Volume 81, Issue 2
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645


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 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.


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  1. Santiago-Stevenson D, Oliver-González J, Hewitt RI, 1947. Treatment of filariasis bancrofti with 1-diethylcarbamyl-4-methylpiperazine hydrochoride (“Hetrazan”). JAMA 135 : 708–712.
  2. Galliard H, 1971. Effects of diethyl-carbamazine on lymphatic filariosis at the beginning of the prophylactic campaign in Tahiti. Bull Soc Pathol Exot Filiales 64 : 340–343.
  3. Galliard H, Mille R, 1949. Essais de traitement de la filariose à Wuchereria bancrofti var. pacifica par le 1-diéthyl-carbamyl-4-méthyl pipérazine, à Tahiti. Bull Soc Pathol Exot 42 : 304–313.
  4. Ch’en T-T, 1964. Demonstration of macrofilaricidal action of hetrazan, antimony and arsenic preparations in man. Chinese Med J 83 : 625–640.
  5. Ch’en T-T, Ch’en C-T, Hsü F-Y, Hsü C-K, Lo H-M, Hsü H-C, Yang C-L, Hu M-T, Shih H-L, 1959. Preliminary observations on intensive Hetrazan treatment of filariasis. Chin Med J 78 : 174.
  6. Jungmann P, Figueredo-Silva J, Dreyer G, 1992. Bancroftian lymphangitis in northeastern Brazil: a histopathological study of 17 cases. J Trop Med Hyg 95 : 114–118.
  7. Dreyer G, Pires ML, Andrade LD, Lopes E, Medeiros Z, Tenorio J, Coutinho A, Norões J, Figueredo-Silva J, 1994. Tolerance of diethylcarbamazine by microfilaraemic and amicrofilaraemic individuals in an endemic area of bancroftian filariasis, Recife, Brazil. Trans R Soc Trop Med Hyg 88 : 232–236.
  8. Dreyer G, Coutinho A, Miranda D, Norões J, Rizzo JA, Galdino E, Rocha A, Medeiros Z, Andrade LD, Santos A, Figueredo-Silva J, Ottesen EA, 1995. Treatment of bancroftian filariasis in Recife, Brazil: a two year comparative study of the efficacy of single treatments with ivermectin or diethylcarbamazine. Trans R Soc Trop Med Hyg 89 : 98–102.
  9. Figueredo-Silva J, Jungmann P, Norões J, Piessens WF, Coutinho A, Brito C, Rocha A, Dreyer G, 1996. Histological evidence for the adulticidal effect of low doses of diethycarbamazine in bancroftian filariasis. Trans R Soc Trop Med Hyg 90 : 192–194.
  10. Rocha A, Addiss D, Ribeiro ME, Norões J, Baliza M, Medeiros Z, Dreyer G, 1996. Evaluation of the Og4C3 ELISA in Wuchereria bancrofti infection: infected persons with undetectable or ultra-low microfilarial densities. Trop Med Int Health 1 : 859–864.
  11. Norões J, Dreyer G, Santos A, Mendes VG, Medeiros Z, Addiss D, 1997. Assessment of the efficacy of diethylcarbamazine on adult Wuchereria bancrofti in vivo. Trans R Soc Trop Med Hyg 91 : 78–81.
  12. Dreyer G, Addiss D, Santos A, Figueredo-Silva J, Norões J, 1998. Direct assessment in vivo of the efficacy of combined single-dose ivermectin and diethylcarbamazine against adult Wuchereria bancrofti. Trans R Soc Trop Med Hyg 92 : 219–222.
  13. Dreyer G, Medeiros Z, Netto MJ, Leal NC, De Castro LG, Piessens WF, 1999. Acute attacks in the extremities of persons living in an area endemic for bancroftian filariasis: differentiation of two syndromes. Trans R Soc Trop Med Hyg 93 : 413–417.
  14. Dreyer G, Santos A, Norões J, Addiss D, 1999. Proposed panel of diagnostic criteria, including the use of ultrasound, to refine the concept of “endemic normals” in lymphatic filariasis. Trop Med Int Health 4 : 575–579.
  15. Figueredo-Silva J, Norões J, Cedenho A, Dreyer G, 2002. The histopathology of bancroftian filariasis revisited: the role of the adult worm in the lymphatic-vessel disease. Ann Trop Med Parasitol 96 : 531–541.
  16. Norões J, Addiss D, Cedenho A, Figueredo-Silva J, Lima G, Dreyer G, 2003. Pathogenesis of filarial hydrocele: risk associated with intrascrotal nodules caused by death of adult Wuchereria bancrofti. Trans R Soc Trop Med Hyg 97 : 561–566.
  17. Figueredo-Silva J, Dreyer G, 2005. Bancroftian filariasis in children and adolescents: clinical-pathological observations in 22 cases from an endemic area. Ann Trop Med Parasitol 99 : 759–769.
  18. Figueredo-Silva J, Norões J, Addiss D, Dreyer G, 2008. Sex ratio of Wuchereria bancrofti in surgical specimens from an endemic area of Brazil. Ann Trop Med Parasitol 102 : 229–238.
  19. Dreyer G, Lins R, Norões J, Rizzo JA, Figueredo-Silva J, 2008. Sensitivity of the ICT test relative to detection of adult Wuchereria bancrofti worms by ultrasound. Am J Trop Med Hyg 78 : 28–34.
  20. Norões J, Addiss D, Amaral F, Coutinho A, Medeiros Z, Dreyer G, 1996. Occurrence of living adult Wuchereria bancrofti in the scrotal area of men with microfilaremia. Trans R Soc Trop Med Hyg 90 : 55–56.
  21. Norões J, Addiss D, Santos A, Medeiros Z, Coutinho A, Dreyer G, 1996. Ultrasonographic evidence of abnormal lymphatic vessels in young men with adult Wuchereria bancrofti infection in the scrotal area. J Urol 156 : 409–412.
  22. Reddy GS, Das LK, Pani SP, 2004. The preferential site of adult Wuchereria bancrofti: an ultrasound study of male asymptomatic microfilaria carriers in Pondicherry, India. Natl Med J India 17 : 195–196.
  23. Michael E, Bundy DAP, Grenfell BT, 1996. Re-assessing the global prevalence and distribution of lymphatic filariasis. Parasitology 112 : 409–428.
  24. Dreyer G, Norões J, Figueredo-Silva J, Piessens WF, 2000. Pathogenesis of lymphatic disease in bancroftian filariasis: a clinical perspective. Parasitol Today 16 : 544–548.
  25. Dreyer G, Addiss D, Norões J, Amaral F, Rocha A, Coutinho A, 1996. Ultrasonographic assessment of the adulticidal efficacy of repeat high-dose ivermectin in bancroftian filariasis. Trop Med Int Health 1 : 427–432.
  26. Dreyer G, Norões J, Amaral F, Nen A, Medeiros Z, Coutinho A, Addiss D, 1995. Direct assessment of the adulticidal efficacy of single dose ivermectin in bancroftian filariasis. Trans R Soc Trop Med Hyg 89 : 441–443.
  27. Dreyer G, Addiss D, Williamson J, Norões J, 2006. Efficacy of co-administered diethylcarbamazine and albendazole against adult Wuchereria bancrofti. Trans R Soc Trop Med Hyg 100 : 1118–1125.
  28. Ottesen EA, 1985. Efficacy of diethylcarbamazine in eradicating infection with lymphatic-dwelling filariae in humans. Rev Infect Dis 7 : 341–356.
  29. Amaral F, Dreyer G, Figueredo-Silva J, Norões J, Cavalcanti A, Samico SF, Santos A, Coutinho A, 1994. Live adult worms detected by ultrasonography in human bancroftian filariasis. Am J Trop Med Hyg 50 : 753–757.
  30. Kar SK, 1986. Atypical features in lymphatic filariasis. Indian J Med Res 84 : 270–274.
  31. Kar SK, Mania J, Kar PK, 1993. Prevalence of lymphatic nodule in a bancroftian endemic population. Acta Trop 55 : 53–60.
  32. Thooris GC, Heuls J, Kessel JF, L’hoiry, Bambridge B, 1956. Research on methods of diagnosis and treatment of filariosis due to Wuchereria bancrofti in French Oceania. Bull Soc Pathol Exot Filiales 49 : 1138–1157.
  33. Dreyer G, Santos A, Norões J, Rocha A, Addiss D, 1996. Amicrofilaraemic carriers of adult Wuchereria bancrofti. Trans R Soc Trop Med Hyg 90 : 288–289.
  34. Dreyer G, Figueredo-Silva J, Carvalho K, Amaral F, Ottesen EA, 2001. Lymphatic filariasis in children: adenopathy and its evolution in two young girls. Am J Trop Med Hyg 65 : 204–207.
  35. Dreyer G, Norões J, Addiss D, Santos A, Medeiros Z, Figueredo-Silva J, 1999. Bancroftian filariasis in a paediatric population: an ultrasonographic study. Trans R Soc Trop Med Hyg 93 : 633–636.
  36. Ottesen EA, Ismail MM, Horton J, 1999. The role of albendazole in programmes to eliminate lymphatic filariasis. Parasitol Today 15 : 382–386.
  37. Araújo AC, Figueredo-Silva J, Souto-Padron T, Dreyer G, Norões J, De Souza W, 1995. Scanning electron microscopy of adult Wuchereria bancrofti (nematoda: filarioidea). J Parasitol 81 : 468–474.
  38. Ramzy RM, Helmy H, el-Lethy AS, Kandil AM, Ahmed ES, Weil GJ, Faris R, 1999. Field evaluation of a rapid-format kit for the diagnosis of bancroftian filariasis in Egypt. East Mediterr Health J 5 : 880–887.
  39. Hussein O, El Setouhy M, Ahmed ES, Kandil AM, Ramzy RMR, Helmy H, Weil GJ, 2004. Duplex doppler sonographic assessment of the effects of diethylcarbamazine and albendazole therapy on adult filarial worms and adjacent host tissues in bancroftian filariasis. Am J Trop Med Hyg 71 : 471–477.
  40. Debrah AY, Mand S, Specht S, Marfo-Debrekyei Y, Batsa L, Pfarr K, Larbi J, Lawson B, Taylor M, Adjei O, Hoerauf A, 2006. Doxycycline reduces plasma VEGF-C/sVEGFR-3 and improves pathology in lymphatic filariasis. PLoS Pathog 2 : e92.
  41. Mand S, Supali T, Djuardi J, Kar S, Ravindran B, Hoerauf A, 2006. Detection of adult Brugia malayi filariae by ultrasonography in humans in India and Indonesia. Trop Med Int Health 11 : 1375–1381.
  42. Delmas V, Dauge MC, 1986. Accessory adrenals in the spermatic cord. Apropos of 2 cases. Ann Urol (Paris) 20 : 261–264 (Paris).
  43. Gualtieri T, Segal AD, 1949. Report of case of adrenal-type tumor of spermatic cord; A review of aberrant adrenal tissues. J Urol 61 : 949–955.
  44. Roca Suarez A, Alvarez Ossorio JL, Del Toro Bacerra JA, Maximiano Vasquez R, Gordon Laporte R, 1993. Adrenal ectopia in the spermatic cord. Actas Urol Esp 17 : 584–587.
  45. Mares AJ, Shkolnik A, Sacks M, Feuchtwanger MM, 1980. Aberrant (ectopic) adrenocortical tissue along the spermatic cord. J Pediatr Surg 15 : 289–292.
  46. Savas C, Candir O, Bezir M, Cakmak M, 2001. Ectopic adrenocortical nodules along the spermatic cord of children. Int Urol Nephrol 32 : 681–685.

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  • Received : 18 Mar 2009
  • Accepted : 08 May 2009

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