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CASE REPORT
Year : 2003  |  Volume : 21  |  Issue : 3  |  Page : 207-208
 

Early diagnosis of filarial pleural effusion


Pranav Pathology Laboratory, Sarang Apt., Raopura, Baroda - 390 001, India

Correspondence Address:
Pranav Pathology Laboratory, Sarang Apt., Raopura, Baroda - 390 001, India

 ~ Abstract 

This paper describes a case of pleural effusion due to filariasis. Microfilaria of Wucheraria bancrofti were detected in the pleural fluid on cytological examination. Treatment with diethylcarbamazine cleared the pleural effusion.

How to cite this article:
Marathe A, Handa V, Mehta G R, Mehta A, Shah P R. Early diagnosis of filarial pleural effusion. Indian J Med Microbiol 2003;21:207-8


How to cite this URL:
Marathe A, Handa V, Mehta G R, Mehta A, Shah P R. Early diagnosis of filarial pleural effusion. Indian J Med Microbiol [serial online] 2003 [cited 2020 Apr 3];21:207-8. Available from: http://www.ijmm.org/text.asp?2003/21/3/207/8020


Filariasis is common in tropical countries and is endemic in India, however, the finding of microfilaria in the pleural fluid is very rare.[1] To our knowledge there are only five such cases of filariasis associated with pleural effusion, reported in the past, in which microfilaria were demonstrated in the pleural effusion.[2],[3]

 ~ Case Report Top

A male patient of thirty years presented in a private clinic in Baroda with the complaints of fever, cough, pain in the left side of the chest and shortness of breath since 15 days. The patient had moderate fever of 100C, normal blood pressure and clinical signs of left sided pleural effusion. The liver and spleen were not palpable. Haemogram showed, haemoglobin 16.3gms%, TLC 12,000/cmm, polymorphs 82 %, lymphocytes 13 %, eosinophils 4 %, monocytes 1% and ESR 5 mm at the end of one hour. The Mantoux test showed induration of less than 4.0 mm x 4.0 mm and X-ray chest revealed left sided pleural effusion [Figure - 1].
Diagnostic pleural tap was performed. Straw coloured pleural fluid showed glucose 104 mg/dL, proteins 5.0gms/dL, and LDH 273 i.u./L. The fluid Leukocyte count was 3200/cmm showing predominantly mononuclear cells. Acid fast bacilli were not detected in the direct smears made from the fluid and the culture for  Mycobacterium tuberculosis  i>and for aerobic bacteria were negative.
During examination of the fluid in the Neubauer chamber for the leukocyte count a single larva was detected. Subsequent wet films made from the sediments of the fluid revealed numerous motile larvae [Figure - 2].
The slides made from the sediment were stained with Leishman's stain. Larvae were identified as Wucheraria bancrofti on the basis of their morphological characteristics [Figure:3].
No microfilariae were detected in the nocturnal peripheral blood smear.

 ~ Discussion Top

The microfilariae in the pleural fluid have been demonstrated only in five cases so far.[2],[3] In four cases[3] the patients were from nonendemic areas and in the fifth case the finding of filarial larvae in the fluid was a delayed diagnosis. In one case microfilariae of Mansonella perstans were detected while in the other four cases[4],[5],[6] microfilariae of Wucheraria bancrofti were identified. One patient had pulmonary eosinophilia and one had tropical pulmonary eosinophilia. The third case presented with some symptoms of tropical pulmonary eosinophilia and lacked the characteristic peripheral eosinophilia. The fifth case also did not show any peripheral eosinophilia. In one case filarial larvae were detected in the pleural biopsy. Our case, therefore, is a case of filarial pleural effusion in which microfilaria have been demonstrated in the pleural fluid and the patient did not show symptoms of tropical pulmonary eosinophilia or peripheral eosinophilia.
The commonest cause of pleural effusion in India is tuberculosis. Filariasis is endemic in India and, therefore, the coexistence of filariasis with pleural effusion was thought to be coincidental rather than etiological. In the present case the patient was not put on anti tubercular treatment since there was no positive finding for the same and the recovery of the patient only with diethycarbamazine stresses the need of high index of suspicion on the part of the cytologist in the detection of the organism in the material for diagnosis of such infection and the prompt institution of appropriate chemotherapy. This may obviate the more serious pathologic changes of advanced disease. It further emphasizes the need to consider filarial etiology in the differential diagnosis of idiopathic cases of pleural effusion from endemic as well as from nonendemic areas. In case of recurrent pleural effusion when tuberculosis and malignancies are ruled out or are remote possibility, careful search for microfilariae in centrifuged pleural fluid may be rewarding. 

 ~ References Top

1.World Health Organization. Lymphatic filariasis: Fourth report of the WHO Expert Committee on filariasis. WHO Tech Rep Ser 1984;702:1-112.  Back to cited text no. 1    
2.Vishwanathan R. Pulmonary eosinophiliosis. Indian Med Gaz 1945;80:392-396.   Back to cited text no. 2    
3.Arora VK, Gowrinath K. Pleural effusion due to lymphatic filariasis. Indian J Chest Dis Allied Science 1994;36( 3):159-161.  Back to cited text no. 3    
4.Hira PR, Lindberg LG, Ryd W, Behbenhani K. Cytological diagnosis of Bancroftian filariasis in a nonendemic area. Acta Cyto 1988;32:267-269.  Back to cited text no. 4    
5.Avasthi R, Jain AP, Swaroop K, Samal N. Bancroftian filariasis in association with pulmonary tuberculosis. Report of a case with diagnosis by fine needle aspiration. Acta Cytol 1991;35:717-718.  Back to cited text no. 5    
6.Agrawal J, Kapila K, Gaur A, Wali JP. Bancroftian filarial pleural effusion. Post Graduate Med 1993;69:869-870.  Back to cited text no. 6    
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2004 - Indian Journal of Medical Microbiology
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