Journal of Cytology
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CASE REPORT  
Year : 2012  |  Volume : 29  |  Issue : 2  |  Page : 147-148
Microfilaria in a patient of achylous hematuria: A rare finding in urine cytology


1 Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
2 Department of Urology, All India Institute of Medical Sciences, New Delhi, India

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Date of Web Publication12-Jun-2012
 

   Abstract 

Filariasis is a widespread public health problem seen commonly in tropical countries. Microfilariae have been reported in aspiration smears from various sites. However, it is very rare to detect these organisms in voided centrifuged urine cytology. We, report this rare finding in a 25-year-old patient who presented with achylous hematuria.

Keywords: Filariasis; hematuria; microfilariae; urine cytology

How to cite this article:
Ahuja A, Das P, Durgapal P, Saini A, Dogra PN, Mathur SR, Iyer VK. Microfilaria in a patient of achylous hematuria: A rare finding in urine cytology. J Cytol 2012;29:147-8

How to cite this URL:
Ahuja A, Das P, Durgapal P, Saini A, Dogra PN, Mathur SR, Iyer VK. Microfilaria in a patient of achylous hematuria: A rare finding in urine cytology. J Cytol [serial online] 2012 [cited 2019 Aug 19];29:147-8. Available from: http://www.jcytol.org/text.asp?2012/29/2/147/97163



   Introduction Top


Filariasis is a general public health problem seen commonly in tropical countries like India. It is caused mainly by three species-Wuchereria bancrofti, Brugia malayi and Brugia timori. In India, W. bancrofti is the commonest and B.timori is the rarest. Filariasis has been reported in cytologic smears from various organs and sites like male genital organs, thyroid, breast, lymph node, liver, soft tissue swellings, bone marrow, cervical smears, body fluids etc. [1],[2],[3],[4],[5],[6],[7] Detection of microfilaria in voided urine sediment, especially in achylous hematuria specimen, is extremely rare. We report a case with microfilariae of W. bancrofti in a 25-year-old patient who presented with achylous hematuria.


   Case Report Top


A 25-year-old male patient presented in urology out-patient department (OPD) with history of intermittent painless hematuria for three weeks. There was no history of fever, trauma, instrumentation, flank pain, ureteric colic or passage of milky white urine. There were no lower urinary tract symptoms (LUTS). On general examination, there was no hepatosplenomegaly or lymhadenopathy. Local examination including genitalia did not reveal any abnormality. Routine hemogram was normal. The peripheral smear examination did not reveal any parasite. A voided urine sample was collected and sent to the cytopathology laboratory for routine cytological examination. Urine sample was processed by centrifuging at 3000 rpm for 3 minutes. The sediment smears made were stained with May-Grünwald-Giemsa (MGG) and Papanicolaou stains. Smears revealed urothelial cells along with neutrophils, lymphocytes, red blood cells and few microfilariae [Figure 1]. No malignant cells were seen. High power examination of the microfilaria showed a sheathed parasite with central axis of nuclei which ended abruptly before the tip of tail [Figure 1]. With this, characteristic morphology the microfilariae were identified as W. bancrofti.

Subsequent to the cytological diagnosis patient was treated with 21 days course of diethylcarbazine (DEC) after which he became asymptomatic.
Figure 1: Photomicrograph of urine sediment showing a sheathed microfilaria with central axis of nuclei ending abruptly before the tip of tail along with few urothelial cells, inflammatory cells and red blood cells (MGG, ×400)

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   Discussion Top


W. bancrofti accounts for majority of the filarial infection in India; accounting for approximately 95% of cases. Infection by this sheathed species is commonly seen in India, China, Indonesia and Eastern Pacific. [8] Filariasis may present with various clinical manifestations, the commonest being asymptomatic. The common presentations include microfilaremia, lymphedema, hydrocele, acute adenolymphangitis (ADL), chronic lymphatic disease and less common presentations are like chyluria and tropical eosinophilia. Achylous hematuria is a very rare presentation. Almost all persons with filariasis, however, have microscopic hematuria and/or protienuria. Shedding of microfilaria in urine is possibly determined by local factors like inflammation, trauma or stasis, which mainly affect the lymphatics and small vessels causing either lymphatic blockage or damage to the vessel wall.

To the best of our knowledge, only few cases of W. bancrofti have been reported in voided urine sample in literature. In most of these reported cases, there was a history of chyluria. [4],[5] There are only occasional case reports in which patient presented with haematuria. Webber et al.[1] first reported microfilaria in a 23-year-old male patient during a routine workup for intermittent painless hematuria. They detected W. bancrofti in both voided and catheterized urine sample. Vankalakunti et al.[2] reported W. bancrofti in a 45-year-old man who presented with painless hematuria and clinical suspicion of malignancy.

In the present case, microfilaria was incidentally detected in a voided centrifuged urine sample of a young male patient who presented with complaints of intermittent painless hematuria. There was no history of chyluria and routine hemogram was normal. Urine sediment also showed mild reactive atypia in the urothelial cells. The explanation of non-chyluric hematuria may be that significant lymphatic obstruction may not have taken place; therefore, patient did not present with chyluria.

The microfilaria can be detected in blood, various body fluids, fine needle aspiration smears and histological examination as well as by serological and immunological tests. Among these, ELISA and rapid - format immunochromatographic card test have a very high sensitivity and specificity. [8] Detection of parasite DNA by polymerase chain reaction (PCR) is now considered as the most sensitive technique for definite diagnosis of this infection. Diethylcarbamazine (DEC, 6 mg/ kg daily for 12 days) remains the treatment of choice for the individual with active infection even after many decades since it was first used in W. bancrofti infection. The drug has both macro- and microfilaricidal properties.

To conclude, detection of microfilaria in urine without chyluria is rare. Most of the infected individuals do not have microfilaremia at the time of clinical manifestation, and definitive diagnosis in such cases can be difficult. Careful screening of the urine sample helped to detect this totally curable infection. It saved the patient from undergoing the trauma of invasive investigations and prevented further complications.

 
   References Top

1.Webber CA, Eveland LK. Cytologic detection of Wuchereria bancrofti microfilariae in urine collected during a routine workup for hematuria. Acta Cytol 2008;26:837-40.  Back to cited text no. 1
    
2.Vankalakunti M, Kumar S, Nijhawan R. Microfilariae in urine. Acta Cytol 2008;52:639-40.  Back to cited text no. 2
[PUBMED]    
3.Roy I, Mukhopadhyay C, Ayyagari A. Multisystem involvement of microfilaria in a HIV positive patient. Nepal Med Coll J 2004;6:64-6.  Back to cited text no. 3
[PUBMED]    
4.Mondal SK. Incidental detection of filaria in fine-needle aspirates: A cytologic study of 14 clinically unsuspected cases at different sites. Diagn Cytopathol 2012;40:292-6.  Back to cited text no. 4
[PUBMED]  [FULLTEXT]  
5.Yenkeshwar PN, Kumbhalkar DT, Bobhate SK. Microfilariae in fine needle aspirates: a report of 22 cases. Indian J Pathol Microbiol 2006;49:365-9.  Back to cited text no. 5
[PUBMED]    
6.Seth A. Microfilaruria in a patient of intermittent chyluria. J Cytol 2009;26:151-2.  Back to cited text no. 6
[PUBMED]  Medknow Journal  
7.Walter A, Krishnaswami H, Cariappa A. Microfilariae of Wuchereria bancrofti in cytologic smears. Acta Cytol 1983;27:432-6.  Back to cited text no. 7
[PUBMED]    
8.Kasper DL, Fauci AS, Longo DL, Braunwald E, Hauser SL, Jameson JL, et al. Harrison's Principles of Internal Medicine. New York City, U.S: McGraw-Hill Companies Inc; 2008;1:1324-6.  Back to cited text no. 8
    

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Correspondence Address:
Sandeep R Mathur
Department of Pathology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi - 110 029
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0970-9371.97163

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This article has been cited by
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