Description, Causes and Risk Factors:
Cellulitis of the spermatic cord due to filariasis; occurs endemically in Sri Lanka and Egypt, and probably elsewhere in the East. Filarial funiculitis is a protozoal disease which is encountered most commonly in Central Africa, South America, India, and South China, while there are some endemic foci in Southern Spain, Tangier, the Nile delta, Turkey. Man is the final host, and the vector and intermediate host is the mosquito.
Filarial funiculitis result from infection with vector-borne tissue-dwelling nematodes called filariae. Depending on the species, adult filariae may live in the lymphatics, blood vessels, skin, connective tissues or serous membranes. The females produce larvae (microfilariae) which live in the bloodstream or skin. All true filariae that infect humans (superfamily Filarioidea; family Onchocercidae) are transmitted by dipteran vectors. The guinea worm (superfamily Dracunculoidea) is not a true filaria but is included in this section as a related nematode transmitted by arthropod vectors. A few species of animal ?lariae may accidentally infect humans. The transmission of human filariae is con?ned to warm climates, a high temperature being necessary for the parasites to develop in the vectors.
The adult worms reside in the lymphatics of the human host. Female W. bancrofti measure 80-100 × 0.25 mm and the male 40 × 0.1 mm. The adult Brugia spp. have only half of this dimension. Microfilariae are produced from ova in the uterus of the female worm. They are sheathed and measure on average 260 × 8 mm. Microfilariae are ingested by the vector female mosquito during a blood meal. They exist in the mosquito stomach, becoming first-stage larvae which penetrate the stomach wall of the mosquito and migrate to the thorax muscles. There they develop through two moults to the infective third-stage larvae (15mm – 20 mm). The development in the mosquito takes a minimum of 10–12 days. Mature infective larvae then migrate to the mouthparts of the mosquito from where they enter the skin of the human host, probably through the puncture site made by the proboscis of the vector when it takes its blood meal. The larvae migrate to the lymphatics and develop into adult worms. Microfilariae appear in the blood after a minimum of 8 months in W. bancrofti and 3 months in B. malayi. The adult worms may live and produce microfilariae for more than 20 years, but on average the lifespan is shorter. Microfilariae have a lifespan of approximately 1 year. Microfilarial densities may reach 10 000 per mL of blood or more but are usually lower.
Signs and Symptoms may include:
- Acute scrotum syndrome.
- Scrotal edema/swelling.
- Scrotal pain.
- Spermatic Cord Mass.
- Swelling of scrotum.
- Tender spermatic cord/vas.
- Thickened/doughy texture spermatic cord.
- Pain/abdomen inguinal radiation.
- Pain/abdomen radiation to genitals.
- Inguinal Mass/Swelling.
Other Symptoms May Include:
Chills or shaking.
- Excessive sweating.
- High fever (higher than 101 degrees Fahrenheit).
- Muscle aches and pains.
- Nausea with or without vomiting.
Differential diagnosis of filarial funiculitis includes indirect inguinal hernia, hydrocele, spermatocele, hematocele, lipoma, tuberculosis, and filariasis.
CBC count: Patients with patent filarial funiculitis commonly have marked eosinophilia.
- Serum immunoglobulins: Elevated serum levels of immunoglobulin E (IgE) and immunoglobulin G4 (IgG4) are seen with filarial funiculitis.
- Commercial tests to detect circulating filarial antigen (CFA) using monoclonal antibodies are widely available.
- Urine examination: Chyluria may be detected macroscopically, and microfilariae may be detected via microscopic examination of voided urine. Proteinuria and hematuria may also be seen with microfilarial infection with renal involvement.
- Peripheral blood examination: Microfilariae may be detected via microscopic examination of peripheral blood. Microfilariae demonstrate a circadian pattern that varies by endemic region, necessitating serum sampling that coincides with periods of activity. Activity may be provoked with administration of DEC.
Imaging: An ultrasound of the inflamed testicle or both can tell the difference between orchitis and testicular torsion, another painful condition.
A course of antibiotics is usually advised as soon as filarial funiculitis is diagnosed. These normally work well. Pain usually ceases within a few days, but swelling may take a week or so to go down, sometimes longer. The choice of the antibiotic depends on the underlying cause of the infection. Common side effects of antibiotics include upset stomach and diarrhea.
Applying a cold compress to the scrotum also helps reduce the inflammation. It also soothes any irritation you might be experiencing. Practice good hygiene and use mild soaps when bathing and wash undergarments in mild detergents; this helps ease the irritation.
Home Remedies: It is recommended that individuals suffering from filarial funiculitis drink a cup of dandelion tea every day. The tea helps ease swelling. Ancient and traditional schools of medicine also recommend herbs like Echinacea, Caltrop and Yellow Duck as a remedy for Filarial funiculitis. These are available in forms of tinctures and capsules. They possess strong antibiotic, immune enhancing, and antibacterial properties.
NOTE: The above information is for processing purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.
DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.
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