Giant scrotal elephantiasis in a migrant from Niger.

We hereby describe the case of a giant scrotal elephantiasis due to infection by Wuchereria bancrofti, imported in Belgium. We briefly discuss diagnostic methods, their subtlety, and therapeutic possibilities.

Case Report: Atypical Presentation of Visceral Leishmaniasis: Two Cases from Northwest Ethiopia.

Human visceral leishmaniasis (VL) is a life-threatening disease caused by protozoan parasites belonging to the Leishmania donovani complex. Atypical cases of leishmaniasis and HIV coinfection have been documented in case reports, mostly associated with gastrointestinal tract, kidney, and skin involvement. We report two VL cases with atypical localizations not reported from east Africa before, both diagnosed and treated at the Leishmaniasis Research and Treatment Center, Gondar, Ethiopia. The first case was an HIV-infected patient with scrotal and penile involvement. Leishmania parasites were detected in the spleen and the scrotum. The second case was an immunocompetent individual with esophageal, laryngeal, and pharyngeal involvement and facial lesions. Leishmania parasites were detected in the spleen, skin, and esophageal biopsies. Current evidence suggests atypical presentation can occur in patients irrespective of their HIV status. Therefore, we suggest a high index of suspicion for VL among clinicians working in endemic areas of Ethiopia.

Ticks on the external male genital structures.

Penis and scrotum are very rarely affected by tick bites. We present four cases of involvement of male genitals by ticks belonging to the family Ixodidae. Dermatological examination showed an apparently healthy skin around the tick. Anti-Borrelia burgdorferi antibodies were negative. In all patients the entire body of the tick was delicately removed by means of pliers. Antibiotic therapy was unnecessary.

Scrotal tick damage as a cause of infertility in communal bulls in Moretele, South Africa.

Calving rate in communal cattle influences both food security and socio-economics in rural households. A previous study indicated that scrotal damage caused by ticks could affect the fertility of communal bulls and reduce the annual calving rate. The objectives of the study were to investigate the annual calving rate in communal herds by counting calves during herd visits, perform breeding soundness examinations on bulls and identify adult ticks attached to their genitalia. This prospective longitudinal survey was based on participatory rural appraisal. Calving rates were estimated in cows (n = 2398) from 100 randomly selected communal herds in Moretele over 12 months in 2013, during routine visits by animal health technicians. Randomly selected bulls (n = 50) from these herds were tested for Brucella abortus, Trichomonas foetus and Campylobacter fetus subspecies venerealis. The calving rate was 35.86% (0.359). The mean scrotal circumference was 37.63 ± 3.42 cm. Total sperm motility was 78.73 ± 35.73%; progressive sperm motility was 27.39 ± 15.81% and non-progressive sperm motility was 51.34 ± 19.92%. Thirty-five of the 38 bulls examined for breeding soundness exhibited severe scrotal and preputial lesions caused by the adult ticks Amblyomma hebraeum and Hyalomma rufipes. Tick control methods used included spraying (n = 20), pour-on (n = 11), no control (n = 1) and various (n = 18). It was concluded that in Moretele genital tick damage had a more serious impact on the fertility of communal bulls than contagious diseases. Targeted acaricidal spot treatment of the genitalia of communal bulls to prevent infestation is recommended, as tick control strategies used by farmers appeared to be inadequate.

Acute scrotum: Hansen's disease versus filariasis.

Hansen's disease is caused by Mycobacterium leprae. The disease is known to involve the visceral organs including the testis apart from the skin and nerves in the lepromatous pole of leprosy due to widespread hematogenous dissemination of lepra bacilli. Furthermore, there can be testicular pain during the type 2 reaction in Hansen's disease. Filariasis is a disease caused by the parasitic nematode, Wuchereria bancrofti. This infection most commonly results in lymphedema and secondary vaginal hydrocele with an associated epididymo-orchitis. Acute epididymo-orchitis is either seen in the acute phase or as a part of secondary bacterial infections. The particular interest of this paper is to report the case of Hansen's disease who presented with testicular pain and posed a diagnostic dilemma when his pain did not respond to the standard mode of treatment and an alternate rare diagnosis was sought. This case report also emphasizes the need of reconsideration of diagnosis when the patient is not responding to standard therapy.

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.

Giant Scrotal Hydrocele and Bilateral Leg Lymphedema as Clinical Manifestation of Chronic Lymphatic Filariasis.

A 51-year-old male came with the complaint of recurrent swelling in the scrotum and legs. Swelling of the scrotum first appeared 17 years ago in the left scrotum approximately the same size as an apple and underwent surgery. However, 2 years after surgery, the swelling reemerged and gradually increase in size in both scrotums. Left leg swelling began to emerge 5 years ago followed by right leg 3 years after. The patient lives in Sarmi regency Papua province (endemic).

Dirofilaria immitis in a child from the Russian Federation.

An immature female worm, Dirofilaria immitis, was isolated from the scrotum of a 14-month-old child. This is the first identification of human dirofilariosis caused by D. immitis in a relatively Northern region (Moscow) of the Russian Federation. The parasite was diagnosed by means of morphological examination of the worm, confirmed by PCR assay. This case raises questions about the range of the D. immitis distribution among humans in Russia. To better understand the geographical distribution of dirofilarioses, detailed clinical and epidemiological information should be collected from human cases with appropriate laboratory confirmation.

Scrotal abscess, a rare case of extra intestinal amoebiasis.

The majority of amoeba infection are asymptomatic, but clinically intestinal amoebiasis or extra intestinal amoebiasis may result. Genital amoebiasis is very rare manifestation of extra intestial amoebiasis, but a case of amoebic scrotal abscess, seen in Surabaya. The invasive form of Entamoeba histolytica trophozoite was seen in Giemsa stained aspirate of the abscess. In case of an abscess bacteria are primarly considered, but the case presented here shows that amoeba can be the cause, although very rarely. Thus when bacteriological diagnostics are negative amoeba should be considered, especially in case of brown-reddish colored and foul smelling pus.

The filarial dance sign in scrotal filarial infection: a case report.

We describe a case of the filarial dance sign (FDS) in the epididymal region of a 22-year-old migrant worker from India who presented with a tender right scrotal swelling. Sonographic examination revealed multiple cystic lesions in the paratesticular region. The FDS was visualized within one of the cystic lesions. FDS is diagnostic of lymphatic filariasis in the appropriate clinical context.

A case of inguinal sparganosis mimicking myeloid sarcoma.

We report here a case of inguinal sparganosis, initially regarded as myeloid sarcoma, diagnosed in a patient undergone allogeneic hematopoietic transplantation (HSCT). A 56-year-old male patient having myelodysplastic syndrome was treated with allogeneic HSCT after myeloablative conditioning regimen. At day 5 post-HSCT, the patient complained of a painless palpable mass on the left scrotum and inguinal area. Pelvic magnetic resonance imaging and computed tomography revealed suspected myeloid sarcoma. Gun-biopsy was performed, and the result revealed eosinophilic infiltrations without malignancy. Subsequent serologic IgG antibody test was positive for sparganum. Excisional biopsy as a therapeutic diagnosis was done, and the diagnosis of sparganosis was confirmed eventually. This is the first report of sparganosis after allogeneic HSCT mimicking myeloid sarcoma, giving a lesson that the physicians have to consider the possibility of sparganosis in this clinical situation and perform adequate diagnostic and therapeutic approaches.

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.

A Case of Inguinal Sparganosis Mimicking Myeloid Sarcoma

We report here a case of inguinal sparganosis, initially regarded as myeloid sarcoma, diagnosed in a patient undergone allogeneic hematopoietic transplantation (HSCT). A 56-year-old male patient having myelodysplastic syndrome was treated with allogeneic HSCT after myeloablative conditioning regimen. At day 5 post-HSCT, the patient complained of a painless palpable mass on the left scrotum and inguinal area. Pelvic magnetic resonance imaging and computed tomography revealed suspected myeloid sarcoma. Gun-biopsy was performed, and the result revealed eosinophilic infiltrations without malignancy. Subsequent serologic IgG antibody test was positive for sparganum. Excisional biopsy as a therapeutic diagnosis was done, and the diagnosis of sparganosis was confirmed eventually. This is the first report of sparganosis after allogeneic HSCT mimicking myeloid sarcoma, giving a lesson that the physicians have to consider the possibility of sparganosis in this clinical situation and perform adequate diagnostic and therapeutic approaches.

Prevalence of endemic Bancroftian filariasis in the high altitude region of south-eastern Nigeria.

BACKGROUND & OBJECTIVES: The study was aimed at determining the prevalence and intensity of Wuchereria bancrofti microfilaraemia in a high altitude region of south-eastern Nigeria, and ascertaining the prevalence of clinical signs and symptoms associated with the filarial infections. METHODS: Thick smear of 50 µl finger-prick blood collected at night between 2200 and 0200 hrs from consenting persons were stained with Giemsa and examined microscopically in a cross-sectional study. Consenting individuals were examined for various gradations of hydrocele, limb and scrotal elephantiasis by qualified medical personnel. RESULTS: The prevalence of W. bancrofti microfilaraemia was 4.3%, highest in the older people but comparable in both sexes. The overall micro filarial (mf) geometric mean intensity (GMI) among mf positive individuals was 123 mf/ml of blood (138 mf/ml for males and 110 mf/ml of blood for females); and rose significantly with increasing age (one-way analysis of variance; p <0.001). Prevalence of clinical manifestations was: hydrocele (7.1%), scrotal elephantiasis (4%), and limb elephantiasis (6%). The mf GMI was significantly higher among those without hydrocele or limb elephantiasis than among those with the clinical manifestations (t-test; p <0.05 for both tests); the opposite was the case for scrotal elephantiasis, (t-test; p <0.01). CONCLUSION: Filariasis is endemic in the high altitude region of south-eastern Nigeria. The chronic clinical manifestations observed there underscore the need for urgent combination therapy interventions.

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 myiasis by Wohlfahrtia magnifica (Diptera, Sarcophagidae) in Sicily (Italy).

Wohlfahrtia magnifica (Schiner, 1862; Diptera: Sarcophagidae), known also as flesh fly or screwworm, is a fly distributed especially in south Europe, Middle East, North Africa and China. Maggots of W. magnifica are responsible for traumatic myiasis in warm-blooded vertebrate animals and humans. In Italy data on wohlfahrtiosis in animals and humans are scant. This paper reports three cases of genital myiasis by W. magnifica in Sicily that occurred in a goat, a ram and a dog, respectively. Maggots were found in the vulva of a goat, in a wound localised in the scrotum of a ram and in the prepuce of a dog. Although the disease was not recorded before in the region, data collected from a questionnaire specifically designed for the study suggest that the disease is endemic in the area for more than 20 years. Larger epidemiological studies in the region are needed to get more data on disease prevalence and pattern of infestation as well as more information and education is needed for both farmers and veterinarians on wohlfahrtiosis and its strategies of control and treatment.