RESUMEN
Background: Lymphatic filariasis is caused by a mosquito-borne parasite affecting roughly 100 million people round the world. There is consensus that hydrocele is the most frequent clinical manifestation of bancroftian filariasis. In endemic areas, about 40% of men are suffering from testicular hydrocele. With this background, the present study was aimed to find the incidence of filariasis in clinically diagnosed primary vaginal hydrocele.Methods: A hospital based prospective, cross-sectional study was conducted with 60 patients diagnosed clinically as primary vaginal hydrocele coming to the department of surgery, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Pimpri, Pune, to assess the incidence of filariasis.Results: Anti-filarial antibody and circulating filarial antigen in serum were detected in 5 (8.3%). Out of 60 patients and anti-filarial antibody was detected in hydrocele fluid of 2 (3.3%) patients. 2 patients out of these 5 showed microfilaria in peripheral blood smear and eosinophilic infiltrates in histopathological examination of sac.Conclusions: In 5 out of 60 cases both anti-filarial antibody and circulating filarial antigen in serum are positive thus proving that incidence of filarial hydrocele is 8% in clinically diagnosed primary vaginal hydrocele which is supposed to be idiopathic. Even though these cases have presented as clinically primary vaginal hydrocele, they are found to be filarial hydrocele after analysis of serum and hydrocele fluid. So, it is advised that all cases of clinically diagnosed primary vaginal hydroceles should be investigated for filariasis and if not, may lead to recurrence in these cases.
RESUMEN
The immunodiagnosis of bancroftian filariasis is a major challenge to the immunoparasitologist. Significant progress is yet to be made in developing convenient laboratory animal model and in in vitro cultivation of filarial parasites making it very difficult to obtain required amount of parasite material for research. Parasitological examination techniques are not useful in low microfilaraemia, occult or chronic .filarial infections. A precise and accurate immunodiagnostic technique is very much needed for successful filaria control programmes. Such a test will also avoid the need for laborious night blood examination in bancroftian filariasis. Due to comparatively easy availability, a good amount of work has been done to explore immunodiagnostic potential of heterologous filarial antigens isolated from Litomosoide carinii, Dirofilaria immitis, Brugia malayi, Setaria digitata, Setaria cervi and number of other filarial species. However, there has been limited or no significant success due to number of false negative and false positive reactions. Extensive study has also been made with antigens isolated from Wuchereria bancrofti microfilariae. Soluble antigens of microfilariae have been used in different immunological techniques such as skin test, counter immuno electrophoresis, indirect haemagglutination test, indirect fluorescent antibody test and enzyme linked immunosorbent assay. Fractionation of Wuchereria bancrofti microfilarial soluble antigens yielded mfS3e antigen fraction which was found to be highly reactive in microfilaraemia by enzyme linked immunosorbent assay, but the yield of the purified antigen was not sufficient enough to make it a practical proposition for large scale isolation of antigen. Wuchereria bancrofti microfilarial excretory-secretory antigens were found to be specific and highly sensitive requiring as little as 0·35 ng antigen protein per well in penicillinase enzyme linked immunosorbent assay for detection of filarial antibody. One ml of culture fluid was found to be sufficient for 400,000 tests. Field evaluation of this test showed that it can replace laborious night blood examination. Assay systems have been developed for detection of filarial antigen in serum, urine, hydrocele fluid and immune complexes using immunoglobulins from chronic filarial sera and antisera to excretory filarial antigens. Further purification of excretory-secretory antigens by affinity chromatography and production of monoclonal antibodies should hopefully give suitable reagents for use in sensitive assays such as enzyme immuno assay and immuno radiometric assay, providing an ideal assay system for detection of active filarial infection in the not too distant future.