A man’s worm infection left him with a “hard stony” testicle

A photomicrograph of Brugia Malayi in larval form, one of several nematodes that can cause lymphatic filariasis
Image: CDC

There is not well place where parasitic worms can wreak havoc in the human body, Bbut doctors in India have their say 80 year old patient developed a particularly unfortunate Pencil case. Human worm infection he left him with a massively swollen and calcified right testicle.

According to the article, published earlier this month in BMJ Reports, the man had visited the doctor complaining of blood in the urine, a common sign of urinary tract infection. But when he was physically examined, doctors noted that he had a “grossly enlarged” right testicle next to his normal left testicle. In addition, the testicle has heard “stony hard “ to the touch.

Image: Goel A, Kumar P, Jain M, et al, BMJ Reports

Once the man was scanned, the doctors saw a bag full of fluid that shouldn’t have been there.. The type of sack they discovered is called a hydrocele, which is formed when the liquid builds up in a thin coating surrounding a testicle. It often occurs in infants, disappearing when they turn one without causing any damage. But when it happens in older men, it is usually due to a local injury or inflammation of the scrotum, the latter of which is often caused by an infection.

In this case, doctors suspected that the man had been infested by a species of filarial worm, which are filiform nematodes that are commonly found in the hottest areas of the world. These worms spread to people like larvae through mosquito bites, then migrate to the lymph nodes scattered throughout the body, including those near our scrotum.

At the beginning, some victims may experience little more than a flu-like illness, while most will feel nothing. But if an infection is left untreated, the larva produced by adult worms can continue to block important lymphatic vessels that trigger painful swelling attacks and make people more vulnerable to other infections. If this happens for long enough, swelling can permanently disfigure the affected parts of the body, a condition known as elephantiasis.

Lymphatic filariasis, as is known, is unfortunately endemic in India. And in endemic parts of the world, these infections are actually the most common cause of hydrocele in men, according to the authors of the case study. But the “calcification of the eggshell” of man’s testicle is an extremely rare complication, probably the result of a very long infection inside the sac, which caused calcium to form around it.

These infections are only somewhat curable in endemic areas. Current medications taken annually can kill most adult larval worms, which can reduce the risk of complications and disrupt the transmission cycle from infected people to mosquitoes. But they have a limited effect on adult worms, which can live up to eight years in the body. Other treatments such as surgery are also needed for complications caused by a chronic infection, including removal of hydroceles.

The authors do not describe how their patient was treated. But echoing recommendations established by the World Health Organization, claim that people living in high-risk areas are treated with anti-filarial drugs every year, regardless of their state of infection. According to the WHO, nearly 900 million people in 49 countries need preventive care, while 25 million infected men have hydroceles.

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