Prasad Gunjal, profile picture
Uploaded byPrasad Gunjal
PPTX, PDF4,846 views

Tissue nematodes

This document provides information on somatic (tissue) nematodes, with a focus on Wuchereria bancrofti. It describes the life cycle, morphology, classification, clinical features, and laboratory diagnosis of W. bancrofti. W. bancrofti resides in the lymphatic system and can cause lymphatic filariasis. It has a complex life cycle involving human and mosquito hosts. Microfilariae are found circulating in blood between 10pm-4am and clinical manifestations include lymphangitis, lymphadenitis and lymphedema. Diagnosis involves microscopic examination of blood for motile microfilariae.

Embed presentation

Downloaded 43 times
Somatic (Tissue) nematodes Mr. Gunjal Prasad Niranjan M.Sc. Medical Microbiology, PG Dip in Clinical Research. Assistant Professor Dept. of Microbiology, UNDER GARADUATE STUDENT’S PRACTICAL BRIFING ON
Aim and Objectives • At the end of this session student must be able to understand • Classification of Somatic (Tissue Nematodes) • Life cycle, pathogenesis and laboratory diagnosis of the following tissue nematodes. • Wuchereria bancrofti • Burgia species • Loa loa • Onchocerca volvulus • Dracunculus medinesis 7/9/2021 Dept of Microbiology 2
General properties • HABITAT: • Filarial worm reside in the lymphatic system, skin, subcutaneous tissue and rarely in the body cavity. • Live upto 5 -7 yrs produces upto millions of offspring. • Blocks the lymphatic system – Network of channels and lymph nodes that helps maintain fluid levels in the body. • Blockage leads to edema – collection of fluid in tissues. 7/9/2021 Dept of Microbiology 3
Morphology – General Properties • ADULT WORM: • Slender, Round 2 - 10 cm(except female of Onchocerca 35-50cm). • Can survive for many years in humans causing chronic obstructive and inflammatory conditions including Elephantiasis & Hydrocele. 7/9/2021 Dept of Microbiology 4
General Properties • Microfilaria: • Female worm produces large number of L1 larvae called as “Microfilaria”. • Highly motile thread like larvae. • Usually non-pathogenic, but sometimes , hypersensitivity reactions can occur against the microfilarial antigen resulting in tropical pulmonary eosinophilia (TEP) caused by an immune hyper- responsiveness to microfilariae trapped in the lungs. 7/9/2021 Dept of Microbiology 5
Classification • Filarial nematodes belongs to – • Class – Secernentea • Superfamily – Filarioidea • Family – Onchocercidea • They are differentiated on following properties 7/9/2021 Dept of Microbiology 6
Classification • HABITAT: • Where they reside – Lymphatics or Subcutaneous tissue or body cavities. • Geographical distribution. • Vector responsible for transmission. • Structure of their larvae for e.g. presence of sheath and nuclei at the tail tip. 7/9/2021 Dept of Microbiology 7
Classification • MICROFILARIAL PERIODICITY: • It is defined as the time when most of the microfilariae are found in peripheral blood. • Microfilariae of various filarial worms exhibit different periodicity and found at different time in peripheral blood. • NOCTURANAL PERIODICITY – Night time between 9pm to 2am for e.g. Wuchereria & Brugia. • DIURNAL PERIODICITY – Day time for e.g. Loa loa. • SUB-PERIODIC – Present throughout with slight increase in the afternoon for e.g. rarely Wuchereria & Brugia. • NON PERIODIC – Any time for e.g. Mansonella & Onchocerca. 7/9/2021 Dept of Microbiology 8
Classification • Periodicity occurs due to biological and evolutionary co-adaptation of the microfilariae to the feeding habit of the mosquito for e.g. Culex bites in night, Aedes bites in daytime. • When not in peripheral blood, the microfilaria are found in the pulmonary blood vessels. 7/9/2021 Dept of Microbiology 9
Difference between filarial nematodes 7/9/2021 Dept of Microbiology 10 Parasite Location of adult Location of microfilaria Microfilaria periodicity Vector Epidemiology Lymphatic filariasis W. bancrofti Lymphatic tissue Blood Nocturnal (mostly) Culex Cosmopolitan (S. America , S. Asia, Africa) Subperiodic (Rare) Aedes Pacific islands B. malayi Lymphatic tissue Blood Nocturnal (mostly) Mansonia, Anopheles South-East Asia, Indonesia and India Subperiodic (Rarely) Coquillettidia & Mansonia South-East Asia B. tumori Lymphatic tissue Blood Nocturnal Anopheles Indonesia
Difference between filarial nematodes 7/9/2021 Dept of Microbiology 11 Parasite Location of adult Location of microfilaria Microfilaria periodicity Vector Epidemiology Subcutaneous filariasis Loa loa Subcutaneous tissue & conjunctiva Blood Diurnal Chrysops (Deer flies) West & Central Africa Onchocerca volvulus Subcutaneous tissue Skin and eye None Simulium South & Central America & Africa
Comparison of microfilariae 7/9/2021 Dept of Microbiology 12 A: Size, B: Periodicity, C: Sheath, D: Habitat
Classification – Tissue Nematodes Lymphatic Wuchereria bancrofti Brugia malayi Skin and Subcutaneous Loa loa (African eye worm) Onchocerca volvulus (blinding filaria) Dracunculus medinensis (thread worm) Brugia timori Conjunctiva Loa loa 7/9/2021 Dept of Microbiology 13
Lymphatic filariasis • Lymphatic filariasis is caused by Wuchereria bancrofti, Brugia malayi, Brugia timori. • WUCHERERIA BANCROFTI • Most widely distributed, • Affecting 8 crore people world wide. • It is found in India, China, Far East, major parts of Africa, South America & central America. • In general it is nocturnal in periodicity except in Pacific islands where it is sub periodic. 7/9/2021 Dept of Microbiology 14
Wuchereria bancrofti • INDIA • 600 million people at risk of 250 district of 20 states in India. • Highly epidemic states –UP, Bihar, Jharkhand, Odisha, AP, TN, Kerala and Gujrat. • Low prevalence in J&K and Punjab. • Sub-periodic W. bancrofti, transmitted by Aedes, reported from Nicobar island. 7/9/2021 Dept of Microbiology 15
7/9/2021 Dept of Microbiology 16 Wuchereria bancrofti (Filarial worm) Definitive host Man. Intermediate host Female Culex, Aedes or Anopheles mosquito. Infective form Third stage larva. Mode of transmission Inoculation – bite of mosquito. Site of localization Lymphatics / lymph nodes of man. Geographical distribution India, China, Far East, Africa, South & Central America.
Wuchereria bancrofti – morphology • Exists in 3 forms : • ADULT : • Worms are thread like, live in lymphatic tissue as tightly coiled nodular mass. • Long slender, creamy white thread like having smooth cuticle, with ends rounded. • ADULT MALE : Measures about 3.5 to 4.0cmX0.1 mm. • ADULT FEMALE : Measures 6-10 cm x 0.2-0.3 mm. • Average life span 4 to 5 years. • Female worm (viviparous) liberates sheathed embryos (Microfilaria). 7/9/2021 Dept of Microbiology 17
Wuchereria bancrofti – morphology • ADULT WORM – • Male can be differentiated from female by • small size, • crock screw tail and • presence of two spicules at posterior end which helps at time of copulation. • Female are viviparous – directly discharge larvae. • LARVAE • Like other nematodes – 4 larval stages present. • First stage larvae – Microfilaria. • The third stage larvae – Filariform larva (Infective from for humans). 7/9/2021 Dept of Microbiology 18
MICROFILARIA : • Microfilaria of W. bancrofti lives in blood vessels and are actively motile. • Diagnostic forms. • Found in peripheral blood between 10 pm to 4 am. • Measures about 275 to 300 um x 8 to 10 um. • Covered with hyline sheath which is 350 um long. 7/9/2021 Dept of Microbiology 19
Microfilaria • Head is blunt and tail is tapering. In unstained preparations these are colourless. • When stained with Giemsa or Romanowsky stains – pink with column of purple to violet nuclei. • These nuclei are absent at the head and tail ends. • They develop in mosquitoes. 7/9/2021 Dept of Microbiology 20
Cultivation of filarial nematodes • Success is limited in its cultivation. • CELL LINES – W. bancrofti, B. malayi can be cultivated in mosquito cell lines like Aedes togoi & Anopheles maculatus. • Grown in modified RPIM-1640 medium or TC199 supplemented with 20% of newborn calf serum and LLC-MK2 cells. • Human embryonic cell lines are also used as feeder layers. • Microfilaria ex-sheath and molt twice to L3 stage larvae in 12-16 days. • Culture method is not used for diagnosis but for maintenance of parasite for Ag preparation, Antifilarial drug sensitivity and research purpose. 7/9/2021 Dept of Microbiology 21
Life cycle of w. bancrofti • Life cycle is complex. Requires 2 hosts. • Humans are definitive hosts. • While mosquitoes of the genera Culex , Aedes & Anopheles are intermediate hosts. • Infective form for humans – third stage larva, present in proboscis sheath of mosquitoes. • Mode of transmission - Larva (L3) are deposited on skin of humans, near the site of bite, larva penetrate through puncture skin or wound to reach subcutaneous tissues. 7/9/2021 Dept of Microbiology 22
Life cycle of w. bancrofti – human cycle • Larva enter afferent lymphatics & reach draining lymph nodes to develop into adults in 3 to 15 months (4-6 wks B. malayi). • Male fertilize female, gravid female lays sheathed embryos – the Microfilaria. • Microfilaria enters efferent lymphatics to reach blood circulation through thoracic duct or right lymphatic duct. • Come in peripheral blood between 10 pm to 4 am, this Nocturnal periodicity is related the night biting habit of mosquitoes. 7/9/2021 Dept of Microbiology 23
Life cycle of w. bancrofti -Mosquito cycle • These sheathed microfilaria (L1) are ingested by mosquitoes with their blood meal. (Culex – at night, Aedes – at day time). • Microfilariae lose their sheath in stomach & penetrate the gut wall to reach the thorax of the mosquitoes. • Develop successively into second stage & third stage larvae which is the infective form for humans. • Third stage larvae measure about 1500 to 2000 um in length and it enters the proboscis sheath, ready to infect a new host. • Development in mosquitoes – 10 to 20 days. 7/9/2021 Dept of Microbiology 24
Life cycle of w. bancrofti • This duration depends on atmospheric temperature, humidity, and the species of mosquito. • One microfilaria develops into one infective form third stage larva. • Multiplication of parasite does not occur in mosquitoes. 7/9/2021 Dept of Microbiology 25
7/9/2021 Dept of Microbiology 26
Clinical features • Infection - Wuchereriasis/ Lymphatic filariasis/ Bancroftian filariasis. • Disease manifestations are due to lymphatic dysfunctions resulting from presence of living or dead worms lymph thrombi, inflammation and immune reactions to worm and worm products. • Pathogenic states are produced only by adult worm (living/ dead) – Classical filariasis. Occult filariasis – Lesions produced by microfilaria. 7/9/2021 Dept of Microbiology 27
Clinical Features • Clinical states in classical filariasis can be classified as: 1. Asymptomatic ( in endemic areas). 2. Inflammatory – lymphangitis and lymphadenitis - Common lymph node enlarged are inguinal, axillary, lymphatics of male genital organs are commonly involved that leads to funiculitis, epididymitis and orchitis. 3. Obstructive – Granuloma, thrombi formation, fibrosis of lymph vessels leading to severe lymphatic obstruction and pedal edema. 7/9/2021 Dept of Microbiology 28
Classical Filariasis - 1. Lymphangitis– Lymph vessels of extremities, testicles & epididymis are inflamed due to - • Mechanical irritation – movement of adult parasite inside lymphatics. • Liberation of metabolites of growing larvae. • Secretion of toxic fluid by fertilized female worms - . • Absorption of toxic products liberated from dead worms. 2. Lymphadenitis- Lymph Nodes of groin & axilla are inflamed. 7/9/2021 Dept of Microbiology 29
3. Lymphoedema : with hypertrophy of the affected parts ( Elephantiasis - of organs like leg, scrotum, penis, vagina, breast, arm etc – fibrotic thickening of skin & subcutaneous tissue) 4. Lymphangiovarix- dilatation of afferent lymph vessels due to obstruction. 5. Hydrocele – Commonest complication disorder in which serous fluid accumulates in a body sac (especially in the scrotum). 6. Chyluria – Excretion of chyle, a milky white fluid in urine occurs rarely . (Rupture of renal lymphatic through the mucous membrane of urinary tract). 7/9/2021 Dept of Microbiology 30
Lymphatic filariasis 7/9/2021 Dept of Microbiology 31
Occult filariasis – Tropical pulmonary Eosinophilia / Weingarten’s syndrome –Distinct syndrome in some individuals. –Proximal cough and wheezing. –Weight loss low grade fever. –Pronounced blood eosinophilia. –Total serum IgE and Antifilarial Ab titres are raised. –Represents a hypersensitivity reaction to microfilarial antigen. –Response well to treatment but in untreated cases can cause progressive pulmonary damage. 7/9/2021 Dept of Microbiology 32
Classical v/s Occult filariasis Classical filariasis Occult filariasis Cause Developing worms & adults Microfilariae Basic lesions Acute inflammation followed by an epitheloid granuloma surrounding the adult worm & a fibrous scar An eosinophilic granuloma (hypersensitivity reaction) Organs involved Lymphatic system Lymphatic system, lungs, liver & spleen Microfilaria Present in Blood Present in affected tissues not in blood Therapeutic response No response to any drug Responds to microfilaricidal drug, Diethylcarbamazine (DEC) 4-6mg/kg-12 days. 7/9/2021 Dept of Microbiology 33
Clinical features • IMMUNE COMPLEX MEDIATED MANIFESTATION – • Circulating immunocomplexes containing microfilarial antigens are found to be deposited in various organs such as – • Kidney – causes nephrotic syndrome, haematuria and proteinuria. • Joints – Causes filarial arthritis of knee or ankle. 7/9/2021 Dept of Microbiology 34
Laboratory diagnosis • SPECIMEN – • Blood collected at night, preferably capillary blood from ear lobes. • Chylous urine, • Hydrocele fluid, • Exudates from Lymphangiovarix 7/9/2021 Dept of Microbiology 35
Microscopic examination • Wet mount – A drop of blood is taken on a slide and covered with cover slip. • Microfilaria are easily identified under low power (10x) due to their size and motility. • Giemsa: • To prepare a stained preparation. • About 20 to 60 mm3 blood is streaked on a slide and allowed to dry. • Then stained with Giemsa stain. • Sheathed microfilaria with no nuclei at tail tip 7/9/2021 Dept of Microbiology 36
Laboratory diagnosis • Concentration techniques – for capillary blood, venous blood (Knott’s technique) • Diethylcarbamazine provocation test – 2mg/kg of DEC orally, examine peripheral blood smear after 30 to 45 minutes. • It provokes microfilaria to come in peripheral blood even during day time. • This test is contraindicated in Onchocerca & Loa loa. 7/9/2021 Dept of Microbiology 37
Laboratory diagnosis • Quantative Buffy Coat examination (QBC) – • Generally done for malaria, can be used for microfilariae. • Blood is centrifuged in capillary tube, stained with acridine organe and examine under fluorescent microscope. • More sensitive than smear microscopy. • Microfilaria may not be found in blood due to many reasons: • Occult filariasis • Chronic filariasis and endemic normal people • Wrong time of blood collection 7/9/2021 Dept of Microbiology 38
Laboratory diagnosis • ANTIGEN DETECTION • Circulating Ag of W. bancrofti can be detected by using monoclonal Abs against Og4C3 and AD12 Ags, by ELISA and ICT. • Advantages : More sensitive than microscopy. • Can be done at daytime. • Differentiate in current and past infection. • Can be detected in urine. • Ag disappears after clinical cure. 7/9/2021 Dept of Microbiology 39
Laboratory diagnosis • ANTIBODY DETECTION • Crud parasitic extract was used to detect serum Abs previously. • Using IHA, IFA and ELISA. Useful for seroepidemiological purposes. • Low specificity – due to cross reactivity with other parasites. • Can not differentiate between current and past infection as Abs can persist even after clinical cure. • PCR, RT PCR are developed for molecular diagnosis. • Xenodiagnosis – mosquitoes are allowed to feed on infected patients and dissected after 4-6 wks to demonstrate microfilariae. 7/9/2021 Dept of Microbiology 40
Treatment • DEC (Diethylcarbamazine) – microfilaricidal: 6mg/ kg/day for 12 days • Elevation of the affected limbs, use of elastic bandages & local foot care – reduces symptoms of lymphatic obstruction • Surgical treatment of Hydrocele. Prevention • Destruction of mosquitoes • Protection against mosquito bites • Treatment of carriers 7/9/2021 Dept of Microbiology 41
Brugia species • Two species infect humans : B. malayi & B. timori. • Causes lymphatic filariasis. • Transmitted by Mansonia & Anopheles species of mosquitoes. • Life cycle, pathogenesis, clinical features, diagnosis & treatment – similar to W. bancrofti, with a following differences 7/9/2021 Dept of Microbiology 42
Brugia species – Children commonly affected. – Rapid development of signs & symptoms. – Elephantiasis affect lower extremities. – Chyluria & Hydrocele rare. – Microfilaria : – Sheathed with 2 widely spaced nuclei & blunt tip at tail end. 7/9/2021 Dept of Microbiology 43
Onchocerca volvulus Definitive host Man. Intermediate host Black flies (Simulium). Infective form Larva. Mode of transmission Inoculation. Site of localization Subcutaneous tissue, dermis & eye. (Blinding filaria – 2nd most common cause of infectious blindness) 7/9/2021 Dept of Microbiology 44
Clinical features • Incubation period - 10 to 12 months. • Eosinophilia and urticaria. • Nodular and erythematous lesions (Onchocercomata) in the skin and subcutaneous tissue. • Photophobia, lacrimation, keratitis and blindness – due to trapping of microfilaria in the cornea, choroid, iris and anterior chambers. 7/9/2021 Dept of Microbiology 45
7/9/2021 Dept of Microbiology 46
Diagnosis & Treatment • Nodular biopsy – adult worm • Skin snip – unsheathed microfilaria with no nuclei. • Treatment – • Ivermectin, • Surgical removal, • DEC in non ocular onchocercosis 7/9/2021 Dept of Microbiology 47
7/9/2021 Dept of Microbiology 48
Loa loa Definitive host Man Intermediate host Chrysops (deer fly) Infective form Larva Mode of transmission Inoculation Site of localization Subcutaneous & deep connective tissue (African eye worm) 7/9/2021 Dept of Microbiology 49
Clinical features • Subcutaneous swelling – Calabar (a dark brown seed of Calabar vine) or fugitive swelling, measuring 5 to 10 cm. • Marked by erythema and angioedema, usually in the extremities. • Due to host inflammatory response to migrating worms (1cm/min speed) or its metabolic products. • Migrating worm in subconjunctival tissue- Causes conjunctival granuloma, edema of eye lid leading to proptosis (bulging). 7/9/2021 Dept of Microbiology 50
Diagnosis & Treatment • Peripheral blood smear - Sheathed microfilaria with nuclei up to rounded tail tip • Isolation of worms from the conjunctiva or subcutaneous biopsy • Treatment - Ivermectin, • surgical removal, • DEC (effective against adult & microfilaria) 7/9/2021 Dept of Microbiology 51
Dracunculus medinensis Adult worms Male 2 to 4 cm Female 70 –120 cm, Viviparous Infective form Larva inside Cyclops Mode of transmission Ingestion of water contaminated with cyclops Site of localization Subcutaneous tissue (Guinea Worm) Human Intermediate host Definitive host Cyclops 7/9/2021 Dept of Microbiology 52
7/9/2021 Dept of Microbiology 53
Clinical Features • Disease – Dracunculosis • Clinical features develop an year after infection following the migration of worm to the subcutaneous tissue of the leg • Blister formation – rupture of blister when in contact with water - ulceration – release of larvae by adult female worm • Secondary bacterial infection of ulcer 7/9/2021 Dept of Microbiology 54
Diagnosis & Treatment • Detection of adult worm – when it appears at the surface of skin • Detection of larva – in milky fluid released by worm on exposure to water • Radiology – calcified worm in deeper tissues 7/9/2021 Dept of Microbiology 55
Treatment – 1. Thiabendazole/ Metronodazole – symptomatic relief, easy removal of worm. 2. Gradual extraction of worm by winding of a few cm. on a matchstick per day, over 3 to 4 weeks. 3. Surgical excision 7/9/2021 Dept of Microbiology 56
Prevention • Provision of safe water supply • Education to discourage people from entering water source • Filtering water through a double folded cloth • Boiling water before drinking • Discouraging the use of step wells 7/9/2021 Dept of Microbiology 57
Expected Questions • Write essay on • Describe life cycle, pathogenesis, and laboratory diagnosis of bancroftian filariasis. • Classify somatic nematodes? Describe their life cycle, pathogenesis and laboratory diagnosis of Burgia malayi? • Write short note on • Onchocerciasis • Loiasis • Guinea worm infection • Differentiate Between: • Microfilaria of Wuchereria bancrofti and Burgia malayi. • Classical filariasis and occult filariasis. 7/9/2021 Dept of Microbiology 58
MCQ • Causative agent of Calabar swelling is: • A. Dracunculus medinesis • B. Wuchereria bancrofti • C. Burgia malayi • D. Loa loa • Which of the following infection is eradicated from India: • A. Wuchereria bancrofti • B. Burgia malayi • C. Dracunculus medinesis • D. Ascaris lumbericoides • Which of the following microfilariae is sheathed? • A. Mansonella perstans • B. Onchocerca volvulus • C. Burgia malayi • D. Mansonella streptocerca 7/9/2021 Dept of Microbiology 59
MCQ • Microfilaria of Burgia malayi differs from that of Wuchereria bancrofti by all except: • A. Coarse, overlapping and darkly stained nuclei • B. Tail tip free from nuclei • C. Possesses secondary kinks • D. Cephalic space longer • Which of the following microfilaria comes to peripheral blood in the day time? • A. Wuchereria bancrofti • B. Burgia malayi • C. Loa loa • D. Burgia tumori • Answers : 1)D 2)C 3)C 4)B 5)C 7/9/2021 Dept of Microbiology 60
7/9/2021 Dept of Microbiology 61

More Related Content

PPTX
Intestinal Nematodes
byrubaiya kabir
 
PPT
4.3._BLOOD_AND_TISSUE_NEMATODES.ppt
byKnqAutlawzvFb
 
PPTX
Introduction to Tissue Nematodes and Filarial Worms
byHazel Barcela
 
PPTX
Intestinal Nematodes
byDr. Rakesh Prasad Sah
 
PPTX
Microfilariae (Wuchereria Bancrofti)
bySyed Mohammad
 
PPTX
Intestinal Nematodes
byAman Ullah
 
PPTX
Trematodes
byAMIT KUMAR
 
PPT
parasitology lec - FLUKES
bylalhai07
 
Intestinal Nematodes
byrubaiya kabir
 
4.3._BLOOD_AND_TISSUE_NEMATODES.ppt
byKnqAutlawzvFb
 
Introduction to Tissue Nematodes and Filarial Worms
byHazel Barcela
 
Intestinal Nematodes
byDr. Rakesh Prasad Sah
 
Microfilariae (Wuchereria Bancrofti)
bySyed Mohammad
 
Intestinal Nematodes
byAman Ullah
 
Trematodes
byAMIT KUMAR
 
parasitology lec - FLUKES
bylalhai07
 

What's hot

PPTX
Wuchereria bancrofti
byHazel Barcela
 
PPT
Introduction To Parasitology
byraj kumar
 
PPTX
Filarial tissuenematodes
byفاتن عبده
 
PPT
parasitology Introduction.ppt
byadisutesfaye21
 
PPTX
1. Entamoeba histolytica
byGovt. College of Nursing, Basti, Uttar Pradesh
 
PPTX
Entrobius vermicularis
byMahaGamalAldein
 
PDF
Hymenolepis nana- Dwarf Tapeworm
byAnup Bajracharya
 
PPTX
Tissue Nematodes
byAman Ullah
 
PPTX
Nematodes by Dr. Rakesh Prasad Sah
byDr. Rakesh Prasad Sah
 
PDF
PARASITIC WORMS (HELMINTHS)
bymed zar
 
PPTX
Schistosomiasis
bySachin Adukia
 
PPTX
Trichuris trichiura
byAnady Eleccion
 
PPTX
Entamaoeba Histolytica (Exam Point of View)
bySchool of Biosciences, MACFAST College, Tiruvalla, Kerala, India
 
PPTX
Tapeworms
bystephanieb3460
 
PPTX
Helminths
bySUMESH KUMAR DASH
 
PDF
Ascariasis- Roundworm Infection
byAnup Bajracharya
 
PPTX
Coccidian parasite
byakifab93
 
PPTX
16. enterobacteriaceae
bymwangi nicholas
 
PPTX
Brugia malayi
byHazel Barcela
 
PPTX
Casoni test
byJF institute of health sciences
 
Wuchereria bancrofti
byHazel Barcela
 
Introduction To Parasitology
byraj kumar
 
Filarial tissuenematodes
byفاتن عبده
 
parasitology Introduction.ppt
byadisutesfaye21
 
1. Entamoeba histolytica
byGovt. College of Nursing, Basti, Uttar Pradesh
 
Entrobius vermicularis
byMahaGamalAldein
 
Hymenolepis nana- Dwarf Tapeworm
byAnup Bajracharya
 
Tissue Nematodes
byAman Ullah
 
Nematodes by Dr. Rakesh Prasad Sah
byDr. Rakesh Prasad Sah
 
PARASITIC WORMS (HELMINTHS)
bymed zar
 
Schistosomiasis
bySachin Adukia
 
Trichuris trichiura
byAnady Eleccion
 
Entamaoeba Histolytica (Exam Point of View)
bySchool of Biosciences, MACFAST College, Tiruvalla, Kerala, India
 
Tapeworms
bystephanieb3460
 
Helminths
bySUMESH KUMAR DASH
 
Ascariasis- Roundworm Infection
byAnup Bajracharya
 
Coccidian parasite
byakifab93
 
16. enterobacteriaceae
bymwangi nicholas
 
Brugia malayi
byHazel Barcela
 
Casoni test
byJF institute of health sciences
 

Similar to Tissue nematodes

PPTX
0 Tissue Nematodes-Moses John.p9999999999ptx
byJamesAmaduKamara
 
PPTX
Wuchereria bancrofti
byRaNa MB
 
PPTX
Filariasis
byPriyanka Patel
 
PPTX
Filariasis ( wuchereria bancrofti)
byRicha Tiwari I.T. College (Lucknow university)
 
PPTX
Filariasis
byrajexh777
 
PPTX
Lymphatic Filariasis jp
byRangineni Prada
 
PPTX
Filarisis
bySuprakash Das
 
PPTX
Lymphatic Filariasis
byDr. Rakesh Prasad Sah
 
PPTX
these are filarial worms that affect humans with deleterial significance
byssuser13f1b2
 
PPTX
Name:-adnan adil, S/O:-md monir alam, vill:-kesath, chauparan, hazaribagh(stu...
byName:- Adnan Adil, S/O:- Md Monir Alam [name of university:- Usha Martin University, ranchi]
 
PPTX
Detailed notes Filarial nematodes-1 (1).pptx
byJohnHawkins862343
 
PPTX
Session11. Wucherelia Bancroft.Presentation
bydorahmkawe212
 
PPTX
Filariasis
by10gupta
 
PPT
Lymphatic filariasis
bypushpamanjari
 
PPTX
Filaria microbiology
bysadiqeahmed
 
PPTX
Biology of filarial infections.pptx (Filaria)
byShivanshu Mishra
 
PPTX
Fil ariasia final
bySuman Chaudhary
 
PPTX
Wuchereria Bancrofti Morphology , Pathogenesis , Lab diagnosis , Treatment & ...
byRemya M S
 
PDF
FILARIASIS_merged (1).pdf
bySoniaNyinawumuntu
 
PPTX
Wuchereria bancrofti and elephantiasis.pptx
bysandeepKumarRaghuvan
 
0 Tissue Nematodes-Moses John.p9999999999ptx
byJamesAmaduKamara
 
Wuchereria bancrofti
byRaNa MB
 
Filariasis
byPriyanka Patel
 
Filariasis ( wuchereria bancrofti)
byRicha Tiwari I.T. College (Lucknow university)
 
Filariasis
byrajexh777
 
Lymphatic Filariasis jp
byRangineni Prada
 
Filarisis
bySuprakash Das
 
Lymphatic Filariasis
byDr. Rakesh Prasad Sah
 
these are filarial worms that affect humans with deleterial significance
byssuser13f1b2
 
Name:-adnan adil, S/O:-md monir alam, vill:-kesath, chauparan, hazaribagh(stu...
byName:- Adnan Adil, S/O:- Md Monir Alam [name of university:- Usha Martin University, ranchi]
 
Detailed notes Filarial nematodes-1 (1).pptx
byJohnHawkins862343
 
Session11. Wucherelia Bancroft.Presentation
bydorahmkawe212
 
Filariasis
by10gupta
 
Lymphatic filariasis
bypushpamanjari
 
Filaria microbiology
bysadiqeahmed
 
Biology of filarial infections.pptx (Filaria)
byShivanshu Mishra
 
Fil ariasia final
bySuman Chaudhary
 
Wuchereria Bancrofti Morphology , Pathogenesis , Lab diagnosis , Treatment & ...
byRemya M S
 
FILARIASIS_merged (1).pdf
bySoniaNyinawumuntu
 
Wuchereria bancrofti and elephantiasis.pptx
bysandeepKumarRaghuvan
 

More from Prasad Gunjal

PPTX
Tissue nematodes
byPrasad Gunjal
 
PPTX
Opportunistic coccidian parasites
byPrasad Gunjal
 
PPTX
T trichiura e vermicularis t spiralis
byPrasad Gunjal
 
PPTX
Laboratory diagnosis of mycology microscopy, staining techniques, culture me...
byPrasad Gunjal
 
PPT
Chlamydiae and Mycoplasma
byPrasad Gunjal
 
PPTX
Laboratory diagnosis of mycology microscopy, staining techniques, culture me...
byPrasad Gunjal
 
PPTX
Enteric fever
byPrasad Gunjal
 
PPT
Clostridium species
byPrasad Gunjal
 
PPTX
Principle of diagnostic methods collection storage and transport of specimens
byPrasad Gunjal
 
PPTX
Lrti punemococcal pneumonia and bordetella pertussis
byPrasad Gunjal
 
PPTX
Enteric fever as per cbme
byPrasad Gunjal
 
PPT
Polio coxsackie mumps virus
byPrasad Gunjal
 
PPTX
Mechanism of immune response ami and cmi
byPrasad Gunjal
 
PPTX
Morphology of Bacteria and Anatomy of Bacterial Cell.pptx
byPrasad Gunjal
 
PPT
Ag-Ab reactions Part I.ppt
byPrasad Gunjal
 
PPT
Bacterial genetics png 2011
byPrasad Gunjal
 
PPTX
Biomedical waste management
byPrasad Gunjal
 
PPTX
Biomedical waste management
byPrasad Gunjal
 
PPTX
Research-Misconducts-in-Medical-Research by PNG 27 March 2024.pptx
byPrasad Gunjal
 
PPT
Ag ab reactions part i
byPrasad Gunjal
 
Tissue nematodes
byPrasad Gunjal
 
Opportunistic coccidian parasites
byPrasad Gunjal
 
T trichiura e vermicularis t spiralis
byPrasad Gunjal
 
Laboratory diagnosis of mycology microscopy, staining techniques, culture me...
byPrasad Gunjal
 
Chlamydiae and Mycoplasma
byPrasad Gunjal
 
Laboratory diagnosis of mycology microscopy, staining techniques, culture me...
byPrasad Gunjal
 
Enteric fever
byPrasad Gunjal
 
Clostridium species
byPrasad Gunjal
 
Principle of diagnostic methods collection storage and transport of specimens
byPrasad Gunjal
 
Lrti punemococcal pneumonia and bordetella pertussis
byPrasad Gunjal
 
Enteric fever as per cbme
byPrasad Gunjal
 
Polio coxsackie mumps virus
byPrasad Gunjal
 
Mechanism of immune response ami and cmi
byPrasad Gunjal
 
Morphology of Bacteria and Anatomy of Bacterial Cell.pptx
byPrasad Gunjal
 
Ag-Ab reactions Part I.ppt
byPrasad Gunjal
 
Bacterial genetics png 2011
byPrasad Gunjal
 
Biomedical waste management
byPrasad Gunjal
 
Biomedical waste management
byPrasad Gunjal
 
Research-Misconducts-in-Medical-Research by PNG 27 March 2024.pptx
byPrasad Gunjal
 
Ag ab reactions part i
byPrasad Gunjal
 

Recently uploaded

PDF
PEDIATRIC CATARACT & IT'S MANAGEMENT BY SAMIKSHA RAI
bySamikshaRai22
 
PPTX
Amyloidosis - MBBS (Pathology)
byReenaz Shaik
 
PDF
Pediatric neurodegenerative disorders and anesthesia considerations. Dalamagk...
bycatlist1
 
PPTX
Spina_Bifida_MBBS_Level_Presentation.pptx
byhokenkerala
 
PDF
General Anesthetics. Dalamagka, Maria. Anaesthetist- physician
bycatlist1
 
PPTX
Neonatal Perioperative Care Pediatric Surgeons Perspective.pptx
byFaheem Andrabi
 
PPTX
Anaesthesia in Hypertension (anaesthesia in intercurrent diseases)
byajoseiyanu4
 
PDF
From Classification to Collaboration: Applying the International Classificati...
byOlaf Kraus de Camargo
 
PPTX
ppt on Cholangiocarcinoma.pptx BY DR MULATU ASFAW D GENERAL SURGEON
byDrmulatuasfaw
 
PPTX
Special Senses (RIT): Vision, Hearing & Taste Explained with Clinical Correlates
byBALAJI SOMA
 
PDF
Ailanthone A novel potential drug ol-20-02-1489for Vestibular Schwannoma
byHaim R. Branisteanu
 
PPTX
ppt on Cholangiocarcinoma.pptx PPT ON CHOLANGIOCARCINOMA EIOLOGY DIAGNOSIS AN...
byDrmulatuasfaw
 
PPTX
Vitamin Deficiency- Vitamin A, C, D (MBBS)
byReenaz Shaik
 
PPTX
Human Excretory System (RIT): Kidney Functions & Urine Formation Made Easy
byBALAJI SOMA
 
PDF
Retinoscopy & It's Principle - static vs dynamic retinoscopy in detail
bySamikshaRai22
 
PDF
Gastrointestinal Infection PCR Panel Diagnostic Screen
byFelixRendon3
 
DOCX
Pneumoconiosis is a group of lung diseases
byHaim R. Branisteanu
 
PDF
Best Selection of Sexologist in Munger, Bihar Male Sexual Problems Dr. Sunil ...
byDubey Clinic
 
PPTX
Easy Peasy Gut: Complete Digestive Support
byEthniq
 
PPTX
HIGH FREQUENCY CURRENT ppt prepared by urvi
byurvipitroda1
 
PEDIATRIC CATARACT & IT'S MANAGEMENT BY SAMIKSHA RAI
bySamikshaRai22
 
Amyloidosis - MBBS (Pathology)
byReenaz Shaik
 
Pediatric neurodegenerative disorders and anesthesia considerations. Dalamagk...
bycatlist1
 
Spina_Bifida_MBBS_Level_Presentation.pptx
byhokenkerala
 
General Anesthetics. Dalamagka, Maria. Anaesthetist- physician
bycatlist1
 
Neonatal Perioperative Care Pediatric Surgeons Perspective.pptx
byFaheem Andrabi
 
Anaesthesia in Hypertension (anaesthesia in intercurrent diseases)
byajoseiyanu4
 
From Classification to Collaboration: Applying the International Classificati...
byOlaf Kraus de Camargo
 
ppt on Cholangiocarcinoma.pptx BY DR MULATU ASFAW D GENERAL SURGEON
byDrmulatuasfaw
 
Special Senses (RIT): Vision, Hearing & Taste Explained with Clinical Correlates
byBALAJI SOMA
 
Ailanthone A novel potential drug ol-20-02-1489for Vestibular Schwannoma
byHaim R. Branisteanu
 
ppt on Cholangiocarcinoma.pptx PPT ON CHOLANGIOCARCINOMA EIOLOGY DIAGNOSIS AN...
byDrmulatuasfaw
 
Vitamin Deficiency- Vitamin A, C, D (MBBS)
byReenaz Shaik
 
Human Excretory System (RIT): Kidney Functions & Urine Formation Made Easy
byBALAJI SOMA
 
Retinoscopy & It's Principle - static vs dynamic retinoscopy in detail
bySamikshaRai22
 
Gastrointestinal Infection PCR Panel Diagnostic Screen
byFelixRendon3
 
Pneumoconiosis is a group of lung diseases
byHaim R. Branisteanu
 
Best Selection of Sexologist in Munger, Bihar Male Sexual Problems Dr. Sunil ...
byDubey Clinic
 
Easy Peasy Gut: Complete Digestive Support
byEthniq
 
HIGH FREQUENCY CURRENT ppt prepared by urvi
byurvipitroda1
 

Tissue nematodes

  • 1.
    Somatic (Tissue) nematodes Mr.Gunjal Prasad Niranjan M.Sc. Medical Microbiology, PG Dip in Clinical Research. Assistant Professor Dept. of Microbiology, UNDER GARADUATE STUDENT’S PRACTICAL BRIFING ON
  • 2.
    Aim and Objectives •At the end of this session student must be able to understand • Classification of Somatic (Tissue Nematodes) • Life cycle, pathogenesis and laboratory diagnosis of the following tissue nematodes. • Wuchereria bancrofti • Burgia species • Loa loa • Onchocerca volvulus • Dracunculus medinesis 7/9/2021 Dept of Microbiology 2
  • 3.
    General properties • HABITAT: •Filarial worm reside in the lymphatic system, skin, subcutaneous tissue and rarely in the body cavity. • Live upto 5 -7 yrs produces upto millions of offspring. • Blocks the lymphatic system – Network of channels and lymph nodes that helps maintain fluid levels in the body. • Blockage leads to edema – collection of fluid in tissues. 7/9/2021 Dept of Microbiology 3
  • 4.
    Morphology – GeneralProperties • ADULT WORM: • Slender, Round 2 - 10 cm(except female of Onchocerca 35-50cm). • Can survive for many years in humans causing chronic obstructive and inflammatory conditions including Elephantiasis & Hydrocele. 7/9/2021 Dept of Microbiology 4
  • 5.
    General Properties • Microfilaria: •Female worm produces large number of L1 larvae called as “Microfilaria”. • Highly motile thread like larvae. • Usually non-pathogenic, but sometimes , hypersensitivity reactions can occur against the microfilarial antigen resulting in tropical pulmonary eosinophilia (TEP) caused by an immune hyper- responsiveness to microfilariae trapped in the lungs. 7/9/2021 Dept of Microbiology 5
  • 6.
    Classification • Filarial nematodesbelongs to – • Class – Secernentea • Superfamily – Filarioidea • Family – Onchocercidea • They are differentiated on following properties 7/9/2021 Dept of Microbiology 6
  • 7.
    Classification • HABITAT: • Wherethey reside – Lymphatics or Subcutaneous tissue or body cavities. • Geographical distribution. • Vector responsible for transmission. • Structure of their larvae for e.g. presence of sheath and nuclei at the tail tip. 7/9/2021 Dept of Microbiology 7
  • 8.
    Classification • MICROFILARIAL PERIODICITY: •It is defined as the time when most of the microfilariae are found in peripheral blood. • Microfilariae of various filarial worms exhibit different periodicity and found at different time in peripheral blood. • NOCTURANAL PERIODICITY – Night time between 9pm to 2am for e.g. Wuchereria & Brugia. • DIURNAL PERIODICITY – Day time for e.g. Loa loa. • SUB-PERIODIC – Present throughout with slight increase in the afternoon for e.g. rarely Wuchereria & Brugia. • NON PERIODIC – Any time for e.g. Mansonella & Onchocerca. 7/9/2021 Dept of Microbiology 8
  • 9.
    Classification • Periodicity occursdue to biological and evolutionary co-adaptation of the microfilariae to the feeding habit of the mosquito for e.g. Culex bites in night, Aedes bites in daytime. • When not in peripheral blood, the microfilaria are found in the pulmonary blood vessels. 7/9/2021 Dept of Microbiology 9
  • 10.
    Difference between filarialnematodes 7/9/2021 Dept of Microbiology 10 Parasite Location of adult Location of microfilaria Microfilaria periodicity Vector Epidemiology Lymphatic filariasis W. bancrofti Lymphatic tissue Blood Nocturnal (mostly) Culex Cosmopolitan (S. America , S. Asia, Africa) Subperiodic (Rare) Aedes Pacific islands B. malayi Lymphatic tissue Blood Nocturnal (mostly) Mansonia, Anopheles South-East Asia, Indonesia and India Subperiodic (Rarely) Coquillettidia & Mansonia South-East Asia B. tumori Lymphatic tissue Blood Nocturnal Anopheles Indonesia
  • 11.
    Difference between filarialnematodes 7/9/2021 Dept of Microbiology 11 Parasite Location of adult Location of microfilaria Microfilaria periodicity Vector Epidemiology Subcutaneous filariasis Loa loa Subcutaneous tissue & conjunctiva Blood Diurnal Chrysops (Deer flies) West & Central Africa Onchocerca volvulus Subcutaneous tissue Skin and eye None Simulium South & Central America & Africa
  • 12.
    Comparison of microfilariae 7/9/2021Dept of Microbiology 12 A: Size, B: Periodicity, C: Sheath, D: Habitat
  • 13.
    Classification – TissueNematodes Lymphatic Wuchereria bancrofti Brugia malayi Skin and Subcutaneous Loa loa (African eye worm) Onchocerca volvulus (blinding filaria) Dracunculus medinensis (thread worm) Brugia timori Conjunctiva Loa loa 7/9/2021 Dept of Microbiology 13
  • 14.
    Lymphatic filariasis • Lymphaticfilariasis is caused by Wuchereria bancrofti, Brugia malayi, Brugia timori. • WUCHERERIA BANCROFTI • Most widely distributed, • Affecting 8 crore people world wide. • It is found in India, China, Far East, major parts of Africa, South America & central America. • In general it is nocturnal in periodicity except in Pacific islands where it is sub periodic. 7/9/2021 Dept of Microbiology 14
  • 15.
    Wuchereria bancrofti • INDIA •600 million people at risk of 250 district of 20 states in India. • Highly epidemic states –UP, Bihar, Jharkhand, Odisha, AP, TN, Kerala and Gujrat. • Low prevalence in J&K and Punjab. • Sub-periodic W. bancrofti, transmitted by Aedes, reported from Nicobar island. 7/9/2021 Dept of Microbiology 15
  • 16.
    7/9/2021 Dept ofMicrobiology 16 Wuchereria bancrofti (Filarial worm) Definitive host Man. Intermediate host Female Culex, Aedes or Anopheles mosquito. Infective form Third stage larva. Mode of transmission Inoculation – bite of mosquito. Site of localization Lymphatics / lymph nodes of man. Geographical distribution India, China, Far East, Africa, South & Central America.
  • 17.
    Wuchereria bancrofti –morphology • Exists in 3 forms : • ADULT : • Worms are thread like, live in lymphatic tissue as tightly coiled nodular mass. • Long slender, creamy white thread like having smooth cuticle, with ends rounded. • ADULT MALE : Measures about 3.5 to 4.0cmX0.1 mm. • ADULT FEMALE : Measures 6-10 cm x 0.2-0.3 mm. • Average life span 4 to 5 years. • Female worm (viviparous) liberates sheathed embryos (Microfilaria). 7/9/2021 Dept of Microbiology 17
  • 18.
    Wuchereria bancrofti –morphology • ADULT WORM – • Male can be differentiated from female by • small size, • crock screw tail and • presence of two spicules at posterior end which helps at time of copulation. • Female are viviparous – directly discharge larvae. • LARVAE • Like other nematodes – 4 larval stages present. • First stage larvae – Microfilaria. • The third stage larvae – Filariform larva (Infective from for humans). 7/9/2021 Dept of Microbiology 18
  • 19.
    MICROFILARIA : • Microfilariaof W. bancrofti lives in blood vessels and are actively motile. • Diagnostic forms. • Found in peripheral blood between 10 pm to 4 am. • Measures about 275 to 300 um x 8 to 10 um. • Covered with hyline sheath which is 350 um long. 7/9/2021 Dept of Microbiology 19
  • 20.
    Microfilaria • Head isblunt and tail is tapering. In unstained preparations these are colourless. • When stained with Giemsa or Romanowsky stains – pink with column of purple to violet nuclei. • These nuclei are absent at the head and tail ends. • They develop in mosquitoes. 7/9/2021 Dept of Microbiology 20
  • 21.
    Cultivation of filarialnematodes • Success is limited in its cultivation. • CELL LINES – W. bancrofti, B. malayi can be cultivated in mosquito cell lines like Aedes togoi & Anopheles maculatus. • Grown in modified RPIM-1640 medium or TC199 supplemented with 20% of newborn calf serum and LLC-MK2 cells. • Human embryonic cell lines are also used as feeder layers. • Microfilaria ex-sheath and molt twice to L3 stage larvae in 12-16 days. • Culture method is not used for diagnosis but for maintenance of parasite for Ag preparation, Antifilarial drug sensitivity and research purpose. 7/9/2021 Dept of Microbiology 21
  • 22.
    Life cycle ofw. bancrofti • Life cycle is complex. Requires 2 hosts. • Humans are definitive hosts. • While mosquitoes of the genera Culex , Aedes & Anopheles are intermediate hosts. • Infective form for humans – third stage larva, present in proboscis sheath of mosquitoes. • Mode of transmission - Larva (L3) are deposited on skin of humans, near the site of bite, larva penetrate through puncture skin or wound to reach subcutaneous tissues. 7/9/2021 Dept of Microbiology 22
  • 23.
    Life cycle ofw. bancrofti – human cycle • Larva enter afferent lymphatics & reach draining lymph nodes to develop into adults in 3 to 15 months (4-6 wks B. malayi). • Male fertilize female, gravid female lays sheathed embryos – the Microfilaria. • Microfilaria enters efferent lymphatics to reach blood circulation through thoracic duct or right lymphatic duct. • Come in peripheral blood between 10 pm to 4 am, this Nocturnal periodicity is related the night biting habit of mosquitoes. 7/9/2021 Dept of Microbiology 23
  • 24.
    Life cycle ofw. bancrofti -Mosquito cycle • These sheathed microfilaria (L1) are ingested by mosquitoes with their blood meal. (Culex – at night, Aedes – at day time). • Microfilariae lose their sheath in stomach & penetrate the gut wall to reach the thorax of the mosquitoes. • Develop successively into second stage & third stage larvae which is the infective form for humans. • Third stage larvae measure about 1500 to 2000 um in length and it enters the proboscis sheath, ready to infect a new host. • Development in mosquitoes – 10 to 20 days. 7/9/2021 Dept of Microbiology 24
  • 25.
    Life cycle ofw. bancrofti • This duration depends on atmospheric temperature, humidity, and the species of mosquito. • One microfilaria develops into one infective form third stage larva. • Multiplication of parasite does not occur in mosquitoes. 7/9/2021 Dept of Microbiology 25
  • 26.
    7/9/2021 Dept ofMicrobiology 26
  • 27.
    Clinical features • Infection- Wuchereriasis/ Lymphatic filariasis/ Bancroftian filariasis. • Disease manifestations are due to lymphatic dysfunctions resulting from presence of living or dead worms lymph thrombi, inflammation and immune reactions to worm and worm products. • Pathogenic states are produced only by adult worm (living/ dead) – Classical filariasis. Occult filariasis – Lesions produced by microfilaria. 7/9/2021 Dept of Microbiology 27
  • 28.
    Clinical Features • Clinicalstates in classical filariasis can be classified as: 1. Asymptomatic ( in endemic areas). 2. Inflammatory – lymphangitis and lymphadenitis - Common lymph node enlarged are inguinal, axillary, lymphatics of male genital organs are commonly involved that leads to funiculitis, epididymitis and orchitis. 3. Obstructive – Granuloma, thrombi formation, fibrosis of lymph vessels leading to severe lymphatic obstruction and pedal edema. 7/9/2021 Dept of Microbiology 28
  • 29.
    Classical Filariasis - 1.Lymphangitis– Lymph vessels of extremities, testicles & epididymis are inflamed due to - • Mechanical irritation – movement of adult parasite inside lymphatics. • Liberation of metabolites of growing larvae. • Secretion of toxic fluid by fertilized female worms - . • Absorption of toxic products liberated from dead worms. 2. Lymphadenitis- Lymph Nodes of groin & axilla are inflamed. 7/9/2021 Dept of Microbiology 29
  • 30.
    3. Lymphoedema :with hypertrophy of the affected parts ( Elephantiasis - of organs like leg, scrotum, penis, vagina, breast, arm etc – fibrotic thickening of skin & subcutaneous tissue) 4. Lymphangiovarix- dilatation of afferent lymph vessels due to obstruction. 5. Hydrocele – Commonest complication disorder in which serous fluid accumulates in a body sac (especially in the scrotum). 6. Chyluria – Excretion of chyle, a milky white fluid in urine occurs rarely . (Rupture of renal lymphatic through the mucous membrane of urinary tract). 7/9/2021 Dept of Microbiology 30
  • 31.
  • 32.
    Occult filariasis – Tropicalpulmonary Eosinophilia / Weingarten’s syndrome –Distinct syndrome in some individuals. –Proximal cough and wheezing. –Weight loss low grade fever. –Pronounced blood eosinophilia. –Total serum IgE and Antifilarial Ab titres are raised. –Represents a hypersensitivity reaction to microfilarial antigen. –Response well to treatment but in untreated cases can cause progressive pulmonary damage. 7/9/2021 Dept of Microbiology 32
  • 33.
    Classical v/s Occultfilariasis Classical filariasis Occult filariasis Cause Developing worms & adults Microfilariae Basic lesions Acute inflammation followed by an epitheloid granuloma surrounding the adult worm & a fibrous scar An eosinophilic granuloma (hypersensitivity reaction) Organs involved Lymphatic system Lymphatic system, lungs, liver & spleen Microfilaria Present in Blood Present in affected tissues not in blood Therapeutic response No response to any drug Responds to microfilaricidal drug, Diethylcarbamazine (DEC) 4-6mg/kg-12 days. 7/9/2021 Dept of Microbiology 33
  • 34.
    Clinical features • IMMUNECOMPLEX MEDIATED MANIFESTATION – • Circulating immunocomplexes containing microfilarial antigens are found to be deposited in various organs such as – • Kidney – causes nephrotic syndrome, haematuria and proteinuria. • Joints – Causes filarial arthritis of knee or ankle. 7/9/2021 Dept of Microbiology 34
  • 35.
    Laboratory diagnosis • SPECIMEN– • Blood collected at night, preferably capillary blood from ear lobes. • Chylous urine, • Hydrocele fluid, • Exudates from Lymphangiovarix 7/9/2021 Dept of Microbiology 35
  • 36.
    Microscopic examination • Wetmount – A drop of blood is taken on a slide and covered with cover slip. • Microfilaria are easily identified under low power (10x) due to their size and motility. • Giemsa: • To prepare a stained preparation. • About 20 to 60 mm3 blood is streaked on a slide and allowed to dry. • Then stained with Giemsa stain. • Sheathed microfilaria with no nuclei at tail tip 7/9/2021 Dept of Microbiology 36
  • 37.
    Laboratory diagnosis • Concentrationtechniques – for capillary blood, venous blood (Knott’s technique) • Diethylcarbamazine provocation test – 2mg/kg of DEC orally, examine peripheral blood smear after 30 to 45 minutes. • It provokes microfilaria to come in peripheral blood even during day time. • This test is contraindicated in Onchocerca & Loa loa. 7/9/2021 Dept of Microbiology 37
  • 38.
    Laboratory diagnosis • QuantativeBuffy Coat examination (QBC) – • Generally done for malaria, can be used for microfilariae. • Blood is centrifuged in capillary tube, stained with acridine organe and examine under fluorescent microscope. • More sensitive than smear microscopy. • Microfilaria may not be found in blood due to many reasons: • Occult filariasis • Chronic filariasis and endemic normal people • Wrong time of blood collection 7/9/2021 Dept of Microbiology 38
  • 39.
    Laboratory diagnosis • ANTIGENDETECTION • Circulating Ag of W. bancrofti can be detected by using monoclonal Abs against Og4C3 and AD12 Ags, by ELISA and ICT. • Advantages : More sensitive than microscopy. • Can be done at daytime. • Differentiate in current and past infection. • Can be detected in urine. • Ag disappears after clinical cure. 7/9/2021 Dept of Microbiology 39
  • 40.
    Laboratory diagnosis • ANTIBODYDETECTION • Crud parasitic extract was used to detect serum Abs previously. • Using IHA, IFA and ELISA. Useful for seroepidemiological purposes. • Low specificity – due to cross reactivity with other parasites. • Can not differentiate between current and past infection as Abs can persist even after clinical cure. • PCR, RT PCR are developed for molecular diagnosis. • Xenodiagnosis – mosquitoes are allowed to feed on infected patients and dissected after 4-6 wks to demonstrate microfilariae. 7/9/2021 Dept of Microbiology 40
  • 41.
    Treatment • DEC (Diethylcarbamazine)– microfilaricidal: 6mg/ kg/day for 12 days • Elevation of the affected limbs, use of elastic bandages & local foot care – reduces symptoms of lymphatic obstruction • Surgical treatment of Hydrocele. Prevention • Destruction of mosquitoes • Protection against mosquito bites • Treatment of carriers 7/9/2021 Dept of Microbiology 41
  • 42.
    Brugia species • Twospecies infect humans : B. malayi & B. timori. • Causes lymphatic filariasis. • Transmitted by Mansonia & Anopheles species of mosquitoes. • Life cycle, pathogenesis, clinical features, diagnosis & treatment – similar to W. bancrofti, with a following differences 7/9/2021 Dept of Microbiology 42
  • 43.
    Brugia species – Childrencommonly affected. – Rapid development of signs & symptoms. – Elephantiasis affect lower extremities. – Chyluria & Hydrocele rare. – Microfilaria : – Sheathed with 2 widely spaced nuclei & blunt tip at tail end. 7/9/2021 Dept of Microbiology 43
  • 44.
    Onchocerca volvulus Definitive hostMan. Intermediate host Black flies (Simulium). Infective form Larva. Mode of transmission Inoculation. Site of localization Subcutaneous tissue, dermis & eye. (Blinding filaria – 2nd most common cause of infectious blindness) 7/9/2021 Dept of Microbiology 44
  • 45.
    Clinical features • Incubationperiod - 10 to 12 months. • Eosinophilia and urticaria. • Nodular and erythematous lesions (Onchocercomata) in the skin and subcutaneous tissue. • Photophobia, lacrimation, keratitis and blindness – due to trapping of microfilaria in the cornea, choroid, iris and anterior chambers. 7/9/2021 Dept of Microbiology 45
  • 46.
    7/9/2021 Dept ofMicrobiology 46
  • 47.
    Diagnosis & Treatment •Nodular biopsy – adult worm • Skin snip – unsheathed microfilaria with no nuclei. • Treatment – • Ivermectin, • Surgical removal, • DEC in non ocular onchocercosis 7/9/2021 Dept of Microbiology 47
  • 48.
    7/9/2021 Dept ofMicrobiology 48
  • 49.
    Loa loa Definitive hostMan Intermediate host Chrysops (deer fly) Infective form Larva Mode of transmission Inoculation Site of localization Subcutaneous & deep connective tissue (African eye worm) 7/9/2021 Dept of Microbiology 49
  • 50.
    Clinical features • Subcutaneousswelling – Calabar (a dark brown seed of Calabar vine) or fugitive swelling, measuring 5 to 10 cm. • Marked by erythema and angioedema, usually in the extremities. • Due to host inflammatory response to migrating worms (1cm/min speed) or its metabolic products. • Migrating worm in subconjunctival tissue- Causes conjunctival granuloma, edema of eye lid leading to proptosis (bulging). 7/9/2021 Dept of Microbiology 50
  • 51.
    Diagnosis & Treatment •Peripheral blood smear - Sheathed microfilaria with nuclei up to rounded tail tip • Isolation of worms from the conjunctiva or subcutaneous biopsy • Treatment - Ivermectin, • surgical removal, • DEC (effective against adult & microfilaria) 7/9/2021 Dept of Microbiology 51
  • 52.
    Dracunculus medinensis Adult wormsMale 2 to 4 cm Female 70 –120 cm, Viviparous Infective form Larva inside Cyclops Mode of transmission Ingestion of water contaminated with cyclops Site of localization Subcutaneous tissue (Guinea Worm) Human Intermediate host Definitive host Cyclops 7/9/2021 Dept of Microbiology 52
  • 53.
    7/9/2021 Dept ofMicrobiology 53
  • 54.
    Clinical Features • Disease– Dracunculosis • Clinical features develop an year after infection following the migration of worm to the subcutaneous tissue of the leg • Blister formation – rupture of blister when in contact with water - ulceration – release of larvae by adult female worm • Secondary bacterial infection of ulcer 7/9/2021 Dept of Microbiology 54
  • 55.
    Diagnosis & Treatment •Detection of adult worm – when it appears at the surface of skin • Detection of larva – in milky fluid released by worm on exposure to water • Radiology – calcified worm in deeper tissues 7/9/2021 Dept of Microbiology 55
  • 56.
    Treatment – 1. Thiabendazole/Metronodazole – symptomatic relief, easy removal of worm. 2. Gradual extraction of worm by winding of a few cm. on a matchstick per day, over 3 to 4 weeks. 3. Surgical excision 7/9/2021 Dept of Microbiology 56
  • 57.
    Prevention • Provision ofsafe water supply • Education to discourage people from entering water source • Filtering water through a double folded cloth • Boiling water before drinking • Discouraging the use of step wells 7/9/2021 Dept of Microbiology 57
  • 58.
    Expected Questions • Writeessay on • Describe life cycle, pathogenesis, and laboratory diagnosis of bancroftian filariasis. • Classify somatic nematodes? Describe their life cycle, pathogenesis and laboratory diagnosis of Burgia malayi? • Write short note on • Onchocerciasis • Loiasis • Guinea worm infection • Differentiate Between: • Microfilaria of Wuchereria bancrofti and Burgia malayi. • Classical filariasis and occult filariasis. 7/9/2021 Dept of Microbiology 58
  • 59.
    MCQ • Causative agentof Calabar swelling is: • A. Dracunculus medinesis • B. Wuchereria bancrofti • C. Burgia malayi • D. Loa loa • Which of the following infection is eradicated from India: • A. Wuchereria bancrofti • B. Burgia malayi • C. Dracunculus medinesis • D. Ascaris lumbericoides • Which of the following microfilariae is sheathed? • A. Mansonella perstans • B. Onchocerca volvulus • C. Burgia malayi • D. Mansonella streptocerca 7/9/2021 Dept of Microbiology 59
  • 60.
    MCQ • Microfilaria ofBurgia malayi differs from that of Wuchereria bancrofti by all except: • A. Coarse, overlapping and darkly stained nuclei • B. Tail tip free from nuclei • C. Possesses secondary kinks • D. Cephalic space longer • Which of the following microfilaria comes to peripheral blood in the day time? • A. Wuchereria bancrofti • B. Burgia malayi • C. Loa loa • D. Burgia tumori • Answers : 1)D 2)C 3)C 4)B 5)C 7/9/2021 Dept of Microbiology 60
  • 61.
    7/9/2021 Dept ofMicrobiology 61