Presentation
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]
Video Ocular Loiasis (00:24) A 21-year-old woman presented to our hospital with the sensation of something moving in her eye. She reported having no systemic or visual symptoms. [nejm.org]
He personally asked one of us (CABO) to report the present case in the medical literature. [scielo.br]
Table 2 Entomologic indices in the present investigation (2012) Full size table Comparison of the entomologic indicators recorded in 1999–2000 and in 2012 Results of comparisons are presented in Table 3. [parasitesandvectors.biomedcentral.com]
Immune System
- Axillary Lymphadenopathy
The patient also declared that lymphoedema and axillary lymphadenopathy appeared in May 2013. [karger.com]
Signs and symptoms Lymphatic filariasis Fever Inguinal or axillary lymphadenopathy Testicular and/or inguinal pain Skin exfoliation Limb or genital swelling - Repeated episodes of inflammation and lymphedema lead to lymphatic damage, chronic swelling, [emedicine.com]
Entire Body System
- Asymptomatic
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. [rarediseases.oscar.ncsu.edu]
Symptoms and Signs Most infected people are asymptomatic, but eosinophilia is common. [merckmanuals.com]
Loiasis is often asymptomatic. Episodic angioedema (Calabar swellings) and subconjunctival migration of an adult worm can occur. [cdc.gov]
Abstract Asymptomatic infection with Loa loa, an eye worm, is reported in a 32-year old Zambian woman. The patient revealed up to 28% eosinophilia but microfileraemia was not noticed. [ncbi.nlm.nih.gov]
- Fatigue
Generalized itching, hives, muscle pains, arthralgias, fatigue, and adult worms visibly migrating under the surface of the skin may be observed. [rarediseases.oscar.ncsu.edu]
Less common are symptoms of itching over the entire body, muscular and joint pain as well as fatigue. [cntd.lstmed.ac.uk]
- 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]
[…] efficacy against both adult worms and microfilariae and provides effective prophylaxis for individuals visiting endemic regions.[39] DEC is contraindicated in patients coinfected with onchocerciasis due to risk of Mazzotti reaction, which consists of fever [eyewiki.aao.org]
Species that occur in the Mediterranean region can transmit sandfly fever, a viral disease also known as Pappataci fever or three-day fever. Life cycle Sandflies are found in various habitats, ranging from semi-desert to rainforest. [who.int]
There may also be fever, muscle or joint pain, weight loss and lymphadenitis. Rash sometimes lasts for several months after treatment. [patient.info]
- Lymphedema
Complications Leg lymphedema, arm lymphedema, encephalitis ( inflammation of the brain tissue s); Cerebral edema (fatal cases). Urticaria, pruritus, and chorioretinitis may also occur. [lymphedemapeople.com]
Some patients develop lymphatic dysfunction causing lymphedema. Episodic angioedema (Calabar swellings) in the arms and legs, caused by immune reactions are common. [the-medical-dictionary.com]
Tropical lymphedemas--control and prevention. N Engl J Med. 2012 Mar 29. 366(13):1169-71. [Medline]. Meyrowitsch DW, Simonsen PE, Garred P, Dalgaard M, Magesa SM, Alifrangis M. [emedicine.com]
Lymphatic filariasis: Wuchereria bancrofti is the causative organism of lymphatic filariasis, a neglected tropical disease that is transmitted by the Aedes aegypti mosquito and which results in obstruction of lymph channels, leading to lymphedema and [eyewiki.aao.org]
- Fishing
When an infected copepod is eaten by a fish, the procercoid develops into the third larval stage, the plerocercoid, and when a human eats an infected fish, the plerocercoid develops into an adult tapeworm in the gut. [doi.org]
[…] differences in occupational exposure, since outdoor labour has been identified as a risk factor for loiasis ( Akue et al., 1996 ; Garcia et al., 1999 ; Wanji et al., 2002, 2003a ) and men spend more time than women outside of the house hunting, farming and fishing [academic.oup.com]
Subsistence farming, hunting and fishing in the forest are major sources of nutrition for people without formal employment. [ncbi.nlm.nih.gov]
Respiratoric
- Pneumonia
Systemic manifestations are uncommon; they are asthenia [14, 21], fever [14, 21], headache, meningoencephalitis (with psychiatric symptoms, such as depression and insomnia) [9], peripheral neuropathy [1, 9], pneumonia, myocardial fibrosis [9], glomerulonephritis [karger.com]
Musculoskeletal
- Arthralgia
Generalized itching, hives, muscle pains, arthralgias, fatigue, and adult worms visibly migrating under the surface of the skin may be observed. [rarediseases.oscar.ncsu.edu]
[…] and microfilariae and provides effective prophylaxis for individuals visiting endemic regions.[39] DEC is contraindicated in patients coinfected with onchocerciasis due to risk of Mazzotti reaction, which consists of fever, tachycardia, hypotension, arthralgia [eyewiki.aao.org]
Skin
- Pruritus
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. [rarediseases.oscar.ncsu.edu]
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]
- Urticaria
The swellings may last for 1-3 days, and may be accompanied by localized urticaria (skin eruptions) and pruritis (itching). [the-medical-dictionary.com]
The swellings develop rapidly over a few hours and may be preceded by localized pain, pruritus, and urticaria; the swellings usually last 1 to 3 days. [med-chem.com]
ADJUNCTIVE THERAPY Diethylcarbamazine (DEC) therapy of loiasis is often associated with a transient exacerbation of symptoms, including urticaria and Calabar swellings. [antimicrobe.org]
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]
- Skin Disease
[…] parasitic skin disease 1 reference stated in Monarch Disease Ontology release 2018-06-29sonu retrieved 28 July 2018 MonDO ID MONDO:0016566 rare skin disease 1 reference stated in Monarch Disease Ontology release 2018-06-29sonu retrieved 28 July 2018 [wikidata.org]
disease in patients with onchocerciasis Clinicians should seek expert assistance when measuring the number of microfilariae and thus determining the severity of the infection. [merckmanuals.com]
Onchocerciasis: the clinical and epidemiological burden of skin disease in Africa. Ann Trop Med Parasitol 2002; 96 : 283–296. [ PubMed ] 20. Gutierrez Y. Diagnostic Pathology of Parasitic Infections with Clinical Correlations. [ncbi.nlm.nih.gov]
- Skin Lesion
Infectious causes of migratory skin lesions and eosinophilia are primarily parasitic (e.g., strongyloidiasis, gnathostomiasis, paragonimiasis and toxocariasis).5 Autoimmune and noninfectious conditions that show similar migratory edematous skin changes [cmaj.ca]
Figure 1: Pruriginous skin lesions due to Loa-loa filariasis. [omicsonline.org]
In Latin America, a variety of more acute skin lesions occurs, while chronic skin lesions are less common. [emedicine.com]
One week prior to the visit to our clinic, the skin lesion reappeared for the third time on her left cheek, and it was then that she presented to our hospital. She also complained of discomfort in her eyes that had begun that morning. [ncbi.nlm.nih.gov]
- 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]
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]
While waiting for treatment with medications available only through the Special Access Programme of Health Canada, the patient presented to the emergency department with the sensation of a foreign body in her left eye (Figure 1), and was found to have [cmaj.ca]
However, discomfort and foreign body sensation are commonly reported symptoms.[2][6][12][13][14] In rare cases, L. loa has been noted to enter the anterior chamber, and live L. loa worms have been reported in the vitreous. [eyewiki.aao.org]
- Eye Pain
Migration causes severe eye pain, inflammation and sometimes blindness and may take a few minutes or up to several hours ( Boussinesq, 2006 ). [academic.oup.com]
Other forms of eye discomfort like red eye, pain in the eye and blurry visions were also noted. [journals.plos.org]
- Visual Impairment
The infection can cause irreversible visual impairment or blindness and stigmatizing dermatitis. More than 32 million people were estimated to be infected with O. volvulus in Africa, and 385,000 suffered from blindness. [unboundmedicine.com]
Prevention of blindness and visual impairment: priority eye diseases. Available at http://www.who.int/blindness/causes/priority/en/index3.htm. Zarroug IM, Hashim K, ElMubark WA, Shumo ZA, Salih KA, ElNojomi NA, et al. [emedicine.com]
Psychiatrical
- Psychiatric Symptoms
Systemic manifestations are uncommon; they are asthenia [14, 21], fever [14, 21], headache, meningoencephalitis (with psychiatric symptoms, such as depression and insomnia) [9], peripheral neuropathy [1, 9], pneumonia, myocardial fibrosis [9], glomerulonephritis [karger.com]
Neurologic
- Asthenia
One patient presented severe troubles with fever, asthenia and conscience troubles beginning at D3, reactive coma at D4, renal impairment with transitory anuria; progressive improvement in 2 weeks and complete recovery at D22; he presented 102 mf/ml CSF [ncbi.nlm.nih.gov]
Systemic manifestations are uncommon; they are asthenia [14, 21], fever [14, 21], headache, meningoencephalitis (with psychiatric symptoms, such as depression and insomnia) [9], peripheral neuropathy [1, 9], pneumonia, myocardial fibrosis [9], glomerulonephritis [karger.com]
- Insomnia
Systemic manifestations are uncommon; they are asthenia [14, 21], fever [14, 21], headache, meningoencephalitis (with psychiatric symptoms, such as depression and insomnia) [9], peripheral neuropathy [1, 9], pneumonia, myocardial fibrosis [9], glomerulonephritis [karger.com]
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]
Microbiology
- Wuchereria Bancrofti
The filarial parasite Loa loa overlaps geographically with Onchocera volvulus and Wuchereria bancrofti filariae in central Africa. [ncbi.nlm.nih.gov]
Korean Journal of Parasitology Detection and discrimination of Loa loa, Mansonella perstans and Wuchereria bancrofti by PCR-RFLP and nested-PCR of ribosomal DNA ITS1 region. [lymphedemapeople.com]
bancrofti, Mansonella perstans and Plasmodium falciparum using mosquito carcasses and faeces: A pilot study in Cameroon. 62 Pryce J...Reimer L 36322515 2022 11 A large case series of travel-related Mansonella perstans (vector-borne filarial nematode) [malacards.org]
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
Treatment Diethylcarbamazine For heavy infections, initial treatment with albendazole and/or apheresis Treatment of loiasis is complicated. Diethylcarbamazine (DEC) is the only drug that kills microfilariae and adult worms. [merckmanuals.com]
Albendazole may also be used as adjunct therapy in cases refractory to multiple treatments with DEC. [eyewiki.aao.org]
[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]
Treatment Treatment includes surgery to remove to worm from the eye or skin. [lymphedemapeople.com]
If microfilaraemia or symptoms persist, a second treatment is given 4 weeks later. [medicalguidelines.msf.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]
Vitreous Chamber One case report of L. loa in the vitreous was effectively treated with vitrectomy with steroid cover.[37] Prognosis Visual acuity is generally not affected by the presence of adult worms in the subconjunctiva, and lasting tissue damage [eyewiki.aao.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
ETIOLOGY: Loiasis is distributed throughout West and Central Africa. It is transmitted by the mango fly, Chrysops dimidia or Chrysops silacea. The fly bites only in the daytime and humans are the only important reservoir for this filariae worm. [acadderm.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]
(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]
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]
Rapid Epidemiological Mapping of Onchocerciasis (REMO) was conducted in the state in 1996 and annual mass ivermectin distribution started in 2000 and it is still ongoing. [journals.plos.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]
The consequences for the affected individuals or populations as well as the pathophysiological consequences of correlating eosinophilia are largely unknown. [unboundmedicine.com]
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]
Prevention
Identifying co-endemic areas for major filarial infections in sub-Saharan Africa: seeking synergies and preventing severe adverse events during mass drug administration campaigns. [eyewiki.aao.org]
Prevention DEC 300 mg po once/wk can be used to prevent loiasis. Using insect repellents (including permethrin -impregnated clothing) and wearing long-sleeved and long-legged clothing may reduce the number of bites by infected flies. [merckmanuals.com]
For a description of CDC’s information for preventing insect bites, see CDC’s Yellow Book. [globalinfoonline.com]
Prevention While there are no vaccine s available to prevent people from being infected. Diethylcarbamazine (DEC) 300mg taken once a week is effective at preventing loiasis in long-term travelers to affected areas. [lymphedemapeople.com]