Journal of Cytology
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ORIGINAL ARTICLE Table of Contents   
Year : 2009  |  Volume : 26  |  Issue : 1  |  Page : 11-14
Cytological diagnosis of microfilariae in filariasis endemic areas of eastern Uttar Pradesh


Department of Pathology, BRD Medical College, Gorakhpur, India

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Date of Web Publication4-Aug-2009
 

   Abstract 

Background: Filariasis is a major health problem in tropical countries including India. Fine needle aspiration cytology plays an important role in prompt recognition of disease.
Aim: To assess the role of fine needle aspiration cytology (FNAC) in diagnosis of filariasis at all possible sites.
Materials and Methods : Total 250 cases of superficial swellings at various sites were subjected to fine needle aspiration cytology.
Results: Out of 250 cases, 24 cases of filariasis were detected which include breast lumps (8 cases), lymph nodes (6 cases), scrotal swellings (4 cases), thyroid swellings (3 cases), soft tissue swellings (2 cases) and ascitic fluid (1 case). Eosinophilia was present in 8 out of 24 cases with a percentage ranging from 12-24%. Significant adherence of inflammatory cells and macrophages to microfilariae was present in 3 out of 24 cases.
Conclusions: In endemic areas, it should be considered one of the differential diagnoses of a superficial swelling. Careful screening of FNAC smears help in detecting microfilaria even in asymptomatic patients and thus plays a significant role in recognition of the disease and institution of specific treatment.

Keywords: Fine needle aspiration cytology; microfilariae; superficial swellings.

How to cite this article:
Mitra SK, Mishra RK, Verma P. Cytological diagnosis of microfilariae in filariasis endemic areas of eastern Uttar Pradesh. J Cytol 2009;26:11-4

How to cite this URL:
Mitra SK, Mishra RK, Verma P. Cytological diagnosis of microfilariae in filariasis endemic areas of eastern Uttar Pradesh. J Cytol [serial online] 2009 [cited 2019 Nov 15];26:11-4. Available from: http://www.jcytol.org/text.asp?2009/26/1/11/51333



   Introduction Top


Filariasis is a global problem. It is a major social and economic scourge in tropics and subtropics of Africa, Asia, Western Pacific and parts of America affecting over 120 million people in 80 countries.

The problem is increasing every year due to gross mismanagement of the environment. The disease is endemic all over India especially in Uttar Pradesh, Bihar, Jharkhand, Andhra Pradesh, Orissa, Tamil Nadu, Kerala and Gujarat.

There are at least six million attacks of acute filarial disease per year and 45 million persons are currently having one or more chronic filarial lesions. [1]

A majority of infected individuals in filarial endemic communities are asymptomatic. Conventional mode of diagnosis of filariasis is by demonstration of microfilaria in peripheral blood smear. Despite high incidence, it is infrequent to find microfilariae in fine needle aspiration cytology (FNAC) smears and body fluids. The literature contains a few reports of microfilariae found in various locations including thyroid nodule, [2],[3] skin and soft tissue swelling, [2],[4] epididymis, [5] breast, [2],[6],[7],[8] salivary gland, [9] cervicovaginal smear, [10] ovarian cyst, [10] urine, [10],[11] lymph node, [2],[3],[12] and effusion fluids. [3],[13]

The aim of present study was to assess the role of FNAC in diagnosis of filariasis in asymptomatic patients having superficial lumps.


   Materials and Methods Top


The study was conducted at the Department of Pathology in collaboration with the Departments of Medicine and Surgery at B.R.D. Medical College, Gorakhpur during a period of two years i.e. 2006-2007.

A total of 250 cases, with age ranging from 15-80 years, having swellings at various sites were included in the present study. All these patients were thoroughly examined and routinely investigated. Aspiration was made by technique of Martin and Ellis. [14] In case of cystic lesions, cyst content was aspirated and smears prepared from cyst fluid after cytocentrifugation were studied along with the aspiration performed from cyst wall. These smears were wet fixed immediately in 95% alcohol and stained by hematoxylin and eosin and Papanicolaou stain. Air dried smears were stained by May-Grünwald Giemsa stain.


   Results Top


This study was conducted on 24 cases of filariasis diagnosed on routine FNAC material from various sites. Out of these 24 cases, maximum cases of filariasis were reported in breast swelling (eight cases), followed by lymph nodes (six cases), scrotal swellings (four cases), thyroid swellings (three cases), soft tissue swellings (two cases) and ascitic fluid (one case).

Clinical presentations of these cases were variable which included swelling, pain, fever and erythema [Table 1].

Smears revealed sheathed microfilariae, tails of which were free from nuclei and many had graceful curves.

Eosinophilia was present in eight out of 24 cases. The percentage ranged from 12 to 24. Thick and thin blood smear examination of nocturnal venous blood revealed microfilariae of Wuchereria bancrofti in three out of 24 cases.

Microscopic examination of breast swellings showed sheathed microfilaria along with few groups of benign ductal epithelial cells, myoepithelial cells, bare nuclei, few fragments of fibrofatty tissue and inflammatory cells comprising of eosinophils and neutrophils [Figure 1]. Two cases of breast lumps showed epithelioid non-necrotising granuloma without giant cells and plasma cells.

Thyroid aspirates revealed few groups of follicular cells in the background of colloid. In between follicular groups, sheathed microfilariae along with macrophages and eosinophils were seen.

Aspirate from scrotal swelling showed numerous coiled and uncoiled sheathed microfilariae along with neutrophils, eosinophils and few lymphocytes [Figure 2].

Lymph node aspirates showed sheathed microfilariae in the background of mixed population of lymphoid cells comprising of mature lymphocytes, centrocytes, centroblasts, dendritic cells and few eosinophils.

Cytological findings of soft tissue swellings showed microfilariae along with neutrophils, eosinophils and granular debris. Epithelioid granuloma was seen in one case of subcutaneous nodule.

Cell adherence of inflammatory cells and macrophages to microfilariae was seen in three out of 24 cases.


   Discussion Top


Filariasis is a major public health problem in tropical countries, including India. In endemic areas like Eastern part of Uttar Pradesh, people become infected early in life with a peak between 15 to 20 years. A majority of infected individuals in filarial endemic communities were asymptomatic.

In the present study maximum cases (eight out of 24 cases) were reported from breast lumps. These cases presented with breast swelling and pain. Erythema was noticed in two out of eight cases.

Many authors have reported microfilariae in breast lumps by FNAC smears. [2],[3],[4],[6],[7],[8] Aspirates from lymph nodes (five out of 24), demonstrated microfilariae in a background of reactive lymphoid cells. Similar finding was reported by Joshi et al [12] and Varghese et al . [3]

Four cases of scrotal swellings showed microfilariae. The lymphatic vessels of spermatic cord appear to be common and perhaps the principal site of adult Wuchereria bancrofti in men with asymptomatic microfilaremia. Occurrence of living W bancrofti in scrotal area of men was demonstrated by Noroes et al . [15]

Three cases of thyroid swellings showed microfilariae along with colloid and thyroid follicular cells. Similar findings were also reported by Varghese et al [3] and Yenkeshwar et al . [12]

Two cases of soft tissue swellings and one case of ascitic fluid showed microfilaria along with inflammatory cell including eosinophils, lymphocytes and macrophages. Demonstrations of microfilariae from these sites were also reported by other workers. [2],[4],[16]

Out of 24 cases showing microfilariae in FNAC smear examination, blood eosinophilia was present in eight cases, of which microfilaremia in nocturnal venous blood smear examination was observed in three cases only. Findings are consistent with observation made by others, [10],[17],[18] who reported that filariasis can exist without microfilaremia.

Significant adherence of inflammatory cells and macrophages to microfilariae was present in three out of 24 cases. Cell adherence to microfilaria of W. bancrofti was first described by Pandit et al . [19] Cell adherence was also reported by Walter et al . [10] Degenerated microfilaria and coiled larvae were also seen surrounded by inflammatory cells.


   Conclusions Top


Despite high incidence of filariasis, microfilaria in fine needle aspiration cytology is not a very common finding. Careful screening of FNAC smears is helpful in detecting microfilaria even in asymptomatic patients. Undoubtedly the demonstration of parasite, in aspirate, play a significant role in recognition of disease and institution of specific treatment, thus obviate the severe manifestations of lymphatic filariasis.

 
   References Top

1.Park JE, Park K. Park's textbook of preventing and social medicine. 17th ed. Jabalpur: Banarasidas Bhanot; 2002.  Back to cited text no. 1    
2.Yenkeshwar PN, Dinkar T, Sudhakar K, Bobhate K. Microfilariae in fine needle aspirates: A report of 22 cases. Indian J Pathol Microbiol 2006;49:365-9.  Back to cited text no. 2  [PUBMED]  
3.Varghese R, Raghuveer CV, Pai MR, Bansal R. Microfilariae in cytologic smear: A report of six cases. Acta Cytol 1996;40:299-301.  Back to cited text no. 3  [PUBMED]  
4.Pandit AA, Shah RK, Shenoy SG. Adult filarial worm in a fine needle aspirates of a soft tissue swelling. Acta Cytol 1997;41:944-6.  Back to cited text no. 4  [PUBMED]  
5.Jayaram G. Microfilariae in fine needle aspiration from epididymal lesions. Acta Cytol 1987;31:59-62.  Back to cited text no. 5  [PUBMED]  
6.Bapat KC, Pandit AA. Filarial infection of the breast: Report of a case with diagnosis by fine needle aspiration cytology. Acta Cytol 1992;36:505-6.  Back to cited text no. 6  [PUBMED]  
7.Kapila K, Verma K. Diagnosis of parasites in fine needle breast aspirates. Acta Cytol 1996;40:653-6.  Back to cited text no. 7  [PUBMED]  
8.Rukmangadha N, Shanthi V, Kiran CM, Nalini PK, Sarella JB. Breast filariasis diagnosed by fine needle aspiration cytology: A case report. Indian J Pathol Microbiol 2006;49:243-4.  Back to cited text no. 8  [PUBMED]  
9.Sahu KK, Pai P, Raghuveer CV, Pai RR. Microfilaria in a fine needle aspirate from the salivary gland. Acta Cytol 1997;41:954.  Back to cited text no. 9  [PUBMED]  
10.Walter A, Krishnaswami H, Cariappa A. Microfilariae of Wuchereria bancrofti in cytologic smears. Acta Cytol 1983;27:432-6.   Back to cited text no. 10  [PUBMED]  
11.Kapila K and Verma K. Coexistent metastatic malignant melanoma cells and Wuchereria bancrofti microfilariae in urinary sediment. Acta Cytol 1986;30:696-7.  Back to cited text no. 11    
12.Joshi AM, Pangarkar MA, Ballal MM. Adult female Wuchereria bancrofti: Nematode in a fine needle aspirate of the lymphnode (left). Acta Cytol 1995;39:138.  Back to cited text no. 12  [PUBMED]  
13.Khan AA, Vasenwaala SM, Ahmad S. Coexistent metastatic adenocarcinoma and microfilaria in ascitic fluid. Acta Cytol 1993;37:643-4.  Back to cited text no. 13    
14.Martin HE, Ellis EB. Biopsy by needle puncture and aspiration. Ann Surg 1930;62:169-81.  Back to cited text no. 14    
15.Noroes J, Addiss D, Amara F, Coutinho A, Mederios Z, Dreyer G. Occurrence of living adult Wuchereria bancrofti in scrotal area of men with microfilaremia. Trans R Soc Trop Med Hyg 1996;90:55-6.  Back to cited text no. 15    
16.Dey P, Walker R. Microfilaria in fine needle aspirate from a skin nodule. Acta Cytol 1994;38:114.  Back to cited text no. 16  [PUBMED]  
17.Beaver PC. Filariasis without microfilaremia. Am J Trop Med Hyg 1970;19:182-9.  Back to cited text no. 17    
18.Hira PR, Lindberg LG, Ryd W, Behbehani K. Cytologic diagnosis of Bancroftian filariasis in a non-endemic area. Acta Cytol 1988;32:267-9.  Back to cited text no. 18  [PUBMED]  
19.Pandit CG, Pandit SR, Iyer IV. The adhesion phenomenon in filariasis: A preliminary note. Indian J Med Res 1929;16:946-53.  Back to cited text no. 19    

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Correspondence Address:
Rajiv K Mishra
Department of Pathology, BRD Medical College, Gorakhpur, UP
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0970-9371.51333

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