FILARIARIS DISEASE

MECHANISM OF DISEASE

Mikrofilaria W.bancrofti

FilariasisDefinition
 Filariasis (elephantiasis disease) is a chronic infectious disease caused by the filarial worm blockage in the gland / lymph channels, causing acute clinical symptoms such as recurrent fever, sore glands / lymph nodes,  edema and chronic symptoms such as elephantiasis.

Cause
 3 species in Indonesia determined filarial worms, including Wuchereria bancrofti, Brugia malayi and Brugia timori that each - each as the cause filariasi bancrofti, malayi filariasis and filariasis timori. Various species of mosquitoes can act as transmitters (vector) disease.Modes of TransmissionA person bitten by a mosquito infected with filariasis when infective larvae containing filarial worms. Mosquitoes that transmit filariasis is Anopheles, Culex, Mansonia, Aedes and Armigeres. Mosquitoes are widespread throughout Indonesia according to the state of their habitat (sewer / water lines, fields, marshes, woods).

Clinical
 1. Filariasis without symptoms
 Generally endemic areas, the physical examination is only found enlarged inguinal lymph nodes, especially in areas. In blood tests found microfilaria role in large quantities and eosinophilia. 

2. Filariasis by Inflammation
 Fever, chills, headache, vomiting, and weakness may last a few days to a few weeks. Organs affected mainly the lymph channels limbs and genitals. In the men - men generally are accompanied by thickening and funikulitis pain epididymitis, orchitis and scrotal swelling. Acute attacks can last a month or more. If the condition can lead to severe kidney abscesses, swelling epididymal, retroperitoneal tissue, and muscle ileopsoas inguinal glands.

3. Filariasis with Healing
 In the chronic stage occurs proliferative granulation tissue and extensive enlargement of lymph channels and elephantiasis arise. Torasikus duct blockage or abdominal lymph channels is affecting the scrotum and penis in males - males and the external genitalia in women. Inguinal gland infection can affect the limbs and external genitalia. Elefanthiasis typically affects the limbs and genitals and cause extensive changes. When the lymph channels bladder and kidney rupture will occur kiluria (lymph fluid discharge in the urine), whereas that of rupture of tunica vaginalis hydrocele or kilokel will happen, and if the rupture occurs peritoneal ascites lymph channels that contain kilus. The picture that appears is often hydrocele and lymphangitis genitals. Lymphangitis and elephantiasis can be exacerbated by secondary infections Streptococcus. 

Diagnosis
 Diagnosis can be established clinical filariasis. The diagnosis is confirmed by finding microfilaria in the peripheral blood were taken at night (22:00 to 02:00 o'clock midnight) and daubed with Giemsa staining. In the chronic state examination is often negative.

Management

1. General Care

• Rest in bed 
• Antibiotics for secondary infection and abscess
 • Treatment of elephantiasis with foot washing and wound care

2. Specific Treatment

For individual treatment given Carbamazine Diethyl Citrate (DEC) 6 mg / kg 3 times daily for 12 days.Side effects: nausea, dizziness and fever while using this medication.Treatment missal (WHO recommendations) are DEC 6 mg / kg and albendazole 400 mg (+ paracetamol) a single dose, once a year for 5 years. Implementation unit (IU) is a district / area of ​​work centers (population 8000-10000 people) 

Dose Table DEC for filariasis by age 
Age                      DEC (100 mg)              Albendazole (400 mg)   
2-6 years                     1 tablet                         1 tablet     
 7-12 years                  2 tablets                       1 tablet 
> 13 years                   3 tablets                       1 tablet