| Abstract|| |
Filariasis, a tropical parasite infection, is a common public health problem in the Indian sub-continent. Occurrence of filariasis with chronic myeloid leukemia (CML) is unusual though there are case reports of leishmaniasis, malaria, and other vector-borne diseases seen in association with leukemias. Filariasis co-existing with CML has not been documented to the best of our knowledge and hence definitely needs a space in literature. We report an incidental finding of bancroftian filariasis in a 35-year-old female already diagnosed as CML.
Keywords: Bancroftian filariasis, chronic myeloid leukemia, microfilaria
|How to cite this article:|
Kinger M, Chakrabarti PR, Sharma S, Kiyawat P. Unusual case of bancroftian filariasis co-existing with chronic myeloid leukemia. Ann Trop Med Public Health 2014;7:64-6
|How to cite this URL:|
Kinger M, Chakrabarti PR, Sharma S, Kiyawat P. Unusual case of bancroftian filariasis co-existing with chronic myeloid leukemia. Ann Trop Med Public Health [serial online] 2014 [cited 2019 Nov 15];7:64-6. Available from: http://www.atmph.org/text.asp?2014/7/1/64/145028
| Introduction|| |
Filariasis is caused by thread-like nematode worms and it is a major health problem in India, and the main culprits are Wuchereria bancrofti and Brugia malayi. Despite its high incidence, it is unusual to find microfilaria along with leukemia. There are only few cases of co-existent microfilaria with neoplasm. Presence of filariasis along with chronic myeloid leukemia (CML) is not described in the literature so far. Here, we describe bancroftian filariasis in a female with CML.
| Case Report|| |
A 35-year-old female presented with high-grade fever with chills and excess sweating, pain in the abdomen located over left hypochondrium, nonradiating, mild dragging in character for 2 months. Pallor and icterus were present along with yellow discoloration of urine. Per abdomen examination revealed hepatospleenomegaly.
The investigation revealed hemoglobin of 8.8 g/dL, total leukocyte count was 1,70,200 cells/mm 3 and platelet count was 5.48 lacs/mm 3 and differential leukocyte count showed the presence of myeloblast 4%, promyelocyte 2%, myelocyte 18%, metamyelocyte 3%, band forms 20%, neutrophils 38%, lymphocyte 1%, eosinophils 4%, basophils 5%. Stained peripheral smears showed normocytic normochromic red blood cells, with marked leukocytosis and shifted to left upto myeloblast with basophilia. Platelets were adequate in number. Microfilariae of W. bancrofti were seen, which were sheathed and had no nuclei in the tail tip. Higher magnification revealed a clear space at the cephalic and caudal ends of the Microfilaria. The final diagnosis of CML with bancroftian filariasis was made [Figure 1] and [Figure 2]. Erythrocyte sedimentation rate was 36 mm/h (Wintrobes method). Ultrasonography of the abdomen revealed enlarged liver (14 cm) and spleen (12 cm). Liver function tests were as follows: Aspartate aminotransferase, 80 IU/L (reference: 5-45 IU/L); alanine aminotransferase, 20 IU/L (reference: 5-45 IU/L) and serum bilirubin were within normal limits. Prothrombin time, activated partial thrombin time, serum electrolytes and glucose-6-phosphate dehydrogenase enzyme levels were in normal range. Renal function test was in normal range. BCR-ABL was done by qualitative reverse transcriptase-polymerase chain reaction and it was positive.
|Figure 1: Photomicrograph showing a sheathed microfi laria (Wucheria bancrofti) in peripheral smear (Field stain ×400)|
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|Figure 2: Photomicrograph showing a sheathed microfi laria (Wucheria bancrofti) with tail tip free of nuclei (Field stain ×1000)|
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| Discussion|| |
Filariasis is considered endemic in tropical and subtropical regions of Asia, Central and South America and Pacific island nations.  It's a global problem affecting over 120 million people in 80 countries. There are at least eight species of Filarial parasite that are specific to man, W. bancrofti, B. malayi, Onchocerca volvulus, Loa loa, Mansonella ozzardi, Mansonella perstan, Mansonella streptocerca, Brugia timori. Out of these only three nematode worms W. bancrofti, B. malayi and B. timori are found in India and cause lymphatic filariasis.  W. bancrofti is the most wide spread of filarial nematode infecting humans. Humans are exclusive host. Mosquito species belonging to the Anopheles, Culex, Aedes, Mansonia, Coquillettidia, Ochlerotatus genera are carriers of lymphatic filariasis.  In India vectors are Culex mosquites in most urban and Anopheles in rural areas.  Microfilaria of W. bancrofti and B. malayi occurring in India displays a nocturnal periodicity, i.e., they appear in large numbers at night and retreat from the peripheral blood stream during the day. , The maximum density in blood is reported between 10 p.m and 2 a.m in blood capillaries.  Microfilaremia is diagnosed primarily through direct observation in peripheral blood, using gold standard known as the finger prick test. 
As Dipetalonema perstans, M. ozzardi are not sheathed and B. malayi and L. loa have nuclei in the tail tip, the diagnosis of microfilaria W. bancrofti was made.  Laboratory diagnosis of microfilaria is conventionally made by demonstration in peripheral blood smear. Adult worm reside in lymphatic vessels, and the larval form may circulate in the peripheral blood.  In humans, W. bancrofti is the most common filarial parasite which causes lymphatic filariasis. They are found in fine needle aspiration cytology smears from the thyroid, breast, lymphnodes and subcutaneous nodules in the cervical scrap smears, in bronchial washings, and in the body fluids. 
In the endemic areas, all the peripheral smears and aspirates must be screened for microfilaria, to detect any asymptomatic carriers.  Peripheral blood eosinophilia is a common hematologic finding in filariasis, but it was not noted in our case. This may be due to the oxidative stress which was associated with the chronic filariasis and CML, which had altered immune response. 
This case is unique as here Microfilaria has been reported in the patient with CML and Microfilaria was a coincidental finding on peripheral smear. Prevalence of microfilaria in females was lower than that of males in South-East Asia and particularly India. Gender Specific estimates indicate that prevalence of W. bancrofti infection in males was 10% more than in females. 
| Conclusion|| |
The co-existence of parasitic and the neoplastic illness in our case is purely incidental. Filariasis in association with solid malignancies is well-described in the literature. However, this case is, to the best of our knowledge, the first with concomitant CML.
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Preeti Rihal Chakrabarti
404, Akanksha Appartments, Sri Aurobindo Medical College and PG Institute, Sanwer Road, Indore - 452 001, Madhya Pradesh
Source of Support: None, Conflict of Interest: None
[Figure 1], [Figure 2]