.

A Mirror of Hospital practice.

A CASE OF FILARIAL ABSCESS.

By H. W. ACTON, J IJEUTSNANT-CmONEX, I.M.S.,

Director and Professor of Bacteriology and Pathology, and

S. SUNDAR RAO, l.m.p.,

Darbhanga Scholar,

Calcutta School of Tropical Mcdicinc and Hygiene.

A casd of filarial abscess has recently been studied at the Carmichael Hospital for Tropical Diseases, Calcutta, which confirms some of the views expressed by Acton and Rao (1929) on the role of secondary organisms in the causation of filarial diseases. This is an interesting- case in which from a filarial abscess in the right femoral region a haemolytic streptococcus was cultured; an organism of the same strain was subsequently isolated from the urine of the patient, and was finally traced to a focus of infection in the teeth.

S. C. M., aged 24, was admitted into the

hospital with high fever and an abscess in the

right femoral region. The temperature ranged between 102?F. and 104?F. for a week prior to admission. This patient was previously examined in connection with a severe form of urticaria which he was suffering from; during the routine tests, he was found to be sensitive to micro-

filarias.

The abscess was opened and cultures were

taken on blood-agar; the cultures showed a pure growth of a long-chain haemolytic streptococcus. From inside the abscess, two long bits of live adult filaria? measuring 22 and 10 mm. long and 103 ft to 145 ft thick (head end 60/'to 68 ]i thick) were recognized and separated out from the blood clot. Only the head end was obtained, the tail

end being missed. These worms were full of

eggs and nearly mature embryos. These observa-

tions show that the abscess was a typical filarial one.

Attempts were now made to locate the source of secondary infection of the abscess and an

examination was made of the nose, nasopharynx

and tonsils; these examinations gave negative results. The left antrum gave defective illumina- tion when tested and it was suspected that it

might be a source of the infection; this was

explored with a negative result. Blood was

cultured on glucose broth in two different days and no growth was obtained. Stools were

examined for ova, protozoa and cultured for non- lactose fermenters; the results were entirely negative. A catheter specimen of the urine was then

cultured and it revealed a pure growth of a

faintly hemolytic strain of streptococcus. This

organism gave the same sugar reactions as the one isolated from the abscess; i.e.,

Sugar reactions:

Glucose = A; Mannite = O; Saccharose = A; Salicin = O ;

Litmus milk = C.

A skiagram was taken of the teeth and it was found that a few teeth showed marginal infec- tion. Cultures were taken from these teeth and a streptococcus was isolated which gave the identical reactions found in the case of the

organisms isolated from the filarial abscess and from the urine.

The stools were plated for streptococci every day, for over five days and the results were

negative. There was no skin lesion of any importance. As a routine procedure, the blood was examined

for parasites, with negative results, except for microfilariae seen in blood smears taken at night. The following was the total and differential leuco- cyte count:?

Leucocytes .. 17,000 per c.mm.

Polymorphs .. 76 per cent.

Lymphocytes . . -

' 18 per cent.

Mononuclears .. 1 per cent.

Eosinophils .. 5 per cent.

The investigations in this case show how from a focus of streptococcal infection in the teeth, the filarial abscess had derived its secondary infection, the presence of the organism in the

urine, without any pathological symptoms in the genito-urinary system, showing that this occurred zia the blood stream.

In another paper, the authors (Acton and Rao, 1929a) have discussed the process by which the defensive mechanism of the tissue is weakened as a result of the invasion by the filaria. When this has taken place, it is easy for the secondary organism from some focus of infection to get into the weakened tissue through the blood stream and to produce either local inflammation ending in an abscess, as in the present case, or lymphan- gitis. This depends on the tissues affected by the parasite; if it is purely local, as in the present instance, a local inflammation is produced. If it is a more generalized irritation affecting the

632 THE INDIAN MEDICAL GAZETTE. [Nov., 1929.

lymphatic trunks, lymphangitis is produced. If it affects the smaller lymphatics, the clinical condition known as cellulitis is the result.

References.

Acton, H. W., and Rao, S. Sundar (1929). The Importance of Secondary Infection in the Causation of Filarial Lymphangitis. Ind. Med. Gas., Vol. LXIV, August 1929, p. 421.

Acton, H. W., and Rao, S. Sundar (1929a). Kata-

phylaxia: a phenomenon seen clinically in acute filariasis.

Ibid., Vol. LXIV, Nov. 1929.