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ARTICLES
Year : 1976  |  Volume : 24  |  Issue : 4  |  Page : 20-22

Conjunctivitis by Dirofilaria conjunctivae


1 Assistant Professor, Social & Preventive Medicine, Medical College, Trivandrum, India
2 Eye Surgeon, Government Hospital, Chirnyinkil, India
3 Director & Professor of Ophthalmology, Medical College, Trivandrum, India

Correspondence Address:
A Joseph
Assistant Professor, Social & Preventive Medicine, Medical College, Trivandrum
India
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Source of Support: None, Conflict of Interest: None


PMID: 924615

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How to cite this article:
Joseph A, Thomas P G, Subramaniam K S. Conjunctivitis by Dirofilaria conjunctivae. Indian J Ophthalmol 1976;24:20-2

How to cite this URL:
Joseph A, Thomas P G, Subramaniam K S. Conjunctivitis by Dirofilaria conjunctivae. Indian J Ophthalmol [serial online] 1976 [cited 2021 Apr 21];24:20-2. Available from: https://www.ijo.in/text.asp?1976/24/4/20/31277

Different stages of a few species of the worms belonging to the family Filaridae have been recovered from human eyes in various parts of the world. But there are very few reports of conjunctivitis in man due to Dirofilaria conjunctivae, recorded previously. Perhaps the earliest authentic record is that of Desportes,[2] who named the worm as Filaria Conjunctivae. Later Faust et al[4] give an account of the unusual filarial infections in man and mentioned Dirofilaria conjunctivae. (Synonym. Filaria conjunctivae). Faust and Russel[5] give a short account of the worm as well as the signs and symptoms of the infe­station. The diagnostic characters of some filarial worms including Dirofilaria are given by Lindsey.[8] Dirofilaria conjunctivae has been recorded from France, Italy, Hungary, Turkey, India, Africa, Thailand and U.S.A. However Duke Elder[3] makes only a casual mention of this in his classical book 'Diseases of the outer eye'. Human infections with filariae of animals have been very well dealt with by Beaver and Orihel.[1] They give cata­logue of all the cases of D. Conjunctivae recovered from different parts of the body and reported from different localities. Orihel and Beaver[9] described the morphological characters of D. Conjunctivae and another closely allied, species namely Dirofilaria tenuis. Soulsley states that Dirofilaria conjunctivae has been associated with hazel-nut shaped nodules on the head, eyelids and other parts of the body. He also refers to the views of some workers who consider Dirofilaria conjunctivae identical with the dog filarial worm Dirofilaria repens.

From a resume of the available literature it is evident that such a case has not hitherto been reported from Kerala. Hence the present paper gives a short account of a case encoun­tered in the Government Hospital, Chirayinkil, Kerala, in June 1976. Chirayinkil is a coastal village thirty-five kilometres north of Tirvandrum city.


  Case Report Top


Paru Amma, a 60 year old Hindu female came to the Hospital with swellings on the right eye, itching, a foreign body sensation, and frequent watering. Though the duration according to the patient was five months, she had severe complaints from seven days prior to the reported date.

Both of her eyes had been operated for cataract four years ago at the Government Ophthalmic Hospital, Trivandrum. There was no relevant history of any sys­temic disease. The patient had never gone out of Trivan­drum district. The general examination showed that she was moderately nourished with average built and health.

There were no skin nodules, or generalised lymphadeno­pathy. Examination of urine and blood showed nothing abnormal. Repeated night blood smears were negative for microfilariae.

Examination of both eyes showed aphakia. Vision, media and fundi were normal. There was a generalised conjunctival congestion, with chemosis and spot haemo­rrhages on the temporal part of the bulbar conjunctiva, in the inter palpebral area. On closer examination of this swelling which was about 1 cm. diameter, the move­ment of a worm under the conjunctiva could be seen. [Figure - 1]

The patient did not submit to exploratory surgery the same day. When examined next day the worm was found to have migrated to the upper conjunctival fornix. Instillation of local anaesthetic drops produced a vig­orous movement of the worm to its original site. The entire worm was removed after incising the overlying conjunctiva. Post-operative recovery was uneventful. A course of antifilarial drugs was given systemically. The patient did not have any further complaints so far. There was only a single worm and its morphological characters are given below.

The extracted worm is whitish resembling white sewing thread. The cuticle is indistinctly and transversely striated. It was 13.5 cm. long, with a mid-body breadth of 0.5 mm. The cephalic region was slightly curved and tapering with a breadth of nearly 250/u. The oral end was unarmed and the oesophagus was 1.5 cm. long. The caudal end was rounded and more pronounced than the rest of the body. Spicules were absent. The anus was sub­terminal. The ovaries were highly coiled. It is an imma­ture female worm, belonging to the family Filaridae genus Dirofilaria and species Dirofilaria conjunctivae.


  Discussion Top


Among the filarial worms belonging to the Genus Dirofilaria, the species D. repens and D. imitis are the common dog parasites. Invasion of the early stages of them in man can cause high eosonophilia. However, Faust and Russel[6] have recorded a single adult male worm of D. repens from the subcutaneous nodule of the lower right eyelid of a female patient of U.S.S.R. Dirofilaria tennis is a subcutaneous parasite of the Raccon. A few cases of human infection with this parasite have been reported from U.S.A.[1],[7],[10] According to Orihel[9] this species is very closely allied to D. conjunctivae and mistaken identification is quite likely.

Dirofilaria conjunctivae has been renoved from the tumours or abscess pockets in various anatomical locations of the human body. Among the recorded cases some are from the palpebral conjunctivae and other tissues of the eye. Generally only immature female worms are obtained. According to Watson,[12] there is no record of Dilofilaria conjunctivae from any other host than man. Microfilariae are un­known. Exact details regarding the life cycle, intermediate host and transmission remain to be discovered. In the absence of any other case so far reported and travel outside the district by this patient, it is suspected as zoonotic filariasis' with some local animals as the reservoir of infection.

Localised oedema, pruritis, urticaria, burning and itching sensations are attributed to the presence of these parasites, by all who have reported these cases previously. In the present case reported by us also the patient had all these complaints. So far no serious patho­genecity due to Dirofilaria infection has been reported.


  Summary Top


Conjunctivitis due to Dirofilaria con­junctivae is a very rare condition, having been reported previously only on very few occasions. In the present paper a short record of a case of conjunctivitis by D. conjunctivae in a 60 year old woman, at Chirayinkil Hospital, the extraction of the worm and its morphological characters are given. It is the first time such a case has been reported from Kerala, India.


  Acknowledgement Top


The authors are grateful to the Director of Health Services, Trivandrum and the Principal, Medical College, Trivandrum for permitting us to publish this paper.

 
  References Top

1.
Beaver, P.C. and Orihel, T,C., 1965, Amer. J, Trop. Med. Hyg., 14, 6, 1010.  Back to cited text no. 1
    
2.
Desportes, 1939; Ann. de. Parst. 17, 515.  Back to cited text no. 2
    
3.
Duke-Elder Stewart, 1965 Diseases of the outer eye, Part 1, p.416. Henry Kimpton, London.  Back to cited text no. 3
    
4.
Faust, E. C. et al, 1952, Amer J. Trop. Med. Hyg. 1, 1, 239.  Back to cited text no. 4
    
5.
Faust, E.C. and Russel, P.F., 1953, Clinical Pathology Lea and Fe biger, U.S.A. 475.  Back to cited text no. 5
    
6.
Faust, E.C., 1959, Animal agents and Vectors of Diseases, Lea and Febiger, U.S.A., 311.  Back to cited text no. 6
    
7.
Jung, R.C. & Espenan, P.H., 1967, Amer. J. Trop, Med. Hyg., 16, 2, 172.  Back to cited text no. 7
    
8.
Lindsey, J.R., 1962, J. Parst., 48, 321.  Back to cited text no. 8
    
9.
Orihel, T.C. & Beaver, P.C., 1965, Amer. J. Trop. Med. Hyg., 14, 6, 1030.  Back to cited text no. 9
    
10.
Pacheco, G & Schofield, H.L., 1968, Amer. J. Trop. Med. Hyg., 17 180.  Back to cited text no. 10
    
11.
Soulsley, E.J.L., 1973, Helminths, Arthropods and Protozoa of Domesticated animals, The Williams and Wilkin Comp., Baltimore.  Back to cited text no. 11
    
12.
Watson, J.M., 1960, Medical Helminthology Baillire, Tindall And Cox, London, 199.  Back to cited text no. 12
    


    Figures

  [Figure - 1], [Figure - 2]



 

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