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Hochberg NS, Dinculescu VV, Nutman TB. Case 17-2023: A 58-Year-Old Woman with Fatigue, Abdominal Bloating, and Eosinophilia. N Engl J Med 2023; 388:2180-2189. [PMID: 37285529 PMCID: PMC10986646 DOI: 10.1056/nejmcpc2201248] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Natasha S Hochberg
- From the Department of Medicine, Boston University School of Medicine (N.S.H.), the Department of Radiology, Massachusetts General Hospital (V.V.D.), and the Department of Radiology, Harvard Medical School (V.V.D.) - all in Boston; and the Laboratory of Parasitic Diseases, National Institutes of Health, Bethesda, MD (T.B.N.)
| | - Vincent V Dinculescu
- From the Department of Medicine, Boston University School of Medicine (N.S.H.), the Department of Radiology, Massachusetts General Hospital (V.V.D.), and the Department of Radiology, Harvard Medical School (V.V.D.) - all in Boston; and the Laboratory of Parasitic Diseases, National Institutes of Health, Bethesda, MD (T.B.N.)
| | - Thomas B Nutman
- From the Department of Medicine, Boston University School of Medicine (N.S.H.), the Department of Radiology, Massachusetts General Hospital (V.V.D.), and the Department of Radiology, Harvard Medical School (V.V.D.) - all in Boston; and the Laboratory of Parasitic Diseases, National Institutes of Health, Bethesda, MD (T.B.N.)
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Aiello F, Palma S, Varesi C, Cerulli A, Valente R, Aiello L. A Rare Case Report of Loa Loa Ocular Filariasis. Eur J Ophthalmol 2018; 20:237-9. [DOI: 10.1177/112067211002000137] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose We report a case of ocular worm treated surgically and confirmed by microbiological identification. Methods A 33-year-old Swiss woman presented to the ophthalmic unit, complaining of pain and foreign body sensation in the left eye. Slit-lamp examination disclosed a subconjunctival amber-colored cord in the conjunctival fornix. Presentation, clinical and histopathologic evaluation, and treatment are described. Results At the time of surgery, an alive and still intact worm was extracted through conjunctival incision. Histopathology confirmed the presence of filariasis. Conclusions As the flow of immigrants from endemic areas to Europe increases, ocular manifestation of loiasis is becoming more frequent and ophthalmologists need to be aware of this diagnosis.
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Affiliation(s)
- Francesco Aiello
- Ophthalmological Unit, Department of Biopathology University of Roma “Tor Vergata”, Roma
| | - Stefano Palma
- Department of Biomedical Sciences “G. D'Annunzio University”, Chieti
| | - Chiara Varesi
- Ophthalmological Unit, Department of Biopathology University of Roma “Tor Vergata”, Roma
| | - Angelica Cerulli
- Ophthalmological Unit, Department of Biopathology University of Roma “Tor Vergata”, Roma
- Department of Pharmaco-Biology, University of Calabria, Cosenza
| | - Rosanna Valente
- Department of Ophthalmology, Civil Hospital Policoro, Policoro (MT) - Italy
| | - Luigi Aiello
- Department of Ophthalmology, Civil Hospital Policoro, Policoro (MT) - Italy
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Nieves-Moreno M, Bañeros-Rojas P, Díaz-Valle D, Gegúndez-Fernández J. Encephalitis secondary to diethylcarbamazine treatment in a patient with ocular loiasis. J Fr Ophtalmol 2017; 40:e229-e230. [DOI: 10.1016/j.jfo.2015.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2015] [Revised: 11/28/2015] [Accepted: 12/09/2015] [Indexed: 10/19/2022]
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Ocular parasitoses: A comprehensive review. Surv Ophthalmol 2016; 62:161-189. [PMID: 27720858 DOI: 10.1016/j.survophthal.2016.09.005] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2016] [Revised: 09/27/2016] [Accepted: 09/29/2016] [Indexed: 12/14/2022]
Abstract
Parasitic infections of the eyes are a major cause of ocular diseases across the globe. The causative agents range from simple organisms such as unicellular protozoans to complex metazoan helminths. The disease spectrum varies depending on the geographic location, prevailing hygiene, living and eating habits of the inhabitants, and the type of animals that surround them. They cause enormous ocular morbidity and mortality not because they are untreatable, but largely due to late or misdiagnosis, often from unfamiliarity with the diseases produced. We provide an up-to-date comprehensive overview of the ophthalmic parasitoses. Each section describes the causative agent, mode of transmission, geographic distribution, ocular pathologies, and their management for common parasites with brief mention of the ones that are rare.
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Inoue T, Akashi K, Watanabe M, Ikeda Y, Ashizuka S, Motoki T, Suzuki R, Sagara N, Yanagida N, Sato S, Ebisawa M, Ohta S, Ono J, Izuhara K, Katsunuma T. Periostin as a biomarker for the diagnosis of pediatric asthma. Pediatr Allergy Immunol 2016; 27:521-6. [PMID: 27062336 DOI: 10.1111/pai.12575] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/05/2016] [Indexed: 01/01/2023]
Abstract
BACKGROUND There are some biomarkers for asthma diagnosis but they are often difficult in clinical use, particularly in pediatric cases. Periostin is an extracellular matrix protein, upregulated in response to IL-4 or IL-13. Serum periostin is expected to be used as a non-invasive biomarker for asthma diagnosis and management. METHODS Twenty-eight children with asthma (BA) and 27 children without asthma (patients with pectus excavatum, etc. as control group) aged 6-16 years were included. Bronchial asthma was diagnosed according to International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire. Fractional exhaled nitric oxide (FeNO), lung function, blood eosinophil counts, total immunoglobulin E (IgE) levels, and serum periostin levels were assessed. Results were compared between BA and controls. Asthma diagnostic accuracies were calculated using receiver operating characteristics (ROC) curve analyses. RESULTS Serum periostin levels in the BA group were significantly higher than those in the control group [medians (with interquartile ranges), 134.0 (116.3-166.3) vs. 112.0 (97.0-132.0) ng/ml; p = 0.012]. The area under the ROC curve (AUC) for periostin, FeNO, and eosinophil counts were 0.70, 0.72, and 0.84, respectively. After the exclusion of controls with pectus excavatum, AUC for periostin, forced expiratory volume in 1 s (FEV1 ), and maximum mid-expiratory flow rate (MMF) were 0.75, 0.74, and 0.80, respectively. CONCLUSION Serum periostin levels were significantly higher in children with asthma. ROC AUC values for periostin were equivalent to conventional biomarkers, including FeNO levels and lung function testing, indicating the utility of serum periostin levels in diagnosing asthma in children.
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Affiliation(s)
- Takashi Inoue
- Department of Pediatrics, Jikei University Daisan Hospital, Tokyo, Japan.,Department of Pediatrics, Sagamihara National Hospital, Kanagawa, Japan
| | - Kenichi Akashi
- Department of Pediatrics, Jikei University Daisan Hospital, Tokyo, Japan
| | - Masako Watanabe
- Department of Pediatrics, Jikei University Daisan Hospital, Tokyo, Japan
| | - Yuichi Ikeda
- Central Clinical Laboratory, Jikei University Hospital, Tokyo, Japan
| | - Shuichi Ashizuka
- Department of Surgery, Division of Pediatric Surgery, Jikei University School of Medicine, Tokyo, Japan
| | - Takanori Motoki
- Department of Pediatrics, Jikei University Daisan Hospital, Tokyo, Japan
| | - Ryohei Suzuki
- Department of Pediatrics, Jikei University School of Medicine, Tokyo, Japan
| | - Nagatoshi Sagara
- Department of Pediatrics, Jikei University School of Medicine, Tokyo, Japan
| | - Noriyuki Yanagida
- Department of Pediatrics, Sagamihara National Hospital, Kanagawa, Japan
| | - Sakura Sato
- Department of Allergy, Clinical Research Center for Allergy and Rheumatology, Sagamihara National Hospital, Kanagawa, Japan
| | - Motohiro Ebisawa
- Department of Allergy, Clinical Research Center for Allergy and Rheumatology, Sagamihara National Hospital, Kanagawa, Japan
| | - Shoichiro Ohta
- Department of Laboratory Medicine, Saga Medical School, Saga, Japan
| | | | - Kenji Izuhara
- Division of Medical Biochemistry, Department of Biomolecular Sciences, Saga Medical School, Saga Japan
| | - Toshio Katsunuma
- Department of Pediatrics, Jikei University Daisan Hospital, Tokyo, Japan
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Antinori S, Schifanella L, Million M, Galimberti L, Ferraris L, Mandia L, Trabucchi G, Cacioppo V, Monaco G, Tosoni A, Brouqui P, Gismondo MR, Giuliani G, Corbellino M. Imported Loa loa filariasis: three cases and a review of cases reported in non-endemic countries in the past 25 years. Int J Infect Dis 2012; 16:e649-62. [PMID: 22784545 DOI: 10.1016/j.ijid.2012.05.1023] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2011] [Revised: 03/13/2012] [Accepted: 05/11/2012] [Indexed: 10/28/2022] Open
Abstract
OBJECTIVES The aim of this study was to highlight the increasing chance of Western physicians encountering patients (both immigrants and expatriates/travelers) seeking help for loiasis. METHODS We describe three cases of imported loiasis observed at two hospitals in Italy and France, and present a review of all previously published cases in the medical literature in the last 25 years (1986-2011). The search was performed using PubMed and Scopus databases using the terms "Loa loa" AND "loiasis". RESULTS We reviewed 101 cases of imported loiasis of which 61 (60.4%) were reported from Europe and 31 (30.7%) from the USA. Seventy-five percent of infestations were acquired in three countries: Cameroon, Nigeria, and Gabon. Overall, peripheral blood microfilariae were detected in 61.4% of patients, eosinophilia in 82.1%, eye worm migration in 53.5%, and Calabar swellings in 41.6%. However, Calabar swellings and eosinophilia were more common among expatriates/travelers, whereas African immigrants were more likely to have microfilaremia. Eye worm migration was observed in a similar proportion in the two groups. Only 35 patients (including the three described here) underwent clinical follow-up for a median period of 10.5 months (range 1-84 months); clinical relapse occurred in three of these patients and persistence or reappearance of blood microfilaria in another two. CONCLUSIONS Due to increasing travel and the migration of people from the endemic countries of West Africa to Europe and the USA, we speculate on the possible emergence of loiasis. Western physicians should be aware of the typical (eye worm migration and Calabar swellings) as well as unusual clinical presentations.
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Affiliation(s)
- Spinello Antinori
- Department of Clinical Sciences L Sacco, Section of Infectious Diseases and Immunopathology, Università degli Studi di Milano, Via GB Grassi, 74, 20157 Milan, Italy.
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Gobbi F, Boussinesq M, Mascarello M, Angheben A, Gobbo M, Rossanese A, Corachán M, Bisoffi Z. Case report: Loiasis with peripheral nerve involvement and spleen lesions. Am J Trop Med Hyg 2011; 84:733-7. [PMID: 21540382 DOI: 10.4269/ajtmh.2011.10-0458] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Loiasis, which is caused by the filarial nematode Loa loa, affects millions of persons living in the rainforest areas and savannah regions of central Africa. Typical manifestations are calabar swellings and the eyeworm. We report a case of loiasis with unusual clinical complications: a peripheral neuropathy and focal hypo-echogenic lesions of the spleen, which disappeared after treatment with albendazole and ivermectin. The literature reports that L. loa infection can be associated with various manifestations, some of them being serious. More information is needed to better characterize the protean manifestations of the disease in loiasis-endemic areas to evaluate the true incidence of loiasis.
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Affiliation(s)
- Federico Gobbi
- Centro per le Malattie Tropicali, Ospedale Sacro Cuore-Don Calabria, Negrar, Verona, Italy.
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Finsterer J, Höger F. Multi-system mitochondrial disorder with recurrent steroid-responsive eosinophilia. Rheumatol Int 2011; 30:135-9. [PMID: 19370352 DOI: 10.1007/s00296-009-0915-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2008] [Accepted: 03/25/2009] [Indexed: 01/20/2023]
Abstract
Though mitochondrial disorders due to a respiratory chain defect may manifest with haematological abnormalities such as anaemia, neutropenia, or thrombocytopenia, recurrent steroid-responsive eosinophilia has not been reported as a manifestation of a mitochondrial disorder. In a polymorbid 65-year old female recurrent erythema, asthma, chronic bronchitis, gastritis with eosinophilic granuloma, recurrent episodes of hypereosinophilia, and polyarthralgia suggested Churg–Strauss syndrome, which was excluded upon absence of eosinophilic vasculitis on any of the biopsies. However, corticosteroids were effective for hypereosinophilia. In addition to the hypereosinophilic syndrome a mitochondrial disorder with multi-system affection was diagnosed upon the clinical presentation and a muscle biopsy indicative of a mitochondrial disorder. Hypereosinophilia was interpreted as a manifestation of the mitochondrial disorder after exclusion of various differentials. Mitochondrial disease may go along with marked eosinophilia mimicking Churg–Strauss syndrome. Steroids may be useful to resolve episodic eosinophilia but may be ineffective for other features of mitochondrial disorders.
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Affiliation(s)
- Josef Finsterer
- Krankenanstalt Rudolfstiftung, Postfach 20, 1180 Vienna, Austria.
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A Technique for Capturing Migratory Periocular Worms: A Case Series and Review of Literature. Ophthalmic Plast Reconstr Surg 2010; 26:323-6. [DOI: 10.1097/iop.0b013e3181c563e9] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Lipner EM, Law MA, Barnett E, Keystone JS, von Sonnenburg F, Loutan L, Prevots DR, Klion AD, Nutman TB. Filariasis in travelers presenting to the GeoSentinel Surveillance Network. PLoS Negl Trop Dis 2007; 1:e88. [PMID: 18160987 PMCID: PMC2154385 DOI: 10.1371/journal.pntd.0000088] [Citation(s) in RCA: 78] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2007] [Accepted: 08/14/2007] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND As international travel increases, there is rising exposure to many pathogens not traditionally encountered in the resource-rich countries of the world. Filarial infections, a great problem throughout the tropics and subtropics, are relatively rare among travelers even to filaria-endemic regions of the world. The GeoSentinel Surveillance Network, a global network of medicine/travel clinics, was established in 1995 to detect morbidity trends among travelers. PRINCIPAL FINDINGS We examined data from the GeoSentinel database to determine demographic and travel characteristics associated with filaria acquisition and to understand the differences in clinical presentation between nonendemic visitors and those born in filaria-endemic regions of the world. Filarial infections comprised 0.62% (n = 271) of all medical conditions reported to the GeoSentinel Network from travelers; 37% of patients were diagnosed with Onchocerca volvulus, 25% were infected with Loa loa, and another 25% were diagnosed with Wuchereria bancrofti. Most infections were reported from immigrants and from those immigrants returning to their county of origin (those visiting friends and relatives); the majority of filarial infections were acquired in sub-Saharan Africa. Among the patients who were natives of filaria-nonendemic regions, 70.6% acquired their filarial infection with exposure greater than 1 month. Moreover, nonendemic visitors to filaria-endemic regions were more likely to present to GeoSentinel sites with clinically symptomatic conditions compared with those who had lifelong exposure. SIGNIFICANCE Codifying the filarial infections presenting to the GeoSentinel Surveillance Network has provided insights into the clinical differences seen among filaria-infected expatriates and those from endemic regions and demonstrated that O. volvulus infection can be acquired with short-term travel.
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Affiliation(s)
- Ettie M Lipner
- Office of Global Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
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Herrero-Morín JD, Fernández González MN, González Rodríguez F, García López E, Díaz Argüelles M. Filariasis ocular por Loa loa . ¿Parasitosis tropical emergente en Europa? An Pediatr (Barc) 2006; 65:168-70. [PMID: 16948983 DOI: 10.1157/13091490] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Saldarreaga A, García-Gil D, Soto-Cárdenas MJ, García-Tapia AM. Angioedema recurrente en mujer joven. Enferm Infecc Microbiol Clin 2004; 22:430-1. [PMID: 15355773 DOI: 10.1016/s0213-005x(04)73126-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Abel Saldarreaga
- Servicio de Microbiología, Hospital Universitario Puerta del Mar, Cadíz, Spain
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Greenberg H. Case 1-2002: Loa loa. N Engl J Med 2002; 346:1751; author reply 1751. [PMID: 12037162 DOI: 10.1056/nejm200205303462217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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