Periocular thelaziasis presenting as an orbital mass - a case report.

Thelazia callipaeda is a rare parasitic infestation caused by spiruroid nematode of the genus Thelazia. We report a case of a 74-year-old gentleman who presented with a painless swelling of left lower lid since 15 days. Examination revealed a firm mobile mass along the inferior orbital rim. Magnetic Resonance Imaging showed a well-defined preseptal cystic lesion and Ultrasound screening revealed multiple mobile worms within. Patient underwent cyst excision in toto under local anesthesia. Four long refractile worms were isolated from within the cyst cavity. Species identification confirmed the parasite as Thelazia callipaeda. Periocular thelaziasis usually presents as free floating worms in the conjunctival sac, anterior chamber or vitreous cavity. It is important to be aware of this rare entity which should be considered as a differential diagnosis in endemic areas.

Gongylonema pulchrum infection in the human oral cavity: A case report and literature review.

Gongylonema infection is a zoonotic disease occurring throughout the world and is mainly caused by consumption of contaminated water and raw food. Adult Gongylonema worms can exist as parasites in the human body for up to 10 years and cause symptoms of local irritation in the oral cavity, esophagus, and pharynx. Herein, we report a rare case in which live Gongylonema pulchrum was detected and extracted from the oral cavity of a woman. The pathogen was confirmed as G. pulchrum on the basis of microscopic examination and morphologic analysis. The patient's symptoms resolved immediately after surgical removal of the parasite, and the patient has been advised not to drink water that has not been boiled and to avoid consuming unwashed raw vegetables.

Thelazia callipaeda infection in a 5-month-old infant.

BACKGROUND: Thelazia callipaeda is the main causative organism in thelaziasis, commonly infecting orbital cavities and associated tissues of carnivores. Thelazia callipaeda infection is rarely reported in humans, especially in infants. CASE PRESENTATION: A 5-month-old male infant presented with 2 weeks of redness and increased secretions in the left eye. On examination, the left eye revealed the presence of one creamy thread-like mobile worm in the conjunctival sac. During surgical exploration, a total of 11 worms were extracted from the left eye. The worms were morphologically identified as seven female and four male T. callipaeda. Ocular symptoms resolved rapidly after the removal of the worms, with no recurrence after the 6-month follow-up. CONCLUSION: We present here detailed clinical and morphological information pertaining to T. callipaeda infection, which is considered to be a probably neglected parasitic disease of the eye. This case illustrates the importance of including thelaziasis into the differential diagnosis of ocular surface diseases, especially in infant patients.

Avioserpens in the Western Grebe (Aechmophorus occidentalis): A new Host and Geographic Record for a Dracunculoid Nematode and Implications of Migration and Climate Change.

We report a new host and geographic range for the dracunculoid nematode (Avioserpens sp.) in a Western Grebe (Aechmophorus occidentalis) from southern Arizona, US. This discovery underscores the importance of parasite discovery and identification in the wildlife rehabilitation setting. Climate change and weather events affect the migratory spread of unusual parasites.

Long-term outcome of transendoscopic oesophageal mass ablation in dogs with Spirocerca lupi-associated oesophageal sarcoma.

Oesophageal sarcoma is a potential sequel of Spirocerca lupi infection. Oesophageal mass excision can be performed by open chest surgery. The objectives of this observational study were to evaluate the feasibility, short-term morbidity and long-term outcome of transendoscopic oesophageal mass ablation in dogs with spirocercosis-associated oesophageal neoplasia. A 9 mm video-endoscope and laser or electrocauterisation were used to debulk the oesophageal mass. Long-term follow-up was done by telephonic interviews. Fifteen dogs were included. The median tumour size was 5 cm (range 3.5-9). The median procedure time was 75 minutes (range 35-165) and was deemed successful in 12/15 dogs (80 per cent). Recovery was uneventful in all dogs. Immediate complications included oesophageal damage (two dogs) oesophageal perforation (one dog) and a focal thermal damage (one dog). The median hospitalisation time of all dogs was less than one day, with all but two discharged on the procedure day. The median survival time, available in nine dogs that were followed, was 202 days (range 51-691). Four of these dogs (44 per cent) survived more than six months, of which three survived more than one year. In conclusion, transendoscopic oesophageal mass ablation might be considered an alternative, palliative procedure for open-chest oesophageal surgery. It has comparable long-term survival, lower morbidity, short hospitalisation time and relatively low cost.

[THE FIRST CASE OF OCULAR THELAZIASIS IN CROATIA].

The first case of ocular thelaziasis in a human male patient in Croatia is presented. Thelaziasis is a zoonosis caused by nematodes of the genus Thelazia, parasites of the conjunctival bags or tear ducts of mammals and birds. Two types of the genus Thelazia (T.) have been described as causes of infection in humans, T. callipaeda and T. californiensis. To date, less than 300 thelaziasis cases in humans have been reported. This zoonosis is very rare in humans in European countries, with a high incidence in Asian countries, especially in China, Thailand and Japan. Because of the high prevalence of the parasites in the Far East, T. callipaeda is called 'Oriental eye worm'. The first case of thelaziasis in Europe was described in 2008 in Italy and France, where cases in animals had already been reported. Seasonal occurrence of thelaziasis in Europe depends on the presence of the vector, fruit flies of Drosophilidae family, Phortica variegate as the most common type. Adult worm is milky white, females grow to 20 mm and males up to 12 mm. Dogs and cats are the most common sources of infection for humans, which occurs as unilateral ocular infection. The clinical picture of infection is similar to bacterial and allergic conjunctivitis with tearing and foreign body sensation. After removal of worms, clinical signs quickly disappear and there is no need for anthelmintic treatment. In the treatment of secondary infections, local antibiotics and corticosteroids can be applied. The 82-year-old male patient presented to outpatient ophthalmology clinic for occasional sensation of pain, itching, redness and tearing in his left eye during the last few days. His left eye was blind due to previous retinal detachment and had severe conjunctival and ciliary infection with large corneal abscess. Worm-like movement in the lateral canthus was observed. After topical anesthesia, seven worms were removed. Upon surgical extirpation of the parasite, the diagnosis of thelaziasis was verified by microbiological identification. Only two cases of Thelazia in dogs were reported in Croatia, in December 2013 and January 2014. It is important to bear in mind this cause of eye infections, especially when caused by larval stages that are difficult to identify. Untimely diagnosis and inadequate treatment lead to extended illness and complications. The appearance of this parasite in Croatian patients suggests the need for inclusion of the pathogen in the differential diagnosis of bacterial or allergic conjunctivitis.

Successful transendoscopic oesophageal mass ablation in two dogs with Spirocerca lupi associated oesophageal sarcoma.

This report describes two cases of oesophageal tumours managed by transendoscopic neodymium:yttrium-aluminum-garnet laser ablation and polypectomy snare electrocautery. In each dog oesophagoscopy revealed caudal oesophageal masses, suspected to be Spirocerca lupi-induced oesophageal neoplasia. To resect the masses, transendoscopic neodymium:yttrium-aluminum-garnet laser ablation was used in the first case and polypectomy snare electrocautery in the second. Recovery was uneventful. Histopathology was consistent with oesophageal fibrosarcoma and osteosarcoma in each case, respectively. Follow-up oesophagoscopy revealed apparently healthy oesophageal tissue except for focal scar tissue in the first case. Transendoscopic laser ablation and polypectomy snare electrocautery is a potential non-invasive, cost effective alternative for surgical oesophageal mass resection.

Magnetic resonance imaging findings of spinal intramedullary spirocercosis.

Spirocerca lupi is a nematode infecting dogs in tropical and subtropical areas. Aberrant S. lupi migration to different body organs, including the spinal cord, has been documented. To date, the diagnosis of aberrant spinal cord migration was made at post-mortem examination or as an incidental finding, during spinal surgery. We describe two dogs with acute asymmetric paraparesis that were subsequently diagnosed with spinal cord spirocercosis. In magnetic resonance (MR) images of the spine, T2 hyperintense lesions were seen in the spinal cord of both dogs. The lesions appeared isointense on T1-weighted images and focal enhancement was detected after gadolinium administration. The MR imaging findings were compatible with focal inflammation, presumably along the parasite migration tract. Gross and microscopic pathologic findings confirmed the diagnosis of aberrant spinal intramedullary migration of S. lupi in one dog, and in the other dog, the clinical and imaging findings were supportive of this diagnosis.

Aberrant extradural spinal migration of Spirocerca lupi: four dogs.

Spirocerca lupi is a nematode mainly affecting dogs but has been found in other animals, particularly carnivores. Anatomical areas of typical and aberrant migration vary. This report describes four cases of Spirocerca lupi causing neurological symptoms, similar to thoracolumbar disc syndrome, as a result of aberrant migration of the nematode into the spinal canal. In two of the cases, the nematode could be demonstrated intraoperatively. The third was discovered on post-mortem examination, while the fourth case displayed compelling evidence of Spirocerca lupi involvement. Surgical removal of the Spirocerca lupi nematode would be the treatment of choice in cases of spinal migration, with therapeutic and preventive treatment with doramectin instituted to treat remote sites and prevent re-infection. In areas endemic for spirocercosis, Spirocerca lupi should be considered as an important differential diagnosis in cases that are presented with clinical signs suggestive of a spinal cord lesion.

Intravitreal gnathostomiasis and review of literature.

Intravitreal gnathostomiasis is a rare disease. To our knowledge, only five case reports are available in the literature wherein the parasites were surgically removed from the vitreous cavity and the species were identified. In this report, we document the clinical features of intravitreal gnathostomiasis along with the route of entry and parasitic migration pattern in ocular tissue, surgical management, and electron microscopic features of the retrieved advanced third-stage larva of Gnathostoma spinigerum (aL3) for a 48-year-old Indian woman with excellent postsurgical visual recovery.

Human Gongylonema infection in Iran.

The first human infection with Gongylonema in Iran is reported in a 35-year-old Iranian woman with complaints of one year duration and treated as a psychotic patient. Two worms, a male, and a female, were retrieved, described, and identified as G. pulchrum based on their morphological characteristics.

Ultrasound biomicroscopy in the diagnosis and management of intraocular gnathostomiasis.

PURPOSE: To describe the use of ultrasound biomicroscopy in the identification of an intraocular nematode in a case of suspected nematode-induced uveitis DESIGN: Observational case report. METHOD: UBM was performed under topical anesthesia in a patient with acute painful uveitis suspected to result from an intraocular nematode. Clinical examination did not reveal the nematode. RESULTS: Over a 6-minute time span, serial UBM examinations revealed the nematode to move from the iris root into the posterior chamber through the zonules. Subsequently, it was seen adhering to the cornea and could be removed surgically, resulting in symptom relief. CONCLUSION: UBM is a useful tool in diagnosis and management of parasitic uveitis.

Case of acute ileus caused by a spirurina larva.

A growing body of clinical cases suggests that a kind of nematode larva, type X larva of the suborder Spirurina that inhabits firefly squids (Watasenia scintillans, or 'Hotaru-ika' in Japanese), can cause acute ileus in humans. However, the larva itself has rarely been found in the wall of the obstructed intestine. We describe here a case of acute ileus, in which a type X spirurina larva was found histologically. A 60-year-old Japanese man suffered from acute abdomen, and an emergency laparotomy revealed a marked stenosis of the ileum. Histological study of the surgically resected ileum showed severe eosinophilic enteritis and a nematode larva. The morphological features of this larva were identical to those of the type X spirurina larva. Interestingly, the larva that was found existed within a small blood vessel, suggesting that the larva migrans of type X spirurina can take place via vasculature. The patient in the present case did not recall ingesting raw squids prior to the onset of his disease. Hence, this indicates that even if the ingestion of raw firefly squids is uncertain, spirurina infection should be included in the differential diagnosis of acute ileus or eosinophilic enteritis.

Intravitreal live Gnathostoma spinigerum.

Intraocular infestation by live Gnathostoma spinigerum is a rare occurrence in humans. Most of the published reports are from South-East Asia. We report a case of intravitreal gnathostomiasis, where the worm was removed live and intact by pars plana vitrectomy.

Spirocercosis-associated esophageal sarcomas in dogs. A retrospective study of 17 cases (1997-2003).

Seventeen client-owned dogs diagnosed with spirocercosis-associated esophageal sarcomas were retrospectively reviewed. The most common clinical signs noticed were vomiting and/or regurgitation (94%), lethargy and depression (59%), pyrexia and anorexia (41% each). Leukocytosis (82%) and microcytic hypochromic anemia (30%) were the most common hematological abnormalities. Caudal thoracic masses were demonstrated on survey radiographs of 13/15 of the dogs and thoracic spondylitis was detected in 12/15 dogs. Spirocerca lupi eggs were detected in 2/8 patients and worms were demonstrated on 1/11 at necropsy. Ten cases underwent surgical attempt to remove the tumors. In six of them partial esophagectomy (PE) was performed and all of them survived the immediate postoperative hospitalization. Five of the cases that underwent PE also received chemotherapy after surgery (doxorubicin (Adriamycin, Upjohn)) with an average survival time of 267 days. The histopathological results of the esophageal tumors were osteosarcoma (9), fibrosarcoma (5) and undifferentiated sarcoma (1). In areas endemic to spirocercosis, regurgitation or vomiting in dogs and microcytic hypochromic anemia and neutrophilia warrant ruling out esophageal sarcomas. Proper surgical treatment could prolong the dogs' lifespan for months, and improve their quality of life.