Intrascrotal Nodules in Adult Men as a Marker for Filarial Granuloma in a Bancroftian Filariasis-Endemic Area

Norões, Joaquim; Figuerêdo-Silva, José; Dreyer, Gerusa

doi:10.4269/ajtmh.2009.81.317

Cited by 4 publications

(3 citation statements)

References 39 publications

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“…It is emphasized that the treatment with DEC for individuals when they present microfilaremia may be of fundamental importance for the control of transmission, highlighting the fact that these individuals continue to live in endemic areas, and are at risk of reinfection [ 36 ]. A retrospective study in Brazil emphasized that the best way to monitor the effectiveness of antifilarial drugs is the combined use of ultrasound and physical examination to monitor the development of scrotal nodules [ 37 ].…”

Section: Discussionmentioning

confidence: 99%

Lymphatic Filariasis: A Systematic Review on Morbidity and Its Repercussions in Countries in the Americas

Medeiros

Vieira

Xavier

et al. 2021

IJERPH

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The Global Program to Eliminate Lymphatic Filariasis (GPELF) is a program that aims to eliminate lymphatic filariasis by 2030. The GPELF strategy is based on interrupting transmission using mass drug administration (MDA) and, in parallel, managing morbidity cases. However, it has been seen that there is a shortage of research in the literature and public policies regarding this last pillar. In this study, we reviewed the literature and available information regarding the burden of filarial morbidity. In addition, we identified that in the Americas, the implementation of structured services with regard to morbidity assistance in the Americas was scarce. We formed a review that aimed to assess the pathogenesis, epidemiology, repercussions, and treatment of filarial morbidity in countries in the Americas where lymphatic filariasis is endemic. Structured searches were carried out on PubMed, LILACS, Scopus, and Web of Science databases without time and language restrictions. Three reviewers evaluated the 2150 studies and performed data extraction, and quality assessment by assigning scores to the studies found. The current literature and available information on the burden of filarial morbidity, as well as the implementation of structured services with regard to morbidity assistance in the Americas, were all found to be scarce. Now that this knowledge gap has been identified, both health services and researchers need to seek the implementation and enhancement of the maintenance of GPELF strategies that relate to the morbidity pillar.

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Section: Discussionmentioning

confidence: 99%

Lymphatic Filariasis: A Systematic Review on Morbidity and Its Repercussions in Countries in the Americas

Medeiros

Vieira

Xavier

et al. 2021

IJERPH

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“…Norões et al [7] demonstrated that, by contrast, acute filarial hydrocele is a consequence of acute interruption of lymph flow from the tunica vaginalis of the testis. This obstruction is caused by filarial granuloma (corresponding to formation of palpable nodules detected by physical examination of intrascrotal contents [15]) resulting from death of W. bancrofti adult worms in the lumen of intrascrotal lymphatic vessels. They observed that 22% of patients who experienced nodule formation also developed acute hydroceles, and reabsorption of the granuloma led to resolution of 76% of such acute hydroceles within seven months during an eighteen month follow up period.…”

Section: Discussionmentioning

confidence: 99%

A Mechanism for Chronic Filarial Hydrocele with Implications for Its Surgical Repair

Norões

Dreyer

2010

PLoS Negl Trop Dis

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BackgroundChronic hydrocele is the most common manifestation of bancroftian filariasis, an endemic disease in 80 countries. In a prospective study, we evaluated the occurrence of intrascrotal lymphangiectasia, gross appearance/consistency of the testis, and the efficacy of complete excision of hydrocele sac in patients living in a bancroftian filariasis endemic area who underwent hydrocelectomy at the Center for Teaching, Research and Tertiary Referral for Bancroftian Filariasis (NEPAF).Methodology/Principal FindingsA total of 968 patients with uni- or bilateral filarial hydrocele (Group-1) and a Comparison Group (CG) of 218 patients from the same area who already had undergone hydrocele-sac-sparing hydrocelectomy elsewhere were enrolled at NEPAF. Twenty-eight patients from the Comparison Group with hydrocele recurrence were re-operated on at NEPAF and constitute Group-2. In Group-1 a total of 1,128 hydrocelectomies were performed (mean patient age of 30.3yr and mean follow-up of 8.6yr [range 5.3–12]). The hydrocele recurrence rates in Group-1 and in the Comparison Group (mean age of 31.5 yr) were 0.3%, and 19.3%, respectively (p<0,001). There was no hydrocele recurrence in Group-2 (mean patient age of 25.1yr and mean follow-up of 6yr [range 5–6.9]). Per surgically leaking or leak-prone dilated lymphatic vessels were seen in the inner or outer surface of the hydrocele sac wall or in surrounding tissue, particularly in the retrotesticular area, in 30.9% and in 46.3% of patients in Group-1 and Group-2, respectively (p = 0.081). The testicles were abnormal in shape, volume, and consistency in 203/1,128 (18%) and 10/28 (35.7%) of patients from Group-1 and Group-2, respectively (p = 0,025).Conclusions/SignificanceLymph fluid from ruptured dilated lymphatic vessels is an important component of chronic filarial hydrocele fluid that threatens the integrity of the testis in an adult population living in bancroftian filariasis endemic areas. To avoid hydrocele recurrence the authors advise complete excision of hydrocele sac and when identified, leaking or leak-prone dilated lymphatic vessels should be sutured or excised.

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“…In such scenarios, eosinophil degranulation is expected to occur, but no studies have specifically investigated this. In men, spontaneous or drug-induced adult W. bancrofti parasite death is followed by the development of a palpable nodule, most commonly localized in intrascrotal lymphatic vessels (21,22). The present study was undertaken to determine the immunohistochemical expression of MBP, EPO and ECP in granulomatous lesions in scrotal nodules removed from DEC-treated and non-treated patients.…”

Section: Introductionmentioning

confidence: 98%

Diethylcarbamazine and Non-Diethylcarbamazine Related Bancroftian Granuloma: An Immunohistochemical Study of Eosinophil Toxic Proteins

Dreyer,

Figueredo-Silva,

Cavalcanti

et al. 2010

Int. J Biomed Sci.

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It has been suggested, mostly using in vitro experiments, that defenses against parasites involve mainly activated eosinophils and their toxic proteins, such as major basic protein (MBP), eosinophil cationic protein (ECP) and eosinophil peroxidase (EPO). Eosinophil degranulation has been described around degenerating onchocercal microfilariae in patients treated with diethylcarbamazine (DEC). In bancroftian filariasis, traditional histopathologic studies have shown remarkable numbers of eosinophils in granulomatous lesions associated with both DEC-induced and spontaneous death of adult Wuchereria bancrofti parasites. No immunohistochemical study targeting eosinophil degranulation has been previously performed in these granulomas, which are found mainly within intrascrotal lymphatic vessels. This investigation was undertaken in 22 (12 DEC-treated and 10 untreated) male patients in order to determine the immunohistochemical expressions of MBP, EPO and ECP in bancofitian granulomas, using the indirect method. Stained intact esosinophils, as well as granular, extra-cellular material positive for all three proteins, were found in all granulomas. The immunohistochemical patterns were similar in both DEC-treated and untreated cases, irrespective of microfilaremia, blood eosinophilia, and granuloma age. Positive intact cells were observed mostly at the periphery of the granulomas, whereas granular material predominated in central areas around dead or degenerating parasites. These results indicate that eosinophils accumulate in the granulomas and degranulate preferentially in close proximity to degenerating or dead adult parasites. In bancroftian granulomas, influx and degranulation of eosinophils are considered a consequence of parasite death, rather than its cause.

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Intrascrotal Nodules in Adult Men as a Marker for Filarial Granuloma in a Bancroftian Filariasis-Endemic Area

Cited by 4 publications

References 39 publications

Lymphatic Filariasis: A Systematic Review on Morbidity and Its Repercussions in Countries in the Americas

Lymphatic Filariasis: A Systematic Review on Morbidity and Its Repercussions in Countries in the Americas

A Mechanism for Chronic Filarial Hydrocele with Implications for Its Surgical Repair

Diethylcarbamazine and Non-Diethylcarbamazine Related Bancroftian Granuloma: An Immunohistochemical Study of Eosinophil Toxic Proteins

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