A Mechanism for Chronic Filarial Hydrocele with Implications for Its Surgical Repair

Chronic hydrocele is the accumulation of fluid around the testis leading to an increase in the volume of the scrotal contents. Depending on the volume of fluid, hydrocele can be disfiguring and even incapacitating. Chronic hydrocele has multiple etiologies, but irrespective of the cause, surgery is the standard form of treatment and this can be done using different surgical techniques. The prevalence of chronic hydrocele in bancroftian filariasis endemic areas—a parasitic disease transmitted by mosquito—is very high and represents the most common clinical manifestation of bancroftosis, following by swollen legs of lower limbs or lymphedema among women. In Greater Recife, northeastern, Brazil, a bancroftian filariasis endemic area, a pioneering, prospective surgical study proposes a new mechanism for filarial-induced hydrocele and presents evidence that the filarial hydrocele fluid may damage the testis. Thus, based on the findings presented, the authors propose that in bancroftian filariasis endemic areas hydrocele patients should be operated on using a specific surgical technique in order to avoid recurrence of the disease, and consequently, additional damage to the testicle

Feasibility and Effectiveness of Basic Lymphedema Management in Leogane, Haiti, an Area Endemic for Bancroftian Filariasis

Lymphatic filariasis is a parasitic disease that is spread by mosquitoes. In tropical countries where lymphatic filariasis occurs, approximately 14 million people suffer from chronic swelling of the leg, known as lymphedema. Repeated episodes of bacterial skin infection (acute attacks) cause lymphedema to progress to its disfiguring form, elephantiasis. To help achieve the goal of eliminating lymphatic filariasis globally, the World Health Organization recommends basic lymphedema management, which emphasizes hygiene, skin care, exercise, and leg elevation. Its effectiveness in reducing acute attack frequency, as well as the role of compressive bandaging, have not been adequately evaluated in filariasis-endemic areas. Between 1995 and 1998, we studied 175 people with lymphedema of the leg in Leogane, Haiti. During Phase I of the study, when compression bandaging was used to reduce leg volume, the average acute attack rate was 1.56 episodes per year; it was greater in people who were illiterate and those who used compression bandages. After March 1997, when hygiene and skin care were emphasized and bandaging discouraged, acute attack frequency significantly decreased to 0.48 episodes per year. This study highlights the effectiveness of hygiene and skin care, as well as limitations of compressive bandaging, in managing lymphedema in filariasis-endemic areas

A complexidade do custo socioeconômico da filariose linfática

A falta de conhecimento do impacto socioeconômico das diversas doenças é, geralmente, um dos maiores obstáculos para a obtenção de verbas para investimentos em pesquisa aplicada, assim como para iniciar a implementação de programas de controle necessários aos países em desenvolvimento. Os autores analisam e ressaltam aspectos relevantes da complexidade de quantificação do impacto socioeconômico da filariose linfática e enfatizam as lacunas existentes em algumas áreas do conhecimento, que ainda não foram devidamente exploradas para os portadores da doença. Aos dados de literatura aliam os ecos do aprendizado adquirido através do atendimento de pacientes portadores de infecção e doença bancroftiana em serviço terciário de referência do Núcleo de Ensino Pesquisa e Assistência em Filariose (NEPAF), Recife, Brasil. O impacto social, no seu sentido mais abrangente, mostra indícios fortes de perdas na qualidade de vida dos pacientes, infelizmente ainda pouco documentadas e, até certo ponto, de muito difícil contabilização, pelo tão peculiar abandono social das comunidades endêmicas