Lymphatic Filariasis

Tropical medicine block

Sisirawaty, dr, MS, SpParK

 Helminths

Nemathelminthes
Platyhelminthes
(cacing gilik) (cacing pipih)

Nematoda
(cacing gelang) Trematoda Cestoda
(cacing daun) (cacing pita)
 Blood & Tissue Nematodes
Lymphatic filariasis
Non-lymphatic filariasis
• Wuchereria bancrofti
• Brugia malayi • Onchocerca volvulus
• Loa loa
• Brugia timori
 Geographical distribution of filariasis
u Wuchereria bancrofti (bancroftian
filariasis) -> widely distributed
throughout the tropic and subtropics
Brugia malayi (malayan filariasis) à Asia :
Sri Langka, Indonesia, Philippines, Southern
India, China, Korea, a small focus in Japan
Brugia timori (timori filariasis) àfirst
reported from the island of Timor(1964),
Flores, Rote, Alor, NTT(eastern
Indoensian)
Distribution of filariasis
 Transmission
- transmitted by mosquitoes
- mosquito species differs
according to region
& particular filariae
Location in host
- Adult worms live mainly in lymphatic
vessels but
occasionally may occur in blood vessels
- microfilariae circulate in blood
 Non lymphatic filariasis

Infection Causative Vector

(disease) agents
Onchocerciasis/ Onchocerca Simulium
river blindness volvulus

Loiasis/ calabar Loa loa Chrysops

swelling
 Filariasis limfatik
Penyakit Vektor Penyebab
Filariasis bancrofti Cx. quiquefas- W. bancrofti
tipe urban ciatus
Filariasis bancrofti An., Cx., Ae W. bancrofti
tipe rural

Filariasis malayi, An. barbirostris, B. malayi

periodik An. nigerrimus

Filariasis malayi , Ma., Cq B. malayi

subperiodik

Filariasis timori An. barbirostris B. timori

Periodicity (circadian rhythms)
= present / absence of microfilariae
in the blood
W. bancrofti
u Nocturnal periodicity ß W. bancrofti
u Diurnal subperiodicity -> Pasific
u Nocturnalsubperiodicity -> thailand
u Nocturnal periodicity : peak numbers
of microfilariae circulate in the peripheral
blood during night-time hours and are
absent at other times
u Diurnal periodicity :peak numbers
of microfilariae circulate in the peripheral
blood during day-time hours and are
absent at other times
u Subperiodicity : microfilariae normally
present at all hoursof the day & night buy
may significantly increase in numbers during
either the night (nocturnally subperiodic)
or during the day (diurnally subperiodic)
u Aperiodic : microfilariae are present in the
peripheral blood at all times without
significant changes in numbers
Life cycle of filariasis
 Clinical features filariasis
1. Seropositive, asymptomatic patient without
microfilaraemia. Common in endemic regions
2. Asymtomatic microfilaraemia
3. Acute lymphatic filariasis :
- fever
- limb lymphadenitis & lymphangitis
- epididymo-orchitis
4. Chronic lymphatic filariasis
- elephantiasis (extensive enlargement of
extremities)
- hydrocele
- chyluria
 Lymphatic filariasis
Pathology is caused by direct effects of the
adult worms in the lymphatics plus the effects
of the host’s immune response
Microfilariae do not cause
Lymphatic pathology but do
cause tropical pulmonary
eosinophilia (TPE)
 Lymphatic filariasis
u Elephantiasis is a striking feature of this
disease à adult worms are found in the
lymphatic system

u Tropical pulmonary eosinophilia is an

immediate hypersensitivity reaction to
microfilariae in the lung
Pathogenesis

u Adult worms in the lymph nodes cause

inflammation that eventually obstructs
the lymphatic vessels, causing edema
àelephantiasis, occurs mainly in
patients who have been repeatedly
infected over a long period.
 Laboratory diagnosis

u Thick blood smears (Giemsa stain) taken

from the patient at night reveal the
microfilariae.
Note : nocturnally periodic form, it is
essential to examine the blood between
9 pm & 3 am

Treatment
u Diethylcarbamazine (DEC)
u Ivermectin
u albendazole
 Identification of microfilariae
Microfilariae present in
- peripheral blood
- superficial layers of the skin
Keys diagnostic :
- sheath +/-, stains (lightly,
deeply, does not stain
in Giemsa)
- cephalic (head) space
- body nuclei
- body curves
- tail end
 Daur hidup
Brugia malayi
Occult filariasis
(Tropical Pulmonary Eosinophlia=TPE)
is an immediate hypersensitivity reaction to
microfilaria lymphatic in the lung

u Penyakit filariasis limfatik yg disebabkan

oleh penghancuran mikrofilaria dalam
jumlah yg berlebihan oleh sistem
kekebalan penderita
u Mikrofilaria dihancurkan oleh zat anti dalam
tubuh hospes akibat hipersensitivitas
terhadap antigen mikrofilaria
 Tropical Pulmonary Eosinophilia

u TPE is characterized by coughing and

wheezing, especially at night.These
symptoms are caused by microfilariae
in the lung that elicit an immediaite
hypersensitivity reaction characterized by a
high immunoglobulin E (IgE) concentration &
eosinophilia
 Gejala klinis

u Batuk dan sesak napas terutama malam hari

-> dahak kental & mukopurulen-> gejala
asma bronkial
u Pembesaran kelenjar limfe (paling sering
kelenjar limfe inguinal; kadang : kelenjar limfe
leher, lipat siku dll
u Demam subfebris
u Pembesaran limpa & hati
 Klinis

u Foto Roentgen paru : garis-garis yg

berlebihan pada kedua hilus &bercak-bercak
halus terutama di lapangan paru bawah
 Diagnosis
u Hipereosinofilia
u Peningkatan kadar Ig E yg tinggi
u Peningkatan zat anti terhadap mikrofilaria
u Foto Roentgen paru
u Biopsi : benda Meyers Kouwenaar
Catatan : Mikrofilaria tidak ditemukan di
dalam darah tepi
 Terapi

u DEC (dietilkarbamasin)
 References

u Buku Parasitologi kedokteran, FK UI, edisi keempat,

2008

u Neva FA, Brown HW. Basic Clinical Parasitology. Sixth

edition, 1994. Appleton & Lange.

u John DT, Petri WA. Markell & Voge’s Medical

parasitology. Ninth edition, 2006. Saunders
Elsevier.