[PAR] Blood and Tissue Nematodes

Wuchereria bancrofti, Brugia malayi

Nematodes whose habitat involves the lymphatic system?

Angiostrongylus cantonensis

Nematodes whose habitat involves the host’s lungs?

Loa loa, Onchocerca volvulus, Dracunculus medinensis

Nematodes whose habitat involves the subcutaneous tissues?

Wuchereria bancrofti, Brugia malayi

Nematodes whose MOT is through infected mosquito bite

Angiostrongylus cantonensis

Nematodes whose MOT is through ingestion of gastropod larvae in contaminated and raw slugs, land snails, freshwater prawns, and vegetables

Loa loa, Onchocerca volvulus

Nematodes whose MOT is through infected fly bite

Dracunculus medinensis

B&T Nematode whose MOT is ingestion of contaminated water containing copepod

L3 Larvae

All infective stage of blood and tissue nematodes is?

Dracunculus medinensis, Angiostrongylus cantenensis

Which blood and tissue nematodies does not consider microfilaria as its diagnostic stage?

Adult worms in the foot

Diagnostic stage of Dracunculus medinensis

L3 larvae (brain)

Diagnostic stage of Angiostrongylus cantonensis

Aedes (poiculus, aegypti),

Culex (fatigans, quenvefasciatos)

Vectors of Wuchereria bancrofti

Mansonia sp.

Vectors of Brugia malayi

Tabanid/Mango/Deer Fly, Chrysops silacea

Vectors of Loa loa

Black flies (Simulium), Buffalo gnat, Simulium damnosum

Remember: BBS

Vectors of Onchocerca volvulus

Dracunculus medinensis, Angiostrongylus cantonensis

Which blood and tissue nematodies does not consider mosquito as its intermediate host?

Cyclops/Copepod, Water fleas

IH of Dracunculus medinensis

Achatina, Pila slugs, planaria, freshwater prawns

IH of Angiostrongylus cantonensis

Angiostrongylus cantonensis

All except which considers man as its definitive host?

Rat

Definitive host of Angiostrongylus cantonensis

Onchocerca volvulus

Which microfilariae of a nematode only has an unsheathed covering

(Recall that D. medinensis and A. cantonensis does not have microfilaria)

Wuchereria bancrofti

Which sheathed microfilariae of a nematode has an unstained covering?

Brugia malayi

Which sheathed microfilariae of a nematode has stained covering?

Loa loa

Which b&t nematode has microfilariae with irregular curves, Corkscrew appearance

W. bancrofti

Which b&t nematode has microfilariae with graceful curvature

B. malayi

Which b&t nematode has microfilariae with kinky, stiff, rigid curvature

W. bancrofti

Which microfilariae of b&t nematode has nuclei that do not extend to the tip?

Loa loa

Which microfilariae of b&t nematode has nuclei that extends to the tip (haphazardly arranged)?

Brugia malayi

Which microfilariae of b&t nematode has two (2) discrete nuclei at the tip?

Onchocerca volvulus

Which microfilariae of b&t nematode has nuclei free tail?

Brugia malayi and Loa loa

Which microfilaiae of b&t nematode has nuclei at its tip?

Nocturnal (10 PM - 2 AM)

Periodicity of W. bancrofti

Subperiodic (Day - 12NN / Night - 8 PM)

Periodicity of B. malayi

Mid-day/Diurnal (12 NN)

Periodicity of L. loa

Non-periodic (anytime)

Periodicity of O. volvulus

Peripheral blood smear - at night (following nocturnal periodicity)

using Knotts technique taken between 8PM-4AM

Diagnosis for W. bancrofti and B. malayi

Diethylcarbamazine (DEC) provocative test

What test can you do to stimulate microfilariae to come out to peripheral circulation for better chances of detection on the peripheral smear, particularly on W. bancrofti?

(+) filarial dance sign

What findings do you excpect on an Ultrasonography when detecting W. bancrofti infection?

circulating filarial antigen

What findings do you expect on a lateral chromatographic assay when detecting W. bancrofti infection?

Diethylcarbamazine citrate (DEC - Hetrazan)

Drug of Choice for W. bancrofti and B. malayi infection

Peripheral blood smear

• best made from blood collected during the mid-day (10 AM-2 PM)

Diagnosis for Loa loa infection

Diethylcarbamazine citrate (DEC)

Drug of Choice for Loa loa infection

Albendazole

Drug that can help control Loa loa infection

Mazzotti Test

• Observe the patient after giving 50 mg dose of diethylcarbamazine (DEC)

Diagnosis for Onchocerca volvulus

Ivermectin

Drug of choice for O. volvolus

Doxycycline

Also found beneficial for the treatment of onchocerciasis

winding worm on stick

Exopected findings on macroscopic inspection for Dracunculus medinensis

X-ray

Diagnositic tool for dead worms of Dracunculus medinensis

Winding Stick Method

What do you call the method of surgically removing worms and caring for the wound for the treatment of D. medinensis infection

Metronidazole - DEC, Thiabendazole, Mebendazole

Drugs that can be used for D. medinensis infection

• Presumptive diagnosis - for those who travel to endemic areas and have an exposure history

• Spinal Tap/CSF Examination - CSF:100-2000 WBC/uL, Eosinophils > 10% in proportion to the WBC

• Adult Worms recovered in the Eye and the Pulmonary Artery

• ELISA

Diagnosis for A. cantonensis infection

True

T/F: No definite anti-helminthic therapy for A. cantonensis infection

Mebendazole, Thiabendazole

Treatment for A. cantonensis infection for eosinophilic meningitis

Prednisone

Treatment for A. cantonensis infection for severe cases with cranial nerve involvement

Surgical remova

Treatment for A. cantonensis infection when parasite lodged in eye

microfilaria

It is the _______ that is infective to the vector

pale pink

The sheath of W. bancrofti stains _______ with the Giemsa stain.

pink-red

The sheath of B. malayi stains _______ with the Giemsa stain.

spaced or well separated/scattered

The nuclei of W. bancrofti are _______ throughout the body except at the tip of its tail.

very crowded

Unlike the Wuchereria wherein it is separated, this time the nucleus off B. malayi appears to be ________.

B. malayi

W. bancrofti / B. malayi: Headspace is twice as long as it is broad

W. bancrofti

W. bancrofti / B. malayi: Headspace is as long as it is wide

False - Stains very lightly or it does NOT stain at all with Giemsa

T/F: Loa loa stains very well with Giemsa

coarse and overcrowded

Characterize the nuclei of L. loa and O. volvulus

Twice longer than broad (similar to B. malayi)

The headspace of Onchocerca volvulus is ?

Arabian seacoast, Pacific Islands

Bancroftian filariasis, is found along in this part of Asia (1) as well as occurs extensively in (2)

filiform

Adult worm of W. bancrofti is creamy white, long, and ____ in shape

longer

The hyaline sheath of the microfilariae of W. bancrofti is (shorter/longer) than the entire microfilaria itself

Aedes and Culex

What are the nocturnal vectors of W. bancrofti?

Anopheles

What are the daytime biting vectors of W. bancrofti?

nodular dilatations in lymph vessels and sinuses of lymph glands

Where are the adult male and female worms of W. bancrofti found tighyly coiling in?

head or proboscis

After 6-20 days of development, L3 larvae (infective stage) of W. bancrofti will migrate out of the muscles causing considerable damage and migrate towards the mosquito's?

• Lymph vessels of lower extremities

• Epididymis in males

• Labial glands of females

Larvae of W. bancrofti develops into adults are usually localized in which parts of the human body?

lymphangitis and lymphadenitis

Acute symptoms of Bancroftian filariasis causes which condition?

elephantoid or filarial fever

During actue stage of Bancroftian filariasis, febrile attacks can be seen with or without associated lymphangitis which is also known as

lower limbs

Mostly affected body parts during the actue stage of Bancroftian filariasis are the?

centrifugally

When seen on the limbs, Bancroftian filariasis develops ______ starting from the region where the lymph node is involved, and then progresses distally

True

T/F: Surrounding areas during acute stage of Bancroftian filariasis may develop edema

Adenolymphangitis/dermatolymphangitis

The condition during acute stage of Bancroftian filariasis that leads sensitization to products of living worms or dead worms

False - starts peripherally then drains towards the lymph nodes

T/F: Signs and symptoms of acute Bancroftian filariasis start in the lymph nodes and then drain peripherally

elephantiasis and hydrocoele

During the chronic stage of Bancroftian filariasis, proliferative overgrowths of fibrous tissues around the dead worm lead to lymphatic obstruction and recurrent dermatolymphangitis, which may cause which clinical conditions?

True

T/F: In Brugia malayi, adult females are indistinguishable with adult males (with W. bancrofti)

W. bancrofti, less severe

Clinical manifestations of B. malayi are similar/same with ____ but the deformities are (more/less) severe

sharply pointed, curved tails

Characteristics of tail of the unsheathed microfilariae of O. volvolus

Pruritus

First clinical manifestation of Onchocerca volvolus

subcutaneous nodules

Another clinical manifestation during the early stage of Onchocerciasis, which are most commonly in trunk, thighs, and arms, and are usually 3-6 in number

“leopard skin”

Changes in skin color due to Onchocerciasis results in what kind of appearance

“cigarette paper-like”

In Onchocerciasis, thinning of the skin with loss of elasticity gives the skin a ________ appearance

Hanging Groin

In Onchocerciasis, thinning of the skin with loss of elasticity gives the skin a “cigarette paper-like” contributes to the condition known as

Calabar/subcutaneous swellings

Characteristic manifestation of Loa loa

rounded

Microfilariae of L. loa are sheathed and its tail gradually tapers to a _____ end

densely

Nuclei of L. loa are (lightly/densely) packed that extends to the tip of the tail

the lungs

Microfilariae of L. loa during the day are found in peripheral blood, but during the non-circulation phase, they are found in ____ .

(1) midgut; (2) hemocoel

After ingestion of the fly of the microfilariae, the microfilariae lose their sheaths and migrate from the fly’s (1) through the (2) to the thoracic muscles of the arthropod.

Non-pitting

Type of edema seen in L. loa infection

Hands, forearms, orbit

Most common sites of calabar/fugitive swellings in L. loa

False: NOT TRUE filarial wormsm, does NOT produce eggs

T/F: Adult worms of Dracunculus medinensis are true filarial worms and produces eggs

Male

Adult Male/Female D. medinensis: Dies after copulation

female

Adult Male/Female D. medinensis: longest nematode

vagina

Adult female D. medinensis loses ___ when gravid