Institute for Medical Microbiology, Immunology and Parasitology, University Hospital Bonn, Bonn, Germany.
Acta Trop. 2011 Sep;120 Suppl 1:S23-32. doi: 10.1016/j.actatropica.2010.07.002. Epub 2010 Jul 29.
(i) To determine the frequencies of urogenital pathologies in men infected with bancroftian filariasis, and (ii) to evaluate the role of ultrasonography (USG) as a diagnostic tool to differentiate between diverse pathologies with different clinical implications. To date, all types of scrotal enlargement resulting from lymphatic filariasis (LF) have been summarized under one term: "filaricele".
Data were compiled from recruitment phases for field trials in an endemic area for LF in Ghana. 1453 men aged 18 years and above underwent ultrasound examinations of the scrotum. Observation parameters were: Filaria Dance Sign (FDS), dilation of supratesticular lymphatic vessels, thickness of scrotal skin, occurrence and amount of fluid accumulation, echogenicity of the fluid between the layers of the tunica vaginalis, as well as position and homogenicity of testis, epididymis and spermatic cord. In 1132 men, blood samples were taken for parasitological analysis.
In 56% of examined patients, fluid accumulation around the testis was detected (38% subclinical-, 18% clinical stages). Differentiation of the echogenicity of the fluid revealed echo-free hydrocele (EFH) in 47% and echo-dense hydrocele (EDH) in 9%. Patients without hydrocele and subclinical stages had a thinner scrotal skin than those in clinical stages or with lymphscrotum (P < 0.001). In the EDH group the scrotal skin was thicker than in the EFH group (P < 0.001). 1.4% had a lymphscrotum. FDS was detected in 24% of all 1453 volunteers who underwent USG. The number of worm nests correlated with microfilarial load and levels of circulating filarial antigen (P < 0.001; 20% microfilaremic, 48% antigen positive).
In an unexpected high number of men (56%) fluid accumulation around the testis was detected by USG of which more than one third (38%) presented with subclinical stages. The study showed that echo-dense and echo-free fluid could be differentiated and that a considerable number of cases had EDH (9%) posing a risk to develop necrotic testis and infertility and therefore requiring immediate surgical intervention. USG thus turned out to be a useful diagnostic technique to differentiate between those cases requiring immediate surgical intervention from those that can be treated with (anti-wolbachial and hyperpermeability reducing) drugs that ameliorate or halt progression of the disease.
（i）确定感染班氏丝虫病的男性泌尿生殖系统疾病的频率，（ii）评估超声检查（USG）作为一种诊断工具，以区分具有不同临床意义的不同病变。迄今为止，所有由淋巴丝虫病（LF）引起的阴囊肿大类型都被归纳为一个术语：“精索鞘膜积液”。
数据来自加纳 LF 流行地区现场试验的招募阶段。1453 名年龄在 18 岁及以上的男性接受了阴囊超声检查。观察参数包括：丝虫舞征（FDS）、鞘膜上淋巴管扩张、阴囊皮肤厚度、积液的发生和量、鞘膜囊各层之间的液体回声、睾丸、附睾和精索的位置和均匀性。在 1132 名男性中，采集了血液样本进行寄生虫学分析。
在 56%的受检患者中，检测到睾丸周围有液体积聚（38%为亚临床期，18%为临床期）。通过对液体回声的区分，发现 47%为无回声性鞘膜积液（EFH），9%为回声致密性鞘膜积液（EDH）。无鞘膜积液和亚临床期患者的阴囊皮肤比临床期或淋巴鞘膜积液患者薄（P<0.001）。EDH 组的阴囊皮肤比 EFH 组厚（P<0.001）。1.4%的患者有淋巴鞘膜积液。FDS 在接受 USG 的 1453 名志愿者中均有 24%的人检测到。虫巢数量与微丝蚴负荷和循环丝虫抗原水平相关（P<0.001；20%微丝蚴血症，48%抗原阳性）。
在出乎意料的大量男性（56%）中，通过 USG 检测到睾丸周围有液体积聚，其中超过三分之一（38%）为亚临床期。研究表明，回声致密和无回声液体可以区分，相当多的病例为 EDH（9%），这可能导致睾丸坏死和不育的风险，因此需要立即手术干预。USG 因此成为一种有用的诊断技术，可以区分需要立即手术干预的病例和可以用（抗沃尔巴克氏体和增加通透性）药物治疗的病例，这些药物可以改善或阻止疾病的进展。
