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Laparoscopic renal pedicle lymphatic disconnection is the most effective method for treating chyluria that has failed to respond to conservative management. Chylous hemothorax is a rare clinical occurrence resulting from the anatomic abnormality. This paper reported a case, who was admitted with painless gross hematuria for 1 month and was diagnosed with left chylous hematuria. Laparoscopic left renal pedicle lymphatic disconnection was performed, and bilateral chylous hemothorax occurred after the operation. After conservative treatment such as bilateral closed thoracic drainage and blood transfusion support, the patient recovered well. After 2 months of follow-up, there was no obvious effusion in the bilateral thoracic cavity, and the chylous test of urine fluid was negative.
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Chyluria is characterized by the presence of chyle in the urine. The most common cause of non-parasitic chyluria is the upstream obstruction of the thoracic duct and reflux of the chyle into the renal collecting system. Traditional treatments include dietary modifications and surgery. The recently developed new interventional technique to treat chyluria. Here, we firstly reported one case of chyluria caused by thoracic duct obstruction in China, which was successful treated with intranodal lymphangiography combined by percutaneous balloon plasty. The symptoms of chyluria were completely relieved after our operation, which provides a minimally invasive, safe and effective method for patients with ineffective chyluria after conservative treatment or surgery.
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Introducción: La eliminación de orina que con tiene grandes cantidades de material quiloso y adquiere un aspecto lechoso se conoce con el nombre de quiluria. Salvo en las regiones donde es endémica, la filariasis linfática, principal etiología, se considera en general como un trastorno raro. Objetivo: Describir un caso de quiluria asociada al embarazo. Caso clínico: Paciente femenina de 32 años de edad, con múltiples ingresos en el Servicio de Nefrología del Hospital Celia Sánchez Manduley desde el año 2007 por presentar orinas de color blanquecino, cuadro que comenzó con el primer embarazo, el síntoma desapareció y luego reapareció con el segundo embarazo, primero de forma intermitente y después, adquirió carácter permanente, con hematuria, proteinuria, edemas y otras alteraciones clínicas y bioquímicas. Conclusiones: La nefrectomía está indicada en la quiluria, cuando pone en riesgo la vida del paciente o afecta su calidad de vida, si no se tienen otras alternativas terapéuticas(AU)
Introduction: The elimination of urine containing large amounts of chyllous material and acquiring a milky appearance is known as quiluria. Except in regions where it is endemic, lymphatic filariasis, the main etiology, is generally considered to be a rare disorder. Objective: To describe a case of chyluria associated with pregnancy. Clinical case: 32-year-old female patient with multiple admissions to the nephrology service at Hospital Celia Sánchez Manduley since 2007 for presenting whitish urine, a clinical picture that began with the first pregnancy. The symptom disappeared, then reappeared with the second pregnancy, first intermittently and then became permanent with hematuria, proteinuria, edema and other clinical and biochemical alterations. Conclusions: Nephrectomy is indicated in chyluria when it puts the patient's life at risk and affects the quality of life, if there are no other therapeutic alternatives(AU)
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Humans , Female , Adult , Urinary Fistula/surgery , Filariasis , Nephrectomy/methodsABSTRACT
Objective: To explore the value of unenhanced MR lymphography (MRL) and CT after direct lymphangiography (DLG) in diagnosis of lympho-urinary fistula location and thoracic duct abnormalities in patients with chyluria. Methods: Data of 24 patients with chyluria were reviewed. The position of lympho-urinary fistula and signs related to obstruction of thoracic duct (TD) were analyzed. Dilated renal lymphatics and other retroperitoneal lymphatics, dilatation of TD, multiple tortuous dilated lymphatics around TD were evaluated with MRL, while contrast media reflux of renal lymphatic and urinary system, lymphatics in the outlet area of iliac trunk and thoracic duct were observed with CT after DLG. Results: MRL depicted lympho-urinary fistula in 19 cases (79.17%), including 2 cases in bilateral kidneys, 6 in left and 10 in right kidney, and 1 case in bladder. CT after DLG showed the level of lympho-urinary fistula, including 6 cases in bilateral kidneys, 7 in left and 10 in right kidney, also 1 case in bladder. The consistency between MRL and DLG plus CT was moderate (Kappa=0.601, P<0.001). There was significant difference of unilateral renal level lympho-urinary fistula between MRL and CT after DLG (χ2=22.463, P<0.001),the sensitivity and specificity of MRL was 68.97% and 100%, respectively. No contrast medium distribution at cervical section of TD was found neither with DLG nor CT after DLG, but was observed in one of them with MRL. MRL detected unilateral double renal pelvis and ureter in 2 cases misdiagnosed with CT after DLG. Conclusion: MRL can be used as a noninvasive preliminary examination for lympho-urinary fistula in patients with chyluria, combining with CT after DLG can provide comprehensive assessment of TD and lympho-urinary fistula.
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Objective To evaluate the use of unilateral pedicle lymphography (PLG) in preoperative localization and treatment of chyluria.Methods From October 2010 to March 2017,25 cases with severe chyluria and undergoing cystoscopy and unilateral PLG before renal pedicle lymphatic disconnection were reviewed.There were 11 males and 14 females,aged 44-71 years,with an average of 58.5 years.The course of the disease was 6 months to 30 years,with an average of 8.3 years.Of them,18 cases had undergone unilateral PLG and spiral CT angiography preoperatively.Surgical treatment was performed according to PLG imaging.Results Unilateral ureteral chyluria was discovered in 16 out of the 19 cases through cystoscopy,with the sensitivity of 84.2％ (16/19).In contrast,unilateral chyluria was only detected in 4 of the other 6 patients with bilateral chyluria.Albiduria were found in the remaining 5 cases in bladder,without ureteral excreted chyle.The sensitivity for chyluria positioning by cystoscopy was 64.5％ (20/31).The location of lesion in 19 patients with unilateral chyuria and 6 patients with bilateral chyluria could be correctly displayed by PLG and the sensitivity was 100％ (31/31).There was no significant difference in location between cystoscopy and PLG in 19 patients with unilateral chyluria (P =0.2482).But in total lesion location,the sensitivity of PLG was higher than cystoscopy(P =0.0026).Eighteen patients who had undergone PLG combined with spiral CT angiography,could not only locate the chylous fistula,but also determine the number of renal vessels as well as their relationship with diseased lymphatic vessels.Chyluria had disappeared immediately after unilateral renal pedicle lymphatic exfoliation in 23 patients.However,it still presented in the other 2 patients who were confirmed contralateral pyeloymphatic fistulas by PLG 3 months after surgery and cured by reoperation.Chyluria recurred in 6 cases during follow-up of 6 to 58 months,and 4 were confirmed bilateral pyelolymphatic fistulas by PLG.Two of these 4 cases were cured by laparoscopic surgery or open surgery,respectively.The other 2 patients were cured by conservative treatment.Moreover,2 patients with unilateral chyluria recurred in situ after the first laparoscopic surgery,which was confirmed by PLG.Notably,all these patients were cured by ESWL finally.Conclusions This study suggested that PLG displays remarkable advantage in terms of localization sensitivity.PLG combined with spiral CT angiography preoperatively can not only locate the chylous fistula,but also determine the number of renal vessels as well as their relationship with diseased lymphatic vessels.Depending on PLG and spiral CT angiography,renal pedicle lymphatic disconnection can effectively protect renal vessel.In addition,it can avoid the omission of ligation for perivascular lymphatic vessels.Furthermore,PLG plays a key role in temporarily obstructing the leakage of pyelolymphatic fistulas to some extent.
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Objective To explore the clinical safety and efficacy of self-made single-port retroperitoneoscopic renal pedicle lymphatic disconnection for chyluria. Methods From Feb 2013 to Mar 2016, clinical data of 34 patients were collected. Of them, 16 cases underwent self-made single-port retroperitoneoscopic renal pedicle lymphatic disconnection and 18 cases underwent three port retroperitoneoscopic renal pedicle lymphatic disconnection. No significant difference was shown in age, body mass index between the two groups (P > 0.05). Mean operative time, estimated bleeding volume, drainage time, postoperative hospital stay, postoperative pain evaluation, satisfaction scores of incision were compared between the two groups. Results All procedures were successfully performed without conversion to open surgery. Compared with the three port surgery group, results in the single-port group were superior in terms of mean operative time [(102.3 ± 16.1) versus (132.4 ± 21.6) min, P < 0.05], there were no significant differences in estimated blood loss, drainage time, postoperative hospital stay, the date in postoperative pain evaluation, satisfaction scores of incision shown that single-port group was superior to three port group. Conclusion Our initial experience revealed that single-port retroperitoneoscopic renal pedicle lymphatic disconnection was a safe, effective, cost-effective and less-invasive procedure for chyluria with improved postoperative pain and cosmetic results.
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Objective To assess the clinical walue of 3D retroperitoneal laparoscopic renal pedicle disconnection by comparing its clinical effects with those of traditional 2D laparoscopic.Methods Clinical data about 49 cases from our department with chyluria respectively treated by 3D retroperitoneal laparoscopic and 2D laparoscopic renal pedicle disconnection were analyzed retrospectively.They were divided into 3D group(26 cases)and 2D group(23 cases),and operated by the same salty doctor.The operation time,intraoperative blood loss,postoperation hospital stay and recurrence rate of the two group were compared.Results The operation time in 3D group[(95.2±30.3)min] was shorter than 2D group[(120.4±25.8)min,P<0.05].The intraoperative blood loss in 3D group[(30.0±12.7)ml] was less than 2D group[(55.0±21.7)ml,P<0.05].There were no difference in postoperation hospital stay between the two groups.All of the cases were not recurred.Conclusion 3D Retroperitoneoscopic renal pedicle lymphatic disconnection for treatment of chyluria is safty and feasible.3D laparoscopy provides high-quality 3D endoscopic view and facilitates precise manipulation during surgery,resulting in shorter operation time and intraoperative blood loss compared with 2D laparoscopy.
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Objective:To evaluate the clinical effect of retroperitoneoscopic renal pedicle lymphatic disconnection via extra-adipose capsule in the management of chyluria and to discuss the management of its complications.Methods:From August 2013 to June 2008,five patients with chyluria were admitted. All the patients were female,aged from 26 to 73 years,and disease course from 1 to 10 years.All the five patients had complained of intermittently voiding milky urine with varying degrees of weight loss,and fa-tigue,of whom two presented with flank pain and one with anemia.Their urine chyle tests were con-firmed to be positive.Preoperative cystoscopy found that chyluria was from the left side in 3 cases,and from the right side in 2 cases.Their proteinuria ranged from +to ++++.All the cases had been treated with the modified procedure by which lymphatic ligation was performed to hilar vessels and proximalureter via extra-adiposecapsule without disconnection of perirenal fat tissues.The operation time,intraoperative blood loss,postoperative intestinal function recovery,catheter time,drainage tube removal time and com-plications during operation were collected.Results:All the five cases were performed successfully.The operation time ranged from 75 to 170 minutes,mean (126.0 ±39.6)minutes,with the intraoperative blood loss 20 to 60 mL,mean (38.0 ±16.4)mL,and the postoperative intestinal function recovery time 1 to 3 days,mean (1.9 ±0.4)days.The catheter time was 1 to 4 days,mean (2.1 ±0.3)days and the drainage tube removal time ranged from 3 to 15 days,mean (9.3 ±1.8)days.Postoperatively lym-phorrhagia was found in two cases.No renal vessels injury occurred during operation.Chyluria of all the patients disappeared on the operation day with negative chyluria test after surgery.Furthermore,urine test revealed that proteinuria was totally negative.No recurrence was detected in our patients in the 9 to 31 months’follow-up.Conclusion:This modified procedure does not have to disconnect perirenal fat tissues and nephropexy during operation.It was characterized with shorter operation time,definitive effect and fewer complications.
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Objective To evaluate the surgical techniques and clinical efficacy of retroperitoneoscopic ligation of renal lymphatic vessels outside adipose capsule and inside adipose capsule for comparison in the treatment of chyluria.Methods Retrospective anal-ysis of the retroperitoneal laparoscopic adipose capsule of kidney pedicle lymphatic duct ligation(group Ⅰ)and adipose capsule pathways in the kidney totally or subtotally free renal pedicle lymphatic ligation(group Ⅱ)and 1 1 1 patients with chyluria clinical data,compared two groups of operation time,bleeding volume,the rate of analgesia,postoperative gastrointestinal function recovery time,drainage time,postoperative recovery time,postoperative hospital stay and postoperative complications and other index differ-ence.Results Retroperitoneal laparoscopic operation group of adipose capsule in operation time,bleeding volume,postoperative an-algesia,postoperative gastrointestinal function recovery time,drainage time,postoperative recovery time,postoperative hospital stay and postoperative complications were better than the adipose capsule of kidney totally or subtotally free operation group,the differ-ence was statistically significant(P<0.05).Conclusion Retroperitoneal laparoscopic renal adipose capsule of kidney pedicle lym-phatic disconnection for the treatment of chyluria effect,and adipose capsule operation ways,the method less trauma,quicker recov-ery,can completely replace the renal adipose capsule total or Sub-total of free kidney pedicle lymphatic disconnection operation,wor-thy of clinical application.
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Objective To investigate the efficacy and safety of high-intensity focused ultrasound (HIFU) in treatment of chyluria.Methods Retrospectively analyze the HIFU-based treatment results of 131 patients with chyluria received treatment between Jan 2010 and Jun 2011.The patients' age ranges from 23 to 83 years old,with average 59.The patients consisted of 59 male patients and 72 female patients.74 cases were on the left side,right side 51 cases,6 cases bilateral.There were 47 patients with chylous hematuria,22 cases of recurrence after renal pedicle lymphatic vessel ligation,5 cases of recurrence after laparoscopic ligation of renal lymphatic,1 cases of recurrent pelvic perfusion after silver nitrate.The treatment was carried out according to the following procedure.The affected kidney pedicle and superior segment of ureter,after being divided into two or three irradiation layers,were irradiated daily from deep to superficial layers which completely cover the affected kidney pedicle and superior segment of ureter.The technical parameters of the treatment were:focal region size 4 mm×4 mm×7 mm,Ultrasonic power 800-1100 W,Unit firing time 0.15s,Dutv time 0.18s,Single point total transmit 50 times.The patients were followed up and re-examined within one to five years after treatment.Statistical analyses were conducted on the data of Color doppler ultrasound images on kidney pedicle and renal function tests before and after the treatment,blood routine examination and routine urianlysis.Results 116 patients were followed up and the treatment to 96 of them was deemed effective in which 85 patients completely recovered (73.3％ recovering rate) and 11 patients became better (9.5％).The other 20 patients (17.2％) was ineffective.With regard to the time required to cure chyluria,67 patients (69.8％) required one week,13 (13.5％) required two weeks,11 (11.5％) required four weeks,and 5 (7.5％) required five weeks.Results of color doppler ultrasound images on kidney pedicle and renal function tests were as follows.The volume of kidney,the inner diameter of renal artery,Vmax,RI,inner diameter and blood flow rate of renal vein and serum Cr,serum BUN had no significant difference before and after the treatment (P＞0.05).Results of anemia,hematuria,microscopic hematuria and urinary protein positive were significantly different from the before-treatment results (P＜0.05).During the treatment process,all patients had stable vital signs without serious complications.Conclusions Treating chyluria with HIFU could be a safe and effective method.
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Objective To evaluate the feasibility and efficacy of laparoscopic single-port transumbilical renal pedicle lymphatic disconnection (TRPLD) for treatment of chyluria. Methods Nine cases of chyluria underwent laparoscopic single-port TRPLD. In all cases a 2-3 cm single inverted Ushaped supraumbilical incision was made, two 5-mm and one 12-mm trocars were inserted, and a medical rubber glove was sutured surrounding the three trocars and incision was made for gas proofing.Conventional straight and flexible instruments were used for dissection. Results All laparoscopic operations were successfully completed without conversion to open surgery. The mean operative time was 135 (96-178) minutes, and the mean estimated blood loss was 126 (50-250) ml. Chyluria disappeared in all patients after operation and did not reoccur during the follow-up (1 - 6 months).Conclusions Laparoscopic single-port transumbilical TRPLD represents a feasible and novel mini-invasive option for patients with chyluria.
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PURPOSE: To evaluate the safety and efficacy of a single instillation in a combination of povidone iodine with contrast agent under fluoroscopy guidance for the treatment of chyluria. MATERIALS AND METHODS: From December 1999 to July 2006 a total of 40 patients with chyluria were treated by renal pelvic instillation therapy (RPIS). The sclerosing solution was prepared using povidone iodine with contrast agent diluted with sterile water in a ratio of 1:1:3. It was instilled on the side having chylous efflux using a bulb tip ureteric catheter. Unilateral instillation was done in 26 cases, 10 on the right side and 16 on left. Fourteen patients had bilateral chylous efflux and RPIS was performed on both sides in the same session. Fluoroscopy was used to evaluate the complete filling of the pelvic calyceal system. The sclerosing solution was kept in the system for 5 minutes and the ureteric catheter was then withdrawn. RESULTS: Immediate clearance was observed in 39 patients. Recurrence occurred in five patients. They were treated again using the same procedure with satisfactory results. The longest follow-up was five years and the shortest five months. CONCLUSION: RPIS of chyluria using a single instillation a combination of povidone iodine with contrast agent is safe and effective. Use of fluoroscopy helps to determine the exact amount of sclerosing solution required to completely fill the system and therefore overfilling is avoided. Moreover, the complications, which arise due to pyelointerstitial backflow, are prevented.
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Adult , Female , Humans , Male , Young Adult , Anti-Infective Agents, Local/administration & dosage , Chyle , Lymphatic Diseases/therapy , Povidone-Iodine/administration & dosage , Sclerosing Solutions/administration & dosage , Urologic Diseases/therapy , Drug Combinations , Fluoroscopy , Instillation, Drug , Kidney Pelvis , Lymphatic Diseases/diagnosis , Pyelonephritis/complications , Treatment Outcome , Urine , Urologic Diseases/diagnosis , Young AdultABSTRACT
Objective To explore the clinical efficacy of renal lymphatic stripping with laparo scope.Methods Twenty cases of chyluria (12 men and 8 women; mean age,52 years) were treatedwith laparoscopic renal lymphatic stripping.The diagnosis of chyluria was setup by chylous tests andcystoscopy.The ultrasonic harmonic scalpel was used during the dissociation and ligation.ResultsThe average operation time was 100 min.The average blood loss was 50 ml and the average hospitalstay after operation was 6 d.No surgical complications occurred.The urine was clear and the chyloustests were negative in 19 patients when the patents discharged Irom the hospital.No recurrence ofchyluria was found during the follow up of 6-24 months.One patient with bilateral chyluria occation ally showed chyluria during follow up.Conclusion Laparoscopic stripping of renal lymphatic vesselsfor the treatment of chyluria could be an efficient method with the advantages of simple operating,mini invasion and rapid recovery.
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A ruptura ou fistulização de vasos linfáticos para o interior do sistema excretor urinário dá origem à quilúria, que tem na bancroftose a sua principal etiologia. Pode ser, raramente, também causada por neoplasia, malformação linfática, traumatismo abdominal, assim como outras doenças infecciosas como a tuberculose. Os autores propõem as diretrizes gerais para a condução do portador de "urina leitosa" em áreas endêmicas e não endêmicas de filariose bancroftiana. Ressaltam a importância dos exames de triagem e de outros mais sofisticados para uma investigação etiológica a partir da realização de anamnese e de exame físico criteriosos. Enfatizam a necessidade de que a doença deve ser conduzida através de uma abordagem mais abrangente, que compreenda, além da médica, a assistência social e a nutricional. Na grande maioria dos casos, o controle da quilúria está basicamente fundamentado na educação e na adequação do paciente a uma dieta hipolipídica/hiperprotéica e rica em líquidos.
The rupture or fistulization of lymph vessels into the urinary system, known as chyluria (milky urine), is caused mainly by bancroftian filariasis. On rare occasions chyluria may also be caused by neoplasia, lymphatic malformation, abdominal trauma, as well as other infectious diseases such as tuberculosis. The authors proposed general guidelines to manage patients suffering from milky urine in Bancroftian filariasis endemic and non-endemic areas. They emphasized the importance of a careful diagnostic process accomplished using screening procedures, evaluating a detailed history of illness and performing a careful physical examination, targeting on the most suitable diagnostic tools for each case. In addition, they emphasized the need to manage the patient from a broader perspective, which goes beyond the medical aspect, involving also social and nutritional contexts. In the great majority of cases, controlling chyluria is fundamentally based on patient education and adjustment to a low lipid, high protein diet in addition to increased fluid intake.
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Animals , Humans , Chyle , Urinary Fistula , Diagnosis, Differential , Diet , Urine , Urinary Fistula/diagnosis , Urinary Fistula/etiology , Urinary Fistula/therapy , Wuchereria bancroftiABSTRACT
Objective:To summarize the experience of retroperitoneoscopic renal pedicle lymphatic disconnection in the management of chyluria,and to investigate a new minimally invasive treatment of chyluria. Methods:9 cases of chyluria were treated by retroperitoneoscopic renal pedicle lymphatic disconnection from Jan 2005 to Dec 2008 with 7 male ones and 2 female ones. The average age was 48 years. 8 of 9 cases obtained success and 1 of 9 cases was converted to open surgery. Operation time, blooding volume, postoperative complication and hospitalization stay, and the operative effect were observed. Results:The operation time was from 65 to 105 min,with the average of 70 min. The blooding volume was from 50 to 100ml, with the average of 60ml. Chyluria disappeared immediately after operation in all patients. Postoperative stay was from 5 to 7d and no complication happened. Conclusion:Retroperitoneoscopic renal pedicle lymphatic disconnection for chyluria is a effective and efficienl method in the management of chyluria. And it is also safe , minimally invasive , with less blood loss, fewer complications , and short hospital stay .
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In this report, we present a case of chyluria that is a very rare urine abnormality in Korea. A 43-year-old woman was referred to our clinic with intermittent turbid and creamy-colored urine for 10 days. The urine tests, including a urine lipid profile, indicated a diagnosis of chyluria. There was no evidence of secondary causes of chyluria such as a tumor and filariasis, and a urinary-lymphatic fistula was not found. The patient was instructed to begin a high protein diet with low fat content and medium chain triglyceride oil supplementation. To the best of our knowledge, this is the first report describing a patient that presented with chyluria in Korea.
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Adult , Female , Humans , Diagnosis , Diet , Filariasis , Fistula , Korea , TriglyceridesABSTRACT
Chyluria is the passage of milky urine due to the leakage of lymph into the urinary tract. Chyluria occurs predominantly in adults and is rare in children. We present an unusual case in which a child with proteinuria, hematuria and milky urine was subsequently diagnosed with non-parasitic chyluria. Retrograde cystogram confirmed a lymphatico-calyceal communication. This case showed spontaneous remission. The etiology of this case was not exactly known; however, the prognosis of non-parasitic chyluria (or idiopathic chyluria) is usually very good and the treatment is mostly conservative.
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Adult , Child , Humans , Hematuria , Prognosis , Proteinuria , Remission, Spontaneous , Urinary TractABSTRACT
We report a rare case of idiopathic chylothorax and chyluria. A 31 year-old woman was referred to our hospital with a right-sided pleural effusion. Cream-colored pleural fluid and urine were confirmed as chylothorax and chyluria, respectively, by a lipoprotein electrophoresis. Even though she had previously underwent surgery for pelvic fibrosarcoma and experienced its recurrence, there has been no change of mass size and no evidence of thoracic duct or urinary tract obstruction as of the moment. Hence, idiopathic chylothorax and chyluira was diagnosed. Because she responded poorly to conservative treatment, thoracic duct ligation and pleurodesis were performend ; wherease chyluria was resolved spontaneously.
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Adult , Female , Humans , Chylothorax , Electrophoresis , Fibrosarcoma , Ligation , Lipoproteins , Pleural Effusion , Pleurodesis , Recurrence , Thoracic Duct , Urinary TractABSTRACT
Objective: To evaluate the clinical effect of chyluria with different methods,flushing pelvis with argenti nitras and nephrolympholysis.Methods:53 cases of chyluria devied into two groups,recived the treament with these two different methods,then observed the rate of chyluria recurrence.Results:45.5%(10/22)cases which treated by flushing pelvis with argenti nitras were observed chyluria recurrence in a short time(average 1.3months),but only two cases(2/31,6.5%) were found chyluria recurrence of opposite side kidney in the nephrolympholysis group.Conclusions:nephrolympholysis is a safe and effective treament with chylria,better than flushing pelvis with argenti nitras.
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Humoral immune parameters like total immunoglobulins and specific antibody levels in serum were studied in filarial chyluria patients. Mean serum IgG was significantly reduced in this group compared to normal controls, while IgA and IgM levels remained comparable to controls. Anti-filarial antibody titre as measured by enzyme-linked immunosorbent assay also was significantly reduced. However, the total and specific IgE antibody titre was similar to that of controls. Specific IgE contents of the patients' sera could be related to their microfilaraemic status.