Tissue Nematodes

II BPT
Dr Ekta Chourasia
Microbiology
 Classification – Tissue
Nematodes
Lymphatic Wuchereria bancrofti
Brugia
malayi
Brugia timori

Subcutaneo Loa loa (african eye

us worm)
Onchocerca volvulus
(blinding filaria)
Dracunculus medinensis
(thread worm)

Conjunctiva Loa loa

08/04/09 Dr Ekta, Microbiology

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

08/04/09 Dr Ekta, Microbiology

Life cycle

08/04/09 Dr Ekta, Microbiology

Clinical features
 Infection - Wuchereriasis/ Lymphatic filarisis/ Bancroftian
filariasis

 Pathogenic states are produced only by adult worm

(living/ dead) – classical filariasis
Occult filariasis – lesions produced by microfilaria

 Clinical states in classical filariasis can be classified as:

 Asymptomatic ( in endemic areas)
 Inflammatory – lymphadenitis, lymphangitis, fever, lymphoedema
 Obstructive – elephantiasis, lymphangiovarix, chyluria, hydrocele
 Tropical pulmonary eosinophilia

08/04/09 Dr Ekta, Microbiology

Obstructive stage

 Lymphatic obstruction – occurs with the

death of worms

 Causes of obstruction –
 Blocking of lumen by dead worms
 Excessive proliferation & thickening of walls
of lymphatic vessels
 Fibrosis of lymphatic vessels

08/04/09 Dr Ekta, Microbiology

Consequences of Lymphatic Obstruction

 Elephantiasis of organs like leg, scrotum,

penis, vagina, breast, arm etc – fibrotic
thickening of skin & subcutaneous tissue

 Lymphangiovarix – dilatation of afferent

lymphatics.

 Rupture of Lymphangiovarix into urinary tract

– chyluria

 Hydrocele

08/04/09 Dr Ekta, Microbiology

 Lymphatic filariasis

08/04/09 Dr Ekta, Microbiology

chyluria

08/04/09 Dr Ekta, Microbiology

Classical v/s Occult filariasis

Classical filariasis Occult filariasis

Cause Developing worms & adults Microfilariae

Basic lesions Acute inflammation followed An eosinophilic granuloma

by an epitheloid granuloma (hypersensitivity reaction)
surrounding the adult worm &
a fibrous scar
Organs involved Lymphatic system Lymphatic system, lungs,
liver & spleen

Microfilaria Present in Blood Present in affected tissues

not in blood

Therapeutic No response to any drug Responds to

response microfilaricidal drug, DEC.

08/04/09 Dr Ekta, Microbiology

Laboratory diagnosis
 Specimen - blood collected at
night, preferably capillary blood
from ear lobes, chylous urine,
hydrocele fluid, exudate from
lymphangiovarix

 Microscopic examination – wet

mount or stained with giemsa:
sheathed microfilaria with no
nuclei at tail tip

08/04/09 Dr Ekta, Microbiology

Laboratory diagnosis
 Concentration techniques – for capillary
blood, venous blood (Knott’s technique)

 DEC provocation test – 100 mg of DEC

orally, examine peripheral blood smear after
30 to 45 minutes

 Serology – using non specific Ags

1. Passive hemagglutination test
2. Fluoresecent ab test
3. ELISA

08/04/09 Dr Ekta, Microbiology

 Treatment Prevention

 DEC (Diethylcarbamazine) –  Destruction of

microfilaricidal: 6mg/ kg/day mosquitoes
for 2-3 weeks
 Protection against
 Elevation of the affected mosquito bites
limbs, use of elastic bandages
& local foot care – reduces  Treatment of carriers
symptoms of lymphatic
obstruction

 Surgical treatment of
hydrocele

08/04/09 Dr Ekta, Microbiology

 Brugia sps
 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
 Children commonly affected
 Rapid development of signs & symptoms
 Elephantiasis affect lower extremities
 Chyluria & hydrocele rare

08/04/09 Dr Ekta, Microbiology

 Onchocerca volvulus
(Blinding filaria – 2nd most common cause of infectious blindness)

Definitive host Man

Intermediate host Black flies (simulium)

Infective form Larva

Mode of transmission Inoculation

Site of localization Subcutaneous tissue, dermis

& eye
08/04/09 Dr Ekta, Microbiology
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.

08/04/09 Dr Ekta, Microbiology

08/04/09 Dr Ekta, Microbiology
Diagnosis & Treatment
 Nodular biopsy – adult
worm

 Skin snip – unsheathed

microfilaria with no
nuclei

 Treatment – Ivermectin,
surgical removal, DEC in
non ocular
onchocercosis

08/04/09 Dr Ekta, Microbiology

08/04/09 Dr Ekta, Microbiology
Loa loa (African eye worm)

Definitive host Man

Intermediate host Chrysops

(deer fly)
Infective form Larva

Mode of transmission Inoculation

Site of localization Subcutaneous & deep

connective tissue
08/04/09 Dr Ekta, Microbiology
Clinical features
 Subcutaneous swelling
– Calabar or fugitive
swelling, measuring 5
to 10 cm, marked by
erythema and
angioedema, usually in
the extremities

 Migrating worm in
subconjunctival tissue

08/04/09 Dr Ekta, Microbiology

Diagnosis & Treatment
• Peripheral blood smear - Sheathed
microfilaria with nuclei upto rounded
tail tip

• Isolation of worms from the

conjunctiva or subcutaneous biopsy

• Treatment - Ivermectin, surgical

removal, DEC (effective against adult
& microfilaria)

08/04/09 Dr Ekta, Microbiology

Dracunculus medinensis (Guinea Worm)

Adult worms Male 2 to 4 cm

Female 70 –120 cms, viviparous

Definitive host Human

Intermediate host Cyclops

Infective form Larva inside Cyclops

Mode of transmission Ingestion of water contaminated

with cyclops

Site of localization Subcutaneous tissue

08/04/09 Dr Ekta, Microbiology

08/04/09 Dr Ekta, Microbiology
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

08/04/09 Dr Ekta, Microbiology
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

 Treatment –
1. Thiabendazole/ Metronodazole –
symptomatic relief, easy removal of
worm
2. Gradual extraction of worm by
winding of a few cms on a matchstick
per day, over 3 to 4 weeks
3. Surgical excision
08/04/09 Dr Ekta, Microbiology
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
08/04/09 Dr Ekta, Microbiology