Subcutaneous Dirofilariasis in Female Pubic Region - Case Report

Concurrent subcutaneous and ocular infections with Dirofilaria repens in a Polish patient: a case report in the light of epidemiological data

Dirofilariasis is an emerging zoonosis caused by nematodes of the genus Dirofilaria, most often D. repens and D. immitis. The main final hosts and reservoirs of pathogens are dogs. The intermediate hosts and vectors of infection are female mosquitoes (Culicidae). Human is an accidental host in which the parasite does not usually mature. Over the past 20 years, the range of Dirofilaria spp. in Europe has expanded. We present an unusual case of multifocal dirofilariasis of mixed subcutaneous-ocular course caused by D. repens in a 52-year-old Polish patient who was probably infected in Spain or Croatia, where she stayed one year before the onset of symptoms. Surgical removal of the nematodes followed by treatment with Ivermectin in a single dose of 1200 μg and Doxycycline 200 mg daily for 7 days resulted in complete recovery. We believe that all cases of human dirofilariasis, especially in countries where the disease is not frequent at present, should be registered for epidemiological purposes. Moreover, due to the widening of the range of D. repens and D. immitis occurrence and the possibility of atypical courses of infection with both nematodes, diagnostics should include the species identification of the parasite.

New cases of human dirofilariosis on the Balkan Peninsula - "Masked intruders" uncovered by a surgeon

Dirofilaria spp. nematodes are accidental parasites of humans causing mild to serious, superficial or visceral infections. Superficial dirofilariosis is rather common in Europe and is typically manifested as subcutaneous form. Herein we report 46 new cases of human dirofilariosis (19 patients with subcutaneous, 18 patients with ocular, 4 patients wih genital, 2 patients with submucosal, 2 patients with pulmonary and 1 patient with intramuscular form of infection) that were recorded from the beginning of 2015 to May 2021 on the Balkan Peninsula with a goal to update the prevalence of this parasitosis and point out potential problems in diagnosis and treatment. Besides, given the high possibility of misinterpretation as tumor, our second aim was to encourage the inclusion of this pathogen in the differential diagnosis of subcutaneous nodules. Although quite common forms, subcutaneous and ocular dirofilariosis can be very often misdiagnosed in clinical practice due to the absence of specific clinical manifestations. Therefore, raising awareness of clinicians about this zoonosis is needed as well as closer collaboration between physicians and veterinarians.

Rare case of Dioctophyme renale (Nematoda: Enoplida) and Dirofilaria sp. (Nematoda: Spirurida) in the subcutaneous tissue of a cat in Espírito Santo, Brazil

Dioctophyme renale is the largest parasitic nematode of animals. It is most often found in the right kidney, but can also occur in the urinary system, ears, free abdominal cavity, mammary gland, thoracic cavity, and more rarely in subcutaneous tissue. The genus Dirofilaria has specific parasitic characteristics according to its location, and may parasitize the respiratory tract or even the skin, varying according to species. This report describes a case of Dioctophyme renale and Dirofilaria sp. in the subcutaneous tissue of a cat in the state of Espírito Santo, Brazil. An adult male mongrel cat showed physical enlargement in the left inguinal region, diagnosed as a subcutaneous nodule. Surgical excision and histopathological evaluation of the nodule were performed, and Dioctophyme renale and Dirofilaria sp. were found inside. Dioctophymosis and heartworm disease are present in Brazil and most other countries, but this is the unprecedented case of the association of Dioctophyme renale and Dirofilaria sp. in the subcutaneous tissue of a cat.

The trends of human dirofilariasis in Croatia: Yesterday - Today - Tomorrow

Introduction

Human dirofilariasis is a disease historically linked to the Mediterranean area. For the last few decades, however, Dirofilaria nematodes have been spreading, both in terms of prevalence and the geographical expansion in non-endemic areas. Currently, cases of human dirofilariasis are recorded in more than 40 countries worldwide. Croatia is considered an endemic area of the Adriatic basin.

Methods

In a nationwide investigation, new and previously published cases of human dirofilariasis in Croatia were analyzed.

Results

Since 1996, 30 cases of human dirofilariosis were reported in Croatia. A total of 14 (46,67%) cases were from the coastal and 16 (53,33%) from continental regions of the country. Based on anatomical location, 13 (43,33%) cases were subcutaneous, 12 (40%) were ocular and five (16,67%) occurred in the reproductive organs. In all 30 cases, Dirofilaria repens was identified as the causative agent.

Conclusions

An increase in air temperature as climate change, changes in mosquito fauna, high prevalence of D. repens in dogs and limited use of chemoprophylaxis are possible risk factors for Dirofilaria infection in the Croatian population. Since reporting to epidemiological services is not mandatory in this country, the real number of human dirofilariasis cases is probably significantly higher than published. This emphasizes the need for mandatory reporting of human cases and surveillance of Dirofilaria infection in dogs and mosquitoes in Croatia, following the “One Health” concept.

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A total of 30 cases of human dirofilariasis have been described in Croatia.

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In all cases, D. repens was identified as the causative agent.

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Geographical distribution among regions was almost identical.

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Subcutaneous nodules were not the major clincal presentation of D. repens infections.