Transpiacental Transfer of Bancroftian Filariasis Randall D. Bloomfield, MD, Jorge R. Suarez, MD, and Ansenio C. Malangit, MD Brooklyn, New York
A pregnant patient with Bancroftian filariasis and documented evidence of transplacental transfer of the larvae is the basis of this report.
Filariasis is a helminthic infection whose major cause is the nematode Wuchereria bancrofti.1 Bancroftian filariasis is prevalent in tropical Africa, Asia, the Pacific Islands, South America, and the Caribbean Islands.2 The parasite is transmitted to man by mosquitoes.' It has been theorized that the microfilariae cross the placental
From the Department of Obstetrics and Gynecology, Brooklyn Cumberland Medical Center, Brooklyn, New York. Requests for reprints should be addressed to Dr. Randall D. Bloomfield, Department of Obstetrics and Gynecology, Box 1216, State University of New York, Downstate Medical Center, 450 Clarkson Avenue, Brooklyn, NY 11203.
barrier to infect the fetus.3 This report documents transplacental migration of the larvae.
Case Report The patient was a 21-year-old woman, para 4, who was admitted with a chief complaint of dyspnea of two weeks duration. She was known to have been asthmatic since childhood. She was born in the Dominican Republic and had come to the United States five years prior to admission. On admission, her vital signs were: temperature, 99.8F; pulse, 80/min; blood pressure, 110/70; respiration, 20/min. Auscultation of the lungs revealed exten-
JOURNAL OF THE NATIONAL MEDICAL ASSOCIATION, VOL. 70, NO. 8, 1978
sive wheezing rales. The remainder of the examination results were within normal limits. The significant laboratory finding was the presence of microfilariae on a routine smear of peripheral blood (Figure 1). This smear was repeated and still showed the presence of microfilariae. Roentgenographic examination of her chest was reported as within normal limits. Her asthma responded to medical management. She subsequently delivered a living male infant having an Apgar score of 6/9. The infant had irregular respiration and required positive pressure oxygen inhalation. Microfilariae were demonstrated in the cord blood but not in the peripheral blood of the fetus (Figure 2). 597
Postpartum, the mother received diethylcarbamazine citrate (Hetrazan), 100 mg t.i.d., p.o., for the filariasis. She signed out against advice but returned for the postpartum checkup six weeks later. She was asymptomatic and there were no microfilariae seen in the peripheral bloodsmear. The infant was seen in the Pediatric Clinic on four occasions for upper respiratory infections.
.................. .. .....
.. .... .tai v=w w.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~.
Figure 1. Periphereal blood smear demonstrating Wuchereria bancrofti.
Discussion
_~
WEff
Filariasis may adversely affect both the patient seeking pregnancy and the pregnant female. In the former, it may cause tubal obstruction, while in the latter, elephantiasis of the labia and clitoris may cause soft tissue dystocia during labor.4 Pregnancy may exacerbate the edema or chyluria of filariasis.2 The effect on the human fetus has been suggested by animal studies which demonstrated the presence of filarial infection in the trachea of newborn lambs whose mothers were infected with this disease.: While microfilariae were not present in the respiratory tract of this infant, the finding of microfilariae in the cord blood confirms the existence of transplacental migration.
Figure 2. Microfilariae in intervillous space of the placenta.
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Literature Cited 1. Cahill KM: Filariasis. NY State J Med
63:1379-1384, 1963 2. Lee RV: Parasitic infections. In Burrows GN, Ferris TF (eds): Medical Complications During Pregnancy. Philadelphia, WB Saunders, 1975, pp 456-457 3. Cort W: Prenatal Infestation with parasitic worms. JAMA 76:170-17 1, 1921 4. Jordan P: Bancroftian microfilaremia in hospital patients. J Trop Med 57:8-12, 1954
598
JOURNAL OF THE NATIONAL MEDICAL ASSOCIATION, VOL. 70, NO. 8, 1978
A pregnant patient with Bancroftian filariasis and documented evidence of transplacental transfer of the larvae is the basis of this report.
Filariasis is a helminthic infection whose major cause is the nematode Wuchereria bancrofti.1 Bancroftian filariasis is prevalent in tropical Africa, Asia, the Pacific Islands, South America, and the Caribbean Islands.2 The parasite is transmitted to man by mosquitoes.' It has been theorized that the microfilariae cross the placental
From the Department of Obstetrics and Gynecology, Brooklyn Cumberland Medical Center, Brooklyn, New York. Requests for reprints should be addressed to Dr. Randall D. Bloomfield, Department of Obstetrics and Gynecology, Box 1216, State University of New York, Downstate Medical Center, 450 Clarkson Avenue, Brooklyn, NY 11203.
barrier to infect the fetus.3 This report documents transplacental migration of the larvae.
Case Report The patient was a 21-year-old woman, para 4, who was admitted with a chief complaint of dyspnea of two weeks duration. She was known to have been asthmatic since childhood. She was born in the Dominican Republic and had come to the United States five years prior to admission. On admission, her vital signs were: temperature, 99.8F; pulse, 80/min; blood pressure, 110/70; respiration, 20/min. Auscultation of the lungs revealed exten-
JOURNAL OF THE NATIONAL MEDICAL ASSOCIATION, VOL. 70, NO. 8, 1978
sive wheezing rales. The remainder of the examination results were within normal limits. The significant laboratory finding was the presence of microfilariae on a routine smear of peripheral blood (Figure 1). This smear was repeated and still showed the presence of microfilariae. Roentgenographic examination of her chest was reported as within normal limits. Her asthma responded to medical management. She subsequently delivered a living male infant having an Apgar score of 6/9. The infant had irregular respiration and required positive pressure oxygen inhalation. Microfilariae were demonstrated in the cord blood but not in the peripheral blood of the fetus (Figure 2). 597
Postpartum, the mother received diethylcarbamazine citrate (Hetrazan), 100 mg t.i.d., p.o., for the filariasis. She signed out against advice but returned for the postpartum checkup six weeks later. She was asymptomatic and there were no microfilariae seen in the peripheral bloodsmear. The infant was seen in the Pediatric Clinic on four occasions for upper respiratory infections.
.................. .. .....
.. .... .tai v=w w.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~.
Figure 1. Periphereal blood smear demonstrating Wuchereria bancrofti.
Discussion
_~
WEff
Filariasis may adversely affect both the patient seeking pregnancy and the pregnant female. In the former, it may cause tubal obstruction, while in the latter, elephantiasis of the labia and clitoris may cause soft tissue dystocia during labor.4 Pregnancy may exacerbate the edema or chyluria of filariasis.2 The effect on the human fetus has been suggested by animal studies which demonstrated the presence of filarial infection in the trachea of newborn lambs whose mothers were infected with this disease.: While microfilariae were not present in the respiratory tract of this infant, the finding of microfilariae in the cord blood confirms the existence of transplacental migration.
Figure 2. Microfilariae in intervillous space of the placenta.
Fiue3
odboo
pcmndmnsrtn
acot.,
Literature Cited 1. Cahill KM: Filariasis. NY State J Med
63:1379-1384, 1963 2. Lee RV: Parasitic infections. In Burrows GN, Ferris TF (eds): Medical Complications During Pregnancy. Philadelphia, WB Saunders, 1975, pp 456-457 3. Cort W: Prenatal Infestation with parasitic worms. JAMA 76:170-17 1, 1921 4. Jordan P: Bancroftian microfilaremia in hospital patients. J Trop Med 57:8-12, 1954
598
JOURNAL OF THE NATIONAL MEDICAL ASSOCIATION, VOL. 70, NO. 8, 1978
