Filariasis
ZHUSUMAMBETOVA SALTANAT
The causative agents of filariasis infections are some types
of roundworms, while various parts of the body are
affected, depending on the type of helminth.
There are many types of filariasis helminths, but only a few of
them infect humans. Species infecting humans can live in:
tissues lying under the layers of skin (subcutaneous tissues), or
in the eyes: the African eye worm (Loa Loa), which is the
causative agent of loaosis, or Onchocerca volvulus, which causes
"river blindness" (onchocerciasis);
lymphatic tissues: Wuchereria bancrofti, Brugia malayi or Brugia
timori, which cause lymphatic filariasis.
Most of these infections occur in tropical and subtropical
[Link] with canine heartworm (Dirofilaria immitis) is
found all over the world, including in North America.
This infection rarely causes symptoms, as canine cardiac
helminthiasis in humans does not develop until maturity. But
sometimes immature heartworms reach the lungs and can cause
chest pain and cough. In very rare cases, the larvae form nodules
in the eyes, brain and/or testicles.
Transmission
The transmission of filariasis infections occurs as follows:
When bitten, an infected fly (for example, gadfly or deer horsefly) or
mosquito deposits parasite larvae under the skin.
The larvae turn into adult worms under the skin or in lymphatic tissues.
Adult helminths produce offspring called microfilariae that circulate in
the blood or live in the skin.
The spread of infection occurs when an infected person is bitten by a
horsefly or a mosquito that absorbs microfilariae.
Inside the insect, microfilariae turn into larvae capable of causing
infection.
Then, when the insect bites, it passes the larvae to another
[Link] infections are not transmitted directly from person to
person.
Symptoms of filariasis infections
Inside the body, adult filariasis worms can migrate and form seals
in lymphatic vessels or under the skin, depending on the type of
filariasis worm that caused the infection.
Adult female worms produce immature forms of worms called
microfilariae.
For the most part, the lesions and many symptoms caused by
phyllarial infections are the result of an inflammatory reaction of
the body to adult worms or microfilariae.
When lymphatic tissues (cells and organs that make up the
lymphatic system) are affected, adult Wuchereria or Brugia
worms and the inflammation that accompanies them can block
lymphatic vessels, causing inflammation and swelling of areas of
the legs, arms or genitals.
After many years, the legs, arms and genitals can greatly enlarge
and become disfigured.
Circulating microfilariae of Wuchereria or Brugia can cause
allergic reactions in the lungs that lead to coughing, shortness of
breath and asthmatic symptoms. Adult Loa Loa worms migrate
under the skin, causing temporary nodules, and sometimes pass
through the eyes under a transparent outer membrane
(conjunctiva). Adult Onchocerca worms live in nodules under the
skin and produce microfilariae that cause itching and skin
damage. They also get into the eyes, causing inflammation and
scarring, which can lead to blindness after many years.
Lymphatic filariasis is an infection of the lymphatic system,
the causative agent of which is one of three types of
roundworms.
A person's temperature rises, lymph nodes increase, pain
appears in the extremities and groin, and if the infection
becomes chronic, edema develops, which can become
permanent and lead to disfigurement of the appearance.
The infection is diagnosed when helminth larvae (microfilariae)
are detected in human blood samples.
Treatment usually consists of taking the drug
diethylcarbamazine, which destroys larvae in the blood and
individual adult worms.
Lymphatic filariasis is a filarial infection that leads to disability in
many countries of the world. As of 2018, about 51 million people
have been infected, and 40 million have been disfigured by the
disease.
In 2000, the World Health Organization launched a Global
Program to eliminate lymphatic Filariasis. As a result, significant
progress has been made in stopping the spread of infection
through large-scale annual treatment of eligible patients in
regions where infection is present.
In 2020, more than 860 million people lived in areas where the
infection was so widespread that it required such annual
treatment.
The causative agents of lymphatic filariasis are:
Wuchereria bancrofti: in tropical and subtropical areas of Africa,
Asia, the Pacific Ocean and the Americas, including Haiti.
Brugia malayi or Brugia timori: in South and Southeast Asia.
Transmission of lymphatic filariasis
Lymphatic filariasis is transmitted when a person is bitten by an
infected mosquito, which deposits larvae in the skin. The larvae
enter the lymphatic system, where they mature. An adult
helminth can have a length of 4 to 10 centimeters. Adults
produce millions of larvae (so-called microfilariae) that circulate
in the bloodstream and lymphatic system. The spread of infection
occurs when a fly bites an infected person and then another.
Symptoms of lymphatic filariasis
The cause of the symptoms of lymphatic filariasis are adult
helminths. Microfilariae do not cause symptoms and gradually
disappear from the bloodstream after a person leaves the area of
spread of the disease.
Early (acute) stage of infection
In the early stage of infection, symptoms may persist for 4-7 days.
These include fever, enlarged lymph nodes in the groin and armpits,
pain in the groin and extremities. Pus can collect in the leg and flow
through the surface of the skin, leading to scar formation.
Bacterial infections of the skin and subcutaneous tissues are more
likely because worms block lymphatic vessels, which reduces the
ability of the immune system to protect the skin and adjacent
tissues from bacteria.
Often, the symptoms resolve first and then reappear. They are most
severely tolerated by newly infected people.
Chronic infection
After many years of infection, the blocked lymphatic vessels expand.
Most people have no symptoms. But in some people, dilated lymph
vessels lead to the development of edema, which gradually becomes
irreversible (chronic).
The legs are most often affected, but the hands, mammary glands
and genitals may also be affected. The causes of the development of
such edema (lymphedema) may be:
Adult helminths live in the lymphatic system and impede the outflow
of lymph from tissues, leading to its accumulation in lymphatic
vessels.
Helminths provoke an immune response, expressed in inflammation
and edema.
Swelling makes the skin loose. When pressed, a dent remains on the
skin, which does not disappear immediately (mild swelling). With
chronic edema, the skin may become stiff and thickened (the so-called
elephantiasis). Men may develop swelling of the scrotum.
Bacterial and fungal skin infections are common in people with
lymphatic filariasis. These infections, along with the inflammation
caused by worms, can cause pain and discomfort.
Infections also contribute to the development of elephantiasis of the
legs, sometimes of the arms, and in some cases, extensive swelling
of the scrotum.
Some people have mild joint pain and blood in their urine.
Less often, microfilariae in the bloodstream affect the lungs, which
leads to a disease called tropical pulmonary eosinophilia.
The temperature may rise slightly, shortness of breath, cough and
wheezing may develop.
If the infection persists, scar tissue (fibrosis) may form in the lungs.
Diagnosis of lymphatic filariasis
Examination of a blood sample
blood tests.
Lymphatic filariasis is diagnosed when microfilariae are detected in a
blood sample or biopsy of lymphatic tissue when examined under a
microscope. During ultrasound examination, adult helminths can be
seen moving in dilated lymphatic vessels.
Blood tests have been developed to help quickly identify signs of
infection (such as antibodies to helminths). (Antibodies are proteins
produced by the immune system to protect the body from certain
types of attacks, including parasitic ones). However, blood tests are
only partially used for diagnosis, since they cannot distinguish worms
that cause lymphatic filariasis from some other worms, as well as
distinguish a past infection from a current one.
Prevention of lymphatic filariasis
The optimal protection against lymphatic filariasis is to prevent
mosquito bites by using:
applying insect repellents to exposed skin;
clothing impregnated with the insecticide permethrin;
clothes with long sleeves and long legs;
nets over the bed.
In areas of lymphatic filariasis, annual mass treatment programs
can help prevent the spread of infection.
Treatment programs usually use 2 or 3 anthelmintic drugs,
depending on whether other parasitic worms are present in the
region.
Mass treatment reduces the number of microfilariae in the blood
of infected people and thus prevents the spread of infection.
Treatment of lymphatic filariasis
Diethyl Carbamazine
Treatment of long-term effects
Treatment of acute infection
Short-term early symptoms usually resolve on their own. Whether the
treatment prevents long-term effects or only mitigates them remains
unknown.
Treatment of chronic infection
As a rule, lymphatic filariasis is treated with diethyl carbamazine. This
drug is taken orally for 1-12 days. It destroys microfilariae and individual
adult helminths.
Before prescribing diethylcarbamazine, doctors check patients for the
presence of loaosis and onchocerciasis, because diethylcarbamazine
can have serious side effects in people with these infections.
Treatment of the effects of chronic infection.
Treatment is prescribed to alleviate the effects of chronic
infection.
Chronic edema requires careful skin care.
You should try to avoid skin damage and carefully treat any minor
cuts and scratches. This helps to avoid bacterial infection.
Swelling can be reduced by wrapping the affected limb with an
elastic bandage or giving it an elevated position.
In the case of severe elephantiasis, including scrotal edema,
surgical intervention may be performed to improve drainage of
the lymphatic system.
Bacterial skin infections are treated with oral antibiotics.
Antibiotics can slow or prevent the progression of elephantiasis.
For lung problems, taking diethylcarbamazine for 14-21 days is
effective. Nevertheless, the infection recurs in about a quarter of
those who become ill. In such cases, the treatment must be
repeated.
Diethylcarbamazine
Antihelmintic agent
It disrupts the function of neuromuscular system of helminths.
Causing their death
Active againts W. bancrofti, Brugia malaya,Brugia timori,
Onchocerca volvulus,Loa loa
Dd 1-6 mg/kg
S/e nausea, vomiting , headache, weakness, allergic reaction
C/i pregnancy, childhood and old age, cardiovascular disease and
kidneys
Ivermektin
Supress the producton of inflammatory cytokines induced by
lipopolysaccharides. Also causes the death of parasites , mainly
through selective binding and high affinity for glutamate-
regulated chlorine channels located in the nerve and muscle cells
of invertebrates
Onchocerciasis
15-20kg-3 mg PO may repeat in3-12 m
26-44 kg- 6 mg PO may repeat in3-12 m
45-64 kg -9mgPO may repeat in3-12 m
65-84 kg-12 mg PO may repeat in3-12 m
85-more-150mcg/kg PO may repeat in3-12 m
Albendazole
M/a- disrupt the processes glucose transport and microtubular
functions, reducing the activity of fumarate reductase in
helminths, which causes paralysis and leads to deaths
400mg (or 10 mg/kg) DD , 3days
Onchocerciasis
Onchocerciasis is an infection caused by a helminth called
Onchocerca volvulus. It causes itching, rashes, sometimes with
scarring, as well as eye symptoms that can lead to blindness.
The infection is spread through the bite of female midges that
breed in streams.
The infection mainly causes severe itching, but in some cases a
rash appears, lymph nodes swell, vision is damaged or complete
blindness occurs.
As a rule, a doctor diagnoses an infection by identifying an
immature form of helminth in a skin sample.
Taking ivermectin once or twice a year for people living in regions
where such an infection is common can control its spread.
If onchocerciasis causes symptoms, ivermectin is used for
treatment in a single dose, which is repeated every 6-12 months
until symptoms are eliminated.
Worldwide, about 21 million people suffer from onchocerciasis.
About 14.6 million people suffer from skin disease, 1.15 million
have visual impairment or blindness. Onchocerciasis is the
second leading cause of infectious blindness in the world after
trachoma.
Onchocerciasis is most common in tropical and southern (sub-
Saharan) Africa. Cases are sometimes reported in Yemen and in a
small transition zone in South America, along the border of
Venezuela and Brazil. The World Health Organization (WHO) has
announced that onchocerciasis has been eradicated in Colombia,
Ecuador, Mexico and Guatemala. People who live or work near
fast-flowing streams or rivers are most susceptible to infection. In
addition to residents, travelers staying in these areas for a long
time, such as missionaries, volunteers or field researchers, are at
risk.
Ways of transmission of onchocerciasis
Onchocerciasis is spread by the bites of female midges, which breed
in fast streams (from this comes the name river blindness).The
infectious cycle begins with the bite of an infected person by a midge
and the infection of the midge with an immature form of helminth
called microfilaria. Microfilariae turn into larvae in the bag. When a
midge bites another person, the larvae move onto that person's skin.
The larvae move under the skin, forming tubercles (nodes), where
they develop into adult worms within 12-18 months. Adult female
helminths can live in such nodes for up to 15 years. After mating,
adult female worms lay eggs, which develop into microfilariae that
leave the worm. The helminth can lay up to 1000 microfilariae per
day. Thousands of microfilariae move through skin tissues and eyes,
causing diseases.
