Communicable Diseases
Subtopic:
Elephantiasis (Bancroftian Filariasis)
Filariasis
Filariasis
is a parasitic disease that is caused by thread-like roundworms.- These are spread by blood-feeding black flies and mosquitoes.
Types
- Lymphatic filariasis is caused by the worms:
These worms occupy the lymphatic system, including the lymph nodes.
In chronic cases, these worms lead to the disease elephantiasis.
- Subcutaneous filariasis is caused by:
- Loa loa (the eye worm)
- Mansonella streptocerca
- Onchocerca volvulus.
These worms occupy the subcutaneous layer of the skin, in the fat layer. Loa loa causes Loa loa filariasis, while Onchocerca volvulus causes river blindness.
- Serous cavity filariasis is caused by the worms:
- Mansonella perstans
- Mansonella ozzardi
These occupy the serous cavity of the abdomen.
Signs and symptoms
- The most spectacular symptom of lymphatic filariasis is elephantiasis—edema with thickening of the skin and underlying tissues. Elephantiasis results when the parasites lodge in the lymphatic system.Elephantiasis affects mainly the lower extremities.
- Different species of filarial worms tend to affect different parts of the body:
- Wuchereria bancrofti can affect the legs, arms, vulva, breasts, and scrotum (causing hydrocele formation)
- Brugia timori rarely affects the genitals.
- The subcutaneous worms present with:
- skin rashes,
- urticarial papules, and arthritis, as well as hyper- and Onchocerca volvulus manifests itself in the eyes, causing “river blindness” (onchocerciasis).
- Serous cavity filariasis presents with symptoms similar to subcutaneous filariasis, in addition to abdominal pain.
Diagnosis
- Thin and thick blood film smears- finger prick test.
- Blood must be drawn at appropriate times, which reflect the feeding activities of the vector insects. Examples are bancrofti, whose vector is a mosquito; night is the preferred time for blood collection.
- Loa loa’s vector is the deer fly; daytime collection is preferred.
- Skin snip/biopsy for:
- streptocerca
- volvulus. Tests are done anytime.
- Polymerase chain reaction (PCR) and antigenic assays, which detect circulating filarial antigens.
- Lymph node aspirate
- Medical imaging, such as CT or MRI
- X-ray tests can show calcified adult worms in lymphatics.
Treatment
- The recommended treatment is albendazole (a broad-spectrum anthelmintic) combined with ivermectin.
- A combination of diethylcarbamazine and albendazole is also effective.
- Doxycycline for 8 weeks.
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