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2.1
Loiasis
Filariasis

Images

WIKIDATA, Public Domain
WIKIDATA, Public Domain

Presentation

Loa loa worms usually appear subconjunctivally or (as in Case 1) in the periorbital subcutis, but may rarely present in the anterior chamber.2, 6 The presentation of ocular Loa loa is characteristic, with patients complaining of something moving in or [nature.com]

Such patients present with a grossly visible intraocular filarial worm on physical exam, usually with pain and photophobia. Associated vision loss at presentation has ranged from 6/24 to light perception. [eyewiki.aao.org]

Microfilaremia was present in 90% and Calabar swellings in only 16% of the endemic patients. Conversely, only 10% of the expatriates were microfilaremic while 95% complained of Calabar swellings. [ncbi.nlm.nih.gov]

Our patients presented early clinical manifestations and few atypical features. Thus, physicians should systematically consider loiasis in migrants with a typical presentation. [idpjournal.biomedcentral.com]

Entire Body System

  • Fatigue

    Generalized itching, hives, muscle pains, arthralgias, fatigue, and adult worms visibly migrating under the surface of the skin may be observed. [ebi.ac.uk]

    Loiasis can be accompanied by transient swellings on the skin known as Calabar swellings, severe itching, joint pain, and fatigue. [ddtd.org]

  • Fever

    Treatment with microfilariacides may cause massive death of microfilariae and provoke fever, meningoencephalitis, nephritis, coma and death. [histopathology-india.net]

    Symptoms described were fever, pruritus, headache, arthralgia. Most symptoms appeared 24 to 36 hours after treatment. Temperature increased significantly in group 3. [ncbi.nlm.nih.gov]

    There may also be fever, muscle or joint pain, weight loss and lymphadenitis. Rash sometimes lasts for several months after treatment. [patient.info]

    […] and elephantiasis of the legs, arms, scrotum, vulva, and breasts The following acute syndromes have been described in lymphatic filariasis: Acute adenolymphangitis (ADL) - Sudden fever with lymphadenopathy Filarial fever - Fever without associated adenitis [emedicine.com]

    R R Hospital, Tirupati with history of pain and foreign body sensation in the left eye, fever, urticarial rash, painless swellings on the ankles, feet and fingers, painless creeping sensation of a worm from the left shoulder, of 1 week duration He had [ijo.in]

Musculoskeletal

  • Arthralgia

    Generalized itching, hives, muscle pains, arthralgias, fatigue, and adult worms visibly migrating under the surface of the skin may be observed. [ebi.ac.uk]

    Pruritus or pricking sensations from adult worm migration, arthralgia, fatigue, and myalgias are common. Eye involvement can cause burning and irritation of the eye. [visualdx.com]

Skin

  • Pruritus

    Onset of pruritus, in the absence of other signs. Subcutaneous migration of an adult worm: pruritic, palpable red cord-like linear lesion, sinuous, advancing (1 cm/hour), disappearing rapidly with no trace a. [medicalguidelines.msf.org]

    A survey from Eastern Cameroon (n = 4146) did not determine the frequency of non-specific pruritus, but showed that among individuals with Calabar swelling pruritus occurred up to 94% [ 29 ]. [ncbi.nlm.nih.gov]

    The infection is chronic and is either asymptomatic or with skin manifestations (transient pruritus, oedema). Loa loa is transmitted by African tabanid flies which live in the rain forest. [parasite-diagnosis.ch]

    Loiasis may either be asymptomatic or manifest as a large, transient area of localized, non-erythematous subcutaneous edema (Calabar swellings), adult worm migration through the sub-conjunctiva (''African eye worm'') and pruritus. [ebi.ac.uk]

  • Urticaria

    Systemic reactions include fever, pain, itching, urticaria, and eosinophilia. Dead worms in or near major nerves may cause paresthesias and focal paralyses. [histopathology-india.net]

    Codes ICD10CM: B74.3 – Loiasis SNOMEDCT: 44250009 – Loiasis Look For Subscription Required Diagnostic Pearls Subscription Required Differential Diagnosis & Pitfalls In regions where onchocerciasis and loiasis are endemic, visitors can present with urticaria [visualdx.com]

    The swellings may last for 1-3 days, and may be accompanied by localized urticaria (skin eruptions) and pruritis (itching). [the-medical-dictionary.com]

    Clinical manifestations of loiasis are different between expatriates and natives: asymptomatic infestation and eye involvement are more common in natives, while Calabar swelling, itching and urticaria are mainly seen in expatriates. [omicsonline.org]

  • Subcutaneous Nodule

    Movable, nontender subcutaneous nodule of Onchocerca volvulus. [emedicine.com]

    In one patient, nonspecific symptoms recurred 2 years later, but unlike her symptoms before albendazole therapy, they were not accompanied by the appearance of subcutaneous nodules containing adult worms. [ncbi.nlm.nih.gov]

    Some nodules may contain many male and female worms. In the subcutaneous nodules, the female worms produce microfilariae, which have a lifespan that may reach two years. [patient.info]

  • Larva Migrans

    Cutaneous larva migrans does not cause eye findings, and the lesions are more superficial and distinct (serpiginous). In Guinea worm infections, the large worm is easily palpable and often partially protruding from the skin. [visualdx.com]

    FREE Publisher Full TextPMC Free Full TextPMC Free PDF StatPearls: Cutaneous Larva Migrans [BOOK] StatPearls. [unboundmedicine.com]

    Migrating infective larvae of hookworms and Strongyloides stercoralis are the cause of cutaneous larva migrans and larva currens, respectively. [scielo.br]

    Amebiasis Amebic liver abscess Ascariasis Creeping eruption Rectal culture Stool ova and parasites exam Taeniasis Visceral larva migrans [ Read More ] [icdlist.com]

  • Cutaneous Manifestation

    Cutaneous larva migrans is distinguished from the cutaneous manifestation of Strongyloides ste… Distinct loiasis infection states and associated clinical and hematological manifestations in patients from Gabon. [unboundmedicine.com]

    Eyeworm is a pathognomonic finding in the disease course and occurs when the adult worm is visualized migrating beneath the bulbar conjunctiva.[2][3][5][6][7]Cutaneous manifestations including Calabar swellings are also pathognomonic and are likely due [eyewiki.aao.org]

Eyes

  • Foreign Body Sensation

    She presented to the emergency department with complaints of foreign body sensation, irritation, and described the feeling of something moving in the left eye. [eyetube.net]

Workup

[…] affecting humans and animals, caused by filariae; ie, nematode parasites of the family Filariidae. [1] Filarial parasites can be classified according to the habitat of the adult worms in the vertebral host, as follows (see Pathophysiology, Etiology, and Workup [emedicine.com]

Other Pathologies

  • Tissue Nematode

    Filariasis, Loa loa (Pathogen – Tissue Nematode) Organism: Loa loa, the African eye worm, was first noted in the eye of a Negro girl in the West Indies in 1770. [med-chem.com]

    nematode) parasites transmitted by Chrysops flies (commonly known as the mango fly or mangrove fly). [emedicine.medscape.com]

Treatment

If microfilaraemia or symptoms persist, a second treatment is given 4 weeks later. [medicalguidelines.msf.org]

Treatment options. Information about treatment was available for 48 cases. Of them, 46 started treatment of loiasis at HTD. [ncbi.nlm.nih.gov]

[citation needed] Treatment[edit] Treatment of loiasis involves chemotherapy or, in some cases, surgical removal of adult worms followed by systemic treatment. [en.wikipedia.org]

Prognosis

Treatment Antiparasitic treatment Diethylcarbamazine (DEC) is the only macrofilaricide available but is contra-indicated in: Patients with microfilaraemia > 2000 mf/ml (risk of severe encephalopathy, with poor prognosis). [medicalguidelines.msf.org]

Outlook / Prognosis What can I expect if I have loiasis? Many people who have loiasis don’t know they have it, and may not have serious health problems from it. If you have symptoms or suspect you have loiasis, talk to your provider. [my.clevelandclinic.org]

Prognosis The prognosis in filariasis is good if infection is recognized and treated early. Filarial diseases are rarely fatal, but the consequences of infection can cause significant personal and socioeconomic hardship for those who are affected. [emedicine.com]

Etiology

(See Pathophysiology and Etiology.) [13] As with most helminths, adult filarial parasites replicate in a definitive host. The adult worm burden in an individual cannot increase unless the host is exposed to additional microfilaria. [emedicine.com]

Congo, Equatorial Guinea, Ethiopia, Gabon, Nigeria, and Sudan.[9] GeoSentinel Surveillance Network data indicate that travelers to endemic regions are more likely to contract Loa loa infection if their duration of exposure is greater than one month.[10] Etiology [eyewiki.aao.org]

Parasite Vector 6:283 CrossRef Google Scholar Languillat G, Garin Y, Tursz A, Beauvais B, Lariviere M (1977) Etiological study of low fertility in eastern Gaboon. III. Filarial endemicity (Loa loa, D. perstans). [link.springer.com]

Epidemiology

METHODS: Rapid assessment surveys were conducted between 2004 and 2005 using both rapid epidemiological mapping of onchocerciasis (REMO) and rapid assessment procedure for loiasis (RAPLOA). [ncbi.nlm.nih.gov]

[…] increased risk of mortality has begun to challenge this conception, but overall, little contemporary attention has been paid to the infection- significant knowledge gaps exist in our understanding of both the parasite’s basic biology and the disease’s epidemiological [londonntd.org]

It is intended for epidemiology purposes and as a population surveillance tool. It is not used to establish a definitive diagnosis or as a basis to recommend a treatment to an individual person. [ddtd.org]

Methods: Rapid assessment surveys were conducted between 2004 and 2005 using both rapid epidemiological mapping of onchocerciasis (REMO) and rapid assessment procedure for loiasis (RAPLOA). [ntdenvision.org]

Pathophysiology

The pathophysiological mechanisms are discussed in the light of these observations and the few other comments on this subject published in the literature. [ncbi.nlm.nih.gov]

Pathophysiology The filarial life cycle, like that of all nematodes, consists of 5 developmental (larval) stages in a vertebral host and an arthropod intermediate host and vector. [emedicine.com]

An understanding of the pathophysiology of these post-treatment reactions is necessary in order to develop strategies to prevent these reactions in the future. [clinicaltrials.gov]

The consequences for the affected individuals or populations as well as the pathophysiological consequences of correlating eosinophilia are largely unknown. [unboundmedicine.com]

Prevention

Prevention How can I reduce my risk of getting loiasis? There aren't any vaccines that prevent loiasis. [my.clevelandclinic.org]

We conclude that diethylcarbamazine given orally once weekly can be an effective, acceptable chemoprophylactic agent to prevent loiasis in temporary residents of regions of Africa where Loa loa is endemic. [ncbi.nlm.nih.gov]

Diethylcarbamazine (DEC) 300 mg orally once a week can be used to prevent loiasis in long-term travelers to endemic regions. [msdmanuals.com]

Manifestation of loiasis The risk of SAE’s related to MDA in persons with loiasis has prevented implementation of MDA programs for LF and Oncho in many areas in sub-Saharan Africa. [dolfproject.wustl.edu]

For a description of CDC’s information for preventing insect bites, see CDC’s Yellow Book. [globalinfoonline.com]

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