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African Eye Worm

Authors
Journal
Journal of Global Infectious Diseases
0974-777X
Publisher
Medknow Publications
Publication Date
Volume
4
Issue
2
Identifiers
DOI: 10.4103/0974-777x.96782
Keywords
  • Letters To Editor
Disciplines
  • Medicine

Abstract

Sir, We report the case of a 24-year-old man, born in the coastal area of Gabon, who had migrated to France and presented to our department with the sensation of something wiggling over the right eyeball. He gave history of transient painful itchy red swellings on wrists, headache with redness in the eyes, and edema of the periorbicular soft tissues in the past 3 years. When first seen, an opaque wriggled motile thin and undulated worm was directly observed in the superotemporal subconjunctival space. The parasite was successfully extracted with toothed forceps [Figure 1]. Its morphological features were most consistent with the Loa loa species. Peripheral blood smear drawn around noontime was positive with microfilarial load at 3500 ml–1. To first decrease this high microfilarial load, the patient was treated with 2 weekly doses of ivermectin 200 μg/kg associated with 0.5 mg/kg/day corticosteroids and antihistaminic for 10 days. Three months later, although the patient became fully asymptomatic, the microfilarial load was still positive at 600 ml–1. He did not return for definitive cure with diethylcarbamazine. Figure 1 Extraction of one adult Loa loa worm after conjunctival incision (snapshot from video) Loa loa worm is a human subcutaneous filarial nematode transmitted by a day-biting forest-dwelling fly of the genus Chrysops. Adult Loa loa worms migrate actively throughout the subcutaneous and collective body tissues. They are most conspicuous and irritating when passing beneath the conjunctiva of the eye. Calabar swellings are localized, tense, inflammatory pruritic subcutaneous edema seen in joints of extremities, lasting for 1–3 days. They represent areas of angioedema resulting from a host response to allergens released by the maturating worm and its metabolic products.[1] Definitive diagnosis is made either by identification of the adult worm in the subcutaneous tissue, the subconjunctiva, or sclera of the eye or by finding microfilariae in the bl

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