Chronic wuchereriasis presenting as a vaginoperineal fistula: report of a case with aspiration cytologic diagnosis.

BACKGROUND: Filariasis is often an occult disease with myriad presentations. Cytology has an established role in diagnosing clinically unsuspected cases. CASE: A 20-year-old female presented with recurring perineal ulcers, vaginal discharge and inguinal lymphadenopathy. Radiology revealed a vaginoperineal fistula. Fine needle aspiration (FNA) of the ulcer bed and smears prepared from the ulcer discharge showed an adult, gravid, female filarial worm and unsheathed larvae. Similar microfilariae were also seen in FNA smears from inguinal lymph nodes. The atypical clinical presentation and unusual parasite morphology posed initial difficulties in characterization of the microfilarial species. CONCLUSION: This case report highlights the morphologic clues to the dif ferential diagnosis offilarial species on cytologic specimens. Chronic wuchereriasis presenting as a vaginoperineal fistula has not been reported previously.

Rapid diagnosis of Brugia malayi and Wuchereria bancrofti filariasis by an acridine orange/microhematocrit tube technique.

A microhematocrit tube technique for diagnosis of human filariasis has been previously described. A system incorporating heparin, EDTA, and acridine orange into a microhematocrit tube (Quantitative Blood Count, QBC) has been commercially developed for the quantitation of blood counts and has been used for the diagnosis of malaria. We evaluated this test for its usefulness in the diagnosis of filariasis. Upon centrifugation, the parasites were concentrated in the area of the buffy coat and could be observed through the wall of the tube. The parasites were concentrated further by a plastic float that expands the buffy coat and confines the parasites to the periphery of the tube. Acridine orange stains the DNA of the parasite, and morphologic characteristics can be examined by fluorescence microscopy. The terminal and subterminal nuclei and long cephalic space of Brugia malayi, as well as the short cephalic space and caudal nuclei of Wuchereria bancrofti, were easily recognized and differentiated from each other. Microfilariae were detected in samples diluted to a level of approximately 50/ml.

Further evidence of a skewed distribution of microfilariae in capillary blood.

Reported are results for 23 Haitian patients with capillary Wuchereria bancrofti microfilaremias greater than 30 mf/20 cmm blood. In capillary blood, the number of microfilariae was 0.9 to 7.8 times greater than expected when compared with that in venous blood. When the values for venous blood and capillary blood from these high count patients were plotted, the simple linear regression y = a + bx (r2 = .36) and the exponential function y = aebx (r2 = .34) both represented the relationship. However, when values for high and low count patients were plotted, the power function y = axb (r2 = 0.82) best described the relationship between the number of microfilariae in venous and capillary blood.

Gravid adult female worms of Wuchereria bancrofti in fine needle aspirates of soft tissue swellings. Report of three cases.

Gravid adult female worms of Wuchereria bancrofti were observed in fine needle aspirates of soft tissue swellings from three patients. An inguinal lymph node was aspirated in two cases, and a breast nodule was the site of aspiration in the third case. In one of the inguinal lymph node aspirates, two adult gravid female worms were identified.

Intraocular filariasis: a brief review.

Fifty-six cases of human intraocular filariasis have been reported. In 6, the objects interpreted as filariae may have been artifacts. In 8, a motile worm that apparently was not a filaria was observed. In the remainder, a motile filaria or filaria-like worm was observed, but in only 6 cases were the filariae removed from the eye, described, and identified. Three of these were identified as Dipetalonema spp., and one each as Wuchereria, Dirofilaria, and Loaina. In 10 cases, filariae were removed and identified as Loa loa (6) or Wuchereria bancrofti (4) but without a supporting description. A filaria was removed but not satisfactorily described or identified in 8 cases, spontaneously disappeared in 4, died following treatment in 4, and met unreported fates in seven. For 3 the original reports were inaccessible. Records of intraocular filariae that are not supported by morphological description are questionable.

Application of biotechnology in the identification of filarial larva in mosquitoes.

Current methods for detecting and identifying filariae in mosquitoes are laborious and time consuming. With today's technology, we can reasonably expect development of rapid, sensitive and specific assays for detecting and identifying filariae in naturally infected mosquito populations. Progress in developing such assays is reviewed.

[Wuchereria bancrofti: value of the diethylcarbamazine provocation test for the diurnal detection of microfilaria carriers]. / Wuchereria bancrofti en Haïti: intérêt du test de provocation par la diéthylcarbamazine pour le dépistage diurne des porteurs de microfilaires.

Sixty-nine of 83 (83%) patients with circulating microfilariae of nocturnally periodic Wuchereria bancrofti were detected in daytime blood films following the one-time administration of diethylcarbamazine at a dose per patient of 1 +/- .25 mg/kg of body weight. This method of detecting microfilaria carriers in Haiti is recommended as a reasonably sensitive alternative when circumstances make it impossible to conduct a nighttime blood survey.