Case Report

Ocular Dirofilariasis after Clinically Manifested Subcutaneous Migration of the Parasite: A Case Report

Abstract

Dirofilaria repens is the causative agent of human subcutaneous or, less often, ocular dirofilariasis. The work presents a rare case of ocular dirofilariasis manifested by previous subcutaneous migration accompanied by severe headache symptoms. In February 2017, a 58-yr-old man from Trnava region, western Slovakia, noticed red and itchy stripes on his left leg. Inflamed but painless stripes disappeared and showed up again every 5–7 days, migrating gradually towards the head. Approximately one month after the first skin´s alterations, strong pain in the left temple, with the swelling of the left face and the enlargement of mandibular lymph nodes appeared. Several days later, the patient felt excruciating pain of the right eyeball accompanied by strong nausea and subsequent vomiting. Ocular examination revealed the presence of a live worm in the subconjunctival space and morphological and molecular analyses of extracted helminth confirmed D. repens as etiological agent of the infection. According to clinical manifestation of the infection, it could be supposed that ocular form of the disease was the result of the migration of a parasite through the subcutaneous tissues. Moreover, a rare phenomenon of lymphadenitis of underlying lymph nodes and the swelling of left face accompanied the migration.

1. Otranto D, Eberhard ML. Zoonotic helminths affecting the human eye. Parasit Vectors 2011; 4:41.
2. Pampiglione S, Rivasi F. Human dirofilariasis due to Dirofilaria (Nochtiella) repens: an update of world litera-ture from 1995 to 2000. In: Genchi C, Rinaldi L, Cringoli G, editors. Dirofilaria immitis and D. repens in dog and cat and human infections. Naples, Italy: Rolando Editore; 2007. p. 81–116. ISBN 8889132140.
3. Ondriska F, Forgáč F, Hrčková G, et al. Case re-port human ocular dirofilariosis in Slovakia, a case report. Helminthologia. 2014; 51(3):246–9.
4. Miterpáková M, Antolová D, Ondriska F, et al. Human Dirofilaria repens infections diagnosed in Slo-vakia in the last 10 years (2007–2017). Wien Klin Wochenschr. 2017; 129(17–18):634–41.
5. Kalogeropoulos CD, Stefaniotou MI, Gorgoli KE, et al. Ocular dirofilariasis: A case series of 8 patients. Middle East Afr J Ophthalmol. 2014; 21(4):312–6. doi: 10.4103/0974-9233.142267.
6. Antolová D, Miterpáková M, Paraličová Z. Case of human Dirofilaria repens infection manifested by cu-taneous larva migrans syndrome. Parasitol Res. 2015; 114(8): 2969–73.
7. Rishniw M. Barr SC, Simpson KW, et al. Discrimi-nation between six species of canine microfilariae by a single polymerase chain reaction. Vet Parasitol. 2006; 135(3–4): 303–14. doi: 10.1007/s00436-015-4499-7.
8. Simón F, Siles-Lucas M, Morchón R, et al. Human and animal dirofilariasis: the emergence of zoonotic mosaic. Clin Microbiol Rev. 2012; 25(3):507–44. doi: 10.1128/CMR.00012-12.
9. Bhat KS, Kotigadde S, Vishwanatha Bhat KN, et al. Subconjunctival dirofilariasis: Case studies with re-view of literature. Trop Parasitol. 2014; 4(2):119–21.
10. Agrawal M, Biswas J. Live intraocular Dirofilaria causing multifocal choroiditis. Retin cases and Brief Rep. 2009;3(2):228-9.
11. Smets M, De Poter P. First cases of ocular diro-filariasis caused by Dirofilaria repens in Belgium. Acta Ophthalmol. 2016; 2016 European Association for Vision and Eye Research Conference.
12. Gupta V, Sankaran P, Mohanraj, et al. Bilateral in-traocular dirofilariasis. Indian J Ophthalmol. 2014; 62(3):357–8.
13. Džamić AM, Colović I, Arsic-Arsenijevic V, et al. Human Dirofilaria repens infection in Serbia. J Hel-minthol. 2009; 83(2),129–37.
14. Klintebjerg K, Petersen E, Pshenichnaya NY, et al. Periorbital Dirofilaria repens imported to Denmark: A human case report. ID Cases. 2015; 2(1):25–26.
15. Čabanová V, Miterpáková M, Valentová D, et al. Urbanization impact on mosquito community and the transmission potential of filarial infection in cen-tral Europe. Parasit Vectors 2018; 11(1):261.
16. Miterpáková M, Iglódyová A, Čabanová V, et al. Canine dirofilariosis endemic in Central Europe – 10 years of epidemiological study in Slovakia. Parasi-tol Res. 2016; 115(6):2389–95.
17. Ermakova LA., Nagorny SA, Pshenichnaya NY,et al. Clinical and laboratory features of human diro-filariasis in Russia. ID Cases 2017; 9:112–5.
18. Genchi C, Venco L, Genchi, M. Guideline for the laboratory diagnosis of canine and feline Dirofilaria infections. In: Genchi C, Rinaldi L, Cringoli G, edi-tors. Dirofilaria immitis and D. repens in dog and cat and human infections. Naples, Italy: Rolando Edito-re; 2007. p. 138-144. ISBN 8889132140.
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IssueVol 15 No 1 (2020) QRcode
SectionCase Report(s)
DOI https://doi.org/10.18502/ijpa.v15i1.2539
Keywords
Dirofilariasis Dirofilaria repens; Subcutaneous migra-tion Ocular infection Slovakia

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How to Cite
1.
ONDRISKA F, BOLDIŠ V, STANISLAVOVÁ M, ANTOLOVÁ D, MITERPÁKOVÁ M, HANÁČEK A, VEŠPEROVÁ S, JANČOVIČ I. Ocular Dirofilariasis after Clinically Manifested Subcutaneous Migration of the Parasite: A Case Report. Iran J Parasitol. 2020;15(1):147-152.