Microfilariae, a Common Parasite in an Unusual Site: A Case Report with Literature Review

An Unusual Encounter: Microfilaria Incidentally Detected in the Bone Marrow Aspirate of a Chronic Kidney Disease Patient

Lymphatic filariasis is endemic in a few states of India and is one of the most common public health concerns. Wuchereria bancrofti (W. bancrofti) is the most common parasite that causes lymphatic filariasis in India. Microfilariae have been commonly found in the peripheral blood and body fluid, as well as demonstrated in fine needle aspirates (FNA) and bronchial cytology. They have been rarely reported in bone marrow aspirates. Due to the nocturnal periodicity of W. bancrofti, it may be missed in peripheral blood during the day. Though peripheral eosinophilia is a presenting feature of filariasis, it may be absent in the majority of cases, as in this case. We report an incidental finding of W. bancrofti in the bone marrow aspirate of a 72-year-old male who had chronic kidney disease.

Incidental Finding of Microfilariae in Cervicovaginal Smears on Liquid-based Cytology - A Case Report of two Cases with Review of Literature

Filariasis is a vector-borne disease, which is quite common in tropical countries such as India. In India, it is most commonly caused either by Wuchereria bancrofti or Brugia malayi. It can present in any possible site, possibly, because of their ability to migrate along the lymphatics. Very few cases have been reported in the literature where microfilariae have been found in cervicovaginal smears. Most of the cases have been reported on conventional Pap smears. Here, we present two such cases where microfilaria was found as an incidental finding in liquid-based cytology preparation.

Asymptomatic filariasis and leprosy co-morbidity in a patient with suspected Guillain-Barrè syndrome: the first case report of an incidental finding in a slit-skin smear

INTRODUCTION

Lymphatic filariasis (LF) and leprosy are both endemic in India. These diseases are on the World Health Organization (WHO) list of neglected tropical diseases (NTDs), as they affect the most marginalized communities in the world, resulting in deformities and functional limitation. We report the first case of asymptomatic filariasis and leprosy co-morbidity in a patient with suspected Guillain-Barré syndrome.

CASE PRESENTATION

A 55-year-old male who was a farmer by occupation presented to the Neurology Outpatient Department (OPD) of our institute with complaints of weakness in all four limbs for the last 15 days. After admission, a detailed history revealed that the patient had been taking multi-drug therapy (MDT) for leprosy for the previous 6 months. After symptomatic management of the presenting complaints, the patient was sent to the Department of Microbiology for a consultation and six-site slit-skin sampling. The initial screening of Ziehl-Neelsen (ZN)-stained smears under a 10× objective led to the incidental finding of sheathed structures resembling microfilaria (Mf) on the smear made from ear lobules. In addition, short acid-fast bacilli (AFB) were also observed under the oil-immersion objective.

CONCLUSION

We emphasize that a high index of suspicion and thorough screening of smears by a microbiologist is essential in specimens obtained from any body site.

Filiarial chyluria with nephrotic-range proteinuria and associated hypoalbuminaemia and hypogammaglobulinaemia secondary to bilateral lymphorenal fistulae

A 55-year-old man of Indian descent, presented to the emergency department with a 2-year history of passing 'milky' white urine, associated with dysuria, urinary retention, bilateral flank pain and 15 kg weight loss. He had migrated to Australia from India at the age of 16, with no overseas travel since, and denied having any fevers, rigours or chills. He was found to have chyluria and nephrotic-range proteinuria with marked hypoalbuminaemia and hypogammaglobulinaemia. Due to his ethnic origin and by diagnostic exclusion, a presumptive diagnosis of filariasis was made. With bilateral lymphorenal disconnection, as definitive management, the patient's chyluria and proteinuria resolved with restoration of normal plasma protein and immunoglobulin levels.