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GOOD AFTERNOON

JOURNAL CLUB – 9

Dr. RAHUL TIWARIPOST GRADUATE STUDENTDEPARTMENT OF ORAL & MAXILLOFACIAL SURGERYSIBAR INSTITUTE OF DENTAL SCIENCES

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TITLE – CASE REPORT

▪ Filariasis in mandible and maxilla ! a rare entity,

first case to report

KEY WORDS:

Filariasis, Oral involvement, Central giant cell granuloma.

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JOURNAL & ARTICLE AUHTOR

▪ PII: S0278-2391(16)31038-2▪ DOI: 10.1016/j.joms.2016.10.028▪ Reference: YJOMS 57521▪ To appear in: Journal of Oral and

Maxillofacial Surgery

▪ Received Date: 20 September 2016

▪ Revised Date: 23 October 2016▪ Accepted Date: 24 October 2016

Dr.Sthitaprajna Lenka , MDSAssociate professor , Department of oral and maxillofacial surgeryInstitute of Dental SciencesBhubaneswar, Orissa. Email-sthitaprajnalenka@gmail.comPhone no- +919337555777

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FILARIASIS ??▪ Wuchereria bancrofti, Brugia malayi and Brugia timori – nematodes - lymphatic

filariasis▪ It can affect individuals of all age groups and both sexes▪ Predominantly affects people of low socioeconomic strata▪ Dwell in the subcutaneous tissues and lymphatics of human hosts▪ Transmitted through the bite of blood sucking infected female anopheles mosquito.▪ Lymphangitis, leading to elephantiasis of the legs, arms, scrotum and breast.▪ Oral and perioral soft tissue is uncommon▪ Central giant cell granuloma secondary to filariasis ▪ Biopsy - innocuous radiolucent bony lesions of the maxilla and mandible.

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LIFE CYCLE

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INTRODUCTION

▪ Infectious parasitic disease – tropical and subtropical region of Africa, Asia, Western Pacific, and Central and South America

▪ Categorized into three basic types depending upon tissue of involvment i.e. lymphatic filariasis, subcutaneous filariasis and serous cavity filariasis

▪ Blood-feeding arthropods, black flies and female anopheles mosquitoes act as intermediate hosts .

▪ SOURCE: -▪ Sabesan S, Palaniyandi M, Das PK, Michael E. Mapping of lymphatic

filariasis in India. Ann Trop Med Parasitol 2000; 94:591-606.

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DISEASE MANIFESTATION

▪ Acute filarial fever▪ Chronic lymphangitis, lymphadenitis,▪ Elephantisis of genitals/legs/arms, ▪ Tropical pulmonary eosinophilia, ▪ Filarial arthritis,▪ Epididimoorchitis▪ Chyluria.▪ EOSINOPHILIA

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DRUG OF CHOICE

▪ DEC (diethylcarbamazine) - micro- and macro-filariacidal.▪ Albendazole has also been used in combination with DEC and ivermectin -

anti-helminthic▪ Only two cases have been reported involving oral soft tissue.▪ Filarial worm in bony lesion is not yet reported.

▪ SOURCE :- ▪ Lymphatic filariasis and onchocerciasis prevention, treatment, and control

costs across diverse settings: A systematic review Joseph Keatinga , Joshua O. Yukicha, Sarah Mollenkopfb, Fabrizio Tediosi

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CASE REPORT

▪ 44 year old male – pain since 6 months. ▪ Local physician – antibiotics and

analgesics▪ Intra oral – no swelling.▪ Palpation - tenderness in left maxilla

and body of the mandible▪ 3D computed tomography of the

maxilla and mandible - central giant cell granuloma

▪ General physical examination and hematology - normal

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LESION – MAXILLA & MANDIBLE

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DIAGNOSIS

▪ EXCISIONLA BIOPSY – INTRA ORAL APPROACH▪ MICROSCOPIC EXAMINATION –

▪ Fibrous connective tissue with several epitheloid cell granulomas in the

middle of moderate infiltrates of lymphocytes, plasma cells,

histiocytes, few neutrophils, eosinophils and multinucleated giant cells

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DIAGNOSTIC FEATURE WAS THE PRESENCE OF DISINTEGRATING ADULT FILARIAL WORM SURROUNDED BY A MILD INFLAMMATION

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FINAL DIAGNOSIS - CENTRAL GIANT CELL GRANULOMA 2° TO FILARIASIS.

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TREATEMENT

▪ The patient was started on the antifilarial drug

diethylcarbamazine citrate, 6 mg/kg orally daily for 2 weeks

and the site of the biopsy healed uneventfully, confirming the

filarial involvement of oral tissue in this patient.

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DISCUSSION

▪ In world - more than 120 million people infected and one billion people are at risk for infection.

▪ An estimation in 2001 revealed that about 51.7 million people were exposed to the risk of W. bancrofti infection just in India, thus making India the largest filariasis endemic country in world

▪ SOURCE : -▪ Sabesan S, Ravi R, Das PK. Elimination of lymphatic filariasis in India. Lancet

Infect Dis 2005;5:4-5.▪ Sabesan S, Palaniyandi M, Das PK, Michael E. Mapping of lymphatic filariasis

in India. Ann Trop Med Parasitol 2000;94:591-606.

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OTHER CASES

▪ Oral and perioral manifestations of lymphatic filariasis are rare. Rajendran in 2001 and Baliga in 2010 reported cases of filariasis in right and left buccal mucosa of two middleaged

▪ Indian female patients, manifesting as submucosal nodules.

▪ SOURCE :-▪ Rajendran R. A lump in the mouth. Lancet 2001; 357: 852.▪ Baliga M, Ramanathan A, Uppal N. Oral filariasis—A case report. Br J

Oral Maxillofac Surg 2010;48:143–4.

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DETECTION MEASURES

▪ Serological antibody tests such as bentonite flocculation, indirect

haemagglutination, ELISA, and indirect fluorescent antibody tests can help in

diagnosis, but they do not differentiate among the various forms of filariasis, or

between past and current infection.

▪ SOURCE: -▪ Eberhard ML, Lammie PJ. Laboratory diagnosis of filariasis. Clin Lab Med 1991;

11: 977–1010.

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CONCLUSION

▪ More than 150 million people, mainly in developing countries, are affected

by filarial nematode infections that cause debilitating and disfiguring

diseases.

▪ However, the incidence of filariasis in the oral and maxillofacial region is

rare.

▪ Until this report only two cases of filariasis of oral mucosa have been

reported, but central giant cell granuloma secondary to filariasis causing

bone loss in maxilla and mandible is unique and yet to be reported in

English literature.

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REFERENCES