1. RANJAN BANERJEE BIOL 062 NOVEMBER 20 TH 2008 Lymphatic Filariasis

2. What is Lymphatic Filariasis? Parasitic disease of lymphatic system

3. What is Lymphatic Filariasis? Parasitic disease of lymphatic system Circulates in blood

4. What is Lymphatic Filariasis? Parasitic disease of lymphatic system Circulates in blood Almost exclusively in humans

5. What is Lymphatic Filariasis? Parasitic disease of lymphatic system Circulates in blood Almost exclusively in humans Among world's leading causes of disability

6. What is Lymphatic Filariasis? Parasitic disease of lymphatic system Circulates in blood Almost exclusively in humans Among world's leading causes of disability Increasing due to unchecked urbanization

7. Prevalence Endemic in tropical regions  Asia, Africa, Central/South America

8. Prevalence >120 million people infected 1 billion at risk for infection

9. Cause Three worms  Wuchereria bancrofti - 90% of cases  Brugia malayi  Brugia timori

10. Transmission cycle is complicated CDC Public Image Library

11. Risk Group People in tropical/subtropical regions www.groovythemes.com/nature/tropics.shtml

12. Repeated mosquito bites over many years dvice.com/archives/2008/07/sk_telecom_offe.php

13. Symptoms Most due to dysfunctional lymphatic system The Physiotherapist Pte Ltd.

14. Symptoms Lymphedema  Gangrene

15. Symptoms Genital damage - hydrocele  10-50% men http://img.tfd.com/dorland/hydrocele.jpg

16. Filarial antigens provoke immune responses Increasing levels of IgE and IgG4

17. Symptoms (cont’d) pulmonary tropical eosinophilia syndrome  Inflammation of the lung  Cough, shortness of breath myweb.lsbu.ac.uk/dirt/museum/p6-633.html

18. Symptoms Manifestation may take years

19. Diagnosis Giemsa stain – differential stain

20. But doing smear is complicated.. Nocturnally periodic Nuchprayoon et al. Filaria Journal 2007 6:6 doi:10.1186/1475-2883- 6-6

21. Serology is another method Immunoglobulin test - antifiliarial IgGs

22. Treatment diethylcarbamazine (DEC)  Kills microfilarae  Prevents transmission Albendazole  Kills adults and microfilarae

23. Slightly different in Africa Ivermectin instead of DEC  Side effects with other diseases  River blindness

24. Secondary Treatment Good hygiene is important http://www.a-wol.net/images/on_legs.jpg

25. Socio-economic Impact Disease of the poor  Incapacitates  cycle http://www.bbc.co.uk/radio4/today/gallery/media/poverty2.jpg

26. Social stigma “Her husband left her when he realized that her legs would not shrink, she said. As her new boyfriend, a handsome out-of-work carpenter, sold goods nearby, she said, "I don't know if he will leave me, too.” - Antoinette St. Fab

27. Efforts In 1993 identified as one of six eliminable infectious diseases In 1997, World Health Assembly called for elimination of LF worldwide

28. WHO: Global Programme to Eliminate LF Goal 1: break cycle of transmission MDA  Combination therapy  Donated Drugs

29. WHO: Global Programme to Eliminate LF Goal 2: Alleviate suffering in infected persons  Community education programs  Community care © Global Alliance to Eliminate Lymphatic Filariasis

32. Future September 20 th, 2007 – genome of Brugia malayi mapped  Vaccine? http://wishart.biology.ualberta.ca/BacM ap/cgview_linked_maps/NC_006833/p ng/1_1.png