Cytological diagnosis of microfilaria at unusual sites in clinically unsuspected cases: some rare presentations of filariasis.

Filariasis is a major concern, particularly in endemic regions. The majority of patients harbouring the parasite may remain asymptomatic for years. Here, we present six patients who were sent for routine cytological examination to rule out neoplastic pathology, in whom cytology identified filarial infestation. The main purposes of our paper are to highlight the importance of fine needle aspiration cytology (FNAC), a cheap and quick investigation to detect the microfilaria from tissue swelling and body fluids, and to point out that clinicians practising in endemic regions should always consider filarial infestation in patients presenting with longstanding swelling.

Toxoplasmosis presented as a submental mass: a common disease, uncommon presentation.

Submental mass secondary to toxoplasmosis is not common in clinical work. A diagnosis of toxoplasmosis is rarely considered by physicians. Here we describe a 50-year-old woman presented with a progressive, painful, submental and left neck swelling for 1 month. After having obtained an insufficient evidence from the fine-needle biopsy, the patient finally received an excisional biopsy which highly indicated the possibility of lymphadenopathy consistent with toxoplasmosis. Diagnosis of toxoplasmosis was finally established by a combination of the pathological criteria, together with the positive serological finding. According to review the clinical presentations, pathological characteristics, diagnostic standard and treatment of this disease, the article aims to remind otolaryngologists who are evaluating a neck mass should be aware of the infectious cause of lymphadenopathy and the possibility of toxoplasmosis.

[What is your diagnosis? A "fat arm". Onchocerciasis]. / Une histoire de "gros bras".

We report a case of edema of the right forearm with pruriginous papules and eosinophilia in the blood. The patient had lived in a forested area of Cameroon. The clinical, laboratory, and geographical findings led to a diagnosis of onchocerciasis, despite the absence of microfilaments on skin biopsy samples. The patient was successfully treated with ivermectin and doxycycline.

A rare manifestation of cysticercosis infestation.

There are many causes of urticaria, which may vary from infections to malignancy. Among the infections, infestations by cysticercosis (larval stage of the tapeworm called Taenia solium) is an important cause. The present report is of forty four years old female who presented with urticaria and swelling on face. The swelling was later diagnosed as cysticercosis by noninvasive ultrasonography. The urticaria subsided after the treatment of cysticercosis. We report this case for rarity of its presentation.

Proteolytic generation of kinins in tissues infected by Trypanosoma cruzi depends on CXC chemokine secretion by macrophages activated via Toll-like 2 receptors.

Previous analysis of the endogenous innate signals that steer T cell-dependent immunity in mice acutely infected by the protozoan Trypanosoma cruzi revealed that bradykinin (BK) or lysyl-BK, i.e., the short-lived peptides excised from plasma-borne kininogens through the activity of cruzipain, induces dendritic cell maturation via BK B(2) receptors (B(2)R). Here, we used the s.c. model of T. cruzi infection to study the functional interplay of TLR2, CXCR2, and B(2)R in edema development. Using intravital microscopy, we found that repertaxin (CXCR2 antagonist) blocked tissue-culture trypomastigotes (TCT)-induced plasma leakage and leukocyte accumulation in the hamster cheek pouch topically exposed to TCT. Furthermore, we found that TCT-evoked paw edema in BALB/c mice was blocked by repertaxin or HOE-140 (B(2)R antagonist), suggesting that CXCR2 propels the extravascular activation of the kinin/B(2)R pathway. We then asked if TLR2-mediated sensing of TCT by innate sentinel cells could induce secretion of CXC chemokines, which would then evoke neutrophil-dependent plasma leakage via the CXCR2/B(2)R pathway. Consistent with this notion, in vitro studies revealed that TCT induce robust secretion of CXC chemokines by resident macrophages in a TLR2-dependent manner. In contrast, TLR2(+/+) macrophages stimulated with insect-derived metacyclic trypomastigotes or epimastigotes, which lack the developmentally regulated TLR2 agonist displayed by TCT, failed to secrete keratinocyte-derived chemokine/MIP-2. Collectively, these results suggest that secretion of CXC chemokines by innate sentinel cells links TLR2-dependent recognition of TCT to the kinin system, a proteolytic web that potently amplifies vascular inflammation and innate immunity through the extravascular release of BK.

Echinostome metacercariae cyst elimination in Rana clamitans (green frog) tadpoles is age-dependent.

Host response to parasite exposure is an important determinant of the outcome of host-parasite interactions. Factors such as host body condition and age can strongly influence host response to parasites and infection. This study followed Echinostoma revolutum infection levels in larval green frogs (Rana clamitans) exposed at 2 different ages. Tadpoles at early developmental stages are more susceptible to the adverse effects of echinostomes. Green frog tadpoles approximately 2 wk apart in age and of the same developmental stage can exhibit dramatically different responses to echinostome infection, with the younger tadpoles having high rates of mortality and the older tadpoles experiencing no mortality. The goal of the present study was to begin to explore the mechanism underlying the striking age-dependent response of tadpoles to echinostomes. I conducted 2 controlled infection laboratory experiments in which tadpoles were preserved at 6 time points ranging from 4 hr to 1 wk postinfection (PI). Tadpoles infected at the younger age did not eliminate echinostome metacercariae. However, tadpoles that were 13 days older at the time of echinostome exposure steadily eliminated metacercariae during the hours and days PI. The absence of echinostome cyst elimination in the younger tadpoles likely contributes to their elevated, infection-induced mortality rates.

An unusual presentation of filariasis: a case report.

BACKGROUND: Filariasis and its consequences are a major health problem in tropical countries, including the Indian subcontinent. Despite its high incidence, it is unusual to find microfilaria in fine needle aspiration cytology (FNAC) smears. We present a case of subcutaneous firm to cystic swelling, aspiration of which revealed a large number of microfilaria. CASE: A 30-year-old man presented with a chain of intermittent, firm swellings in both arms. FNAC of the swellings revealed a large number of 4 microfilariae with associated giant cell reaction and inflammatory cell-like eosinophils. CONCLUSION: Besides the documented usual mode of presentation of filarial infection, it can present in an atypical manner, so careful examination of aspirates from the subcutaneous swellings, especially in filariasis endemic zones, is very important.

[Primary extensive hydatidosis of the thigh: unusual radiological aspects]. / Hydatidose primitive et étendue de la cuisse: aspect radiologique inhabituel.

Soft tissue involvement by hydatid disease remains unusual (5%) even in endemic areas. Patients typically present late because disease progression is slow and often asymptomatic. The authors report the unusual imaging appearance in a 59 year old woman with a one year history of progressive diffuse painless swelling of the left thigh. Ultrasonography showed multiple anechoic and hypoechoic cystic lesions, some of which containing serpentine echogenic structures consistent with partly calcified membranes. CT and MRI confirmed a diagnosis of hydatid disease and were helpful to demonstrate the relationship between cysts and adjacent structures. Surgical management was performed early because of fistulization to the skin.

Preadult stage parasites and multiple timed exposure to infective larvae are involved in development of limb edema in Brugia malayi-infected Indian leaf monkeys (Presbytis entellus).

The pathogenesis of filarial limb edema is not known. The role of parasitological variables and parasite-mediated phenomena in the development of limb edema was investigated in the Presbytis entellus-Brugia malayi model. Infection was initiated with subcutaneous inoculation of infective third-stage larvae (L(3)), and the animals were reexposed to different doses of L(3) at the prepatent, patent, and diminishing microfilaremia (0 to 5% of peak microfilaremia count) stages of infection. A large L(3) inoculum size and repeated inoculation in the ankle region during the prepatent, patent, and diminishing microfilaremia stages of infection were found to be necessary for reproducible induction of limb edema. The preadult stage of the parasite was found to be the most potent inducer of limb edema, followed by L(5) and L(4). The presence of the proinflammatory cytokines tumor necrosis factor alpha, interleukin-1beta, and interleukin-6 in edema fluid in the leg receiving the parasite challenge indicated that the limb edema development was due to parasite-mediated cytokine responses. The absence of bacterial infection or anti-streptolysin O titer in the edema fluid and blood indicated that bacterial infection is not necessary for the development of limb edema.

[Persistent erythema and edema of the face associated with rosacea and lymph vessel dysplasia]. / Persistierendes Erythem und Odem des Gesichts bei Rosazea und Lymphgefässdysplasie.

A 24-year-old woman with lymph vessel dysplasia had experienced a progressive edema of her legs since her second year of life and progressive facial edema for the past year. She also had telangiectasias and papules on the background of a diffuse erythema as well as marked seborrhea on her face. Histopathological examination of a representative facial lesion revealed a granulomatous dermatitis with periadnexal distribution mainly consisting of lymphocytes and histiocytes. In addition, there was a moderate fibrosis of the dermis with numerous mast cells. By duplex ultrasound, a diagnosis of a massive edema of the legs without evidence for chronic venous insufficiency was made. The clinical and histopathological findings were consistent with solid persistent erythema and edema of the face associated with rosacea and lymph vessel dysplasia. The chronic course, absence of serological abnormalities and nonspecific histopathological features as well as resistance to therapy are the most important diagnostic criteria of this disease also known as Morbihan's disease.

Upper extremity swelling and hyperpigmentation due to onchocerciasis in an American.

An American woman who had lived in Equatorial Guinea was seen in the United States with intermittent swelling, pruritus, hyperpigmentation, and mild cutaneous atrophy of the right arm. Filarial diseases were considered in the differential diagnosis; skin snips subsequently revealed Onchocerca volvulus microfilariae. There was no evidence of ocular involvement. The case illustrates the importance of obtaining a history of international travel, the need to consider "exotic" parasitic diseases in travelers returning from the tropics, and several of the presenting features of onchocerciasis. In the past, onchocerciasis was treated with diethylcarbamazine and suramin, both of which have appreciable toxicity. A major recent advance has been the introduction of ivermectin, which appears to be more effective and less toxic, and is currently undergoing clinical evaluation in the United States and abroad.

The pathogenesis of experimentally induced Trypanosoma brucei infection in the dog. I. Tissue and organ damage.

Inoculation of dogs with Trypanosoma brucei produced an acute fetal disease similar to that seen following natural infection. The disease was characterised by high levels of parasitaemia, moderately severe anemia, and marked changes in the lymphoid system. Extravascular invasion by large numbers of trypanosomes was widespread throughout the body and was accompanied by severe tissue damage. Tissue invasion by trypanosomes was associated with marked cellular infiltration involving lymphoid cells and plasma cells followed by macrophages and polymorphonuclear leukocytes. Associated with these reactions, severe cellular degeneration and focal necrosis occurred. While these changes were widespread and were found in the majority of tissues examined, consistently severe lesions were found in the heart, eyes and central nervous system. In many organs, lymphatic vessels were distended with fluid, trypanosomes, and a cell population similar to that in the surrounding tissue; fibrin deposition and thrombus formation was sometimes observed within the lymphatic lumens. Thrombosis was also found in the blood vessels of the pampiniform plexus, the venous plexus of the ovary, and branches of the renal vein. A severe necrotizing vasculitis affecting only the coronary vessels was a prominent feature in some animals.