Orbital dirofilariasis

Human Subcutaneous Dirofilariasis Behind a Blepharoconjunctivitis: A Case Report and Review of the Literature

The diagnosis of skin lesions involving the eyes can be challenging, especially when uncommon etiologies are considered. We present a case of a 52-year-old female initially diagnosed with blepharoconjunctivitis but later found to have a subcutaneous heartworm infection. The patient experienced recurrent episodes of unilateral palpebral edema, pain, pruritus, and a sensation of a foreign body in her eye. Upon examination, a vermiform structure with peristaltic movements was observed, raising suspicion of subcutaneous dirofilariasis and prompting further investigations. Serological tests confirmed the presence of anti-Dirofilaria spp. antibodies. Surgical removal of the worm led to the resolution of symptoms. This case highlights the importance of considering uncommon etiologies, such as subcutaneous heartworm infection, in patients presenting with atypical migratory skin lesions or ocular manifestations when there is no definite diagnosis and the condition does not respond to usual medical treatment.

Unusual Masquerading Infraorbital Mass-A Case Report of Human Ocular Dirofilariosis Found in A Ukrainian Patient in Switzerland

A 78-year-old Ukrainian woman who had immigrated to Switzerland presented with a rapid growing subcutaneous infraorbital mass. Surgical excision of the mass revealed a well-circumscribed, encapsulated tumor, adherent to the skin. The excision showed a soft tissue inflammation with parts of Dirofilaria spp. The number of cases of human dirofilariosis reported in the last 50 years has gradually increased. Dirofilaria repens is now endemic in many countries and is currently considered to be one of the fast spreading zoonoses in Central, Eastern and Northern Europe. The first empirical evidence of Swiss spreading of D. repens infections was in a dog from southern Switzerland in 1998. Ours is the first case of human orbital dirofilariosis found in a Ukranian patient reported in Switzerland. Our purpose is to inform the ophthalmologist to consider orbital dirofilariosis in the differential diagnosis of inflammatory masses of the orbit and to warn about the spread of this infection in Switzerland.

Filarial worms: a systematic review and meta-analysis of diversity in animals from Iran with emphasis on human cases

Current systematic review and meta-analysis demonstrate the prevalence reports of filariasis in animals in Iran along with human cases. Studies were screened, relevant papers were selected and the random-effect model was used by forest plot with 95% confidence interval (CI). Of 17 records of human case-reports, particularly from Khuzestan province (5 cases), Dirofilaria repens was the most detected parasite (10 cases) with higher involvement of the right eye (7 cases) than other organs. Eleven animal species were reported to be parasitised by filarioids in Iran. The prevalence of Dirofilaria immitis in canids was 14.69% (95% CI: 10.33-19.67), with highest rates (20.92%; 95% CI: 13.84-29.03) in free-ranging dogs. Male (10.07%; 95% CI: 5.10-16.47) and more than 1-year old (20.77%; 95% CI: 8.66-36.42) dogs were more likely to be found infected. The frequency of other filarioids of zoonotic interest was: Acanthocheilonema reconditum in dogs 2.15% (95% CI: 0.71-4.33), Dipetalonema evansi in camels 10.16% (95% CI: 4.73-17.34), Onchocerca cervicalis in horses 3.63% (95% CI: 1.44-6.75%) and Onchocerca fasciata 16.57% (95% CI: 10.12-24.24%) in camels. Still, our knowledge on parasitic filariae in Iran is limited and more investigation is needed in both human and animal populations.

Zoonotic Helminth Diseases in Dogs and Dingoes Utilising Shared Resources in an Australian Aboriginal Community

The impacts of free-roaming canids (domestic and wild) on public health have long been a concern in Australian Indigenous communities. We investigated the prevalence of zoonotic helminth diseases in dogs and sympatric dingoes, and used radio telemetry to measure their spatial overlap, in an Aboriginal community in the Wet Tropics of Australia. Samples collected from dingoes and dogs showed high levels of infection with the zoonotic hookworm, Ancylostoma caninum. Dingoes were also positive for A. ceylanicum infection (11.4%), but dogs were infection free. Whipworm, Trichuris vulpis, infection was far more prevalent in necropsies of domestic dogs (78.6%) than dingoes (3.7%). Dogs were free from Dirofilaria immitis infection, while dingoes recorded 46.2% infection. Eleven dingoes and seven free-roaming domestic dogs were fitted with Global Positioning System collars and tracked over an extended period. Dingo home-ranges almost completely overlapped those of the domestic dogs. However, dingoes and dogs did not utilise the same area at the same time, and dogs may have avoided dingoes. This spatial overlap in resource use presents an opportunity for the indirect spill-over and spill-back of parasites between dogs and dingoes. Tracking and camera traps showed that the community rubbish tip and animal carcasses were areas of concentrated activity for dogs and dingoes.

Prevalence of Anaplasmataceae and Filariidae species in unowned and military dogs in New Caledonia

Dogs are competent reservoir hosts of several zoonotic agents, including Filariidae nematodes and Anaplasmataceae family bacteria. The latter family unites human and veterinary pathogens (Anaplasma, Ehrlichia and Neorickettsia bacteria) with Wolbachia, some of which are obligatory endosymbionts of pathogenic filarial nematodes. The epidemiology of Anaplasmataceae and Filariidae species infecting dogs living in kennels in New Caledonia was studied. 64 EDTA blood samples were screened for the presence of Anaplasmataceae and filarial nematodes. Molecular study was conducted using primers and probe targeting the of 23S rRNA long fragment of Anaplasmataceae species. Next, all blood sample was screened for the presence of Filariidae species targeting the primers and probe targeting the COI gene, as well as primers targeting the COI and 5S rRNA genes of all filarial worms. Anaplasma platys was identified in 8/64 (12.5, 95% confidence interval [CI]: 4.4–20.6%) and Wolbachia endosymbiont of Dirofilaria immitis in 8/64 (12.5%, CI: 4.4–20.6%). Filariidae species investigation was performed and showed that 11/64 (17.2%, CI: 7.9–26.4%) dogs were infected with D. immitis, whereas, 2/64 (3.1%, CI: 0.0–7.3%) were infected with Acanthocheilonema reconditum. Finally, we checked the occurrence of co‐infection between Anaplasmataceae and Filariidae species. Co‐occurrence with Wolbachia endosymbiont of D. immitis was observed in seven dogs, one dog was co‐infected with A. platys and A. reconditum and another was co‐infected with Wolbachia endosymbiont of D. immitis and A. reconditum. These results are the first report of Anaplasmataceae and Filariidae occurring in dogs in New Caledonia.

Rare Orbital Infections ~ State of the Art ~ Part II

Infections of the orbit and periorbita are relatively frequent. Identifying unusual organisms is crucial because they can cause severe local and systemic morbidity, despite their rarity. Opportunistic infections of the orbit should be considered mainly in debilitated or immunocompromised patients. The key to successful management includes a high index of suspicion, prompt diagnosis, and addressing the underlying systemic disease. This review summarizes unusual infectious processes of the orbit, including mycobacterial, fungal, and parasitic infections, as well as their pathophysiology, symptoms, signs, and treatment.

Ocular dirofilariasis by Dirofilaria immitis in a child in Iran: A case report and review of the literature

This report describes a rare case of ophthalmic dirofilariasis in a 2-year-old boy with redness, irritation, pain and foreign body sensation in the right eye. Slit lamp examination demonstrated a thread-like whitish nematode in the anterior chamber of the right eye that twisted around itself. The nematode worm (35mm long and 150-200μm width) was removed surgically. The presence of the smooth cuticular surface without longitudinal ridges and the vulva showed that it could be a female Diroflaria immitis. PCR amplification was done to verify the Diroflaria species. PCR amplification and sequence analysis of mitochondrial 12S rDNA confirmed that recovered worm was D. immitis. Ocular dirofilariasis caused by D. immitis is very rare, but it must be considered in humans living in endemic areas.

Periocular dirofilariasis: A case series

OBJECTIVE

To cite a series of patients presenting with complaints of a lid swelling associated with preseptal cellulitis.

METHODS

Three patients on three different occasions came with complaints of a unilateral lid swelling associated with preseptal cellulitis. Examination showed palpable mass in the upper eyelid localized, firm in consistency and was freely mobile and occasionally disappeared during palpation. CT scan showed nonspecific preseptal inflammation. A trial of antibiotics was given in each of the cases with temporary reduction in the swelling but a consecutive flare up following which patient was subjected to excision biopsy. Each of the biopsies was subjected to histopathological and microbiological examination.

RESULTS

On excision biopsy in all the three cases it was reported to be a parasitic infestation belonging to the genus Dirofilaria.

CONCLUSIONS

Dirofilariaiasis is a common zoonotic infection among wild animals but rarely infects human beings with ocular involvement. Hence dirofilariasis should be considered as a differential diagnosis for migratory subcutaneous swellings and conjunctival nodules in the southern belt of India.

Dingoes (Canis dingo Meyer, 1793) continue to be an important reservoir host of Dirofilaria immitis in low density housing areas in Australia

Heartworm (Dirofilaria immitis) is a parasitic nematode responsible for canine and feline cardiopulmonary dirofilariasis and human zoonotic filariosis in both tropical and temperate regions throughout the world. Importantly, this study in the Wet Tropics of Far North Queensland found D. immitis remains at high prevalence (72.7%) in wild dingoes in low density housing areas in Australia. This prevalence is equivalent to the highest levels seen in wild dogs in Australia and represents an ongoing risk to domestic dogs, cats and humans. In contrast, in higher density residential areas prevalence was significantly lower (16.7%, p=0.001). It is possible that chemotherapeutic heartworm (HW) prevention in domestic dogs in these higher density housing areas is helping to control infection in the resident dingo population. Five dingoes killed in council control operations around Atherton, a non-endemic HW region in the Wet Tropics, were all negative for HW likely due to the colder climate of the region restricting transmission of the disease. This survey highlights the importance of dingoes as reservoir hosts of HW disease and that the subsequent risk of infection to companion animals and humans depends on local factors such as housing density, possibly linked to chemotherapeutic HW control in domestic dogs and climate. Our findings show that veterinary clinicians need to ensure that pet owners are aware of HW disease and do not become complacent about HW chemoprohylaxis in areas which support dingo populations.

Case of human Dirofilaria repens infection manifested by cutaneous larva migrans syndrome

Dirofilaria repens, parasite of subcutaneous tissues of dogs and other carnivores, represents high infection risk for animals and humans in Europe. In men, infection usually presents as nodule in subcutaneous tissues or, less often, the lesions are localised around the eyes. The work presents first confirmed clinical case of human D. repens infection connected with cutaneous larva migrans syndrome. In patient, the migration of the worm caused true signs of creeping eruption, elevated sinuous track under the skin. It was connected with severe pain, burning and erythema of adjacent skin. Symptoms appeared at least three times, approximately once a month, always in the evening or night and lasted from several minutes to several days. In December 2014, during the scratching of residual pruritic lesion, patient removed 6-cm long, whitish worm from the wound. Morphological features (longitudinal ridges) and PCR amplification of cytochrome oxidase subunit 1 (CO1) confirmed Dirofilaria repens as etiological agent of infection. Herein, presented case confirmed that D. repens infection in humans can be associated with real creeping eruption, clinical sign of cutaneous larva migrans and should be included in its differential diagnosis.

A rare case of anterior chamber dirofilariasis

We report a rare case of anterior chamber live dirofilariasis presenting as anterior uveitis. A 60-year-old man presented with dimness of vision in the right eye for 1 month. Vision recorded was 6/18 P, N 18 in the right eye. Slit lamp examination of the right eye revealed anterior uveitis with a moving nemathelminthes. The worm was removed live from the anterior chamber under local anesthesia with assisted methyl cellulose delivery and post-operatively, the worm was examined directly under light microscope. Morphometric measurement showed length of the worm was 6.061 mm. A thin, pale, slender worm was diagnosed as immature female Dirofilaria repens and was documented completely. Patient had made an excellent recovery of vision and intraocular inflammation after the surgical removal of the worm. Intraocular infection of dirofilaria is a rare presentation and successful surgical removal of the worm resulted in complete recovery of uveitis and visual status in the affected eye.

Dirofilaria presenting as orbital mass

Dirofilaria is a common roundworm infection of dogs, cats, raccoons, and other animals that is commonly referred to as "heartworm." The genus Dirofilaria includes D. immitis, which is a common cause of animal disease in the western hemisphere and primarily manifests as pulmonary lesions in humans, and D. repens, which is the more common causative agent of animal disease in Eurasia and primarily results in subcutaneous and ocular lesions in humans. Humans are accidental end hosts, with infection resulting from bites by mosquitoes of the Culicidae family in which ingested microfilaria have matured to infectious larvae.

Parasitic diseases of zoonotic importance in humans of northeast India, with special reference to ocular involvement

Parasitic zoonotic diseases are prevalent in India, including the northeastern states. Proper epidemiological data are lacking from this part of the country on zoonotic parasitic diseases, and newer diseases are emerging in the current scenario. Systemic manifestation of such diseases as cysticercosis, paragonimiasis, hydatidosis, and toxoplasmosis are fairly common. The incidence of acquired toxoplasmal infection is showing an increasing trend in association with acquired immunodeficiency syndrome. Among the ocular parasitic diseases, toxoplasmosis, cysticercosis, toxocariasis, dirofilariasis, gnathostomiasis, hydatidosis, amebiasis, giardiasis, etc, are the real problems that are seen in this subset of the population. Therefore, proper coordination between various medical specialities, including veterinary science and other governing bodies, is needed for better and more effective strategic planning to control zoonoses.

Dirofilaria in the anterior chamber: a rare occurrence

Dirofilariasis is a parasitic infection of the carvivores that may present as a zoonotic infestation in humans. Systemic involvement in man is subcutaneous, pulmonary, or ocular. We report a rare occurrence of ocular dirofilariasis in a 25-year-old male patient who presented with pain and redness in the eye. A live, white, coiled, and highly motile worm was present in the anterior chamber. The worm, however, could not be detected in the anterior chamber, posterior segment, or the angle of the anterior chamber when the patient was taken to the operating room for surgical removal of the worm. The patient was made to lie prone till the worm reappeared in the anterior chamber and was removed by paracentesis. The worm was identified as Dirofilaria repens on the basis of microscopic and histopathological examination.

Intramuscular dirofilariasis mimicking an orbital metastasis in a patient with breast cancer

We present the unusual case of a 74 year-old female with a history of breast cancer who presented with acute painless orbital swelling and vertical diplopia. MRI revealed a focal enhancing mass within the superior rectus muscle. As the concern for metastatic disease was high, surgical biopsy was performed and revealed an unusual mimicker of metastatic disease, the parasitic infection dirofilariasis.

Human and animal dirofilariasis: the emergence of a zoonotic mosaic

Dirofilariasis represents a zoonotic mosaic, which includes two main filarial species (Dirofilaria immitis and D. repens) that have adapted to canine, feline, and human hosts with distinct biological and clinical implications. At the same time, both D. immitis and D. repens are themselves hosts to symbiotic bacteria of the genus Wolbachia, the study of which has resulted in a profound shift in the understanding of filarial biology, the mechanisms of the pathologies that they produce in their hosts, and issues related to dirofilariasis treatment. Moreover, because dirofilariasis is a vector-borne transmitted disease, their distribution and infection rates have undergone significant modifications influenced by global climate change. Despite advances in our knowledge of D. immitis and D. repens and the pathologies that they inflict on different hosts, there are still many unknown aspects of dirofilariasis. This review is focused on human and animal dirofilariasis, including the basic morphology, biology, protein composition, and metabolism of Dirofilaria species; the climate and human behavioral factors that influence distribution dynamics; the disease pathology; the host-parasite relationship; the mechanisms involved in parasite survival; the immune response and pathogenesis; and the clinical management of human and animal infections.

Orbital parasitosis

Orbital parasitoses are uncommon diseases. Due to specific characteristics of orbital space, many different diseases, such as tumors and inflammatory disease, can present with similar clinical manifestations. The aim of this study is to review the most important clinical, epidemiological, and treatment aspects of orbital parasitoses described worldwide.

Orbital dirofilariasis in Iran: a case report

Dirofilariasis is a common parasitic disease in both domestic and wild animals around the world, with canines as the principal reservoir host and mosquitoes as the vector. Human ophthalmic dirofilariasis is an uncommon condition, but there have been reports from many parts of the world, including Africa, Australia, the Americas, Europe, and Asia. Ophthalmic involvement with Dirofilaria may present itself as periorbital, subconjunctival, orbital, or intraocular infections. In this report, we present a case of orbital dirofilariasis with lateral rectus muscle involvement. To our knowledge, this is the first orbital dirofilariasis case reported in Iran. Although debulking of the tumor usually leads to resolution, our patient showed an episode of recurrence after biopsy. Complete recovery was achieved after a spontaneous discharge, without the need for systemic medication.

Periocular dirofilariasis in a young woman: a case report

A case of periocular dirofilariasis has been diagnosed in Iran. A 27-yr old female referred with a history of edema and redness in the left eye since 2 wk ago. On slit lamp examination, a moving thread-like worm was seen in the subconjunctival area. Two days later, a 126 mm long, live filaria worm was extracted from the lower lid subcutaneous tissue. The worm was diagnosed as, likelihood, Dirofilaria immitis on microscopic examinations. The present case suggests that D. immitis can cause periocular infections.

Intravitreal dirofilariasis: a rare ocular infection

Human ocular dirofilariasis is a zoonotic disease, rare in Europe, caused by filarial nematodes. The parasite is either encysted in a subcutaneous nodule or located under the bulbar conjunctiva. We report the case of a 62-year-old man with intravitreal dirofilariasis, which is a rare site of presentation of the nematode in the human eye. It was located in the fundus area and was surgically removed. The nematode was identified as Dirofilaria repens (D. conjuctiva) by two different Microbiology Departments, making this the fifth report of identified intravitreal dirofilariasis caused by D. repens in the relative literature.

A case of palpebral dirofilariasis

PURPOSE

Dirofilaria repens infection is the most frequent and widespread dirofilariasis in the world. In Italy subcutaneous dirofilariasis is present especially in Northern-Central areas.

METHODS

A woman with a palpebral lump is presented.

RESULTS

After subcutaneous and muscular décollement, the authors found and removed a parasite. The final diagnosis was subcutaneous parasitosis due to D. repens.

CONCLUSIONS

Surgery was both diagnostic and therapeutic.