MINISTRY OF HEALTH

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MINISTRY OF HEALTHPOPULATIONLymphatic
Filariasis Elimination Program
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MINISTRY OF HEALTHPOPULATIONLymphatic
Filariasis Elimination Program

• TRAINING COURSE
• FOR PHYSICIANS OF TARGETED PHCUs
• (3rd Round )

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MINISTRY OF HEALTHPOPULATIONLymphatic
Filariasis Elimination Program

TRAINING COURSE FOR PHYSICIANS OF TARGETED PHCUs
(3rd Round 9th SEPTEMBER2002 )
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Lymphatic Filariasis the disease

• Passed from human to human by mosquitoes which
  must survive at least ten days for transmission
  of microfilariae
• Parasites live in the lymphatic system for 4-6
  years, producing millions of microfilariae
• Infection acquired in childhood
• Obstacle to healthy development

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Lymphatic Filariasis the disease

• Lymphatic filariasis is primarily a disease of
  the poor because of its frequent prevalence in
  remote rural areas and disfavoured periurban and
  urban areas
• Filariasis patients are physically incapacitated
  and cannot work nor lead a normal life

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Lymphatic Filariasis distribution in Egypt
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Twin pillars of LF elimination

• Interrupt transmission
• mass treatment of at risk population
• Morbidity control - relief of suffering
• community-level care of those with disease
• lymphoedema
• acute inflammatory attacks
• hydrocoele repair

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Interrupt transmission

• Mass treatment of at risk population
• single-dose, once yearly 2-drug regimen
  albendazole DEC for 4-6 years

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Morbidity control

• Lymphoedema treatment
• assisting lymph flow elevation, exercise,
  bandages
• Prevention of acute inflammatory episodes
• preventing secondary bacterial infection
• soap and water hygiene
• skin care, treatment of entry lesion
• Hydrocoele management
• surgical repair

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Life cycle of lymphatic filarial parasites
HUMANS
adult worms in lymphatics
mf in blood
Exposure to infective vectors
Uptake by vectors
pathology
L 1
maturation
L 2
L 3
VECTORS
From Lymphatic Filariasis, Edited by Thomas B.
Nutman, Imperial College Press
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Life cycle of lymphatic filarial parasites
From Lymphatic Filariasis, Edited by Thomas B.
Nutman, Imperial College Press
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The lymphatic system

• Anatomy
• network of
• delicate porous vessels peripherally
• transport vessels (large)
• lymph nodes
• absence of intrinsic pumping mechanism

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The lymphatic system

• Anatomy
• network of
• delicate porous vessels peripherally
• transport vessels (large)
• lymph nodes
• absence of intrinsic pumping mechanism
• Function
• removes large molecules and excess fluid from
  interstitial spaces
• facilitates immune response to bacterial/antigen
  challenge

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The lymphatic system
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Effect of LF on the lymphatic system

• Anatomy
• adult worms live in the lymphatic system
• cause dilatation not obstruction
• dilatation leads to dysfunction
• Dysfunction
• accumulation of fluid (oedema) in tissues
• increased risk of infection
• transport of bacteria to lymph nodes is impaired,
  thus bacteria multiply in the tissues

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Suffering and disability caused by LF

• Physical
• Social
• Psychological
• Economic

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Suffering and disability caused by LF

• Physical
• acute inflammatory attacks
• disfigurement
• decreased mobility
• decreased function of limbs
• obesity
• hidden disease

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Suffering and disability caused by LF

• Acute inflammatory attacks
• painful bacterial infections of the skin and
  superficial tissues
• bacteria enter through breaks in the skin
• stasis of lymph provides conditions for rapid
  growth of bacteria
• high fever, pain, swelling, nausea
• last 5-7 days
• damage to small lymphatic vessels
• fibrosis and progression of elephantiasis

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Suffering and disability caused by LF

• Disfigurement
• lymphoedema
• elephantiasis
• hydrocoele
• male genital disease

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Suffering and disability caused by LF

• Hidden disease
• lymphatic damage and dysfunction
• risk of lymphoedema, acute attacks
• kidney damage
• blood and protein loss in the urine
• chyluria
• rupture of dilated lymphatics into urinary system
• leakage of lymph, lipids and protein wasting

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Suffering and disability caused by LF

• Physical
• Social
• Psychological
• Economic

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Suffering and disability caused by LF

• Social
• inability to care for self
• isolation from the community
• ostracism, loss of social support
• family stress
• caregiving
• shame, stigma
• sexual disability

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Suffering and disability caused by LF

• Physical
• Social
• Psychological
• Economic

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Suffering and disability caused by LF

• Psychological
• depression
• passivity
• hopelessness and fatalism
• suicide

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Suffering and disability caused by LF

• Physical
• Social
• Psychological
• Economic

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Suffering and disability caused by LF

• Economic
• decreased ability to work
• during acute inflammatory attacks
• lowered capacity due to chronic disease
• loss of family income
• costly treatment (often ineffective)