[Acute respiratory distress syndrome caused by tropical eosinophilic lung disease: a case in Gabon]

The purpose of this report is to describe the case of a 28-year-old woman in whom acute respiratory distress syndrome (ARDS) following cholecystectomy led to the discovery of eosinophilic lung disease. Outcome was favorable after oxygenotherapy and medical treatment using ivermectin and corticosteroids. The case shows that hypereosinophilic syndrome can be the underlying cause of ARDS.

Loa loa in the anterior chamber of the eye: a case report

An unusual case of loiasis from Assam is reported here. Loa loa is a subcutaneous filarial parasite of man and is transmitted to humans by chrysops flies. The patient presented with foreign body sensation and visual disturbances of the right eye. Examination revealed a white coiled structure in the cornea. Routine blood and other investigations were within normal limits. A live adult worm was extracted and identity was confirmed by microscopy to be Loa loa. Patient was treated with diethylcarbamazine and steroid. We found this case interesting as the worm was present in the anterior chamber--an unusual site and there were no other positive findings besides the lone worm.

Loa-Loa-Infektion des Auges - eine Fallserie

BACKGROUND

With increasing migration tropical diseases such as Loa loa infections are becoming more frequent in Europe. While the ocular diagnosis is usually straight forward, systemic work-up and treatment requires an interdisciplinary approach. We review the diagnostic and therapeutic work-up of ocular Loa loa infections based on a series of 4 cases that presented between 1998 and 2004.

HISTORY AND SIGNS

The first symptoms in all cases were ocular irritations occurring 2 months to 8 years after a trip to West Africa. One case presented with a swollen upper eyelid without a visible worm. In three patients microfilariae were detected in the blood.

THERAPY AND OUTCOME

In two cases visible subconjunctival worms could be removed under the slit lamp. Three cases required systemic treatment as inpatients while one case could be observed without systemic treatment. All 4 cases had a favourable outcome with complete eradication of the disease.

CONCLUSION

Surgical removal of adult Loa loa worms from the subconjunctival space only improves the ocular symptoms. An interdisciplinary approach (ophthalmology, infectious disease and parasitology) for a systemic work-up and treatment is usually required.

[Ocular involvement in systemic Loa-Loa filariasis. Case report and review of the literature]

BACKGROUND

Within the last few years there is more and more evidence for nonspecific ocular symptoms caused by "exotic" pathogens. We herewith report another case of such an infection to underline the increasing importance and diagnostic relevance even of rare diseases.

PATIENT

A 35-year-old female German patient presented with recurrent left retrobulbar "feeling of pressure" after a 6-month-stay in Central Africa 5 years ago. In addition, she reported on repeated swelling of the skin and joints of her hands and arms. Multiple ophthalmologic and rheumatologic investigations had been carried out without diagnostic results. Her ophthalmologist referred her with the presumed diagnosis of a subconjunctival worm.

RESULTS

Slit-lamp biomicroscopy confirmed the original suspicion, and after topical anesthesia a female Loa-Loa worm was easily removed with forceps through a conjunctival incision. The general examination showed symptoms of systemic infection (calabar swelling, eosinophilia). Classification and initiation of treatment with diethylcarbamazine and mebendazole were carried out by the University Institute of Parasitology.

CONCLUSION

Loa-Loa is a parasitic infection endemic in the tropical rain forests of Western, Central, and Eastern Africa. It is transmitted by the Chrysops fly. An increasing number of oculosystemic infections in non-African patients with Loa-Loa are being published. Therefore, any patient with an unclassifiable eye affection should also be investigated for those rare pathogens.

Subconjunctival Loa Loa worm: case report

A 38-year old Ghanaian suddenly had the sensation of a foreign body in his right eye. Slit-lamp examination revealed a transparent worm underneath the conjunctiva. With topical anesthesia, the complete worm, 3.5 cm long, was removed surgically. A microbiological analysis at the Institute of Tropical Medicine confirmed the diagnosis of Loa Loa. Laboratory tests showed negative blood eosinophilia, positive blood film examination for microfilariae and positive results for filarial serology. The postoperative treatment consisted of progressive doses of di-ethyl-carbamazine (50-->100-->200 mg/d). A subconjunctival Loa Loa worm is rare in Belgium and usually occurs in immigrants or travellers returning from Tropical (Equatorial) West and Central Africa. Our patient visited Nigeria in 1985 and Ivory Coast in 1986. Those regions are highly endemic for Loa Loa.

Splenectomy for suspected malignant lymphoma in two patients with loiasis

Intrasplenic lesions can cause diagnostic difficulties because malignant diseases can be excluded only by histologic examination. We present the cases of two patients with splenic manifestations of loiasis. Both patients had visited central Africa. Several years later, intrasplenic lesions were found during routine examinations (for chest trauma and employment, respectively). Both patients underwent splenectomies because malignant lymphoma was suspected. In both cases, histologic examination of the spleen showed eosinophilic granulomata with multiple Loa loa microfilariae.

Current knowledge on the epidemiology, diagnosis, immunology, and treatment of loiasis

At the Centre International de Recherches Médicales (CIRMF) in Franceville, Gabon, a mini-symposium was held on the progress made in the research and control of loiasis from 20-22 February, 1995. The mini-symposium fulfilled its role as a platform for summarising and discussing recent advances in the research of this filarial infection and enabled the formulation of the presently most challenging issues: a specific and sensitive diagnostic test, the potential of ivermectin as a mass treatment and the factors and mechanisms of occult loiasis.

[Value of filariopheresis in the treatment of Loa loa filariasis]

To prevent the side effects as encephalitis, related with diethylcarbamazine treatment in loiasis, an exchange blood transfusion was proposed. To avoid the disadvantage of this heavy technique, the authors are proposing filariopheresis to trap the microfilariae using cytapheresis technique and filtration. They obtained a medium 75 p. cent microfilariae extraction: 55-70 p. cent by cytapheresis and 5-20 p. cent by filtration. The number of blood cells must be supervised as an important decrease of the platelets may occur temporary. This simple and not expensive technique is efficient, but diethylcarbamazine treatment must be instituted very quickly after filariopheresis session. Furthermore, the millions of microfilariae collected can provide useful antigen for immuno-parasitological tests.

Loa loa: the use of a blood cell separator to reduce microfilaraemia before specific chemotherapy

Three years after returning to the U.K. a 58-year-old British engineer, who had worked in the Nigerian oilfields for 24 years, was found to have Loa loa. His midday microfilarial count ranged between 12 X 10(6) and 16 X 10(6) parasites per litre. Before starting treatment, I litre of leucocyte/platelet-rich plasma was removed by means of a blood cell separator. Six intermittent cycles of blood separation were performed during a single 4-h session around midday in order to coincide with the period of maximum microfilarial presence in the peripheral circulation. This resulted in a 50% reduction of the microfilaraemia. Where facilities for blood cell separation are available, this procedure, together with appropriate chemotherapy, should be particularly beneficial in the management of heavy filarial infections.

Usefulness of apheresis to extract microfilarias in management of loiasis

Two patients with loiasis in whom treatment with diethylcarbamazine had to be interrupted because of serious side effects underwent apheresis to extract microfilarias from the blood. After three apheresis sessions the number of microfilarias in the blood had dropped from 8980 to 3412/ml in one patient and from 2950 to 1840/ml in the other. Between 40 and 45 X 10(6) microfilarias were removed from each of the patients. After reduction of the parasitaemia the two patients were given diethylcarbamazine; no appreciable side effects occurred, and the patients were cured.