SOMATIC NEMATODES

(Lymphatic Filarial Nematodes)

General Characteristics of Filarial Worms
Habitat: Filarial worms reside in the lymphatic system, skin,
subcutaneous tissue, and rarely in the body cavity.
Viviparous – directly discharge larval forms after fertilization
Adult Worm: The adult worms are slender, round, measuring
2-10 cm in length (except the female Onchocerca 35 –
50cm). Some adult worms can survive for many years (6-8
years) in humans causing a number of chronic obstructive
and inflammatory conditions including elephantiasis and
hydrocele.
General Characteristics of Filarial Worms
Microfilariae: The female worm produces large number of
L1 larvae called as microfilariae which are highly motile
thread-like larvae.
Microfilarial periodicity: It is defined as the time when most
of the microfilariae are found in the blood.
 Nocturnal: night time (9pm – 2am) e.g. Wuchereria and Brugia
 Diurnal: day time (e.g. Loa loa)
 Sub-periodic: present throughout; with slight increase in the
afternoon (rare occasion for Wuchereria and Brugia)
 Non-periodic: any time (e.g. Mansonella and Onchocerca)
Brugia malayi
Brugia malayi
• Is one of the three causative agents of lymphatic filariasis in
human.
• It is a parasitic worm, which is known for infecting the
human lymphatic system. This remarkable parasite has a
very interesting method of reproducing and migrating from
person to person.
 History
• In 1927, Lichtenstein and Brug identified microfilaria that
were distinct from the previously discovered Wucheria
bancrofti while in Indonesia. They called the new
species Filaria malayi.
• Their hypothesis was not accepted until the 1940s, when
Rao and Mapelstone identified two adult worms in India.
• In 1958, Buckley proposed the recognition of a new
genus Brugia. F. malayi became known as Brugia malayi.
 Microfilarial stage of Brugia malayi

Figure A: Section of an adult

of Brugia sp. from a lymph node, stained
with hematoxylin and eosin (H&E).
Image taken at 200x magnification.
Figure A: Microfilaria of B. malayi in a thick Figure B: Microfilaria of B. malayi in a
blood smear, stained with Giemsa. thin blood smear, stained with Giemsa.
 Morphology

• The adult worms are essentially similar to that of W. bancrofti except they
are smaller in size; males (3.5 cm × 0.1 mm) and females (5–6 cm × 0.1
mm). Microfilariae measure 175–230 µm × 5–6 µm in size.

• The typical B. malayi microfilaria possesses a sheath, a round anterior end,

and numerous nuclei. The characteristic that distinguishes it from the other
sheathed organisms is the presence of two distinct nuclei on the tip of the
pointed tail.
 Epidemiology
• B. malayi occurs primarily in eastern India, Indonesia,
Malaysia and Philippines.
• The parasite flourishes in freshwater swamp forests in rural
locations in Southeast Asia (Ridley 2011); about 65% of
cases are found here.
• Many mosquito bites over several months to years are
needed to get lymphatic filariasis. People living for a long
time in tropical or sub-tropical areas where the disease is
common are at the greatest risk for infection.
 Epidemiology

• B. malayi infects 13 million people in south and southeast

Asia and is responsible for nearly 10% of the world’s total
cases of lymphatic filariasis. B. malayi infection is endemic
or potentially endemic in 16 countries.
• Reservoir: Humans are the main reservoir; except for the
sub-periodic strains of B. malayi where monkeys, cats and
dogs are the animal reservoirs
 Epidemiology
• Periodicity: Two different forms of B. malayi can be found in the body.
The first is considered the periodic form because the microfilariae
appear periodically in the blood stream. This form of the microfilariae
are nocturnal and can usually be found from 10pm-2am. The second
form of B. malayi is subperiodic because the microfilariae are found in
the blood of the host throughout the day.
• Vector: Mansonia (M. annulifera and M. uniformis) is the main vector
for the nocturnal strains, Anopheles and Aedes also can transmit the
infection.
• The sub-periodic strains are transmitted by Coquillettidia and
Mansonia.
 Life Cycle
1. During a blood meal, an infected mosquito introduces third-stage
filarial larvae onto the skin of the human host, where they penetrate
into the bite wound. 2. They develop into adults that commonly reside
in the lymphatics. 3. The adult worms resemble those of Wuchereria
bancrofti but are smaller. The microfilariae migrate into lymph and
enter the blood stream reaching the peripheral blood. 4. A mosquito
ingests the microfilariae during a blood meal. 5. After ingestion, the
microfilariae lose their sheaths and work their way through the wall of
the proventriculus and cardiac portion of the midgut to reach the
thoracic muscles. 6. There the microfilariae develop into first-stage
larvae 7. and subsequently into third-stage larvae. 8. The third-stage
larvae migrate through the hemocoel to the mosquito’s prosbocis 1.
and can infect another human when the mosquito takes a blood meal
• Because they have only longitudinal muscles, they move in an S
shape motion. This allows for the male to wrap around the female
when they are ready for reproduction.

• The male and females now undergo sexual reproduction in which

the male twines and coils itself around a female during
intercourse. Amazingly a female produces an average of 10,000
eggs everyday. Adult Brugia malayi can survive in the lymphatic
system anywhere from 5-15 years and undergo sexual
reproduction as long as 8-9 years.
 Clinical Features
Both lymphatic filariasis and tropical pulmonary eosinophilia
syndrome are observed in brugian filariasis. Clinical features are
similar to bancroftian filariasis except:
oMore frequent episodes of acute adenolymphangitis and filarial
abscesses
oChronic manifestations (lymphedema and elephantiasis) occur
less frequently
oThe genital involvement is not seen
oElephantiasis: Swelling is limited to leg below the knee
oChyluria is not marked
 Diagnosis
• The most efficient way to diagnose the infection of B.
malayi is to take a blood smear of the potential carrier. The
blood can then be examined under a microscope looking for
microfilariae. The blood sample should be taken at night,
due to their nocturnal periodicity, which will ensure the
microfilariae are circulating in the blood. Serologic
techniques provide an alternative to microscopic detection
of microfilariae for the diagnosis of lymphatic filariasis.
Patients with active filarial infection typically have elevated
levels of antifilarial IgG4 in the blood and these can be
detected using routine assays.
 Diagnosis
• Upon initial infection, symptoms of B. malayi may not be
present because it hasn't yet matured. As the microfilariae
mature, swelling of the lymph nodes takes place. Once B.
malayi has grown into an adult, inflammation of the
lymphatic vessels commences. The effected vessels may
become tender and warm to the touch. Abscesses, sores,
and ulcerations may also form during infection (CDC 2013).
Brugia timori
Brugia timori
is a human filarial parasitic nematode (roundworm) which
causes the disease “Timor filariasis”. While this disease was
first described in 1965, the identity of Brugia timori as the
causative agent was not known until 1977.
Distribution is limited to the Timor islands of south-eastern
Indonesia.
Brugia timori
 Morphology: Similar to B. malayi except:
- Microfilariae is longer: Measures 265 – 325 µm (average 310 µm
long)
- 5-8 nuclei are present in the tail region (with 2 distinct nuclei in tail tip)
- Sheath doesn’t stain with Giemsa stain
 Life Cycle:
1. Definitive Host: Man
2. Intermediate Host: Anopheles barbirostris (vector)
3. Infective Stage: Filariform Larva
 Clinical feature, lab diagnosis, and treatment are similar to B. malayi.
 Treatment
• Diethylcarbamazine (DEC) is the treatment of choice
for lymphatic filarial parasites including W. bancrofti
and Brugia spp.
Microfilaria of B. timori in a thick blood smear from a patient from Indonesia, stained with
Giemsa and captured at 500x oil magnification. Image from a specimen courtesy of Dr.
Thomas C. Orihel, Tulane University, New Orleans, LA.
 Notes of Interest
A condition called tropical eosinophilia or occult filariasis
(hidden or not apparent) is known to occur in persons who
reside in areas of the world in which both B. malayi and W.
bancrofti are endemic. These patients experience a number
of pulmonary and asthmatic symptoms.
On thorough examination of infected patients, no
microfilariae are found in their blood. It is suspected that a
filarial parasite is present for this condition but hidden deep
in the body such as in the lungs.
 References
• Clinical Parasitology: A Practical Approach (2nd Edition) – Elizabeth A. Zeibig © 2013
• Bailey & Scott’s Diagnostic Microbiology (13th Edition) – Patricia M. Tille © 2014
• Essentials of Medical Parasitology – Apurba Sankar Sastry, Sandhya Bhat K ©2014
• Photos and other information taken from:
https://www.cdc.gov/parasites/lymphaticfilariasis/prevent.html
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