tropis tissue helminth1 filariasis

7/28/2019 Tropis Tissue Helminth1 Filariasis

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Tissue helminth

Sitti Wahyuni, MD, [email protected]

Department of ParasitologyMedical Faculty

Hasanuddin University

6/18/2012 S. Wahyuni, Parasitology Dept, Medical Faculty, Unhas 1


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Filaria---- lymphatic filariasis

Schistosome---- Bilharziasis

Trichinella spiralis-Trichinellosis

Toxocara & animal Ancylostoma---visceral & cutaneus larva

migrans

Onchocerca volvulus & Loa-loa ----cutaneus & subcutaneusfilariasis

Capillaria hepatica Capillariasis


ascoops s us


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caused by:

Brugia malayiBrugia timori

not lethal but can be seriousl debilitatin

causing an economic burden on infected



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t s an o sease.


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subtropics countries

76 million have preclinical infection

potentially eradicable diseases

2020



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.

Health Minister & UI (1983): mf prev. has- ,

WHO (2000) stated:- endemic in 22 of 27 provinces

-150 million eo le at risk of infection

- the highest prev. in South East Asia



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creamycreamy--white, minute, threadwhite, minute, threadlike nematodes with smothlike nematodes with smothcuticulacuticula

tapering toward both end,&tapering toward both end,&

terminations are bluntly roundedterminations are bluntly rounded

head: slighty swollen,head: slighty swollen,surmounted by 2 rings of smallsurmounted by 2 rings of small

papillaspapillas

Mouth: unarmed, no buccalMouth: unarmed, no buccal


vestibulevestibule


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Live in lymph nodesLive in lymph nodes

Can stay alive for 15 yearsCan stay alive for 15 years

Vivipar & produce microfilariaVivipar & produce microfilaria

(febrile, extremitas oedema,(febrile, extremitas oedema,hidrochele & elephanthiasishidrochele & elephanthiasis

Can only be seen if it circulate inCan only be seen if it circulate inhidrocele/incision of l m h nodeshidrocele/incision of l m h nodes



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Microfilaria

Wuchereria bancrofti

Body: gently curved

Tail: tapered to a point

packed, & nuclei can be

visualized individuallyand do not extend to thetip of the tail.

with hematoxylin. Thick blood smears stained

with hematoxylin



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Microfilaria

Wuchereria bancrofti

collected b filtration

with a Nucleoporemembrane.

e pores o t emembrane are

visible.

Thick blood smears stainedwith Giemsa can not demonstrate the

sheath



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Microfilaria

Brugia

Shape: more tightlycoiled

nuc ear co umn:more tightly packed,

not be visualize

stained withhematox lin. Thick blood smears


stained with hematoxylin


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Microfilaria

Brugia

collected by the Knott

concentration technique,in 2% formalin wet


preparation


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Host Definitive:

- . .

-human & animals: B. malayi Intermediate: mas uitos

- urban W.bancrofti: Culex quenquefasciatus

- rural W.bancrofti:A. farauti & A. punctulatis- nocturnally B. malayi (Sulawesi):

Anopheles barbirostris

- - .Mansonia spp.- nocturnal B timori :A. barbirostris



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s ectrum of clinical andparasitological manifestations

endemic normals/asimptomaticamicrofilaraemics

Chronic obstructive disease



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Acute

lymphangitis/lymphadenitis

Often occur in chronic patients

ause y yng or egenera ng a u

worms Bacterial or fungal superinfections in limbs

with compromised lymphatic dysfunction

play a significant role



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-main clinical manifestation: hydrocele-

(elephantiasis) of the whole arm/leg

-

Brugian filariasis

- knee or arm below the elbow


- y roce e as se om een recor e


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Tro ical ulmonar eosino hilia(TPE)

A relatively unusual manifestation of

microfilariae are generally absent from thec rcuaton

hypereosinophilia, elevation of anti-filarial

antibodies (lgE) & pulmonary symptomsuch as bronchial asthma



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Detection of microfilariae

n gen e ec on assays

Molecular Diagnosis USG detection of adult worms



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lymphatic Still the golden

standard

The time accord to

Two methods: finger

filtration



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finger with a lancet-

Stained with Giemsa's stain Screen presence of mf under a light

microscope

sensitivity of this assay is low



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1-10 ml blood filtrated to the filter

The filters: stained and examined in the samemanner as finger prick blood

str uton o m n t e perp ery non-ran om,mf can be missed as they are subject to

The time of blood collection is inconvenient

Requires skilled personnel & proper precautions



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Based on a monoclonal raised against bovineOnchocerca ibson named Gib-13

-93% W. bancrofti mf(+) were found positive

-Detect CFA in mf (-) subjects with acutesymptoms-53% of asymptomatic mf(-) subjects

Unfortunately, no CFA has been developed for



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Molecular Dia nosis Characterization of filaria species-specific

DNA using PCR-based assays

primers for both W.bancrofti & B malayihave been designed successfully

P itiv nl in th r n f ir l tinmf

PCR is an expensive assay


Requires well-equipped laboratories &

personnel


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vessels/scrotal area: 'filaria dance sign

macrofilaricidal effects

on- nvas ve por a e equpmen savailable

Restricted to the male population Not available for B.malayi



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Antibod assa s

Anti-filarial lgG4 : have high specificity &sens tvty

Anti-filarial lgG4 correlate strongly with thepresence of mf

Can discriminate active from ast infection



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general

s ra eg es o re uce ransm ss on

Treat the infection person-

Reduce the population of mosquitovec ors y nsec c es,po ys yrene ea sor biocides



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Diethylcarbamazine citrate

primary drug of choice

Demonstrated the rapid decline of mf ine perp ery a er rea men

Have macrofilaricidal potential, if

prolonged treatment is supplied A art of individuals seem resistant

6/18/2012 S. Wahyuni, Parasitology Dept, Medical Faculty, Unhas 34 Side effects are recorded


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Dosa e of DEC

Standard : 12-14 da course of 6 m /k BW

Meta-analysis of studies : a single dose/ayear for several years equivalently reducem eve s

New opplications : mass administration of

Combination therapy ivermectin.

Have a long-term effects



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Current control programs

in Indonesia

drug administration (MDA): DEC 6 mg/kg-

subsequent years.

reducing mf prevalence ofB.timori and

,East Nusa Tenggara from 26.8% to 3.8%


tropis tissue helminth1 filariasis

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