FILARIASIS

Brief Description
Human Lymphatic Filariasis is a chronic parasitic infection caused by nematode parasites
known as Wuchereria bancrofti, Brugia malayi, and/or Brugia timori. The young and adult
worms live in the lymphatic vessel and lymph nodes while the microfilariae are usually found in
the blood. The life span of the adult parasites is about 10 years (but a 40-year life span has been
reported) while the microfilariae live for about a year at the most. The disease is transmitted to a
person through bites from an infected female mosquito primarily Aedes poecilius that bites at
night. The incubation period which starts from the entry of the infective larvae to the
development of clinical manifestation is variable. Nevertheless, it ranges from 8-16 months.
Classifications of Filariasis
Filariasis is classified depending on the area of the body which the worms mainly affect. Its
classifications include:
1. Lymphatic Filariasis

affects the lymphatic system

can result to a more serious complication such as enlargement of body parts
can cause pain and permanent disability

2. Subcutaneous Filariasis

Affects the subcutaneous area of the skin

3. Serous Cavity Filariasis

Affects the abdomens serous cavity

Pathophysiology
The filarial life cycle, like that of all nematodes, consists of 5 developmental (larval)
stages in a vertebral host and an arthropod intermediate host and vector. Adult female worms
produce thousands of first-stage larvae, or microfilariae, which are ingested by a feeding insect
vector. Some microfilariae have a unique daily circadian periodicity in the peripheral circulation.
The arthropod vectors (mosquitoes and flies) also have a circadian rhythm in which they obtain
blood meals. The highest concentration of microfilariae usually occurs when the local vector is
feeding most actively.
Microfilariae undergo 2 developmental changes in the insect. Third-stage larvae then are
inoculated back into the vertebral host during the act of feeding for the final 2 stages of
development. These larvae travel through the dermis and enter regional lymphatic vessels.
During the next 9 months, the larvae develop into mature worms (20-100 mm in length). An
average parasite can survive for about 5 years.

LIFE CYCLE OF HUMAN LYMPHATIC FILARIAL PARASITES

Microfilaria ingested by
mosquito during blood meal
Development in mosquito from
microfilaria to L1 to L2 to
L3 (infective larvae)
Female bring microfilaria (MF)
into bloodstream

Infective larvae escape from

proboscis of mosquito and enter
persons skin thru bite of the vector

Adult worms (Male and Female)

Development from L3 to L4
to adult worm in skin and
lympahtic vessel

Clinical Manifestation

Asymptomatic Stage
- Characterized by the presence of microfilariae in the peripheral blood
- No clinical signs and symptoms of the disease
- Some remain asypmtomatic for years and in some instances for life
- Others progress to acute and chronic stages
- Microfilariae rate increases with age and then levels off
- In most endemic areas including the Philippines, men have higher microfilariae rate
then women.
Acute Stage
- Lymphadenitis (inflammation of lymph nodes)
- Lymphangitis (inflammation of lymph vessels)
- In some cases, the male genitalia is affected leading to funiculitis, epidydimitis, or
orchitis (redness, painful and tender scrotum.
Chronic Stage
- Develop 10-15 years from the onset of the first attack.
- Immigrants from areas where Filariasis is not endemic tend to develop this stage
more often and much sooner (1-2 years) than do the indigenous population of

endemic areas.
Chronic Signs and Symptoms
- Hydrocoele (swelling of the scrotum)
- Lyphedema (temporary swelling of the upper and lower extremities)
- Elephantiasis (enlargement and thickening of the skin of the lower and/or upper
extremities, scrotum, breast)

Diagnostic Procedure

Chest radiography - Diffuse pulmonary infiltrates are visible in patients with TPE
Immunochromatographic Test (ICT) It is the rapid assessment method. An antigen test

that can be done at daytime.

Ultrasonography - Can be used to demonstrate and monitor lymphatic obstruction of the
inguinal and scrotal lymphatics; has also been used to demonstrate the presence of viable
worms

Lymphoscintigraphy

Circulating filarial antigen (CFA) - This diagnostic examination determines the presence
of W. bancrofti that is released by infected mosquitos. It can be performed any time of the
day.

Polymerase chain reaction (PCR) - This diagnostic exam detects whether the body is
already infected by Filariasis. This test is not usually available in the market.

Blood smears - This test can also be helpful in identifying roundworms and any infection
that takes place inside the body. It can be conducted during selected times of the day,
particularly during at night since roundworms are nocturnal.

Antifilarial body tests - This diagnostic exam determines the rise of IgG levels and IgG4.
Although this test is essential in determining Filarial entry, it cannot detect presence of
infection and past infections.

Ultrasound and Lymphoscintigraphic techniques - These tests distinguish any presence of

worm in the lymphatic system.

Skin test - This test can also determine presence of filarial infection. Clients who undergo
this test may experience pain since medical professionals will use a tiny razor blade to cut
a small portion of the skin.

Medical Management

Chronic manifestation such as elephantiasis and hydrocoele can be handled through

surgery. This is usually referred to hospitals for management.

Mild cases of lymphedema can be treated by lymphovenous anastomosis distal to the site

of the lymphatic destruction.

Chyluria is operated on by ligation and stripping of the lymphatics of the pedicle of the
affected kidney while hydrocoeles can be managed by inversion or resection of the tunica
vaginalis.

Pharmacologic Management

Ivermectine drug of choice for W. Bancrofti

Doxycycline used to reduce tissue swelling
Suramin effective against adult roundworms
Diethylcarbamazine (DEC) treatment for W. Bancrofti
Albendazole and Flubendazole eliminate roundworms easily

Nursing Management

Monitor clients vital signs, particularly the temperature.

Assess skin color and integrity. Note for wounds, bleeding or any skin changes.
Assess for any discomfort and pain.
Provide wound care.
Elevate affected body area to reduce swelling.
Administer medications if ordered and discuss them to the client.
Provide support to perform basic activities.
Encourage range of motion and simple exercises of the affected extremities to stimulate

lymphatic flow.
Recognize clients self-esteem needs.
Provide health teaching and information for continuity of care.

Republic of the Philippines

Mariano Marcos State University
COLLEGE OF HEALTH SCIENCES
City of Batac, Ilocos Norte, 2906 Philippines
Telefax: +6377 7923882; E-mail address: mmsu_chs_2009@yahoo.com
Website: www.mmsu.edu.ph
DEPARTMENT OF NURSING

FILARIASIS

Presented by:
Lizelle Joyce A. Onnagan
BSN IIIA

Presented to:
Prof. Joy Leilanie Ilagan
Clinical Instructor

April 2014