Filariasis

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Filariasis:

Filariasis Involvement may then involve scalp, vulva, penis, female breasts, arms Legs are usually affected symmetrical manner Thickening becomes massive and pachydermatous Thickened integument hangs in apposing folds between which there is a fetid exudate

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Scrotal involvement causes area to become enormous and penis becomes hidden in it Skin, first glazed, later becomes coarse and verrucous or ulcerated or gangrenous Resistant urticaria may occur Filarial orchitis and hydrocele are common Testicle may enlarge rapidly to apple size and can be painful Swelling may subside within a few days, enlargement may be permanent Resulting obstruction and dilation of thoracic duct may occur; obstruction of lower abdominal tributaries into urinary tract, chyle appears in urine

Filariasis:

Filariasis Lobulated swellings of inguinal and axillary glands, called varicose glands occur These are caused by obstructive varix and dilation of lymphatic vessels Filaria are transmitted person-to-person by bites of mosquitoes Culex, Aedes, and Anopheles species Adult worms are threadlike, cylindrical and creamy white Females are 4-10 cm long Microfilarial embryos may be seen coiled each in its own membrane near posterior tip

Filariasis:

Filariasis Fully grown, shealthed microfilariae are 130-320 microns long Adult worms live in lymphatic system producing microfilariae An intermediate host is needed fror further development of parasite Endemic in Africa, India, South China, Japan, Samoa, Taiwan Occurs also in West Indies and Costa Rica In Malaya, Ceylon, Indonesia, China, and Korea there is Malayan filariasis caused by B. malayi B. timori is restricted to eastern Indonesian archipelago

Filariasis:

Filariasis W. bancrofti or B. malayi has been known in India since the sixth century BC. Estimated that 250 million people are infected with these parasites Infestation often is asymptomatic Elephantiasis usually occurs only if hundreds of thousands of mosquito bites are suffered over a period of yrs- with episodes of intercurrent streptococcal lymphangitis

Filariasis:

Filariasis There is a striking periodicity to time of appearance and disappearance of microfilariae in skin and superficial vessels Cutex fatigans bites at night Microfilariae of W. bancrofti are found in peripheral circulation at midnight (nocturnal periodicity) but rarely during daytime In South Pacific, it is nonperiodic

Filariasis:

Filariasis Search for microfilariae should be made on fresh cover-slip films of blood from finger or ear and examined with a low-power objective lens Specimens should be taken at midnight Calcified adult worms may be seen on x-ray Adult filariae are found in abscesses or in material taken for path exam Filarial worm can be traced fluorescently as microfilariae and adult worms have an affinity for tetracyclines, which fluoresce in UV light in a dark room Filarial complement fixation tests are useful in seeking the cause of lymphedema

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Prognosis is good Living may become burdensome unless condition is alleviated Ivermectin, 100- 440 micrograms/kg in one dose=TOC Regimen (as well as alternative tx with diethylcarbamzine) will clear microfilariae but not adult worms Surgical operations have been developed to remove edematous subcutaneous tissue from scrotum and breast Prophylactic measures consist of appropriate mosquito control; diethylcarbamazine has been effective in mass prophylaxis

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