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Year : 2015  |  Volume : 58  |  Issue : 3  |  Page : 332-334
Subconjunctival dirofilariasis caused by Dirofilaria repens: A case report with short review


1 Department of Microbiology, Smt Kashibai Navale Medical College, Pune, Maharashtra, India
2 Department of Microbiology, B. J. Government Medical College, Pune, Maharashtra, India

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Date of Web Publication14-Aug-2015
 

   Abstract 

Human dirofilariasis is a rare infection caused by filarial worms of genus Dirofilaria. Subconjunctival dirofilariasis has been reported from Asia, Europe, Italy and Africa. In India majority cases are from Kerala, Karnataka and very few from Maharashtra. We report the rare case of subconjunctival dirofilariasis caused by Dirofilaria repens from Maharashtra, western India.

Keywords: Dirofilaria repens , subconjunctival dirofilariasis, western India

How to cite this article:
Choure AC, Palewar MS, Dohe VB, Mudshingkar SS, Madhuri K, Bharadwaj RS. Subconjunctival dirofilariasis caused by Dirofilaria repens: A case report with short review. Indian J Pathol Microbiol 2015;58:332-4

How to cite this URL:
Choure AC, Palewar MS, Dohe VB, Mudshingkar SS, Madhuri K, Bharadwaj RS. Subconjunctival dirofilariasis caused by Dirofilaria repens: A case report with short review. Indian J Pathol Microbiol [serial online] 2015 [cited 2022 Jan 17];58:332-4. Available from: https://www.ijpmonline.org/text.asp?2015/58/3/332/162866



   Introduction Top


Human dirofilariasis is a zoonotic disease caused by the filarial nematode of genus Dirofilaria. Dirofilaria includes different species like Dirofilaria immitis, Dirofilaria repens, Dirofilaria tenius, Dirofilaria ursi and Dirofilaria striata. The life cycle of Dirofilaria species is same as that of other filariae. Domestic animals like dog, cat, wolf, raccoon and bear are the definitive hosts. Microfilariae are accidently transmitted to humans by infected culex, aedes and anopheles mosquito. Man is a dead end host for the parasite because Dirofilaria dies in human body without producing microfilaria.

We present the brief review of subconjunctival dirofilariasis caused by D. repens and a case report in a patient from Maharashtra. This is the third case to the best of our knowledge from Western India. The first reported case was from New Mumbai, caused by female D. repens[1] and the second case from rural Gujarat. [2] Our's is the first case report from Western India in which causative agent is male D. repens.


   Case Report Top


A 59-year-old male, businessman from Pune, Maharashtra came to the hospital with complaints of irritation, pain in right eye along with swelling and moving foreign body sensation since 2 days. He was treated with topical antibiotics. There was no history of trauma or foreign body and similar episodes in the past. As the patient is a businessman, he gave a history of travel to Spain, Hongkong, Japan, Korea and Taiwan. He also gave a history of pets like cat and dog. In past, patient had a lump in the groin 15 years back, which was associated with itching and dryness. Biopsy was done, but nothing was revealed on it. Since then he had itching on and off all over the body.

On the next day, patient came to the outpatient department as the symptoms continued despite treatment. On examination, right eye showed conjunctiva congestion. A swelling was observed on the nasal part of the bulbar conjunctiva. On slit lamp examination, motile worm was seen beneath conjunctiva. On fundoscopic examination, normal vision was 6/6. Ophthalmological examination of left eye was normal. Systemic examination was within normal limits. Intact live worm [Figure 1] was extracted under local anesthesia. It was stored in physiological saline and sent to our laboratory for identification. Peripheral blood smear examination was negative for microfilaremia and eosinophilia. Stool and urine examinations were normal. Antifilarial drugs were given to the patient after removal of worm. Complete resolution of symptoms was seen in follow-up.
Figure 1: Intact live worm was extracted from subconjunctival space under local anesthesia


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   Morphology Top


The worm [Figure 2] was thin, whitish, threadlike and cylindrical approximately 6 cm in length and 0.5 mm in breadth. The anterior and posterior ends were rounded. The entire body of the worm was covered with cuticle, which was thick and had prominent longitudinal ridges and transverse striations. Anterior end [Figure 3] was unarmed and wider than the posterior end. Posterior end [Figure 4] was coiled with a subterminal anus and caudal papillae with spicules. Based on the cuticle morphology, size, and posterior end, the worm was identified as a male D. repens.
Figure 2: The worm was thin, whitish, threadlike and cylindrical approximately 6 cm in length and 0.5 mm in breadth. Posterior end was coiled


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Figure 3: Anterior end was unarmed, rounded and wider than posterior end


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Figure 4: Posterior end was coiled with a sub terminal anus and caudal papillae with spicules. The worm body with prominent longitudinal ridges and transverse striations


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   Discussion Top


The first case of ocular dirofilariasis in human was reported during 1885. Addario from Milan, Italy described it as an infection caused by Filaria conjunctivae. [3] Previously, it was considered as a rare entity, but more and more cases are now being reported from India and Worldwide, which indicates a possible emerging zoonosis.

In India, first two cases of ocular dirofilariasis were reported from Kerala in 1976 [4] and 1978 [5] respectively. Initially it was thought that the dirofilariasis is problem of south India, but in last decade cases were reported from other parts of India, e.g., Assam, [6] Gujrat, [2] Maharashtra [1] and Punjab. [7] Majority of reported subconjunctival dirofilariasis cases were caused by D. repens with some exception where the causative agent is D. tenuis. [8] In literature search, we have found that where-ever mentioned the gender was female D. repens; but in our report it was the male D. repens causing dirofilariasis. We have reviewed only subconjuctival involvement!! If we consider the involvement of other body parts, the number of cases will definitely increase.

Clinical presentation in ocular dirofilariasis varied from case to case. It included scleritis, [1] subconjunctival cysts, eyelid swelling, [6] involvement of the anterior chamber [7] and motile swelling on conjunctiva. [2] In our case, there was motile swelling involving nasal part of the bulbar conjunctiva. Sometimes it may complicate to nodules, painful inflammatory swellings and abscess formation in subcutaneous tissue. In the peripheral blood smear, presence of microfilariae and increased eosinophil count is rarely seen.

Treatment of ocular dirofilariasis varies from antifilarial drugs-like ivermectin and diethylcarbamazine used in D. immitis to surgical extraction under local anesthesia for D. repens.

To conclude, subconjunctival dirofilariasis by D. repens is alarmingly increasing not only in India but also in world. For microbiologists, it is important to identify and differentiate the species of Dirofilaria.

Whenever there is patient complaining of nodule on conjunctiva or inflammatory swelling of the eye, although rare, ophthalmologists must always consider this as an important differential diagnosis!!


   Acknowledgment Top


Authors thank Dr. Salim Pathan and Dr. Geeta Vasandani, ophthalmologists for sending worm to our department.

 
   References Top

1.
Sangit VA, Haldipurkar SS. Subconjunctival dirofilariasis mimicking scleritis: First report from Western India. Indian J Ophthalmol 2012;60:76-7.  Back to cited text no. 1
[PUBMED]  Medknow Journal  
2.
Patel R, Singh S, Bhavsar S. A rare case of subconjunctival dirofilariasis by Dirofilaria repens in rural Gujarat. Indian J Ophthalmol 2014;62:649-51.  Back to cited text no. 2
[PUBMED]  Medknow Journal  
3.
Beaver PC, Jung RC, Cupp EW. The Filariae. Clinical Parasitology. 9 th ed. Philadelphia: Lea & Febiger; 1984. p. 387-90.  Back to cited text no. 3
    
4.
Joseph A, Thomas PG, Subramaniam KS. Conjunctivitis by Dirofilaria conjunctivae. Indian J Ophthalmol 1977;24:20-2.  Back to cited text no. 4
    
5.
Khurana S, Singh G, Bhatti HS, Malla N. Human subcutaneous dirofilariasis in India: A report of three cases with brief review of literature. Indian J Med Microbiol 2010;28:394-6.  Back to cited text no. 5
[PUBMED]  Medknow Journal  
6.
Nath R, Gogoi R, Bordoloi N, Gogoi T. Ocular dirofilariasis. Indian J Pathol Microbiol 2010;53:157-9.  Back to cited text no. 6
[PUBMED]  Medknow Journal  
7.
Chopra R, Bhatti SM, Mohan S, Taneja N. Dirofilaria in the anterior chamber: A rare occurrence. Middle East Afr J Ophthalmol 2012;19:349-51.  Back to cited text no. 7
[PUBMED]  Medknow Journal  
8.
Bhat S, Sofia O, Raman M, Biswas J. A case of subconjunctival dirofilariasis in South India. J Ophthalmic Inflamm Infect 2012;2:205-6.  Back to cited text no. 8
    

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Correspondence Address:
Dr. Archana Chintaman Choure
Department of Microbiology, Smt Kashibai Navale Medical College, Pune, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0377-4929.162866

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    Figures

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

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    Abstract
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   Discussion
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