A rare clinical presentation of human Dirofilaria repens infection as a pseudo-tumour of the epididymis - Case Report.

Introduction. Epididymal dirofilariasis is one of the unusual manifestations of this zoonosis. In Slovakia, this is the third case out of 20 Dirofilaria repens infected patients in whom the worm (the parasite) was identified in the epididymis. The patient felt a painless tumour about 2 cm in size on the left testicle. During ultrasound examination, the radiologist observed a cyst containing a live worm within the epididymis. After mechanical stimulation, the movement characteristic for filarial worms (´filarial dance sign´) appeared. An orchiectomy was performed at the Department of Urology in the University Hospital in Kosice. Histopathology confirmed a parasitic cyst with a worm, and based on characteristic morphological features, the parasite was identified as Dirofilaria repens. Objective. The aim of case report is to alert physicians to the possibility dirofilarial infection of the epididymis, where tumors and cystic structures often occur and to present clinical signs of the disease.

Pseudo-Tumor of the Epididymis, a Rare Clinical Presentation of Human Dirofilaria repens Infection: a Report of Autochthonous Case of Dirofilariasis in Southwestern Slovakia.

PURPOSE: Dirofilariasis caused by the filarial nematode Dirofilaria repens is mainly a disease of dogs and other carnivores. Also, humans can be accidentally infected with this parasite. The infective third-stage filariform larvae are transmitted by various species of mosquitoes. Until this day, a total of 17 human cases caused by D. repens have been diagnosed in Slovakia, 11 subcutaneous, 4 ocular, 1 pulmonary and 1 in the epididymis. The aim of this report was to describe an unusual clinical case of dirofilariasis of the scrotum. METHODS: Extirpated worm was subjected to the molecular and histological identification. PCR for the amplification of cytochrome oxidase subunit 1 (CO1) was performed using specific D. repens primer pair. RESULTS: Here we document the 13th case of human dirofilariasis in a 46-year-old man from southwestern Slovakia. Very rare in humans, genital involvement manifests itself as pseudotumor nodule affecting the epididymis. The patient consulted a general practitioner due to a palpable subcutaneous lump in the scrotum. Routine laboratory analysis revealed blood eosinophilia (16.6%). The ultrasound examination was indicated, and subsequently, surgical excision of the right epididymal nodule was performed. On the basis of histological microscopic examination and PCR-based detection, the helminth was identified as Dirofilaria repens. This represents the ninth case of autochthonous dirofilariasis in Slovakia. CONCLUSIONS: The majority of D. repens infections were recorded in southwestern regions of Slovak Republic, which are considered to be endemic areas for canine dirofilariasis. Our described patient also comes from southwestern part of Slovakia (Topolníky, Dunajská Streda region).

Scrotal Paragonimiasis in adults: Two case reports and review of literature.

RATIONALE: Paragonimiasis is a parasitic disease caused by Paragonimus in the lungs; it can be divided into intrapulmonary type and extrapulmonary type. Adult patients with scrotal paragnonimus are rarely seen clinically and not widely reported in the literature. Here, we report 2 cases of scrotal paragonimiasis in adults and their treatment process. PATIENT CONCERNS: Two young males sought medical advice because of scrotal masses. Both patients had the previous history of eating uncooked river crabs and presented with palpable quasicircular nodules of about 1.5 × 1.0 cm in testicles, which were well-defined, resilient in tenderness. The bilateral inguinal lymph nodes were not enlarged. DIAGNOSIS AND INTERVENTIONS: The 2 patients underwent scrotal mass resection; postoperative pathology examination confirmed scrotum paragonimiasis. Both the patients were administered praziquantel after operation. OUTCOMES: They were followed up for 1 year and 4 years, respectively; both recovered well, free from recurrence. Scrotum color Doppler ultrasound examination found no obvious abnormality. LESSONS: Adult patients with scrotum paragonimiasis are rarely seen clinically. Moreover, its clinical manifestations are not typical that leads to missed diagnosis and misdiagnosis. Diagnosis of the disease needs to combine with disease histories, manifestations, and relevant auxiliary examinations. But the diagnosis can be confirmed only by histopathological examination. The main method for treatment of scrotal paragonimiasis is antiparasitic treatment. However, health education is crucial to prevent this disease and relapse.

Preputial Demodex species in big brown bats (Eptesicus fuscus) in eastern Tennessee.

The presence of preputial Demodex species in four captive, wild-caught big brown bats (Eptesicus fuscus) in eastern Tennessee, USA, examined between 2008 and 2010 is reported. In three of four cases, there was associated folliculitis, dermatitis, or preputial adenitis. There were no clinical signs directly attributable to the mites, although penile prolapse was present in one case. Mites were retrieved from preputial skin samples of other archival big brown bats by potassium hydroxide digestion and analyzed by polymerase chain reaction (PCR). DNA sequencing of the 16S rRNA gene revealed 99.6% homology to Demodex canis, although morphologic differences distinguish the two species. Mites of this report differ in anatomic location from Demodex spp. previously reported in bats and represent a species unreported to public databases.

Filarial dance--sonographic sign of filarial infection.

A 17-year-old boy presented with a 3-month history of swelling and vague pain in the scrotum. US revealed multiple anechoic cyst-like lesions in the body of left epididymis. These cysts showed tubular echogenic internal structures with peculiar twirling motion. This was recognised as the sonographic filarial dance-sign of live adult filarial worms. The boy subsequently underwent needle aspiration of the lesion, which microscopically demonstrated microfilaria of Wuchereria bancrofti. Our report includes an online video clip that will help familiarise readers with the filarial dance.

Trichomonas vaginalis genital infections: progress and challenges.

Trichomonas vaginalis (TV) infection is the most prevalent curable sexually transmitted infection in the United States and worldwide. Most TV infections are asymptomatic, and the accurate diagnosis of this infection has been limited by lack of sufficiently sensitive and specific diagnostic tests, particularly for men. To provide updates for the 2010 Centers for Disease Control and Prevention's Sexually Transmitted Diseases Treatment Guidelines, a PubMed search was conducted of all TV literature published from 9 January 2004 through 24 September 2008. Approximately 175 pertinent abstracts and articles were reviewed and discussed with national experts. This article describes advances in TV diagnostics which have led to an improved understanding of the epidemiology of this pathogen, as well as potential biologic and epidemiological interactions between TV and human immunodeficiency virus (HIV). New data on treatment outcomes, metronidazole-resistant TV, management of nitroimidazole-allergic patients, frequency of recurrent TV infection following treatment, and screening considerations for TV in certain populations are also presented.

The "filarial dance" is not characteristic of filariasis: observations of "dancing megasperm" on high-resolution sonography in patients from nonendemic areas mimicking the filarial dance and a proposed mechanism for this phenomenon.

The objective of this series was to show that the sonographic appearance described as the "filarial dance" is not characteristic of filariasis but occurs in nonendemic areas as a manifestation of epididymal obstruction. An experienced observer documented cases after initial observation of the filarial dance in routine clinical practice using high-frequency linear array transducers. The filarial dance was described as excessive to-and-fro movement of echogenic particles within a prominent epididymis and graded 1 to 4 according to the extent and distribution of the abnormality. The country of birth, exposure to filarial infection or travel to a filarial-endemic area, previous scrotal surgery including vasectomy, any previous or current scrotal inflammatory disease, and any congenital testicular abnormalities were recorded. Over a 10-year period, sonographic appearances consistent with the filarial dance were observed in 18 patients (bilateral in 6). The mean patient age was 47.7 (range, 28-91) years. The abnormality was graded in the 24 affected testes as follows: grade 1, n = 3; grade 2, n = 8; grade 3, n = 8; and grade 4, n = 5. No patient had a history of filariasis or travel to an endemic area. Six of 18 patients (33.3%) had bilateral vasectomies; 5 (27.8%) had a history of epididymo-orchitis in the ipsilateral testis; 3 (16.7%) had previous scrotal surgery; and 4 (22.2%) had no relevant urologic history. We have described a sonographic appearance identical to the filarial dance in men with no history of filarial infection. Most had previous scrotal surgery or infection, suggesting that the filarial dance may not always be due to movement of filarial worms. The unifying condition in patients with filariasis and our patients is lymphatic obstruction, likely the underlying cause of the appearance in both groups.

Genital lesions in male red fronted gazelles (Gazella rufifrons) experimentally infected with Trypanosoma brucei and the effect of melarsamine hydrochloride (Cymelarsan®) and diminazene aceturate (Berenil®) in its treatment.

Thirty red fronted gazelles (Gazella rufifrons) were used to assess the genital lesions associated with trypanosomosis and the efficacy of melarsamine hydrochloride (Cymelarsan®) and diminazene aceturate (Berenil®) in the treatment of the condition. The animals were divided into 6 equal groups (A-F). Animals in groups A-E were infected with Trypanosoma brucei, and later treated on day 8 post infection (p.i.) with either melarsamine hydrochloride (Cymelarsan®) at 0.3 mg/kg (Group A) and 0.6 mg/kg (Group B) or diminazene aceturate (Berenil®) at 3.5 mg/kg (Group C) and 7.0 mg/kg (Group D). Animals in group E remained untreated while group F served as healthy controls. Parasitaemia was established by day 8 p.i. in all infected groups and eliminated by day 16 following treatment on day 8 p.i. with melarsamine hydrochloride (Cymelarsan®) (Groups A and B) or diminazene aceturate (Berenil®) (Group D). On the other hand, diminazene aceturate treatment (Berenil®) on day 8 p.i. at 3.5 mg/kg (Group C) caused a temporary disappearance of parasites from the circulation by day 16 p.i. but there was a relapse parasitaemia on day 44 with a peak count of 500 ± 2.79 × 10(3) parasites/µL of blood by day 52 p.i. In the infected/untreated group (E), parasitaemia fluctuated but attained the same peak as Group C by day 52 p.i. Increase in body temperatures (40.5 ± 3.16 - 42.8 ± 3.25 °C) occurred during the first wave of parasitaemia but declined to pre-infection values from day 28 p.i. in Groups A, B and D. In Groups C and E, there was a second wave of parasitaemia (P < 0.05) with peak counts of 42.4 ± 0.81 × 10(3)/µL and 41.8 ± 0.80 × 10(3)/µL respectively by day 52 p.i. A significant (P < 0.05) decline in packed cell volume was also noted by day 52 p.i. The major clinical signs observed in Groups C and E were pyrexia, inappetance, emaciation, anaemia, dullness, starry hair coat, pallor of buccal and ocular mucous membranes. Similarly, in Groups C and E, the testicles appeared oedematous and painful to touch with degenerative changes, morphological sperm abnormalities and oligospermia with 2.0% and 0% sperm reserves respectively. Sperm reserve was 100% in Groups A, B and D. It is therefore, concluded that trypanosomosis can cause serious infertility in male red fronted gazelles and that early treatments with melarsamine hydrochloride (Cymelarsan®) at 0.3 and 0.6 mg/kg body weight or diminazene aceturate (Berenil®) at 7.0 mg/kg body weight may prevent such effects.

The role of ultrasonography in the differentiation of the various types of filaricele due to bancroftian filariasis.

OBJECTIVE: (i) To determine the frequencies of urogenital pathologies in men infected with bancroftian filariasis, and (ii) to evaluate the role of ultrasonography (USG) as a diagnostic tool to differentiate between diverse pathologies with different clinical implications. To date, all types of scrotal enlargement resulting from lymphatic filariasis (LF) have been summarized under one term: "filaricele". PATIENTS AND METHODS: Data were compiled from recruitment phases for field trials in an endemic area for LF in Ghana. 1453 men aged 18 years and above underwent ultrasound examinations of the scrotum. Observation parameters were: Filaria Dance Sign (FDS), dilation of supratesticular lymphatic vessels, thickness of scrotal skin, occurrence and amount of fluid accumulation, echogenicity of the fluid between the layers of the tunica vaginalis, as well as position and homogenicity of testis, epididymis and spermatic cord. In 1132 men, blood samples were taken for parasitological analysis. RESULTS: In 56% of examined patients, fluid accumulation around the testis was detected (38% subclinical-, 18% clinical stages). Differentiation of the echogenicity of the fluid revealed echo-free hydrocele (EFH) in 47% and echo-dense hydrocele (EDH) in 9%. Patients without hydrocele and subclinical stages had a thinner scrotal skin than those in clinical stages or with lymphscrotum (P < 0.001). In the EDH group the scrotal skin was thicker than in the EFH group (P < 0.001). 1.4% had a lymphscrotum. FDS was detected in 24% of all 1453 volunteers who underwent USG. The number of worm nests correlated with microfilarial load and levels of circulating filarial antigen (P < 0.001; 20% microfilaremic, 48% antigen positive). CONCLUSION: In an unexpected high number of men (56%) fluid accumulation around the testis was detected by USG of which more than one third (38%) presented with subclinical stages. The study showed that echo-dense and echo-free fluid could be differentiated and that a considerable number of cases had EDH (9%) posing a risk to develop necrotic testis and infertility and therefore requiring immediate surgical intervention. USG thus turned out to be a useful diagnostic technique to differentiate between those cases requiring immediate surgical intervention from those that can be treated with (anti-wolbachial and hyperpermeability reducing) drugs that ameliorate or halt progression of the disease.

[Two cases of penoscrotal elephantiasis treated by Ouzilleau's surgical procedure]. / Deux cas d'éléphantiasis pénoscrotal traités par la technique d'Ouzilleau.

Two cases of penoscrotal elephantiasis treated following Ouzilleau's technique. The authors present two cases of penoscrotal elephantiasis operated following Ouzilleau's technique. This pathology is characterized by his painless, that the reason of a long time evolution and hence in consultation. Filariosis is the common etiology in tropical area. In our cases, the aetiology is unknown. Scrotal and penis elephantiasis is responsible of aesthetic and functional embarrassment. Resection of a considerable cutaneous mass associated with a reconstruction of the scrotal purse and the cutaneous sleeve of the penis using local flaps remain the suitable means to give a comfort of life.

Assessment of reproductive tract disease in cats at risk for Tritrichomonas foetus infection.

OBJECTIVE: To determine whether Tritrichomonas foetus infection resides in reproductive tract tissues from cats housed for breeding and for which a high prevalence of colonic T foetus infection has been reported. ANIMALS: 61 purebred cats in 36 catteries undergoing elective ovariohysterectomy or castration and for which reproductive tract tissues, feces, and a reproductive history were obtained. PROCEDURES: Reproductive tract tissues were examined for T foetus via light microscopy, immunohistochemical analysis, and PCR assay. History of reproductive tract disease was examined to detect statistical associations with identified or reported exposure to colonic T foetus infection. RESULTS: 15 of 61 (25%) cats and 22 of 33 (67%) catteries were identified with active or reported T foetus infection. Light microscopic, immunohistochemical, or molecular evidence of T foetus infection of the reproductive tract was not detected in any cats, including 15 cats with colonic T foetus infection, 29 cats residing in a cattery in which T foetus-infected cats were identified, and 8 cats for which gross or light microscopic evidence of reproductive tract disease was identified. There were no differences in total number of litters, number of litters per breeding, kitten mortality rate, or birth defects between cats or catteries infected with T foetus and those for which T foetus infection was not identified. CONCLUSIONS AND CLINICAL RELEVANCE: No evidence of reproductive tract colonization by T foetus was detected in this study. Accordingly, it is unlikely that reproductive tract infection with T foetus plays an important role in overall disease transmission.

Preputial cellular and antibody responses of bulls vaccinated and/or challenged with Tritrichomonas foetus.

Systemic and genital immune responses in bulls were determined after infection with Tritrichomonas foetus and systemic vaccination with whole cell antigens. Vaccinated bulls resisted infection, developed IgG1 and IgG2 antibodies against T. foetus in preputial secretions and serum, and had increased MHC II(+) and CD205(+) cells (probably dendritic cells), CD3(+) and CD8(+) T cells, and B cells including IgG1 and IgA plasma cells in the prepuce. Non-vaccinated bulls challenged with T. foetus were persistently infected and had no detectable antibodies to T. foetus in either preputial secretions or serum for 6 weeks post challenge. We conclude that genital and serum IgG antibodies to T. foetus accounts for resistance of vaccinated bulls to T. foetus infection and that the lack of an antibody response in infected bulls accounts for persistent infection.

Lymph scrotum: an unusual urological presentation of lymphatic filariasis. A case series study.

Lymphatic filariasis (LF) causes a wide range of clinical signs and symptoms, including urogenital manifestations. Transmission control and disability/morbidity management/control are the two pillars of the overall elimination strategy for LF. Lymph scrotum is an unusual urological clinical presentation of LF with important medical, psychological, social and economic repercussions. A retrospective case series study was conducted on outpatients attended at the National Reference Service for Filariasis, in an endemic area for filariasis (Recife, Brazil), between 2000 and 2007. Over this period, 6,361 patients were attended and seven cases with lymph scrotum were identified. Mean patient age was 45 years (range, 26 to 64 years). Mean disease duration was 8.5 years (range, two to 15 years). All patients had evidence of filarial infection from at least one laboratory test (parasitological, antigen investigation or 'filarial dance sign' on ultrasound). Six patients presented histories of urological surgery. The authors highlight the importance of the association between filarial infection and the inadequate surgical and clinical management of hydrocele in an endemic area, as risk factors for lymph scrotum. Thus, filarial infection should be routinely investigated in all individuals presenting urological morbidity within endemic areas, in order to identify likely links in the transmission chain.