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Year : 2007  |  Volume : 55  |  Issue : 2  |  Page : 165-166

Subconjunctival loa loa with calabar swelling

Rotary Eye Hospital Dondaicha, Dhule, Maharashtra, India

Correspondence Address:
Vijay D Khetan
Rotary Eye Hospital Dondaicha, Dhule, Maharashtra
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0301-4738.30727

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How to cite this article:
Khetan VD. Subconjunctival loa loa with calabar swelling. Indian J Ophthalmol 2007;55:165-6

How to cite this URL:
Khetan VD. Subconjunctival loa loa with calabar swelling. Indian J Ophthalmol [serial online] 2007 [cited 2022 Dec 3];55:165-6. Available from: https://www.ijo.in/text.asp?2007/55/2/165/30727

Dear Editor,

Loa Loa is unique among the human filarial as adult worms are occasionally visible during subconjunctival migration.[1],[2] Transient pruritic subcutaneous calabar swellings are a classic manifestation of the disease. We report a case with subconjunctival loaiasis and calabar swelling on the limbs treated with surgical excision of worm and oral course of di-ethylcarbamazine (DEC). Medline search revealed this as the first case report of subconjunctival loaiasis associated with calabar swelling from India.

An 18-year-old girl presented with chronic headache with pain, itching and redness in the left eye for last two days. History of painful itchy red swelling near the right knee joint of two days duration was noted. She gave history of similar localized intermittently appearing swellings on limbs since last six months. An isolated tender tense subcutaneous nodule with erythematous smooth skin surface measuring 5 x 5 cm near right knee joint was noted. Vision was 20/20 in both eyes. Left eye showed lid edema, congestion and chemosis with supero-temporal quadrant petechiael hemorrhages. A coiled translucent worm was noted in the superotemporal subconjunctival space [Figure - 1]. Under anesthesia, a live motile worm was extracted from the subconjunctival space [Figure - 2][Figure - 3]. The worm measured 11.2 cm in length [Figure - 4]. Microscopic examination confirmed the worm to be an adult male Loa Loa.

Peripheral blood smears showed eosinophilia and were negative for microfilariae. Serum was positive for antibody to microfilarial antigen suggesting filarial etiology. The patient was treated with DEC started at low dose of 100 mg/day and increased progressively to 500 mg/day for three weeks and oral prednisolone 60 mg/day for one week, tapered over the next three weeks. The calabar swelling near the right knee joint disappeared the very next day of worm excision. On follow-up over the next three months, the patient was apparently healthy with no recurrence of calabar swellings. Loa Loa is a subcutaneous filarial nematode of man.[3] Humans are infected by day-biting forest-dwelling fly of the genus chrysops.[4] The first sign is usually a calabar swelling - localized tense pruritic subcutaneous edema, lasting for one to three days.[3],[4] They represent areas of angioedema to allergens released by worms and are seen around joints. The migration of the adult worm through the subcutaneous tissues often goes unnoticed, unless passing beneath the conjunctiva of the eye.

Infection in endemic individuals is asymptomatic, with microfilaremia and a few calabar swellings. Nonendemic individuals are amicrofilaremic with frequent calabar swellings. Definitive diagnosis is made either by identification of adult worm in the subcutaneous tissue or conjunctiva and microfilariae in the blood [Figure - 5]. Blood samples should be drawn around noontime, when microfilaremia is highest.[1] Serodiagnostic tests cannot yet differentiate Loa Loa from other filarial nematodes.[4] Complete surgical removal of adult worm from the subconjunctiva is curative.[5] Di-ethylcarbamazine kills both the microfilariae and adult worms. In summary, this is a case of loaiasis encountered in a nonendemic area, characterized by the presence of an adult worm in the subconjunctiva with the classic calabar swellings, a positive serology and amicrofilaremia.

  Acknowledgment Top

We would like to express our gratitude to Dr. Mrs. Dravid M N, Head of Department of microbiology at government medical college Dhule, for her help in getting the worm identified and providing the worm macrophotograph. Our regards to Dr. Harinath B C, director Jamnalal Bajaj tropical disease research centre Sevagram, for serological diagnosis.

  References Top

Satyavani M, Rao KN. Live male adult Loaloa in the anterior chamber of the eye: A case report. Indian J Pathol Microbiol 1993;36:154-7.  Back to cited text no. 1
Lakshmi N, Gururaj KA. Loiasis (a case report). Indian J Ophthalmol 1988;36:98-9.  Back to cited text no. 2
[PUBMED]  Medknow Journal  
Abad JC. Parasitic and rickettsial ocular infections. In: Albert DM, Jakobiec FA, editors. Principles and Practice of Ophthalmology. W. B. Saunders Company: Philadelphia; 2000. p. 135-60.  Back to cited text no. 3
Christopher RW, Ian AD, editors. Davidson's Principles and Practice of Medicine. 16th ed. Churchill Livingstone: 1991. p. 179-80.  Back to cited text no. 4
Chhabra RC, Bhat S, Shukla SM. Occular loiasis in a Zambian woman. East Afr Med J 1989;66:491-4.  Back to cited text no. 5


  [Figure - 1], [Figure - 2], [Figure - 3], [Figure - 4], [Figure - 5]

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