Finding the elephant in the room

Filariasis affects 120 million people in tropical and sub-tropical countries and involves infection, by means of a mosquito bite, with microscopic worms called microfilaria. These worms enter through the skin and travel to the lymph vessels, where they can grow into adults and live for up to seven years. When adults mate, they release millions of microfilaria into the blood stream.

Most people with filariasis don’t have any symptoms, but sometimes these worms block the lymph vessels and cause severe swellings. Extreme cases lead to elephant-looking limbs, a condition called elephantiasis.

An Indian man working in Qatar for two years, where filariasis has only been reported once previously, was recently diagnosed with the disease. His physicians say his case demonstrates the importance of having a high degree of clinical suspicion while evaluating patients with unusual signs and symptoms.

The 38-year-old man was admitted into Hamad General Hospital in Doha with fever, chills, shortness of breath and a tender, warm swelling on his right thigh. An ultrasound performed on the swelling revealed the “filarial dance sign”, which shows the twirling movement of microfilaria. Although rarely documented, this is considered a diagnostic sign of filariasis. Fine-needle aspiration from the swelling confirmed the presence of microfilaria.

Both of these findings are unusual in cases of filariasis, which is usually diagnosed by finding microfilaria in the bloodstream. However, they did not show up in blood tests done on this patient.

The patient was admitted to hospital and given a single dose of the anti-parasitic worm drug ivermectin. He was also given a diuretic to get rid of water accumulation in the body due to lymphatic obstruction, which was causing the patient’s chest and breathing symptoms. The leg swelling was also opened and drained the following day. The patient was kept in hospital and given anti-filaria treatment for two weeks, after which he was discharged from hospital due to resolution of his signs and symptoms. He was only put on an antibiotic for a further four weeks.

1. Shibu Kandalam, P. T. et al. An unusual presentation of filariasis in a nonendemic country. Qatar Med. J. 2015, 17 (2015). | article