Scrotal Filariasis
Introduction
Introduction to scrotal filariasis Scrotal filariasis is an early lesion of genitourinary filariasis. The main lesion is the accumulation of blood filaria adults or their corpses in the lymphatics or tiny veins of the spermatic cord, causing local inflammation, fiber proliferation, or due to corpus toxins. Tissue edema, infection, etc. basic knowledge The proportion of illness: 0.002% Susceptible people: male Mode of infection: mosquito bite spread Complications: Epididymitis orchitis acute lymphangitis acute lymphadenitis lymphedema vulvar elephantiasis myocarditis
Cause
Cause of scrotal filariasis
(1) Causes of the disease
Most of the male reproductive system filariasis is caused by early or late male reproductive lymphatic damage caused by the filariasis. The scrotal filariasis is caused by filarial infestation in the inguinal region and the scrotal spermatic lymphatics and lymph nodes. To.
(two) pathogenesis
Filaria adult parasitic in the lymphatic system, causing mechanical damage and allergic inflammatory reaction, resulting in chyle pool, lymphatic vessels near the main trunk of the lumbar intestine, lymphatic vessels in the central part, lymphatic wall, especially valve damage, causing lymph The tube is distorted, the valve is incomplete, the chyle lymph fluid is delayed, the retention is increased, the pressure in the tube is increased, and the liquid falls back into the telecentric tube. The long-term depression results in a relatively large range of relative atresia and lymphatic varices in the distal lymphatic valve. .
After infection with silkworms, half of the patients did not develop symptoms and there was microfilaria in the blood, which became "asymptomatic infected". Malay filars mainly parasitized in the superficial lymphatic system, which could cause lymph nodes or lymphangitis of the extremities and lymphedema of lower limbs. Or rubber swelling, generally no genitourinary damage, in addition to parasitic in the lymphatic system of the limbs, the filariasis can also be parasitic in the deep lymphatic system, such as the lymphatic tissue near the abdominal cavity and spermatic cord, so deep symptoms such as chyluria and spermatic cord Inflammation and nodules of the epididymis, testis, scrotum, etc. are more common.
Prevention
Scrotal filariasis prevention
(1) Anti-mosquito and mosquito killing
Cut off the means of transmission and eliminate mosquito breeding grounds. It is best to use mosquito nets during the mosquito season; when working outdoors, pay attention to the skin on the exposed parts such as anti-mosquito oil, mosquito repellent and other repellents. The head can be impregnated with 701 anti-mosquito net made of cotton. .
(2) census
In the summer, a census of people over 1 year old in the epidemic area requires more than 95% of the residents to receive blood collection; early detection of patients and worms, timely cure, not only to ensure the health of the people, but also to reduce and eliminate the source of infection. In the winter, the microfilariae-positive or microfilaria-negative but with a history and signs of filariasis were treated.
(3) Epidemiological surveillance
Strengthen epidemiological surveillance of areas where basic filariasis indicators have been eliminated. In the monitoring work, it should be noted that: 1 the original positive patients should be reviewed and re-examined; those who have not been tested in the past should be supplemented and supplemented; at the same time, the management of the floating population should be strengthened, and the patients should be treated promptly until they turn negative.
2 Strengthen the mosquito-borne surveillance of blood-positive households and find that infected mosquitoes, that is, focus on infected mosquitoes, expand blood tests and kill mosquitoes to surrounding people to remove epidemic spots and prevent further spread.
(4) Protect susceptible populations
In the endemic areas, the sea group raw salt therapy is used. Each kilogram of salt is mixed with seaweed 3g, with an average of 16.7g of salt per person per day, containing 50mg of sea group, which can reduce the positive rate of microfilaria in the population.
Complication
Scrotal filariasis complications Complications Epididymitis orchitis acute lymphangitis acute lymphadenitis lymphedema vulva elephant skin swelling myocarditis
The disease is often accompanied by epididymitis, occasionally orchitis. In the acute phase, it can also have recurrent lymphangitis, lymphadenitis and fever. The chronic phase is lymphedema and elephantiasis. In severe cases, myocarditis, lower extremity or scrotal edema, mental symptoms and even exhaustion may occur.
Symptom
Symptoms of scrotal filariasis Common symptoms Inflammatory cell infiltration
History
History of filariasis, history of filariasis.
2. Clinical manifestations
(1) Acute spermatic sinusitis: can cause local severe pain, radiating to the lower abdomen and waist; or mild, only dull pain, pulling feeling, physical examination shows swelling of the spermatic cord, hardening, diffuse thickening, hypertrophy, Touching the nodules, the nodules are not connected with the vas deferens, and are mostly located at the lower end of the spermatic cord and the tail of the epididymis, which may have mild fever.
(2) spermatic lymphangiitis: common in recurrent seizures, the spermatic cord is thick, tortuous, dilated, beaded, or the bundle is thick and thick, and the activity and standing position are aggravated, rest and lying When the position is relieved, occasionally the lymphatic vessels are dilated like a cyst, and the inside is white or light yellow turbid liquid, and the texture is soft.
(3) hydrocele and sheath chyle: a common complication of filariasis, less initial effusion, due to orchitis, epididymitis recurrence caused by increased fluid volume, up to hundreds of milliliters, can make the penis Indented into the scrotum, the effusion is grassy yellow at the early stage, clear and transparent; the lymphatic varices of the late sheath are ruptured, and the chyle falls into the capsular sac called the sheath chyle, and the effusion is milky white, often the microfilaria is found. Late sheath hypertrophy, fibrotic plaque, testicular compression and atrophy, positive early in the light transmission test, negative in the late sheath wall hypertrophy with chyle.
3. Experimental treatment of methotrexate, carbazone treatment, often in the spermatic cord, epididymis appeared new granulomatous nodules, the general granulomatous nodules can not subside.
Examine
Examination of scrotal filariasis
1. Blood tests for eosinophils in peripheral blood, and blood venous can be seen at night.
2. In the hydrocele, microfilaria, spermatic cord and epididymal nodule biopsy can confirm filariasis, and the silkworm adult can be picked out in its profile.
3. Body fluid and urine examination Microfilaria: Microfilaria can also be found in various body fluids and urine, so microfilaria can be found in hydrocele, lymph, ascites, chyluria and urine. Direct smear of the above body fluids may be taken, staining microscopic examination; or by centrifugation concentration method, membrane filtration concentration method and the like. The liquid containing chyle can be added with ether to fully dissolve the fat, remove the fat layer above, dilute with water 10 times, centrifuge at 1500-2000 rpm for 3 to 5 minutes, and take a sediment microscopy.
4. Biopsy in the blood microfilaria examination negative patients may take subcutaneous nodules, superficial lymph nodes, epididymal nodules and other pathological biopsy to determine the diagnosis.
Diagnosis
Diagnosis and identification of scrotal filariasis
diagnosis
According to the epidemic areas, the history of personal infections, other signs of filariasis, and positive blood microfilariae, it is not difficult to make a diagnosis.
Differential diagnosis
1. However, it should be differentiated from non-filaria complications such as pseudo-elephantiasis or elephantiasis nostra, which is often caused by chronic streptococcal infection of the scrotal lymphatic system. Lymphatic obstruction, connective tissue edema, inflammatory cell infiltration, and other diseases such as cancer spread, syphilis and other sexually transmitted diseases can also cause rubber-like changes.
2. Acute epididymis, orchitis mainly manifests as testicular pain and swelling of the scrotum, can be radiated to the lower abdomen and waist, has a sense of traction, physical examination of the testicles, epididymal enlargement, hard, tender, but the patient has no filaria The history of infection often occurs after exertion. There are often urinary tract devices and indwelling catheterization history, accompanied by systemic symptoms such as fever and chills. Although the scrotum is swollen, there is no rough skin thickening, cleft palate and secondary infection. Blood routine showed a significant increase in neutrophils and antibiotic treatment.
3. Testicular hydrocele also showed scrotal swelling with sac sexy, positive light transmission test, similar to the scrotal filariasis colitis effusion, but the patient has no history of filariasis, more epididymitis, spermatic inflammation And fever symptoms, the sheath cyst puncture fluid is clear, while the sheath chyle effusion fluid test is positive in the early stage, but it is negative in the late stage. The sheath capsule puncture fluid is chylomorphous or turbid amber, in a few effusions. I found the microfilaria.
