Home Print this page Email this page Small font sizeDefault font sizeIncrease font size
Users Online: 1137

 

Home About us Editorial board Search Ahead of print Current issue Archives Submit article Instructions Subscribe Advertise Contacts Login 
     

  Table of Contents  
CASE REPORT
Year : 2014  |  Volume : 55  |  Issue : 5  |  Page : 438-440  

Incidental detection of microfilariae in a lymph node aspirate: A case report


1 Department of Morbid Anatomy and Histopathology, Lautech Teaching Hospital, Ogbomoso, Oyo State, Nigeria
2 Department of Surgery, Lautech Teaching Hospital, Ogbomoso, Oyo State, Nigeria
3 Department of Medical Microbiology and Parasitology, Lautech Teaching Hospital, Ogbomoso, Oyo State, Nigeria
4 Department of Obstetrics and Gynaecology, Lautech Teaching Hospital, Ogbomoso, Oyo State, Nigeria

Date of Web Publication9-Sep-2014

Correspondence Address:
Adetunji S Oguntola
Department of Surgery, Ladoke Akintola University of Technology, Ogbomoso, Oyo State
Nigeria
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0300-1652.140392

Rights and Permissions
   Abstract 

Lymphatic filariasis is a global health problem endemic in Nigeria. Peripheral blood smears are frequently negative for microfilariae in a significant number of infected patients in whom conventional diagnostic methods may also fail to identify the disease. In such cases, fine needle aspiration cytology may play an important role in disease identification. A 49-year-old South-western male Nigerian farmer, presented with a one-year history of a right groin swelling, which became painful 2 weeks before coming to the hospital. A clinical assessment of lymphogranuloma venereum was made to rule out a non-Hodgkin lymphoma. Initial laboratory investigations only showed mild eosinophilia and haematuria. However, fine needle aspiration cytology performed on the swelling showed microfilariae of Wuchereria bancrofti for which appropriate treatment was instituted with excellent outcome. This case demonstrates that lymphatic filariasis should be considered in the differential diagnosis of lymph node swellings in the groin and that aspiration cytology may play an important role in its diagnosis, especially in an endemic resource poor country.

Keywords: Aspirate, incidental, lymph node, microfilariae


How to cite this article:
Sabageh D, Oguntola AS, Oguntola AM, Bajowa OO. Incidental detection of microfilariae in a lymph node aspirate: A case report. Niger Med J 2014;55:438-40

How to cite this URL:
Sabageh D, Oguntola AS, Oguntola AM, Bajowa OO. Incidental detection of microfilariae in a lymph node aspirate: A case report. Niger Med J [serial online] 2014 [cited 2019 Nov 12];55:438-40. Available from: http://www.nigeriamedj.com/text.asp?2014/55/5/438/140392


   Introduction Top


Lymphatic filariasis is a disabling parasitic disease endemic in over 80 countries including Nigeria with an estimated 120 million infected individuals and 1.2 billion at risk of acquiring the infection. [1],[2] Nigeria is the third most endemic country in the world. [2]

While mortality from lymphatic filariasis is low, the disease may produce acute or chronic clinical manifestations. [3] In fact, lymphatic filariasis has been identified by the World Health Organisation as a leading cause of permanent and long-term disability in the world. [4]

A large majority of infected individuals have asymptomatic microfilaraemia, although peripheral blood smears are frequently negative for microfilariae in a significant number of other patients in whom conventional diagnostic methods may fail to identify the organism. [5]

The demonstration of microfilaria in fine needle aspiration cytology (FNAC) smears and body fluids is not a very common finding. [6],[7] Indeed, only few reports of microfilariae found in smears and aspirates from various body locations have been documented. [8]

Here, we report the incidental finding of microfilaria in a fine needle aspirate from a patient presenting with a groin swelling suspected to be a lymphoma and demonstrate the role of FNAC in the diagnosis of filariasis in a resource-poor setting.


   Case report Top


A 49-year-old male farmer, domiciled in one of the South-western states of Nigeria, presented at the accident and emergency unit of our hospital with a one-year history of a right groin swelling, which suddenly became painful about 2 weeks before presentation.

The swelling had quadrupled in size over the course of the year. The patient also reported a positive history of progressive weight loss, generalised body itching and associated nocturia with a feeling of incomplete bladder emptying. There were no associated skin changes, fever, visual impairment or gastrointestinal symptoms.

Physical examination showed a middle-aged man, who was afebrile, not pale, anicteric and without pedal oedema. His vital signs were essentially normal. There was no significant peripheral lymphadenopathy. There was, however, a firm and tender right groin mass, which measured 16 cm × 10 cm and extended from the right anterior superior iliac spine to the root of the penis. The mass was irreducible, immobile and was firmly attached to the overlying skin which appeared normal.

An assessment of inguinal adenitis, possibly due to lymphogranuloma venereum was made to rule out a non-Hodgkin lymphoma.

The patient was commenced on oral doxycycline, intramuscular gentamicin as well as pain relievers pending the results of the laboratory investigations [Table 1].
Table 1: Results of laboratory investigations

Click here to view


The abdomino-pelvic ultrasound showed multiple heterogeneous matted superficial groups of lymph nodes. An ultrasound-guided FNAC was therefore performed with the smears showing many microfilariae of Wucherera bancrofti in a background of numerous eosinophils, neutrophilis and lymphocyctes [Figure 1] and [Figure 2]. Based on this, a peripheral blood film was prepared from blood sample taken from the patient. This also showed similar microfilariae.
Figure 1: Low power view of microfi laria surrounded by numerous infl ammatory cells (×40)

Click here to view
Figure 2: Medium power view showing microfi laria of Wuchereria bancrofti with clear space free of nuclei at the caudal end. A polymorphic infl ammatory infi ltrate (including eosinophils) is seen in the background (×100)

Click here to view


The patient was treated with oral diethylcarbamazine with an appreciable outcome, with almost complete disappearance of the swelling 2 months after discharge from the hospital.


   Discussion Top


The chronic stage of lymphatic filariasis may present as a hydrocoele, lymphadenopathy, lymphoedema or elephantiasis. Unexplained chronic lymphadenopathy is, however, a well- recognised manifestation in children unlike adults in whom lymphoedema is characteristically encountered. [1] Our patient presented with an uncharacteristic chronic lymphadenopathy. The diagnosis, even in endemic areas, thus depends of a high index of suspicion as a significant number of infected individuals may remain asymptomatic or present to the hospital with vague clinical signs and symptoms that cause a great deal of diagnostic dilemma. [9] Our index patient is a classical example of the diagnostic confusion that may be encountered even in endemic areas such as South-western Nigeria. The low index of suspicion in this patient may actually be due to the fact that the patient presented to the hospital located in a semi-urban area even though he was domiciled in a rural community, where the disease is known to be more prevalent.

The laboratory diagnosis of filariasis is usually made by finding microfilariae in peripheral blood, chylous urine, hydrocoele fluid and the skin or by detecting the filarial antigen and/or antibody. [1] This notwithstanding, microfilariae may not be seen in the peripheral blood of infected individuals even after a diethylcarbamazine provocation test. [1] This may also be a source of diagnostic difficulty even when the patient presents with classical clinical features or there is a high index of suspicion. In the present case, except for the mild eosinophilia and haematuria, all other laboratory investigations were within normal limits. Microfilariae were detected in peripheral blood only after the diagnosis had been made using FNAC.

Although a review of literature reveals that microfilariae have been detected in smears from virtually every body part, these cases remain at best incidental findings. This is because FNAC is rarely requested for the evaluation of patients for filariasis, especially where the peripheral blood films are negative for microfilariae. [1] Nevertheless, FNAC is known to play an important role in the diagnosis of filariasis in patients who present with mass lesions, which may or may not be clinically suspected to be associated with filarial infection. [12] Such diagnosis depends on the identification of microfilariae and/or fragments of adult worms or their ova within the smears. [5],[10] Fine needle aspiration cytology is thought to be a simple, more convenient, effective and cheap diagnostic method, which may prove invaluable in resource-poor countries where more sophisticated serological diagnostic methods are not readily available. This becomes imperative since many infected patients may have transient microfilaraemia or none at all.

Since, there is at present no radical cure or chemoprophylaxis for the chronic stage of filariasis, early diagnosis and treatment are the best options for infected individuals and FNAC may be an effective tool in this regard especially in clinically unusual cases.

 
   References Top

1.Awolola TS, Manafa OU, Idowu ET, Adedoyin JA, Adeneye AK. Epidemiological mapping of lymphatic filariasis in Southern Nigeria. Preliminary survey of Akinyele local government area. Afr J Clin Exp Microbiol 2004;5:231-4.   Back to cited text no. 1
    
2.Okon OE, Iboh CI, Opara KN. Bancroftian filariasis among the mbembe people of cross river state, Nigeria. J Vector Borne Dis 2010;47:91-6.  Back to cited text no. 2
    
3.Akhtar S, Gumashta R, Pande S, Maimoon S, Mahore S. Cytodiagnosis of filarial infection on a non healing ulcer: An unusual presentation and review of literature. Prog Health Sci 2012;2:195-9.   Back to cited text no. 3
    
4.Michael E, Bundy DA, Grenfell BT. Re-assessing the global prevalence and distribution of lymphatic filariasis. Parasitology 1996;112:409-28.  Back to cited text no. 4
    
5.Jha A, Shrestha R, Aryal G, Pant AD, Adhikari RC, Sayami G. Cytological diagnosis of bancroftian filariasis in lesions clinically anticipated as neoplastic. Nepal Med Coll J 2008;10:108-14.  Back to cited text no. 5
    
6.Basu A, Gon S, Bera S, Chakravati S. Breast filariasis: A rare cytomorphological diagnosis. J Pak Med Stud 2013;3:103-5.  Back to cited text no. 6
    
7.Chauhan K, Agarwal S. Incidental detection of microfilaria in lymph node aspirate - A case report. Int J Sci Res 2013;2:424-5.   Back to cited text no. 7
    
8.Menon B, Garg A, Karla H, Sharma R. Microfilarial pleura effusion in a case of tropical pulmonary eosinophilia. Indian J Chest Dis Allied Sci 2008;50:241-3.  Back to cited text no. 8
    
9.Mahesh KU, Potekar RM, Nodule over arm during pregnancy: An unusual presentation of filariasis. J Interdiscipl Histopathol 2013;1:230-3.  Back to cited text no. 9
    
10.Madhuri SK, Preeti J, Dhar R. Incidental detection of microfilaria on fine needle aspiration cytology (FNAC) of a breast lump - A case report. Southeast Asian J Case Rep Rev 2013;2:369-73.  Back to cited text no. 10
    
11.Rupinder K, Kandathil JP, Kanwal M, Rajeev K, Cecil J. Filariasis of the breast mimicking inflammatory carcinoma. Labmedicine 2009;40:683-5.  Back to cited text no. 11
    
12.Kaya B, Namiki T, Tauchi P. Cytological diagnosis of bancroftian filariasis: Clinical implications. Acta Cytol 1995;39:1042.  Back to cited text no. 12
    


    Figures

  [Figure 1], [Figure 2]
 
 
    Tables

  [Table 1]


This article has been cited by
1 First report of equine Setaria digitata (von Linstow 1906) infestation in Malaysia
T.L. Peng,M. Mimi Armiladiana,H.H. Ruhil,M. Maizan,S.S. Choong
Veterinary Parasitology: Regional Studies and Reports. 2019; 17: 100310
[Pubmed] | [DOI]
2 Eosinophilia in Infectious Diseases
Elise M. O’Connell,Thomas B. Nutman
Immunology and Allergy Clinics of North America. 2015; 35(3): 493
[Pubmed] | [DOI]



 

Top
  
 
  Search
 
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  In this article
    Abstract
   Introduction
   Case report
   Discussion
    References
    Article Figures
    Article Tables

 Article Access Statistics
    Viewed1497    
    Printed30    
    Emailed0    
    PDF Downloaded84    
    Comments [Add]    
    Cited by others 2    

Recommend this journal