Elefantiasis vulvar por filarias / Vulvar Elephantiasis by Filarias

En el año 2000, había más de 120 millones de personas infectadas por filarias en el mundo; unos 40 millones están desfiguradas e incapacitadas por la enfermedad. La infestación de los ganglios linfáticos por el parásito Wuchereira bancrofti, es la causa más frecuente del linfedema secundario. Se presenta un caso inusual de elefantiasis vulvar por filariasis. Se analizan las alternativas terapéuticas que incluyen el tratamiento farmacológico y quirúrgico, con el fin de considerar esta última como un tratamiento paliativo más que curativo tanto para el linfedema como para la cirugía reconstructiva(AU)

In 2000, there were more than 120 million people infected by filarias in the world; some 40 million are disfigured and disabled by the disease. Infestation of the lymph nodes by Wuchereira bancrofti parasite is the most frequent cause of secondary lymphoedema. An unusual case of vulvar elephantiasis due to filariasis is reprted in this paper. The therapeutic alternatives that include pharmacological and surgical treatment are analyzed, in order to consider the latter as a palliative rather than a curative treatment both for lymphedema and for reconstructive surgery(AU)

Lymph scrotum: an unusual urological presentation of lymphatic filariasis: a case series study / Linfoescroto: apresentação rara de filaríase linfática: estudo retrospectivo

Lymphatic filariasis (LF) causes a wide range of clinical signs and symptoms, including urogenital manifestations. Transmission control and disability/morbidity management/control are the two pillars of the overall elimination strategy for LF. Lymph scrotum is an unusual urological clinical presentation of LF with important medical, psychological, social and economic repercussions. A retrospective case series study was conducted on outpatients attended at the National Reference Service for Filariasis, in an endemic area for filariasis (Recife, Brazil), between 2000 and 2007. Over this period, 6,361 patients were attended and seven cases with lymph scrotum were identified. Mean patient age was 45 years (range, 26 to 64 years). Mean disease duration was 8.5 years (range, two to 15 years). All patients had evidence of filarial infection from at least one laboratory test (parasitological, antigen investigation or "filarial dance sign" on ultrasound). Six patients presented histories of urological surgery. The authors highlight the importance of the association between filarial infection and the inadequate surgical and clinical management of hydrocele in an endemic area, as risk factors for lymph scrotum. Thus, filarial infection should be routinely investigated in all individuals presenting urological morbidity within endemic areas, in order to identify likely links in the transmission chain.

A filariose linfática (FL) é responsável por uma grande variedade de sinais e sintomas clínicos incluindo manifestações urogenitais. O controle da transmissão e da incapacitação bem como o manuseio da morbidade são os dois pilares da estratégia global de eliminação da FL. O linfoescroto é uma rara apresentação da FL, tendo importantes repercussões do ponto de vista clínico, psicológico e socioeconômico. Realizou-se um estudo retrospectivo de uma série de casos com diagnóstico de linfoescroto, identificados entre os 6.361 pacientes ambulatoriais atendidos no período de 2000 a 2007 no Serviço de Referência Nacional em Filarioses (Recife, Brasil) área endêmica de filariose. Foram identificados sete casos, com a idade média de 45 anos (com variação de 26 a 64 anos). O tempo médio de evolução da doença foi de 8,5 anos (com variação de 2 a 15 anos). Todos apresentavam evidência de infecção filarial por algum dos exames realizados (parasitológico, pesquisa antigênica ou "sinal da dança da filaria" na ultrasonografia). Seis pacientes relatavam historia prévia de cirurgia urológica. Os autores destacam a importância da associação da infecção filarial e de inadequado manuseio cirúrgico e de acompanhamento de pacientes com hidrocele de uma área endêmica, como fatores de risco para o surgimento de linfoescroto. Assim, a infecção filarial deve ser rotineiramente investigada em todos os indivíduos procedentes de áreas endêmicas apresentando morbidade urológica, para identificar melhor os elementos da cadeia de transmissão.

Giant penoscrotal filariasis.

A 42 year old male individual having a hugely distended scrotum and barely perceptible penis, unable to maintain his livelihood on account of his handicap and socially withdrawn for the fear of humiliation, got admitted into the Surgery department of Mymensingh Medical College Hospital in August 5, 2007. The person had been carrying the so called curse for the last four years. On the basis of clinical, serological and haematological examinations, diagnosis was established as lymphatic filariasis causing elephantiasis of the scrotum. After assessment for operative feasibility, the patient underwent an operation in August 20, 2007 during which, ligation of both the spermatic cords, excision of the scrotum along with the testicles and reposition of the penile shaft into the anterior pelvic wall in the subcutaneous plane (Fleying procedure) was performed. The scrotum measured about 36 inches in diameter and weighed 40 kgs after excision. Histopathological examination of the scrotal skin confirmed the diagnosis. The patient was released without any complication, on the 11th post operative day after removal of stitches, with indwelling urethral catheter. He was prescribed Doxicycline for the next 8 weeks, a drug which has been found to be effective in treating filariasis in a number of studies, and acts by killing a symbiotic bacteria necessary for the survival of the worm. Follow up after 3 months was uneventful.

Border and imported bancroftian filariases: baseline seroprevalence in sentinel populations exposed to infections with Wuchereria bancrofti and concomitant HIV at the start of diethylcarbamazine mass treatment in Thailand.

Border bancroftian filariasis caused by Wuchereria bancrofti nocturnally subperiodic mainly exists in Karens residing alongside the Thailand-Myanmar border. Imported bancroftian filariasis caused by W. bancrofti nocturnally periodic mainly exists in cross-border Myanmar migrants. We analyzed seroprevalence data based on W. bancrofti adult worm antigen (Ag) loads and human immunodeficiency virus (HIV) immunoglobulins in the sentinel population samples which were studied prior to the start of the diethylcarbamazine (DEC) mass treatment phase in the PELF during fiscal years 2002-2006. In the Karens, the cumulative infection prevalence (36.8% serological antigen positivity or SAP) was specific for age (p < 0.001) but universal for gender (p = 0.77). The infection intensity (median Ag load = 60,827 antigen units or AU/ml) was specific for age (p = 0.031) and for males (p = 0.016). In the Myanmars, infection prevalence (24.0% SAP) was universal for age (p = 0.961) and for gender (p = 0.676). The infection intensity (median Ag load = 19,068 AU/ml) was universal for age (p = 0.433) but specific for females (p = 0.027). Overall, the Ag loads between the groups were significantly different (p = 0.014). In analysis of concomitant HIV and W. bancrofti infections, 7 (3.2%) Myanmars infected with HIV 1 and 3 (5.7%) with concomitant infections, subjected to biannual DEC treatment with 300 mg oral-dose FILADEC, were prevalent. The antigenemia clearance in the concomitant infections (r = -0.732, p = 0.039) as well as in the single W. bancrofti infection (r = -0.781, p = 0.022) was correlated with time required to clear antigenemias. We reemphasize that W. bancrofti adult worm Ag loads in the sentinel population samples would be beneficial for the PELF's implementers at the provincial level to probe the disease burdens in target areas and to evaluate and monitor the DEC treatment efficacy and effectiveness in those sentinel populations, including those with concomitant HIV eligible for the DEC mass treatment phase in the PELF.

Management of disability in lymphatic filariasis--an update.

The global lymphatic filariasis elimination programme incorporates disability management along with transmission control, to ensure 'a visible impact' on those who are already affected by the disease. The common manifestations of lymphatic filariasis like lymphoedema; elephantiasis and hydrocele result from irreversible damage caused to the lymphatics by the adult worms. Only palliative treatment in the form of physical methods and surgery is available for lymphoedema and elephantiasis. Hydrocele can be corrected by surgery. The most distressing aspect of lymphatic filariasis is the attacks of acute adenolymphangitis, which cause considerable short-term and also long-term disability by worsening the lymphoedema. Since each episode prevents the person from attending his work for several days, the economic loss is substantial. The precipitating cause of these attacks is secondary infection, the bacteria entering the tissues through 'entry lesions' in the skin. These episodes can very well be prevented by proper 'local-hygiene' of the affected limbs, which is a simple, effective, cheap and sustainable method that can be carried out even in the patient's house. These subjects and the providers of 'home care' should be trained in foot-hygiene programme, so that the message percolates to various levels in the affected communities, ultimately benefiting the patient.

A preliminary study of filariasis related acute adenolymphangitis with special reference to precipitating factors and treatment modalities.

Episodic adenolymphangitis (ADL) is one of the important clinical manifestations of lymphatic filariasis. Recurrent ADLs contribute to the progress of the disease and also have important socioeconomic implications since they cause significant loss of man days. The present study was conducted in order to identify the precipitating factors responsible for ADL attacks and also to examine the different modalities of treatment. Sixty-five individuals with filariasis related ADL attacks, who are residents of Alleppey district (endemic for Brugia malayi) were studied. All efforts were taken to identify the precipitating factors for ADLs in these individuals. They were hospitalized for a period of five days or more. All of them received symptomatic antipyretic/antiinflammatory therapy and topical antibiotic/antifungal treatment of the affected limbs. They were then randomly allocated to one of the following four regimens: group I - symptomatic alone; group II - symptomatic plus antibiotics; group III - symptomatic followed by diethylcarbamazine citrate (DEC) and group IV - symptomatic plus antibiotic followed by DEC. Patients in groups III and IV received DEC every three months up to one year. There was a significant relationship between the number of ADL attacks and the grade of edema. Presence of focus of infection in the affected limb could be identified in 28 of the 65 patients. In the majority of patients (48) response to treatment was rapid (resolution in less than five days). Neither antibiotics nor DEC (given at intervals of three months) appeared to alter the frequency of ADL attacks. On the otherhand simple hygienic measures combined with good foot care and local antibiotic/antifungal cream application (where required), were effective in reducing the number of ADL attacks.

Pleural effusion due to lymphatic filariasis.

A case of pleural effusion is reported. Pleural biopsy showed microfilariae on histopathological examination. Treatment with diethyl carbamazine yielded excellent results. Filarial aetiology should be included in the differential diagnosis of idiopathic pleural effusions, especially in endemic areas.

Myiasis in filarial lymphoedema due to Chrysomyia bezziana.

In patients with filarial lymphoedema of the limbs, infestation by maggots is extremely rare. We saw three patients with lymphoedema who harboured Chrysomyia bezziana in leg ulcers and in one of them 128 maggots were recovered. A course of local dressing, antibiotics and anti-inflammatory drugs resulted in healing of the wounds. Ulcers in patients with lymphoedema should be carefully tended with cleaning and dressing otherwise myiasis may supervene.

The use of ivermectin for scabies.

BACKGROUND. Ivermectin, a modified avermectin, is widely known to be an ectoparasiticidal agent in animals but its effect on human ectoparasites is not known. METHODS. As a part of a chemotherapy trial with ivermectin against Wuchereria bancrofti microfilaraemia, two males with clinical scabies were studied. Three skin scrapings were taken from the lesions of each of the cases and examined with potassium hydroxide solution for the presence of eggs, larvae or adult mites. RESULTS. Following a single oral dose of ivermectin at either 100 micrograms or 20 micrograms/kg body weight both the itching and eruptions were reduced and the lesions healed after 14 days of treatment. Skin scrapings taken on days 7 and 30 after administering the drug did not reveal any mites. However, the lesions reappeared after 3 months. CONCLUSION. The beneficial results on the healing of scabetic lesions following ivermectin therapy indicates that the drug may have a scabicidal effect. Reappearance of the lesions may have been due to an inadequate dose. This emphasizes the need for future controlled trials on the efficacy of ivermectin against human scabies infection. If proven, this may be an additional advantage in mass chemotherapy campaigns, when there is co-existence of filariasis, intestinal helminthiasis and scabies.

Epidemiology of Brugia malayi infection and its co-existence with Wuchereria bancrofti in and around Sillaberia PHC, District Midnapur, West Bengal.

Of 2186 persons investigated in thirteen villages of Sillaberia PHC, 19 were found to be infected with Brugia malayi and only one person harboured microfilaria (mf) of Wuchereria bancrofti. Similarly 41 persons exhibited signs and symptoms of chronic filariasis. The mf and disease rates percent worked out to be 0.914 and 1.87 respectively. The earliest ages showing mf and disease manifestations were 3 and 11 respectively. The mean mf density ranged from 2 to 12.2 per 20 cumm of blood. The male and female ratio in terms of mf carriers and chronic cases worked out to be 1.4:1 and 1:2 respectively. The entomological collections revealed a high ten man hour density (163.20) in case of Culex quinquefasciatus and comparatively much lower in case of Mansonia (Mansonioides) annulifera (47.51) and Mansonia (Mansoni oides) uniformis (23.83) respectively. The infection and infectivity rates in case of Mansonia (Mansonioides) annulifera were 6.1 and 1.2 per cent respectively.

Filariasis and malaria sera from Orissa lack HTLV-III antibody reactivity.

Reports exist indicating a correlation between seropositivity for human T-lymphotrophic virus (HTLV) antibodies and certain parasitic infections in some parts of the world. In 274 filariasis and 119 malaria sera examined from Orissa, none was reactive in a test for anti-HTLV-III antibodies.