Filaria Sis

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Filariasis


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INTRODUCTION

Filariasis afflicts filipino living in the endemicareas. The disease often progresses to becomechronic, debilitating and disfiguring, since itssymptoms are often unnoticed and unfamiliar tohealth workers.

The social stigma, especially among women,keeps the disease hidden and undiagnosed withinfamilies in inaccessible communities. Filariasis is

endemic in 45 out of 78 provinces.

A 1960 national prevalence survey showed thatthe Filariasis Contorl Unit (FCU) had provinceswith the highest prevalence rates from the

Refions 5, 8, 11 and CARAGA.


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Two other provinces, marinduqueand Sarangani province, wereidentified as endemic provinces. FCU

had case finding activities bringingthe total number of endemicprovinces to 45. provincial prevalence

rates in the survey ranged from 0.2-100.8 per 1,000 with Sulu accountingfor highest prevalence and Cebu withthe lowest rate.


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Infectious Agents

human Lymphatic Filariasis is a chronicparasitic caused by nematode parasiteknown as Wuchereria bancrofti, Brugia

malayi and/ or Brugia timori. The youngand adult worms live in the lymphaticvessels and lymph nodes while themicrofilariae are usually found in blood.

Wuchereria bancrofti Brugia malayi


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The life span of the adult parasitesis about 10 years (but a 40-years life-span has been reported) while the

microfilariae live for about a year atthe most.

microfilariae


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Mode of Transmission

The disease is transmitted to aperson through bites from an infectedfemale mosquito primarily Aedes

poecilius that bites at night.

Aedes poecilius


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Incubation Period

The incubation period which startfrom the entry of the infective larvaeto the development of clinical

manifestation is variable.Nevertheless, it ranges from 8-16months.


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Asymptomatic Stage

Characteristic by the presence ofmicrofilariae in the peripheral blood

No clinical sings and symptoms of the

disease Some remain asymptomatic for years

and in some instances for life

Others progress to acute and chronic

stages Microfilariae rate increases with age and

then levels off

In most endemic areas includingPhilippines, men have higher


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Acute Stage

Start when there are already manifestation such as: Lymphadenitis (inflammation of

lymph nodes)

Lymphangitis

(inflammation of


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In some cases, the male genitalia isaffected leading to:

Funiculitis Epidydimitisorchitis

(redness, painful


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Chronic Stage

Develop 10-15 years from the onsetof the first attack.

Immigrants from the areas whereFilariasis is not endemic tend todevelop this stage more often andmuch sooner 91-2 years0 than do

the indigenous population ofendemic areas.


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Chronic Signs and Symptoms

Hydrocoele(swelling of the scrotum)

Lymphedema

(temporaryswelling of theupper andlower extremities)


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Elephantiasis(enlargement and

thickening of theskin of the lowerand/or upper

extremities,scrotum, breast)


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Diagnosis

Physical examination is done in themain health center or duringscheduled survey bites in the

community History taking

Observation of the major and minor

signs and symptoms


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Laboratory examination

Nocturnal Blood Examination (NBE) -blood are taken from the patients

at the patients residence or in thehospital after 8:00 pm


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Treatment

The treatment or cases in endemic communitiesis the most effective way to reduce or preventmorbidity and transmission. Health workers mustemphasize the importance of compliance to theprescribed treatment regimen.

The community must be informed of theobjective of treatment which is to reduce andinterrupt transmission of infection.

Diethylcarbamazine Citrate (DEC) or Hetrazan,kills almost all microfilaria and a good proportionof adult worms. Drug is given to patients withclinical manifestation of infection


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Diethylcarbamazine Citrate (DEC) orHetrazan, kills almost all microfilariaand a good proportion of adult worms.

Drug is given to patients with clinicalmanifestation of infection.


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Side Effect and Contraindication of DEC(hetrazan)

there are two types of side reactions,general and local, both with or withoutfever.

The systemic reaction aremanifestuonsdue to host inflammatoryresponses to parasites antigensliberated by the rapid death of themicrofilariae while the localized adverse

reactions are induced by their death


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Mass Treatment

Distribution to all population

Endemic and infected or not infectedwith filariasis in establishedendemic areas

The dosage is 6 mg/kg body weighttaken as a single dose per year


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Surgical Treatment

Chronic manifestation such aselephantiasis and hydrocoele can behandled through surgery. This isusually referred to hospitals formanagement.

Mild cases of lymphedema can betreated by lymphovenous anastomosis

distal to the site of lymphaticdestruction.

Chyluria is operated on by ligation and

stripping of the pedicle of the affectedkidne while h drocoelescan be


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Supportive Care for Filariasis

Filariasis patients are advised to

obseve personal hygiene by washingthe affected areas with soap andwater at least twice a day orprescribed antibiotics or anti-fungals

for super infection.


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Prevention and Control

A. Measures aimed to control the Vector Environment sanitation such as proper drainage

and cleanliness of surroundings . Spraying with insecticide (may also produce

harmful effect)

B. Measures aimed to protect the individual &families in endemic areas.

Use of mosquito nets Use of long sleeves, long pants and socks Application of insect repellants screening of

houses Health education


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The function and responsibilities ofthe public health nurse include healthteaching on preventive measures andrendering suportive care duringmanagement and treatment.

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