Professor Jack M.

Regala, RMT, MPH, DAP&E

BSMLS 2B
References: Online Lecture | PPT Presentation | Belizario 3rd Ed | CDC RMT 2025

OTHER NEMATODES
TOPIC OUTLINE
I. Angiostrongylus spp.
II. Trichinella spiralis
III. Dracunculus medinensis
IV. Lymphatic Filariasis
V. Non-Lymphatic Filariasis
VI. Dirofilaria

I. Angiostrongylus spp.
→ Angiostrongylus is the same as
Parastrongylus
Order Strongylida → Adult worms taken from a rat (Rattus rattus)
Family Metastrongyloidea found in the town where this case occurred. The
→ Foodborne worm on the left is a male and the larger worm
→ includes 20 species infective to mammals (2 on the right is a female where the typical
are pathogenic to man) barber-pole-like dark intestine can be seen
• Angiostrongylus cantonensis through he translucent body
→ neurotropic, causes eosinophilic
meningoencephalitis (neural LIFE CYCLE
angiostrongyliasis), and occasional ocular
angiostrongyliasis
• Angiostrongylus costaricensis
→ causes abdominal strongyliasis
(intestinal angiostrongyliasis)
• Others:
• A. mackerrase, A. malaysiensis
→ causes eosinophilic
meningoencephalitis in Australia and
Southeast Asia, respectively

Angiostrongylus cantonensis
→ “Rat lungworm”
→ Prevalent in the Pacific Islands and
Southeast Asia Gastropod Intermediate Hosts: Mollusk
→ Adult Males: 20-25 mm x 0.32-0.42 mm Definitive Host Rat (Rattus rattus)
→ Adult Females: 22-34 mm x 0.34-0.56 mm Intermediate Host Mollusk (Gastropods)
Accidental Host Man
Infective Stage L3 larvae

DIAGNOSIS
→ A history of eating raw or undercooked
mollusks
→ Peripheral eosinophilia (↑eosinophil count)
→ Spinal fluid eosinophilia
→ Demonstration of larvae and young adults in
CSF
→ IgM and IgE serum antibodies by ELISA and
→ Adult A. cantonensis recovered from rat Immunoblot analysis
lungs. A.) Adult female worm with characteristic →Real-time Polymerase Chain Reaction of
barber pole appearance (anterior end of the CSF specimens
worm is top). Scale bar = 1mm. B.) tail of the
adult male, showing copulatory bursa and long Note: Specimen of choice is the Cerebrospinal Fluid
spicules (arrow. Scale Bar = .85mm (CSF) because it is neurotropic, affects the CNS

RUMPON | BSMLS 2B 1
 Professor Jack M. Regala, RMT, MPH, DAP&E
BSMLS 2B
References: Online Lecture | PPT Presentation | Belizario 3rd Ed | CDC RMT 2025

OTHER NEMATODES
TREATMENT LIFE CYCLE

According to Sir Jack’s PPT

• Levamisole and Thiabendazole
→ used for the treatment of
eosinophilic meningoencephalitis
though their effectiveness is still
doubtful

According to Belizario 3rd Ed

• No anthelminthic treatment is
recommended at present, although
mebendazole and albendazole have
been demonstrated to effectively treat
parastrongyliasis in China, Taiwan , and
Thailand
• Anthelminthic therapy has been
Habitat: Pulmonary arteries
shown to relieve symptoms and reduce
the duration of the disease. Definitive Host Rat (Rattus rattus)
• Ocular parastrongyliasis may require Intermediate Host Slug
surgical removal of worms from the Accidental Host Man
eyes Infective Stage L3 larvae
• Symptomatic treatment with the use of
analgesics and lumbar puncture can DIAGNOSIS
relieve headaches experienced by the → Serological Test (ELISA, Latex agglutination
patient with eosinophilic meningitis tests)
• Prednisone 30mg daily is → Radiological Examination: shows a mass in
recommended, particularly in severe the right lower quadrant, thickening of the
cases with cranial nerve involvement intestine wall at the ileo-cecal region and a
• Anti-inflammatory and narrowed intestinal lumen
immunosuppressive affects of steroids
are helpful in mitigating the disease
TREATMENT
progress
• Thiabendazole
PREVENTION AND CONTROL • Thiabendazole in combination with
→ ingestion of infected hosts and water/ Diethylcarbamazine (DEC)
vegetables contaminated with L3 larvae must • High-dose Mebendazole
be avoided • Surgical Treatment- for definitive cure
→ killing of larvae by boiling for 2-3 minutes or
freezing at -15°C for more than 12 hours II. Trichinella spiralis
→ wash all fruits and vegetables → causes Trichinosis, also known as
→ cook food thoroughly Trichinellosis
→ Foodborne (eating pork)
→ cover tanks and containers
→ Most infections are subclinical
Watch: https://www.youtube.com/watch?v=V_f1IK93ZtE • Minimum infective dose to produce
symptoms: 100 larvae
Angiostrongylus costaricensis • Fatal dose: 300,000 larvae
→ Adult Males: 140 mm x 22mm → Disease stages:
→ Adult Females: 350 mm x 42 mm • Intestinal invasion
→ Egg: Oval, about 90 μm long, have a thin → occurs within 2-3 weeks that includes
shell, and embryonated (may be embryonated the penetration and development of adult
in human) with some larvae released from the parasites and appearance of symptoms
eggs) • Larval Migration
→ include the invasion of muscles: fever,
myalgia, periorbital edema, hemorrhages in

RUMPON | BSMLS 2B 2
 Professor Jack M. Regala, RMT, MPH, DAP&E
BSMLS 2B
References: Online Lecture | PPT Presentation | Belizario 3rd Ed | CDC RMT 2025

OTHER NEMATODES
mucus membranes, nailbeds, sclera of the
eyes, eosinophilia
→ damage caused by larvae penetrating
cells becomes serious when this occurs in
cardiac and CNS tissues. Myocarditis,
sometimes severe enough to cause death,
is transient as Nurse cells cannot form in
the heart tissue. In the CNS, larvae tend to
stay and wander about frequently cause
significant damage even in mild infections
• Encystation
→ in striated muscles of hosts (pigs, man,
rats)
→ caused by Trichinella spiralis
Trichinella spiralis (Larvae)
→ Common Name: Trichina worm
• Size: 80 μm length x 7-8 μm diameter
→ Geographical Distribution: Cosmopolitan,
• Encysted Larvae (infective stage): 1mm
but is more prevalent in Europe and US than in
length x 36 μm diameter
the Tropics and the Orient
→ Encystation only occurs in the striated
→ Habitat
muscles (not in other tissues as they
• Encysted larvae: striated muscles of pigs,
degenerate and other are absorbed →
rats, and man
calcification)
• Adults: small intestine (duodenum and
jejunum)
LIFE CYCLE

→ Male: 1.4-1.6 mmm in length x 0.44 mm

diameter while Female: 3.4 mm length x 0.66
mm diameter (one of the smallest nematodes in
man)
→ The male bears a pair of conspicuous
papillae (claspers) that it uses to hold on the
female worm during mating
→ Viviparous (release l1 larvae in the intestinal LABORATORY DIAGNOSIS
mucosa) • Detection of Spiral Larvae in muscle
→ the male dies after fertilizing the female. The tissue (muscle biopsy of biceps, deltoid,
female dies after 16 weeks (after discharging gastrocnemius, pectoralis)
the larvae) • Detection of Adult worm and Larvae in
stool during diarrheic stage (occasionally
positive only)
• Blood examination: slightly elevated WBC
count (12-15 x109/ L) with eosinophilia (20-
95%)

RUMPON | BSMLS 2B 3
 Professor Jack M. Regala, RMT, MPH, DAP&E
BSMLS 2B
References: Online Lecture | PPT Presentation | Belizario 3rd Ed | CDC RMT 2025

OTHER NEMATODES
• Serology: detection of T. spiralis antibody → Therefore, eradication programs require
ELISA using antigens obtained from the stopping infections both in humans and animals
infective stage Definitive hosts Domestic dogs and
• History of having eaten raw/ improperly cats
processed pork/ pork products (2 weeks Intermediate hosts Cyclops
earlier) + Occasions of “gastroenteritis” Final hosts Man
• Bachman Intradermal Test : immediate Habitat Subcutaneous
small white swelling around the site of tissue
injection surrounded by an unraised, Infective stage L3 larvae
irregular, erythematous wheal 5cm
diameter with 15-20 minutes after injection LIFE CYCLE
• X-ray Examination : presence of calcified
cysts

TREATMENT
• Mebendazole
→ 100 mg thrice a day for 3 days
(recommended therapy)

PREVENTION
Trichinosis can be prevented by:
• Properly cooking pork or freezing at -20°C
for 3 days
• Inspection of slaughtered pigs (meat
inspection)
• Preventing pigs from eating raw meat and • Humans get infected by drinking stagnant
offal (intestine, internal organs → waste water contaminated with tiny water fleas
feeding) (cyclops) that carry infective stage guinea-
worm larvae
III. Dracunculus medinensis • Inside the body, the larvae mature into
→ causes Dracunculiasis worms, growing up to 1 meter in length.
→ also called • Painful blister occurs 90% of the time on the
• Guinea worm lower leg- and one or more worms emerge
• Disease of the Empty Granary accompanied by a burning sensation
• Fiery serpent of the Israelites • The painful blisters eventually burst open to
→ viviparous nematode (they discharge expose the female worm on the skin. To
embryos (larvae) into the water) soothe the burning pain, patients often
→ vector borne disease (cyclops/ copepods/ immerse the infected area in water. In the
water fleas) water, the worm then releases thousands
of larvae, contaminating the water source
→ Adult worm: female worms could reach 50cm
and life cycle of Dracunculiasis to continue
in length and 1.5mm in diameter. Male worms
in water fleas
are rarely seen and die after mating.
→ Intermediate host: Cyclops
• Mesocyclops spp.
• Thermocyclops vermifer
• Eucyclops seralatus

TRANSMISSION
→ animals infected with same species of
nematode, D. medinensis
→ Found in domestic dogs and cats

RUMPON | BSMLS 2B 4
 Professor Jack M. Regala, RMT, MPH, DAP&E
BSMLS 2B
References: Online Lecture | PPT Presentation | Belizario 3rd Ed | CDC RMT 2025

OTHER NEMATODES
Currently, there is no medication or vaccine to • Filtration of drinking water to prevent
treat/ prevent infection. infection
• Intense surveillance and control to detect
STICK THERAPY for Dracunculus every case within 24 hours of the
medinensis emergence of worms
• Treatment of ponds with the larvicide
temephos that kills the water fleas
• Promoting health education and behavior
change

IV. LYMPHATIC FILARIASIS

CLASS NEMATODA
EXTRA-INTESTINAL
Guinea-worm disease does not kill, but infected FILARIAL GROUP
people become non-functional for months. LYMPHATIC NON-LYMPHATIC
Since peak transmission period often coincides FILARIASIS FILARIASIS
with agricultural season, fields are left untended • W. bancrofti • O. volvulus
and food production level goes down. In Mali, • B. malayi • Loa loa
guinea -worm disease is called “the disease of • B. timori • Mansonella spp.
the empty granary”. As adults lie sick, older • B. pahangi • Dirofilaria
children must take on the household chores
and miss months of schooling. Small children → Neglected Tropical Disease (NTD)
might miss vital vaccinations. → also known as Elephantiasis or Untut
→ Lymphatic Filariasis is vector borne parasitic
Early case detection (when the patient feels the
disease that is endemic in many tropical and
initial pain) is vital top contain the disease.
subtropical countries
There are thousands of village volunteers in the
→ The disease is caused by white, slender
remaining endemic countries who are trained to
find new cases, take care of them, and report roundworms: Wuchereria bancrofti (90%) and
them to area supervisors. remaining by Brugia malayi and Brugia timori
→ Live for 5-7 years, produce millions of
Once a new case is identified, the volunteer offspring (microfilaria)
must clean, disinfect and bandage the wound → Block the lymphatic system
to protect it from secondary infections. The → network of channels and lymph nodes that
volunteer returns every other day to gradually helps maintain fluid level in the body
pull the worm out, a few painful inches each → Blockage leads to edema (collection of fluid
day. in tissues)

The worm must be pulled out gently (by winding BANCROFTIAN FILARIASIS
to a matchstick or slow pulling) to avoid → exclusive to humas
breaking or tearing it apart. Broken worms lead → species: Wuchereria bancrofti
putrefaction (worms rotting inside the ulcer) and
→ widely distributed in tropical and subtropical
skin slough surrounding the worm. Pulling out
countries
the worms is very painful ( like skin burnt on
→ several curvatures and graceful appearance
fire).

PREVENTION AND CONTROL

A successful eradication program for guinea -
worm disease comprises several preventive
strategies such as:
• Ensuring wider access to safe drinking-
water supplies

RUMPON | BSMLS 2B 5
 Professor Jack M. Regala, RMT, MPH, DAP&E
BSMLS 2B
References: Online Lecture | PPT Presentation | Belizario 3rd Ed | CDC RMT 2025

OTHER NEMATODES
BRUGIAN FILARIASIS
→ in both humans and animals
→ Species:
• Brugia malayi
• Brugia timori
• Brugia pahangi
→ Widely distributed in Asia
→ in animal reservoir host: cats, macaques
(Macaca spp.), leaf monkeys (Presbytis spp.)
→ angular curvatures with secondary kinks

Infective Stage to L3 larvae

Man
Infective Stage to Microfilaria
the Mosquito
Definitive Host of W. Man
bancrofti
Intermediate Host Mosquito

GEOGRAPHICAL DISTRIBUTION PERIODICITY

AND VECTORS → presence of microfilariae in the peripheral
blood circulation in relation to time and day
Bancroftian Brugian Filariasis Microfilariae present
Filariasis Nocturnal Periodicity in greatest number in
Wuchereria Brugia malayi Brugia timori peripheral blood
bancrofti during night hours
• Culex • Mansonia • Anopheles Microfilariae are
• Aedes • Aedes
• Anopheles • Anopheles
present in greatest
Diurnal Periodicity number in the
Occurs in Africa, Occur mainly in Limited to peripheral blood
SEA, India, China, India, Timor Island of during day hours
Pacific island, Malaysia, Indonesia
and Latin Philippines, Microfilariae can be
America Indonesia, and found in the
Pacific Island Nocturnal Sub peripheral blood
Periodicity or Diurnal through 24 hours
LIFE CYCLE Sub Periodicity with only a slight
increase in number
during day or night
hours

Bancroftian Filariasis
→ many areas
→ nocturnal periodicity (10pm to 2am)
→ absent during daytime
→ transmitted by Culex and Anopheles spp.
→ in Pacific Islands, exhibit sub periodicity
o Presence of microfilariae all time of
the day
o Highest microfilaremia between
noon-8am
o Transmitted by Aedes spp.
Note: When not in blood stream, microfilaria reside in the
capillaries and small vessels of lungs

RUMPON | BSMLS 2B 6
 Professor Jack M. Regala, RMT, MPH, DAP&E
BSMLS 2B
References: Online Lecture | PPT Presentation | Belizario 3rd Ed | CDC RMT 2025

OTHER NEMATODES
Brugian Filariasis ACUTE CONDITION
Brugia malayi → fever | lymphangitis | lymphadenitis
→ depending on areas may develop → also known as elephantid fever
subperiodic/ periodicity → begins with chills → high fever 1-2 days →
→ vector Mansonia (zoophilic strain)
gradually subside in 2-5 days
→ vector Anopheles (Anthropophilic strain)
→ lymphangitis commonly affect limbs but may
occur in breast, scrotum, other parts on the
Brugia timori
→ only exhibit nocturnal periodicity limbs progress distally from affected lymph
node
→ vector Anopheles barbirostris
→ lymphangitis recur periodically
Note: Nocturnal or sub periodic activity may overlap with
bancroftian filariasis areas → accompanied by lymphadenitis and abscess
along lymph vessel and nodes
PATHOGENICITY
→ Pathogenic effects are produced by adult Note:
worm (living/dead) Lymphangitis: inflamed lymphatic vessels,
→ Due to presence/ movement, production of distended and tender; overlying skin hot, tender
and swollen, on and off
toxin or metabolite of adult worms leads to
Lymphadenitis: inflamed and enlarged lymph
lymphangitis and lymphadenitis
nodes , usually and epitrochlear nodes; firm’
→ The lymph valve becomes damaged due to
discrete and tender; epitrochlear nodes occur
repeated inflammation which permits the
for sub periodic only; permanent disorder
leakage of fluid high concentration of protein
into surrounding tissue
CHRONIC CONDITION
→ Repeated leakage of lymph into tissue → Elephantiasis
results first in lymphoedema then to
→ may develop in any limbs
elephantiasis of one or more limb, breast,
→ more common in scrotum, breast, vulva
penis, scrotum, or vulva
→ permanent disfigurement
Recurrent lymphangitis → leads to secondary bacterial and fungal
and lymphadenitis infections

Lymphoedema In Brugian filariasis (contrast to Bancroftian

filariasis)
→ lymphadenitis most frequent in inguinal are
Elephantiasis (groin)
→ no involvement of genitalia and chyluria
→ elephantiasis involve leg below the knee,
arm below elbow

Chyluria: presence of milky fluid containing fat

droplets in the urine stream, which results in
urine appearing milky white

GENITO URINARY INVOLVEMENT

(HYDROCELE)
→ more common in Bancroftian filariasis
→ common in males
→ residence of adult worms
→ Diagnosed by ultrasound: Filarial Dance
Sign (FDS)
→ due to repeated dilation and inflammation of
lymph vessels in the inguinal, scrotal, testicular,
and abdominal sites

RUMPON | BSMLS 2B 7
 Professor Jack M. Regala, RMT, MPH, DAP&E
BSMLS 2B
References: Online Lecture | PPT Presentation | Belizario 3rd Ed | CDC RMT 2025

OTHER NEMATODES
→ rupture of lymph varices leads to release of Diurnal sub-periodic 14:00-18:00 (peak at
lymph to surrounding tissue and lead to lymph W. bancrofti 16:00)
scrotum Nocturnal periodic B. 22:00-04:00 (peak at
→ the development of lymph scrotum results in malayi 24:00)
Nocturnal sub- 20:00-22:00 (peak at
chyluria with lymph getting in urine
periodic B. malayi 21:00)
→ presence of microfilaria in these fluids
Nocturnal periodic B. 22:00-04:00 (peak at
timori 24:00)
Occult Filariasis due to microfilaria
(Cryptic Filariasis) IMMUNOASSAY
Occult Filariasis Acute or Chronic → Serology-based diagnostic tools can be
Filariasis
divided into 2 categories:
→ also called → due to adult
• Antigen-detection assays
Tropical Pulmonary worms- movement/
Eosinophilic mechanical blockage • Antibody-detection assays
Syndrome (TPE) of dead worms
→ symptomatic but → microfilaria in PB And examples of established qualitative and
amicrofilaremic circulation quantitative test kit for detection:
→ microfilaria not in → presence/
blood but in organ absence of Wuchereria bancrofti
→ microfilaria microfilaremic • AlereTM Filariasis Test Strip
present but in lungs, symptoms • Og4C3-ELISA (Cell Labs)
liver, spleen, NOT IN → antifilarial drugs •
PB has no effect in Brugia malayi and Brugia timori
→ features: chronic filariasis • Brugian Rapid (Reszon Diagnostics)
paroxysms of • PanLF Rapid (Reszon Diagnostics)
nocturnal cough,
wheezing and
FILARIASIS TEST STRIP (FTS)
breathlessness
→ AlereTM Filariasis Test Strip – since 2013
→ lab test: presence
of antifilarial → Currently manufactured by Abbott
antibody, high serum → Recommended by WHO for mapping,
IgE antibody monitoring and evaluation activities
→ Similar with previous assay (different
DIAGNOSIS format):
→ clinical observation or/ and supplemented • BinaxNOW Filariasis Card Test (Alere,
with laboratory diagnosis Scarborough, ME)
• Immunochromatography Card Test (ICT)
MICROSCOPY • Used since 2000
→ gold standard
→ examination of blood for microfilariae at TREATMENT
correct based on their periodicity → surgical excision of excess skin/ abscess/
→ thick blood smears are stained with Giemsa ulcer
stain → treat bacterial/ fungal infections
→ in case of low parasitemia or when samples → lymphatic channel reconstruction
are collected at suboptimal times, → Self-management of patients to deal with the
concentration techniques may help to detect disease
circulating microfilariae • Practicing self-hygiene
• Prevention and cure of lesion entry
Periodic form of Collection time • exercise
filarial parasite
• use proper footwear
Nocturnal periodic 22:00-04:00 (peak at
W. bancrofti 24:00)
Nocturnal sub- 20:00-22:00 (peak at
periodic W. bancrofti 21:00)

RUMPON | BSMLS 2B 8
 Professor Jack M. Regala, RMT, MPH, DAP&E
BSMLS 2B
References: Online Lecture | PPT Presentation | Belizario 3rd Ed | CDC RMT 2025

OTHER NEMATODES
V. NON-LYMPHATIC FILARIASIS → wandering of adult causing subconjunctival
Loaisis of the eye
Loa loa
Fly vector Onchocerca volvulus MICROFILARIAE
Mansonella spp. → sheathed and measure 250-300 µm long in
Mosquito vector Dirofilaria spp. stained blood smears
→ the tail is tapered, and nuclei extend to the
GENERAL LIFE CYCLE OF NLF tip of the tail
→ microfilariae circulate in blood (diurnal
periodicity, peaks at midday)
Stain: Giemsa Stain

LIFE CYCLE

VECTORS OF NLF

Loa loa
Vector: Female Mango Fly Species:
• Chrysops dimidiate
• Chrysops silacea
• Other spp.

Onchocerca volvulus
Vector: Female Black Fly
Genus: Simulium fly
CLINICAL SIGNS AND SYMPTOMS
→ most infected people are symptomatic
Mansonella ozzardi
Vector: Female Cullicoides spp. and Black → adult worms wander in subcutaneous tissues
Fly of man
Biting midge and Simulium spp. → most common on back of hands and arms
causing hypersensitivity reactions → painless
Mansonella perstans swelling known fugitive or Calabar swelling
Vector: Female Cullicoides spp. and Black → wanders slowly across conjunctiva of the eye
Fly
→ subconjunctival Loaisis
Cullicoides spp.
Biting Midge → removal via surgery
→ peripheral blood shows high eosinophilia
Loa loa
→ common name: African eye worm DIAGNOSIS OF LOIASIS
→ Disease: Loiasis • PARASITOLOGIC DIAGNOSIS

ADULT ADULT
→ Adult worms are thin, whitish, and thread like → observation of an adult worm
subconjunctivally crossing the eye
→ Female: 40-70 mm in length and 0.55 mm in
→ identification of an adult worm removed from
diameter
the eye or skin
→ survive up to 17 years in human body
→ live in subcutaneous connective tissue

RUMPON | BSMLS 2B 9
 Professor Jack M. Regala, RMT, MPH, DAP&E
BSMLS 2B
References: Online Lecture | PPT Presentation | Belizario 3rd Ed | CDC RMT 2025

OTHER NEMATODES
MICROFILARIA → the adult females lie coiled in the fibrous
→ microscopic detection of microfilaria in subcutaneous nodules, life span 8-15 years
peripheral blood → the males migrate in the subcutaneous
→ collection time (diurnal periodicity: 10 am tissues to the nodules for reproduction
and 2 pm (peak)
MICROFILARIA
• SEROLOGY TEST → the microfilaria actively migrates throughout
→ many serologic test for antibodies does not the dermis and connective tissue
differentiate Loa loa from other filarial → unsheathed and only about 150 to 350 µm
nematode infection long
→ non periodic and may live for 30 months
• PCR
→ Quantitative PCR (qPCR) tests have been LIFE CYCLE
developed, but they are not widely available in
laboratory

TREATMENT
→ Recommended drug: Diethylcarbamazine
(DEC), Albendazole (ALB), and Ivermectin
(IVM)
→the treatment strategy depends on the risk of
adverse events, which is related to microfilarial
density

Adverse effects of DEC and Ivermectin

• DEC only suitable for mild loiasis
monoinfection
• For heavy infection
→ (> 8000 Loa loa microfilaria/ mL of blood)
CLINICAL SIGNS AND SYMPTOMS
DEC inflammation caused by the rapid
→ adult worms grow in subcutaneous tissues
release of antigens from dying microfilariae
are at the risk of brain damage and death into dense fibrous nodules at sites where bones
are prominent (knees, hips, iliac crest, ribs,
In the case of coinfection (Loiasis + scapulae, elbows, scalp)
Onchocerciasis) → nodules are movable, painless
→ Ivermectin often leads to severe or fatal → they are called onchocercomas (1 nodule
complication may contain 2-3 females with 1-2 male worms)
→ DEC, primary treatment of Low-level Loa loa → microfilaria wanders through the skin and
infection, can result in a severe systemic reach the eyes → corneal and retinal lesion →
reaction (Mazzotti reaction) in individuals with blindness
onchocerciasis → while wandering, it causes severe itching
and chronic itch leads to gross thickening of
Onchocerca volvulus skin → dermatitis called sowda
→ Common Name: The convoluted filaria/ river → chronic loss of elasticity of skin around
blindness inguinal area (groin) associated with enlarged
→ Disease: Onchocerciasis lymph nodes caused “hanging groin”
→ in long standing and heavy infections,
ADULT disfiguring skin lesions develop, the most
→ whitish, wire like, less than 5mm in diameter. common being a mottled depigmentation of the
The females are much larger than males, skin known as “leopard skin” and generalized
measuring up to 50 cm whereas males are not dermal atrophy
more than 5 cm long

RUMPON | BSMLS 2B 10
 Professor Jack M. Regala, RMT, MPH, DAP&E
BSMLS 2B
References: Online Lecture | PPT Presentation | Belizario 3rd Ed | CDC RMT 2025

OTHER NEMATODES
DIAGNOSIS M. streptocerca Affcets man and
→ Parasitological diagnosis by skin snip biopsy non-human primates
→ elevating a small cone of skin (3mm in
diameter) with a needle VECTORS OF MANSONELLOSIS
→ shaving it off with a scalpel
Mansonella streptocerca
→ tissue is then incubated in normal saline at
• Primary vector is Cullicoides grahamii, a
room temperature (24 h) to allow the
day-biting midge
microfilaria (larva) to emerge • Its geographic distribution overlaps with
→ identification by microscopy that of M. perstans. O. volvulus, and Loa
loa
MANAGEMENT AND TREATMENT
• Vector Control Mansonella ozzardi
→ kill larvae of the black fly vectors using • In the West Indies, Surinam, and
environmentally safe insecticides Argentina, Cullicoides species of biting
→ Onchocerciasis Control Program in West midges are the vectors of M. ozzardi
Africa (OCP) conduct vector control weekly by • In Brazil and Columbia, Blackflies
(Simulium amazonicum and Simulium
aerial spraying of insecticides over fast-flowing
sanguineum) are the vectors
rivers and streams- the breeding sites of
blackflies
Mansonella perstans
• Ivermectin (Mectizan)
• Biting midges species Cullicoides
→ Paralyses and kills microfilaria, relieve austeni and Cullicoides grahammi
intense itching and stops progression to
blindness, reduces transmission by preventing LIFE CYCLE
adult worms to produce more microfilaria
→ single dose to be taken annually
→ free cost by Merck & Co. since 1987
(Mectizan Donation Program)

Mansonella spp.
→ Disease: Mansonellosis
→ human mansonellosis is caused by M.
perstans, M. ozzardi, and M. streptocerca, the
three main filarial species in genus Mansonella

Mansonella spp. Geographic

Distribution
Mostly in wet
subtropical and
M. perstans tropical areas of
Africa, form Senegal
to Zimbabwe and
South America
Distributed in tropical
M. ozzardi regions of North and
South America, from
Mexico to Argentina
M. streptocerca West and Central
Africa

M. perstans Man is the only

definitive host
M. ozzardi Man is the only
definitive host

RUMPON | BSMLS 2B 11
 Professor Jack M. Regala, RMT, MPH, DAP&E
BSMLS 2B
References: Online Lecture | PPT Presentation | Belizario 3rd Ed | CDC RMT 2025

OTHER NEMATODES

Mansonella perstans
• identifying non-sheathed microfilariae in
a blood smear. Microfilariae can be
identified in blood both day and night
(non-periodic)
• eosinophilia is often present

TREATMENT

Mansonella streptocerca
• Diethylcarbamazine (DEC) treatment is
effective against both microfilariae and
adults
CLINICAL SIGNS AND SYMPTOMS • However, it has been commonly
associated with significant adverse drug
reactions
Mansonella streptocerca
• Ivermectin: 150 µg/kg, single dose; not
• usually asymptomatic active against adult worm
• the symptoms are similar with
onchocerciasis. The most common
Mansonella ozzardi
presentation is a chronic itching
dermatitis (streptocerciasis); Mazzotti- • Optimal treatment has not been defined
like papules of skin following DEC • Ivermectin: 200 µg/kg, single dose
reduces microfilariae
Mansonella ozzardi • Not active against adult worms
• Treatment with DEC or albendazole is
• usually asymptomatic
ineffective
• although M. ozzardi infection is usually
described as relatively harmless, it has
been associated with keratitis Mansonella perstans
• Anthelminthic drugs have limited efficacy
Mansonella perstans • Diethylcarbamazine (DEC) +
mebendazole: 200 mg/ 12 hrs + 100-200
• usually asymptomatic
mg/day x 21 days
• symptoms are related to the migration of
• Mebendazole: 100 mg/ 12hrs x 30 days
the worms, and include transient
subcutaneous swellings (similar to the • Doxycycline: 200 mg/ day x 6 weeks
Calabar swellings caused by Loa loa) • Doxycycline kills adult worms by killing
• degenerating adult worms may manifest Wolbachia bacteria on which adult worm
as focal abscesses that can develop into depend in order to survive
granulomas and scars
→ The use of DEC and Ivermectin should be
DIAGNOSIS closely monitored especially in the region co-
exist with Loiasis and/or Onchocerciasis
Mansonella streptocerca → No current large-scale filariasis control
• identifying the microfilariae in skin snips program is targeting mansonellosis
or biopsies → Mansonellosis is not listed among the
• blood can be drawn at any time (non- neglected diseases by WHO
periodic) → No control strategy has not been defined
against human filariasis
Mansonella ozzardi
• the diagnosis is confirmed by identifying Refer to attached table for the morphology
non sheath microfilariae in blood or skin
specimen VI. Dirofilaria
• blood can be drawn at any time (non-
→ type of non-lymphatic filariasis
periodic)
→ caused by Dirofilaria immitis and Dirofilaria
repens

RUMPON | BSMLS 2B 12
 Professor Jack M. Regala, RMT, MPH, DAP&E
BSMLS 2B
References: Online Lecture | PPT Presentation | Belizario 3rd Ed | CDC RMT 2025

OTHER NEMATODES
→ Disease: Dirofilariasis CLINICAL SIGND AND SYMPTOMS
→ a zoonotic parasitic disease caused by a
nematode worm in the filarial (non-lymphatic) Dirofilaria immitis
group. • Many people are asymptomatic
→ also known as the Dog (Canine) or Cat therefore prevalence maybe
underestimated
(Feline) Heartworm Disease because it is
• D. immitis is most often associated with
mostly found among domestic dogs and cats,
coin lesions of the lung, usually a single
also among wild carnivores solitary nodule containing the adult
→ the parasite is transmitted trough mosquito worm, that can be mistaken as lung
bites of Culex pipiens, Aedes spp. and tumor
Anopheles spp. • Extrapulmonary infections can occur as
→ D. tenuis (racoon worm), D. ursi (bear), D. a hepatic nodule, cutaneous or
subdermata (porcupine, D. lutrae (North conjunctival nodule
American otter), D. striata (wild American
felines), and D. spectans (Brazillian otter) may Dirofilaria repens
also infect man • Is the most frequent and widespread
form of dirofilariasis in the world
LIFE CYCLE • The most common form is subcutaneous
or submucosal nodule containing adult
worm

Dirofilaria tenuis
• Causes subcutaneous facial nodules
and ophthalmic dirofilariasis in Florida

Dirofilaria striata
• Infections in the eye

Dirofilaria spectans
• Infections has been extracted from a
digital artery lesion of a Brazilian man

DIAGNOSIS
→ Clinical presentations
→ Laboratory Tests:
• Eosinophilia
• Serology CFT, ELISA, IHA tests give 75%
seropositivity rate
• PCR
• Imaging by X-ryas, MRI, CT scans,
ultrasound

→ Definitive Host: Dogs and Cats

→ Acquired by man through mosquito bites
(mosquito also bitten the dog, which is a carrier
of D. immitis) TREATMENT
→ mosquitoes will transmit the L3 larvae → surgical removal of adult worms
→ Dirofilaria spp. will not mature inside man → antifilarial drugs not effective

RUMPON | BSMLS 2B 13
 Professor Jack M. Regala, RMT, MPH, DAP&E
BSMLS 2B
References: Online Lecture | PPT Presentation | Belizario 3rd Ed | CDC RMT 2025

OTHER NEMATODES
→ regular veterinary care of domestic cats and
dogs
→ surgical biopsy of subcutaneous nodules
and HPE
→ bronchoscopy with cytology
→ open lung biopsy with wedge resection of
affected lung segment

Huwag mo ishare bhiee without permission, senkyuu!

________________________, fRMT
2nd year, 2nd semester | Midterms
Aral. Tiwala. Dasal

RUMPON | BSMLS 2B 14