Filariasis. Nematoda Systemic round worms

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1 Filariasis Nematoda Systemic round worms

2 Filaria -a roundworm -Adult filaria live in body cavities, lymphatics, and subcutaneous tissues -embryos (microfilaria) live in blood or dermis -all require an insect or crustaean vector -microfilaria ( µ long) - adults 2 cm 120 cm (4 10 µ wide)

3 Filaria 1. Onchocerca volvulus - river blindness - black fly 2. Wuchereria bancrofti - lymphatic filariasis - mosquito Brugia malayi 3. Loa Loa - eye worm - deer fly 4. Dracunculus medinensis - Guinea worm - cyclops 5. Mansonella perstans - midge 6. Mansonella ozzardi - midge

4 Wuchereria bancrofti and Brugia malayi lymphatic filariasis elephantiasis

5 Lymphatic filariasis Wuchereria bancrofti Brugia malayi

6 Lymphatic filariasis Wuchereria bancrofti and Brugia malayi - vector - mosquito (Culex, Anopheles) - adult - in lymphatics length 4-10 cm. -microfiliaria - in blood µ long µ wide

7

8

9 Loa Onchocerca Wuchereria Chengmai

10 Clinical states of Wuchereria bancrofti 1. assymptomatic 2. inflammatory - lymphangitis - arms 25% - legs 11% - epididimitis, funiculitis 42% - filarial fevers - orchitis - filarial abscess 3. Obstructive - elephantiasis - chyluria - hydrocoele 4. Tropical pulmonary eosinophilia

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13 blood microfilaria 1 direct examination (thick or thin smear) 2 Knotts concentration technique 3 millipore filtration 4 antigen capture

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15 Loa loa eye worm

16 Loa loa (eye worm)

17 Crysops (Loa loa vector)

18 Calabar swelling

19 Calabar swelling

20 Loa loa adult in Calabar swelling x section

21 Loa loa (the eye worm )

22 Loa loa microfilaria

23

24 Onchocerca volvulus River blindness

25 Simulium damnosum The black fly

26 Onchocerca nodule

27 X section of Onchocercal nodule

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29 Skin snips for microfilaria with oculoscleral biopsy forceps

30 Onchocerca microfilaria from a skin snip

31 Anterior chamber microfilaria and keratic precipitates

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33 Kingdom Animalia Subkingdom Protozoa Phylum Sarcomastigophora Phylum Apicomplexa Phylum Ciliophora Phylum Microspora Subkingdom Metazoa Phylum Nematoda Taxonomy Phylum Platyhelminthes cestodes (tapeworms) trematodes (flukes)

34 Trematodes flukes

35 Trematodes = flatworms adult Source (cercaria/metacercaria) Schistosoma human (blood) water Opisthorchis human (liver) freshwater fish Paragonimus human (lung) freshwater crabs, cray fish Fasciola human (liver) watercress

36

37 hermaphroditic liver flukes, lung flukes etc. two sexes blood flukes

38 Schistosoma life cycle Human adult ~5-8 yrs) Egg (~21 days in tissue) Miracidium (~10 hrs) Cercaria ~2 days) Snail Redia/sporocysts (~6 wks)

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40 Schistosomiasis (blood flukes) Schistosoma mansoni Schistosoma hematobium Schistosoma japonicum etc.

41 S. hematobium S. mansoni S. japonicum

42 swimming ciliated miracidium

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44

45 Swimming cercaria

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47 Clinical Presentation of schistosomiasis Intestinal S. mansoni Urinary S. hematobium S. japonicum S. intercalatum S. mekongi

48 Geographic distribution

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50

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53 Chronic Intestinal Schistosomiasis portal hypertension with splenomegaly oesophagial varices hypersplenism ascitis pulmonary hypertension CNS lesions: spine - transverse myelitis cerebral seizures (S. japonicum) intestinal polyposis: both sessile and pedunculated chronic salmonellosis intestinal granulomatosis: contractures of colon, intusseception

54 Urinary schistosomiasis Schistosoma haematobium

55 Schistosoma near urethra

56

57 Schistosoma hematobium Presentation hematuria (terminal) urinary frequency pyuria pyelonephritis obstructive uropathy cancer of bladder (squamous cell) distant metastases (spinal column) (pulmonary hypertension) Laboratory debris in urine eggs in urine (overnight-millipore) I.V.P. abnormalities cystoscopy serology

58 Diagnosis: intestinal schistosomiasis 1. History of freshwater exposure 2. Stool for O&P (egg counts and viability) 3. Serology-- Elisa and Western Blot 4. Antigen capture 5. Eosinophilia 6. Rectal snips or biopsies 7. Liver biopsy 8. Ultrasound or CT of abdomen

59 Treatment of Schistosomiasis praziquantel

60 Schistosoma japonicum is a zoonosis

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