eMedicine Specialties > Pediatrics: General Medicine > Parasitology

Bancroftian Filariasis

Author: Robert W Tolan Jr, MD, Chief, Division of Allergy, Immunology and Infectious Diseases, The Children's Hospital at Saint Peter's University Hospital; Clinical Associate Professor of Pediatrics, Drexel University College of Medicine
Contributor Information and Disclosures

Updated: Jan 21, 2009

Introduction

Background

Bancroftian filariasis specifically refers to filarial infection with the nematode parasite Wuchereria bancrofti. Adult worms usually reside in the large lymphatics of the human host. For a description of other helminths that cause lymphatic filariasis (ie, Brugia malayi, Brugia timori), see Filariasis.

Pathophysiology

As with all nematodes, the filarial life cycle consists of 5 developmental or larval stages in a vertebral host and an arthropod intermediate host and vector. Adult female worms produce thousands of first-stage larvae, or microfilariae, that a feeding insect vector ingests. Some microfilariae have a unique circadian periodicity in the peripheral circulation over a 24-hour period. The arthropod vectors, mosquitoes and flies, also have a circadian rhythm in which they obtain blood meals. The highest concentration of microfilariae is usually observed when the local vector is feeding most actively. Microfilariae then undergo 2 developmental changes within the insect. Third-stage larvae are inoculated back into the vertebral host when the insect feeds, beginning the final 2 stages of development.

Frequency

United States

No form of bancroftian filariasis is currently endemic. W bancrofti was once prevalent in Charleston, SC because of the presence of suitable mosquito vectors.1 Immigrant populations and long-term travelers to the tropics are more likely to be affected and are potential reservoirs of infection. Returning missionaries and Peace Corps volunteers are particularly at risk for lymphatic filariasis because of the long prepatent period between exposure to infective insect bites and the development of sexually mature adult worms and the relatively high intensity of exposure required.

International

Lymphatic filariasis is found throughout the tropics and subtropics. Worldwide prevalence is more than 90 million. The World Health Organization (WHO) initiated a program in 1997 to eliminate lymphatic filariasis globally as a public health priority.

Mortality/Morbidity

Filarial diseases are rarely fatal, but the consequences of infection can cause significant personal and socioeconomic hardship for those who are infected. The WHO has identified lymphatic filariasis as the second leading cause (after leprosy) of permanent and long-term disability in the world. Morbidity of human filariasis is due mainly to the host reaction to microfilariae or to developing adult worms in different areas of the body.

Race

No racial predilection for bancroftian filariasis is known.

Sex

Both sexes are equally susceptible to infection. Because of different local, cultural, social, and work practices, as well as exposure to insect vectors, either sex may be more exposed to infection.

Age

People of all ages are susceptible and potentially microfilaremic. Microfilaremia rates increase with age through childhood and early adulthood, although clinical infection may be inapparent. Typically, acute and chronic filariasis manifests only after years of repeated and intense exposure to infected vectors in endemic areas.

Clinical

History

Symptoms of bancroftian filariasis may be acute or chronic in nature.

  • Lymphatic filariasis: Lymphatic filariasis symptoms predominantly result from the presence of adult worms residing in the lymphatics. Symptoms include fever; inguinal or axillary lymphadenopathy; testicular pain, inguinal pain, or both; skin exfoliation; and limb or genital swelling. People with microfilaremia are generally considered to be asymptomatic, although those with heavy microfilarial loads may develop acute and chronic inflammatory granulomas secondary to splenic destruction. Passage of cloudy milklike urine may denote chyluria.
  • Tropical pulmonary eosinophilia (TPE): TPE is a form of occult bancroftian filariasis. Presenting symptoms include a paroxysmal dry cough, wheezing, dyspnea, anorexia, malaise, and weight loss.

Physical

Signs of filariasis present on examination may be acute or chronic.

  • Lymphatic filariasis
    • Acute manifestations of lymphatic filariasis are usually referred to as adenolymphangitis (ADL). Episodic attacks of fever associated with inflammation of the inguinal lymph nodes, testis, spermatic cord, lymphedema, or a combination of these symptoms characterize ADL. Skin exfoliation of the affected body part usually occurs with resolution of an episode.
    • Repeated episodes of inflammation and lymphedema lead to lymphatic damage, chronic swelling, and elephantiasis of the legs, arms, scrotum, vulva, and breasts.
    • Hydrocele is the most common manifestation of chronic W bancrofti infection in males in endemic areas. Chyluria may also be present in individuals who are chronically infected.
  • TPE
    • Scattered wheezes and crackles are heard.
    • Lymphadenopathy and hepatomegaly may be present.

Causes

  • Lymphatic filariasis
    • Mosquitoes of the genera Aedes, Anopheles, Culex, and Mansonia are the intermediate hosts and vectors of all lymphatic filariasis species.
    • Acute lymphatic filariasis is related to larval molting and adult maturation to fifth-stage larvae. Adult worms are found in lymph nodes and lymphatic vessels distal to the nodes. Females measure 80-100 mm in length, and males measure 40 mm.
    • Nodes in the femoral and epitrochlear regions are the most commonly affected. Abscesses may form at the nodes or anywhere along the distal vessel. Cellular invasion with plasma cells, eosinophils, and macrophages, together with hyperplasia of the lymphatic endothelium, occurs with repeated inflammatory episodes. Lymphatic damage and chronic leakage of protein-rich lymph in the tissues, thickening and verrucous changes of the skin, and chronic streptococcal and fungal infections result; all of these contribute to the appearance of elephantiasis.
  • Occult bancroftian filariasis
    • Occult bancroftian filariasis denotes infection in which microfilariae are not observed in the blood, although they may be found in other body fluids, tissues, or both.
    • The occult syndromes include TPE, filarial arthritis, filarial breast abscess, and filarial-associated immune complex glomerulonephritis. TPE symptoms result from allergic and inflammatory reactions elicited by the microfilariae and parasite antigens that the lungs clear from the bloodstream.

More on Bancroftian Filariasis

Overview: Bancroftian Filariasis
Differential Diagnoses & Workup: Bancroftian Filariasis
Treatment & Medication: Bancroftian Filariasis
Follow-up: Bancroftian Filariasis
Multimedia: Bancroftian Filariasis
References
Further Reading
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Further Reading

See Image 28 and Image 56 at the McGill Faculty of Medicine Web site.

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Keywords

bancroftian filariasis, adenolymphangitis, ADL, Aedes, Anopheles, chyluria, Culex, elephantiasis, filarial arthritis, filarial-associated immune complex glomerulonephritis, filarial breast abscess, filarial disease, filarial infection, filariasis, hepatomegaly, human filariasis, hydrocele, lymphatic filariasis, Mansonia, microfilaremia, occult bancroftian filariasis, tropical pulmonary eosinophilia, TPE, Wuchereria bancrofti, W bancrofti

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Contributor Information and Disclosures

Author

Robert W Tolan Jr, MD, Chief, Division of Allergy, Immunology and Infectious Diseases, The Children's Hospital at Saint Peter's University Hospital; Clinical Associate Professor of Pediatrics, Drexel University College of Medicine
Robert W Tolan Jr, MD is a member of the following medical societies: American Academy of Pediatrics, American Medical Association, American Society for Microbiology, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, Phi Beta Kappa, and Physicians for Social Responsibility
Disclosure: GlaxoSmithKline Honoraria Speaking and teaching; MedImmune Honoraria Speaking and teaching; Merck Honoraria Speaking and teaching; sanofi pasteur Honoraria Speaking and teaching; Baxter Healthcare Honoraria Speaking and teaching

Medical Editor

Rosemary Johann-Liang, MD, Medical Officer, Infectious Diseases and Pediatrics, Division of Special Pathogens and Immunological Drug Products, Center for Drug Evaluation and Research, Food and Drug Administration
Rosemary Johann-Liang, MD is a member of the following medical societies: American Academy of Pediatrics, American Medical Association, and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Martin Weisse, MD, Program Director, Associate Professor, Department of Pediatrics, West Virginia University
Martin Weisse, MD is a member of the following medical societies: Ambulatory Pediatric Association, American Academy of Pediatrics, and Pediatric Infectious Diseases Society
Disclosure: Nothing to disclose.

CME Editor

Daniel Rauch, MD, FAAP, Director, Pediatric Hospitalist Program, Associate Professor, Department of Pediatrics, New York University School of Medicine
Daniel Rauch, MD, FAAP is a member of the following medical societies: Ambulatory Pediatric Association, American Academy of Pediatrics, and Society of Hospital Medicine
Disclosure: Baxter Honoraria Consulting

Chief Editor

Russell W Steele, MD, Head, Division of Pediatric Infectious Diseases, Ochsner Children's Health Center; Clinical Professor, Department of Pediatrics, Tulane University School of Medicine
Russell W Steele, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Immunologists, American Pediatric Society, American Society for Microbiology, Infectious Diseases Society of America, Louisiana State Medical Society, Pediatric Infectious Diseases Society, Society for Pediatric Research, and Southern Medical Association
Disclosure: None None None

 
 
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