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Intrascrotal Nodules in Adult Men as a Marker for Filarial Granuloma in a Bancroftian Filariasis-Endemic Area

A retrospective study was undertaken in Recife, Brazil to evaluate the specificity of intrascrotal nodules detected by physical examination as a marker of dead or degenerating adult Wuchereria bancrofti worms (filarial granuloma). A total of 372 nodules from 340 adult male patients (mean age 23.1 years) were studied. Of those, 253 (68%) nodules were from 226 patients treated with antifilarial drugs (Group 1) and 119 (32%) nodules were considered non-drug related and were obtained from 114 patients (Group 2). On histologic examination, all nodules from Group 1 and all but one (99.1%) from Group 2 contained degenerated or dead adult worms. In the one case without filarial granuloma, ectopic cortical adrenal tissue was found in the spermatic cord. These findings emphasize the high specificity of intrascrotal nodules for bancroftian granuloma and draw attention to the importance of examining the scrotal contents of young men in studies of antifilarial drug efficacy. These findings also have potential implications for bancroftian filariasis control programs.

Received March 18, 2009. Accepted for publication May 8, 2009.

Acknowledgments: We thank David Addiss for critically reading and making valuable suggestions on the original manuscript; Hospital das Clínicas (NEPAF) at the Federal University of Pernambuco, where all biopsies were performed; Carmelita Cavalcanti for technical assistance and Wendilynn W. McAfee for invaluable help with literature retrieval.

Finacial support: The study was supported by NGO Amaury Coutinho, Recife, Brazil.

Disclaimers: None of the authors have conflicts of interest to declare.

^* Address correspondence to Gerusa Dreyer, Organização Não Governamental Amaury Coutinho para Doenças Endêmicas e Tropicais, Rua Conselheiro Portela, 665, Sala 120, Graças, Recife, Pernambuco, Brazil, CEP 52020-030. E-mail: dreyer-g{at}uol.com.br

Authors’ addresses: Joaquim Norões, Departamento de Cirurgia, Centro de Ciências da Saúde, Universidade Federal de Pernambuco, Av. Prof. Moraes Rego s/n, Cidade Universitária, Recife-PE, Brazil, CEP 50670-900; Organização Não governamental Amaury Coutinho para Doenças Endêmicas e Tropicais, Rua Conselheiro Portela, 665, Sala 120, Graças, Recife-PE, Brazil, CEP 52020-030, Tel: 55 81 34264348, Fax: 55 81 34426195, E-mail: jnoroes{at}hotmail.com. José Figueredo-Silva, Núcleo de Ensino e Pesquisa em Patologia, Faculdade de Ciências Médicas, Universidade Estadual do Piauí, Rua Olavo Bilac, 2335 - Centro-Sul, Teresina-PI, Brazil, CEP 64001-280; Organização Não governamental Amaury Coutinho para Doenças Endêmicas e Tropicais, Rua Conselheiro Portela, 665, Sala 120, Graças, Recife-PE, Brazil, CEP 52020-030; Tel/Fax: 55 86 3221 4749, E-mail: figueredo_silva{at}hotmail.com. Gerusa Dreyer, Núcleo de Ensino Pesquisa e Assistência em Filariose (NEPAF), Hospital das Clínicas, Universidade Federal de Pernambuco, Av. Prof. Moraes Rego s/n, Cidade Universitária, Recife-PE, Brazil, CEP 50670-900, Centro de Pesquisas Aggeu Magalhães, Fundação Oswaldo Cruz, (FIOCRUZ), Av. Prof. Moraes Rego s/n, Cidade Universitária, Recife-PE, Brazil, CEP 50670-420; Organização Não governamental Amaury Coutinho para Doenças Endêmicas e Tropicais, Rua Conselheiro Portela, 665, Sala 120, Graças, Recife-PE, Brazil, CEP 52020-030, Tel: 55 81 34264348, Fax: 55 81 34426195, E-mail: dreyer-g{at}uol.com.br.

Reprint requests: Gerusa Dreyer, Organização Não Governamental Amaury Coutinho para Doenças Endêmicas e Tropicais, Rua Conselheiro Portela, 665, Sala 120, Graças, Recife, Pernambuco, Brazil, CEP 52020-030, E-mail: dreyer-g{at}uol.com.br.