Brugia malayi

Brugia malayi

<p align="CENTER"><span style="font-size: large;"><i><b>Brugia malayi</b></i></span><span style="font-size: large;"><b> (Brug, 1928) Buckley, 1960</b></span></p> <p align="CENTER"><span style="font-size: large;"><b>(Figures 4-50 through 4-51)</b></span></p> <p align="JUSTIFY"></p> <p align="JUSTIFY"><span style="font-size: medium;"><b>ETYMOLOGY</b></span><span style="font-size: medium;">: </span><span style="font-size: medium;"><i>Brugia</i></span><span style="font-size: medium;"> for Dr. Brug and </span><span style="font-size: medium;"><i>malayi</i></span><span style="font-size: medium;"> for the area in which the parasite was initially isolated.</span></p> <p align="JUSTIFY"></p> <p align="JUSTIFY"><span style="font-size: medium;"><b>SYNONYMS:</b></span><span style="font-size: medium;"><i>Filaria</i></span><span style="font-size: medium;"><i>malayi</i></span><span style="font-size: medium;"> Brug, 1927; </span><span style="font-size: medium;"><i>Microfilaria</i></span><span style="font-size: medium;"><i>malayi</i></span><span style="font-size: medium;"> (Brug, 1927) Faust, 1929; </span><span style="font-size: medium;"><i>Filaria</i></span><span style="font-size: medium;"><i>bancrofti</i></span><span style="font-size: medium;"> Cobbold, 1877; </span><span style="font-size: medium;"><i>Wuchereria</i></span><span style="font-size: medium;"><i>malayi</i></span><span style="font-size: medium;"> (Brug, 1927) Rao and Maplesonte, 1940.</span></p> <p align="JUSTIFY"></p> <p align="JUSTIFY"><span style="font-size: medium;"><b>HISTORY</b></span><span style="font-size: medium;">: </span><span style="font-size: medium;"><i>Brugia</i></span><span style="font-size: medium;"><i>malayi</i></span><span style="font-size: medium;"> was first described as </span><span style="font-size: medium;"><i>Filaria</i></span><span style="font-size: medium;"><i>malayi</i></span><span style="font-size: medium;"> by Dr. SL Brug on the basis of the morphology of microfilariae that were found in people in Indonesia by a Dr. A Lichtenstein (Brug, 1928). Dr. Lichtenstein had noted that unlike the human parasite </span><span style="font-size: medium;"><i>Wuchereria</i></span><span style="font-size: medium;"><i>bancrofti</i></span><span style="font-size: medium;"> in Indonesia, the microfilariae of this parasite did not increase in the peripheral circulation nocturnally and were not infective to culicine mosquitoes (Lichtenstein, 1927). Rao and Maplestone (1940) were the first to describe the adults of this species. Buckley (1960) erected a new genus, </span><span style="font-size: medium;"><i>Brugia</i></span><span style="font-size: medium;">, on the basis of specimens of </span><span style="font-size: medium;"><i>Brugia</i></span><span style="font-size: medium;"><i>malayi</i></span><span style="font-size: medium;"> from monkeys, </span><span style="font-size: medium;"><i>Brugia</i></span><span style="font-size: medium;"><i>p</i></span><span style="font-size: medium;">ahangi from cats, dogs, and monkeys in Malaysia, and </span><span style="font-size: medium;"><i>Brugia</i></span><span style="font-size: medium;"><i>patei</i></span><span style="font-size: medium;"> from cats and dogs in East Africa. </span></p> <p align="JUSTIFY"></p> <p align="JUSTIFY"><span style="font-size: medium;"><b>GEOGRAPHIC LOCATION:</b></span><span style="font-size: medium;"> The location of </span><span style="font-size: medium;"><i>Brugia</i></span><span style="font-size: medium;"><i>malayi</i></span><span style="font-size: medium;"> in Asia is illustrated by Denham &amp; McGreevy (1977), but this illustration is based mainly on reports in people. Basically this region includes India, Sri Lanka, Sumatra, Java, Borneo, Malaysia, the Philippines, southern Thailand and northern Vietnam, South Korea, and coastal China. Cats only become infected with </span><span style="font-size: medium;"><i>Brugia</i></span><span style="font-size: medium;"><i>malayi</i></span><span style="font-size: medium;"> in areas where this species is present in a subperiodic form, i.e., microfilariae are present in the blood throughout all hours of the day. This subperiodic form is present in Malaysia, Thailand, Vietnam, Borneo, Java, and the Philippines. In these areas, several studies have identified circulating microfilariae in cats. Chang et al. (1992) found 10.5% of 191 domestic cats positive for </span><span style="font-size: medium;"><i>Brugia</i></span><span style="font-size: medium;"><i>malayi</i></span><span style="font-size: medium;"> in 12 Malay villages in Sarawak, Malaysia, and Mak et al (1980) found infected cats in peninsular Malaysia. Dondero and Menon (1972) found 2 of 9 cats in Perak Malaysia with circulating microfilariae. Palmieri (1985)in South Kalamantan Indonesia found 4 of 325 cats positive; Partono et al (1977) found 13 of 51 cats positive). Phatana et al. (1987) found a cat positive for </span><span style="font-size: medium;"><i>Brugia</i></span><span style="font-size: medium;"><i>malayi</i></span><span style="font-size: medium;"> in southern Thailand. </span></p> <p align="JUSTIFY"></p> <p align="JUSTIFY"><span style="font-size: medium;"><b>LOCATION IN HOST: </b></span><span style="font-size: medium;">The adult worms are found in the lymphatic vessels as also are larval stages (Ahmed, 1966). Ewert (1971) showed that if infective-stage larvae were inoculated into the foot of the cat, the worms developed within the popliteal lymph node of that same leg, only very rarely were worms recovered from other sites.</span></p> <p align="JUSTIFY"></p> <p align="JUSTIFY"><span style="font-size: medium;"><b>PARASITE IDENTIFICATION: </b></span><span style="font-size: medium;">The adult males of </span><span style="font-size: medium;"><i>Brugia</i></span><span style="font-size: medium;"><i>pahangi</i></span><span style="font-size: medium;"> are 13 to 23 mm long; the adult females of </span><span style="font-size: medium;"><i>Brugia</i></span><span style="font-size: medium;"><i>pahangi</i></span><span style="font-size: medium;"> are 43 to 55 mm long (Buckley &amp; Edeson, 1956). The adults of </span><span style="font-size: medium;"><i>Brugia</i></span><span style="font-size: medium;"><i>pahangi</i></span><span style="font-size: medium;"> are most easily recognized by the male spicules; those of those of </span><span style="font-size: medium;"><i>Brugia</i></span><span style="font-size: medium;"><i>malayi</i></span><span style="font-size: medium;"> are the longest, those of </span><span style="font-size: medium;"><i>Brugia</i></span><span style="font-size: medium;"><i>patei</i></span><span style="font-size: medium;"> are intermediate in length, and the spicules of </span><span style="font-size: medium;"><i>Brugia</i></span><span style="font-size: medium;"><i>pahangi</i></span><span style="font-size: medium;"> are the shortest of the </span><span style="font-size: medium;"><i>Brugia</i></span><span style="font-size: medium;"> spp. in cats. The left spicule of </span><span style="font-size: medium;"><i>Brugia</i></span><span style="font-size: medium;"><i>malayi</i></span><span style="font-size: medium;"> is 390 µm; the right spicule is 125 µm long. There is probably no good way to distinguish the females of these </span><span style="font-size: medium;"><i>Brugia</i></span><span style="font-size: medium;"> species.</span></p> <p align="JUSTIFY"><span style="font-size: medium;"> Diagnosis of infection is made by finding the microfilariae in the blood using a Knott’s technique or by direct smear (Figs. 4-50 &amp; 4-51). The microfilaria of </span><span style="font-size: medium;"><i>Brugia</i></span><span style="font-size: medium;"><i>malayi</i></span><span style="font-size: medium;"> is 177 µm to 230 µm long when examined in a thick blood film. In humans, the microfilariae of the subperiodic strain differs from that of the periodic form in that the microfilaria of the subperiodic form tends to lose its sheath in the process of dying on slides. The numbers of circulating microfilariae per milliliter of blood appears to remain lower than that of the microfilariae of cats infected with Brugia pahangi. Burren (1972) found in experimentally infected cats that there was around a maximum of &lt;1 to only 3 microfilaria per μl of blood. It is difficult to distinguish the microfilaria of </span><span style="font-size: medium;"><i>Brugia</i></span><span style="font-size: medium;"><i>malayi</i></span><span style="font-size: medium;"> from that of </span><span style="font-size: medium;"><i>Brugia</i></span><span style="font-size: medium;"><i>pahangi</i></span><span style="font-size: medium;">. The distinction between the two species is made by the examination of the innenkorper of Giemsa stained microfilariae, the innenkorper in the microfilaria of </span><span style="font-size: medium;"><i>Brugia</i></span><span style="font-size: medium;"><i>malayi</i></span><span style="font-size: medium;"> is shorter than that in </span><span style="font-size: medium;"><i>Brugia</i></span><span style="font-size: medium;"><i>pahangi</i></span><span style="font-size: medium;"> (Sivanandam and Fredericks, 1966). Also, when the microfilariae are stained using the acid phosphatase histochemical method, the microfilaria of </span><span style="font-size: medium;"><i>Brugia</i></span><span style="font-size: medium;"><i>malayi</i></span><span style="font-size: medium;"> are red mainly at the excretory and anal pores while those of </span><span style="font-size: medium;"><i>Brugia</i></span><span style="font-size: medium;"><i>pahangi</i></span><span style="font-size: medium;"> tend to be red throughout their length (Redington et al., 1975). An antigen detection ELISA and counter-immunoelectrophoresis have been used to detect infections of </span><span style="font-size: medium;"><i>Brugia</i></span><span style="font-size: medium;"><i>pahangi</i></span><span style="font-size: medium;"> in cats (Au et al., 1981; Kumar et al., 1991), but these tests are not commercially available. Pasomsitti et al (1983) used an indirecte fluorescece technique to examine antibody levels in cats infected with </span><span style="font-size: medium;"><i>Brugia</i></span><span style="font-size: medium;"><i>malayi</i></span><span style="font-size: medium;">, </span><span style="font-size: medium;"><i>Brugia</i></span><span style="font-size: medium;"><i>pahangi</i></span><span style="font-size: medium;">, or </span><span style="font-size: medium;"><i>Dirofilaria</i></span><span style="font-size: medium;"><i>repens</i></span><span style="font-size: medium;">.</span></p> <p align="JUSTIFY"></p> <p align="JUSTIFY"><span style="font-size: medium;"><b>LIFE CYCLE: </b></span><span style="font-size: medium;">Ewert (1971) examined the development of </span><span style="font-size: medium;"><i>Brugia</i></span><span style="font-size: medium;"><i>malayi</i></span><span style="font-size: medium;"> in experimentally infected cats. If larvae were inoculated into the hind leg, the majority of adult worms were recovered from lymph nodes associated with that same leg. In one cat, examined 16 weeks after infection, worms were recovered from soakings of the skin of the leg and a single female worm was recovered from soakings of the scrotum and testes. Ewert (1976) found no difference as to the susceptibility of male and female cats to infection; also , out of 59 female and 41 male cats that were experiemntally infected, microfilariae appeared in the blood of about 90% (92% in the females and 88% in the males) of all these cats. </span></p> <p align="JUSTIFY"><span style="font-size: medium;">In cats infected with third-stage infective larvae from mosquitoes, the prepatent period ranged from 80 to 96 days (Edeson and Buckley, 1959; Edeson and Wharton, 1957; Wharton et al., 1958). The inoculated third-stage larvae reach the regional lymph glands and vessels within 16 hours, and typically, as also shown by Ewert (1971), the site of adult development was typically realated to the site of inoculation. The mole from third stage to fourth stage occurred about 10 days after the cats were infected, and the molt to the adult stage takes place 35 to 40 days after infection. Ewert and Bosworth (1975) described the results of experimentally exposing cats to a second inoculation at various times after the primary inoculation. The first infection did not consistently result in lowered numbers of developing worms in the same leg, but the worms that did develop were typically further from the inoculation site on the foot. Also, the primary infection had no apparent effect on the early migration and development of worms when the second infection was in the other hind leg.</span></p> <p align="JUSTIFY"><span style="font-size: medium;">The development in mosquitoes was described by Feng (1936). The first molt took place four days after the mosquito fed on the infected blood, and the second molt took place 2 days after the first molt. The infective larvae were 1.3 mm long.. </span></p> <p align="JUSTIFY"></p> <p align="JUSTIFY"><span style="font-size: medium;"><b>CLINICAL PRESENTATION AND PATHOGENESIS: </b></span><span style="font-size: medium;">There have been no reports detailing the clinical presentation of naturally acquired </span><span style="font-size: medium;"><i>Brugia</i></span><span style="font-size: medium;"><i>malayi</i></span><span style="font-size: medium;"> infection in cats. Ewert et al (1972) examined the lymphographic changes in young cats that had been experimentally infected in the hind feet. After infection, lymphatic vessels in the infected limb become occluded by developing worms, and collateral lymphatics develop to maintain drainage. Eventually infested lymphatic vessels become obliterated (Folse et al., 1981). In affected limbs, the collagen content increases (Dresden &amp; Ewert, 1984), and in experimentally infected cats thrombi within the lymph vessels slowly turn into fibrous tissue that occludes the flow of lymph (Fader &amp; Ewert, 1986). Dependent limb edema develops in cats with experimental infections that can be grossly visible (Folse &amp; Ewert, 1988).</span></p> <p align="JUSTIFY"><span style="font-size: medium;">In an attempt to explain why some humans infected with </span><span style="font-size: medium;"><i>Brugia</i></span><span style="font-size: medium;"><i>malayi</i></span><span style="font-size: medium;"> develop elephantiasis while the majority of those infected do not, work was performed to examine the effects of secondary bacterial infections on the course of infection of Brugia malayi in cats. When cats infected in one hind leg were challenged with streptococci in both hind legs, serious complications developed only in the previously worm-infected leg (Bosworth &amp; Ewert, 1975). When similar conditions were extended to over a year, an elephantoid condition developed in the legs of 5 of 6 cats that had been repeatedly exposed to Brugia malayi and streptococcus (Ewert et al, 1980). </span></p> <p align="JUSTIFY"></p> <p align="JUSTIFY"><span style="font-size: medium;"><b>TREATMENT: </b></span><span style="font-size: medium;">In human infections with </span><span style="font-size: medium;"><i>Brugia</i></span><span style="font-size: medium;"><i>malayi</i></span><span style="font-size: medium;">, treatment has been aimed at giving both diethylcarbamazine (DEC) and ivermectin at levels that are low enough to prevent the circulation of microfilariae for a year without the induction of major side effects amongst infected individuals. In other cases, DEC has been added to salt in endemic areas (Panicker et al., 1997). There have been no reported attempts to either treat or control infections in naturally infected cats.</span></p> <p align="JUSTIFY"><span style="font-size: medium;">Ewert and Emerson (1979) reported on the effects of DEC on fourth-stage and adult Brugia malayi in experimentally infected cats. When the cats were treated 20 days after infection with 100 mg/kg of DEC, no worms were present in the treated cats. When the cats were treated with 50, 25, or 10 mg/kg of DEC at 20 days after infection, worms were present in all cats at necropsy, although less than in the control groups. Treatment with 1 mg/kg had no effect on the number of worms developing. When the cats were treated 8 weeks after infection, 2 of the 5 treated cats harbored 1 or 2 adult worms, while the mean number of worms present in the control cats was 23 adults. The results of treatment at 1, 10, 25, and 50 mg/kg were similar to those reported for larvae (Hillman et al., 1983).</span></p> <p align="JUSTIFY"></p> <p align="JUSTIFY"><span style="font-size: medium;"><b>EPIZOOTIOLOGY:</b></span><span style="font-size: medium;"> Relative to the cat, the most important aspect of the epizootiology of this disease is that cats are only infected naturally in those areas of the world where people are infected with the subperiodic form of the disease. Thus, throughout most of the range of this parasite, cats are not reservoirs of the infection. The cat can be experimentally infected with the nocturnally periodic form of the parasite, and in the experimentally infected cat, the periodic form becomes subperiodic (Denham and McGrreevy, 1977; Laing, 1961). This means that cats entering an area where the nocturnal form of the disease is prevalent may be at some risk of becoming infected.</span></p> <p align="JUSTIFY"></p> <p align="JUSTIFY"><span style="font-size: medium;"><b>HAZARDS TO OTHER ANIMALS:</b></span><span style="font-size: medium;"> Various primates and species of wild felid are considered to be susceptible to infection with Brugia malayi. Thus, if cats are held in places where they may be bitten by mosquitoes, the parasite could be transmitted from an infected cat to one of these other hosts.</span></p> <p align="JUSTIFY"></p> <p align="JUSTIFY"><span style="font-size: medium;"><b>HAZARD TO HUMANS:</b></span><span style="font-size: medium;"><i>Brugia</i></span><span style="font-size: medium;"><i>malayi</i></span><span style="font-size: medium;"> is a significant enough human pathogen to warrant separate sections in most human parasitology texts. It is very much unclear what role the cat plays in the infection of people with </span><span style="font-size: medium;"><i>Brugia</i></span><span style="font-size: medium;"><i>malayi</i></span><span style="font-size: medium;">. It is assumed that they serve as reservoirs in Malaysia and nearby countries, but it is truly not clear whether the cats or the human beings are the actual reservoirs of the observed infections.</span></p> <p align="JUSTIFY"></p> <p align="JUSTIFY"><span style="font-size: medium;"><b>CONTROL/PREVENTION:</b></span><span style="font-size: medium;"> Oral ivermectin administered to four leaf monkeys, </span><span style="font-size: medium;"><i>Prebytis</i></span><span style="font-size: medium;"><i>cristata</i></span><span style="font-size: medium;">, at doses of 200 μg/kg to 300 μg/kg at the same time as the subcutaneous inoculation of infective larvae failed to prevent the development of patent infections in these animals (Mak et al., 1987). On the other hand, diethylcarbamazine appears to be highly effective in preventing the infection of cats with this parasite (Ewert &amp; Emerson, 1975). In cats that were experimentally infected with 50 larvae, the treatment of the cats the first week after infection with 10 mg of diethylcarbamazine per kg body weight caused only 1 of 22 cats to have any detectable living larvae at necropsy two weeks after infection. When cats were administered 5 mg diethylcarbamazine per kilogram body weight, a single living larva was recovered from each of 2 of the 5 treated cats. It would thus seem warranted to begin cats on daily diethylcarbamazine at 6 mg per kilogram body weight (e.g., Filaribits) before taking them into a country where this parasite is endemic.</span></p> <p align="JUSTIFY"></p> <p align="JUSTIFY"><span style="font-size: medium;"><b>REFERENCES:</b></span></p> <p align="JUSTIFY"><span style="font-size: medium;">Ahmed SS. 1966. Location of developing and adult worms of </span><span style="font-size: medium;"><i>Brugia</i></span><span style="font-size: medium;"> sp. in naturally and experimentally infected animals. J Trop Med Hyg 69:291-293.</span></p> <p align="JUSTIFY"><span style="font-size: medium;">Bosworth W, Ewert A. 1975. The effect of streptococcus on the persistence of </span><span style="font-size: medium;"><i>Brugia</i></span><span style="font-size: medium;"><i>malayi</i></span><span style="font-size: medium;"> and on the production of elephantiasis in cats. Int J Parasitol 5:383-389 9maybe 583-589).</span></p> <p align="JUSTIFY"><span style="font-size: medium;">Buckley JJC, Edeson JFB. 1956. On the adult morphology of </span><span style="font-size: medium;"><i>Wuchereria</i></span><span style="font-size: medium;"> sp (malayi?) from a monkey (</span><span style="font-size: medium;"><i>Macaca</i></span><span style="font-size: medium;"><i>irus</i></span><span style="font-size: medium;">) and from cats in Malaya, and on </span><span style="font-size: medium;"><i>Wuchereria</i></span><span style="font-size: medium;"><i>pahangi</i></span><span style="font-size: medium;"> n. sp. from a dog and a cat. J Helm 30:1-20.</span></p> <p align="JUSTIFY"><span style="font-size: medium;">Burren CH. 1972. The behaviour of </span><span style="font-size: medium;"><i>Brugia</i></span><span style="font-size: medium;"><i>malayi</i></span><span style="font-size: medium;"> microfilariae in experimentally infected domestic cats. Ann Trop Med Parasitol 66:235-242.</span></p> <p align="JUSTIFY"><span style="font-size: medium;">Chang Ms, Ho BC, Hardin S., Dorasisingam P. 1992. Filariasis in Kota Samarahan District Sarawak, East-Malaysia. Trop Biomed 9:39-46.</span></p> <p align="JUSTIFY"><span style="font-size: medium;">Dondero TJ, Menon VVV. 1972. Clinical epidemiology of filariasis due to </span><span style="font-size: medium;"><i>Brugia</i></span><span style="font-size: medium;"><i>malayi</i></span><span style="font-size: medium;"> on a rubber estate in West Malaysia. SE Asian J Trop Med Pub Hlth 3:355-365.</span></p> <p align="JUSTIFY"><span style="font-size: medium;">Dresden MH, Ewert A. 1984. Collagen metabolism in experimental filariasis. J Parasitol 70:208-212.</span></p> <p align="JUSTIFY"><span style="font-size: medium;">Edeson JFB. 1959. Studies on filariasis in Malaya: the periodicity of the microfilariae of </span><span style="font-size: medium;"><i>Brugia</i></span><span style="font-size: medium;"><i>malayi</i></span><span style="font-size: medium;"> and </span><span style="font-size: medium;"><i>B</i></span><span style="font-size: medium;">. </span><span style="font-size: medium;"><i>pahangi</i></span><span style="font-size: medium;"> in animals. Ann Trop Med Parasitol 53:381-387.</span></p> <p align="JUSTIFY"><span style="font-size: medium;">Edeson JFB, Buckley. 1959. Studies on filariasis in Malaya: on the migration and rate of growth of </span><span style="font-size: medium;"><i>Wuchereria</i></span><span style="font-size: medium;"><i>malayi</i></span><span style="font-size: medium;"> in experimentally infected cats. Ann Trop Med Parasitol 53:113-119.</span></p> <p align="JUSTIFY"><span style="font-size: medium;">Edeson JFB, Wharton RH. 1957. The transmission of </span><span style="font-size: medium;"><i>Wuchereria</i></span><span style="font-size: medium;"><i>malayi</i></span><span style="font-size: medium;"> from man to the domestic cat. Trans Roy Soc Trop Med Hyg 51:366-370.</span></p> <p align="JUSTIFY"><span style="font-size: medium;">Edeson JFB, Wharton RH. 1958. The experimental transmission of </span><span style="font-size: medium;"><i>Wuchereria</i></span><span style="font-size: medium;"><i>malayi</i></span><span style="font-size: medium;"> from man to various animals in Malaya Trans Roy Soc Trop Med Hyg 52:25-45.</span></p> <p align="JUSTIFY"><span style="font-size: medium;">Edeson JFB, Wilson T. 1964. The epidemiology of filariasis due to </span><span style="font-size: medium;"><i>Wuchereria</i></span><span style="font-size: medium;"><i>bancrofti</i></span><span style="font-size: medium;"> and </span><span style="font-size: medium;"><i>Brugia</i></span><span style="font-size: medium;"><i>malayi</i></span><span style="font-size: medium;">. Ann Rev Entomol 9:245-268.</span></p> <p align="JUSTIFY"><span style="font-size: medium;">Ewert A. 1971. Distribution of developing and mature </span><span style="font-size: medium;"><i>Brugia</i></span><span style="font-size: medium;"><i>malayi</i></span><span style="font-size: medium;"> in cats at various times after a single inoculation. J Parasitol 57::1039-1042.</span></p> <p align="JUSTIFY"><span style="font-size: medium;">Ewert A. 1976. The comparative susceptibility of male and female and of mature and immature cats to infection with subperiodic </span><span style="font-size: medium;"><i>Brugia</i></span><span style="font-size: medium;"><i>malayi</i></span><span style="font-size: medium;">. Rev Biol Trop 24:262-266.</span></p> <p align="JUSTIFY"><span style="font-size: medium;">Ewert A, Balderach R, Elbiharia S. 1972. Lymphographic changes in regional lymphatics of cats infected with </span><span style="font-size: medium;"><i>Brugia</i></span><span style="font-size: medium;"><i>malayi</i></span><span style="font-size: medium;">. Am J Trop Med Hyg 21:407-414.</span></p> <p align="JUSTIFY"><span style="font-size: medium;">Ewert A, Bosworth W. 1975. Distribution and development of </span><span style="font-size: medium;"><i>Brugia</i></span><span style="font-size: medium;"><i>malayi</i></span><span style="font-size: medium;"> in reinfected cats. J Parasitol 61:610-614.</span></p> <p align="JUSTIFY"><span style="font-size: medium;">Ewert A, El Bihari S. 1971. Rapid recovery of </span><span style="font-size: medium;"><i>Brugia</i></span><span style="font-size: medium;"><i>malayi</i></span><span style="font-size: medium;"> following experimental infection of cats. Trans Royu Soc Trop Med Hyg 65;364-368.</span></p> <p align="JUSTIFY"><span style="font-size: medium;">Ewert A, Emerson GA. 1975. Effects of diethylcarbamazine on third stage Brugia malayi larvae in cats. Am J Trop Med Hyg 24:71-73.</span></p> <p align="JUSTIFY"><span style="font-size: medium;">Ewert A, Emerson GA. 1979. Effects of diethylcarbamazine citrate on fourth stage and adult </span><span style="font-size: medium;"><i>Brugia</i></span><span style="font-size: medium;"><i>malayi</i></span><span style="font-size: medium;"> in cats. Am J Trop Med Hyg 28:496-499.</span></p> <p align="JUSTIFY"><span style="font-size: medium;">Ewert A, Reitmeyer JC, Folse D. Chronic infection of cats with </span><span style="font-size: medium;"><i>Brugia</i></span><span style="font-size: medium;"><i>malayi</i></span><span style="font-size: medium;"> and streptococcus. SE Asian J Trop Med Publ Hlth 11:32-39.</span></p> <p align="JUSTIFY"><span style="font-size: medium;">Fader RC, Ewert A. 1986. Evolution of lymph thrombi in experimental </span><span style="font-size: medium;"><i>Brugia</i></span><span style="font-size: medium;"><i>malayi</i></span><span style="font-size: medium;"> infections: a scanning electron microscopic study. Lymphology 19:146-152.</span></p> <p align="JUSTIFY"><span style="font-size: medium;">Feng LC. 1936. 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Natural infection of </span><span style="font-size: medium;"><i>Brugia</i></span><span style="font-size: medium;"><i>malayi</i></span><span style="font-size: medium;"> in a child outside endemic area, Thailand. Mosq Borne Dis Bull 9:128-130.</span></p> <p align="JUSTIFY"><span style="font-size: medium;">Wharton RH, JFB Edeson, ABG Laing. 1958. Laboratory transmission of </span><span style="font-size: medium;"><i>Wuchereria</i></span><span style="font-size: medium;"><i>malayi</i></span><span style="font-size: medium;"> by mosquito bites. Trans Roy Soc Trop Med Hyg 52:288</span></p> <p align="JUSTIFY"></p> <p align="JUSTIFY"></p> <h4 class="western">FIGURES</h4> <p align="JUSTIFY"></p> <p align="JUSTIFY"><span style="font-size: medium;"><b>Figure 4-50. </b></span><span style="font-size: medium;">Brugia malayi. Microfilaria from human, Hematoxylin stain.</span></p> <p align="JUSTIFY"></p> <p align="JUSTIFY"><span style="font-size: medium;"><b>Figure 4-51.</b></span><span style="font-size: medium;"> Brugia malayi. Microfilaria from human, Giemsa stain.</span></p> <p align="JUSTIFY"></p> <p align="JUSTIFY"></p>