Ocular parastrongyliasis (=angiostrongyliasis): probable first report of human infection from a patient in Ceylon (Sri Lanka).

What is considered to be the first case of human parastrongyliasis (angiostrongyliasis) worldwide is described from a patient in Ceylon (Sri Lanka) in 1925. It also predates the description of the parasite in humans by Chen (1935).

Third report of ocular parastrongyliasis (angiostrongyliasis) from Sri Lanka.

A further case of ocular parastrongyliasis has been seen in a patient from Sri Lanka. As it is a juvenile female worm it could not be identified to the species, but it is probably Parastrongylus (= Angiostrongylus) cantonensis which is the commonly reported species in the country. This is the third authentic case of such an infection in Sri Lanka in recent years.

Recovery of a species of Brugia, probably B. ceylonensis, from the conjunctiva of a patient in Sri Lanka.

A species of Brugia, probably B. ceylonensis, was recovered from the conjunctiva of a patient in Sri Lanka for the first time. This infection represents only the second record of Brugia in the human conjunctiva, and is clearly zoonotic, acquired from a dog. Brugia ceylonensis has a distinct head bulb like that of Wuchereria bancrofti and B. malayi. However, the parasite recovered was not W. bancrofti, as specific IFAT and DNA probes gave negative results, and B. malayi is believed to have been eradicated from Sri Lanka several years ago. The presence of a distinct head bulb excludes the possibility that the parasite was B. buckleyi.

Rhinosporidiosis presenting with two soft tissue tumors followed by dissemination.

Rhinosporidiosis is caused by Rhinosporidium seeberi. Most mycologists believe that R. seeberi is either a Chytridium related to the Olpidiaceae (order Chytridialis, class Chytridiomycetes) or a Synchytrium. This is the first documented case of tumoral rhinosporidiosis in a Sri Lankan and the third documented case in the world literature. A 44 year old male presented with a large mass above the thigh and a similar mass over the anterior chest wall, both masses contained R. seeberi. Later examination of the patient revealed nasal polyps, confirming that the tumors were due to systemic spread of this infection.

Efficacy of single dose combinations of albendazole, ivermectin and diethylcarbamazine for the treatment of bancroftian filariasis.

In a 'blind' trial on 50 male asymptomatic microfilaraemic subjects with Wuchereria bancrofti infection, the safety, tolerability and filaricidal efficacy of a single dose of albendazole (alb) 600 mg alone or in combination with ivermectin (iver) 400 micrograms/kg or diethylcarbamazine citrate (DEC) 6 mg/kg was compared with a single dose of the combination DEC 6 mg/kg and iver 400 micrograms/kg over a period of 15 months after treatment. All but one subject, with 67 microfilariae (mf)/mL, had pre-treatment counts > 100 mf/mL. All 4 treatments significantly reduced mf counts, but alb/iver was the most effective regimen for clearing mf from night blood: 9 of 13 subjects (69%) were amicrofilaraemic by membrane filtration 15 months after treatment compared to one of 12 (8%), 3 of 11 (27%), and 3 of 10 (30%) in the groups treated with alb, alb/DEC, and DEC/iver, respectively. Filarial antigen tests suggested that all 4 treatments had significant activity against adult W. bancrofti; alb/DEC had the greatest activity according to this test, with antigen levels decreasing by 77% 15 months after therapy. All 4 regimens were well tolerated and clinically safe, although mild, self-limited systemic reactions were observed in all treatment groups. These results suggest that alb/iver is a safe and effective single dose regimen for suppression of microfilaraemia in bancroftian filariasis that could be considered for control programmes. Additional benefits of this combination are its potent, broad spectrum activity against intestinal helminths and potential relative safety in areas of Africa where DEC cannot be used for filariasis control because of co-endemicity with onchocerciasis or loiasis.

First reports of subcutaneous sparganosis in Sri Lanka.

OBJECTIVE: To report and create awareness of sparganosis, a parasitic zoonosis caused by a larval stage of Spirometra sp. SETTING: Two patients with non-tender subcutaneous lumps. DIAGNOSIS CRITERIA: Morphology of solid cestode larva in excision biopsies. CONCLUSIONS: Although these two instances were innocuous, infection is potentially dangerous as larvae are long lived and could invade vital organs. The most likely source of infection in Sri Lanka is ingestion of the infected first intermediate host, Cyclops, in water.

Human dirofilariasis caused by Dirofilaria (Nochtiella) repens in Sri Lanka.

Human dirofilariasis due to Dirofilaria (Nochtiella) repens is a common zoonotic infection in Sri Lanka. Todate 70 cases are on record, and they include 3 expatriates from Russia, England and Korea, who were undoubtedly infected in Sri Lanka. Around 30-60% of dogs are infected with D. repens in various parts of the country and the mosquito vectors are Aedes aegypti, Armigeres subalbatus, Mansonia uniformis and M. annulifera. Unlike in other countries of the old world infection is most common in children under the age of 9 years, the youngest being 4 months old and the scrotum, penis and perianal regions of male children appear to be frequent sites for the worms. Dirofilaria (Dirofilaria) immitis is not present in Sri Lanka though it is present in neighbouring countries like India, and Malaysia.

Prolonged clearance of microfilaraemia in patients with bancroftian filariasis after multiple high doses of ivermectin or diethylcarbamazine.

In a double-blind trial on 37 asymptomatic microfilaraemic subjects (minimum 400 microfilariae [mf] per mL) with Wuchereria bancrofti infection, the safety, tolerability and macrofilaricidal efficacy of 12 fortnightly doses of ivermectin, 400 micrograms/kg (ivermectin group), was compared with 12 fortnightly doses of diethylcarbamazine (DEC), 10 mg/kg (DEC group), over a period of 129 weeks after treatment. A control group (LDIC group) was treated with low dose ivermectin to clear microfilaraemia, for ethical reasons. Both ivermectin and DEC in high multiple doses were well tolerated and clinically safe. Macrofilaricidal efficacy was assessed by prolonged clearance of microfilaraemia, appearance of local lesions, and reduction of circulating W. bancrofti adult antigen detected by an antigen capture enzyme-linked immunoassay based on the monoclonal antibody AD12. Mf counts fell more rapidly after ivermectin than after DEC, but low residual mf levels were equivalent in these groups after week 4. Conversely, filarial antigen levels fell more rapidly after DEC than after ivermectin, but low residual antigen levels in these groups were statistically equivalent at all times beyond 12 weeks. Mild, self-limited systemic reactions to therapy were observed in all 3 treatment groups. Local reactions, such as development of scrotal nodules, were observed in several subjects in the DEC and ivermectin groups. These results suggested that high dose ivermectin and DEC both had significant macrofilaricidal activity against W. bancrofti, but neither of these intensive therapeutic regimens consistently produced complete cures. Thus, new drugs or dosing schedules are needed to achieve the goal of killing all filarial parasites in the majority of patients.

On an infection of a human eye with Parastrongylus (= Angiostrongylus) sp. in Sri Lanka.

A metastrongyle worm extracted from the anterior chamber of the right eye of a patient in Sri Lanka belongs to the genus Parastrongylus and probably to a yet undescribed species, related to P. cantonensis well known to infect man. It is mostly a parasite of rodents, wandering in man and unadapted to this host. Evidence for this lack of adaptation are that the specimen is undergoing necrosis (teratological specimen) and is located in an organ with little immunological defences.