Cytological diagnosis of bancroftian filariasis in lesions clinically anticipated as neoplastic.

Filariasis is a common disabling parasitic disease in this region and cytological diagnosis is often not required. Cytology has important role in diagnosis of sub-clinical filariasis. Most cases of cytologically diagnosed filariasis are clinically unanticipated. Microfilaria, ova and fragments of adult worm of Wuchereria bancrofti, in exfoliative as well as aspiration cytology have been reported and are useful in cytological detection of bancroftian filariasis. Microfilaria is frequently detected in association with neoplasm, although the role in tumorogenesis is controversial. The objective of the study was to investigate importance of cytology in diagnosis of filariasis in lesions clinically anticipated to be of neoplastic and to review the cytomorphology of bancroftian filaria and its association with neoplasm. This is a retrospective study carried out in cytology department of Tribhuvan University Teaching Hospital. 14 cases of cytological specimen out of 4291 (0.3%) showed microfilaria; 12 cases were from FNAC from different sites and 2 cases were from pleural fluid. 2 cases showed ova in addition to microfilaria and one of them in addition showed fragment of adult worm. Microfilaria in 4 cases of FNAC and one case ofpleural fluid were associated with malignant cells.

Clinico-laboratory profile of 45 filarial arthritis cases.

This prospective observational study was done during the period from January 2000 to December 2004 including 45 cases of lymphatic filariasis manifested with acute arthritis. Different investigations were carried out to exclude allergy, parasitic and infectious diseases, autoimmune disorder and malignancy. They were given standard treatment with oral non-steroidal anti-inflammatory drugs (NSAIDs). Articular symptoms were not relived satisfactorily. Later they were given oral corticosteroids. During treatment slight relief of symptoms were noted, but all sign-symptoms reappear after withdrawal of corticosteroid drugs. Treatment with oral diethylcarbamazine citrate (DEC) (150 mg/day) for 3 weeks showed complete resolution of arthritis. No side effects or relapse were encountered. The basic mechanism of relief of pain remains unknown. It was assumed that during benign course of lymphatic filariasis, development of arthritis result most likely due to reaction against some occult agents in the joints.

Persistent corneal edema secondary to presumed dead adult filarial worm in the anterior chamber.

We present three cases of persistent corneal edema secondary to presumed dead adult filarial worms lying in the anterior chamber with their attachment to the endothelium. Two of them were initially diagnosed as descemet's fold with corneal edema. Two patients underwent penetrating keratoplasty and in one case, surgical removal was partly possible with clearing of cornea.

Microfilariae in bone marrow aspiration smears, correlation with marrow hypoplasia: a report of six cases.

Microfilariae have been reported in various cytological preparations, however there are very few case reports describing microfilariae in bone marrow aspirates. We report six such cases with the interesting finding of marrow hypoplasia in five of these cases.

Aplastic anaemia following varicella infection with coexistent microfilaremia of Wuchereria bancrofti--a case report.

Filariasis is a common public health problem in various regions of Indian subcontinent. There are many reports describing detection of microfilaria in different organ systems. There are limited number of reports available describing the presence of microfilaria in bone marrow. Here we report a young patient who developed aplastic anaemia following varicella infection. Peripheral blood and bone marrow showed many microfilariae of Wuchereria bancrofti. There are no reports describing this unique combination in the available literature.

Relationship between male hydrocele and infection prevalences in clustered communities with uncertain transmission of Wuchereria bancrofti on the Thailand-Myanmar border.

A cross-sectional community-based study was conducted in three clustered communities, belonging to a single small village in Mae Chan subdistrict, Umphang district, Tak Province, close to the Thailand-Myanmar border, where regular night blood survey have been discontinued since 1997 and no epidemiological study had been conducted. In order to understand prevalences of distribution of male hydrocele and infection in clinically diagnostic and epidemiologic implications in uncertain transmission of Wuchereria bancrofti, we analyzed the relationship between male hydrocele and community infection prevalences in 219 (90.5% coverage) subjects aged > or =1 year old, including 54.8% migratory and 45.2% local Karen inhabitants. Migratory inhabitants tended to have high prevalence of antigenemia (p < 0.05) and hydrocele. Overall rates of 23.7% antigenemia, 3.7% microfilaremia, and 4.6% male hydrocele were observed. Male hydrocele prevalence was significantly correlated (r = 0.348, p < 0.0001) with antigenemia prevalence, but not with microfilaremia prevalence (r = 0.065, p = 0.493). However, high antigenemia prevalence in local inhabitants was evident, particularly antigenemia prevalence in children suggesting that transmission in the village may have occurred in recent years.

A clinico-epidemiological perspective of lymphatic filariasis in Satyabadi block of Puri district, Orissa.

BACKGROUND & OBJECTIVES: Lymphatic filariasis is a major public health problem in the coastal district of Orissa. However, no systematic studies have been done to document the prevalence of microfilaraemia/disease in different regions of the State. Therefore, the present cross sectional study was undertaken during 1996-97 to obtain information on the clinical and epidemiological status of the disease in Satyabadi block area of Puri district, known to be endemic for filariasis. METHODS: Night blood smear survey and clinical examinations were performed on 4646 individuals aged 0-> or = 60 yr from systematically selected households of 17 randomly selected villages of the Block. Microfilaraemia was detected by thick drop technique using 20 microliters of peripheral blood and microfilariae (mf) density by nucleopore filtration technique collected during 1900-2300 h. RESULTS: The prevalence of microfilaraemia was observed to be 14.8 per cent; 13.3 per cent Wuchereria bancrofti, 1.4 per cent Brugia malayi and 0.09 per cent had mixed infections. Geometric mean microfilaraemia density (infected persons only) was found to be 1288 per ml in case of W. bancrofti and 204 per ml in case of B. malayi. The disease rate was observed to be 19.8 per cent; 12.85 per cent had acute manifestations and 6.97 per cent had chronic manifestations. INTERPRETATION & CONCLUSION: The rate of acute disease manifestations was observed to be significantly higher (P < 0.001) than chronic manifestations. There was a male preponderence among the affected individuals (P < 0.001). The interesting observations of the study were the occurrence of occult filarial manifestations viz., tropical pulmonary eosinophilia (TPE) in 0.47 per cent cases and other associated manifestations like asymptomatic microscopic haematuria, monoarticular arthritis and filarial associated respiratory diseases in 0.50, 0.24 and 0.19 per cent of cases respectively. The present study indicates that the area is highly endemic for lymphatic filariasis with active transmission.

Filariasis as a cause of pleural effusion.

Filariasis, a mosquito borne disease is endemic in many tropical countries and sub tropics including India. A 44 years old male presented with signs and symptoms of pleural effusion. Pleural fluid on examination was exdudative in nature and showed presence of microfilariae of Wuchereria bancrofti.

Extralymphatic disease due to bancroftian filariasis

Infection with Wuchereria bancrofti, Brugia malayi, or B. timori not only affects the structure and function of lymphatic vessels but is also associated with extralymphatic pathology and disease. Because it is now possible to detect living adult worms by ultrasonography, much emphasis is placed on lymphatic pathology. However, the finding of renal damage in asymptomatic microfilaremic carriers has led to increased recognition of the importance of extralymphatic clinical manifestation in bancroftian filariasis. The authors present a number of clinical syndromes that may be manifestations of extralymphatic filarial disease and discuss possible mechanisms that cause these conditions. The main purpose of this paper is to raise the awareness of students and physicians of the prevalence and the importance of extralymphatic disease in bancroftian filariasis so that it is diagnosed and treated properly and also to alert for the need of additional research in this area.

Report study on chyluria

A case of chyluria is repored, detected in a non-endemic area, although the patient hails from an endemic belt in India. The chronicity and reinfection theoty leading to this complication of filariasis caused by the nematode wuchereria bancrofti are confirmed. Various investigative and treatment aspects and preventive measures are discussed

Microfilariae of Wuchereria bancrofti in ascitic fluid.

We have presented a patient with ascites who demonstrated bancroftian microfilariae in the ascitic fluid. Such a presentation is exceedingly uncommon.

Tropical vaginal hydroceles: are they all filarial in origin?

Hydrocele of the tunica vaginalis testis has been conventionally used as an absolute indicator of filarial disease in most clinical surveys. The prevalence of filarial etiology in 100 consecutive hydroceles was studied using clinical, parasitological, histopathological and immunological parameters. Filarial etiology could be proved in 57% of hydrocele cases using major criteria: presence of microfilaria in hydrocele fluid, presence of chyle in hydrocele fluid, demonstration of adult worm in tunica, ratio of fluid antibody titer to serum antibody titer more than 2 and presence of filarial antigen in hydrocele fluid. The results of other tests in these 57 cases were used to define the minor criteria. In the other 43 cases, based on the minor criteria, 12 hydroceles could be classified as likely to be due to filariasis and the rest were probably non-filarial. Thus only 69% of hydroceles were definitely or probably filarial.

Budd Chiari syndrome and pericaval filariasis.

A young girl presented with Budd-Chiari syndrome (BCS) with narrowing of the retrohepatic segment of inferior vena cava (VC). Dorsal cavoatrial bypass (DCAB) was unsuccessful due to thrombotic occlusion of the graft. A limited autopsy revealed occlusion of the retrohepatic segment of IVC and the terminal parts of the three major hepatic veins. Caval occlusion was just above the level of the superior hepatic veins, and caused by a transverse fibrous shelf. An adult filarial worm was found amidst pericaval fibrosis. Filariasis should be included as a possible aetiological factor in chronic BCS.

Tropical pulmonary eosinophilia in an Orissa village.

BACKGROUND. Tropical pulmonary eosinophilia is usually seen in areas endemic for filariasis. It affects only a small proportion of the population at risk and microfilaria are rarely demonstrated in the peripheral blood. The actual prevalence of the tropical pulmonary eosinophilia syndrome has not been previously studied in an area endemic for filariasis. METHODS. We screened the population of a village in the Puri district of Orissa, where filarial infection is endemic, to determine the prevalence of tropical pulmonary eosinophilia by clinical examination measuring the absolute eosinophil counts, performing a chest X-ray and examining the stools for the presence of the parasite. Sera from symptomatic cases who had an eosinophil count above 2000 per cmm were further tested for filarial specific IgG and total IgE and the results compared with control sera obtained from 15 age- and sex-matched normal individuals. RESULTS. We were able to screen 1754 (91%) out of 1918 villagers who were more than 5 years old and found 69 cases who had typical clinical features of tropical pulmonary eosinophilia. Only 6 (0.34%) of these had eosinophil counts above 3000 per cmm and were considered to have the disease. Only 2 of the 6 had associated filarial lesions, one had microfilaraemia and 3 had typical chest X-ray changes. The mean (+/- SD) titres for filaria specific IgG (0.355 +/- 0.315 v. 0.120 +/- 0.092) and total IgE (0.455 +/- 0.316 v. 0.114 +/- 0.075) were significantly higher in cases with tropical pulmonary eosinophilia than in control subjects. The level of eosinophilia was related neither to the patients' immune status nor to the severity of the radiological lesions. All cases recovered after therapy with diethylcarbamazine. CONCLUSION. Tropical pulmonary eosinophilia is not uncommon in this community in Orissa where filariasis is endemic. However, the syndrome is rarely associated with clinical filarial lesions.