Detection of filarial antigen and antibody in serum and hydrocele fluid of 100 patients of hydrocele

AIM

The present study was carried out to detect an association between isolated non-communicable hydrocoele and filariasis and to provide awareness to positive patients regarding sequel and advising methods for the reduction of morbidity.

METHODS

Blood samples and hydrocoele fluids were used to detect filarial antigen and antibody by ICT Kit, Trop-bio kit and Sevafilachek Kit. These were followed by statistical evaluation by chi2 test.

RESULTS

14% of cases were positive for filarial antigen and antibody in hydrocoele patient serum, while 15% of cases were positive for filarial antigen and antibody in the serum of non-hydrocoele patients.

CONCLUSION

Probability is less than 0.05, which is statistically significant.

Diagnosis of Wuchereria bancrofti infection by the polymerase chain reaction using urine and day blood samples from amicrofilaraemic patients

A sensitive and specific polymerase chain reaction (PCR) based on a highly repeated deoxyribonucleic acid (DNA) sequence (188 bp; SspI repeat) was tested for the detection of Wuchereria bancrofti DNA in blood and urine samples collected during the day from individuals in Coque, Recife, Brazil, an endemic area for W. bancrofti. All microfilaraemic individuals were also positive by PCR, irrespective of the samples used. The PCR system was capable of detecting W. bancrofti DNA in amicrofilaraemic individuals: c. 93% were positive by PCR when day blood samples were used and 59.7% when urine samples collected at 07:00 were used. Thus, nocturnally periodic W. bancrofti infection can be detected in blood samples collected during the day, which is convenient for large-scale screening. In addition, non-invasive urine collection provided suitable samples for PCR, which is clearly advantageous for preliminary mass diagnosis.

Endoscopic treatment of refractory filarial chyluria: a preliminary report

PURPOSE

We report our experiences treating 5 patients who had filarial chyluria using an endoscopic approach.

MATERIALS AND METHODS

Two men and 3 women 47 to 83 years old with chyluria were treated with endoscopic coagulation using guide tube methods. Intrarenal pelvic instillation of silver nitrate was not effective in 4 patients and catheterization was impossible in 1.

RESULTS

The responsible lesion was successfully coagulated in all 5 patients. Because the lesion was in the ruptured portion of the caliceal fornix, we thought that chyluria had arisen in the fragile portion of the fornix (fistulization). After endoscopic treatment there was no recurrence in any patient.

CONCLUSIONS

Endoscopy is effective and minimally invasive therapy for filarial chyluria.

Urine lipids in patients with a history of filariasis

The presence of lipids in postprandial urine was assessed in 116 patients with a history of filariasis and 70 normal individuals using a biochemical autoanalyzer. Urinary triglycerides (TGs) ranging from 10 to 1955 mg/dl were detected in 13 individuals with a history of chyluria, including 3 with TG levels ranging from 233 to 1955 mg/dl and cholesterol levels of 6-35 mg/dl. Three patients who had a filarial history but without chyluria were also found to have urinary TGs (13-15 mg/dl) without detectable cholesterol. Neither TGs nor cholesterol were detected in the urine of normal individuals. Fluctuations in postprandial urine lipid contents were measured by time course determinations of urinary TG and cholesterol in 17 patients with filariasis and a history of chyluria, 16 patients with filariasis and hydrocele and 16 normal individuals. The level of urine lipid excretion was found to increase within 1-4 h postprandially, with urinary TG levels ranging between 7.8 and 1284 mg/h in eight patients and urinary cholesterol levels between 1.2 and 138 mg/h in seven patients with a history of chyluria. To evaluate the origin of the urine lipids in hematochyluria, fish oil containing 360 mg eicosapentaenoic acid (EPA) and 240 mg docosahexaenoic acid (DHA) was prescribed to a patient with hematochyluria. The excretion of EPA and DHA in urine was increased postprandially in the patient, similar to the elevation of urinary TG and cholesterol. The profile of fatty acids from urine samples showed it was of dietary origin. Our results suggest that postprandial urine lipids, especially TG, might be used as markers for the clinical evaluation of chyluria.

Laparoscopic nephrolysis for chyluria: case report of long-term success

Laparoscopic nephrolysis was performed in an 81-year-old man with recurrent chyluria. A total of five trocars were used for approaching the lymphatic ducts over the right ureter and renal hilum. The lymphatic ducts identified were easily ligated under laparoscopic magnification. The recovery of this patient was quick and uneventful. The follow-up urinalysis for chyle was negative, and his serum albumin concentration increased from 3.0 g/dL to 4.2 g/dL at 2 years postoperatively. This case report attests to the long-term efficacy of a laparoscopic approach to ligation of lymphatic fistulas for the treatment of recalcitrant chyluria.

Use of fractionated urinary filarial antigen in the diagnosis of human filariasis

Fractionated urinary filarial antigen UFA C2 has shown high antigenic activity after absorption of urinary albumin present in the fraction. As little as 500 ag (10(-18) g) of albumin absorbed UFA C2, labelled as UFA C2-A, was found to be sufficient to detect filarial antibody. Stick enzyme immunoassay to assess the immunodiagnostic potential of UFA C2-A indicated filarial IgG antibody in 89% of microfilaraemic (mf) cases, 84% of clinical filariasis and 7% of endemic normals. UFA C2-A was found to be present in circulation in active as well as clinical infections as observed by inhibition assay using UFA C2-A penicillinase conjugate. Eighty-six per cent of mf, 50% of clinical cases and 6% of endemic normal subjects revealed parasite antigen to UFA C2-A on further serological analysis. None of the non-endemic normal sera showed the presence of filarial antibody/antigen to UFA C2-A. Furthermore, the test to determine phosphorylcholine (PC) bearing epitopes in UFA C2-A indicated no immunological reaction with anti-PC monoclonal antibody by avidin-biotin enzyme linked immunosorbent assay (ELISA). The highly sensitive and more easily obtainable non-PC urinary filarial antigen, UFA C2-A, is of great immunodiagnostic interest for lymphatic filariasis.

Fractionation and characterization of urinary filarial antigen in bancroftian filariasis

Urine samples from microfilaraemic patients were concentrated and fractionated by gel chromatography on Ultrogel AcA 44. Four protein fractions labelled as UFA C1, UFA C2, UFA C3 and UFA C4 were tested for filarial antigenicity by sandwich ELISA. UFA C1 and UFA C2 showed antigenic activity. On further analysis by SDS-PAGE, UFA C1 and UFA C2 showed antigenic components with MW ranging from 10.4 K to 123 K. UFA C1-1 and UFA C2-2 showed high antigen titre in ELISA. Urinary albumin was observed as a major component in UFA C2. Absorption of albumin from UFA C2 enhanced its antigenic activity considerably. As little as 0.01 pg antigenic protein per test was found to be sufficient for the detection of filarial antibody in ELISA. Biochemical characterization indicated a glycoprotein nature of UFA C2.

Cytologic detection of Wuchereria bancrofti microfilariae in urine collected during a routine workup for hematuria

A 23-year-old Guyanese man experienced intermittent, total, painless, gross hematuria for a month for which he sought medical attention at the Kings County Hospital Center in Brooklyn. Hematuria was accompanied by weakness but not by frequency of urination or burning on urination. Catheterized urine at the time of cystoscopy and each of two subsequent voided specimens examined cytologically contained sheathed microfilariae. Distinguishing features of the microfilariae were well demonstrated with the Papanicolaou stain. The well-stained nuclei, which did not extend into the clear zone, and the distinct, pale-stained sheath led to the positive identification of the microfilariae as Wuchereria bancrofti. The Papanicolaou stain may well be the stain of choice for the identification of microfilariae in the blood. The excellent detail obtained with this routine cytologic stain is as good as that with Giemsa, which does not stain the sheath.

Role of lymphography in management of filarial chyluria

1. One hundred patients with chyluria were studied with lymphography and 80 cases were followed up for a period varying between six months to two and one half years. 2. There was preponderance of left sided lesions. The site of fistulations were mostly in the region of pelvis and calyces of the kidney. 3. It was observed that lymphography was very useful in treatment of chyluria. Thirty-eight patients (48%) with chyluria were completely free from symptoms and after lymphography, 23 (28%) of them had relief and 19 (24%) of the patients did not have any beneficial effect after lymphography. This procedure was of great help in demonstrating the site of fistulations which could be surgically corrected, in certain situations. 4. Lymphographic appearances of thoracic duct was helpful in deciding the operation of thoracic duct jugular vein anastomosis in some cases. 5. Lymphatico venous anastomosis was done in 3 patients at the root of the scrotum in whom retrograde flow of contrast material occurred into the testicular lymphatics on lymphography.

Lymphangiography in the management of filarial chyluria

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