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 Table of Contents  
CASE REPORT
Year : 2012  |  Volume : 2  |  Issue : 1  |  Page : 77-79  

Cytodiagnosis of filariasis from a swelling of arm


Department of Pathology, Bankura Sammilani Medical College, Bankura, West Bengal, India

Date of Acceptance26-Jan-2012
Date of Web Publication16-Jun-2012

Correspondence Address:
Jyoti Prakash Phukan
Department of Pathology, Bankura Sammilani Medical College, P.O. Kenduadihi, Bankura- 722 102, West Bengal
India
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DOI: 10.4103/2229-5070.97251

PMID: 23508558

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   Abstract 

Cytological demonstration of microfilaria and adult worms often helps in diagnosis of asymptomatic filarial cases. But demonstration of microfilaria in cytological smears from upper extremity lesions is seldom reported. We are presenting a 32-year-old female patient with elongated, small subcutaneous swelling in the medial aspect of right lower arm. Aspirates from the lesion demonstrate microfilaria though there is no eosinophilia or microfilaremia on subsequent examination of blood sample. In endemic areas, filariasis should always be considered as a possible diagnosis during cytological assessment of any swelling.

Keywords: Cytodiagnosis, filariasis, microfilaria


How to cite this article:
Phukan JP, Sinha A, Sengupta S, Bose K. Cytodiagnosis of filariasis from a swelling of arm. Trop Parasitol 2012;2:77-9

How to cite this URL:
Phukan JP, Sinha A, Sengupta S, Bose K. Cytodiagnosis of filariasis from a swelling of arm. Trop Parasitol [serial online] 2012 [cited 2019 Nov 15];2:77-9. Available from: http://www.tropicalparasitology.org/text.asp?2012/2/1/77/97251


   Introduction Top


Filariasis, caused by slender thread-like nematodes of Filarioidea superfamily, can predominately involve skin and subcutaneous tissue (Onchocerca volvulus and Loa loa) or the lymphatic system (Wuchereria bancrofti and Brugia malayi). [1] Lymphatic filariasis or elephantiasis affects more than 125 million people worldwide and is regarded by World Health Organization as the second leading cause of permanent and long-term disability after leprosy. [2] In India, the prevalence of lymphatic filariasis is quite high (5-10%) with highest case burden from coastal areas and banks of big rivers. [3] Sustruta, the famous ancient Indian physician and surgeon, described the clinical picture of elephantiasis as early as 600 BC. [4] 98% of the diagnosed cases of lymphatic filariasis in India is caused by W. bancrofti. [3] The disease usually follows a chronic course with predominant involvement of the lymphatic system of lower limbs, retroperitoneal tissues, spermatic cord, and epididymis. [5] Aspiration cytology often helps in demonstration of microfilaria and adult worms from these common sites as well as from uncommon diverse areas like breast, thyroid, effusion fluid, soft tissue swellings, etc. [6] We are describing a case of bancroftian filariasis presenting with small subcutaneous swelling in the medial aspect of the upper arm.


   Case Report Top


A 32-year-old female, a resident of a village of Bankura district, West Bengal, India, attended fine needle aspiration cytology (FNAC) clinic of Bankura Sammilani Medical College (BSMC), Bankura with a small swelling near medial aspect of right lower arm. On examination, it was a small subcutaneous slightly elongated swelling 2×1 cm, non-tender, firm, and without any fixity to deeper tissue. FNAC was done with clinical diagnosis of benign soft tissue neoplasm and a drop of fluid was aspirated. Smears show the presence of numerous microfilaria of W. bancrofti without significant inflammatory cell infiltration [Figure 1], [Figure 2] and [Figure 3]. There was no evidence of inguinal or femoral filariasis and no history of fever. Routine blood examination revealed normal eosinophil population (4%) and nocturnal blood sample as well as blood sample drawn 1 hour after an oral dose of diethyl carbamazine (provocative test) [1] failed to demonstrate microfilaraemia.
Figure 1: Photomicrograph of the microfilaria of Wuchereria bancrofti in a background containing thin serous fluid (MGG ×4)

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Figure 2: Photomicrograph showing a sheathed microfilaria of Wuchereria bancrofti with a rounded anterior and tapered posterior end (MGG ×10)

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Figure 3: Photomicrograph of the microfilaria of Wuchereria bancrofti with a clear space free of nuclei at the caudal end (MGG ×40)

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   Discussion Top


Diagnosis of lymphatic filariasis in symptomatic cases with typical clinical presentation is often easy and straight forward. Unfortunately, a majority of the affected remain asymptomatic particularly in the endemic areas with continued disease transmission. [7] In endemic areas, microfilaremia is often absent or transient, further complicating detection of disease. [8] But microfilariae, even in asymptomatic cases can reach tissue spaces due to vascular or lymphatic obstruction, leading to extravasations of larva. [9] Cytology can demonstrate these extravasated larva in tissue spaces or fluids.

In our case, the patient came from an endemic area explaining lack of clinical symptoms and amicrofilaremic state. FNAC is proved to be an effective measure in diagnosis of this type of asymptomatic cases.

Microfilaria of W. bancrofti are identified on cytological smears as long, thin, colorless, transparent, sheathed, thread-like structures (280-300 × 67 μ) with blunt head, pointed tail, and absence of nuclei in the tip. Brugian larva in comparison is smaller with secondary kinks instead of a smooth curve and the presence of nuclei in the tip. [10] Adult worms of both the species appear as white, thin, thread-like structures with tapering ends and distinction is often impossible. [9]


   Conclusion Top


FNAC can be helpful in diagnosis of symptomatic as well as asymptomatic cases of lymphatic filariasis. [6] During cytological evaluation of tissue fluids and aspirate from lesions of any part of the body, possibility of filariasis must be kept in mind as a possible differential diagnosis, particularly in endemic areas.

 
   References Top

1.King CL, Freedman DO. Filariasis. In: Hunter's Tropical Medicine and Emerging Infectious Diseases. In: Strickand GT, editor. 8 th ed. Philadelphia: WB Saunders; 2000. p. 740-54.  Back to cited text no. 1
    
2.Rosen PP. Specific Infections.In: Rosen PP, editor. Breast Pathology. 2 nd ed. Philadelphia: Lippincott Willams and Wilkins; 2001. p. 65-75.  Back to cited text no. 2
    
3.Sabesan S, Palaniyandi M, Das PK, Michael E. Mapping of lymphatic filariasis in India. Ann Trop Med Parasitol 2000;94:591-606.  Back to cited text no. 3
[PUBMED]  [FULLTEXT]  
4.Faust EC, Russel PF, Jung RC. Plasmid Nematode, Parasite of man. Filarioidea. In: Craig and Faust's Clinical Parasitology. 8 th ed. Philadelphia, PA: Lea and Febiger; 1970. p. 361-404.  Back to cited text no. 4
    
5.McCarthy JS. Diagnosis of lymphatic filarial infections in lymphatic filariasis. In: Nutman TB, editor. London: Imperial College Press; 1999. p. 127-49.  Back to cited text no. 5
    
6.Mallick MG, Sengupta S, Bandyopadhyay A, Chakravorty J, Ray S, Guha D. Cytodiagnosis of filarial infections from an endemic area. Acta Cytol 2007;51:843-9.  Back to cited text no. 6
    
7.Das PK, Pani SP, Krishnamoorthy K. Prospects of elimination of lymphatic filariasis in India. ICMR Bulletin 2002;32:41-54.  Back to cited text no. 7
    
8.Beaver PC. Filariasis without microfilaremia. Am J Trop Med Hyg 1970;19:181-9.  Back to cited text no. 8
[PUBMED]  [FULLTEXT]  
9.Chatterjee KD. Phylum Nemathelminthes: Class Nematoda. In: Parasitology (Protozoology and Helminthology) in Relation to Clinical Medicine. 12 th ed. Kolkata: Chatterjee Medical Publishers; 1980. p. 184-99.  Back to cited text no. 9
    
10.Hira PR. Wuchereria bancrofti: The staining of the microfilarial sheath in giemsa and haematoxylin for diagnosis. Med J Zambia 1977;11:93-6.  Back to cited text no. 10
[PUBMED]    


    Figures

  [Figure 1], [Figure 2], [Figure 3]


This article has been cited by
1 Cytological diagnosis of bancroftian filariasis presented as a subcutaneous swelling in the cubital fossa: an unusual presentation
P. Pandey,A. Dixit,S. Chandra,A. Tanwar
Oxford Medical Case Reports. 2015; 2015(4): 251
[Pubmed] | [DOI]



 

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