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FILARIASIS

(Zoonosis;
Tissue Helminthiasis)
CAUSED BY THREE FILARIAL
NEMATODES:
WUCHERERIA BANCROFTI, BRUGIA
MALAYI, BRUGIA TIMORI

ETIOLOGI
Wurcheria bancrofti
Aedes, culex, anofeles, mansoni

Brugia malayi
Anofeles, mansoni, armigeres

Brugia timori
Anofeles barbirotris

HOSPES
Hospes intermediate
Nyamuk

Hospes Definitif
Manusia manusia, kera, anjing

Pembuluh limfe

larva

Nyamuk

Daur hidup
Filariasis

Mikrofilaria
Ke sal. limfe

Masa
tunas 2 bl
1 th
Dewasa
(dalam 5 tahun)

Infeksi & Mikrofilaria (per mm3)


0,5 tidak infektif
3 infeksi optimal
ll
10 membunuh nyamuk
tidak infektif

Manifestasi klinis tergantung


jumlah mikrofilaria/mm3

Patofisiologi
filariasis

Nyamuk + larva
infektif
Kulit sal. limfe
Larva menetap dewasa
Reaksi jaringan

(histiosit, epiteloid, limfosit, sel plasma, makrofag,


eosinofil)
Hiperplasia endotel & infiltrasi seluler perilimfatik
(sekitar filaria & proksimal pemb. limfe)
Limfangitis % limfadenitis
Stenosis pemb.

Patofisiologi
filariasis

Stenosis pemb.
limfe
Kerusakan katup

Kolateral ke dukt.
Torasikus u/ s. limfe
perut bag. bawah

Alat kelamin &


kelenjar
ingunal
elefantiasis

Tek. hidrostatik /
permeabilitas
Sal. limfe
bocor/pecah
Protein merembes
keluar

peritoneu
m
kiloasites

Ves.urinari/re
n

T.
vaginalis

kiluria

hidrokel

CLINICAL FINDINGS (1)


SYMPTOMS AND SIGNS
- INCUBATION PERIOD: 8-16 MONTHS
1. ACUTE DISEASE
2. CHRONIC DISEASE
3. OCCULT DISEASE

CLINICAL FINDINGS (2)

ACUTE DISEASE
- FEVER FILARIAL FEVER:
* WITH/WITHOUT INFLAMMATION OF
LYMPHATICS NODES
* IRREGULAR INTERVALS
* LAST FOR SEVERAL DAYS
- ADENOLYMPHANGITIS RETROGRADE
EXTENSION FROM THE AFFECT NODE

CLINICAL FINDINGS (3)


- EPIDIDYMITIS & ORCHITIS/OVORITIS
- RERTOPERITONEAL LYMPHATICS
- LYMPH NODE ENLARGEMENT MAY PERSIST
- ALLERGIC-LIKE FINDINGS
- LYMPHANGITIS & LYMPHADENITIS

CLINICAL FINDINGS (4)


2. CHRONIC DISEASE
- OBSTRUCTIVE PHENOMENA OF LYMPHATIC FLOW:
~ HYDROCELE
~ SCROTAL LYMPHEDEMA
~ LYMPHATIC VARICES
~ ELEPHANTIASIS:
EXTREMITIES
GENITALS
BREASTS

Clinical finding

Elephantiasi
s

Fase obstruksi (kronis)


Kel. Inguinal Elefantiasis
Kel. Limfe ren & ves. urinaria
kiluria chylus/kilus
Tunika vaginalis hidrokel/kilokel
Kel. Limfe peritoneal kiloasites

chyluri
a

THE
TESTES/SCROTUM
HAVE A MAN

CLINICAL FINDINGS (5)


- CHILURIA RUPTURE OF LYMPHATIC INTO
THE URINARY TRACT
- HEPATOMEGALY
- SPLENOMEGALY

CLINICAL FINDINGS (6)


3. OCCULT DISEASE
- CLASSIC CLINICAL MANIFESTATION &
MICROFILAREMIA
- MICROFILARIAE ARE PRESENT IN THE TISSUE

TREATMENT (1)
A. GENERAL MEASURES: DURING ACUTE INFLAMMATORY
- BED REST
- ANTIBIOTICS FOR SECONDARY INFECTIONS
- ELASTIC STOCKINGS & PRESSURE BANDAGES FOR
EDEMA
- SUSPENSORY BANDAGE FOR ORCHITIS &
EPIDIDYMITIS

TREATMENT (2)
B. DRUGS
a. DIETHYLCARBAMAZINE
- 2 MG/KG THREE TIMES A DAY AFTER MEALS,
STARTING WITH SMALL DOSES, AND GRADUALLY
INCREASING OVER 3-4 DAYS.
- CURE REQUIRE MULTIPLE 3-WEEK COURSES
b. IVERMECTIN, SINGLE 200-400 G/KGBW DOSE,
REPEATED IN 6 MONTHS.
c. ALBENDAZOLE 400 MG, COMBINED WITH IVERMECTIN
IS BETTER

TREATMENT (3)
C. LOCALLY INJECTED SCLEROSING AGENT FOR SMALL
HYDROCELES
D. SURGERY:
- ELEPHANTIASIS
- LYMPHOVENOUS SHUNT, COMBINED WITH REMOVEL
OF EXCESS SUBCUTANEOUS FATTY & FIBROUS
TISSUE
- POSTURAL DRAINAGE
- PHYSIOTHERAPY

TREATMENT (4)
- Rx OF TREATMENT:
* LOCAL:
~ LYMPHADENITIS
~ ABSCESS
~ ULCERATION
* SYSTEMIC:
~ FEVER
~ HEADACHE
~ MYALGIA
~ DIZZITION

PROGNOSIS
- GOOD WITH TREATMENT FOR EARLY &
MILD CASES
- IN ADVANCED INFECTION THE PROGNOSIS
IS POOR