Clinical Identification and Nursing Management of Filariasis

1. GOOD AFTERNOON

4. What is lymphatic filariasis (LF)
• Lymphatic filariasis, considered globally as
a neglected tropical disease, is a parasitic disease
caused by microscopic, thread-like worms
• Lymphatic filariasis (LF), commonly known as
elephantiasis, is a disfiguring, disabling disease,
usually acquired in childhood

5. Causal Agents
• Lymphatic filariasis is caused by nematodes
(roundworms) that inhabit the lymphatic vessels and
lymph nodes of a human host. Wuchereria
bancrofti, Brugia malayi and Brugia timori cause
lymphatic filariasis.

6. MODE OF TRANSMISSION
• The adult produces millions of very small, immature
larvae known as microfilariae, which circulate in the
peripheral blood with marked nocturnal periodicity. The
worms usually live and produce microfilariae for 4-6
years.

7. • Lymphatic filariasis is transmitted through mosquito
bites.
• The microfilariae enter the body of a mosquito when
it feeds on the blood of a person carrying
microfilariae in their blood (mf carriers).
• It takes 7-21 days for the microfilariae to develop
inside the body of the mosquito.

9. Who is at risk for infection
• Living in filaria endemic regions

10. Clinical Manifestations of
Lymphatic Filariasis
A. Stage of Invasion
The infective larva gains its entry into the human host and
starts undergoing further development
• Diagnosis at this stage rests on the triad of: Eosinophilia,
lymphadenopathy and a positive intradermal test with the
supporting evidence of history of residence in an endemic
area.

11. B. Asymptomatic or Carrier Stage
• This stage is usually with no clinical manifestation.
The microfilaria (mf) carriers are usually detected by
night blood examination.

12. C. Stage of Acute Manifestations
• These comprise filarial fever, lymphangitis,
lymphadenitis and lymphoedema of the various parts
of the body and epididymo – orchitis in the male. It is
mainly because of the infection of the lymphatic
vessels (channels) by the adult worm.

13. The lymphedema of the limbs is
commonly graded as
• Grade I - Pitting edema, reversible on elevation of the
affected limb.
• Grade II - Pitting or non-pitting edema, which does
not reverse on elevation of the affected limb and there
are no skin changes.

14. • Grade III - Non-pitting edema that is not reversible,
with thickening of the skin.
• Grade IV - Non-pitting edema that is not reversible,
with thickening of skin along with nodular or warty
excrescences - the stage of elephantiasis.

16. D. Stage of Chronic Manifestations
• The clinical manifestations comprise of elephantiasis
of genitals, legs or arms, hydrocele, chyluria, etc.

17. Diagnosis
• Identification of microfilariae in a blood smear by
microscopic examination
• The microfilariae that cause lymphatic filariasis
circulate in the blood at night (called nocturnal
periodicity)

18. What is the treatment for lymphatic
filariasis
• The drug DEC (diethyl carbamazine) is the mainstay of
therapy for filiariasis.
• The dose is 6 mg/kg/wt given as a single dose daily for
about three weeks.
• Ivermectin is another drug that can be used. It is
particularly useful against the parasites Bancrofti and
Brigia.

19. • DEC does not kill all the adult worms, it does prevent
infected people from giving the disease to someone
else

20. To prevent lymphoedema from getting worse by
following several basic principles:
• Carefully wash the swollen area with soap and water
every day.
• Use anti-bacterial cream on any wound. This stops
bacterial infections.
• Elevate and exercise the swollen arm or leg to move
the fluid and improve the lymph flow.

21. • Heat therapy using either wet heat or hot ovens
• Surgical procedures: lymph nodo-venous shunts,
excision with skin grafting

24. Side effect from the medicine
• Persons harbouring microfilariae in their blood, may
experience some mild side effects like bodyache,
vomiting, heachache and dizziness or fever,
sometimes rash and itchiness may occur.
• These side effects usually subside within a day.
• If any symptoms persist, go to health centre for
immediate treatment.

25. Why should healthy persons
consume DEC tablets
• Apparently healthy persons may still carry parasites
that may lead to symptoms like elephantiasis after a
few years and during the symptomless status, one
may continue to transmit the infection to others
through mosquito bites.

26. Why the drug is given to the whole
village
• DEC kills microfilariae in the blood and the
mosquitoes will not be able to transmit the infection if
the population in the village take the drug .Therefore
the Mass Drug Administration (MDA) with single
dose is given annually .

27. • Adult female filaria worm lives in body usually for 5-
7 years & produce baby filaria (microfilariae),
therefore the MDA is implemented for 5-7 years.

28. Who should take the medicine
• Everyone living in filaria endemic area above two
year age, except pregnant women & seriously ill
person

29. How often one should take DEC
tablets
• Once a year during Mass Drug Administration.

30. How tablets should be taken
• The tablets should be swallowed with water and
tablets should not be taken on empty stomach.

31. How many DEC tablets should be
taken during MDA
0-2 years Nil
2-5 years 1 tablet of 100 mg.
6-14 years & above 2 tablets of 100 mg. each
15 years & above 3 tablets of 100 mg. each

32. How can I prevent infection
• at night
– sleep in an air-conditioned room
– sleep under a mosquito net
• between dusk and dawn
– wear long sleeves and trousers and
– use mosquito repellent on exposed
skin.