Cytological diagnosis of microfilariae in filariasis endemic areas of eastern Uttar Pradesh

Cytological diagnosis of microfilariae in clinically unsuspected cases: A retrospective review of 12 cases

BACKGROUND

Filariasis is a major health problem in India. Despite the high prevalence, microfilariae are rarely found in cytology smears. Most of the cases are incidentally found, solely or in association with other pathologies.

AIMS AND OBJECTIVES

This study was undertaken to analyse the prevalence and cytological findings of cases of incidentally found microfilariae in cytology smears (fine needle aspiration cytology [FNAC]/exfoliative cytology) from different parts of the body.

MATERIALS AND METHODS

This was a retrospective study over 3 years, in which cases of microfilariae in aspirates from swelling of different locations, body fluids, and pap smears were reviewed, and the clinicopathological data analysed.

RESULTS AND ANALYSIS

Out of 11 530 cases of FNAC, 8700 cases of fluid cytology, and 9000 of conventional cervicovaginal smears, 12 cases (0.04%) of incidental findings of microfilariae were documented in cytology smears. The cases were diagnosed from lymph node (one case), hand (one case), scrotal area (one case), axilla (one case), breast (one case), subcutaneous tissue (three cases), urine (three cases), and Pap smear (one case). We found eosinophilia in one case (8.3%) of filarial lesions. We found two cases of incidental findings of microfilariae in association with malignant lesions.

CONCLUSION

Cytology smear examination can play an important role in diagnosing occult filariasis in clinically unsuspected cases in association with other pathologies.

Filariasis presenting as a solitary testicular mass

In an endemic country like India, the occurrence of filariasis is very common, especially in the states of Uttar Pradesh, Bihar, Jharkhand, Odisha, Andhra Pradesh, and Tamil Nadu. The present study describes the case of a male from a nonendemic state who presented with a testicular lump. Fine-needle aspiration cytology (FNAC) of the lump revealed many adult filarial worms. The appearance of adult filarial worms in different sites, other than lymph nodes and lymphatic vessels, are relatively rarer and should always be reported. Filariasis remains asymptomatic for a long time and responds very well to treatment if diagnosed early. Despite the availability of multiple diagnostic options, FNAC holds a great importance in diagnosing filariasis, especially in cases where there are normal eosinophil counts and no peripheral filarial parasite. Finally, careful examination of cytological smear for the parasite in high-risk groups is helpful in labeling the disease in early asymptomatic states.

Atypical cases of filariasis from a non-endemic area

Filariasis can present in many different ways and pose significant dilemma to the clinician. We report four atypical cases of filariasis which presented as abdominal mass, cervical lymph node enlargement, fever in pregnancy and nosocomial febrile illness respectively. All the four cases were treated successfully with oral antifilarial agents. It is essential to be aware of such atypical presentations of filariasis so that prompt therapy can be initiated.

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.

Cytological findings of microfilariae in different sites: A retrospective review of 22 cases from endemic region

Background:

Filariasis is a major health problem in India. Despite the high prevalence, microfilariae are rarely found in cytology smears. Most of the cases are incidentally found, solely or in association with other pathologies.

Aims and Objectives:

The study was undertaken to analyze the prevalence and cytology findings of cases of incidentally found microfilariae in cytology smears (fine-needle aspiration cytology [FNAC]/body fluids) from different body parts.

Materials and Methods:

This was a retrospective study over 5 years, where the cases of microfilariae in aspirates from swelling of different locations and body fluids were reviewed, and clinic-pathological data were analyzed.

Results and Analysis:

Out of 16,738 cases of FNAC and 882 cases of fluid cytology, 22 cases (0.124%) of incidental finding of microfilaria were documented in cytology smears. The cases were diagnosed from lymph nodes (5 cases), skin and soft tissue (4 cases), scrotal (4 cases), breast (3 cases), thyroid (2 cases), and pleural fluid (2 cases). We found eosinophilia in 15 cases (68.18%) of filarial lesions. We found two cases of incidental findings of microfilariae in association with malignant lesions.

Conclusion:

Filariasis should be considered as differential diagnosis of swelling of lymph nodes, skin, soft tissue, inguinoscrotal region, and other sites as well. Careful screening of cytology smears may help in detection of incidental cases in the association of other pathologies.

Incidental detection of two adult gravid filarial worms in breast: a case report

Background

Microfilaria is a major public health problem in tropical and subtropical countries and is an endemic problem in India. Wuchereria bancrofti is the commonest filarial infection. In some lesions, microfilariae and adult filarial worm have been incidentally detected in fine-needle aspirates.

Case presentation

A 35 year old hindu female presented with lump in upper outer quadrant of left breast. Fine needle aspiration revealed two adult gravid female filarial worms.

Conclusion

To our knowledge this is the first ever case report to demonstrate two live gravid female and embryoid forms in wet mount preparation.

Electronic supplementary material

The online version of this article (doi:10.1186/s13104-017-2709-3) contains supplementary material, which is available to authorized users.

Filarial abscess: Aspiration of adult gravid female worm from submandibular region, an unusual presentation

Microfilaria is a major public health problem in tropical and subtropical countries and is an endemic problem in India. Wuchereria bancrofti is the most common filarial infection. In some cases, microfilariae and adult filarial worm have been incidentally detected in fine-needle aspirates of various lesions; detection of microfilaria from subcutaneous site or from abscess site is even rarer. We here report an unusual case of Bancroftian microfilariasis in a 68-year-old female coming from endemic area presenting with right submandibular abscess. Our aim is to highlight the chances of finding microfilaria and adult worm in cytology of an unsuspected case at an unusual site.

Filariasis of Stensen's Duct: An Index Case

Filariasis, a neglected tropical disease, is a global health problem and is endemic to 73 countries including India. It is caused by nematodes of Filariodidea family, namely, W. bancrofti and B. malayi in India, which have a predilection for the lower limbs and testis. We report a never before reported case of filariasis of the main parotid duct in a 25-year-old male that resolved on medical management, exemplifying the importance of maintaining a high index of suspicion and careful examination of cytological smears in endemic countries, allowing for an early diagnosis and treatment, decreasing the morbidity of this debilitating disease.

Microfilarial involvement of the neck region: A case report and review of literature

INTRODUCTION

Filariasis is caused by parasitic infections, most commonly Brugia malayi and Wuchereria bancrofti. India is one of the endemic countries for such disease. The usually involved organs are lower limbs and external genitalia. Neck region is rarely involved and only a few cases have been reported in literature.

CASE REPORT

We reported such a case where filarial involvement has involved the neck region and reached up to the level of upper cervical vertebra. A huge neck swelling and torticollis were the main presenting features. Diagnosis was confirmed by MRI and live presence of microfilarial parasite in FNAC. The patient responded excellently to antihelminthic drugs. He has been under our regular follow-up and there has been no complication till date.

DISCUSSION

The purpose of this case report was to highlight this rare presentation of microfilaria parasite.

Microfilaria Coexistent with Fibroadenoma - An Unusual Association

Filariasis is an endemic problem in India. Involvement of breast by filariasis is uncommon, but known to occur in endemic areas. However, microfilaria co-existing with neoplastic lesions is very rare. Here we report an unusual finding of microfilaria co-existing with fibroadenoma in a 20-year-old female patient.

Non chylous filarial ascites: A rare case report

Filariasis is a common health problem in tropical and subtropical regions including India. It commonly presents with lymphatic involvement in form of nonpitting pedal edema, chylous ascites, chyluria, hydrocele and lymphocele. Detection of microfilaria in ascitic fluid is an extremely uncommon finding. We present a case of non chylous ascites where microfilaria were detected in the ascitic fluid.

Incidental Diagnosis of Filariasis in Superficial Location by FNAC: A Retrospective Study of 10 Years

BACKGROUND

Filariasis, transmitted by the bite of various species of mosquito, is a common disease of tropical belt of the world. In South East Asia, including India, it is a major public health problem. The parasite is primarily confined to Lymphatic channel or lymph nodes where it can remain viable for more than two decades. The most common presentation of the disease is asymptomatic/ subclinical microfilaremia, Hydrocele, acute adeno-lymphangitis (ADL) and chronic lymphatic disease. However, the disease may rarely present as superficial swellings at unusual sites. Incidental findings of microfilaria on fine needle aspiration cytology in these situations, helps in prompt recognition of the disease.

AIM

The aim of this retrospective study was to assess the incidental diagnosis of Filariasis on fine needle aspiration cytology (FNAC), done for swellings in superficial locations over last ten years at our institute.

MATERIALS AND METHODS

This retrospective study was conducted over a period of 10 years from April 2003 to March 2013 on the cases where FNAC was carried out on swellings in superficial locations of the body. Twenty cases of filariasis were diagnosed on routine FNAC material obtained from various superficial sites. Their data was retrieved and analyzed.

RESULTS

Among the 20 cases diagnosed as filariasis on FNAC, six cases involved lymph nodes, six involved testiculo-scrotal region, three cases of thyroid swelling, soft tissue swelling in three cases and breast lump in two cases. On FNA smears, microfilariae were seen in all 20 cases, eggs in three cases, adult female worm in two cases and adult male worm in one case. Adherence of inflammatory cells and macrophages to microfilariae was noticed in 4 cases. Eosinophilia was present in seven cases. Microfilaremia was present in only three cases. Causative agent was Wuchereria bancrofti in all cases.

CONCLUSION

Although not so common, filariasis should be considered as one of the differential diagnosis of a superficial swelling particularly if clear fluid is obtained on FNAC. Careful screening of smears plays a significant role in recognition of the disease even in asymptomatic patients.

Incidental detection microfilaria in subcutaneous breast nodule of lactating female fnac: a rare case report

Filariasis is a major public health problem which is faced in tropical countries like India. Its diagnosis is made by using peripheral blood smears. However, microfilaria has been detected incidentally during FNACs of various lesions, which were done in clinically unsuspected cases. We are reporting here, an uncommon case of filariasis, which caused a nodular, subcutaneous swelling in left breast of a 30 year old lactating female. A nodular subcutaneous swelling can be caused in breast of a lactating female by lactational associated mastitis, but filaria causing a nodular swelling in a lactating breast is a rare presentation. Aspiration of the swelling demonstrated enormous pathogen presence caused by Woucheria bancrofti and the patient responded well to six weeks of daily anti-filarial treatment with diethylcarbamazine citrate.

Fine needle aspiration cytology of epididymal nodules

Background:

The incidence of non neoplastic lesions are much more common in epididymis. Clinically, epididymal nodules are easily accessible to fine needle aspiration cytology (FNAC) procedure. There are very few literature reports documenting the role of cytology in evaluation of epididymal nodules. Thus, we studied patients presenting with palpable epididymis nodules in the out patient department (OPD) from a tertiary care general hospital.

Aim:

This study is aimed to put forth the diagnostic utility of FNAC in palpable lesions of epididymis.

Materials and Methods:

A total of 40 palpable epididymal nodules were aspirated as a routine OPD procedure as part of this study. Smears were fixed in isopropyl alcohol and air dried. In all the cases, wet fixed papanicoloau stained and air dried giemsa stained smears were studied. Zeihl Neelsen stain was performed in cases which yielded caseous aspirate.

Results:

Except for two cases of adenomatoid tumor of epididymis all other lesions were nonneoplastic and included 14 cases (35%) of tuberculous granulomatous inflammation, 10 (25%) cystic nodules (9 spermatoceles and 1 encysted hydrocele), 5 (12.5%) of nonspecific inflammations, 3 (7.5%) filarial infection, 3 (7.5%) sperm granulomas and 3 (7.5%) adenomatous hyperplasia of rete testes. Except for the two tumors, one adenomatous hyperplasia and one tuberculous lesion, no other lesion was excised. Follow up and response to therapy was available in 78% patients and resolution indicated appropriateness of the diagnosis

Conclusions:

Thus, as most of the lesions in epididymis are non neoplastic responding to medical line of treatment and FNAC served to aid diagnosis of non specific inflammation and avoid surgical excision in most cases.