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Lymphatic Filariasis

Title               

Ñ    Lymphatic Filariasis

Definition

Ñ    Infestation caused by lymphatic dwelling filarial worms

Aetiology

Nematodes

Ñ    Wucheriria bancrofti

Ñ    Brugia malayi

Vector

Ñ    Culex:

Fatigans commonly

Ñ    Aedes

Ñ    Anopheles

Ñ    Mansonia:

Malayan filariasis

Pathogenesis

Life cycle

Ñ    Adult worms in lymphatics

Ñ    Mate and produce microfilariae

Ñ    Microfilariae migrate and enter the blood stream

Ñ    Microfilariae ingested by mosquito

Ñ    From the stomach of the mosquito they enter the body cavity and thoracic musculature

Ñ    Grow and moult to form infective stage larvae

Ñ    Enter proboscis of mosquito

Ñ    Infect bite and enter skin

Ñ    Skin to peripheral lymphatics to regional lymphatics and larger lymph vessels

Ñ    Moult and mature into adults

Pathological Process

Ñ    Inflammation around worms:

Eosinophilic or granulomatous

Ñ    Lymphangiectasia

Ñ    Lymphoedema

Clinical Features

Incubation period

Ñ    8 months to 1 year

Adenolymphangitis

E&M

Ñ    Fever with chills

HS

Ñ    Enlarged painful regional lymph nodes

RAG

Ñ    Epididymo-orchitis

Ñ    Funiculitis

Acute Filarial Lymphangitis

Ñ    Circumscribed inflammatory nodule

Ñ    Centrifugal lymphangitis

Acute Dermatolymphangitis

Ñ    Diffuse subcutaneous inflammation:

With or without ascending lymphangitis

Complications

IS

Ñ    Elephantiasis

RS

Ñ    Chylous pleural effusion

GIT

Ñ    Chylous ascites

KUS

Ñ    Chyluria

RAG

Ñ    Hydrocoele

Investigations

Fluids

Blood

Immunology

Ñ    Filarial antibody titre

Microbiology

Ñ    Microfilariae:

·          Examine thick blood film for microfilariae:

Between 2100 and 0300 hours

Ñ    Diethylcarbamazine provocative test (daytime testing):

Treat with diethylcarabamazine and then examine thick blood film

Imaging

Ultrasound

Ñ    Detect adult worms in scrotum

Management

Cure

Drugs

Ñ    Diethylcarbamazine

Ñ    Ivermectin:

No effect on adult worm

Reduces microfialrial load

Ñ    Albendazole:

In combination with ivermectin

Has effect on adult worm

Symptom Relief

Surgery

Ñ    Hydrocoele

Ñ    Chronic lymphoedema

Prevention

Drugs

Ñ    Diethylcarbamazine:

Mass treatment

Biological Agents

Ñ    Vector control

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