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 Table of Contents  
CASE REPORT
Year : 2021  |  Volume : 27  |  Issue : 2  |  Page : 182-183

Filarial dance in epididymis: A pathognomonic sign of scrotal filariasis


Division of Urology, Lourdes Institute of Nephro-Urology, Lourdes Hospital, Kochi, Kerala, India

Date of Submission01-Apr-2021
Date of Decision07-Apr-2021
Date of Acceptance15-Apr-2021
Date of Web Publication15-Nov-2021

Correspondence Address:
Dr. Biju S Pillai
Division of Urology, Lourdes Institute of Nephro-Urology, Lourdes Hospital, Kochi - 682 012, Kerala
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ksj.ksj_14_21

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  Abstract 


Lymphatic filariasis is caused by the worms Wuchereria bancrofti, Brugia malayi, and Brugia timori. The most common clinical presentation is hydrocele, with lymphedema and elephantiasis occurring less commonly. Among various imaging modalities, sonography is most commonly used for diagnosis and assessing treatment response. We report a case of a boy with painless swelling and low-grade fever in whom real-time ultrasonography depicted the presence of filarial dance sign in right epididymis.

Keywords: Filarial dance sign, scrotal filariasis, Wuchereria bancrofti


How to cite this article:
Kumar R, Pillai BS. Filarial dance in epididymis: A pathognomonic sign of scrotal filariasis. Kerala Surg J 2021;27:182-3

How to cite this URL:
Kumar R, Pillai BS. Filarial dance in epididymis: A pathognomonic sign of scrotal filariasis. Kerala Surg J [serial online] 2021 [cited 2021 Nov 30];27:182-3. Available from: http://www.keralasurgj.com/text.asp?2021/27/2/182/330393




  Introduction Top


Lymphatic filariasis is a widespread disease endemic to South-East Asia and Africa. This disease causes swelling of the limbs and male genitalia leading to social and physical disabilities.[1] Wuchereria bancrofti is a type of roundworm that is responsible for 90% of lymphatic filariasis.[2] Larvae are contained within the intrascrotal lymphatic system where they develop into adult worms that can survive for 15 years or more. Adult worms then produce microfilaria. Brugia malayi and B. timori are other parasitic roundworms that may act as causative agents .Among various imaging modalities, sonography is most commonly used for diagnosis and assessing treatment response.[3] The twirling motion of the microfilaria is seen on sonography as mobile echogenic materials and is described as the “filariasis dance.”[4],[5]


  Case Report Top


A 19-year-old boy from West Bengal, working in Kochi for the past 2 years presented with painless swelling in the right testis for last 6 months with mild low grade fever occasionally. Although he belonged to an area endemic for filariasis, he did not have a history of filariasis infestation previously. There was no history suggestive of any previous scrotal surgeries. On examination, the right epididymis was thickened, nontender, and firm; the spermatic cord was normal. His routine blood and urine examinations were normal.

Ultrasound scrotum was done which showed twirling motion of microfilariae noted in dilated lymphatic channels in the epididymis which is called filarial dance sign. The dilated channels are identified by the absence of color flow on Colour Doppler study (CDS) and the microfilariae as curvilinear echogenic undulating structures within it [Figure 1] and [Figure 2]. Generally 5-6 microfilariae are seen per channel. The video clip of the random, undulating motion is available in the link https://www.dropbox.com/s/0nyyb6gv5nqvlh6/Image01.mp4?dl=0.
Figure 1: Right epididymis showing swirling echogenic particle

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Figure 2: Dilated channels are identified with the absence of color flow on color Doppler study and the microfilariae as curvilinear echogenic undulating structures within it

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  Discussion Top


The findings first described as 'filarial dance' in men affected with lymphatic filariasis, a parasitic disease, were identified most commonly as due to W. bancrofti filarial roundworm. W. bancrofti is endemic in tropical and subtropical regions. It is transmitted through mosquitoes infected with microfilaria, the larval form of the filarial worm. Following a mosquito bite, the microfilaria invade human lymphatic channels and develop into adult worms, producing and releasing microfilaria, which eventually invade the bloodstream. In the acute phase, filariasis presents as acute lymphangitis. The chronic presentation is described as 'elephantiasis', with lymph edema of an affected limb, resulting from adult worms obstructing the lymphatic channels, causing extreme enlargement of the affected limb. Filariasis may also affect the lymphatic ducts of the inguinal channel and the scrotal sac, causing epididymitis, hydrocele, or scrotal swelling.


  Conclusions Top


Filarial dance sign is a pathognomonic ultrasound scan finding of scrotal filariasis.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
World Health Organization. Global Programme to Eliminate Lymphatic Filariasis. Progress Report 2000–2009 and Strategic Plan 2010–2020. Geneva, Switzerland: World Health Organization; 2010.  Back to cited text no. 1
    
2.
Nutman TB, Kumaraswami V: Regulation of the immune response in lymphatic filariasis perspectives on acute and chronic infection with Wuchereria bancrofti in South India. Parasite Immunology 200;23:389-99.  Back to cited text no. 2
    
3.
Mand S, Marfo-Debrekyei Y, Dittrich M, Fischer K, Adjei O, Hoerauf A. Animated documentation of the filaria dance sign (FDS) in bancroftian filariasis. Filaria J 2003;2:3.  Back to cited text no. 3
    
4.
Amaral F, Dreyer G, Figueredo-Silva J, Noroes J, Cavalcanti A, Samico SC, et al. Live adult worms detected by ultrasonography in human bancroftian filariasis. Am J Trop Med Hyg 1994;50:753-7.  Back to cited text no. 4
    
5.
Shyamkumar NK, Mehrotra S, Philip R, Taranath A, Nair S, Chacko NK. Can we see microfilaria on ultrasound? A real-time ultrasound and wet smear demonstration of dancing microfilaria. Internet J Urol 2004;2:1.  Back to cited text no. 5
    


    Figures

  [Figure 1], [Figure 2]



 

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Introduction
Case Report
Discussion
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