A case of lacrimal gland dirofilariasis

Ocular Dirofilariasis in Bosnia and Herzegovina: A Case Report and Review of the Literature

Purpose:

To report a rare occurrence of ocular dirofilariasis in Bosnia and Herzegovina and provide a short overview on clinical characteristics and treatment options for ocular dirofilariasis.

Methods:

A 75-year-old woman was admitted to the University Clinical Centre Tuzla with pain and redness in her left eye. A live, white, coiled, and active worm was noticed in subconjunctival space of bulbar conjunctiva.

Results:

After successful surgical extraction, the parasite was identified as the adult form of Dirofilaria repens. There were no signs of intraocular or systemic inflammation.

Conclusion:

Ophthalmologists should have in mind a possible infestation, especially in cases with repeated inflammatory reactions and swelling of the ocular region, which does not respond to conventional therapy.

The trends of human dirofilariasis in Croatia: Yesterday - Today - Tomorrow

Introduction

Human dirofilariasis is a disease historically linked to the Mediterranean area. For the last few decades, however, Dirofilaria nematodes have been spreading, both in terms of prevalence and the geographical expansion in non-endemic areas. Currently, cases of human dirofilariasis are recorded in more than 40 countries worldwide. Croatia is considered an endemic area of the Adriatic basin.

Methods

In a nationwide investigation, new and previously published cases of human dirofilariasis in Croatia were analyzed.

Results

Since 1996, 30 cases of human dirofilariosis were reported in Croatia. A total of 14 (46,67%) cases were from the coastal and 16 (53,33%) from continental regions of the country. Based on anatomical location, 13 (43,33%) cases were subcutaneous, 12 (40%) were ocular and five (16,67%) occurred in the reproductive organs. In all 30 cases, Dirofilaria repens was identified as the causative agent.

Conclusions

An increase in air temperature as climate change, changes in mosquito fauna, high prevalence of D. repens in dogs and limited use of chemoprophylaxis are possible risk factors for Dirofilaria infection in the Croatian population. Since reporting to epidemiological services is not mandatory in this country, the real number of human dirofilariasis cases is probably significantly higher than published. This emphasizes the need for mandatory reporting of human cases and surveillance of Dirofilaria infection in dogs and mosquitoes in Croatia, following the “One Health” concept.

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A total of 30 cases of human dirofilariasis have been described in Croatia.

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In all cases, D. repens was identified as the causative agent.

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Geographical distribution among regions was almost identical.

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Subcutaneous nodules were not the major clincal presentation of D. repens infections.

An unusual presentation of lacrimal gland dirofilariasis

Dirofilariasis is a helminthic infection caused by filarial parasite of the genus Dirofilaria. It is a common zoonotic disease mostly affecting canines and uncommon in humans. It is endemic to Mediterranean countries, with few reports from other parts of the world. The clinical forms in humans are pulmonary, subcutaneous, and ocular. Ocular involvement is rare. We report a case of lacrimal gland dirofilariasis, an unusual ocular presentation which masquerades as a lacrimal gland tumor. Ours would be the third reported case in the world and first in India. This case was managed with excision of the lacrimal gland mass. Postoperatively the patient recovered completely and there has been no recurrence in the 1-year follow-up.

Canine and human Dirofilaria infections in the Balkan Peninsula

Dirofilaria immitis and Dirofilaria repens infections are mosquito-borne diseases, mainly of dogs. Both parasites are zoonotic, and they sometimes cause serious infections in humans. The aim of this short review was to examine the situation in the Balkan Peninsula, from where it is not always easy to obtain suitable data, often reported in journals and other publications difficult to be retrieved and with poor or no visibility. The review included data from international and regional literature, doctoral theses, and conference proceedings.

The first case of human autochtonous subconjunctival dirofilariosis in Poland and MALT lymphoma as possible consequence of this parasitosis

The first case of human dirofilarosis in Poland was recorded in 2007. Until that time our country was free of Dirofilaria repens. Recent studies show that 21,4- 60% of dogs in Warsaw region harbour microfilariae, therefore it is becoming a growing problem in Central Europe.

In April 2013 a subconjunctival D. repens was removed from the eye of 61-year-old woman. It was the twenty first case of this disease in Poland, the third case of eye dirofilaria and the fourth autochtonous case. The patient had never been abroad, so it was the first case of autochtonous human ocular dirofilariosis in Poland. Nine months after the D. repens had been removed, a MALT lymphoma was discovered. In the article we discuss whether a MALT lymphoma of the lacrimal gland of the eye, previously affected by the parasite, may be the consequence of the invasion.

Discrete eyelid swelling caused by live subconjunctival Dirofilaria repens

We present a case concerning a 48 year-old man, who had complaints about ocular pains and an unpleasant feeling, which had started two days before admission. It was as if there was “something moving in his left eye.” The examination showed an extremely motile white worm, which was wrapped in concentric circles around the limb in the subconjunctival space of the patient’s left eye. It was identified as the adult female form of Dirofilaria repens. The patient had a normal clinical finding, except eosinophilia. Ocular filariasis is as a possibility to think about, even when the cases are not in a typically endemic area and with no specific subjective complains.

Recently recognized cases of ophthalmofilariasis in Hungary

PURPOSE

To report four cases of zoonotic ophthalmodirofilariasis infection caused by Dirofilaria repens in Hungary.

METHODS

Four cases of ophthalmofilariasis have been treated at our department during the last 14 months. A subconjunctival moving worm was observed by slit lamp biomicroscopy in two cases. In one of these a living filaria was surgically removed, but the other disappeared. Red eye and migrating edema were the presenting signs in two cases. A biopsy taken from the subcutaneous masses disclosed D repens.

RESULTS

Histopathologic or parasitologic examination identified a female D repens in every case. Laboratory alterations were not found. Symptoms subsided after treatment.

CONCLUSION

The clinical presentation of filariasis is not always straightforward, and a high index of suspicion is necessary in cases presenting with orbital or periorbital inflammation. During the past 10 years the identification of locally acquired infections by D repens has increased in Hungary.