Lymphatic Filariasis

LYMPHATIC FILARIASIS

*INTRODUCTION*


Lymphatic filariasis is a abnormally extremities so it can be treated able using of medication as per your doctor order. LF also known as *elephantiasis* is caused by parasitic worms of the Filariodae type. Many cases of the diseases have no symptoms. Some however develop large amounts of swelling of the arms, legs or genitals. The skin may also become thicker and pain may occur. The changes to the body can result in social and economic problems for the affected person.
The worms are spread by the bites of infected mosquito. Infection usually begins when people are children. There are three types of worms that cause the disease; Wuchereria bancrofti, Brugia malayi and Brugia timori. Wuchereria bancrofti is the most common. The worms damage the lymphatic system. The disease is diagnosed by looking, under a microscope, at blood collected during the night. The blood should be in the form of a tick smear and stain with Giemsa.
Medication used includes albendazole with Ivermectin or albendazole with di-ethyl-carbamazine. The medication do not kill the adult worm but prevent fmjurther spread of the disease until the worms die on their own. Efforts to prevent mosquito bite are also recommended including reducing the number of mosquitoes and the use of bed nets.
More than 120 million people are infected with lymphatic filariasis. About 1.4 billion people are at risk of the disease in 73 countries. The areas where it is most common are Africa and Asia. The disease results in economic losses of many billions of dollars a year.

 *CHARACTARISTIC OF FILARIAL WORMS*


1. The adult worm are found in lymphatic system and subcutaneous tissue
2. The female are vaviporous (produce laeva) called *microfilaria*
3. They require two hosts to complete their life cycle.
4. There is no multiplication of laeva
5. They are normally found in thick blood film

 *HISTORY*

       Lymphatic filariasis is thought to have affecting human since about 4000 years ago. Artefacts’ from ancient Egypt (2000 BC) and Nok civilization in West Africa (200BC) show possible elephantiasis symptoms. The first clear reference to the diseases occurs in ancient Greek literature, where scholars differentiated the often similar symptoms of lymphatic filariasis from those of leprosy.
       In 1866, Timothy Lewis, building on the work of Jean-Nicolars Demarquary and Otto Henry Wucherer, made the connection between *microfilariae and elephantiasis,* establishing the course of research that would ultimately explain the disease.
       In 1867, Joseph Bancroft discovered the adult form of the worm. In 1877, the lifecycle involving an arthropod vector was theorized by Patrick Manson, who proceeded to demonstrate the presence of the worm in mosquitoes. Manson incorrectly hypothesized that the disease was transmitted through skin contact with water in which the *mosquitoes had laid eggs.*
       In 1990, George Carmichael Low determined the actual transmission method by discovering the presence of the worm in the proboscis of the *mosquito vector.*

 *GEOGRAPHICAL DISTRIBUTION/ EPIDIMEOLOGY OF FILARIAL WORMS*

_*Wuchereria buncrufti*_:- is the most widespread species, affecting about 120 million people in the tropical countries of *Africa, India South America, Central America, South-East Asia and the pacific island.*

_*Burgia Malayi*_: - is endemic in part of South America, and is found mainly in *Malaysia, India, Vietnam, China, South Korea and Japan.*

_*Burgia Timori*_: - takes its name from the *Island of Timor.* It is found in Indonesia and low laying river.

 *CAUSES/ETIOLOGY/EFFECT*


*Lymphatic filariasis* is caused by infection with parasite classified as nematode *(round worms)* of the family filariodae. There are 3 types of these threads like worms which are:

_*Wuchereria buncrofti*_:  which is for 90% of the case.

_*Brugia malayi*_: which causes most of the reminder of case.

_*Brugia timori*_ :which is also, causes the disease.

*Which live in the lymphatic vessel and lymph nodes. Because of their similarities, the parasite discussed together under one heading.*

 *MODE OF TRANSMISSION*

_Wuchereria bancrofti._ _Brugia malayi and Brugia timori_ are transmitted by mosquitoes belongs to the genera

 (i) Culex, 

 (ii) Anopheles,

 (iii) Aedes 

(iv) Mansonia._*

 *LIFE CYCLE*


The three species carry out their lifecycle in two host human being serve as the definitive host and mosquitoes as the inter-mediate host.
When an infected mosquito come to take blood from a man, it usually inoculate the microfilaria form of the parasite, the parasite enter the lymph vessel and migrate to the lymph node where it stay up-to 4-6years until it get matured to the worms i.e male and female worm, female produce sheated microfilariea.
Another mosquito come to take blood from infected person it will take blood together with sheated microfilaria forms of parasite. The sheated microfilarae move to the mid gut of the mosquito and become unsheated  where it stay up-to 2-6 hour then it will migrate to the thoracic muscle ready to inject to another man.

 *PHATOGENICITY/
PATHOPHYSIOLOGY/PATHOGENESIS*

*Four stages of the diseases are recognized.*

1. The incubation period is 3 to 12 months in which there are no symptoms.

2. The acute symptomatic stage in which some swelling of the extremities may occur and this may be accompanied by pain, weakness of the arm and legs, headache, fever is usually not present.

3. There is a period of recovery which is permanent re-infection does not occur.

4. If there is continue of re-infection the cycle repeats and elephantiasis may occur.

 *DIAGNOSTIC EVALUATION /LABORATORY DIAGNOSIS*

_By using a thick blood film and stain with Giemsa stain._

_*Procedure for tick blood films*_


*A drop of blood sample is placed at the centre of grease-free microscopic glass slide.*

*By using applicator stick the blood is emulsify in a circular motion.*

*Allow it to air dry and fix.*

_*Procedure of Giemsa stain*_

*A fix slide is place on a staining rack.*

*The slide is cover with a Giemsa working solution.*

*Allow it to stand for 15minutes.*

*Wash with distilled water.*

*Wipe the back of the glass slide and allow it to air dry*

*View it microscopically by using X100 objective lens.*

 *PREVENTION AND CONTROL*

1. *Netting*: - either treated or untreated net.

*Biological method*: - is the process of inviting another organism to feed on mosquito larvae eg. Tilapia fish.

*Electrification:* - by using electricity because mosquito is a nocturnal organism it hates light.
Chemical method:- by using insecticide such as ( Shaltox, Mosquito Coil ) etc

*Environmental sanitation:*- by cutting a taller grass and channelling the quilters.

*Health education*:- by educating people on the danger of mosquito bite.

 *TREATMENT*


1. Di-ethyl-carbamazine.
2. Ivermectin.
3. Albendazole.

*MANAGEMENT*
*  symptomatic treatment
* systematic treatment
* monitor the vital signs
*assess the condition of client
*provide the medication as per physician order
*  maintain the IV fluids
*monitor the intake and output chart *provide comfort device pillow and comfort position