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| CASE REPORT |
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| Year : 2014 | Volume
: 5
| Issue : 2 | Page : 188-190 |
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Filariasis in body fluids: Report of three cases
K Jayaprakash Shetty, HL Kishan Prasad, Harish S Permi, Meera Jayakumar, HS Kiran, Netra Sajjan
Department of Pathology, KS Hegde Medical Academy of Nitte University, Mangalore, Karnataka, India
| Date of Web Publication | 1-Jul-2014 |
Correspondence Address:
H L Kishan Prasad
Department of Pathology, K S Hegde Medical Academy of Nitte University, Deralakatte, Mangalore - 575 018, Karnataka
India
 Source of Support: None, Conflict of Interest: None DOI: 10.4103/0975-9727.135778
Filariasis is disabling parasitic disease which is prevalent worldwide and caused by various species of filarial organism. Wuchereria bancrofti (W. Bancrofti) is responsible for 90% of cases of filariasis and is found throughout the tropics and in some sub-tropical areas. Cytology has an important role in the diagnosis of subclinical filariasis. Microfilaria is frequently detected in association with neoplasm, although the role in tumorogenesis is controversial. The early detection of the disease could thus mean the difference between a productive healthy life and a lifetime of chronic disability. The identification of microfilaria in body fluids is a rare scenario. We are presenting here with three cases of microfilaria, which was detected in the pleural fluid, bronchoalveolar lavage, pericardial fluid, and in semen with different clinical scenarios. The purpose of this paper was to illustrate these examples and to review the appropriate literature in order to make physicians aware of this uncommon entity. Keywords: Association with malignancy, filariasis, incidental, Wuchereria
How to cite this article:
Shetty K J, Kishan Prasad H L, Permi HS, Jayakumar M, Kiran H S, Sajjan N. Filariasis in body fluids: Report of three cases. Muller J Med Sci Res 2014;5:188-90 |
How to cite this URL:
Shetty K J, Kishan Prasad H L, Permi HS, Jayakumar M, Kiran H S, Sajjan N. Filariasis in body fluids: Report of three cases. Muller J Med Sci Res [serial online] 2014 [cited 2021 Sep 28];5:188-90. Available from: https://www.mjmsr.net/text.asp?2014/5/2/188/135778 |
| Introduction | |  |
Filariasis is a group of tropical diseases caused by various thread like parasitic round worms and their larvae. [1],[2],[3] It affects approximately 170 million people in the tropical areas of Southeast Asia, South America, and Africa. It is one of the only six "potentially eradicable" infectious disease named by World Health Organization (WHO). [2],[3],[4] Filariasis is a major public health problem in India. Wuchereria bancrofti (W. bancrofti) is the most widespread of the filarial organisms, infecting man. The parasite is endemic in both urban and rural areas of India. [2],[3],[4],[5] It has been estimated that 374 million persons are living in endemic areas and 45 million are infected in India. [2],[3] Conventional diagnostic procedures include the demonstration of microfilaria in the blood smears or in the skin snips. [3],[5],[6] Both of these procedures have high false-negative rates. The early detection of the disease could thus mean the difference between a productive healthy life and a lifetime of chronic disability. The identification of microfilaria in body fluids is a rare scenario. [3],[4],[5],[6] We are presenting here with three cases of microfilaria, which was detected in the body fluids with different clinical scenarios. The purpose of this paper was to illustrate these examples and to review the appropriate literature in order to make physicians aware of this uncommon entity.
| Case Reports | | |
Case 1
A 60-year-old male, presented with fever, cough, pain in the left side of the chest, and dyspnoea since 15 days. Chest X-ray showed left-sided pleural effusion. Hematological and biochemical parameters were within normal limits. Diagnostic pleural tap showed straw-colored pleural fluid; on wet films, the fluid revealed numerous filarial larvae of W. bancrofti. Bronchoalveolar lavage also showed similar findings [Figure 1]a and b. The patient had bronchogenic carcinoma diagnosed by computed tomography (CT)-guided transbronchial cytology. | Figure 1: (a) Microfilaria in the pleural fluid [May-Grunwald-Giemsa, MGG, ×100] (b) Microfilariae in the bronchoalveolar lavage [MGG, ×100] (c) Pericardial fl uid cytology smear showing microfi laria in a hemorrhagic background (Leishman stain, ×400)
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Case 2
A 53-year-old male was admitted with dyspnea since 2 days. He complained of cough and breathlessness for 1 month and generalized weakness for 15 days. Echocardiogram showed massive pericardial effusion with cardiac tamponade, and CT scan revealed large anterior mediastinal mass. Pericardiocentesis drained 1.5 litres of hemorrhagic fluid. Cytology revealed microfilaria of W. bancrofti [Figure 1]c. Adenosine deaminase was 62/L. Fine needle aspiration cytology (FNAC) and trucut biopsy from the anterior mediastinal mass showed spindle cell thymoma. On installation of diethylcarbamazine (DEC) therapy, patient improved dramatically.
Case 3
A 32-year-old man presented with history of infertility. Wet mount preparation of the semen showed microfilaria of W. bancrofti [Figure 2]a and b. | Figure 2: (a) Filarial worm seen in the wet mount preparation of semen [×400] (b) Microfilaria seen in wet mount preparation of semen [×400]
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| Discussion | | |
Filariasis is transmitted by culex mosquito and is caused by two closely related nematodes W. bancrofti and Brugia malai is responsible for 90% and 10% of the cases, respectively. [3],[4],[6] Although microfilariasis, in unusual conditions, are considered incidental findings, the association of microfilaria with debilitating conditions suggests that it may be an opportunistic infection or coincidental with various neoplasms. [4],[6],[7]
The major clinical presentations of filariasis include fever, asymptomatic microfilariaemia, lymphatic obstruction, and tropical pulmonary eosinophilia. [2],[4],[5] Acute manifestations are usually fever, adenolymphangitis, funiculitis, epididymitis, or orchitis. Lymphoedema, hydrocele, elephantiasis, chyluria are the features of chronic filariasis. However, all our three citations are uncommon manifestations.
In surgical material, the diagnosis is relatively easy when viable filarial worm is present. Similarly, microfilaria may be missed if you are not aware of the possibility, particularly in cases where tissue eosinophilia is absent. [3],[5],[6],[7]] Diagnosis of filariasis is made on demonstrating microfilariae in blood samples and body fluids. [4],[6],[7] The host's immune response directed against the parasite lying in different lymphatic vessels appears to be the major factor in determining the clinical presentation. Exudative effusion appears to be due to lymphangitis or incomplete obstruction of lymphatics. Microfilariae in cytologic smears from various sites such as breast, thyroid, bronchus, cervix/vagina, pericardium, and hydrocele have been reported in the literature. [2],[4],[5],[6],[7] Few case reports of bancroftian filariasis from pleural fluid and hydrocele have been described. [3],[5],[6],[7]] Some cases where microfilariae were found in body fluid cytology and fine needle aspiration smears in association with tubercular pleural effusion/lymphadenitis, pregnancy, non-Hodgkin's lymphoma, malnutrition, and young age. [3],[5],[7] Although the finding of microfilariae in cytologic smears is considered incidental, the association of microfilariae with debilitating conditions suggests that it is an opportunistic infection. [4],[6],[7] Filarial worm demonstration in semen analysis is extremely rare scenario and probably first of its kind in world literature. Filariasis is rarely asssociated with infertility.
Filarial antigen in body fluids as secretions and as surface products of the parasite have immense value in immunoparasitology, and it acts as a marker for the diagnosis of active infection. [7],[8] Purification and characterization of filarial antigen from body fluids is a prerequisite for identifying the antigens of immunodiagnostic importance. Several investigators have isolated filarial antigens from body fluids viz., blood, urine, and hydrocele fluid to study the nature and properties of these antigens to use them as diagnostic reagents in the detection of bancroftian filariasis. There are considerable difficulties in obtaining required human parasite material due to lack of suitable animal model. Some studies have shown that absorption of urinary albumin improved the sensitivity of urinary filarial antigen detection. [7],[8]
At present, there is no substitute for DEC as the drug of choice for filariasis. However, ongoing trials with Ivermectin as a single daily dose appears promising. [3],[5],[7]
| Conclusion | | |
In one of the above-mentioned case, the dramatic recovery of the patient with DEC stresses the need for detection of the organism for diagnosis and proper treatment. Body fluids are thus of paramount diagnostic importance and may help obviate the more serious pathological changes of advanced disease.
| References | | |
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| 3. | Menon B, Garg A, Kalra H, Sharma R. Microfilarial pleural effusion in a case of tropical pulmonary eosinophilia. Indian J Chest Dis Allied Sci 2008;50:241-3.
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| 4. | Permi SH, Samaga BN, Subramanyam K, Shetty KJ, Thirthnath S, Baikunje V, et al. Microfilariae in pericardial effusion coexisting with spindle cell thymoma-a rare case report. Nitte University Journal of Health Sciences (NUJHS) 2011;1:40-2.
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| 6. | Arora VK, Gowrinath K. Pleural Effusion due to lymphatic filariasis. Indian J Chest Dis Allied Sci 1991;36:159-61.
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| 7. | Marathe A, Handa V, Mehta GR, Mehta A, Shah PR. Early diagnosis of filarial pleural effusion. Indian J Med Microbiol 2003;21:207-8.
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| 8. | Chenthamarakshan V, Padigel UM, Ramaprasad P, Reddy MV, Harinath BC. Diagnostic utility of fractionated urinary filarial antigen. J Biosci 1993;18:319-26.
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[Figure 1], [Figure 2]
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