FILARIASIS

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common parasitic infestation in Sri lanka.

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FILARIASIS: 

FILARIASIS

Filariasis- Learning Objectives: 

Filariasis- Learning Objectives Be able to recognize spectrum of diseases caused by filarial worms in Sri Lanka Different diagnostic methods and their utility Understand the basis of treatment protocols Aware of preventive measures used in Sri Lanka

Filariasis- main types : 

Filariasis- main types Lymphatic – Wuchereria Bancrofti Brugia Malayi S.cutaneous– Onchocerca volvulus & ocular Loa Loa

Lymphatic Filariasis: 

Lymphatic Filariasis Worldwide distribution in Asian African and Pacific Islands Caused by W. Bancrofti in SL Vector – Anopheles, Culex and Aedes mosquitoes Breeding and biting habits influence the epidemiology of these infections Human disease is caused by prolonged and repeated infections

Lymphatic Filariasis- Clinical Features: 

Lymphatic Filariasis- Clinical Features Depend on – area of transmission age of the first exposure degree of exposure Sex of the Individual Immune response of the host [hyper / hypo immune]

Clinical Features : 

Clinical Features Acute – Fever malaise, headache,3-7 days Lymphangitis and /or Lymphadenitis Epidedemo orchitis, Hydrocele Due to immune mediated – nocturnal cough, Urticaria

Clinical Features – Chronic : 

Clinical Features – Chronic Occur due to prolonged exposure or repeated acute attacks Hydrocele Lymphoedema Elephantiasis Chyluria – due to obstruction & rupture of abdominal lymphatics to urinary bladder

Clinical Features : 

Clinical Features Tropical Pulmonary Eosinophilia due to immune reaction for microfilaria Characterized by high eosinophil count Paroxysmal nocturnal cough resembling bronchial asthma Typical Chest radiographic findings [mottling] Lung function tests show obstructive + restrictive pattern

Diagnosis : 

Diagnosis Established case- Clinical Diagnosis Parasitological Diagnosis by finding microfilaria, tissue diagnosis of lymph nodes , New diagnostic methods with high sensitivity using antigen and antibody assays are being developed

Diagnosis by Microfilaria : 

Diagnosis by Microfilaria In thick blood film, hydrocele fluid, urine Problems due to periodicity and need for personnel with experience May not be present in early and late stage of the disease Has a variable correlation with the clinical disease.

Immunological methods: 

Immunological methods Antibody tests Antigen Tests

Immunological methods Antibody tests- : 

Immunological methods Antibody tests- FAT – Filarial Antibody Test Not useful as a diagnostic tests at all !!! [due to high rate of false positive, do not indicate clinical disease, do not differentiate past infection from current disease ]

Immunological methods – Antigen tests: 

Immunological methods – Antigen tests ICT – Immune Chromatography Test Expensive , not routinely available May indicate past infection

Immunological Tests - New: 

Immunological Tests - New Ig-G subclasses against specific filarial antigens developed Has been shown to be positive in saliva, Urine in addition to blood Can be used as a tests to evaluate therapeutic efficacy Still initial stages of development

Management: 

Management DEC – Drug of choice Kills microfilaria and adult worms dose 6 mg/kg given annually as mass treatment campaigns [along with Albendazole 400mg to supplement its anti filarial action.

Management: 

Management Lympangitis – Oral Antibiotics to cover against common skin pathogens- Erythromycin Elevation Diuretics to reduce swelling – cosmetic/early recovery/ functional gain

Management : 

Management Elephantiasis- Prophylaxis against bacterial skin sepsis [oral penicillin/ monthly benzathine penicillin ] Good foot hygiene, nail care, raising the foot at night appropriate footwear Periodic DEC to prevent re infection

Management: 

Management Hydrocele – Surgery Elephantiasis – Surgical care in specialized centers – Shunt surgery , removal of excess tissue