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Nitte University Journal of Health Science HUMAN DIROFILARIASIS: AN UNCOMMON CASE OF SUB
Sanjeev H , Rajini M , Prasad S.R
Assistant Professor, Department of Microbiology, K.S. Hegde Medical Academy 2Associate Professor, Department of Microbiology, Sri Devaraj Urs Medical College, Tamaka, Kolar
3Professor & HOD, Department of Microbiology, Sri Devaraj Urs Medical College, Tamaka, Kolar
Sanjeev H,
Assistant professor, Department of microbiology, K.S. Hegde Medical Academy, Deralakatte, Mangalore - 575018. Mobile No. : 99722 12280 E-mail : [email protected] Abstract:
Dirofilaria are a group of arthropod borne filarial nematodes that cause infection in wide range of domestic and wild animals. Dirofilaria repens is a common zoonotic infection in countries like Sri Lanka. Human infection with Dirofilaria repens is not widely recognized in India. Most of the documented cases of human dirofilariasis recorded in India presented with ocular infections, affecting the eyelid, periorbital region and occasionally the sub conjunctivae. Here we report a rare case of sub cutaneous dirofilariasis, which presented as a swelling at an uncommon Keywords : Dirofilariasis, Dirofilaria repens, Dirofilaria tenuis
D. repens is a common zoonotic infection in countries like Dirofilaria are a group of mosquito borne filarial Sri Lanka. Human infection with D. repens is not widely nematodes that cause infection in wide range of recognized in India. However, there is probably a focus of domestic and wild animals. The widely recognized human infection with D. repens in Kerala, from where parasites among them are Dirofilaria immitis (D.immitis), the agent of cardiovascular Dirofilariasis, and Dirofilaria Case report
repens causing sub cutaneous infection. D. repens is a An 18 year old female patient, hailing from Allepey mosquito borne filarial parasite of the sub cutaneous district of Kerala, presented with swelling on the right tissue of domestic and carnivores such as dogs, cats and side of the neck of six months duration. The swelling foxes. Dirofilaria species may be divided into two groups: increased in size in the past one week and was associated subgenus Dirofilaria represented by Dirofilaria immitis, which is characterized by smooth cuticle and normally found in the right heart and pulmonary vessels of dogs, On examination a 4cm x 3cm swelling was noted in the the natural host ; and subgenus Nochtiella, which right supraclavicular region (Figure1). The surface of the parasitize the sub cutaneous tissue. Species of this group swelling was smooth and the borders ill defined. It was have longitudinal ridges on the cuticle. Representative not fixed to the underlying muscle or deeper tissue. The species are Dirofilaria (Nochtiella) repens, found in dogs swelling was tender on palpation and redness was noted and cats, and Dirofilaria tenuis, found in raccoons .The over the swelling. No similar swelling was noted mature D. repens live in the tissues and organs of e l s e w h e r e . C l i n i c a l d i a g n o s i s o f c e r v i c a l vertebrates, while the immature stages or the lymphadenopathy was made. Needle aspiration cytology microfilaria prefer the blood and the lymph vessels .
was advised. On FNAC a thin thread like white worm was HUMAN DIROFILARIASIS
Nitte University Journal of Health Science infections are being reported. Though man is not a suitable host, there are reports of the infective larvae The worm was thin, thread like, cylindrical measuring developing into adult worm and in exceptional cases 9cms long and 497um wide with rounded anterior end even producing blood circulating microfilaria .
and tapering posterior end. On glycerin wet mount the worm revealed thick cuticle with longitudinal ridges. Identification of D.repens is made by studying the Muscles were separated into dorsal and ventral bands. morphology of the worm. An adult male worm is 5-7cm The thick cuticle had prominent longitudinal ridges with long and 370-450µm wide with 2-6 pre anal papillae on fine transverse striations (Figure 2). The body cavity the right side and 4-5 on the left. The spicules are showed elongated esophagus and uterus with small unequal. The left spicule is 460-590µm and right ones are round structures within the uterus, which were the 180-210µm. The female are 10-17cm long and 460- immature eggs. The worm was unfertilized or immature. 650µm wide with a vulva 1.15-1.62 cm from the anterior The posterior end was tapering and unremarkable. end. The microfilaria is unsheathed and occurs in the sub Based on size, cuticular and internal morphology, the cutaneous lymph spaces and in the blood of natural worm was identified as D. repens. The identity of the worm was confirmed as immature female D. repens at The other species of Dirofilaria reported from India are the Veterinary Sciences College, Hebbal, Bangalore.
D.immitis and D.tenuis . However, D.immitis can be Routine hematological and biochemical test results were differentiated from D.repens by the absence of normal and no microfilaria was seen in peripheral longitudinal ridges and transverse striations . Many parasitologists believe that D. tenuis is restricted to USA and consider that D. tenuis is synonymous with Discussion
D.repens . In the natural hosts, like dogs, studies have Dirofilariasis is often reported from European countries reported parasitemia varying from 12-37% .
surrounding the Mediterranean particularly from Italy. The first D.repens case is said to have been reported by Simple extraction of the worm or surgical excision of the Angelo Pace in Palermo in 1867 . In India, sub cutaneous lesion is the treatment of choice for human dirofilariasis. dirofilariasis is rare, only few cases having been reported There is seldom a need for chemotherapy as from Kerala and most of the documented cases of Microfilaraemia is extremely rare. In a small number of human dirofilariasis recorded in India presented with cases, ivermectin and/or diethylcarbamazine has been ocular infections, affecting the eyelid, periorbital region tried with good results. The symbiosis of filarial and occasionally the sub conjunctivae. .
nematodes and intracellular bacteria, Wolbachia, has been recently exploited as a target for antibiotic therapy Dirofilaria repens infection, rarely seen in humans, is a of filariasis. Antibiotic treatment of filarial nematode zoonotic illness. Humans get infected through blood results in sterility and inhibits larval development. In the sucking arthropods such as mosquitoes, fleas and ticks. first trial on human onchocerciasis, depletion of bacteria For D. repens, the human body is not an appropriate following treatment with doxycycline resulted in a host, and therefore, no mature stages of the parasite are complete and long term block of embryogenesis .
found in man . With changing host, agent and environmental factors, an increasing number of human HUMAN DIROFILARIASIS
Nitte University Journal of Health Science Conclusion
molecular techniques like multilocus analysis of gene Human cases of dirofilariasis are most probably under enzyme system and PCR. However these tests are not reported because many of them remain undiagnosed or available for routine diagnostic purpose. Diagnostic unpublished. The current case was diagnosed as constraints and lack of awareness often result in under subcutaneous Dirofilariasis based on parasitological reporting of cases. Awareness and high degree of observation. Definitive diagnosis can be made by suspicion is the key to diagnosing human Dirofilariasis.
Figure 1- Clinical presentation of swelling Figure 2- Immature female worm of Dirofilaria repens in wet
mount showing (1) Thick cuticle (2) Intestine (3) Posterior end
(4) Thick muscular coat with longitudinal ridges and transverse
5. Padmaja P, Kanagalakshmi, Samuel R, Kuruvilla PJ and Mathai 1. Soner K, Kadri O and Nizami D. Subconjuctival infection with Dirofilaria E.Subcutaneous Dirofilariasis in Southern India: A case report. Annals of repens. Annals of Saudi medicine 2002: 22:75-76.
tropical medicine & Parasitology 2005; 99(4):437-440. 2. Pamplione S, Canestri TG, Rivasi F. Human Dirofilariasis due to Dirofilaria 6. Badhe BP, Sane SY. Human pulmonary dirofilariasis in India: A case (Nochtiella) repens: a review of world literature. Parasitologia 1995; report. J Trop Med Hyg 1989; 92:425-6.
7. Bhat KG, Wilson G, Mallya S. Human dirofilariasis. Indian J Med Microbiol 3. Singh R, Shwetha JV, Samantaray JC, Bando G. Dirofilariasis: A rare case report. Indian J Med Microbiol 2010;28:75-77 8. Khurana S, Singh G, Bhatti HS, Malla N. Human subcutaneous 4. Sathyam P, Manikandan P, Bhaskar M, Padma S, Singh G, Appalaraju B. dirofilariasis in India: A report of three cases with brief review of Subtenons infection by Dirofilaria repens. Indian J Med Microbiol literature. Indian J Med Microbiol 2010;28:394-396.


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