1. Lymphatic Filariasis / Elephantiasis Ali Bbdullah M. Al mareed
الفيلاريا الليمفاوية / داء الفيل
Ali Bbdullah M. Al mareed
PhD student at KSU

2. وهو يصف المتلازمة التي تتضخم فيها الأرجل والذراعين والأعضاء التناسلية بصورة واضحة للعين إلى أحجام تشبه الأحجام في الفيل

3. مناطق وجود داء الفيل - الفيلاريا
ويوجد المرض في أمريكا الجنوبية، وسط أفريقيا، وآسيا، وجزر المحيط الهادي، والكاريبي .

4. What is it ?
Wuchereria bancrofti and Brugia malayi are filarial nematodes
Spread by several species of night - feeding mosquitoes
Causes lymphatic filariasis, also known as Elephantiasis
Commonly and incorrectly referred to as “Elephantitis”

5. Definitive Host العائل النهائي
Humans are the definitive host for the worms that cause lymphatic filariasis

6. Intermediate Host العائل المتوسط
Anopheles
Intermediate Host
العائل المتوسط
Aedes
Transmitted by Culex, Aedes, and Anopheles species
B.malayi is transmitted by Anopheles and Mansonia species.
Culex
Mansonia

7. Lymphatic Filariasis by the numbers
Endemic in 83 countries
1.2 billion at risk
More than 120 million people infected
More than 25 million men suffer from genital symptoms
More than 15 million people suffer from lymphoedema or elephantiasis of the leg

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Morphology I
Adult: White and thread-like. Two rings of small papillae on the head.
Female:5~10cm in length
Male: 2.5~4cm and a curved tail with two copulatory spicules.
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Morphology II
Microfilaria: 177~296 µm in length, a sheath with free endings. Bluntly rounded anteriorly and tapers to a point posteriorly. A nerve ring with no nuclei at anterior 1/5 of the body.
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Wuchereria bancrofti
Brugia malayi

10. Characteristic of life cycle
Host: Mosqutoes (intermediate host)
Human (final host)
Location: Lymphatics and lymph nodes
Infective stage: Infective larvae
Transmission stage: Microfilariae
Diagnostic stage: Microfilariae

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Life cycle
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Wuchereria Life Cycle
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13. أعراض الإصابة الحادة بداء الفيل هي:
ارتفاع درجة الحرارة.
ألم بالمنطقة أسفل الحوض
وجود رعشة.
وجود عرق.
صداع وقيئ و آلام.
تضخم بالغدد الليمفاوية.

14. قرح بالجلد.
ألم بالعظام والمفاصل.
شعور بالتعب.
قد تحدث خطوط حمراء على الذراع أو الساق.
قد تظهر خراريج Abscesses على الجلد أو بالغدد الليمفاوية.

15. Nocturnal periodicity
Phenomen which the number of microfilariae in peripherial blood is very low density during daytime, but increase from evening to midnight and reach the greatest density at 10p.m to 2 a.m.May be related to cerebral activity and vasoactivity of pulmonary vessels.

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Larva deposited by mosquito bite
Travel through dermis to lymphatic vessels
Growth (approx 9 months) to mature worms(20-100mm long)
Worms live 5-7 years (occasionally up to15 years)
Mate->Microfilariae (1st stage larva)
Females->release up to 10,000 microfilariae/day into bloodstream
Microfilarie taken up by mosquito bite
Develop into 2nd and 3rd stage larva over days inside mosquito vector
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Lymphatic System
Network of vessels that collect fluid that leaks out of the blood into tissues (lymph)
Redirects lymph back into the blood stream
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Clinical Course
Initially asymptomatic
Symptoms develop with increasing numbers of worms
Less than 1/3 of infected individuals have acute symptoms
Clinical Course is 3 phases:
Asymptomatic Microfilaremia
Acute Adenolymphangitis (ADL)
Chronic/Irreversible lymphedema
Superimposed upon repeated episodes of ADL
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Acute ADL
Presents with sudden onset of fever and painful lymphadenopathy
Retrograde Lymphangitis
Inflammation spreads distally away from lymph node group
Immune mediated response to dying worms
Most common areas: Inguinal nodes and Lower extremities
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Inflammation spontaneously resolve after 4-7 days but can recur frequently
Recurrences usually 1-4 times/year with increasing severity of lymphedema
Secondary bacterial infections in edematous(elephantatic) areas
Filarial fever (fever w/o lymphangitis)
Tropical Pulmonary Eosinophilia
Hyperresponsiveness to microfilariae trapped in lungs
Nocturnal Wheezing
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21. Chronic Manifestations
Lymphedema
Mostly LE and inguinal, but can affect UE and breast
Initially pitting edema, with gradual hardening of tissues  hyperpigmentation & hyperkeratosis
GenitaliaHydroceles
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22. Chronic Manifestations
Renal involvement
Chylurialymph discharge into urine
Loss of fat and protein hypoproteinemia & anemia
Hematuria, proteinuria from ?immune complex nephritis
Secondary bacterial/fungal infections
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Elephantiasis: accumulation of lymph in extremeties, fibrosis, and thickening of skin.
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24. Microfilariae are seen in blood smears and are DIAGNOSTIC
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25. Blood Smear - Microfilaria
Note wavy microfilarial worm in the thick part of blood film.
Dark blue structures are nuclei
Tail end tapering (no nuclei)
Sheath covering worm.
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26. Blood Smear - Microfilaria
Note wavy microfilarial worm in the thick part of blood film.
Head end of the worm – rounded (no nuclei)
(Sheath is not clearly seen)
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27. Blood Smear - Microfilaria
Note wavy microfilarial worm in the thick part of blood film.
Dark blue structures are nuclei
Tail end - tapering sheath (no nuclei)
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28. Hydrocele fluid – cell block.
Note wavy microfilarial worms.
Inflammatory cells – lymphocytes.
Hemorrhagic fluid sediment
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29. Hydrocele fluid – cell block.
Inflammatory cells – lymphocytes.
RBC
Microfilaria.
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30. Control
As with malaria, the most effective method of controlling the spread of W.bancrofti and B.malayi is to avoid mosquito bites
The CDC recommends that anyone in at-risk areas:
Sleep under a bed net
Wear long sleeves and trousers
Wear insect repellent on exposed skin, especially at night

31. Vector control
Covering water-storage containers and improving waste-water and solid-waste treatment systems can help by reducing the amount of standing water in which mosquitoes can lay eggs.
Killing eggs (oviciding) and killing or disrupting larva (larviciding) in bodies of stagnant water can further reduce mosquito populations.

32. Treatment Treatment of filariasis involves two components:
Getting rid of the microfilariae in people's blood
Maintaining careful hygiene in infected persons to reduce the incidence and severity of secondary (e.g., bacterial) infections.

33. thank you for your attention
AL mareed A.A
PhD student at KSU