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Pallara E, Cotugno S, Guido G, De Vita E, Ricciardi A, Totaro V, Camporeale M, Frallonardo L, Novara R, Panico GG, Puzo P, Alessio G, Sablone S, Mariani M, De Iaco G, Milano E, Bavaro DF, Lattanzio R, Patti G, Papagni R, Pellegrino C, Saracino A, Di Gennaro F. Loa loa in the Vitreous Cavity of the Eye: A Case Report and State of Art. Am J Trop Med Hyg 2022; 107:tpmd220274. [PMID: 35914685 PMCID: PMC9490677 DOI: 10.4269/ajtmh.22-0274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 05/06/2022] [Indexed: 11/20/2022] Open
Abstract
Loa loa is a filarial nematode responsible for loiasis, endemic to West-Central Africa south of the Sahara and transmitted by flies. This study reports a case of L. loa in the vitreous cavity of the eye of a young patient, along with an in-depth literature review. A 22-year-old woman from Cameroon who migrated from Cameroon to Italy was referred to the Emergency Ophthalmology Department at Policlinico di Bari in July 2021 with the presence of a moving parasite in the subconjunctiva of the left eye. A recent onset of a papular lesion on the dorsal surface of the right wrist and a nodular lesion in the scapular region were detected. L. loa filariasis was diagnosed based on anamnestic data, clinical and paraclinical signs, and a parasitological test confirming the presence of microfilariae in two blood samples collected in the morning of two different days. Because of the unavailability of diethylcarbamazine (DEC), albendazole (ALB) 200 mg twice daily was administered for 21 days. A mild exacerbation of pruritus occurred during treatment, but resolved with the use of an antihistamine. A single dose of 12 mg ivermectin was prescribed at the end of the treatment with albendazole. Unlike other endemic parasite infections, L. loa is not included in the Global Program to Eliminate Lymphatic Filariasis, because it is not mentioned in the WHO and CDC list of neglected tropical diseases. This can result in an overall risk of lack of attention and studies on loiasis, with lack of data on global burden of the disease.
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Affiliation(s)
- Elisabetta Pallara
- Clinic of Infectious Diseases, Department of Biomedical Sciences and Human Oncology, University of Bari “Aldo Moro,” Bari, Italy
| | - Sergio Cotugno
- Clinic of Infectious Diseases, Department of Biomedical Sciences and Human Oncology, University of Bari “Aldo Moro,” Bari, Italy
| | - Giacomo Guido
- Clinic of Infectious Diseases, Department of Biomedical Sciences and Human Oncology, University of Bari “Aldo Moro,” Bari, Italy
| | - Elda De Vita
- Clinic of Infectious Diseases, Department of Biomedical Sciences and Human Oncology, University of Bari “Aldo Moro,” Bari, Italy
| | - Aurelia Ricciardi
- Clinic of Infectious Diseases, Department of Biomedical Sciences and Human Oncology, University of Bari “Aldo Moro,” Bari, Italy
| | - Valentina Totaro
- Clinic of Infectious Diseases, Department of Biomedical Sciences and Human Oncology, University of Bari “Aldo Moro,” Bari, Italy
| | - Michele Camporeale
- Clinic of Infectious Diseases, Department of Biomedical Sciences and Human Oncology, University of Bari “Aldo Moro,” Bari, Italy
| | - Luisa Frallonardo
- Clinic of Infectious Diseases, Department of Biomedical Sciences and Human Oncology, University of Bari “Aldo Moro,” Bari, Italy
| | - Roberta Novara
- Clinic of Infectious Diseases, Department of Biomedical Sciences and Human Oncology, University of Bari “Aldo Moro,” Bari, Italy
| | - Gianfranco G. Panico
- Clinic of Infectious Diseases, Department of Biomedical Sciences and Human Oncology, University of Bari “Aldo Moro,” Bari, Italy
| | - Pasquale Puzo
- Section of Ophthalmology, Department of Medical Science, Neuroscience and Senso Organs, Bari Policlinico Hospital University of Bari, Bari, Italy
| | - Giovanni Alessio
- Section of Ophthalmology, Department of Medical Science, Neuroscience and Senso Organs, Bari Policlinico Hospital University of Bari, Bari, Italy
| | - Sara Sablone
- Section of Legal Medicine, Department of Interdisciplinary Medicine, University of Bari “Aldo Moro,” Bari, Italy
| | - Michele Mariani
- Clinic of Infectious Diseases, Department of Biomedical Sciences and Human Oncology, University of Bari “Aldo Moro,” Bari, Italy
| | - Giuseppina De Iaco
- Clinic of Infectious Diseases, Department of Biomedical Sciences and Human Oncology, University of Bari “Aldo Moro,” Bari, Italy
| | - Eugenio Milano
- Clinic of Infectious Diseases, Department of Biomedical Sciences and Human Oncology, University of Bari “Aldo Moro,” Bari, Italy
| | - Davide F. Bavaro
- Clinic of Infectious Diseases, Department of Biomedical Sciences and Human Oncology, University of Bari “Aldo Moro,” Bari, Italy
| | - Rossana Lattanzio
- Clinic of Infectious Diseases, Department of Biomedical Sciences and Human Oncology, University of Bari “Aldo Moro,” Bari, Italy
| | - Giulia Patti
- Clinic of Infectious Diseases, Department of Biomedical Sciences and Human Oncology, University of Bari “Aldo Moro,” Bari, Italy
| | - Roberta Papagni
- Clinic of Infectious Diseases, Department of Biomedical Sciences and Human Oncology, University of Bari “Aldo Moro,” Bari, Italy
| | - Carmen Pellegrino
- Clinic of Infectious Diseases, Department of Biomedical Sciences and Human Oncology, University of Bari “Aldo Moro,” Bari, Italy
| | - Annalisa Saracino
- Clinic of Infectious Diseases, Department of Biomedical Sciences and Human Oncology, University of Bari “Aldo Moro,” Bari, Italy
| | - Francesco Di Gennaro
- Clinic of Infectious Diseases, Department of Biomedical Sciences and Human Oncology, University of Bari “Aldo Moro,” Bari, Italy
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Okonkwo ON, Hassan AO, Alarape T, Akanbi T, Oderinlo O, Akinye A, Oyekunle I. Removal of adult subconjunctival Loa loa amongst urban dwellers in Nigeria. PLoS Negl Trop Dis 2018; 12:e0006920. [PMID: 30427837 PMCID: PMC6261630 DOI: 10.1371/journal.pntd.0006920] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 11/28/2018] [Accepted: 10/14/2018] [Indexed: 11/28/2022] Open
Abstract
Loiasis is a neglected tropical disease caused by infection with the filarial parasite Loa loa. It is a disease considered by many to be benign. Several reports of trans border importation of the Loa loa worm amongst immigrants and visitors from endemic regions of the world exist. In most cases an adult subconjunctival worm is removed from the patient. An interventional case series is reported and examines the practice of removal of subconjunctival adult Loa loa worms amongst urban dwellers in Nigeria. Four cases of ocular loiasis seen amongst urban dwellers in Nigeria exemplify the different presentations and removal methods of the subconjunctival adult worm. There were 2 males and 2 females aged 35years, 23years, 25years and 30years respectively. Each patient gave a history of having been raised in a rural community in childhood years, during which they were exposed to streams and muddy farm land; and then migrated to the urban community in later years. They all present with the finding of a subconjunctival adult worm, which was successfully removed and identified to be Loa loa. There are more urban dwellers in Nigeria who present with symptoms of foreign body sensation that may be related to the manifestation of a subconjunctival worm and are not recognized. This is because the emphasis on this disease has erstwhile been on the rural, village dwellers and not on urban dwellers. Eye care practitioners working in urban centers need to be aware of the possibility of this presentation, and be ready to remove any subconjunctival worm when it presents. Subconjunctival adult Loa loa is one of the ocular manifestations of paraisitosis by Loa loa, which is categorized as a neglected benign disease. Loa loa transmission has predominantly been amongst inhabitants in rural communities in Nigeria, one of the countries in the endemic belt of Africa. However we report a case series of 4 patients presenting with subconjunctival Loa loa who in childhood lived in rural communities but later migrated from rural to urban cities where they presented. The varied presentation of the patients in this series and the technique of worm removal are reported.
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Affiliation(s)
- Ogugua Ndubuisi Okonkwo
- Department of Ophthalmology, Eye Foundation Hospital Group Eye Foundation Retina Institute, Lagos, Nigeria
| | - Adekunle Olubola Hassan
- Department of Ophthalmology, Eye Foundation Hospital Group Eye Foundation Retina Institute, Lagos, Nigeria
| | - Taofik Alarape
- Department of Ophthalmology, Eye Foundation Hospital Group, Lagos, Nigeria
| | - Toyin Akanbi
- Department of Ophthalmology, Eye Foundation Hospital Group, Lagos, Nigeria
| | - Olufemi Oderinlo
- Department of Ophthalmology, Eye Foundation Hospital Group Eye Foundation Retina Institute, Lagos, Nigeria
| | - Ayodele Akinye
- Department of Ophthalmology, Eye Foundation Hospital Group, Lagos, Nigeria
| | - Idris Oyekunle
- Department of Ophthalmology, Eye Foundation Hospital Group Eye Foundation Retina Institute, Lagos, Nigeria
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