Parasite infestation of the testicular tunica and spermatic cord by filariae are rarely reported and may present with few clinical signs, depending upon the stage. Occasionally, it may mimic a testicular tumor. We present a case of a 29-year-old man who presented with left testicular swelling and discomfort for 4 months. Clinical examination and imaging suggested an intrascrotal cystic lesion with a normal left testis. However, the intraoperative findings revealed a tumor-like mass; hence, a left orchidectomy was performed. However, histopathology reported a diagnosis of a cystic testicular tunica and spermatic cord with parasite infection. Here, we review the literature of scrotal and testicular parasite disease and discuss the course of the appropriate management involved.
Parasitic nematodes from the Berlin (ZMB) and Vienna (NMW) Museum collections referred to the genus Filaria Mueller, 1787 by von Linstow or Molin were studied. Three samples were in good condition and the specimens redescribed. Litomosa hepatica (von Linstow, 1897) n. comb., sample ZMB Vermes Entozoa 3368, from the megachiropteran Pteropus neohibernicus, Bismarck Archipelago, resembles L. maki Tibayrenc, Bain & Ramanchandran, 1979, from Pteropus vampyrus, in Malaysia, but the buccal capsule differs. Both species display particular morphological characters which differ from species of Litomosa parasitic in microchiropterans. The remaining material originates from Brazil. The spicule morphology of Litomosoides circularis (von Linstow, 1899) Chandler, 1931, sample ZMB Vermes Entozoa 1059 from Hesperomys spec. (= Holochilus brasiliensis), Porto Alegre, confirms that it belongs to the sigmodontis group; the microfilaria presents characters of the genus Litomosoides, e.g. body attenuated at both extremities and salient cephalic hook. Taxonomic discussions by others confirm that species of Litomosoides belonging to the sigmodontis group and described subsequently are distinct from L. circularis. Litomosoides serpicula (Molin, 1858) Guerrero, Martin, Gardner & Bain, 2002, is redescribed, sample NMW 6323 from the bat Phyllostoma spiculatum (= Sturnira lilium), Ypanema. It is very close to L. brasiliensis Almeida, 1936, type host Moytis sp., but distinguished by a single ring in the buccal capsule, rather than two, supporting previous conclusions that the taxon L. brasiliensis, as generally regarded, may represent a complex of species. Samples NMW 6322 and NMW 6324, from other bats and also identified by Molin (1858) as Filaria serpicula, contain unidentifiable fragments of Litomosoides incertae sedis. Filaria hyalina von Linstow, 1890, sample ZMB Vermes Entozoa Q 3905 from Sorer vulgaris (= Sorex araneus), is incertae sedis because it contains two unidentifiable posterior parts of male, which might be an acuarid, Stammerinema sp. Filaria vesperuginis von Linstow, 1885, sample ZMB Vermes Entozoa Q 3929, from the bat Vesperugo serotinus (= Eptesicus serotinus), contains encysted nematode larvae and is a nomen dubium.
The dynamics of the transmission of subperiodic Brugia malayi in a typical endemic area in Malaysia was studied over a period of 4 years. Mass chemotherapeutic control with diethylcarbamazine citrate was found to be inefficient, new cases being detected even after the fifth treatment cycle of 6 mg/kg X 6 days per cycle. This is in marked contrast to the situation in periodic b. malayi areas where mass treatment efficiently controlled the infection. The disparity in results in these two areas is attributed to zoonotic transmission of subperiodic B. malayi from non-human primates where a mean infection rate of 76.3% was found.
The chemoprophylactic use of diethylcarbamazine citrate at total oral doses of 15--180 mg/kg body weight was tested against subperiodic Brugia malayi infection in the leaf monkey (Presbytis melalophos). A total dose of 45 mg/kg body weight given over 9 days killed all developing infective larvae. Similarly, a total dose of 35 mg/kg body weight given over 7 days killed all fourth stage larvae. The minimum effective dose that prevents infection would be 5 mg/kg body weight daily for 7 days every month.
Breinlia booliati exhibited nocturnal subperiodicity in its natural host, Rattus sabanus in contrast to experimentally infected laboratory-reared albine rats which showed irregular fluctuations of microfilariae throughout the 24 hour cycle. All the infected albino rats showed a prepatent period between 11-14 weeks postinoculation. Three patterns of microfilaraemia were discerned during the course of infection 38/49 rats displayed a single peak, 4/49 displayed 2 peaks about 12-15 weeks apart and 7/49 showed a sustained high plateau-like pattern of microfilaraemia. Cortisone had no effect on microfilarial levels when administered to rats near postpatency and some at postpatency.
Comparative studies of vector efficiency were done with the Liverpool and Malaysian strains of Aedes (Finlaya) togoi for subperiodic Brugia malayi and Brugia pahangi. The Malaysian strain of A. togoi was found to take in fewer microfilariae under the same experimental conditions than the Liverpool strain. Also, for various microfilarial densities in the host's peripheral blood, the Malaysian strain had less mean infective larvae per fed mosquito than the Liverpool strain. The microfilarial intake of A. togoi was not affected by the site of feeding on the host affected by the site of feeding on the host. Most of the mosquitoes took in fewer microfilariae than expected. It is concluded from these studies that the Malaysian strain of A. togoi is a susceptible and reasonably good vector for subperiodic B. malayi and B. pahangi. Further field studies should be carried out to determine its importance as a natural vector of Brugian filariasis.
The indirect hemagglutination (IHA) test done with turkey red cells was applied to 173 serum samples obtained from patients and persons exposed to Wuchereria bancrofti and Brugia malayi in endemic areas of Peninsular Malaysia. A crude extract of adult worms of the rat filaria, Breinlia booliati, was used as the antigen. When a titer of 1:16 was taken as negative, positive IHA test rates in sera from microfilaria-negative persons in endemic areas, microfilaremic cases, and patients with clinical filariasis were 13%, 75%, and 80%, respectively. Results of the IHA test correlated well with results obtained with the indirect fluorescent technique.
Levels of immunoglobulins G, A, M and E as well as complement components C3c and C4 have been determined in populations in various endemic areas in Peninsular Malaysia and also in filariasis patients. High immunoglobulin levels were seen. In the microfilarial-negative group IgG was 2009 mg% while IgE was 3967 I.U./ml. In the filariasis group, Wuchereria bancrofti patients had significantly higher levels of IgG, IgM and IgE, namely, 3314 mg%, 804 mg% and 18400 I.U./ml respectively. The significance of these levels is discussed.
The indirect immunofluorescence test using sonicated microfilariae of Brugia malayi has been evaluated on 173 sera from patients and persons exposed to Wuchereria bancrofti and B. malayi in endemic areas of Peninsular Malaysia. In the microfilaria-negative group, without signs and symptoms of filariasis 55/62 sera (89%) had titers of 1:16 and less. In the microfilaremic groups and in the amicrofilaremic cases with clinical filariasis, all the sera tested were positive, with the antibody titers ranging generally from 1:16 - 1:256. Cross-reaction tests were done on 16 samples of onchocerciasis sera from West Africa using sonicated antigen as well as antigen-coated CNB1-activated sepharose. Antibody titers were detected in all the sera. The usefulness of the sonicated microfilarial antigen in serodiagnosis of filariasis is discussed.