Filariasis

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Filariasis:

Filariasis

Introduction:

Introduction Tissue dwelling Nematodes Wuchereria Bancrofti Brugia Malayi Onchocerca Volvulus Loa Loa

Vector:

Vector Culex fatigans Anopheles / Aedes Mansonides – B. Malayi infection Adult worm – Lymphatic vessels Microfilariae – Blood, Pulmonary capillaries W. Bancrofti

Pathogenesis:

Pathogenesis Living adult worm Inflammatory response caused by death of the worm Microfilariae Secondary Infection

Pathogenesis:

Pathogenesis Inflammatory damage to lymphatics is caused by adult worms and NOT Microfilariae Toxins / inflammatory damage  Lymphatic dysfunction  Chronic manifestations (Elephantiasis / Hydrocele / secondary infection Microfilaria – TPE

Clinical Features:

Clinical Features Most common presentations Asymptomatic Microfilaremia / Subclinical Acute Filarial Lymphangitis (ADL) Hydrocele Chronic Lymphatic Disease Tropical Pulmonary Eosinophilia

Asymptomatic / Subclinical:

Asymptomatic / Subclinical Endemic areas Microscopic hematuria and / or proteinuria Dilated and tortous lymphatics – imaging Large number of circulating MF

Acute Filarial Lymphangitis:

Acute Filarial Lymphangitis High fever Lymphatic inflammation (Pain / redness / tenderness / retrograde) Local oedema Enlarged, painful, tender regional lymphnodes Upper and lower extremities

Acute Filarial Lymphangitis:

Acute Filarial Lymphangitis Genital Lymphatic – W. Bancrofti Funiculitis Epididymitis Scrotal pain and tenderness More acute and intense in newly exposed individuals than in natives of endemic areas Acute attacks are short lived and not accompanied by fever

Chronic Lymphatic Disease:

Chronic Lymphatic Disease Elephantiasis Chyluria Intermittent Most prominent in the morning Chylous ascites, Chylous Pleural effusion Scrotal oedema

Investigation:

Investigation Definite diagnosis – parasite detection Microfilariae Blood (Nocturnal) Hydrocele Adult worms Lymphatic vessels / Nodes “Filaria dance sign”

Investigation:

Investigation Eosinophilia Serum IgE – elevated Antifilarial antibodies Radionuclide lymphoscintigraphic imaging of limbs Lymphatic abnormalities Not for diagnosis of filarial infection Assessment of lymphoedema of all causes

Treatment:

Treatment DEC 6 mg/Kg daily in 3 divided doses after food x 12 days Macro & Micro filaricidal properties Single dose may be equally efficacious For acute lymphangitis Antipyretics / Analgesics Antibiotics – if secondary bacterial infections present

Treatment:

Treatment Chronic Lymphatic Disease Hygeine Prevention of secondary infections Physiotherapy Prophylactic antibiotic to prevent secondary infection Hydrocele Surgically treated

Side Effects:

Side Effects DEC Host response to dying MF Directly proportional to MF load 24 to 36 hours of 1 st dose Fever, chills, headache, nausea, vomiting, arthralgia Antihistamines / corticosteroids

Prevention:

Prevention Avoid mosquito bite Mosquito control programmes Mass annual distribution of Albendazole + DEC Salt fortified with DEC

Tropical Pulmonary Eosinophilia:

Tropical Pulmonary Eosinophilia

Clinical Features:

Males : Females = 4 : 1 3 rd decade of life Residence in filaria endemic region Paroxysmal cough and wheezing – usually nocturnal Low grade fever Weight loss Lymphadenopathy Clinical Features

Investigations:

Investigations Eosinophilia Circulating microfilaria – NOT found Chest X- Ray Normal  Bronchovascular markings Diffuse miliary lesions

Investigations:

Investigations PFT:- Restrictive abnormality in most Serum IgE level – Elevated Antifilarial antibodies

Pathogenesis:

Pathogenesis Rapid clearance of MF from the blood stream by lungs  Allergic and inflammatory reactions

Pathogenesis:

Pathogenesis Not properly treated / untreated  Interstitial fibrosis  Chronic ILD

Treatment:

Treatment DEC 6 mg/Kg / day in divided doses x 14 days Symptoms usually resolve within 3 to 7 days Relapse (which occurs rarely)– retreatment

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