|Year : 2004 | Volume
| Issue : 3 | Page : 235-6
A case of subcutaneous dirofilariasis of the eyelid in the South Indian state of Kerala.
TP Ittyerah, D Mallik
CBM Ophthalmic Institute, Little Flower Hospital, Angamaly, Kerala, India
|Date of Submission||29-Mar-2003|
|Date of Acceptance||13-Jun-2003|
T P Ittyerah
CBM Ophthalmic Institute, Little Flower Hospital, Angamaly, Kerala
Source of Support: None, Conflict of Interest: None
This report describes a case of dirofilariasis of the upper eyelid of a young female patient from Kerala. This is probably the first reported case from India in which a live dirofilarial worm was recovered from the subcutaneous tissues of the eyelid.
Keywords: Dirofilaria , eyelid
|How to cite this article:|
Ittyerah T P, Mallik D. A case of subcutaneous dirofilariasis of the eyelid in the South Indian state of Kerala. Indian J Ophthalmol 2004;52:235
Dirofilariasis, a disease commonly found in carnivorous mammals, is uncommon in humans. Two important species of genous Dirofilaria , are reported to involve the eye. They include D.tenuis and D.repens . D.tenuis is the most common Dirofilaria spicies causing human dirofilariasis in the United States while D.repens has been reported from Malaysia, Sri Lanka (formerly known as Ceylon) and Thailand. The only two published reports on dirofilariasis of the eye from India, describe involvement of the subconjuntival space. We report on a case of dirofilariasis of the subcutaneous tissue of the eyelids from the South Indian state of Kerala.
| Case report|| |
A 14-year-old female patient presented with a vermiform swelling of the left upper eyelid, that she had noticed for several days [Figure - 1]. She also reported occasional movements within the swelling. The skin overlying swelling was intact and showed no blister. Both eyes were otherwise normal and had a vision of 6/6. No swelling was noted on any other part of the body. An examination of the patient's stool did not reveal any parasite ova or cysts and peripheral blood did not show eosinophilia. The patient was a resident of the town of Angamaly (Kerala) in South India.
The skin over the vermiform swelling was carefully incised after a subcutaneous injection of a local anaesthetic agent. The coiled worm was seen immediately beneath the skin. The worm was gently extracted from the surgical wound with a pair of forceps [Figure - 2]. It had a white slender body measuring 105 mm in length and showed active movements on removal. The specimen was examined by parasitologists at the Liverpool School of Tropical Medicine, who concluded that the worm was a sexually immature female Dirofilaria repens. The worm showed a prominent cuticle and a short segment of the body removed at the level of the uterus showed oocytes but no microfilariae.
| Discussion|| |
Dirofilariasis commonly affects domestic and wild animals. Zoonotic dirofiloarial infestations following incidental infection of humans are uncommon and may be caused by several species of dirofilaria. Subcutaneous infection ,,, and less commonly ocular infection have been reported.,,
D.tenuis is a natural parasite of raccoons. D.tenuis has not been reported from the state of Kerala probably as there are no raccoons here. D.repens is found in cats, dogs and foxes. The source and route of infection is not known definitively. The black salt marsh mosquito Aedes taeniorhyncus has been described as a possible vector for D.tenuis infection. Probably a similar mosquito vector is also responsible for the spread of D.repens . The south Indian state of Kerala is studded with a network of backwaters which could serve as breeding grounds for mosquitoes. A study was conducted at a district veterinary centre at Thrissur (Kerala) using histochemical techniques for species identification. They have identified D.repens as the only species of microfilaria infecting the local dog population, and that the incidence of infection is the highest during the summer months.
Humans are a suboptimal host for dirofilaria and many of the worms recovered are either immature or dead. The worm we recovered was a female worm whose uterus contained only oocytes, showing that the worm was sexually immature.
Dirofilarial worms are identified by their thick laminated cuticle, broad lateral chords and large muscle cells [Figure - 3]. Accurate species identification is best done by examination of mature worms. Surgical removal of the worms is the treatment of choices and generally , further treatment is not recommended.
| Acknowledgement|| |
We are grateful to Dr.J.W.Bailey at the Clinical Diagnostic Parasitology Laboratory of the Liverpool School of Tropical Medicine, UK, for her help in identifying the worm.
| References|| |
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[Figure - 1], [Figure - 2], [Figure - 3]