Indian Journal of Ophthalmology

CASE REPORT
Year
: 1988  |  Volume : 36  |  Issue : 2  |  Page : 98--99

Loiasis (A case report)


N Lakshmi, Gururaj A Kumar 
 Department of Microbiology, S.V. Medical College, Tirupati, India-517 507, India

Correspondence Address:
N Lakshmi
Department of Microbiology, S.V. Medical College, Tirupati, India-517 507
India

Abstract

A case of Loiasis in a Nigerian male presenting in an unusual manner with two adult worms, one under­neath the conjunctiva of the left eye and another in subcutaneous tissue below the sternal end of the left clavicle, is reported This was associated with calabar swell­ings, and microfilariae in the peripheral blood smear taken during day time. It was diagnosed by the morphology of the adult worms removed surgically and of the microfilariae.



How to cite this article:
Lakshmi N, Kumar GA. Loiasis (A case report).Indian J Ophthalmol 1988;36:98-99


How to cite this URL:
Lakshmi N, Kumar GA. Loiasis (A case report). Indian J Ophthalmol [serial online] 1988 [cited 2020 May 31 ];36:98-99
Available from: http://www.ijo.in/text.asp?1988/36/2/98/26138


Full Text

 Introduction



Loiasis, caused by Loa loa is found throughout the rain forest areas of the Sudan, the basin of the Congo, West and Central Africa especially in Nigeria Man is infected by the bite of Chrysops (mangrove flies). The adult worm migrates through the subcutaneous tissue and shows a special predilection for creeping in and around the eye. During migration it causes oedema of the subcutaneous tissue known as 'Calabar swellings' which disappear in 2 to 3 days and are regarded as allergic mainfestations of the tissues to filarial toxins.

Microfilaria can seldom be found during the period of calabar swellings, that is, during the first 4 years of the infection and the diagnosis is based upon history of such Calabar swellings associated with intense eosinophilia

of 30-40% [1],[2],[3],[4].

 Case report



A Nigerian male aged 20 years had attended the Ophthalmology department of S. V. R R Hospital, Tiru­pati with history of pain and foreign body sensation in the left eye, fever, urticarial rash, painless swellings on the ankles, feet and fingers, painless creeping sensation of a worm from the left shoulder, of 1 week duration He had come to India from Nigeria 9 months ago. On examination a slender creeping worm was seen in the left eye underneath the conjunctiva associated with conjunctivitis and orbital oedema [Figure 1]. Similarly another slender creeping worm was seen subcutaneously below the sternal end of the left clavicle [Figure 2]. There was no impairment of vision arthritis or lymphadeno­pathy. Past history was unsignificant Peripheral blood smear taken at 10 AM showed microfilaria which were sheathed and having nuclei upto the tail tip [Figure 3]. There was moderate eosinophilia of 28%, VDRL test was non-reactive. Skin snips were also examined for microfilariae to exclude concurrent onchocercasis and found to be negative.

Both the adult worms were rerrroved under anaesthesia On examination both were identified as adult female Loa loa worms, which were of 5 cms length, white, cylindrical, semitransparent and with curved caudal ends [Figure 4]. Microscopically they showed numerous round, smooth translucent protruberances (cuticular bosses) which were more over the body [Figure 5] and caudal end [Figure 6] than at the cephalic end The cephalic - end was provided with one pair of lateral papillae and two pairs of small submedian papillae.

After surgical removal of the adult worms the patient was treated with, diethylcarbamazine 100 mgs. three times a day for 3 weeks and subsequently no microfil­ariae were demonstrated in the blood. The case was further followed up for 9 months, during which period the patient remained asymptomatic.

 Discussion



The endemicity of certain parasites in certain geographic locations is a well known fact Human loiasis is one among them Usually the manifestations occur 13 or 4 years after acquiring the infection Although many African citizens have been residing in India for relatively periods no case of loiasis occuring in any of them has been reported from India in the recent past.

Maplestone [5] reported a case of loiasis wherein he described two adult female worms, one from under the conjunctiva and another from the neck of a European woman in India He designated the worms as Loa inquirenda as the adults differed from the classical Loa loa.

This patient who came from Nigeria only9 months back had the clinical signs of calabar swellings, urticaria, creeping worms underneath the conjunctiva and sub­cutaneous tissue. It is stated that microfilaria will not be demonstrated in the peripheral blood during the period of calabar swellings [1],[2],[3],[4].­

Similarly it was also stated that microfilariae may be found in peripheral blood films taken during the day time in only 20-30% of cases and recovery of adult worm from the skin is rare'. In this case not only microfilaria were seen in the peripheral blood smear taken during the day time but also an adult female worm from under the skin was recovered Because of the paucity of reports and a few rare features observed this case is reported[6].

References

1Edward K MarkelL, and Marietta Voge.: Medical Parasitology. 5th Ed., Philadelphia., W, B. Saunders Co. pp 243-244., 1981.
2Chaterjee, K.D. : Parasitology 12th Ed., Calcutta., Chaterjee Medical Publishers. p. 202, 1982.
3Manson- Bahr, P.E.C., and Apted F.LG : Mansori s Tropical Diseases 18th Ed. London, E.LaS. and Bailliere Tindall, pp. 162, 727-728., 1983.
4Paul Chester Be-aver, Rodney Clifton Jung and Eddie Wayne Cupp.: Clinical Parasitology, 9th Ed..Philadelphia Lea and Febiger, pp. 377-379, 1988
5Maplestone, P.A : Anew filarial worm from human being, Indian Med. Gaz 73: 8-10, 1938.
6Robert S. Goldsmith : Infectious diseases Helminthic, In Marcus, A Krupp, and David Werdegar., (ed) Current Medical Diagnosis and Treatment Singapore, Lange Medical Publications, Maruzen Asia, p. 937, 1985.