• Acute Dermatolymphangioadenitis (ADLA) is caused by
• Caused by Group A Streptococcus
55
• Directly caused by adult worms that died spontaneously or following treatment (evidence macrofilaricidal efficacy) • Self-limited
Acute Filarial Lymphangitis (AFL)
56
Acute Stage (4)
Asymptomatic Microfilaremia Expatriate Syndrome Dermatolymphangioadenitis (ADLA) Acute Filarial Lymphangitis (AFL)
57
Chronic Stage
Lymphedema and Elephantiasis Hydrocoele
58
• Characteristic Feature: fibrosis and cellular hyperplasia in and around the lymphatic walls • Dead calcified adult worms: elicit immune response — lymphatic blockage — Lymphedema — Elephantiasis
Lymphedema and Elephantiasis
59
: most common manifestation of chronic lymphatic filariasis
Lymphedema
60
Elephantiasis: _______ >>> Wuchereria bancrofti
Brugia malayi
61
Lower Extremities > Upper Extremities • Increased risk to secondary bacterial infection
Elephantiasis
62
• Results in the obstruction of lymphatics of______ • Clear or straw colored hydrocele fluid accumulate in closed sac of_____ ________>>> Brugia malayi
Hydrocoele tunica vaginalis testis • Wuchereria bancrofti
63
: rupture of lymphatics in the kidney manifested as milky urine
Chyluria
64
Occult Filariasis ____________ • Microfilaria not found in blood but may be found in____ • Caused by immunologic hyperresponsivness to filarial infection
• Tropical Pulmonary Eosinophilia tissues
65
Paroxysmal nocturnal cough, hypereosinophilia diffuse miliary lesions
Tropical Pulmonary Eosinophilia
66
Small epithelioid granuloma (Meyers-Kouwenaar bodies) • Misdiagnosed as bronchial asthma or TB
Tropical Pulmonary Eosinophilia
67
Diagnosis
Thick blood smear DEC Provocative test Circulating Filarial Antigens (CFA) Detection Knott Concentration Method
68
Thick Blood Smear • Curved microfilaria:____ • Kinky microfilaria:_____ • Specimen collection best done at night______ •______ periodicity of the parasite
W. bancrofti B. malayi 8pm to 4am Nocturnal
69
_____Provocative Test • Stimulates microfilariae into coming out to the peripheral circulation allowing daytime collection of blood smear
DEC
70
• Preferred method • Can detect latent infections
Circulating Filarial Antigens (CFA) Detection
71
• If low intensity infection Collect 1 mL of blood + 10mL formalin. Shake. (Formalin lyses RBC) Centrifuge. (If no centrifuge, allow the tube to stand in upright position for 12 hours) Decant the supernatant fluid. Examine a drop of sediment on slide and cover slip. A portion of sediment may be spread on a slide as thick smear and stain with Giemsa or Hematoxylin
Knott Concentration Method
72
Treatment _______: drug of choice • Effective against adult and microfilaria • Adverese events: fever, myalgia, headache, sore throat or cough lasting 24-48 hours; self-limited à symptomatic treatment
Diethylcarbamazine (DEC)
73
Treatment
• Pain reliever • Antibiotics for secondary bacterial infection • Proper foot care program • Surgery
74
Prevention and Control • Interrupt transmission of parasite via preventive chemotherapy __________
Annual Diethylcarbamazine (DEC) plus Albendazole or Ivermectin in endemic area

Parasitology Lec (31 decks)

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