Lymphatic filariasis, also known as elephantiasis, is a parasitic disease caused by roundworms that enter the body through mosquito bites and block the lymphatic system. It affects over 120 million people globally. The main parasites that cause it are Wuchereria bancrofti and Brugia malayi. Countries with the highest burden include Nigeria, India, and various countries in Asia and the Pacific Islands. Symptoms range from fever and skin abnormalities to swelling of the limbs and genitals. Diagnosis involves detecting parasites or antigens in the blood. Treatment focuses on killing the parasites with drugs like diethylcarbamazine or ivermectin, along with managing symptoms like swelling and

1. Filariasis
Deji Ajayi FWACP,FACP,FRCP
Professor of Medicine
Ekiti State University and Teaching Hospital

2. History
 Pre-1876
 The only known symptom of this disease was elephantiasis because of its
outward appearance.
 600BC
 Ancient Hindu medical workers referred to elephantiasis in Sanskrit texts.
 600- 250BC
 Men affected by elephantiasis were not allowed to become Buddhist
priests.
 10th- 13th Centuries
 Persian and European physicians have accurate descriptions of
elephantiasis.
 1876
 Joseph Bancroft discovered the parasite that causes lymphatic filariasis in
an abscess on the arm of a butcher.

3. What is Lymphatic Filariasis?
 This is a Parasitic disease in
which worms enter the
blood stream through
numerous mosquito bites
over a number of years.
 Affects 120 million
individuals in over 80
countries in the tropical
regions due to stagnant
water and poor irrigation
systems

4. Infected Regions

5. Epidemiology- International
 120 million in 80 countries
 1 billion at risk
 90% - Wucheraria Bancrofti
 Remainder – Brugia Malayi

7. Epidemiology
Nigeria is estimated to have the highest
burden of lymphatic filariasis (LF), a disease
also known as elephantiasis

8. Parasites
 White, slender roundworms
 Three types: Wuchereria
bancrofti, Brugia malayi,
Brugia timori
 Live for 5-7 years, produce
millions of offspring
 Block the lymphatic system
 Network of channels and
lymph nodes that help
maintain fluid levels in the
body
 Blockage leads to edema
(collection of fluid in tissues)

9. Vectors – Wucheraria Bancrofti
 Major – Culicine Mosquitoes ( urban and
semi-urban areas )
 Anophelines – Rural areas ( mainly Africa )
 Aedes – Endemic Pacific Islands

11. Vectors – Brugia Malayi
 Mansonia
 Anopheline
Brugia Malayi is mainly confined to east and
south Asia, especially India, Malaysia,
Indonesia, the Philippines, and China.

12. Process of Infection

14. Pathogenesis and Pathology
 Complex interplay of the pathogenic
potential of the parasite, the immune
response of the host, and external
('complicating') bacterial and fungal
infections.
 Most recognizable complications – Genital
damage ( Hydroceles ) and
Lymphoedema/elephantiasis

15. Symptoms
 Fever
 Kidney damage
 Skin abnormalities due to
bacterial infection.
 Elephantiasis
 Swelling of limbs and genitalia
 Male: Enlargement of scrotum,
penis retracted under skin,
spermatic cords thickened
 Female: Long tumorous mass
covered by thickened
ulcerated skin arising from the
vulva

19.  Histologically - dilatation and proliferation of
lymphatic endothelium & abnormal
lymphatic function
 'non-inflammatory pathway'
 ‘inflammatory pathway‘ - adenitis and
retrograde lymphangitis
 bacterial and fungal superinfections

20. Clinical Features
 Chronic manifestations: Hydrocoele (most
common ), elephantiasis, Chyluria
 Acute manifestations: Acute inflammatory
episodes 'DLA'(dermatolymphangioadenitis) ,
'filarial fever' , tropical pulmonary eosinophilia,
acute inflammatory reaction
 Asymptomatic Presentations
 Other Syndromes: arthritis (typically
monoarticular), endomyocardial fibrosis,
tenosynovitis, thrombophlebitis,
glomerulonephritis, lateral popliteal nerve palsy,
and others.

25. Social Impact of Disease
Sexual Disability
Communities frequently
shun those disfigured
(stigmatization).
Inability to work
Women with visible signs
may never marry or
spouses and families will
reject them.

26. Diagnosis
 Until recently, diagnosis depended on the
direct demonstration of the parasite
 Antigen detection: Circulating filarial antigen
(CFA) - 'gold standard' for diagnosing
Wuchereria bancrofti infections.
 Clinical Diagnosis

28. Diagnosis
 Until recently, very difficult
to diagnose
 Nocturnal periodicity: The
worms can only be detected
in the blood of those infected
around the hour of midnight.
 New specific card test:
Detects parasites using
only finger prick blood tests
any time of day.
 Ultrasound can identify
rapidly moving adult worms.

29. Treatment and Management of
Elephantiasis
 Prevention
 Mosquito nets, insect repellents
 Voodoo healing techniques
 Elevate and exercise affected body
part
 Skin treatment
 Wash area twice daily
 Antibacterial cream
 CDP (Complex decongestive
physiotherapy)
 Lymph drainage, massage, compressive
bandages

30. Management
 Treating the infection: DEC (6 mg/kg per
day) for 12 days in bancroftian filariasis and
for 6 days in brugian filariasis, repeated at 1-
6 monthly intervals if necessary
 Ivermectin
 Albendazole
 Side effects : headaches, fever, myalgia,
lymphadenopathy, occasionally rash and
itching

31.  Treating the consequences: treatment of
infection in communities with either
intermittent (monthly, 6-monthly, yearly)
drug administration or the steady use of
DEC-fortified table/cooking salt
 Intensive local hygiene efforts and antibiotic
ointments

32. Prevention
 By decreasing contact between humans and
vectors or by decreasing the amount of
infection the vector can acquire
 Population: through reducing the numbers
of mosquito vectors
 2-drug treatment regimens (selecting among
albendazole and either ivermectin or
diethylcarbamazine [DEC])

33.  Individuals: personal repellents, bednets or
insecticide-impregnated materials.
 Prophylactic regimen of DEC (6 mg/kg per
day x 2 days each month)

34. Thank You