Chiluria in a lymphatic filariasis endemic area
Araújo et al. BMC Res Notes
Chiluria in a lymphatic filariasis endemic area
Paulo Sérgio Ramos de Araújo 0 1 2
Valter Romão de Souza Junior 0 2
Anderson de Souza 0 2
Luciana de Barros Correia Fontes 0 2
Eduardo Brandao 1
Abraham Rocha 1
0 Federal University of Pernambuco , Av. Prof. Moraes Rego 1235, Recife, Pernambuco 50670‐901 , Brazil
1 Instituto Aggeu Magalhaes, FIOCRUZ , Av. Prof. Moraes Rego 1235, Recife 50670‐901 , Brazil
2 Federal University of Pernambuco , Av. Prof. Moraes Rego 1235, Recife, Pernambuco 50670‐901 , Brazil
Objective: To establish clinical and laboratory data of individuals presenting chyluria in endemic areas. Results: 75 individuals were studied. The majority were females with an average age of 45 years residing in the Metropolitan Region of Recife. The mean time between the beginning of the presentation of chyluria and the first care service in the Serviço de Referencia Nacional em Filarioses was approximately 5 years. The most frequent urinalysis changes were hematuria (27.6%), leukocytes (21.9%) and proteinuria (10.5%). The Addis test showed mean values of 155.43 E/min/mL of cylinders, 52,892 E/min/mL of erythrocytes and 291,660 E/min/mL of leukocytes. Among recorded cases, proteinuria had a mean value of 1372.80 mg/dL in 24 h, and the presence of lymphocytes in the urine was positive in 68.3%. Among lymphatic filariasis tests, immunochromatography was positive in 16.7%, there was circulating filarial antigen determined by detection of OG4C3 antibodies in 7.7% and microfilaremia in only 1/55.
Chyluria; Lymphatic filariasis; Wuchereria bancrofti
Introduction
Lymphatic filariasis (LF), also known as elephantiasis,
occurs through infection by Brugia malayi, Brugia timori
and Wuchereria bancrofti [
1, 2
]. It has been considered
a neglected disease, responsible for permanent or
longterm physical disabilities in more than 40 million people,
a considerable portion of a total of 120 million people
infected worldwide [
3, 4
]. Endemic in 72 subtropical and
tropical countries, it is estimated that there are 947
million individuals at risk of infection in 54 countries [
5–7
].
Currently, according to the Pan American Health
Organization, there are 720,000 infected people in the
American continent, distributed in Guyana, Dominican
Republic and Haiti, and 9 million people living in areas
with a risk of contamination [
8
]. In Brazil, there is no
record of new autochthonous cases of MCF since 2014,
causing the Ministry of Health to start a program of
verification and elimination of LF, aiming the interruption of
its transmission [
9
].
Adult worms of Wuchereria bancrofti prefer the
lymphatic system, where they are able to live from 4 to
8 years [
10
]. Despite a tropism through lymphatic vessels,
the pathogenesis of the damage is still not completely
clear. It is known, however, that the presence of adult
worms in vessels and lymph nodes, mainly in the
pelvic region (legs and scrotum), breasts and arms, causes
damage to these structures, leading to lymphedema,
hydrocele, keruria and elephantiasis [
11–13
]. Although it
occurs in other clinical conditions, lymphatic fistulation
syndromes (lichen, kilocele, and lymphocele) are
considered strongly associated with this pathology in endemic
areas of LF.
Chyluria, or milky urine, is the presence of pylorus in
the urine, a fluid composed of lymph and chylomicrons
absorbed by lymphatic vessels, transported to the
thoracic duct and then drained into the subclavian vein.
Normally, lymphatic vessels do not communicate with
the urinary tract. When this occurs, the chylium escapes
into the urine, and the point of leakage may occur in the
kidney, ureter or bladder. The urine then acquires a
characteristically milky coloration [
14, 15
].
It is believed that approximately 2–10% of
individuals with LF develop chyluria, which is the main parasitic
etiology of this clinical finding [
16–18
]. Chyluria
generally occurs several years after infection by Wuchereria
bancrofti and is characteristically intermittent [
19
]. As it
causes protein loss, its association with asthenia, weight
loss and malnutrition is common [
20
].
Main text
Methods
Study area, population and study design
A retrospective study was carried out, based on data
recorded in the records of the National Reference
Service in Filariasis of the Aggeu Magalhães Research
Center (CPqAM), a unit of the Oswaldo Cruz Foundation
(Fiocruz) in the State of Pernambuco, Recife, northeast of
Brazil. This service meets the demands of all regions of
the country.
There was respect for the universal principles of
Human Rights and Bioethics in Research. The project
was previously approved by Ethics Committee of
Instituto Aggeu Magalhaes. It was considered a census
sample of medical records of patients seen between 1996 and
2016.
In the analysis of the data, measurements of central
tendency, dispersion measures and statistical tests were
obtained, adopting a sampling error of 5%, wi (...truncated)