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Chapter 12 : Filarial Nematodes

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Abstract:

The filarial nematodes are a group of arthropod-borne worms that reside in the subcutaneous tissues, deep connective tissues, lymphatic system, or body cavities of humans. Depending on the species, microfilariae may exhibit periodicity in the circulation. Infection begins with the bite of an infected arthropod vector. Infection with , , or causes lymphatic filariasis, while causes "river blindness," which can lead to severe ocular involvement and blindness. In areas of endemic infection around the world, the presumptive diagnosis of filarial infections is frequently based on clinical evidence; however, definitive diagnosis is based on the detection of microfilariae, primarily in the blood. Drug combinations containing diethylcarbamazine (DEC) are the most effective against microfilarial prevalence and intensity relative to single drugs or other combinations. The microfilariae differ from those of by having two terminal nuclei that are distinctly separated from the other nuclei in the tail. Tropical pulmonary eosinophilia (TPE) is associated with or infections causing diffuse pulmonary infiltrates with significant local and systemic eosinophilia and high levels of polyclonal and parasite-specific immunoglobulin E (IgE). The number of microfilariae in the skin is extremely small, and there is extensive follicular hyperplasia of the regional lymphnodes. Currently, there are two subgenera, and , based on the presence or absence of external longitudinal cuticular ridges.

Citation: Garcia L. 2007. Filarial Nematodes, p 319-356. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch12

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Figures

Image of Figure 12.1
Figure 12.1

Distribution of and infections in humans. (Armed Forces Institute of Pathology photograph.)

Citation: Garcia L. 2007. Filarial Nematodes, p 319-356. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch12
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Image of Figure 12.2
Figure 12.2

Life cycles of and

Citation: Garcia L. 2007. Filarial Nematodes, p 319-356. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch12
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Image of Figure 12.3
Figure 12.3

microfilaria in a peripheral thick blood film. (From A Pictorial Presentation of Parasites: A cooperative collection prepared and/or edited by H. Zaiman. Photograph courtesy of L. Garcia.)

Citation: Garcia L. 2007. Filarial Nematodes, p 319-356. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch12
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Image of Figure 12.4
Figure 12.4

microfilaria. (Upper) Head of microfilaria; note the sheath and very clearly delineated nuclei. (Lower) Tail of microfilaria; note that the sheath and the tail nuclei do not go all the way to the end of the tail. (From A Pictorial Presentation of Parasites: A cooperative collection prepared and/or edited by H. Zaiman. Photograph courtesy of L. Garcia.)

Citation: Garcia L. 2007. Filarial Nematodes, p 319-356. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch12
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Image of Figure 12.5
Figure 12.5

Characteristics of human microfilariae. (A) ; (B) ; (C) ; (D) ; (E) ; (F) ; (G) (Illustration by Nobuko Kitamura.)

Citation: Garcia L. 2007. Filarial Nematodes, p 319-356. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch12
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Image of Figure 12.6
Figure 12.6

Key to microfilariae commonly found in the blood.

Citation: Garcia L. 2007. Filarial Nematodes, p 319-356. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch12
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Image of Figure 12.7
Figure 12.7

(Upper) female in lymph node (cross section). (Armed Forces Institute of Pathology photograph.) (Lower left) Inguinal nodes enlarged due to filariasis. (Adapted from the Public Health Image Library, Centers for Disease Control and Prevention.) (Lower right) Scrotal lymphangitis due to filariasis. (Adapted from the Public Health Image Library, Centers for Disease Control and Prevention.)

Citation: Garcia L. 2007. Filarial Nematodes, p 319-356. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch12
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Image of Algorithm 12.1
Algorithm 12.1

Bancroftian and Malayan filariasis.

Citation: Garcia L. 2007. Filarial Nematodes, p 319-356. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch12
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Image of Figure 12.8
Figure 12.8

elephantiasis of lower extremities. (Panel A from A Pictorial Presentation of Parasites: A cooperative collection prepared and/or edited by H. Zaiman; panel B adapted from the Public Health Image Library, Centers for Disease Control and Prevention.)

Citation: Garcia L. 2007. Filarial Nematodes, p 319-356. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch12
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Image of Figure 12.9
Figure 12.9

(Left) Head of microfilaria; note that the sheath is not that clearly visible. (Right) Tail of microfilaria; note the sheath and the two terminal tail nuclei.

Citation: Garcia L. 2007. Filarial Nematodes, p 319-356. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch12
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Image of Figure 12.10
Figure 12.10

Both images show the microfilarial tail. Note the sheath and two terminal tail nuclei with the bulge in the tail.

Citation: Garcia L. 2007. Filarial Nematodes, p 319-356. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch12
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Image of Figure 12.11
Figure 12.11

elephantiasis of the lower extremity. (From A Pictorial Presentation of Parasites: A cooperative collection prepared and/or edited by H. Zaiman. Photograph courtesy of D. Dennis, Kuala Lumpur.)

Citation: Garcia L. 2007. Filarial Nematodes, p 319-356. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch12
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Image of Figure 12.12
Figure 12.12

microfilarial tail. Note the two terminal tail nuclei with no bulge in the tail.

Citation: Garcia L. 2007. Filarial Nematodes, p 319-356. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch12
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Image of Figure 12.13
Figure 12.13

Life cycle of

Citation: Garcia L. 2007. Filarial Nematodes, p 319-356. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch12
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Image of Figure 12.14
Figure 12.14

microfilariae in blood. Note the presence of the sheath and the tail nuclei positioned to the end of the tail.

Citation: Garcia L. 2007. Filarial Nematodes, p 319-356. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch12
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Image of Figure 12.15
Figure 12.15

(Left) Microfilarial tail; note that the tail nuclei go to the tip of the tail. (Right) Microfilarial tail enlarged; note that the tail nuclei go to the tip of the tail.

Citation: Garcia L. 2007. Filarial Nematodes, p 319-356. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch12
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Image of Figure 12.16
Figure 12.16

Subconjunctival nematode. (From A Pictorial Presentation of Parasites: A cooperative collection prepared and/or edited by H. Zaiman. Photograph courtesy of D. Gendelman.)

Citation: Garcia L. 2007. Filarial Nematodes, p 319-356. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch12
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Image of Figure 12.17
Figure 12.17

beneath the conjunctiva of the eye. (Armed Forces Institute of Pathology photograph.)

Citation: Garcia L. 2007. Filarial Nematodes, p 319-356. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch12
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Image of Figure 12.18
Figure 12.18

adult extracted from the eye. (Armed Forces Institute of Pathology photograph.)

Citation: Garcia L. 2007. Filarial Nematodes, p 319-356. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch12
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Image of Figure 12.19
Figure 12.19

microfilaria in the capillaries of the dermis. (Armed Forces Institute of Pathology photograph.)

Citation: Garcia L. 2007. Filarial Nematodes, p 319-356. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch12
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Image of Algorithm 12.2
Algorithm 12.2

Loiasis.

Citation: Garcia L. 2007. Filarial Nematodes, p 319-356. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch12
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Image of Figure 12.20
Figure 12.20

microfilaria. Note that the microfilaria is unsheathed and that the tail is pointed and slightly flexed and has a longer caudal space than

Citation: Garcia L. 2007. Filarial Nematodes, p 319-356. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch12
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Image of Figure 12.21
Figure 12.21

microfilaria. Note that the microfilaria is unsheathed and that there is a cephalic space and very little caudal space.

Citation: Garcia L. 2007. Filarial Nematodes, p 319-356. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch12
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Image of Figure 12.22
Figure 12.22

Life cycle of

Citation: Garcia L. 2007. Filarial Nematodes, p 319-356. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch12
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Image of Figure 12.23
Figure 12.23

microfilariae in the skin (cross section). (From A Pictorial Presentation of Parasites: A cooperative collection prepared and/or edited by H. Zaiman.)

Citation: Garcia L. 2007. Filarial Nematodes, p 319-356. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch12
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Image of Figure 12.24
Figure 12.24

microfilariae in the dermis. (Armed Forces Institute of Pathology photograph.)

Citation: Garcia L. 2007. Filarial Nematodes, p 319-356. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch12
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Image of Figure 12.25
Figure 12.25

Onchocerciasis. The nodule on the patient’s head contains adult worms of (From A Pictorial Presentation of Parasites: A cooperative collection prepared and/or edited by H. Zaiman.)

Citation: Garcia L. 2007. Filarial Nematodes, p 319-356. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch12
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Image of Figure 12.26
Figure 12.26

Onchocerciasis. Nodules on the back prior to surgical removal. (From A Pictorial Presentation of Parasites: A cooperative collection prepared and/or edited by H. Zaiman.)

Citation: Garcia L. 2007. Filarial Nematodes, p 319-356. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch12
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Image of Figure 12.27
Figure 12.27

Onchocerciasis. Surgical removal of a nodule on the back. (From A Pictorial Presentation of Parasites: A cooperative collection prepared and/or edited by H. Zaiman.)

Citation: Garcia L. 2007. Filarial Nematodes, p 319-356. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch12
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Image of Figure 12.28
Figure 12.28

Wrinkling of the skin due to onchocerciasis. (Armed Forces Institute of Pathology photograph; published in D. H. Connor, N. E. Morrison, F. Kerdel-Vegas, H. A. Berkoff, F. Johnson, R. Tunnicliffe, F. C. Failings, L. N. Hale, and K. Lindquist, 553–579, 1970.)

Citation: Garcia L. 2007. Filarial Nematodes, p 319-356. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch12
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Image of Figure 12.29
Figure 12.29

Hanging groin due to femoral lymphadenitis. (Armed Forces Institute of Pathology photograph.)

Citation: Garcia L. 2007. Filarial Nematodes, p 319-356. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch12
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Image of Figure 12.30
Figure 12.30

Depigmentation due to onchocerciasis. (Armed Forces Institute of Pathology photograph.)

Citation: Garcia L. 2007. Filarial Nematodes, p 319-356. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch12
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Image of Figure 12.31
Figure 12.31

Keratitis due to onchocerciasis. (Armed Forces Institute of Pathology photograph.)

Citation: Garcia L. 2007. Filarial Nematodes, p 319-356. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch12
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Image of Algorithm 12.3
Algorithm 12.3

Onchocerciasis.

Citation: Garcia L. 2007. Filarial Nematodes, p 319-356. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch12
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Image of Figure 12.32
Figure 12.32

Adult (From A Pictorial Presentation of Parasites: A cooperative collection prepared and/or edited by H. Zaiman.)

Citation: Garcia L. 2007. Filarial Nematodes, p 319-356. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch12
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Image of Figure 12.33
Figure 12.33

Adult within a canine heart. (Original photograph by S. Kume; from A Pictorial Presentation of Parasites: A cooperative collection prepared and/or by H. Zaiman.)

Citation: Garcia L. 2007. Filarial Nematodes, p 319-356. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch12
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Image of Figure 12.34
Figure 12.34

Pulmonary nodule with (cross section). (Original photograph by G. Healy; from A Pictorial Presentation of Parasites: A cooperative collection prepared and/or edited by H. Zaiman.)

Citation: Garcia L. 2007. Filarial Nematodes, p 319-356. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch12
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Image of Figure 12.35
Figure 12.35

Dirofilariasis. (Upper) Computed tomogram image with fine needle in left pulmonary round focus; round focus in right lung periphery. (Lower) Histology of resected “coin lesion” with immature in the peripheral pulmonary artery; silver methenamine stain. (From R. Fueter and J.-O. Gebbers, 2014, 1997, with permission).

Citation: Garcia L. 2007. Filarial Nematodes, p 319-356. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch12
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Image of Figure 12.36
Figure 12.36

(Upper) Cross section from right flank muscle. (Lower) Cross section enlarged. Note the key characteristics: thick cuticle; low, rounded, wavy external longitudinal cuticular ridges; prominent lateral chords; prominent somatic musculature; and location within soft tissue. (Photographs courtesy of Marjorie R. Fowler, with permission.)

Citation: Garcia L. 2007. Filarial Nematodes, p 319-356. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch12
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References

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Tables

Generic image for table
Table 12.1

Characteristics of species causing human filariasis

Citation: Garcia L. 2007. Filarial Nematodes, p 319-356. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch12
Generic image for table
Table 12.2

Treatment options for bancroftian filariasis

Citation: Garcia L. 2007. Filarial Nematodes, p 319-356. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch12
Generic image for table
Table 12.3

species infecting humans

Citation: Garcia L. 2007. Filarial Nematodes, p 319-356. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch12

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