Subconjunctival Loa loa worm: first case report in Brazil / Verme subconjuntival da espécie Loa loa: primeiro caso no Brasil

We report the first case of ocular infestation by Loa loa in Brazil. Loiasis is caused by infestation with Loa loa, a filarial parasite originally found in the rainforests of western and central Africa. It is transmitted by the bite of the fly Chrysops and has been recently described in other places other than Africa, in African immigrants or travellers. Our case is a 33 year-old woman from Cameroon who was living in São Paulo, Brazil, for 5 years. She was asymptomatic until one morning she started feeling "something moving" in the left eye. Under topical anesthesia, on the slit lamp, a moving worm was removed from the subconjunctival space, which later was confirmed to be a male Loa loa adult specimen. Blood tests revealed microfilaraemia of 129 mf/mL. The patient was treated with 400 mg oral albendazole for 3 weeks and 60 mg prednisone. This report illustrates an unusual ocular disease, which is extremely rare outside of Africa, but easily diagnosed and treated. Ophthalmologists should be aware of it, in face of an increasingly globalized world.

Este é o primeiro relato na literatura nacional e internacional de infestação ocular por Loa loa no Brasil. A loíase é uma filariose causada pelo parasita Loa loa, encontrado nas florestas tropicais da África equatorial. A transmissão se dá pela picada do mosquito Chrysops e casos têm sido descritos em países não africanos, em imigrantes e viajantes. O presente caso trata-se de uma paciente de 33 anos natural de Camarões e residente em São Paulo, Brasil, há 5 anos. Até então assintomática, uma manhã sentiu algo "se mexendo" em seu olho esquerdo. Sob anestesia tópica, na lâmpada de fenda, um verme altamente móvel foi removido do espaço subconjuntival e enviado para identificação, que confirmou tratar-se de um espécime macho adulto de Loa loa. Testes sanguíneos revelaram microfilaremia de 129 mf/mL. A paciente foi tratada com albendazol 400 mg e prednisona 60 mg esquema regressivo por 3 semanas. Este relato ilustra uma doença excepcionalmente rara no Brasil, e praticamente desconhecida dos oftalmologistas em nosso país.

A historical note on an imported case of loiasis in Rio de Janeiro, Brazil, 1964 / Nota histórica sobre caso importado de loíase no Rio de Janeiro, Brasil, 1964

Loiasis is a filarial disease transmitted by the Chrysops spp. tabanid flies in West and Central Africa. It is most commonly diagnosed by the clinical manifestations of Calabar swellings (transient localized inflammatory edema) or, most dramatically, by the appearance of a migrating worm through the conjunctival tissues or the bridge of the nose. We report the case of a 35-year-old resident in the city of Rio de Janeiro who displayed a moving Loa loa in the bulbar conjunctival tissue two years after returning from a six-month trip to Uganda. Surgical removal of the worm was performed.

A loaíase é uma filaríase transmitida por tabanídeos (mutucas) do gênero Chrysops na África central e ocidental, comumente diagnosticada pela apresentação clínica de edema de Calabar (edema inflamatório transitório e localizado) ou, mais dramaticamente, pela migração de um verme adulto pelo tecido conjuntival ou asa do nariz. Descrevemos o caso clínico de um paciente do sexo masculino, 35 anos, residente no Rio de Janeiro, que se apresentou com um verme adulto de Loa loa migrando sobre o tecido conjuntival bulbar dois anos após retornar de uma viagem de seis meses de duração a Uganda. Procedeu-se a remoção cirúrgica do verme.

International Travel and Imported Parasitic Diseases / 한양의대학술지

International travel has become increasingly common as travelers of various purposes. It is estimated that there are 900 million international tourist arrivals alone each year. Unfortunately, some health impairments were reported in about 50% of short term travelers to the tropics or sub-tropics, usually due to infectious agents. In this paper, the author reviewed imported parasitic diseases in Korea from 1970 to 2009 with literature and data collected by Korea Centers for Disease Control and Prevention (KCDC). The author also reviewed warning points about parasitic disease in pregnant and immune deficit travelers. Most prevalent imported parasitic disease was malaria. About 30~70 travelers infected with malaria are returned home anually from abroad, mostly South East Asia and Africa. Subtype of malaria classified from 2003~2006 surveillance data showed Plasmodium falciparum infection in about 55% of patients identified. Over 20 cases of hydatid disease and cutaneous leishmaniasis cases were reported respectively. Visceral leishmaniasis (5 cases), babesiosis (7 cases), loiasis (3 cases), cutaneous myiasis (1 case), pentastomiasis (1 case), gnathostomiasis (4 cases, 41 people), angiostrongylosis (1 case, 10 people), heterophyiasis (2 cases), schistosomiasis (13 cases), cyclosporiasis (1 case), cutaneous larva migrans (4 cases), ancylostomiasis (1 case) and syngamosis (1 case) were reported. Prevention and surveillance plan of imported parasitic diseases is organized and conducted by KCDC since 2001. According to increasing travel to developing or under developed countries, retraining of doctor and technician, systematization of consulting system for diagnosis of parasitic disease, supply of medication, supplement of the personnel, and financial supports are needed.

Imported Parasitic Diseases in Korea

International migration of people has risen exponentially during the past two decades. Many people travel abroad for business purposes, sightseeing, volunteer activities, immigration, education, missonary work, etc., and are exposed to vector-borne and food or water-borne parasitic diseases, especially when they are traveling to the tropical and sub-tropical areas. Recently, imported parasitic diseases have also increased in Korea due to frequent traveling by the local residents or entry of foreign workers to the country. According to the statistics from 1970 to 2008, malaria (727 cases) was the most frequently imported parasitic disease in Korea followed by gnathostomiasis (42 cases) and hydatidosis (31 cases). From 1970 to 2010, cases of ancylostomiasis (1 case), angiostrongylosis (15 cases), babesiosis (8 cases), cutaneous larva migrans (8 cases), cutaneous myiasis (2 cases), cyclosporiasis (1 case), heterophyiasis (2 cases), leishmaniasis (28 cases), loiasis (3 cases), pentastomiasis (1 case), schistosomiasis (13 cases), and syngamosis (1 case) have also been reported. Travelers to Sub-Saharan Africa, Southeast Asia, and Central and South America should be on alert against malaria and other tropical diseases. National surveillance for imported diseases started in 2001 by Korea Centers for Disease Control and Prevention (KCDC). This article reviews imported parasitic diseases in Korea with review of literature.

Adverse reactions from community directed treatment with ivermectin (CDTI ) for onchocerciasis and loiasis in Ondo State, Nigeria

Onchocerciasis is an endemic disease in Ondo state, Nigeria. Community directed distribution of ivermectin is currently on-going in some local government areas of the state. Randomly selected persons (2 331 males and 2 469 females) were interviewed using a modified rapid assessment procedure for Loa loa (RAPLOA) to assess community directed treatment with ivermectin. The retrospective study evaluated the coverage, impacts and adverse reactions to the drug treatment. A questionnaire was administered by house-to-house visit in six local government areas, implementing community directed treatment with ivermectin (CDTI) in this bioclimatic zone. A total of 2,398 respondents were reported to have participated in the treatment. The overall ivermectin coverage of 49.96% was recorded (range 0 - 52% in different communities). Adverse reactions from ivermectin administration were experienced in 38% of individuals. Diverse adverse reactions experienced included predominantly itching (18.50%); oedema, especially of the face and the limbs (8.2%); rashes (3.4%) and body weakness (2.4%). Expulsion of intestinal worms occurred in 0.96% of the respondents. The occurrence of adverse reactions in relation to age categories was statistically significant. Neither fatal nor severe adverse reactions were reported by respondents. Significantly, despite experienced adverse reactions, continued participation, acceptability and compliance to ivermectin treatment was expressed by the various communities. This attitude is in consonance with the African Programme for Onchocerciasis Control (APOC) objectives. Rev. Biol. Trop. 56 (4): 1635-1643. Epub 2008 December 12.

La oncocercosis es endémica en el estado Ondo, Nigeria. Se seleccionaron 4 800 personas al azar para evaluar con encuesta retrospectiva la cobertura, efectos y reacciones al tratamiento farmacológico con ivermectina administrado por la misma comunidad. La cobertura global de ivermectina fue 50 % con reacciones adversas en 38 % de los individuos. Estas fueron comezón picazón (18%), edema, especialmente de la cara y las extremidades (8%), erupciones cutáneas (3%) y debilidad (2%); dependieron de la edad y no hubo reacciones más graves. La expulsión de las lombrices intestinales se produjo en 96% de los encuestados. A pesar de las reacciones adversas, hubo continuidad, aceptación y cumplimiento del tratamiento con ivermectina, en consonancia con los objetivos del Programa Africano para el Control de Oncocercosis (APOC).

Market survey of loiasis: prevalence and adverse reactions to ivermectin using a rapid procedure for loiasis / Encuesta de mercado de loiasis: prevalencia y reacciones adversas a la ivermectina usando un procedimiento rápido para la loiasis

OBJECTIVES: 1. To assess the levels of endemicity of loiasis in a total of 30 selected villages covering an area of 5.2 sq km in Owo, Akure North, Akure South, Ondo East, Ondo West and Ifedore local governments in Ondo State, Nigeria, using Rapid Assessment for loiasis technique. 2. To obtain information on adverse reactions which occurred during previous administrations of the drug ivermectin used for the treatment of loiasis and onchocerciasis in the study area. METHODS: Consent was obtained from the chairman of each local government village head and individuals were co-opted into the study. A total of 480 individuals were interviewed, 80 from each of the six local governments, during the regular scheduled community market days. Survey for Loa loa was carried out according to specifications in "Guidelines for rapid Assessment of Loa loa (TDR, 2002). RESULTS: Among the 480 respondents, 80 (16.7%) reported having had a history of loiasis while 11 (2.3%) had recent occurrence of the disease. The local name given to the disease in all the villages studied is "aran oju". Respondents in Ondo East local government had an eyeworm history of 23 (28.8%) and occurrence of loiasis was 02 (2.5%), these were the highest figures recorded. Using the SPSS version 10 package for data analysis, demographic factors of age and gender were not significant determinants of prevalence (> 0.05). Ondo East and Ifedore local governments had significant levels of loiasis prevalence (p < 0.05). Adverse reactions from the retrospective ivermectin administration was 04 (0.83%). This was statistically insignificant (p > 0.05). CONCLUSION: Market surveys in rural communities were considered to be cost effective and rapid in the determination of prevalence of any disease. Since less than 40% of the respondents in the study area reported having had a history of eyeworm, the entire area was classified as "low risk" as regards the administration of ivermectin.

OBJETIVOS: 1. Evaluar los niveles de endemicidad de loiasis en un total de 30 poblados seleccionados, que abarcan un area de 5.2 sq km in Owo, Akure North, Akure South, Ondo East, Ondo West y los gobiernos locales de Ifedore in Ondo State, Nigeria, usando una evaluación rápida para técnica de loiasis. 2. Obtener información acerca de las reacciones adversas que ocurrieron durante las administraciones previas del medicamento invermectina usado para el tratamiento de loiasis y onchocerciasis en el área de estudio. MÉTODOS: Se obtuvo el consentimiento del presidente de cada uno de los gobiernos locales de los poblados de cabecera, así como de los individuos cooptados para la realización del estudio. Se entrevistaron un total de 480 individuos, 80 de cada uno de los seis gobiernos locales, durante los días de mercado regularmente programados para la comunidad. Se llevó a cabo una encuesta de Loa loa de acuerdo con las especificaciones de las "Guías para la evaluación rápida de Loa loa". RESULTADOS: De los 480 encuestados, 80 (16.7%) reportaron haber tenido una historia de loiasis, mientras que 11 (2.3%) tuvieron padecimientos recientes de esta enfermedad. El nombre local dado a esta enfermedad en todos los poblados estudiados es "aran oju". Los encuestados en el gobierno local de Ondo East local tenían antecedentes de gusano ocular de 23 (28.8%) y la manifestación de loiasis fue 02 (2.5%). Estas fueron las cifras más altas registradas. Usando el paquete SPSS versión 10 para el análisis de datos, se observó que los factores demográficos de edad y sexo no fueron significativamente determinantes de la prevalencia (> 0.05). Los gobiernos locales de Ondo East y de Ifedore tuvieron niveles significativos de prevalencia de loiasis (p < 0.05). Las reacciones adversas de la administración de ivermectina retrospectiva fue 04 (0.83%). Esto fue estadísticamente significativo (p > 0.05). CONCLUSIÓN: Las encuestas de mercado en las comunidades rurales fueron consideradas costo-efectivas y rápidas en la determinación de la prevalencia de cualquier enfermedad. Puesto que menos del 40% de los encuestados en el área de estudio reportaron haber tenido una historia de gusano ocular, toda el área fue clasificada como de "bajo riesgo" en relación con la administración de la invermectina.

Loa loa infection in non-endemic area: a case study and disease review

Loiasis is a cutaneous filarial parasite of humans caused by the filarial nematode Loa loa, which is transmitted to humans by day-biting Chrysops flies. Human loiasis is confined to the rain forest and swamp forest areas of Western and Central Africa; however; sporadic cases hove been reported from other parts of the world including India. United Arab Emirates is relatively free from arthropod-borne parasitic diseases, but the region remains vulnerable to the introduction of such infections from areas where they are endemic due to a high traffic of a large expatriate population. We report a suspected case of loaiasis in a patient from India who lived and worked in Dubai, UAE, for several years and who had never visited Africa in the past. We assume that this is the first case of loaiasis reported from the gulf region where transmission of the infection has occurred outside the endemic areas

Subconjuctival Loa loa with Calabar Swelling

Loa loa is unique among the human filariae in that adult worms are occasionally visible during subconjuntival migration. A 29-yr-old African female student, living in Korea for the past 5 yr without ever visiting her home country, presented with acute eyelid swelling and a sensation of motion on the left eyeball. Her symptoms started one day earlier and became worse over time. Examination revealed a threadlike worm beneath the left upper bulbar conjunctiva with mild eyelid swelling as well as painless swelling of the right forearm. Upon exposure to slit-lamp illumination, a sudden movement of the worm toward the fornix was noted. After surgical extraction, parasitologic analysis confirmed the worm to be a female adult Loa loa with the vulva at the extreme anterior end. On blood smear, the microfilariae had characteristic features of Loa loa, including sheath and body nuclei up to the tip of the tail. The patient also showed eosinophilia (37%) measuring 4,100/microliter. She took ivermectin (200 microgram/kg) as a single dose and suffered from a mild fever and chills for one day. This patient, to the best of our knowledge, is the first case of subconjunctival loiasis with Calabar swelling in Korea.

Traveling and Imported Parasitic Diseases

Recently, many peoples travel abroad for sightseeing, business, missionary and other works. At the same time, imported parasitic diseases including malaria has been increased in Korea. The vector borne and food borne diseases were imported from many other countries, Africa, Middle East and South east Asia. Recently many foreigners entered to Korea for studying, working and other purposes. Imported foods, fishes, meats, vegetables are important for parasitic infection, too. The author reviewed imported parasitic diseases in Korea from 1970 to 2006 with literatures. Malaria is most prevalent. And babesiosis of 6 cases, cutaneous leishmaniasis of over 20 cases, visceral leishmaniasis of 5 cases, loiasis of 3 cases, gnathostomiasis of 40 cases, angiostrongylosis of 10 cases, heterophydiasis of 2 cases, schistosomiasis haematobium of 6 cases, schistosomiasis mansoni of 3 cases, hydatidosis of 24 cases, cutaneous larva migrans of 4 cases, and one case of ancylostomiasis, syngamosis, cutaneous myiasis and pentastomiasis are reported, respectively. The protozoa of 5 species and helminthes of 11 species are imported from many other countries. In Korea, re-emerging malaria was appeared at Demilitarized zone (DMZ) on 1993. Last year, 2,051 cases of indigenous malaria were reported by Korean Center for Diseases Control (KCDC). However, the most prevalent imported malaria was Plasmodium falciparum and indigenous malaria was only P. vivax. For the prevention of imported parasitic diseases, the education, training for tropical medicine, supply of medication and vaccine are needed. The surveillance system for imported diseases was started by KCDC on 2001.

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.