Management of vulvar lymphedema of filarial origin in a pregnant woman and its outcome: A case report.

Lymphedema of filarial origin affecting the vulva is extremely rare. It is a dilemma if seen in a pregnant woman as there are no guidelines regarding excision and the mode of delivery. With the World Health Organization-driven global program to eradicate filaria, it is unfortunate to see such cases. We report of a woman who had massive lymphedema of both the labia majora following filarial infection with a small secondary ulcer. She presented to our outpatient department in early pregnancy. After detailed counseling with the couple, a decision was taken for excision. The same was carried out. The wound healed well but the lymphedema recurred after 6 weeks. She was thereafter managed symptomatically. Pregnancy advanced without any complication. Her intrapartum management for a successful vaginal delivery is outlined in the report.

Human intraocular filariasis caused by Pelecitus sp. nematode, Brazil.

A male nematode was extracted from iris fibers of a man from the Brazilian Amazon region. This nematode belonged to the genus Pelecitus but was distinct from the 16 known species in this genus. Similarities with Pelecitus spp. from neotropical birds suggested an avian origin for this species.

Giant cutaneous cyst in a dog infected by Cercopithifilaria bainae.

Cercopithifilaria bainae is the most prevalent species of filarioids within the genus. This parasite localizes in the skin, sometimes causing erythematous dermatitis. Herein, the authors describe a case of giant cutaneous cyst in a dog infected by Cercopithifilaria bainae. A 9-year-old male mixed-breed dog presented to a veterinary facility in Dourados, Mato Grosso do Sul (Midwest Brazil) with a mass in the lumbosacral region. On clinical examination, the mass was observed to be approximately 15 cm in diameter with a floating consistency and conspicuous presence of viscous fluid; the lesion, however, was non-ulcerated and non-adherent. Cytological examination revealed the presence of moderate lymphocyte cellularity and foamy macrophages, erythrophagocytosis and the presence of numerous microfilariae. After morphological and molecular analysis of the 12S ribosomal RNA gene, the microfilariae were identified as C. bainae, exhibiting 99-100% identity with DNA sequences available from Genbank. Surgery was recommended and after resection of the giant cyst, the dog was treated with ivermectin for two weeks and the clinical condition was completely resolved. Based on the presence of microfilariae in the cyst fluid the role of this filarioid in the determinism of the lesion has been discussed.

Intravitreal live adult Brugian filariasis.

Human ocular infestation by live filarial worm is a rare occurrence and has been reported mostly form South-East Asia. It involves the eyelids, conjunctiva, cornea, anterior chamber and uvea. No case of intravitreal Brugian microfilaria / adult worm has been found by Medline search. Here we report a case of live intravitreal adult Brugian filaria, where the parasite was successfully removed by pars plana vitrectomy. Identification of the worm was done by light microscopy and confirmed by immuno chromatographic test.

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.

Incidental detection of two adult gravid filarial worms in breast: a case report.

BACKGROUND: Microfilaria is a major public health problem in tropical and subtropical countries and is an endemic problem in India. Wuchereria bancrofti is the commonest filarial infection. In some lesions, microfilariae and adult filarial worm have been incidentally detected in fine-needle aspirates. CASE PRESENTATION: A 35 year old hindu female presented with lump in upper outer quadrant of left breast. Fine needle aspiration revealed two adult gravid female filarial worms. CONCLUSION: To our knowledge this is the first ever case report to demonstrate two live gravid female and embryoid forms in wet mount preparation.

Filiarial chyluria with nephrotic-range proteinuria and associated hypoalbuminaemia and hypogammaglobulinaemia secondary to bilateral lymphorenal fistulae.

A 55-year-old man of Indian descent, presented to the emergency department with a 2-year history of passing 'milky' white urine, associated with dysuria, urinary retention, bilateral flank pain and 15 kg weight loss. He had migrated to Australia from India at the age of 16, with no overseas travel since, and denied having any fevers, rigours or chills. He was found to have chyluria and nephrotic-range proteinuria with marked hypoalbuminaemia and hypogammaglobulinaemia. Due to his ethnic origin and by diagnostic exclusion, a presumptive diagnosis of filariasis was made. With bilateral lymphorenal disconnection, as definitive management, the patient's chyluria and proteinuria resolved with restoration of normal plasma protein and immunoglobulin levels.

"Worm in the eye": the rationale for treatment of DUSN in south India.

AIM: To discuss the rationale for different techniques of treatment for DUSN (diffuse unilateral subacute neuroretinitis) and their effectiveness in two patients from south India. METHODS: Two rare cases of live worms in DUSN from India are reported, where filarial Brugia malayi is endemic. Both cases presented with progressive unilateral loss of vision with no history of animal contact. They were 40 year old, apparently healthy men. In case 1, the worm (1500-2000 microm) was easy to identify with wriggling movements among crisscrossing diffuse subretinal tracks. The worm was destroyed by a single shot of laser to its advancing end, which was followed by oral steroid to control the inflammation caused by the dead worm. In case 2, the worm was small and difficult to identify. Initially diffuse neuroretinitis was diagnosed and treated with intravenous methylprednisolone and oral corticosteroid. A week later, a small live worm (400-600 microm) was found and subsequently destroyed by laser photocoagulation followed by a combination of anthelminthics. RESULTS: The patients' vision had improved to 6/60-6/36 from counting fingers after a few weeks. CONCLUSION: The role of a combination of laser treatment, systemic steroid, and anthelminthics is discussed.

A juvenile filarial worm, Wuchereria bancrofti, extracted from the vitreous of the eye: the first report in the world literature.

A live worm was extracted from the vitreous of the eye of a patient in Sri Lanka. Based on the details of its length, width, oesophagus and vulva it was identified as Ajuvenile female Wuchereria bancrofti.

Omentoplasty in the management of filarial lymphoedema.

A trial of omentoplasty was carried out on 20 patients with unilateral filarial lymphoedema to assess its role in the reduction of oedema volume after failed lymphonodo-venous shunt (LNVS) or as a primary procedure. Omentoplasty was done through a midline laparotomy. The omentum was mobilized from the colon, preserving both gastroepiploic vessels, and transferred to the thigh either through the lower end of the laparotomy incision or through a separate stab and placed subcutaneously in the upper third of the thigh. There was no operative mortality. Morbidity was mainly incisional hernia and superficial wound infection. Fourteen of 18 patients had more than 25% reduction in oedema volume during the immediate postoperative period, and 5 of the 18 had more than 50% reduction. However, there was a gradual loss of response with time. Age, gender, grade of lymphoedema, duration, and previous surgery did not influence the outcome. The incidence of incisional hernia could be reduced by transferring the omentum through the midline. There was a statistically significant reduction in postoperative adenolymphangitis attacks whether or not the oedema volume was reduced. In some patients the oedema was reduced sufficiently to permit subcutaneous excision of the lymphoedematous tissue. There appears to be a definite but limited role for omentoplasty in patients who have failed LNVS.

Filarial worm (Loa loa) in the anterior chamber. Report of two cases.

Two Nigerian patients with intraocular parasitism by adult Loa loa worms are reported. Whereas Loa loa infestation of the subcutaneous tissues around the eye usually has no permanent effect on visual acuity, in the two cases reported the affected eye became blind.

Retroperitoneoscopic nephrolympholysis and ureterolysis for management of intractable filarial chyluria.

PURPOSE: To evaluate the feasibility of retroperitoneoscopic lymphatic disconnection in patients with intractable filarial chyluria with the aim of reducing the morbidity of the surgery. PATIENTS AND METHODS: Two patients presented to us with intractable chyluria. They did not respond to conservative measures and endoscopic sclerotherapy. In view of the severe lipid and protein loss associated with recurrent bouts of chyluria, they merited surgical correction by lymphatic disconnection. Because this operation requires extensive mobilization within the retroperitoneum over a large area, it necessitates a large flank or midline incision. In order to reduce the incision-related morbidity, it was decided to undertake the procedure laparoscopically. The retroperitoneal route was chosen for its obvious advantages. RESULTS: Surgery was carried out uneventfully in both patients, with a mean operating time of 2 hours. The patients stayed in the hospital for an average of 2.5 days. Chyluria resolved in the immediate postoperative period, and they have been asymptomatic over a follow-up of 30 and 18 months. One patient had drainage of lymph for 5 days, which resolved spontaneously. CONCLUSIONS: The objectives of open surgery can be achieved by the minimally invasive approach of retroperitoneoscopy. The new approach significantly reduces the incision-related morbidity without compromising the principles of open surgery. We propose five important steps necessary to avoid recurrence and reduce postoperative morbidity.

Acute carpal tunnel syndrome due to filarial infection.

A case of acute carpal tunnel syndrome (CTS) due to filarial infection is reported in a resident of Newfoundland, Canada. The patient presented with classical symptoms and signs of acute CTS and a filarial worm was identified in synovial tissue removed during surgery that was morphologically consistent with the genus Brugia. Antifilarial antibodies were present in serum. Surgical removal of the infected tissue, without administration of antifilarial drugs, proved adequate in eradicating the infection and a subsequent serum sample was negative for antifilarial antibodies. The patient remains asymptomatic more than two years after surgery. This case is unusual in its clinical presentation and geographic location.

Lymphovenous anastomosis in filarial lymphedema.

Correction of established filarial edema requires lymphaticovenous by-pass, to overcome the lymphatic obstruction and debulking to reduce the lymphatic load. Lymphnodovenous shunt at inguinal area has given 90% success in the authors hand, proving the by-pass. However, in an enormously swollen leg the dilated distal lymphatics may not be adequately drained and hence a distal lymphaticovenous anastomosis should theoretically offer further reduction; and thereby make debulking effective. In this article 3 cases are reported in whom lymphovenous anastomosis was done, in 2 at the knee level and in 1 at the ankle, their result and rationale are discussed.

Microfilariae in the mammary gland of a bitch.

A microfilarial infection of the mammary gland of a bitch with Dirofilaria immitis was diagnosed by fine needle aspiration biopsy. The animal had had a progressively enlarging, painful, pendulous, cystic swelling, measuring 12 x 18 cm, in the second left abdominal mammary gland for four to five months. Two separate biopsies revealed microfilariae and mammary duct epithelial cells, but no inflammatory cells. A histological examination revealed atrophic and necrotic mammary lobules with dilated and cystic ducts. Solid carcinoma was also observed in a small area of the mammary mass. The interlobular connective tissue was oedematous and the lymphatic and vascular channels were dilated. Microfilariae were observed within both the small blood vessels and capillaries and in the interlobular stroma of the mammary tissue, but there was no evidence of an inflammatory response.

Subconjunctival adult bancroftian filarial worm.

We report a case of live adult Bancroftian Filarial nematode removed from the sub conjunctival tissue of a 58-year-old woman from the temporal limbus of her left eye.

[Filaria: a tropical disease as the etiology of acute scrotum]. / Filarien: eine Tropenkrankheit als Ursache für das akute Skrotum.

In the diagnosis and treatment of acute scrotal pain and swelling it is important to differentiate between testicular torsion and epididymo-orchitis. A special case of a thirty-eight-year-old male asylant from Nepal was presented in the urological service with acute scrotal pain. To exclude testicular torsion, a diagnostic exploration of the scrotum was done with the findings of an acute funiculitis with abscess formation. Under surgical drainage of abscess together with medical treatment the acute inflammation disappeared. The diagnosis of filarial funiculitis was made after identifying the microfilariae in a blood vessel and in the peripheral blood smear. A filaricide medication with diethylcarbamacine citran was administered with good symptomatic relief.

[Subconjunctival localization of a Wuchereria bancrofti adult female]. / Localisation sous-conjonctivale d'une femelle adulte de Wuchereria bancrofti.

The authors describe a case of conjunctival localization of a living adult Wuchereria bancrofti female observed in a 6 year old native Haitian girl, two years after her arrival in France. The adult was surgically removed from the conjunctiva. Microfilariae were evidenced in blood samples obtained at midnight. This is the first case of sub-conjunctival localization of W. bancrofti. This case stresses the necessity to identify the filaria by studying the microfilariae in blood samples obtained at different times of the nycthemere and/or by observing the adult after surgical extraction. The presence of a Loa, a Dirofilaria, a Mansonella, or a Wuchereria calls for different medical therapies.