CWM Hospital Fiji School of Medicine Depts. of Medicine

1
CWM Hospital / Fiji School of Medicine Depts. of
Medicine Pathology
CPC Meeting 6/3/2002

• Epitrochlear lypmphadenitis - Filariasis

2
History

• 61 Year old Fijian Male.
• Swollen Right arm for one week.
• Palpable large epitrochlear lymphnode.
• Mild fever on and off since two weeks.

3
Blood Smear - Microfilaria

• Note wavy microfilarial worm in the thick part of
  blood film.
• Clumps of RBC (normal in thick part of film).
• Platelet clumps around the worm.

4
Blood Smear - Microfilaria

• Note wavy microfilarial worm in the thick part of
  blood film.
• Clumps of RBC (normal in thick part of film).
• Platelet clumps

5
Blood Smear - Microfilaria

• Note wavy microfilarial worm in the thick part of
  blood film.
• Head part
• Tail (dark blue structures are nuclei)

6
Blood Smear - Microfilaria

• Note wavy microfilarial worm in the thick part of
  blood film.
• Dark blue structures are nuclei
• Tail end tapering (no nuclei)
• Sheath covering worm.

7
Blood Smear - Microfilaria

• Note wavy microfilarial worm in the thick part of
  blood film.
• Head end of the worm rounded (no nuclei)
• (Sheath is not clearly seen)

8
Blood Smear - Microfilaria

• Note wavy microfilarial worm in the thick part of
  blood film.
• Dark blue structures are nuclei
• Tail end - tapering sheath (no nuclei)

9
Case 2 - Hydrocele fluid

• Specimen sent from primary health center
• Hydrocele fluid for examination.
• Cell block preparation from the fluid stained
  with routine HE Stain.

10
Hydrocele fluid cell block.

• Note wavy microfilarial worms.
• Inflammatory cells lymphocytes.
• Hemorrhagic fluid sediment

11
Hydrocele fluid cell block.

• Note wavy microfilarial worms.
• Inflammatory cells lymphocytes.
• RBC

12
Hydrocele fluid cell block.

• Note wavy microfilarial worms.
• Inflammatory cells lymphocytes.
• RBC

13
Hydrocele fluid cell block.

• Inflammatory cells lymphocytes.
• RBC

• Microfilaria.

14
Discussion Filariasis

• infestation by nematodes widely distributed.
• Adult worms both male and female, several cm
  long, reside in subcutaneous tissue, lymph
  blood vessels.
• Motile embryos - microfilariae circulate in blood
  or on skin.
• Microfilariae are not infectious to humans but to
  arthropod (mosquito)

15
Discussion Filariasis

• Filaria infesting humans
• Wuchereria bancrofti Elephantiasis
• Brugia malayi milder form, lymphatics.
• Onchocerca volvulus Eye, blindness, Africa
• Loa Loa Loaisis, Africa, repeated swellings.
• Mansonella perstans Africa, asymptomatic.