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   Table of Contents      
BRIEF COMMUNICATION
Year : 2013  |  Volume : 61  |  Issue : 6  |  Page : 298-300

Periorbital dirofilariasis-Clinical and imaging findings: Live worm on ultrasound


1 Dr. Shaji's MRI and Research Centre, Calicut, India
2 Vasan Eye Care Hospital, Calicut, India
3 Aswini Diagnostics, Calicut, India

Date of Submission03-May-2012
Date of Acceptance20-Sep-2012
Date of Web Publication27-Jun-2013

Correspondence Address:
Thandre N Gopinath
Dr. Shaji's MRI and Research Centre, Mini Byepass Road, Puthiyara, Kozhikode - 673 001, Kerala
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0301-4738.114111

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  Abstract 

Ocular dirofilariasis is a zoonotic filariasis caused by nematode worm,Dirofilaria. We present a case of dirofilariasis affecting the upper eyelid in a 2-year-old child presenting as an acutely inflammed cyst, from southern Indian state of Kerala. Live adult worm was surgically removed and confirmed to be Dirofilaria repens. Live worm showing continuous movement was seen on the pre-operative high-resolution ultrasound. Ultrasound can be helpful in pre-operative identification of live worm.Imaging findings reported in literature are very few. We describe the clinical, ultrasound, and magnetic resonance imaging (MRI) findings.

Keywords: Magnetic resonance imaging, ocular dirofilariasis, ultrasound


How to cite this article:
Gopinath TN, Lakshmi K P, Shaji P C, Rajalakshmi P C. Periorbital dirofilariasis-Clinical and imaging findings: Live worm on ultrasound. Indian J Ophthalmol 2013;61:298-300

How to cite this URL:
Gopinath TN, Lakshmi K P, Shaji P C, Rajalakshmi P C. Periorbital dirofilariasis-Clinical and imaging findings: Live worm on ultrasound. Indian J Ophthalmol [serial online] 2013 [cited 2017 Nov 24];61:298-300. Available from: http://www.ijo.in/text.asp?2013/61/6/298/114111

Ocular dirofilariasisis a zoonotic filariasis caused by nematode worm, Dilofilaria, transmitted to humans by the bite of Aedes, Culex,or Anopheles mosquitoes. Eye involvement may be periocular, sub-conjunctival, sub-tenon, or intraocular. The species Dirofilaria repens is endemic in southern-middle Europe and in some parts of Asia and Africa. [1] There are very few reports of imaging findings in literature. We describe the clinical, ultrasound, and Magnetic resonance imaging (MRI) features.


  Case Report Top


A 2-year-old female child presented with acute onset of periorbital edema in right eye. She was initially diagnosed as preseptal cellulitis and treated with systemic antibiotics. There was mild resolution of edema, but a cystic swelling was apparent in the right upper eyelid.

Ultrasound was performed with high-resolution probe (8MHz) and showed a well-defined cyst approximately 2.5×1.5 cm in the lateral part of right upper eyelid. The cyst showed within it a coiled structure with parallel echogenic walls [Figure 1]. It showed continuous movement which represents the live worm. MRI was done to know any deep intraorbital extension and exclude other intraorbital abnormalities. MRI of orbits showed a cyst in the lateral part of upper eyelid which showed hyperintense signal on coronal short-tau inversion recovery image [Figure 2]a, hypointense signal on coronal T1 image [Figure 2]b and revealed rim enhancement on post-contrast T1-weighted fat saturated images [[Figure 2]c (coronal) and d (sagittal)]. The cyst was confined to the upper lid. Ill-defined intermediate signal intensity was seen on STIR images [Figure 2]a within the cyst which may represent the worm.
Figure 1: Axial high resolution ultrasound (8MHZ) images showing a cystic lesion in the upper lid. A coiled structure with parallel echogenic wall is seen within it (white arrow), which represents the worm

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Figure 2:

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Surgical excision of the parasitic cyst was done through an upper lid crease incision. The cyst was adherent to the levator palpebrae superioris muscle. It contained a live motile worm measuring about 9 cm in length [Figure 3]. Histopathological examination [Figure 4] showed a worm with thick cuticle, muscle coat, longitudinal and transverse striations and double uterus. Based on histopathological appearance, the worm was identified as D.repens.

Post-operatively, the child was asymptomatic except for a mild residual ptosis which was improving.
Figure 3: Photograph showing the long worm and the excised inflamed cyst

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Figure 4: Histopathological photograph (longitudinal section) of worm showing thick cuticle and transverse striations

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  Discussion Top


Ocular dirofilariasisis is a zoonotic filariasis caused by nematode worm, Dilofilaria. It is transmitted to humans by the bite of Aedes, Culex, or Anopheles mosquitoes. Dogs are main source of infection and humans are accidental hosts.

Human infection is caused by Dirofilaria immitis, Dirofilaria tenius, Dirofilaria ursi, and D.repens. The condition associated with D.repens is the most frequent and the most widely distributed in the world, of the dirofilariases of medical relevance. [1] The species D.repens is endemic in southern-middle Europe and in some parts of Asia and Africa. [1] In India, dirofilariasisis is predominantly reported in published literature in southern India with reports from Kerala, [2] Karnataka, [3] and Tamil Nadu. [4] Cases of Dirofilariasis have also been reported from Assam, [5] Northern India, [6] and Western India. [7]

Clinically, ocular involvement may be periorbital, [8] sub-conjuctival, [6],[9] sub-tenon, [4] and intraocular. [10] Apart from ocular involvement, subcutaneous [11] and pulmonary manifestations [12] can also occur.

Imaging findings have not been well described in literature. Few reports have described the imaging findings. [13],[14] In one report, the live worm was shown on ultrasonography as an actively motile, folded tubular structure with parallel echogenic walls. [13] A soft tissue with enhancing periphery was seen on the contrast computed tomography. [13]

MRI findings have been described in a single case [14] and include the visualization of an enhancing thick-walled, semiliquid structure with a discrete, tubular, central signal, representing the worm on T1-weighted images.

In our case, high-resolution ultrasound (8MHz) showed a well-defined cyst in upper eye lid with a coiled structure showing parallel echogenic walls. It showed continuous movement. MRI was also done in our case to look for any deep extension and assess other intraorbital structures. MRI showed a well-defined cyst in lateral part of upper eyelid.Rim enhancement was seen on post-contrast T1-weighted fat saturated images, which represents surrounding inflamed tissue. The cyst was within upper eye lid and rest of the orbit was normal. Ill-defined intermediate signal intensities were seen on STIR images which may represent the worm. The definitive visualization of worm was, however, done on ultrasound. MRI mainly showed the inflamed cyst. It excluded deep extension and other conditions such as inflammatory pseudo tumor and lacrimal gland tumor.


  Conclusion Top


This is a report of a case of periorbital type of ocular dirofilariasis. Ultrasound can be used as a non-invasive diagnostic tool to identify live adult worm and may help in pre-operative diagnosis.

 
  References Top

1.
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. 1
[PUBMED]    
2.
Sekhar HS, Srinivasa H, Batru RR, Mathai E, Shariff S, Macaden RS. Human ocular dirofilariasis in Kerala Southern India. Indian J Pathol Microbiol 2000;43:77-9.  Back to cited text no. 2
[PUBMED]  Medknow Journal  
3.
Nadgir S, Tallur SS, Mangoli V, Halesh LH, Krishna BV. Subconjunctival dirofilariasis in India. Southeast Asian J Trop Med Public Health 2001;32:244-6.  Back to cited text no. 3
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4.
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. 4
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5.
Nath R, Gogoi R, Bordoloi N, Gogoi T. Ocular dirofilariasis. Indian J Pathol Microbiol 2010;53:157-9.  Back to cited text no. 5
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6.
Gautam V, Rustagi IM, Singh S, Arora DR. Subconjunctival infection with Dirofilaria repens. Jpn J Infect Dis 2002;55:47-8.  Back to cited text no. 6
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7.
Badhe BP, Sane SY. Human pulmonary dirofilariasis in India: A case report. J Trop Med Hyg 1989;92:425-6.  Back to cited text no. 7
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8.
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. 8
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9.
Mittal M, Sathish KR, Bhatia PG, Chidamber BS. Ocular dirofilariasis in Dubai, UAE. Indian J Ophthalmol 2008;56:325-6.  Back to cited text no. 9
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10.
Beaver PC. Intraocular filariasis: A brief review. Am J Trop Med Hyg 1989;40:40-5.  Back to cited text no. 10
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11.
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. 11
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12.
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. 12
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13.
Smitha M, Rajendran VR, Devarajan E, Anitha PM. Case report: Orbital dirofilariasis. Indian J Radiol Imaging 2008;18:60-2.  Back to cited text no. 13
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Groell R, Ranner G, Uggowitzer MM, Braun H. Orbital dirofilariasis: MR findings. AJNR Am J Neuroradiol 1999;20:285-6.  Back to cited text no. 14
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    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]


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