Figure.3 Gram staining of pus showing microfilaria
The patient underwent incision and drainage (I&D) for a right inguinal
abscess located under the ulcer. In addition, medical management was
provided using steroids (Prednisolone) and Diethylcarbamazine (6mg/kg) (7). There was dramatic improvement in ulcer healing within 3 weeks with minimal scar. Patient was followed up in 4 months without recurrance and healed ulcers.
Discussion:
Filariasis is the most common cause of lymphedema worldwide. Around 120
million people are infected, and approximately 40 million have lymphatic
problems. The disease is seen in Africa, Southeast Asia, the Western
Pacific, the Americas, and the Middle East (8). Transmission and morbidity rates are highest in Southeast Asia and Sub-Saharan Africa. It is
caused by Wuchereria bancrofti, Brugia Malayi, and Brugia Timori, and is
transmitted by female mosquitoes (Culex, Anopheles, and Aedes). Nearly
90% of microfilariae are of W. bancrofti (6,9). Usually, people residing
in endemic zones and being exposed to repeated mosquito bites over
several months are required in order to acquire lymphatic filariasis.
The majority of infected patients are asymptomatic, while others present
with acute symptoms such as fever, headache, malaise, inguinal and
axillary lymphadenitis, lymphangitis, cellulitis, abscess formation, and
funiculoepididymo-orchitis. In the chronic form, it can lead to the
formation of elephantiasis in the legs, arms, scrotum, vulva, penis, and
breasts. Chyluria and lymphovarix are rare conditions. Eosinophilia and
microfilaremia are common during the acute phase.
Peripheral blood smears stained with Gram stain, Ziemsa stain, or H&E are crucial for diagnosing microfilaria, as they enable detection in the blood. Differential diagnosis of filariasis should be
considered for any lymphedema in an endemic zone, even in the absence of
circulating antigens or parasites on laboratory examination.
Conclusion
This case report highlights rare finding of the presence of microfilaria
in the pus sample of an ulcer over an elephantiasis leg. Lymphatic
filariasis, caused by Wuchereria bancrofti, is a common public health
issue in endemic areas. The patient presented with chronic leg swelling,
recurrent ulceration, and lymphadenopathy. Microscopic examination of
the pus sample revealed the presence of microfilariae. The patient was
managed with incision and drainage for abscess, along with medical
treatment involving steroids and diethylcarbamazine. This case
emphasizes the importance of considering filariasis as a differential
diagnosis in chronic non-healing ulcers, particularly in endemic
regions, even in the absence of circulating antigens or parasites on
laboratory examination. Early detection and appropriate management can
be crucial in reducing the morbidity associated with lymphatic
filariasis.
Acknowledgements:
Author wants to thank all teaching staff of Department of Dermatology
and staffs of Department of Microbiology, Bakulahar Ratnanagar Hospital
for their suggestions and constant support to make this work successful.
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https://doi.org/10.20546/ijcmas.2020.906.372 Declaration of Conflicting Interests: The author(s) declared no
potential conflicts of interest with respect to the research,
authorship, and/or publication of this article.
Funding: The author(s) received no financial support for the
research, authorship, and/or publication of this article.
Patient consent: Written informed consent was obtained from the
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