Filariasis in Pregnancy: Prevalent yet Less known Global Health Burden:
Lymphatic filariasis is a vector-borne disabling parasitic infection causing elephantiasis, lymphedema, and hydrocele (in males). The infection is endemic in 83 countries worldwide, with more than 1.2 billion people at risk and 120 million already infected. It is an endemic disease in many parts of Southeast Asia, especially South India.The statistics in pregnant women are poorly known due to the exclusion of pregnant women from filarial mass treatment strategies.Without further investigations, filariasis in pregnancy remains a neglected tropical disease.This case of filariasis in pregnancy is a reflection of this global burden.
This rare case of inguinal lymphangiovarix and chronic abruption in pregnancy is of a 45-year-old gravida 3 para 2 and live 2 woman with 7 months amenorrhea presenting with complaints of painful swelling in both the inguinal regions and with history of low-grade, periodic fever lasting for 4–5 days every month. On examination, she was febrile with 101°F and anemic. There was a soft, nodular, mobile, tender mass of about 3 cm in the right inguinal region and similar mass of 2 cm in the left inguinal region. There was no other swelling or lymph node enlargement anywhere else and was not associated with organomegaly. There was nonpitting edema in both the limbs and pitting edema in the left arm . The skin over edema was dry and there was no rubor, calor, or dolor. General physical examination was otherwise normal. Her vitals were normal with blood pressure of 130/80 and pulse rate of 88/min. Her obstetric examination corresponded with gestational age and fetal heart sounds were not audible on auscultation. Her ultrasound was suggestive of an intrauterine death and chronic abruption. She was managed accordingly.
Her blood investigations were significant for hemoglobin 7 g %, raised erythrocyte sedimentation rate of 40 mm, and total count of 12,000 with lymphocytosis. Peripheral smearshowed numerous microfilariae in a background microcytic hypochromic red blood cell and few lymphocytes. Since the patient was pregnant, diethylcarbamazine (DEC) was not advised.
She delivered a fresh stillbirth with early growth retardation 6 h after induction of labor and 400 g of retroplacental clots was observed. She was then put on DEC and managed medically. She was discharged healthy and follow-up was done. Histopathology of placental tissue was confirmatory for chronic abruption and was negative on pathogens. There was no evidence of inflammation.
Parasitic infections in pregnancy directly or indirectly lead to a spectrum of adverse maternal or fetal outcomes and placental effects. Their consequences in chronically undernourished anemic women of reproductive age are considerable. More global attention to the diagnosis and treatment of parasitic infections in pregnancy are warranted. There is not enoughresearch on treatment modalities in filariasis in pregnancy. DEC being contraindicated in pregnancy is a limitation. This is why our case is unique and gives an insight into the possible global impact of the condition, warranting the need to implement screening techniques, mass prevention, and new antihelminthic drug trials in pregnancy.
Journal of Basic and Clinical Reproductive Sciences