Filariasis & Leishmaniasis PDF

Filariasis  Lymphatic filariasis (elephantiasis), painful, profound disfiguring disease acquired in childhood. In adult lead to disability. In endemic countries10-50% men and up to 10 % women can be affected.  Agent: 8 species, 3 lymphatic, 5 non lymphatic. W. bancrofti >90%of...

Filariasis  Lymphatic filariasis (elephantiasis), painful, profound disfiguring disease acquired in childhood. In adult lead to disability. In endemic countries10-50% men and up to 10 % women can be affected.  Agent: 8 species, 3 lymphatic, 5 non lymphatic. W. bancrofti >90%of all human filariasis, prevailing in some foci in Egypt.  Reservoir of infection: - w. bancrofti, Brugia malayi cause lymphatic filariasis. - They live 4-6 years producing millions of immature microfilaria (minute larvae that circulate in blood). - Mode of transmission: disease transmitted by Culex mosquito (C. fatigans, C.pipiens, anopheles, Aedes may have some role) that bite human & pick up microfilaria that develop inside mosquito to infective stage in 7-21 days , the larva then migrate to mosquito biting mouth parts ready to entered in punctured skin.  Filariasis  Susceptibility: all ages, males affected more, migration , mobility, illiteracy, poverty, urbanization…  IP: 8-16 months  CP: obstructive manifestation of lymphatic circulation, resulting in elephantiasis  Acute episodes of local infection of skin, LN, lymphatic vessels with chronic elephantiasis due to body immune response against parasite, or as bacterial infection of skin where normal defenses lost by lymphatic damage.  Diagnosis: -Nocturnal periodicity restrict their appearance in blood film to only hours around midnight 10pm – 2 am. - Card test: finger prick blood droplet to detect parasite Ag Filariasis  Control of filariasis: - 1ry goal to eliminate microfilaria so, transmission by mosquito interrupted - Recent studies single dose of Diethylcarbamazine single dose/year have same effect of long term 12 days decrease microfilaria, use of single doses of 2 drugs administered concurrently (DEC with albendazole or ivermectin) 99% effective in removing microfilaria from blood for a full year after ttt. yearly single dose for 4-6 years.  WHO Strategy  Stop spread of infection through ttt  Alleviate suffering: by intensive local hygiene, possible improvement in the damage that already occurred, in and preventing debilitating and painful acute episodes of inflammation Leshmaniasis  Definitions: it caused by several flagellated protozoan parasites. WHO estimate prevalence 12 million, annual mortality 60,000. Found in latin America, South Asia, Middle east, Mediterranean area  Agent: Intracellular parasite, they infect and divide within macrophages. 23 leshmania species cause human leshmania with no cross immunity.  Vector: Female phelpotomus paptasi and sergenti. Sand fly become infective 6-9 days after infective meal.  Reservoir of infection: dogs, rodents, foxes, humans  Mode of transmission: - Bite of infected female phlebotomine sand fly - Kala azar from person to person by bite of female sand fly. - Rarely: blood transfusion, contaminated needle, pregnant women to her baby. - IP: variable weeks to- months - Susceptibility: Age females, population movements, traveling, low socio-economic. Leshmaniasis  Clinical Picture (CP) - Cutaneous: enlarged papule then ulcer with raised edge give volcano appearance - Mucocutaneous: in central ,south America cutaneous sore on face that affect mucus membrane of nose, mouth - Visceral: chronic enlarged liver, spleen  Diagnosis - Parasitological demonstration of parasites LD bodies in spleen ,liver, bone marrow, LN, skin - Serological tests: direct agglutination test, ELISA - Leshmania intradermal test: results after 48-72 hrs indurations >5mm +ve - Hematological; leucopenia, anemia. Reversed A/G ratio  Control: control of reservoir: active , passive detection & ttt of cases  Sand fly control: limit outdoor, insecticides, window screen, protective clothes