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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Filarial abscess in the submandibular region</title><author><name sortKey="Kaur, Rupinder" sort="Kaur, Rupinder" uniqKey="Kaur R" first="Rupinder" last="Kaur">Rupinder Kaur</name><affiliation><nlm:aff id="aff1"></nlm:aff></affiliation></author><author><name sortKey="Philip, Kandathil Joseph" sort="Philip, Kandathil Joseph" uniqKey="Philip K" first="Kandathil Joseph" last="Philip">Kandathil Joseph Philip</name><affiliation><nlm:aff id="aff1"></nlm:aff></affiliation></author><author><name sortKey="Laxman, Kumar R" sort="Laxman, Kumar R" uniqKey="Laxman K" first="Kumar R" last="Laxman">Kumar R. Laxman</name><affiliation><nlm:aff id="aff2"><italic>Department of Oral and Maxillofacial Surgery, Christian Medical College and Hospital, Ludhiana, Punjab, India</italic></nlm:aff></affiliation></author><author><name sortKey="Masih, Kanwal" sort="Masih, Kanwal" uniqKey="Masih K" first="Kanwal" last="Masih">Kanwal Masih</name><affiliation><nlm:aff id="aff1"></nlm:aff></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">24250107</idno><idno type="pmc">3830255</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3830255</idno><idno type="RBID">PMC:3830255</idno><idno type="doi">10.4103/0973-029X.119769</idno><date when="2013">2013</date><idno type="wicri:Area/Pmc/Corpus">002312</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">002312</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Filarial abscess in the submandibular region</title><author><name sortKey="Kaur, Rupinder" sort="Kaur, Rupinder" uniqKey="Kaur R" first="Rupinder" last="Kaur">Rupinder Kaur</name><affiliation><nlm:aff id="aff1"></nlm:aff></affiliation></author><author><name sortKey="Philip, Kandathil Joseph" sort="Philip, Kandathil Joseph" uniqKey="Philip K" first="Kandathil Joseph" last="Philip">Kandathil Joseph Philip</name><affiliation><nlm:aff id="aff1"></nlm:aff></affiliation></author><author><name sortKey="Laxman, Kumar R" sort="Laxman, Kumar R" uniqKey="Laxman K" first="Kumar R" last="Laxman">Kumar R. Laxman</name><affiliation><nlm:aff id="aff2"><italic>Department of Oral and Maxillofacial Surgery, Christian Medical College and Hospital, Ludhiana, Punjab, India</italic></nlm:aff></affiliation></author><author><name sortKey="Masih, Kanwal" sort="Masih, Kanwal" uniqKey="Masih K" first="Kanwal" last="Masih">Kanwal Masih</name><affiliation><nlm:aff id="aff1"></nlm:aff></affiliation></author></analytic><series><title level="j">Journal of Oral and Maxillofacial Pathology : JOMFP</title><idno type="ISSN">0973-029X</idno><idno type="eISSN">1998-393X</idno><imprint><date when="2013">2013</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p>Filariasis is a parasitic infectious disease caused by filarial nematode worms. These worms mainly dwell in subcutaneous tissues and lymphatics of the human host, with a predilection for lower limbs, retroperitoneal tissues, spermatic cord, and epididymis. Oral or perioral involvement of the filarial nematode is rare. This case report describes a filarial abscess in the right submandibular region. Fine needle aspiration cytology of the abscess revealed the presence of microfilaria of <italic>Wuchereria bancrofti</italic> species. The parasite was also present in the peripheral blood smear. Filarial infection presenting in this region is unusual and can cause diagnostic dilemma. The clinician can consider filariasis as one of the differential diagnosis while treating those abscesses in the orofacial region that are unresponsive to routine management, especially, patients hailing from endemic areas.</p></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Faust, Ec" uniqKey="Faust E">EC Faust</name></author><author><name sortKey="Russell, Pf" uniqKey="Russell P">PF Russell</name></author><author><name sortKey="Jung, Rc" uniqKey="Jung R">RC Jung</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Sodhani, P" uniqKey="Sodhani P">P Sodhani</name></author><author><name sortKey="Murty, Da" uniqKey="Murty D">DA Murty</name></author><author><name sortKey="Pant, Cs" uniqKey="Pant C">CS Pant</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Chowdhary, M" uniqKey="Chowdhary M">M Chowdhary</name></author><author><name sortKey="Langer, S" uniqKey="Langer S">S Langer</name></author><author><name sortKey="Aggarwal, M" uniqKey="Aggarwal M">M Aggarwal</name></author><author><name sortKey="Agarwal, C" uniqKey="Agarwal C">C Agarwal</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="Prabhu, Sr" uniqKey="Prabhu S">SR Prabhu</name></author><author><name sortKey="Bhatt, Ap" uniqKey="Bhatt A">AP Bhatt</name></author><author><name sortKey="Viswanathan, R" uniqKey="Viswanathan R">R Viswanathan</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Baliga, M" uniqKey="Baliga M">M Baliga</name></author><author><name sortKey="Ramanathan, A" uniqKey="Ramanathan A">A Ramanathan</name></author><author><name sortKey="Uppal, N" uniqKey="Uppal N">N Uppal</name></author></analytic></biblStruct><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></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 Oral Maxillofac Pathol</journal-id><journal-id journal-id-type="iso-abbrev">J Oral Maxillofac Pathol</journal-id><journal-id journal-id-type="publisher-id">JOMFP</journal-id><journal-title-group><journal-title>Journal of Oral and Maxillofacial Pathology : JOMFP</journal-title></journal-title-group><issn pub-type="ppub">0973-029X</issn><issn pub-type="epub">1998-393X</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">24250107</article-id><article-id pub-id-type="pmc">3830255</article-id><article-id pub-id-type="publisher-id">JOMFP-17-320a</article-id><article-id pub-id-type="doi">10.4103/0973-029X.119769</article-id><article-categories><subj-group subj-group-type="heading"><subject>Case Report</subject></subj-group></article-categories><title-group><article-title>Filarial abscess in the submandibular region</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Kaur</surname><given-names>Rupinder</given-names></name><xref ref-type="aff" rid="aff1"></xref></contrib><contrib contrib-type="author"><name><surname>Philip</surname><given-names>Kandathil Joseph</given-names></name><xref ref-type="aff" rid="aff1"></xref><xref ref-type="corresp" rid="cor1"></xref></contrib><contrib contrib-type="author"><name><surname>Laxman</surname><given-names>Kumar R</given-names></name><xref ref-type="aff" rid="aff2">1</xref></contrib><contrib contrib-type="author"><name><surname>Masih</surname><given-names>Kanwal</given-names></name><xref ref-type="aff" rid="aff1"></xref></contrib></contrib-group><aff id="aff1"><italic>Department of Pathology, Christian Medical College and Hospital, Ludhiana, Punjab, India</italic></aff><aff id="aff2"><label>1</label><italic>Department of Oral and Maxillofacial Surgery, Christian Medical College and Hospital, Ludhiana, Punjab, India</italic></aff><author-notes><corresp id="cor1"><bold>Address for correspondence:</bold><italic>Dr. Kandathil Joseph Philip, Department of Pathology, Christian Medical College and Hospital, Punjab, Ludhiana - 141 008, Punjab, India. E-mail: <email xlink:href="drphiljose@yahoo.co.in">drphiljose@yahoo.co.in</email></italic></corresp></author-notes><pub-date pub-type="ppub"><season>May-Aug</season><year>2013</year></pub-date><volume>17</volume><issue>2</issue><fpage seq="a">320</fpage><lpage>320</lpage><permissions><copyright-statement>Copyright: © Journal of Oral and Maxillofacial Pathology</copyright-statement><copyright-year>2013</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-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.</license-p></license></permissions><abstract><p>Filariasis is a parasitic infectious disease caused by filarial nematode worms. These worms mainly dwell in subcutaneous tissues and lymphatics of the human host, with a predilection for lower limbs, retroperitoneal tissues, spermatic cord, and epididymis. Oral or perioral involvement of the filarial nematode is rare. This case report describes a filarial abscess in the right submandibular region. Fine needle aspiration cytology of the abscess revealed the presence of microfilaria of <italic>Wuchereria bancrofti</italic> species. The parasite was also present in the peripheral blood smear. Filarial infection presenting in this region is unusual and can cause diagnostic dilemma. The clinician can consider filariasis as one of the differential diagnosis while treating those abscesses in the orofacial region that are unresponsive to routine management, especially, patients hailing from endemic areas.</p></abstract><kwd-group><kwd>Filarial abscess</kwd><kwd>fine needle aspiration cytology</kwd><kwd>microfilaria</kwd><kwd>perioral filariasis</kwd><kwd><italic>Wuchereria bancrofti</italic></kwd></kwd-group></article-meta></front><body><sec id="sec1-1"><title>INTRODUCTION</title><p>Filariasis is a major public-health problem in the Asian and African subcontinent. Lymphatic filariasis is caused by the worms <italic>Wuchereria bancrofti</italic>, (<italic>W. bancrofti</italic>) <italic>Brugia malayi</italic> (<italic>B. malayi</italic>), and <italic>Brugia timori</italic> (<italic>B. timori</italic>). Among these <italic>W. bancrofti</italic> is the most prevalent parasite in India with a predilection for lower limbs, spermatic cord, and epididymis.[<xref ref-type="bibr" rid="ref1">1</xref>] Breast,[<xref ref-type="bibr" rid="ref2">2</xref>] thyroid,[<xref ref-type="bibr" rid="ref3">3</xref>] body fluids,[<xref ref-type="bibr" rid="ref4">4</xref><xref ref-type="bibr" rid="ref5">5</xref>] and skin[<xref ref-type="bibr" rid="ref6">6</xref>] are unusual sites for filariasis. Oral or perioral involvement is rare.[<xref ref-type="bibr" rid="ref7">7</xref>] We present a patient with filarial abscess in the submandibular region.</p></sec><sec id="sec1-2"><title>CASE REPORT</title><p>A 25-year-old lady presented to dental out-patient services with swelling and pain in the right side of the face. Local examination showed a fluctuant swelling measuring 5 mm × 3 cm over the right side of the angle of mandible [<xref ref-type="fig" rid="F1">Figure 1</xref>]. The swelling was warm and tender on palpation with signs of impending rupture. Clinical examination of the orofacial region did not reveal any odontogenic or non-odontogenic foci of infection. Patient's vitals were in the normal limits. All the hematological parameters were normal except for borderline leukocytosis and a low hemoglobin level. Incision and drainage (I and D) of the abscess was carried out under local anesthesia. As the patient was in her 12<sup>th</sup> week of gestation, antibiotics were prescribed in consultation with the gynecologist.</p><fig id="F1" position="float"><label>Figure 1</label><caption><p>An indurated area (black arrow) approximately measuring 5 cm × 3 cm over the right angle region of mandible. The unresolved swelling seen after 2 weeks following incision and drainage (inset)</p></caption><graphic xlink:href="JOMFP-17-320a-g001"></graphic></fig><p>On a follow-up visit after 2 weeks, a painless indurated swelling at the same site was noted [<xref ref-type="fig" rid="F1">Figure 1</xref>, inset]. Pus culture carried out during the incision and drainage had not revealed any bacterial growth. As the condition was not resolving, a fine needle aspiration cytology (FNAC) was advised in consultation with the pathologist, to rule out tubercular infection.</p><p>Aspirate from the swelling yielded purulent material. The smears were moderately cellular and showed abundant necrotic debris within which were seen polymorphs and histiocytes. One of the smears revealed the presence of a single microfilaria of <italic>W. bancrofti</italic>, which was rounded anteriorly and tapered posteriorly [<xref ref-type="fig" rid="F2">Figure 2</xref>]. The caudal end of the microfilariae had a clear space free of nuclei. After the aspiration, the patient was admitted and a midnight blood sample was taken. The wet mount preparation showed motile microfilariae, which confirmed the diagnosis of filariasis.</p><fig id="F2" position="float"><label>Figure 2</label><caption><p>Photomicrograph showing a microfilaria of <italic>Wuchereria bancrofti</italic> with rounded anterior and tapering posterior ends (MGG stain, ×400)</p></caption><graphic xlink:href="JOMFP-17-320a-g002"></graphic></fig><p>Since, the patient was in the first trimester of pregnancy, decision was taken to start the anti-filarial drugs after delivery.</p></sec><sec sec-type="discussion" id="sec1-3"><title>DISCUSSION</title><p>Filariasis is common in tropical and subtropical areas of Africa, Asia, South and Central America. It is endemic in many parts of India. There are nine known filarial nematodes which use man as definitive host. Out of these, three worms live in lymphatics of the human host namely <italic>W. bancrofti</italic>, <italic>B. malayi</italic>, <italic>and B. timori</italic>. <italic>B. malayi</italic> is mostly confined to South-East Asia. <italic>B. timori</italic> is restricted to Indonesian islands. In India 99% of the cases are infected with <italic>W. bancrofti</italic>.[<xref ref-type="bibr" rid="ref8">8</xref>]</p><p>The life-cycle of the filarial worms (bancroftian and brugian filariasis) can be divided in to the mosquito phase and the human phase. Man is the definitive host and mosquito the intermediate host. The microfilaria of <italic>W. bancrofti</italic> and <italic>B. Malayi</italic>, both prevalent in India, display nocturnal periodicity as a part of the biological adaptation correlating with the nocturnal biting habits of the mosquito. Adult female worms of the above two mentioned species cannot be distinguished though, adult male worms show minor differences. Species diagnosis thereby is made on the basis of morphology of the microfilaria. Microfilariae of <italic>B. malayi</italic> are smaller than those of <italic>W. bancrofti</italic>, possess secondary kinks instead of smooth curve and unlike the latter, the tip is not free of the nuclei.[<xref ref-type="bibr" rid="ref9">9</xref>]</p><p>The common manifestations of lymphatic filariasis include, asymptomatic microfilaremia, early filariasis (filarial fever, lymphadenitis, lymphangitis, funiculitis, epididymitis, filarial orchitis, and filarial abscess), chronic obstructive filariasis (lymph node enlargement, thickened lymphatic channels, hydrocele, chyluria, chylocele, chylous ascitis, chylous diarrhea, elephantiasis, and lymphedema) and occult filariasis (tropical pulmonary eosinophilia, filarial arthritis, diffuse mesangial proliferative glomerulonephritis, pericardial, and endomyocardial fibrosis).[<xref ref-type="bibr" rid="ref10">10</xref>]</p><p>Perioral manifestations of lymphatic filariasis are extremely rare. Edematous swelling of lips and interdental papilla has been reported in a young patient with microfilaremia.[<xref ref-type="bibr" rid="ref7">7</xref>]</p><p>This case was unusual regarding clinical presentation, as the patient presented with an unresolved abscess in the orofacial region, clinically suspected to be of bacterial etiology, proven to be filarial abscess on FNAC. In addition, presence of microfilaria in the peripheral blood without associated eosinophilia is also a rare finding. Rare entities such as filarial abscess can be considered in the event of unresponsiveness to routine abscess management.</p></sec></body><back><fn-group><fn fn-type="supported-by"><p><bold>Source of Support:</bold> Nil.</p></fn><fn fn-type="conflict"><p><bold>Conflict of Interest:</bold> None declared.</p></fn></fn-group><ref-list><title>REFERENCES</title><ref id="ref1"><label>1</label><element-citation publication-type="book"><person-group person-group-type="author"><name><surname>Faust</surname><given-names>EC</given-names></name><name><surname>Russell</surname><given-names>PF</given-names></name><name><surname>Jung</surname><given-names>RC</given-names></name></person-group><article-title>Plasmid nematode, parasites of man. 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