Filarial Chyluria in Japan

Abstract

The clinical manifestations of bancroftian filariasis may be roughly classified into three stages: subclinical, acute, and chronic. Filaria bancrofti has a special predilection for the lymphatic system. After a long period of so-called “incubation,” the symptoms of the acute stage appear, e.g., repeated fever attacks, called “Kusafurui,” often associated with lymphangioadenitis. The chronic complications, occurring from five to twenty years after the primary infestation, are represented by various conditions, such as elephantiasis of the leg, hydrocele testis, chyluria, or permanent swelling of the lymph nodes. A survey of filariasis among 7,766 people in Okinawa by Saigo (1) showed an incidence of 14.24 per cent for microfilaremia, 1.07 per cent for chyluria, and 1.94 per cent for elephantiasis. Sassa (2) found a microfilaremia incidence of 10.76 per cent in 22,698 people in the Amami-Oshima and Okierabu Islands. These islands are far south of Japan and just north of Okinawa. Since lymphographic demonstration of filarial chyluria is of great interest, 30 cases are presented in this communication and the roentgenographic features are discussed, with special reference to lymphaticopelvic fistulization. The therapeutic effects of lymphography in chyluria are also taken up. In a review of the literature, the present authors found only three papers that include more than 5 cases of lymphography in chyluria, perhaps because of its rarity and peculiar intermittent behavior (3–5). Method and Materials Lymphography was carried out in 38 patients of the Amami-Oshima and Okierabu Islands. Radiographs were taken immediately and twenty-four hours after the injection of 10 cc of Ethiodol into the dorsum of each foot by Kinmonth's method. Between the end of July and the beginning of August 1966, 31 cases were studied by field survey lymphography, using condenser type apparatus. Six of 7 patients now live in a nonendemic region, Tokyo. Six of 38 patients were excluded because the amount of injected contrast medium was not sufficient to permit accurate roentgenographic analysis. Two additional patients, in whom filariasis was suspected, were also excluded. These live in Okierabu, and, although they suffer from urinary disturbances, urinalysis shows no chyluria. Thus, this paper is based on the findings in 30 cases. Only 2 of these patients were examined by lymphography with excretory urography. The age range of the 30 patients was from fourteen to sixty-seven years, the average being forty-six and two-tenths years. Seventy-three and two-tenths per cent were more than forty years of age. There were 10 males and 20 females. The time between the first appearance of bloody or milky urine and the lymphographic examination varied from one month to fifty-four years. The continuing duration of chyluria varied also from about one week to four months.