Filariasis
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Rickson P. Rambuyon, BSN III - A
Filariasis Overview Filariasis afflicts Filipinos living in endemic areas. The disease often progresses to become chronic, debilitating and disfiguring, since its often asymptotic. Filarisais is endemic in 48 out of 78 provinces with the highest prevalence rates in region 5, 8, 11 and CARAGA. Two another provinces, namely Marinduque and Sarangani were Identifies as endemic provinces.
What is Filariasis? Human Lymphatic Filariasis is a chronic parasitic Infection caused by nematode parasites known as Wuchereria bancrofti, Brugya malyti and B. timori. The young adult worms live in the lymphatic vessels and lymph nodes while the microfilariae are usually found in blood. The life-span of the adult parasite is about 10 years (but 40 years has been also reported) while the microfilariae live for abut a year at the host. The disease is transmitted to a person through bites of an infected female mosquito primarily Aedes poecillus that bites at night between 10pm-12pm.
Incubation Period The incubation period which starts from the entry of the microfilariae larvae ,to the development of clinical manifestations is variable. Nevertheless it ranges from 8-16 months.
Assymptomatic stage • • • • •
Characterized by the presence of micorfilariae in the peripheral blood Co clinical signs and symptoms of the disease Some remain assymptomatic for years and some instances for life Others progress into acute and chronic stages Microfilariae rates are increases with age and then levels off
Acute Stage • • •
Lymphadenitis Lymphangitis In some cases, the male the male genitalia is affected leading to funiculaitis, epididymitis, or orchitis (redness, painful and tender scrotum)
Chronic stage • •
Developed 10-15 years from the onset of the first attack Immigrants from areas where Filariasis is not endemic tend developed this stage more often and sooner (1-2 years) than so the indigenous population of endemic areas.
Chronic signs and Symptoms • • •
Hydrocele (swelling of the scrotum) Lymphedema (temporary swelling of the upper and lower extremities) Elephantiasis (enlargement and thickening of the skin of the lower and or upper extremities, scrotum, breast)
Laboratory Diagnosis Physical examination is done in the main health center or during the scheduled survey bites in the community. • •
History taking Observation of the major and minor signs and symptoms.
Laboratory Examinations • •
Nocturnal Blood Examination (NE) – taken at patients residence hospital after 8:00pm. Immunochromatographic Test ( ICT) – it is a rapid assessment method
Treatment The treatment cases in endemic communities is the most effective way to reduce or prevent morbidity. Health workers must emphasize the importance of strictly complying with the treatment regimen prescribed. The community must be informed of the objective- to reduce and interrupt transmission of infection. The following are some drugs that are used in Filariasis: Diethylcarbamazine citrate (DEC) or HETRAZAN – an individual treatment kills almost microfilariae and a good proportion of adult worms. Drug is given to patients which clinical manifestations or microfilariae.
Mass treatment • • •
Distribution to all population Endemic and infected or not infected with filariasis in established endemic areas. The dosage is 6 mg/kg boy weight taken as a single dose per year.
Surgical Treatment Chronic manifestation such as elephantiasis and hydrocele can e handles through surgery. This is usually referred to hospitals for management. • •
Mild cases of lymphedema can be treated by lymphovenous anastomosis distal to the site of the lymphatic destruction. Chyluria is operated on y ligation and stripping of the lymphatic of the pedicle of the affected kidney while hydrocoeles can be managed by inversion or resection of the tunica vaginalis.
Supportive Care for Filariasis Filariasis patient are advised to observe personal hygiene y washing the affected areas with soap and water at least twice a day or prescribed antibiotics or anti-fungals for super infection.
Prevention Control A. Measures aimed to control the vector • •
Environmental sanitation such as proper drainage and cleanliness of the surroundings. Spraying with insecticides (may also produce harmful effects)
B. Measures aimed to protect the individual and families in endemic areas. • • • • •
Us o mosquito nets Use of long sleeves, long pants and socks Application of insect repellants Screening of houses Health education
The Functions and responsibilities of the Community health nurse includes health teaching on preventative measures and rendering supportive care during management and treatment.
Life Cycle of Filariasis:
Filariasis Overview Filariasis afflicts Filipinos living in endemic areas. The disease often progresses to become chronic, debilitating and disfiguring, since its often asymptotic. Filarisais is endemic in 48 out of 78 provinces with the highest prevalence rates in region 5, 8, 11 and CARAGA. Two another provinces, namely Marinduque and Sarangani were Identifies as endemic provinces.
What is Filariasis? Human Lymphatic Filariasis is a chronic parasitic Infection caused by nematode parasites known as Wuchereria bancrofti, Brugya malyti and B. timori. The young adult worms live in the lymphatic vessels and lymph nodes while the microfilariae are usually found in blood. The life-span of the adult parasite is about 10 years (but 40 years has been also reported) while the microfilariae live for abut a year at the host. The disease is transmitted to a person through bites of an infected female mosquito primarily Aedes poecillus that bites at night between 10pm-12pm.
Incubation Period The incubation period which starts from the entry of the microfilariae larvae ,to the development of clinical manifestations is variable. Nevertheless it ranges from 8-16 months.
Assymptomatic stage • • • • •
Characterized by the presence of micorfilariae in the peripheral blood Co clinical signs and symptoms of the disease Some remain assymptomatic for years and some instances for life Others progress into acute and chronic stages Microfilariae rates are increases with age and then levels off
Acute Stage • • •
Lymphadenitis Lymphangitis In some cases, the male the male genitalia is affected leading to funiculaitis, epididymitis, or orchitis (redness, painful and tender scrotum)
Chronic stage • •
Developed 10-15 years from the onset of the first attack Immigrants from areas where Filariasis is not endemic tend developed this stage more often and sooner (1-2 years) than so the indigenous population of endemic areas.
Chronic signs and Symptoms • • •
Hydrocele (swelling of the scrotum) Lymphedema (temporary swelling of the upper and lower extremities) Elephantiasis (enlargement and thickening of the skin of the lower and or upper extremities, scrotum, breast)
Laboratory Diagnosis Physical examination is done in the main health center or during the scheduled survey bites in the community. • •
History taking Observation of the major and minor signs and symptoms.
Laboratory Examinations • •
Nocturnal Blood Examination (NE) – taken at patients residence hospital after 8:00pm. Immunochromatographic Test ( ICT) – it is a rapid assessment method
Treatment The treatment cases in endemic communities is the most effective way to reduce or prevent morbidity. Health workers must emphasize the importance of strictly complying with the treatment regimen prescribed. The community must be informed of the objective- to reduce and interrupt transmission of infection. The following are some drugs that are used in Filariasis: Diethylcarbamazine citrate (DEC) or HETRAZAN – an individual treatment kills almost microfilariae and a good proportion of adult worms. Drug is given to patients which clinical manifestations or microfilariae.
Mass treatment • • •
Distribution to all population Endemic and infected or not infected with filariasis in established endemic areas. The dosage is 6 mg/kg boy weight taken as a single dose per year.
Surgical Treatment Chronic manifestation such as elephantiasis and hydrocele can e handles through surgery. This is usually referred to hospitals for management. • •
Mild cases of lymphedema can be treated by lymphovenous anastomosis distal to the site of the lymphatic destruction. Chyluria is operated on y ligation and stripping of the lymphatic of the pedicle of the affected kidney while hydrocoeles can be managed by inversion or resection of the tunica vaginalis.
Supportive Care for Filariasis Filariasis patient are advised to observe personal hygiene y washing the affected areas with soap and water at least twice a day or prescribed antibiotics or anti-fungals for super infection.
Prevention Control A. Measures aimed to control the vector • •
Environmental sanitation such as proper drainage and cleanliness of the surroundings. Spraying with insecticides (may also produce harmful effects)
B. Measures aimed to protect the individual and families in endemic areas. • • • • •
Us o mosquito nets Use of long sleeves, long pants and socks Application of insect repellants Screening of houses Health education
The Functions and responsibilities of the Community health nurse includes health teaching on preventative measures and rendering supportive care during management and treatment.
Life Cycle of Filariasis:
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