Cleanliness and filariasis

in IndiaRahul Dilip & Shubham Rashkender

Sharma

Its kinda bad• Rank #123 in

cleanliness (Forbes)• Combination of

unhygienic environment and high population density

• 103 m lack safe drinking water. Around 550m lack sanitation services

Why? • Many reasons.

Attitude of people a main reason.

• In mixed communities, people only take care of self.

• Caste system• Unaware of potential

harm

Changing times• Present government is

aggressive in tackling the matter

• Attitude changing at least in major cities.

• Need for low cost solutions. Both for waste disposal and sanitary services.

• Need for widespread access to clean water.

Puddles…• Standing water is a

major health hazard.• Breeding ground for

mosquitoes.• Malaria, dengue,

chikunguniya, and filariasis

• Nearly 40 million are infected with mosquito borne diseases every year.

Introduction

• Filariasis is a parasitic disease caused by an infection with roundworms of filarioidea type.

• These are spread by blood feeding black flies and mosquitoes.

• This disease belongs to the group of diseases called helminthiasis.

Filariasis Classification

• Can be classified depending on their habitat in human tissues.

1. Lymphatic filariasis is the main one.2. Body cavity filariasis in rare cases.3. Connective tissue filariasis in rare cases as well.

What is Lymphatic Filariasis?

• Parasitic disease where microfilaria enter the blood stream through mosquito bites.

• The adult worms only live in the human lymph system.

• The lymph system fights infections and maintains body fluid balance.

Parasites• White ,slender thread like roundworms,• 3 types: Wuchereria bancrofti, Brugia malayi,

Brugia timori.• Live for 5-7 years, produce millions of microfilaria

in human lymph system.• They belong to the class of helminth parasite.• Creamy filariform 2-50 cm female twice male.

Epidemiology• W.bancrofti occurs in the following regions: sub

saharan africa,southeast asia, the indian subcontinent and many of the pacific islands.

• B.malayi occurs mainly in india, malaysia,the philippines,indonesia and pacific islands.

• B.timori is limited to the timor island of indonesia.

Epidemiology

• It is estimated that more than 120 million people are infected with one of these 3 microfilariae.

• More than 90 percent of these infections are due to W.bancrofti ,and the remainder are mostly due to B. malayi.

• Estimates suggest that more than 40 million infected individuals are seriously incapacitated and disfigured by the disease.

Process of Infection• Adult worms in body produce immature larvae• When blood ingested my mosquitoes, larvae

mature into infectious ones• When mosquito bites another person, larvae

travel to the lymphatic vessels and develop into adult worms.

Symptoms• Most infected people are asymptomatic. However

parasites still damage the lymphatic system.• Lymphoedema. Mostly in the legs, can also affect

the arms, breast, and genitalia. In males hydrocele can develop (W. bancrofti).

• Decreased function of lymphatic system affects immunity. Increased bacterial infections in skin and lymphatic system.

• Hardening and thickening of the skin.• Tropical pulmonary eosinophilia syndrome.

Clinical Features• Most people infected with Brugian or Bancroftian

filariasis in endemic areas are asymptomatic, since the development of symptoms relates to increase number of worms.

• Course of L.filariasis includes 3 distinct phases:1. Asymptomatic microfilaremia2. Acute episodes of adenolymphangitis[ADL].3. Chronic lymphedema disease which is often

superimposed upon repeated episodes of ADL.

Acute Adenolymphangitis

• Episodic adenolymphangitis periodic occurrence of lymphangitis and lymphadenitis in filarial lymphedema,characterized by tenderness and swelling of the affected limb,with red streaks running along its length, and lymph node enlargement.

Chronic Lymphedema• Lymphedema or swelling of a limb relates to

chronic inflammation of the lymphatic vessel a common late sequela of filarial infection.

• When the lymph vessels in the inguinal region are involved swelling of the lower limb ensues.

• When axillary lymph nodes are involved swelling of upper limb results.

• When lymphedema is severe , it is often referred to as elephantiasis.

Filarial Fever• This is characterized by acute , self limiting

episode of fever, often in the absence of any obvious lymphangitis or lymphadenopathy.

• Because of the lack of associated features, this syndrome is frequently confused with other causes of fever in tropics , such as malaria.

Tropical Pulmonary Eosinophilia

• This is characterized by nocturnal wheezing.• It is caused by an immune hyperresponsivenes to

microfilariae trapped in the lungs and is typically seen in young males.

Treatment • Abendazole and

ivermectin prevent transmission of W. bancrofti.

• Effect of mass treatment such as these have reportedly been sustained for up to 6 years.

• No vaccines yet• Hydroceles are

manageable by surgery. Correction of gross limb is less successful.

bibliography• Medindia.net• stanford.edu• Who.int• Emdicine.medscape.com• Jpgmonline.com• Broadinstitute.org• Medicinemosul.uomosul.edu.iq• Thediplomat.com