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   Table of Contents      
BRIEF COMMUNICATION
Year : 2008  |  Volume : 56  |  Issue : 4  |  Page : 325-326

Ocular dirofilariasis in Dubai, UAE


1 Department of Ophthalmology, Welcare Ambulatory Care Centre, Dubai, United Arab Emirates
2 Department of Ophthalmology, Welcare Hospital, Dubai, United Arab Emirates
3 Department of Ophthalmology, Welcare Eye Centre, Dubai, United Arab Emirates

Date of Submission15-Jun-2007
Date of Acceptance03-Oct-2007
Date of Web Publication19-Jun-2008

Correspondence Address:
Prashant G Bhatia
Department of Ophthalmology, Welcare Hospital, P.O. Box 31500, Dubai
United Arab Emirates
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0301-4738.41417

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  Abstract 

A rare occurrence of ocular subconjunctival dirofilariasis in a 53-year-old healthy Indian male working in Dubai, UAE presenting with an acute red eye is reported. Surgical excision under topical anesthesia was carried out uneventfully in the outpatient clinic. The live worm removed from the subconjunctival space was identified as Dirofilaria repens on the basis of microscopic examination and histopathology. Surgical excision of subconjunctival dirofilariasis is safe in an outpatient setting and curative precluding the need for further systemic antihelminthics.

Keywords: Dirofilaria repens , ocular dirofilariasis, subconjunctival dirofilariasis, zoonotic infection


How to cite this article:
Mittal M, Sathish K R, Bhatia PG, Chidamber B S. Ocular dirofilariasis in Dubai, UAE. Indian J Ophthalmol 2008;56:325-6

How to cite this URL:
Mittal M, Sathish K R, Bhatia PG, Chidamber B S. Ocular dirofilariasis in Dubai, UAE. Indian J Ophthalmol [serial online] 2008 [cited 2019 Oct 19];56:325-6. Available from: http://www.ijo.in/text.asp?2008/56/4/325/41417

Dirofilariasis is a well-documented parasitic infection that may present as zoonotic infestation in humans. [1] The microfilariae are accidentally transmitted to humans by Culex and Aedes mosquitoes. Man is a dead end host for the parasite and systemic involvement may be subcutaneous, [2] ,[3] pulmonary [4] or generalized. [5] Ophthalmic involvement may be periorbital, [6],[7],[8] subconjunctival, [9] ,[10] sub-tenons [11] or intraocular. [12] Such lesions are usually associated with moderate to severe inflammation. Subcutaneous dirofilariasis over the abdomen was reported in Kuwait in 1994. [13] To our knowledge, ocular dirofilariasis in the Arabian Peninsula is hitherto unreported and this is the first report of subconjunctival dirofilariasis in the Middle Eastern region.


  Case Report Top


A 53-year-old Indian male employed in Dubai, UAE presented with a sudden onset of foreign body sensation in his left eye while at work for which he used an eyewash from the first-aid kit. This was followed by an acute bout of pain, redness and watering which was attributed to the eyewash being past the expiry date. The patient was referred by the treating emergency physician with a suspected bleb and to rule out chemical conjunctivitis. There was no history of injury, allergy or of recent travel. The patient did have a history of longstanding generalized episodic itching over six to nine months with localized subcutaneous swelling lasting for a few seconds to five minutes and affecting the hands, chest and neck.

Slit-lamp examination revealed conjunctival chemosis with a live worm in the subconjunctival space adjacent to the nasal limbus, responding to light and to gentle pressure over the conjunctiva with a cotton swab. The head end was coiled up at the nasal limbus at the 9 O'clock meridian [Figure 1] while the tail end was coiled up at the temporal limbus at the 3 O'clock meridian giving the appearance of two separate worms. Rest of the ocular examination was unremarkable.

The worm was immobilized using topical lignocaine. A nick was made in the conjunctiva and the live worm was removed in toto using a blunt forceps [Figure 2]. It measured approximately 11 cm in length. Histopathological examination carried out elsewhere at an overseas parasitology laboratory reported an adult female Dirofilaria repens [Figure 3].

Complete blood picture and erythrocyte sedimentation rate (ESR) were within normal limits with no evidence of eosinophilia. Peripheral smear was unremarkable and no microfilaremia was detectable.

Symptoms resolved promptly following surgical removal with no ocular or systemic recurrences over a follow-up of one year.


  Discussion Top


Dirofilariasis is a zoonotic illness, rarely seen in humans. The worms may be subcutaneous as Dirofilaria repens or may be deep-seated as Dirofilaria imitis which frequently results in pulmonary dirofilariasis. Dirofilaria repens is a natural parasite of carnivorous animals, primarily dogs, foxes and cats.

Dirofilariasis is often reported from European countries surrounding the Mediterranean region. A review of world literature [14] ,[15] reports over 780 documented cases in diverse geographical locations with Italy, Sri Lanka and some countries of the former Soviet Union being the most affected areas.

Dirofilariasis has been reported to be associated with travel to 'foreign' lands. [2] ,[3] A history of migratory swellings and travel to endemic areas should arouse the suspicion of its possible diagnosis. [16] In India, dirofilariasis is predominantly reported in published literature in southern India with reports from Kerala, [17] Karnataka [10] and Tamil Nadu. [11] Being an inhabitant of Kerala and working in Dubai, in this patient it is unclear if he contracted the infection from his bi-annual visits back to his home country, through the frequently imported African machinery as a part of his occupation or locally in Dubai itself which is not a known endemic area.

Migratory subcutaneous dirofilariasis [2] has been frequently reported, however, simultaneous ocular involvement has not been documented. While it has not been clinically documented, this patient did have a past history suggestive of a subcutaneous involvement six to nine months prior to the ocular manifestations.

Surgical removal of the worm is curative [18],[19],[20] and a technically simple procedure. We were able to carry out this procedure uneventfully in an outpatient setting minor procedure room under topical anesthesia with lignocaine. Alternatively, the live worm could have been paralysed using topical pilocarpine.

Identification was done using standard histopathological methods by diagnostic evaluation of microscopic cross-sections and macroscopic characteristics of the worm. Dirofilarial worms are identified by their thick laminated cuticle, broad lateral chords and large muscle cells. Accurate species identification is best done by examination of mature worms. Direct polymerase chain reaction (PCR) protocols may aid in identification in instances of tissue degeneration or poor specimen preservation practices and may have a clinical application as a routine diagnostic aid. [21]

In conclusion, we report the first incidence of a live subconjunctival dirofilariasis in the Arabian Peninsula. Surgical removal and management along previously described guidelines led to satisfactory resolution of symptoms with a good clinical outcome.

 
  References Top

1.
Stringfellow GJ, Francis IC, Coroneo MT, Walker J. Orbital dirofilariasis. Clin Exp Ophthalmol 2002;30:378-80.  Back to cited text no. 1
    
2.
Logar J, Novsak V, Rakovec S, Stanisa O. Subcutaneous infection caused by Dirofilaria repens imported to Slovenia. J Infect 2001;42:72-4.  Back to cited text no. 2
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3.
de Vries PJ, Visser LG, Vetter HC, Muller HP, Polderman AM. Migrating subcutaneous swellings due to dirofilariasis after a visit to the South of France. Ned Tijdschr Geneeskd 2003;147:566-9.  Back to cited text no. 3
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Hirano H, Kizaki T, Sashikata T, Matsumura T. Pulmonary dirofilariasis--clinicopathological study. Kobe J Med Sci 2002;48:79-86.  Back to cited text no. 4
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5.
Pampiglione S, Fioravanti ML, Piccolotti D, Pizzicannella G, Reale D. Human dirofilariasis in Italy: A new case in the spermatic cord. Parassitologia 2002;44:93-6.  Back to cited text no. 5
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6.
Font RL, Neafie RC, Perry HD. Subcutaneous dirofilariasis of the eyelid and ocular adnexa: Report of six cases. Arch Ophthalmol 1980;98:1079-82.  Back to cited text no. 6
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7.
Jariya P, Sucharit S. Dirofilaria repens from the eyelid of a woman in Thailand. Am J Trop Med Hyg 1983;32:1456-7.  Back to cited text no. 7
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8.
Fuentes I, Cascales A, Ros JM, Sansano C, Gonzales AJ, Alvar J. Human subcutaneous dirofilariosis caused by Dirofilaria repens in Ibiza, Spain. Am J Trop Med Hyg 1994;51:401-4.  Back to cited text no. 8
    
9.
Gautam V, Rustagi M, Singh S, Arora DR. Subconjunctival infection with Dirofilaria repens. Jpn J Infect Dis 2002;55:47-8.  Back to cited text no. 9
    
10.
Nadgir S, Tallur SS, Mangoli V, Halesh LH, Krishna BV. Subconjunctival Dirofilariasis in India. South Asian J Trop Med Public Health 2001;32:244-6.  Back to cited text no. 10
    
11.
Sathyan P, Manikandan P, Bhaskar M, Padma S, Singh G, Appalaraju B. Subtenons infection by Dirofilaria repens. Indian J Med Microbiol 2006;24:61-2.  Back to cited text no. 11
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12.
Beaver PC. Intraocular filariasis: A brief review. Am J Trop Med Hyg 1989;40:40-5.  Back to cited text no. 12
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13.
Hira PR, Madda JP, al-Shamali MA, Eberhard ML. Dirofilariasis in Kuwait: First report of human infection due to Dirofilaria repens in the Arabian Gulf. Am J Trop Med Hyg 1994;51:590-2.  Back to cited text no. 13
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14.
Pampiglione S, Canestri Trotti G, Rivasi F. Human dirofilariasis due to Dirofilaria (Nochtiella) repens: A review of world literature. Parassitologia 1995;37:149-93.  Back to cited text no. 14
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15.
Pampiglione S, Rivasi F. Human dirofilariasis due to Dirofilaria (Nochtiella) repens: An update of world literature from 1995 to 2000. Parassitologia 2000;42:231-54.  Back to cited text no. 15
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16.
Kersten RC, Locastro AJ, Eberhard ML, Spaulding AG, Kulwin DR. Periorbital dirofilariasis. Ophthal Plast Reconstr Surg 1994;10:293-6.  Back to cited text no. 16
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17.
Sekhar HS, Srinivasa H, Batru R, Mathai E, Shariff S, Macaden RS. Human ocular Dirofilariasis in Kerala South India. Indian J Pathol Micorbiol 2000;43:77-9.  Back to cited text no. 17
    
18.
Ruiz-Moreno JM, Bornay-Llinares FJ, Maza GP, Medrano M, Simon F, Eberhard ML. Subconjunctival Infection with Dirofilaria repens: Serological Confirmation of Cure Following Surgery. Arch Ophthalmol 1998;116:1370-2.  Back to cited text no. 18
    
19.
Aravanitis PG, Vakalis NC, Damanakis AG, Theodossiadis GP. Ophthalmic dirofilariasis. Am J Ophthalmol 1997;123:689-91  Back to cited text no. 19
    
20.
Rouhette H, Marty P, Zur C, Bain O, Fenollar S, Gastaud P. Ocular filariasis: Not strictly tropical. Ophthalmologica 1999;213:206-8.  Back to cited text no. 20
    
21.
Vakalis N, Spanakos G, Patsoula E, Vam-Vamvakopoulos NC. Improved detection of Dirofilaria repens DNA by direct polymerase chain reaction. Parasitol Int 1999;48:145-50.  Back to cited text no. 21
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]


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