Chiluria in a lymphatic filariasis endemic area

BMC Research Notes, May 2018

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.

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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)


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Paulo Sérgio Ramos de Araújo, Valter Romão de Souza Junior, Anderson de Souza, Luciana de Barros Correia Fontes, Eduardo Brandao, Abraham Rocha. Chiluria in a lymphatic filariasis endemic area, BMC Research Notes, 2018, pp. 269, Volume 11, Issue 1, DOI: 10.1186/s13104-018-3357-y