|Year : 2001 | Volume
| Issue : 3 | Page : 195-196
Subconjunctival adult bancroftian filarial worm
Mayank A Nanavaty, Ambarish J Nanavaty, Jitendra D Lakhani, Sucheta J Lakhani, Abhay R Vasavada
"Prarabdh", 11 Punit Bunglows, B/h Welcome Plaza, Ganesh Cross Roads, Anand - 388 001, Gujarat, India
Mayank A Nanavaty
"Prarabdh", 11 Punit Bunglows, B/h Welcome Plaza, Ganesh Cross Roads, Anand - 388 001, Gujarat
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Nanavaty MA, Nanavaty AJ, Lakhani JD, Lakhani SJ, Vasavada AR. Subconjunctival adult bancroftian filarial worm. Indian J Ophthalmol 2001;49:195-6
We report a case of live adult Bancroftian Filarial nematode removed from the sub conjunctival tissue of a 58-year-old woman from the temporal limbus of her left eye.
Filarial and filarial-like nematodes top the list of the nematodes that affect the eye. Filariasis is caused by Wuchereria bancrofti, which has infected 79 million people worldwide and has a widespread distribution in Asia, Africa and Latin America (WHO).
The larvae of Wuchereria Bancrofti can enter anterior chamber, iris, lens capsule, retina and Choroids. The adult worm has also been seen in the subretinal space. In most areas infection by Wuchereria Bancrofti is nocturnally periodic, transmitted through the bite of Culex and Anopheles mosquitoes.
Bancroftion, Toxocariasis, Brugian, Filariasis, Gnathostomiasis, Trichinosis, Angiostrongyliasis, are nematode infections commonly described in the literature, that affects the eye. Round worm [Ascariasis lumbricoides] in the lacrimal passage has also been reported in India.
| Case report|| |
A woman aged 58 years presented to an eye camp in South Gujarat with complaints of redness, itching, watering and pain in the left eye for 2 months.
On ophthalmologic examination a small (3-4 mm) circumscribed, congested tumour-like elevation was noted on the outer side of the temporal limbus of the left eye. While observing the lesion for a few minutes, some movement was noted under the congested conjunctiva. A white thread-like worm appeared to be moving under swelling, which was covered with small black spots. Under subconjunctival infilteration anaesthesia, a 2 mm radial incision was made and the white thread like loop was hooked with a bent 26-gauge needle. The live worm was slowly pulled out using a side-to-side movement. The conjunctival incision was thoroughly washed with balanced salt solution and gentamicin (20 mg) and dexamethasone (2 mg) were injected sub conjunctivally. Later on examination she had non-pitting oedema of legs due to filariasis. The peripheral blood showed microfilariae, Wuchereria bancrofti with mild eosinophilia. The ophthalmologic examination was otherwise normal including corrected visual acuity in both eyes.
| Discussion|| |
The adult nematode appeared as a thread-like, milky white worm with a cylindrical body measuring 11cm in length and 0.5 mm diameter. The tail was tapering and head was globular (Figure). It appeared to be a female filarial worm. Since the cuticula was not smooth it could be W Bancrofti, O volvulus or Loa Loa. In most filarial-like worms only females are seen infecting the human body. Its microfilariae were characteristic of W Bancrofti. Beaver has reviewed 56 human cases of intraocular filariasis. The filarial worms identified were W Bancrofti, Loa loa, Dipetalonema spp and Dipofilaria spp. An immature stage of Wuchereria bancrofti in the human eye was also reported from India in 1980.
Of all the worm infestations of the eye including Onchocerciasis, Loasis, Dracontiasis, Gnathostomiasis, Bancroftian filariasis, ocular filariasis caused by filarial worm Onchoceria volvulus (Onchocereiasis), is one of the leading causes of blindness worldwide. It is thought to affect about 19 million people, mostly in West and Central Africa. It is estimated that about 360,000 people are blind due to Onchocereiasis. The other filarial worm Loa loa is the 'Eye worm of Africa.' The adult worm is found in subcutaneous tissue, often in subconjunctival tissue of the human eye. The oriental eye worm Thelazia callipaeda, which is a nematode of the order Spirunida [the same order as the filarioidea superfamily] is considered to involve the conjunctiva of dogs, rabbits and humans in India, Myanmar and parts of China. The worm can be seen within the conjuctival sac; an intraocular infection by this worm was described in a 8-year-old Pakistani girl.
Filarial worms and the Guinea worm are from the same "order" and are difficult to differentiate from one another except by locating microfilariae. Dracontiasis of the eye due to Guinea worm is described as causing the infection of the orbit; however, subconjunctival Guinea worm is described very rarely. A case report of a 12-year-old girl from India who presented with irritation, watering of the eye and swelling of conjunctiva has been described. In this case, an adult female Guinea worm was removed surgically.
Common clinical manifestations of Bancroftian filariasis are adenolymphangitis, involvement of spermatic cord (funiculitis, lymphocele, epidydimoorchitis), hydrocele and elephantiasis (which most commonly affects lower limbs). The upper limbs, scrotum, vulva, penis, breast may also be affected, but eye involvement by W bancrofti is rare. Our patient had lower limb and, eye involvement and microfilariae in the blood. She was from an area endemic for Wuchereria bancrofti infestation.
This case is reported in the hope that it will lead to the generation of a larger pool of information an ocular involvement of infection by the Bancroftian worm. According to WHO, 80% of blindness is in developing countries, and 80% of this is avoidable - that is, either preventable and/or curable. Eye infection by the filarial or filarial-like worm could be one type of preventable blindness.
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