Home About us Editorial board Search Ahead of print Current issue Archives Submit article Instructions Subscribe Contacts 276


 
 Table of Contents  
CASE REPORT
Year : 2014  |  Volume : 5  |  Issue : 2  |  Page : 188-190

Filariasis in body fluids: Report of three cases


Department of Pathology, KS Hegde Medical Academy of Nitte University, Mangalore, Karnataka, India

Date of Web Publication1-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
Login to access the Email id

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0975-9727.135778

Rights and Permissions
  Abstract 

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 Top


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 Top


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)

Click here to view


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]

Click here to view



  Discussion Top


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 Top


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 Top

1.Haleem A, Juboury MA, Husseini HA. Filariasis: A report of three cases. Ann Saudi Med 2002;22:77-9.  Back to cited text no. 1
    
2.Yelikar BR, Potekar RM, Mahesh KU, Vijayalakshmi SP. Filariasis presenting as non resolving pleural effusion. Int J Biol Med Res 2012;3:2284-6.  Back to cited text no. 2
    
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.  Back to cited text no. 3
    
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.  Back to cited text no. 4
    
5.Jha A, Shrestha R, Aryal G, Pant AD, Adhikari RC, Sayami G. Cytological diagnosis of bancroftian filariasis in lesions clinically anticipated as neoplastic. Nepal Med Coll J 2008;10:108-14.  Back to cited text no. 5
    
6.Arora VK, Gowrinath K. Pleural Effusion due to lymphatic filariasis. Indian J Chest Dis Allied Sci 1991;36:159-61.  Back to cited text no. 6
    
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.  Back to cited text no. 7
[PUBMED]  Medknow Journal  
8.Chenthamarakshan V, Padigel UM, Ramaprasad P, Reddy MV, Harinath BC. Diagnostic utility of fractionated urinary filarial antigen. J Biosci 1993;18:319-26.  Back to cited text no. 8
    


    Figures

  [Figure 1], [Figure 2]



 

Top
 
 
  Search
 
Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)

 
  In this article
Abstract
Introduction
Case Reports
Discussion
Conclusion
References
Article Figures

 Article Access Statistics
    Viewed4807    
    Printed71    
    Emailed0    
    PDF Downloaded306    
    Comments [Add]    

Recommend this journal


[TAG2]
[TAG3]
[TAG4]