Lymphatic Filariasis

I K Agus Somia

Division of Infectious and Tropical Disease

Department of Internal Medicine
UDAYANA School Medicine
SANGLAH General Hospital
Denpasar BALI

26 November 2007
 Lymphatic Filariasis (LF): the disease

Passed from human to human by

mosquitoes which must survive at least ten
days for transmission of microfilariae
Parasites live in the lymphatic system for 4-
6 years, producing millions of microfilariae
Filariasis patients are physically
incapacitated and cannot work nor lead a
normal life
Epidemiologic

80 endemic countries
120 million people infected
1 billion people (20% of the world)
population are at risk
Target: Global elimination by 2020
Etiology
Wuchereria bancrofti
Brugia malayi
Brugia timori
Vector

Culicine mosquitoes
Anopheline mosquitoes
Mansonia spp
Aedes spp
Life cycle of lymphatic filarial
parasites HUMANS

adult worms Microfilaria

in lymphatics in blood

Exposure Uptake
to infective pathology by
vectors vectors

L1

L2

L3
VECTORS
Pathogenesis
Pathogenic of the parasite
Immune response of the host
External (complicating) bacterial and
fungal infections
Effect of LF on the lymphatic system

Anatomy
adult worms live in the lymphatic system
cause dilatation
dilatation leads to dysfunction

Dysfunction
accumulation of fluid (oedema) in tissues
Transport of fluid and protein from tissues to
lymph nodes for filtering is interrupted
increased risk of infection
transport of bacteria to lymph nodes is
impaired, thus bacteria multiply in the tissues
Clinical features
Asymptomatic
Acute manifestation
Chronic manifestation

Asymptomatic
Inflammatory
Obstructive
Asymptomatic
In endemic area
Enlargement of lymph node (commonly
the inguinal node)
Microfilariae in blood
eosinophilia
Acute manifestation

Bacterial or fungal superinfection

Filarial fever
Tropical pulmonary eosinophilia
Eosinophillia
asthma-like symptoms
restrictive (and often obstructive) lung ds
very high level of specific antifilarial Ab
excellent therapeutic response with DEC
Acute inflammatory reaction (early after
infection)
Chronic manifestation
Hydrocele
Elephantiasis
Chyluria
 Hydrocele:
fluid filled balloon- like
enlargement of the
sacs around the testes
Location of adult worms
in the lymphatic of the
spermatic cord
In endemic area 40-
60% of all adult males
 Elephantiasis:
disabling and
disfiguring
lymphoedema of the
limbs, breasts and
genitals (up to several
times their normal size)
accompanied by
marked thickening of
the skin
Rarely microfilaremic
Chyluria
rupture of dilated lymphatics into
urinary system
leakage of lymph, lipids and protein;
wasting
Acute inflammatory attacks
Painful bacterial infections of the skin and
superficial tissues
Bacteria enter through breaks in the skin
Stasis of lymph provides conditions for rapid
growth of bacteria
High fever, pain, swelling, nausea
last ~ 5-7 days
Damage to small lymphatic vessels
Fibrosis and progression of elephantiasis
Diagnosis

Clinical diagnosis
Microfilaria detection
- Giemsa or Wright stain
Antigen detection
- ELISA
- immunochromatography
Biopsi
Management
Antiparasitic drug therapy
Supportive
Complication
Education and counseling
Antiparasitic drug therapy
Diethylcarbamazine (DEC) 2-3 mg/kg-
BW three times per days for 7 - 14 days
Ivermectin (mectizan):
effective in decreasing level of
microfilaremia, not to kill adult worms
Albendazole
kill adult worms after prolonged courses
(2-3 weeks) and to inhibit production of
microfilariae after single doses (400 mg)
Supportive and complication
management
Acute attack
pain: cool cloth compress, rest, elevate the affected limb
Fever: drink lots of water or fruit juices, antipiretic
Infection:
Antibiotic, antifungal
Lymphedema and elephantiasis:
rigorous hygiene for the swollen limbs with wound care, exercise and
elevation
Hydrocele:
Watchful waiting: often no treatment is necessary for mild cases
Surgical drainage: Drainage of fluid, blood or pus using usually-minor
surgical measures.
Surgical removal: Removal or excision by surgical measures.
Chyluria:
nutritional support ( fat-rich diets with high protein, high fluid diets)
Prevention
Population based prevention
annual mass drug administration program for
at-risk population
Individual based prevention:
personal insect repellents
Bed nets,
insecticide-impregnated material
terimakasih

aGsmia