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CASE REPORT
Year : 2007  |  Volume : 52  |  Issue : 1  |  Page : 48-49
Subcutaneous filariasis: An unusual case report


Dept. of Pathology, Grant Medical College and Sir. J. J. Gr. of Hospital, Byculla, Mumbai, India

Correspondence Address:
Yoganand V Patil
Dept. of Pathology, Grant medical college and Sir J.J. Gr. of Hospital, Byculla, Mumbai - 400 008
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-5154.31925

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   Abstract 

Wuchereria bancrofti presented in subcutaneous nodule is a very rare presentation. Wuchereria bancrofti first reported by Bancrofti in Brisbane in 1876 and the name filaria Bancrofti was given in 1877 and the generic name was given in 1878. A 15-year-old male patient's known case of pulmonary Koch's with incidentally detected subcutaneous nodule on right arm pit, cytology from the nodule shows many sheathed microfilaria along with segment of an adult female worm. Wet mount peripheral blood smear shows nocturnal motile microfilaria. The Wuchereria bancrofti is known to be associated with pulmonary Koch's. Nocturnal motility and cytomorphological features differentiate Wuchereria bancrofti from Wuchereria loa loa . After giving diethyl carbamazine (DEC 6 mg/kg) for 21 days without disturbing anti Koch's treatment schedule and microfilaria disappeared from peripheral blood.


Keywords: Microfilariae, subcutaneous nodule, Wuchereria bancrofti


How to cite this article:
Valand AG, Pandya BS, Patil YV, Patel LG. Subcutaneous filariasis: An unusual case report. Indian J Dermatol 2007;52:48-9

How to cite this URL:
Valand AG, Pandya BS, Patil YV, Patel LG. Subcutaneous filariasis: An unusual case report. Indian J Dermatol [serial online] 2007 [cited 2019 Dec 9];52:48-9. Available from: http://www.e-ijd.org/text.asp?2007/52/1/48/31925



   Introduction Top


Filariasis, a huge public health problem of the tropics and subtropics is commonly seen in countries like India, China, Indonesia, Africa and the Far East.

The life cycle of Wuchereria bancrofti was found in two hosts. Man is definitive host and mosquito is an intermediate host. The periodicity of appearance in the blood is usually between 10 pm to 2 am.[1]

The microfilaria Bancrofti was detected by fine needle aspiration cytology (FNAC) at so many different sites like breast, thyroid, lymph node, liver, lungs and small number of cases have been reported in bone marrow and body fluids; but subcutaneous nodule is a very rare presentation.[1],[2],[3],[4],[5],[6]In contrast to Wuchereria bancrofti; Wuchereria loa loa commonly presented as subcutaneous nodules and usually having day time motility in peripheral blood.


   Case Report Top


Clinical Summary

A 15-year-old male known case of pulmonary Koch's on anti Koch's treatment. He visited Calcutta during the course of treatment and came for follow-up after three months. The small subcutaneous nodule; of about 1 x 1 cm on right upper arm; was incidentally noted by the clinician. FNAC from the nodule was initially hemorrhagic and inadequate. Hence it was repeated after two days and showed whitish brown aspirate.

Cytological findings

Cytological examination revealed moderately cellular smears against a dirty necrotic background admixed with lymphocytes, histocytes, plasma cells and abundant eosinophils.[5] Along with clusters of microfilaria; segment of adult female worm was also seen. The micrometry measurement shows microfilaria which was measuring 263 m x 8.2 m and is covered by a hyaline sheath measuring 337 mm in length and the segment of adult worm measuring 0.29 mm in width.[1]

Peripheral blood examination

Midnight wet mount preparation was done and it showed motile microfilariae. Hetrazan induction was not done to avoid false positivity of motile microfilariae; Wuchereria loa loa shows daytime motility and it is the close differential diagnosis of subcutaneous filariasis.

Peripheral blood smear examination revealed 15% eosinophilia.


   Discussion Top


Wuchereria bancrofti presented as subcutaneous nodule is a very rare presentation.[1],[2],[3],[4],[5],[6] The subcutaneous filariasis is mainly caused by Wuchereria loa loa ; Onchocerca volvular and Mansonella streptococca of which Wuchereria loa loa is found both in peripheral blood and subcutaneous nodule; and the other two found only in the skin.[1]

Cabbott given the name Bancrofti in 1877 and generic name was given in 1878. In 1881, Manson described nocturnal periodicity of Wuchereria bancrofti . Life cycle has two host (i.e., man is definitive host and female culex quinquefasciatus is most important (> 50%) vector of Wuchereria bancrofti as an intermediate host).[1]

In our study needle aspiration from the subcutaneous nodule showed whitish brown aspirate and moderately cellular smears against the dirty necrotic background.[5] It revealed many sheathed microfilaria and segment of an adult female worm. Wuchereria bancrofti confirmed by both cephalic end and tip of tail free of nuclei and also shows nocturnal motility, which differentiates it from Wuchereria loa loa . The cytomorphological features and dimensions by micrometry study confirms adult female worm.

The association of microfilariae with pulmonary Koch's is known as observed in our case.[2]

The patient was asymptomatic for the filarial disease; which was incidentally detected on cytological smears.[3]

The X-ray of subcutaneous nodular region did not show any calcification.

The patient was treated with diethylcarbamazine (DEC- 6 mg/kg) is the drug of choice for the treatment of Bancroftian filariasis for 21 days. After completion of treatment patient was free from the disease, which was confirmed by nocturnal negative peripheral blood examination.

 
   References Top

1.Arora D R, Arora B, Medical parasitology, 2nd ed. SDR: Delhi; 2005. p. 184-90.  Back to cited text no. 1      
2.Avasthi R, Jain AP, Swaroop K, Samal N. Bancroftian microfilariasis in association with pulmonary tuberculosis: Report of a case with diagnosis by fine needle aspiration. Acta Cyto 1991;35:717-8.  Back to cited text no. 2  [PUBMED]    
3.Kumar M, Shukla VK, Gupta S. Incidental detection of microfilariae in cytological smears: Clinical examples. J Trop Med Hyg 1991;94:110.  Back to cited text no. 3      
4.Rodriguez B, Troper L, Arroyo R, Mora J. Subcutaneous nodule produced by Wuchereria bancrofti (author's transl). Bol Chil Parasitol 1978;33:35-6.  Back to cited text no. 4  [PUBMED]    
5.Chaturvedi S, Arora VK. Soft tissue swelling: Cytology comes to rescue. J Postgrad Med 2001;47:144.  Back to cited text no. 5  [PUBMED]  Medknow Journal  
6.Dey P, Walker R. Micfofilariae in a fine needle aspiration from skin nodule. Acta Cytol 1994;38:114.  Back to cited text no. 6      



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    Abstract
    Introduction
    Case Report
    Discussion
    References

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