Journal of Postgraduate Medicine
 Open access journal indexed with Index Medicus & ISI's SCI  
Users online: 801  
Home | Subscribe | Feedback | Login 
About Latest Articles Back-Issues Article Submission Resources Sections Etcetera Contact
 
  NAVIGATE Here 
  Search
 
 :: Next article
 :: Previous article 
 :: Table of Contents
  
 RESOURCE Links
 ::  Similar in PUBMED
 ::  Search Pubmed for
 ::  Search in Google Scholar for
 ::  [PDF Not available] *
 ::  Citation Manager
 ::  Access Statistics
 ::  Reader Comments
 ::  Email Alert *
 ::  Add to My List *
* Registration required (free) 

  IN THIS Article
 ::  Abstract
 ::  Introduction
 ::  Material and Methods
 ::  Observations
 ::  Discussion
 ::  Acknowledgements
 ::  References
 ::  Article Figures
 ::  Article Tables

 Article Access Statistics
    Viewed4247    
    Printed92    
    Emailed1    
    PDF Downloaded0    
    Comments [Add]    

Recommend this journal


 


 
ARTICLE
Year : 1978  |  Volume : 24  |  Issue : 4  |  Page : 205-208

Surgical manifestations of filariasis


1 Department of Surgery, Medical College, Miraj., India
2 Department of Surgery, Mahatma Gandhi Institute of Medical Sciences, Sevagram, Wardha 442102 (M.S.), India

Correspondence Address:
M Subrahmanyam
Department of Surgery, Medical College, Miraj.
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


PMID: 370376

Rights and PermissionsRights and Permissions


 :: Abstract 

Surgical manifestations of filariasis as seen in 150 cases over a period of three years in the department of Surgery, Mahatma Gandhi Institute of Medical Sciences, Sevagram, Wardha are reviewed. The genital manifestations are more common than the elephantiasis in this endemic zone.



How to cite this article:
Subrahmanyam M, Belokar W K, Gole S. Surgical manifestations of filariasis. J Postgrad Med 1978;24:205-8

How to cite this URL:
Subrahmanyam M, Belokar W K, Gole S. Surgical manifestations of filariasis. J Postgrad Med [serial online] 1978 [cited 2019 Dec 13];24:205-8. Available from: http://www.jpgmonline.com/text.asp?1978/24/4/205/42647



 :: Introduction Top


Filariasis is the term given to the vari­ous clinico-pathological phenomena caus­ed by infestation with different varieties of Nematode worm-filaria. Of these Wuchereria bancrofti and Brugia malayi are responsible for elephantoid states. Wardha district in Maharashtra, Central India, is an endemic zone for filariasis and a number of afflicted cases seek hospital advice. We report below our experience of the past 3 years with such filarial cases.


 :: Material and Methods Top


One hundred and fifty cases of filarial disease encountered at The Mahatma Gandhi Institute of Medical Sciences, Sevagram, Wardha, during a 3 year period (1974-1977) have been studied in detail with special reference to the mode of presentation of surgical manifestations.


 :: Observations Top


[Table 1] depicts the surgical manifesta­tions of filariasis encountered in the pre­sent study. The lesions were multiple in many cases. Out of the 150 cases of fila­riasis. 23 had elephantiasis, 35 had lymph gland enlargement, 15 had lymphangitis, 36 had epididymo-orchitis, 80 had hydro­celes, 48 had filarial fever, 6 had lymph varix, 5 had hematuria and 5 had chylu­ria. Males suffered more frequently than the females in the ratio of 6:1. The maxi­mum incidence occurred in 15-30 years of age group (98) followed by age group of 30-40 years (53) while in the 10-15 years of age group only 9 cases were detected.

Lymphangitis

[Figure 1] (see page 206A) reveals the clini­cal appearance. There were 15 cases of lymphangitis, out of which 13 occurred in the upper limb and 2 in the lower limb. Lymph vessels of affected extremity appeared as red streaks under the skin. The limb appeared red, hot, tender and swollen.

Epididymo-orchitis and Fitniculitis

Patients had tender, thickened epididy­mis and spermatic cord. Of the 35 cases recorded, one had associated arthritis of left knee, myositis of neck muscles and lymphangitis of right lower limb. 6 had hydroceles and 20 of them were having filarial fever. In 8 cases microfilariae could be demonstrated in the peripheral smear at night.

Abscess

This usually followed lymphangitis and occurred in 10 cases-2 in the lower limb, 3 in the upper limb, 4 in the scrotum and one in the breast. In 3 cases adult worm could be demonstrated in the abs­cesses including one in the breast.

Lymph Scrotum

This is caused by varicosity of the lym­phatics of the skin and subcutaneous tissues of scrotum. 6 cases of enlarged scrotum with rugosity and lymphatic vessels of variegated sizes were observed. 4 of these patients who were operated upon for hydroceles subsequently deve­loped lymph scrotum, after varying in­tervals of 10 days to 30 days.

Lymph Varix

The lymphatics of spermatic cord are elongated, tortuous, elastic and characte­rised by bulkiness of the cord (6 cases). When such varices occur in groin, these are then designated as varicose groin glands (2 out of 6).

Hydrocele

These patients had enlarged scrotum to such an extent that the penis was com­pletely burried inside it. This is due to elephantiasis of scrotum. Bulkiness of the cord, edema of the tissues in the field of operation, presence of lymph varices in the cord, microfilariae in hydrocele fluid have been taken as evidence of lymphatic obstruction. 80 cases of hydrocele were recorded. Out of these 5 had elephantiasis of the scrotum. In 15 cases of hydrocele there was also thickening and tenderness of the spermatic cord and testis. In 2 of these cases microfilariae could be demon­strated in the hydrocele fluid. [Figure 2] (see page 206A) is a clinical photograph of hydrocele due to filaria origin.

Elephantiasis

Of the 23 cases recorded, 14 were in the lower limb, 4 in the upper limb, while the rest had their scrotum involved. 8 patients had hydrocele in addition. The limbs were swollen, skin was stretched and had nonpitting oedema. One case of elephantiasis of the glans penis was seen see [Figure 3] on page 206B. [Figure 4] see page 206B shows elephantiasis of the lower limb.

Chyluria

Chyle appears in the urine when vari­cose chyle laden lymph vessels rupture into the bladder, kidneys or ureters. Urine is opalescent, yellowish, milky white in colour due to regurgiated chyle from the intestinal lymphatics through retrograde channels. 5 such cases were seen.

Haematuria

In 2 cases of haematuria microfilariae could be demonstrated in the urine as well as in peripheral smear. One case had chyluria in addition.

Pyocele

There were 10 cases of pyocele. This started with fever, chills and rigors, funi­culitis and orchitis and presented to us as pyoceie within 3-7 days.

Diagnosis of filariasis can be confirmed by demonstration of microfilariae in the peripheral smear at night. In 11 of our cases, microfilariae could be seen. In single sex infection prepatent or latent in­fection microfilaria cannot be seen in the peripheral smear. Eosinophilia, if present, may be a pointer but intestinal helminthic worm infestations should be excluded. Histopathological-confirmation can be obtained from the tissue biopsies wherever it is feasible. In the present study, adult worm was found on histo­pathology in 25 cases. Out of these, 8 were in the epididymis, 6 were in the tissue biopsies of chronic lymphangitis, 2 in the testis and the rest were detected in the inguinal lymph nodes. However, in cases of epididymo-orchitis, hydroceles and lymph varix, it is the clinical asump­tion.


 :: Discussion Top


Bancroftian filariasis is widely distri­buted but largely confined to tropical and subtropical countries. It is endemic in certain parts of India, Southern China, Japan, North Australia, West and Central Africa. In India it is distributed along the Eastern and Western coasts and some districts of West Bengal. It is estimated that at least 250 million people throughout the world are infected with Wuchereria Bancro fti and Brugia Malayi. Estimated population at risk in India has increased from 69.2 million in 1960 to 121.8 million in 1969 which is particularly marked in Urban areas. [7] A high incidence of fila­riasis has been quoted by Desai and Williams [3] in Kerala and Gujarat (Surat District). An increased incidence of fila­riasis around Lucknow has been reported by Chandra et al, [1] in 1973.

A lot of variation exists over the dis­tribution of elephantiasis and hydrocele. Reported series in India show elephan­tiasis as common presentation, [6] but re­cently Dondero [4] reported that the genital manifestations are more common present­ation in a suburb of Calcutta. In East Africa hydrocele is a more common pre­sentation than elephantiasis, whereas in China, hydrocele, elephantiasis of leg and scrotum and chyluria are quite common.

The acute inflammatory manifestations are attributed to the helminthic toxins liberated by the worm which then by ab­sorption produces the characteristic clini­cal manifestations-local and constitu­tional. Particularly the dead worms un­dergoing absorption, disintegration or calcification by causing toxicity produce lymphangitis and fever. Lymph oedema is due to narrowing and occlusion of lymph vessels following post-inflammatory and infective changes in addition to disinte­gration and fibrosis of lymph glands, draining the area. [5] In hydrocele the obstruction is located in para-aortic nodes and in elephantiasis of the leg, the site is in inguinal or iliac group of nodes.

Lymph scrotum developing after opera­tion for hydroceie of filarial origin is ex­plained on the basis of obliteration of potential space. Transudation from the dilated lymphaties of the cord and the sac, result in the fluid collections within the tunica in these hydroceles. Due to obliteration of the potential space after the operation and persistance of ob­struction, transudation of lymph takes place into the subcutaneous tissues of the scrotum and the penis.

In cases of early hydroceles, acute epididymo-orchitis or lymph varix, the investigations are of help to confirm the diagnosis of filariasis. However, absence of microfilaria in the peripheral smear and inability to demonstrate the adult worm in the tissue biopsy make it diffi­cult to confirm the diagnosis. Particularly in acute epididymo - orchitis, a therapeutic trial with diethyl carbimazine improves the condition. A need for serological tests, or use of antigen in the diagnosis of fila­riasis by skin test to show laboratory evidence arises when the other simpler investigations are not conclusive.

With the continued pervalence of the g disease and varied manifestations of fila­riasis it is imperative to make a prompt and early diagnosis and subject to adequate treatment.


 :: Acknowledgements Top


We are thankful to Dr. M. L. Sharma, Principal and Medical Superintendent and to Dr. Sushila Nayar, Director Mahatma Gandhi institute of Medical Sciences for their kind permission to publish this paper.

Our thanks are due to Dr. S. N. Girnikar, of the Filarial Research-cum-Training Centre, Wardha for his constructive criticism. Thanks are due to Shri Shan­mukha Rao for his secretarial assistance.

 
 :: References Top

1.Chandra, S., Chandra, R., Katiyar, J. G., Govil, P., George, P A. and Sen, A. B.: Observations on filariasis in some villages around Lucknow, U.p., Ind, J. Med. Res.,61: 1127-1133, 1973.  Back to cited text no. 1    
2.Chatterjee, P.: Filariasis. In, "Tropical Surgery."Butterworths ,London 1965 ,PP.51 & 103.  Back to cited text no. 2    
3.Desai, H. C. and Williams, H. W.: Treat­ment of eliphantiasis by wide excision and grafting. Ind, J. Surg., 21: 369-371, 1959.  Back to cited text no. 3    
4.Dondero, T. Jr., Bhattacharya, N C Black, H. R., Chowdhury, A. B., Gubler, D. J., Inui, T. S. and Muckerjee, Nl. Clinical manifestations of Bancroftian filariasis in suburb of Calcutta, India, Amer. J Trop. Med. & HYg, 25: 64-73, 1976.  Back to cited text no. 4    
5.Drinker, C. K. and Yoffey, J. M: "Lym­phatics, Lymph and Lymphoid Tissue; Their Physiological and Clinical signi­ficance." Harvard University Press, Cam­bridge, Massachusetts, 1941.  Back to cited text no. 5    
6.Ghooi, A. M. and Khanna, T.: Surgical manifestations of filariasis, Ind. J. Surg, 8: 150-153, 1976.  Back to cited text no. 6    
7.W.H.O.: Report of The Expert Committee on Filariasis-Third Report. Technical port series No. 542, 1974.  Back to cited text no. 7    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]
 
 
    Tables

  [Table 1]



 

Top
Print this article  Email this article
Previous article Next article
Online since 12th February '04
© 2004 - Journal of Postgraduate Medicine
Official Publication of the Staff Society of the Seth GS Medical College and KEM Hospital, Mumbai, India
Published by Wolters Kluwer - Medknow