eMedicine Specialties > Urology > Infections and Related Inflammatory Conditions

Hydrocele, Filarial: Workup

Author: Bradley Fields Schwartz, DO, FACS, Professor of Urology, Director, Center for Laparoscopy and Endourology, Department of Surgery, Southern Illinois University School of Medicine
Coauthor(s): Joe Miller, MD, Staff Physician, Division of Urology, Southern Illinois University Affiliated Hospitals; Rizk El-Galley, MD, Director of Clinical Research, Assistant Professor, Department of Surgery, Division of Urology, University of Alabama
Contributor Information and Disclosures

Updated: Jul 2, 2009

Workup

Laboratory Studies

  • CBC count: Patients with patent filarial infection commonly have marked eosinophilia.
  • Serum immunoglobulins: Elevated serum levels of immunoglobulin E (IgE) and immunoglobulin G4 (IgG4) are seen with microfilarial infection.
  • Circulating filarial antigen: Commercial tests to detect circulating filarial antigen (CFA) using monoclonal antibodies (mAb Og4C3 or mAb AD.12) are widely available.
  • Hydrocele fluid examination: CFA may be detected in hydrocele fluid, and microfilariae may be found on cytology.
  • Urine examination: Chyluria may be detected macroscopically, and microfilariae may be detected via microscopic examination of voided urine. Proteinuria and hematuria may also be seen with microfilarial infection with renal involvement.
  • Peripheral blood examination: Microfilariae may be detected via microscopic examination of peripheral blood. Microfilariae demonstrate a circadian pattern that varies by endemic region, necessitating serum sampling that coincides with periods of activity. Activity may be provoked with administration of DEC.

Imaging Studies

Ultrasonography: Lymphatic obstruction can be demonstrated on ultrasonography. Motile adult worms may be seen in symptomatic and subclinical filarial hydroceles. The characteristic movements of adult filarial worms are called the filarial dance sign (FDS) and are a reliable diagnostic finding. Ultrasonography may also be used to monitor response to treatment.

More on Hydrocele, Filarial

Overview: Hydrocele, Filarial
Workup: Hydrocele, Filarial
Treatment: Hydrocele, Filarial
Follow-up: Hydrocele, Filarial
Multimedia: Hydrocele, Filarial
References
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References

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  2. Lammie PJ, Cuenco KT, Punkosdy GA. The pathogenesis of filarial lymphedema: is it the worm or is it the host?. Ann N Y Acad Sci. Dec 2002;979:131-42; discussion 188-96. [Medline].

  3. Taylor MJ. A new insight into the pathogenesis of filarial disease. Curr Mol Med. May 2002;2(3):299-302. [Medline].

  4. Bernhard P, Magnussen P, Lemnge MM. A randomized, double-blind, placebo-controlled study with diethylcarbamazine for the treatment of hydrocoele in an area of Tanzania endemic for lymphatic filariasis. Trans R Soc Trop Med Hyg. Sep-Oct 2001;95(5):534-6. [Medline].

  5. Approaches to the urogenital manifestations of lymphatic filiariasis. Geneva, Switzerland: World Health Organization; 2002.

  6. Bosworth W, Ewert A. The effect of Streptococcus on the persistence of Brugia malayi and on the production of elephantiasis in cats. Int J Parasitol. Dec 1975;5(6):583-9. [Medline].

  7. Cohen LB, Nelson G, Wood AM, Manson-Bahr PE, Bowen R. Lymphangiography in filarial lymphoedema and elephantiasis. Am J Trop Med Hyg. Nov 1961;10:843-8. [Medline].

  8. Dreyer G, Norões J, Figueredo-Silva J, Piessens WF. Pathogenesis of lymphatic disease in bancroftian filariasis: a clinical perspective. Parasitol Today. Dec 2000;16(12):544-8. [Medline].

  9. Eigege A, Richards FO Jr, Blaney DD, Miri ES, Gontor I, Ogah G. Rapid assessment for lymphatic filariasis in central Nigeria: a comparison of the immunochromatographic card test and hydrocele rates in an area of high endemicity. Am J Trop Med Hyg. Jun 2003;68(6):643-6. [Medline].

  10. Hussein O, El Setouhy M, Ahmed ES, Kandil AM, Ramzy RM, Helmy H, et al. Duplex Doppler sonographic assessment of the effects of diethylcarbamazine and albendazole therapy on adult filarial worms and adjacent host tissues in Bancroftian filariasis. Am J Trop Med Hyg. Oct 2004;71(4):471-7. [Medline].

  11. Nielsen NO, Bloch P, Simonsen PE. Lymphatic filariasis-specific immune responses in relation to lymphoedema grade and infection status. I. Cellular responses. Trans R Soc Trop Med Hyg. Jul-Aug 2002;96(4):446-52. [Medline].

  12. Ottesen EA. The human filariases: New understanding, new therapeutic strategies. Curr Opin Infect Dis. 1994;7:550-8.

  13. Ottesen EA, Vijayasekaran V, Kumaraswami V, Perumal Pillai SV, Sadanandam A, Frederick S, et al. A controlled trial of ivermectin and diethylcarbamazine in lymphatic filariasis. N Engl J Med. Apr 19 1990;322(16):1113-7. [Medline].

  14. Tobian AA, Tarongka N, Baisor M, Bockarie M, Kazura JW, King CL. Sensitivity and specificity of ultrasound detection and risk factors for filarial-associated hydroceles. Am J Trop Med Hyg. Jun 2003;68(6):638-42. [Medline].

  15. Weekly epidemiological record. Geneva, Switzerland: World Health Organization; 2006.

  16. Weil GJ, Lammie PJ, Weiss N. The ICT Filariasis Test: A rapid-format antigen test for diagnosis of bancroftian filariasis. Parasitol Today. Oct 1997;13(10):401-4. [Medline].

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Further Reading

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Keywords

filarial hydrocele, scrotal lymphedema, filarial worms, filaria, filariae, Filaria bancrofti, F bancrofti, Wuchereria bancrofti, W bancrofti, Brugia malayi, B malayi, Filaria malaya, F malaya, Culex pipiens, C pipiens, parasitic disease, parasitemia, parasite infection, filariasis, mosquito bite, lymphatic filariasis, nematode, roundworm, round worm, lymphangiectasia, filarial infestation, scrotal filarial infestation, skin sclerosis, elephantiasis, tropical eosinophilia, eosinophilic interstitial pneumonitis, chyluria, bancroftian filariasis, acute filarial lymphangitis, AFL, filarial dance sign, FDS

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Contributor Information and Disclosures

Author

Bradley Fields Schwartz, DO, FACS, Professor of Urology, Director, Center for Laparoscopy and Endourology, Department of Surgery, Southern Illinois University School of Medicine
Bradley Fields Schwartz, DO, FACS is a member of the following medical societies: American College of Surgeons, American Urological Association, Association of Military Osteopathic Physicians and Surgeons, Endourological Society, Society of Laparoendoscopic Surgeons, and Society of University Urologists
Disclosure: Nothing to disclose.

Coauthor(s)

Joe Miller, MD, Staff Physician, Division of Urology, Southern Illinois University Affiliated Hospitals
Joe Miller, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Surgeons, and American Medical Student Association/Foundation
Disclosure: Nothing to disclose.

Rizk El-Galley, MD, Director of Clinical Research, Assistant Professor, Department of Surgery, Division of Urology, University of Alabama
Rizk El-Galley, MD is a member of the following medical societies: American Urological Association, Royal College of Surgeons of England, and Southwest Oncology Group
Disclosure: Nothing to disclose.

Medical Editor

Edmund S Sabanegh Jr, MD, Director, Center for Male Fertility, Glickman Urological and Kidney Institute, Cleveland Clinic Foundation
Edmund S Sabanegh Jr, MD is a member of the following medical societies: American College of Surgeons, American Medical Association, American Society for Reproductive Medicine, American Society of Andrology, American Urological Association, Society for the Study of Male Reproduction, Society of Reproductive Surgeons, and Southwest Oncology Group
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

CME Editor

J Stuart Wolf Jr, MD, FACS, David A Bloom Professor of Urology, Director of Division of Minimally Invasive Urology, Department of Urology, University of Michigan
J Stuart Wolf Jr, MD, FACS is a member of the following medical societies: American College of Surgeons, American Urological Association, Catholic Medical Association, Endourological Society, Society for Urology and Engineering, Society of Laparoendoscopic Surgeons, Society of University Urologists, and Society of Urologic Oncology
Disclosure: Terumo Corporation Consulting fee Consulting; Omeros Corporation Consulting fee Consulting

Chief Editor

Edward David Kim, MD, FACS, Professor of Surgery, Division of Urology, University of Tennessee Graduate School of Medicine; Consulting Staff, University of Tennessee Medical Center
Edward David Kim, MD, FACS is a member of the following medical societies: American College of Surgeons, American Society for Reproductive Medicine, American Society of Andrology, American Urological Association, and Tennessee Medical Association
Disclosure: Lilly Consulting fee Consulting; Astellas Consulting fee Speaking and teaching; Indevus Consulting fee Speaking and teaching

 
 
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