Filarial abscess: Aspiration of adult gravid female worm from submandibular region, an unusual presentation
Identifieur interne : 002292 ( Pmc/Corpus ); précédent : 002291; suivant : 002293Filarial abscess: Aspiration of adult gravid female worm from submandibular region, an unusual presentation
Auteurs : Ruquiya Afrose ; Mohammad Feroz Alam ; Syed Shamshad Ahmad ; Mohammed NaimSource :
- Journal of Cytology [ 0970-9371 ] ; 2017.
Abstract
Microfilaria is a major public health problem in tropical and subtropical countries and is an endemic problem in India.
Url:
DOI: 10.4103/0970-9371.197626
PubMed: 28182103
PubMed Central: 5259939
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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Filarial abscess: Aspiration of adult gravid female worm from submandibular region, an unusual presentation</title><author><name sortKey="Afrose, Ruquiya" sort="Afrose, Ruquiya" uniqKey="Afrose R" first="Ruquiya" last="Afrose">Ruquiya Afrose</name><affiliation><nlm:aff id="aff1">Department of Pathology, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India</nlm:aff></affiliation></author><author><name sortKey="Alam, Mohammad Feroz" sort="Alam, Mohammad Feroz" uniqKey="Alam M" first="Mohammad Feroz" last="Alam">Mohammad Feroz Alam</name><affiliation><nlm:aff id="aff1">Department of Pathology, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India</nlm:aff></affiliation></author><author><name sortKey="Ahmad, Syed Shamshad" sort="Ahmad, Syed Shamshad" uniqKey="Ahmad S" first="Syed Shamshad" last="Ahmad">Syed Shamshad Ahmad</name><affiliation><nlm:aff id="aff1">Department of Pathology, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India</nlm:aff></affiliation></author><author><name sortKey="Naim, Mohammed" sort="Naim, Mohammed" uniqKey="Naim M" first="Mohammed" last="Naim">Mohammed Naim</name><affiliation><nlm:aff id="aff1">Department of Pathology, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India</nlm:aff></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">28182103</idno><idno type="pmc">5259939</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5259939</idno><idno type="RBID">PMC:5259939</idno><idno type="doi">10.4103/0970-9371.197626</idno><date when="2017">2017</date><idno type="wicri:Area/Pmc/Corpus">002292</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">002292</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Filarial abscess: Aspiration of adult gravid female worm from submandibular region, an unusual presentation</title><author><name sortKey="Afrose, Ruquiya" sort="Afrose, Ruquiya" uniqKey="Afrose R" first="Ruquiya" last="Afrose">Ruquiya Afrose</name><affiliation><nlm:aff id="aff1">Department of Pathology, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India</nlm:aff></affiliation></author><author><name sortKey="Alam, Mohammad Feroz" sort="Alam, Mohammad Feroz" uniqKey="Alam M" first="Mohammad Feroz" last="Alam">Mohammad Feroz Alam</name><affiliation><nlm:aff id="aff1">Department of Pathology, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India</nlm:aff></affiliation></author><author><name sortKey="Ahmad, Syed Shamshad" sort="Ahmad, Syed Shamshad" uniqKey="Ahmad S" first="Syed Shamshad" last="Ahmad">Syed Shamshad Ahmad</name><affiliation><nlm:aff id="aff1">Department of Pathology, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India</nlm:aff></affiliation></author><author><name sortKey="Naim, Mohammed" sort="Naim, Mohammed" uniqKey="Naim M" first="Mohammed" last="Naim">Mohammed Naim</name><affiliation><nlm:aff id="aff1">Department of Pathology, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India</nlm:aff></affiliation></author></analytic><series><title level="j">Journal of Cytology</title><idno type="ISSN">0970-9371</idno><idno type="eISSN">0974-5165</idno><imprint><date when="2017">2017</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p>Microfilaria is a major public health problem in tropical and subtropical countries and is an endemic problem in India. <italic>Wuchereria bancrofti</italic> 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 <italic>Bancroftian microfilariasis</italic> 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.</p></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Park, K" uniqKey="Park K">K Park</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Chatterjee, Kd" uniqKey="Chatterjee K">KD Chatterjee</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Mitra, Sk" uniqKey="Mitra S">SK Mitra</name></author><author><name sortKey="Mishra, Rk" uniqKey="Mishra R">RK Mishra</name></author><author><name sortKey="Verma, P" uniqKey="Verma P">P Verma</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Varghese, R" uniqKey="Varghese R">R Varghese</name></author><author><name sortKey="Raghuveer, Cv" uniqKey="Raghuveer C">CV Raghuveer</name></author><author><name sortKey="Pai, Mr" uniqKey="Pai M">MR Pai</name></author><author><name sortKey="Bansal, R" uniqKey="Bansal R">R Bansal</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Walter, A" uniqKey="Walter A">A Walter</name></author><author><name sortKey="Krishnaswami, H" uniqKey="Krishnaswami H">H Krishnaswami</name></author><author><name sortKey="Cariappa, A" uniqKey="Cariappa A">A Cariappa</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Valand, Ag" uniqKey="Valand A">AG Valand</name></author><author><name sortKey="Pandya, Bs" uniqKey="Pandya B">BS Pandya</name></author><author><name sortKey="Patil, Yv" uniqKey="Patil Y">YV Patil</name></author><author><name sortKey="Patil, Lg" uniqKey="Patil L">LG Patil</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Kaur, R" uniqKey="Kaur R">R Kaur</name></author><author><name sortKey="Philip, Kj" uniqKey="Philip K">KJ Philip</name></author><author><name sortKey="Laxman, Kr" uniqKey="Laxman K">KR Laxman</name></author><author><name sortKey="Masih, K" uniqKey="Masih K">K Masih</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Kapila, K" uniqKey="Kapila K">K Kapila</name></author><author><name sortKey="Verma, K" uniqKey="Verma K">K Verma</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Nor Es, J" uniqKey="Nor Es J">J Norões</name></author><author><name sortKey="Addiss, D" uniqKey="Addiss D">D Addiss</name></author><author><name sortKey="Amaral, F" uniqKey="Amaral F">F Amaral</name></author><author><name sortKey="Coutinho, A" uniqKey="Coutinho A">A Coutinho</name></author><author><name sortKey="Medeiros, Z" uniqKey="Medeiros Z">Z Medeiros</name></author><author><name sortKey="Dreyer, G" uniqKey="Dreyer G">G Dreyer</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Pandit, Aa" uniqKey="Pandit A">AA Pandit</name></author><author><name sortKey="Shah, Rk" uniqKey="Shah R">RK Shah</name></author><author><name sortKey="Shenoy, Sg" uniqKey="Shenoy S">SG Shenoy</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Arora, Vk" uniqKey="Arora V">VK Arora</name></author><author><name sortKey="Sen, B" uniqKey="Sen B">B Sen</name></author><author><name sortKey="Dev, G" uniqKey="Dev G">G Dev</name></author><author><name sortKey="Bhatia, A" uniqKey="Bhatia A">A Bhatia</name></author></analytic></biblStruct></listBibl></div1></back></TEI><pmc article-type="case-report"><pmc-dir>properties open_access</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-ta">J Cytol</journal-id><journal-id journal-id-type="iso-abbrev">J Cytol</journal-id><journal-id journal-id-type="publisher-id">JCytol</journal-id><journal-title-group><journal-title>Journal of Cytology</journal-title></journal-title-group><issn pub-type="ppub">0970-9371</issn><issn pub-type="epub">0974-5165</issn><publisher><publisher-name>Medknow Publications & Media Pvt Ltd</publisher-name><publisher-loc>India</publisher-loc></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">28182103</article-id><article-id pub-id-type="pmc">5259939</article-id><article-id pub-id-type="publisher-id">JCytol-34-66</article-id><article-id pub-id-type="doi">10.4103/0970-9371.197626</article-id><article-categories><subj-group subj-group-type="heading"><subject>Case Report</subject></subj-group></article-categories><title-group><article-title>Filarial abscess: Aspiration of adult gravid female worm from submandibular region, an unusual presentation</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Afrose</surname><given-names>Ruquiya</given-names></name><xref ref-type="aff" rid="aff1"></xref><xref ref-type="corresp" rid="cor1"></xref></contrib><contrib contrib-type="author"><name><surname>Alam</surname><given-names>Mohammad Feroz</given-names></name><xref ref-type="aff" rid="aff1"></xref></contrib><contrib contrib-type="author"><name><surname>Ahmad</surname><given-names>Syed Shamshad</given-names></name><xref ref-type="aff" rid="aff1"></xref></contrib><contrib contrib-type="author"><name><surname>Naim</surname><given-names>Mohammed</given-names></name><xref ref-type="aff" rid="aff1"></xref></contrib></contrib-group><aff id="aff1">Department of Pathology, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India</aff><author-notes><corresp id="cor1"><bold>Address for correspondence:</bold> Dr. Ruquiya Afrose, Department of Pathology, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh - 202 002, Uttar Pradesh, India. E-mail: <email xlink:href="ruqs.afrose@gmail.com">ruqs.afrose@gmail.com</email></corresp></author-notes><pub-date pub-type="ppub"><season>Jan-Mar</season><year>2017</year></pub-date><volume>34</volume><issue>1</issue><fpage>66</fpage><lpage>68</lpage><permissions><copyright-statement>Copyright: © 2017 Journal of Cytology</copyright-statement><copyright-year>2017</copyright-year><license license-type="open-access" xlink:href="http://creativecommons.org/licenses/by-nc-sa/3.0"><license-p>This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.</license-p></license></permissions><abstract><p>Microfilaria is a major public health problem in tropical and subtropical countries and is an endemic problem in India. <italic>Wuchereria bancrofti</italic> 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 <italic>Bancroftian microfilariasis</italic> 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.</p></abstract><kwd-group><kwd>Adult female worm</kwd><kwd>filarial abscess</kwd><kwd>submadibular region</kwd></kwd-group></article-meta></front><body><sec sec-type="intro" id="sec1-1"><title>Introduction</title><p>Lymphatic filariasis is caused by the worms <italic>Wuchereria bancrofti</italic>, <italic>Brugia malayi</italic>, and <italic>Brugia timori</italic>. <italic>B. malayi</italic> is mostly confined to Southeast Asia. <italic>B. timori</italic> is restricted to Indonesian islands. In India, almost 99% of the cases are infected with <italic>W. bancrofti</italic> that is transmitted by the <italic>Culex</italic> mosquitoes.[<xref rid="ref1" ref-type="bibr">1</xref>] It has predilection for lower limbs, spermatic cord, and epididymis.[<xref rid="ref2" ref-type="bibr">2</xref>] Breast, thyroid, body fluids,[<xref rid="ref3" ref-type="bibr">3</xref><xref rid="ref4" ref-type="bibr">4</xref><xref rid="ref5" ref-type="bibr">5</xref>] and skin[<xref rid="ref6" ref-type="bibr">6</xref>] are unusual sites for filariasis. Despite the fact that large number of people are at risk and wide variety of tissues are affected, it is not common to find microfilariae or adult worm in fine-needle aspiration cytology (FNAC) smears.[<xref rid="ref4" ref-type="bibr">4</xref>]</p><p>Submadibular or head and neck region involvement is an even rarer presentation.[<xref rid="ref7" ref-type="bibr">7</xref>] Hereby, we report a case of filarial abscess in right submandibular region that is clinically presented as inflammatory pyogenic abscess.</p></sec><sec id="sec1-2"><title>Case Report</title><p>A 68-year-old lady presented to surgery outpatient department with swelling and pain in the right submandibular region for the last 2 months. Local examination showed a soft and fluctuant swelling of 4 × 3 cm over right submandibular region. It was warm and tender on palpation. Clinical examination of the orofacial region did not revealed any odontogenic or nonodontogenic foci of infection.</p><p>All the hematological parameters were normal except for mild peripheral eosinophilia (12%) and a low hemoglobin level. A clinical diagnosis of submandibular pyogenic abscess was made and to exclude tuberculosis, FNAC was advised.</p><p>FNAC from the swelling yielded purulent material along with a creamy white thread. Smears showed adult gravid female filarial worm having an intact outer cuticle layer and body cavity filled with different stages of developing ova and microfilariae [<xref ref-type="fig" rid="F1">Figure 1</xref>]. In addition, numerous embryos and coiled larvae and fully straightened larvae of <italic>W. bancrofti</italic> that were sheathed and had no nuclei in the tail end were also visualized. The background was composed of inflammatory cells including neutrophils, lymphocytes, macrophages, and eosinophils. Hence, a final diagnosis of filarial abscess was made.</p><fig id="F1" position="float"><label>Figure 1</label><caption><p>An adult gravid female with sheathed microfilaria of <italic>Wuchereria bancrofti.</italic></p><p>Note the tail tip is free from nuclei. (Giemsa stain, ×400)</p></caption><graphic xlink:href="JCytol-34-66-g001"></graphic></fig></sec><sec sec-type="discussion" id="sec1-3"><title>Discussion</title><p>In India, <italic>W. bancrofti</italic> is distributed chiefly along the seacoast and along the banks of big rivers (except Indus). But it has also been reported from Rajasthan, Punjab, Uttar Pradesh, and Delhi.[<xref rid="ref1" ref-type="bibr">1</xref>] The life cycle of the filarial worms (bancroftian and brugian filariasis) can be divided in to the mosquito phase and human phase. Man is the definitive host and mosquito is the intermediate host. Adult worm resides in lymph node where gravid female worm release a large number of microfilariae. These larva pass through thoracic duct and pulmonary capillaries and ultimately come into the blood stream. Microfilariae are capable of living in the peripheral blood for a considerable time without undergoing any developmental metamorphosis. Subsequently, they are taken up by the female mosquitoes during their blood meal. Further development of microfilariae takes place in its intermediate host (mosquito) after which they become infective to man.</p><p>The microfilaria of both <italic>W. bancrofti</italic> and <italic>B. malayi</italic> display nocturnal periodicity as a part of the biological adaptation and thus correlating with the nocturnal biting habits of the mosquito. Adult female worms of the two abovementioned species cannot be distinguished though, adult male worms show minor differences. Species diagnosis thereby is made on the basis of morphology of the microfilaria. The microfilaria of <italic>W. bancrofti</italic> is larger in size and possesses smooth body curve, its body nuclei are more well defined, discrete, round, and uniform in size compared to that of <italic>B. malayi</italic>, which is smaller in size, possesses secondary kinks and blurred and intermingled nuclei. Tail tapers to a delicate point with absent terminal nucleus in <italic>W. bancrofti</italic> whereas later it is more bulbous and have two distinct terminal nuclei.[<xref rid="ref2" ref-type="bibr">2</xref>] However, differentiation between these two nematodes is not clinically important as the mode of treatment remains same.</p><p>Filarial worm produces disease due to migration of adult parasite through the lymphatic system.[<xref rid="ref8" ref-type="bibr">8</xref>] The adult <italic>W. bancrofti</italic> may involve the lymphatics of the lower limbs, spermatic cord, epididymis, testis, retroperitoneum, and female breast.[<xref rid="ref8" ref-type="bibr">8</xref>] Its classical presentation are elephantiasis, chronic lymphedema, epididymitis, funiculitis, and lymphadenitis.[<xref rid="ref8" ref-type="bibr">8</xref>] The diagnosis of filariasis is made either by demonstrating microfilariae, adult worm, or filarial antigen in blood or on ultrasound using B-mode and M-mode scan with or without color Doppler or pulsed wave Doppler by demonstrating filarial dance sign in dilated lymphatics.[<xref rid="ref9" ref-type="bibr">9</xref>] In our case, radiological investigations were not performed as the patient was presenting as an inflammatory abscess in submandibular region and clinically filariasis was not suspected. Hence, FNAC was done where we found numerous microfilariae along with adult gravid worm. There are many case reports where the diagnosis of filariasis was made by demonstrating microfilariae in cytological smears, it is unusual to find adult filarial worms on aspiration smears. In the present case, the patient had a solitary swelling from which purulent exudates and fragment of adult worm was aspirated. There are a few reports in which adult filarial worms is aspirated from soft-tissue swellings,[<xref rid="ref8" ref-type="bibr">8</xref><xref rid="ref10" ref-type="bibr">10</xref>] lymph node,[<xref rid="ref3" ref-type="bibr">3</xref><xref rid="ref11" ref-type="bibr">11</xref>] and epididymal nodules. In all these cases, the swelling was painless and the patient was asymptomatic. This case was unusual and similar to the case reported by Kaur <italic>et al</italic>.[<xref rid="ref7" ref-type="bibr">7</xref>] where the patient presented with an inflammatory abscess in the submandibular region, which is clinically suspected to be of pyogenic in origin and later on proved as a filarial abscess on FNAC.</p></sec><sec sec-type="conclusion" id="sec1-4"><title>Conclusion</title><p>The main purpose of this case report is to raise the awareness that in tropical countries such as India where filariasis is endemic, it should always be considered as a differential diagnosis of swelling at any site. Our presentation revealed that adult female worm and microfilaria may even be present at rare sites such as submandibular region. Careful examination of cytological smears is very important in prompt recognition of the disease and institution of specific treatment especially in unsuspected and asymptomatic cases.</p><sec id="sec2-1"><title>Financial support and sponsorship</title><p>Nil.</p></sec><sec id="sec2-2" sec-type="COI-statement"><title>Conflicts of interest</title><p>There are no conflicts of interest.</p></sec></sec></body><back><ref-list><ref id="ref1"><label>1</label><element-citation publication-type="book"><person-group person-group-type="author"><name><surname>Park</surname><given-names>K</given-names></name></person-group><person-group person-group-type="editor"><name><surname>Park</surname><given-names>K</given-names></name></person-group><source>Epidemiology of communicable disease. 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