Year : 1990 | Volume
: 38 | Issue : 2 | Page : 92--93
Live male adult W. bancrofti in the anterior chamber-A case report
Yogesh Arora, Ravin N Das
Dept. of Ophthalmology, M.G.I.M.S., Sewagram, India
Ravin N Das
Registrar. Ophthalmology,A-44. J.N.B.H, M.G.I.M.S, Sewagram (Wardha) MS-442102
A unique case of an adult, live, Filarial warm (W.Bancrofti) in the anterior chamber of an adult female is being reported.
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Arora Y, Das RN. Live male adult W. bancrofti in the anterior chamber-A case report.Indian J Ophthalmol 1990;38:92-93
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Arora Y, Das RN. Live male adult W. bancrofti in the anterior chamber-A case report. Indian J Ophthalmol [serial online] 1990 [cited 2020 Mar 29 ];38:92-93
Available from: http://www.ijo.in/text.asp?1990/38/2/92/24537
There are many reports of ocular filariasis in the past two centuries and species included under the term 'filaria' gave been reported in the eye(W.Bancrofti, B. malayi, Loa loa, B. timori, T.Persians, M. ozzardi, T.streptocerca, O.volvulus).
Though there has been previous reports ,, of a filarial worm in the anterior chamber; a case report of a W.Bancrofti filarial worm in the chamber is made having some unique features.
A 35 year old female, resident of Chandrapur, complained of flashes of light in her right eye. She had been using aphakic correction in the form of contact lenses, following operation for traumatic cataract in the other eye. The patient was admitted in the Mahatma Gandhi Institute of Medical Sciences, Sewagram.
Fifteen days prior to the date of admission, she had had, recurrent attacks of pain and redness with watering in 'her right eye, without any dimunition of vision, for which she had gone to a private practitioner with the history of a worm in her right eye since one year, saying that it had never previously created any problems. The worm was identified by the ophthalmologist to be a 'microfilarium' and the patient was started on di-ethylcarbamezipine (Hetrazan) and topical corticosteroid drops and ointment, to which she responded symptomatically.
On admission she was noticed to have a mild superficial diffuse conjunctival congestion, with a clear cornea, and a silvery white threadlike organism, approximately 40mm in length, in the anterior chamber, executing graceful, brisk, movements. There was no anterior chamber reaction. The patient was restarted on Hetrazan which she had discontinued. The intraocular tension was found to be normal. Thick peripheral blood smears were taken on three consecutive nights (10 PM), in addition to taking samples for cell counts, and a sample for enzyme linked immunosorbent assay, (ELISA).
ELISA was found to be positive for W.bancrofti, the peripheral thick blood smears where found to contain 3 microfilaria per slide on an average, and quite interestingly, the differential cell count, showed eosiriophils to be only 3%.
Two days following admission the worm disappeared from the anterior chamber, with a moderate anterior chamber reaction and with raised intraocular pressure i The anterior chamber reaction was easily controlled using topical steroids, subconjunctival hydrocortisone injections, and homatropine; however, the intraocular pressure had to be controlled using mannitol 20% infusion along with oral acetazolamide.
Following subsidence of the anterior chamber reaction, gonioscopy was performed, and direct and indirect ophthalmoscopy was done under full mydriasis. Slit lamp examination revealed the presence of a macular grade corneal (deep) opacity (2/1 mm circular at 7'0' Clock position), and a small patch of similar dimensions on the iris surface, yellow-white in colour. There were no other findings in either the anterior or the posterior segment.
On presentation the vision had been 6/5, at the time of discharge it was found to be . 6/9.
The patient had knowledge of the worm in her eye for a period of approximately one year, without any symptoms. As the patient would not have noticed a microfilarium, the larval stage of the adult worm, it would be appropriate to think-of this to have been the adult worm. The size of the adult male W.bancrofti is about 40 mm, man is the definitive host, and the life span of the adult worm has been noted to be as much as 15 years 31 The adult worm lives in the skin or the lymphatic tissues of man, possibly developing there from the larval stage after active penetration. The details of the development of this worm are not fully understood 39,40
The anterior chamber reaction can be explained on the basis of an allergic response to worm proteins, or some other products, as is seen in the other tissues of the body following administration of di-ethyl carbamazepine 39. The susceptibility of the organism to this drug itself is a controversial issue. The fate of the worm requires speculation, either it was lysed (as can be explained on the basis of the anterior chamber reaction to the worm proteins), or it has taken a route out of the eye(which seems less likely due to the size of the worm. In previous reports, these worms have vanished on their own 25,32,33,34 or are said to have vanished following therapy: atropine 35, di-ethyl carbamezipine36 ,sub 38 Benzimidazole 37.
Regarding the route of entry, it is quite likely that the organism may have crossed the blood barriers to the eye in it's larval stage by active penetration, thus evolving into the adult stage within the anterior chamber.
It is also worth mentioning that the worm had remained in the anterior chamber over a period of a year without causing any trouble to the patient, until active therapy against it was administered.
We also wish to thank the department of Biochemistry(Clinical) for the help extended to us, based on their vast field experience on filariasis, with a special note of thanks to Prof. Harinath (Head, Dept of Biochemistry M.G.I.M.S, Sewagram) and Dr. Reddy. We also wish to thank the Dept. of Microbiology for the clinical help extended to us.
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