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Tissue helminth
Sitti Wahyuni, MD, [email protected]
Department of ParasitologyMedical Faculty
Hasanuddin University
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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
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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
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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
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stained with hematoxylin
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Microfilaria
Brugia
collected by the Knott
concentration technique,in 2% formalin wet
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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
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- 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
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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
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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%
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