Angiostrongylus-a technique for removing a rare parasite from the cornea of a child.

We report a case of an Angiostrongylus parasite in the corneal stroma in an 8-year-old boy and our technique for its removal. The parasite was identified on slit-lamp examination. Its location was confirmed on anterior segment optical coherence topography (AS-OCT). The parasite was found on the superficial corneal stroma in the periphery and was removed after lamellar dissection of the cornea following marking with trephine.

Angiostrongylus cantonensis in anterior chamber.

Live worm in anterior chamber is a rare finding. We hereby report a case of ocular Angiostrongylus cantonensis, which, to the best of our knowledge, is the third case report from India. A 70-year-old female presented with the complaints of watering and foreign body sensations in right eye since 2 months. On examination, a translucent worm of approximately 15 mm length was found freely moving in anterior chamber. Patient underwent surgical removal of live worm, which was identified as A. cantonensis. Educating people regarding importance of hygiene is important for prevention of worm infestation.

Intravitreal Angiostrongylus cantonensis: first case report in South America.

This study reports the first case of intravitreal angiostrongyliasis in South America treated with posterior worm removal via pars plana vitrectomy. This was a retrospective, observational case study. Data from medical charts, wide-field digital imaging, ocular ultrasound, and visual evoked potential studies were reviewed. A 20-month-old boy presented with eosinophilic meningitis and right eye exotropia. Polymerase chain reaction analysis of the cerebrospinal fluid showed a positive result for Angiostrongylus cantonensis. Fundus examination revealed a pale optic disc, subretinal tracks, vitreous opacities, peripheral tractional retinal detachment, and a dead worm in the vitreous cavity. The patient underwent pars plana vitrectomy with worm removal. This case report illustrates the first case of intravitreal angiostrongyliasis in South America, possibly related to the uncontrolled spread of an exotic invasive species of snail.

Intravitreal Angiostrongylus cantonensis: first case report in South America / Angiostrongylus cantonensis intravítreo: primeiro relato de caso na América do Sul

ABSTRACT This study reports the first case of intravitreal angiostrongyliasis in South America treated with posterior worm removal via pars plana vitrectomy. This was a retrospective, observational case study. Data from medical charts, wide-field digital imaging, ocular ultrasound, and visual evoked potential studies were reviewed. A 20-month-old boy presented with eosinophilic meningitis and right eye exotropia. Polymerase chain reaction analysis of the cerebrospinal fluid showed a positive result for Angiostrongylus cantonensis. Fundus examination revealed a pale optic disc, subretinal tracks, vitreous opacities, peripheral tractional retinal detachment, and a dead worm in the vitreous cavity. The patient underwent pars plana vitrectomy with worm removal. This case report illustrates the first case of intravitreal angiostrongyliasis in South America, possibly related to the uncontrolled spread of an exotic invasive species of snail.

RESUMO O objetivo deste estudo foi relatar o primeiro caso na América do Sul de angiostrongilíase intravítrea tratada com vitrectomia posterior via pars plana e remoção do verme. Este foi um relato de caso observacional. O prontuário médico, sistema de imagem digital de campo amplo, ultrassonografia ocular, e potenciais evocados visuais foram revistos. Um menino de 1 ano e 8 meses de idade manifestou meningite eosinofílica e exotropia olho direito. A análise de PCR do liquor foi positiva para Angiostrongylus cantonensis. O exame de fundo de olho revelou disco óptico pálido, faixas sub-retinianas, opacidades vítreas, descolamento de retina tracional periférico e um verme morto no vítreo. O paciente foi submetido a vitrectomia posterior via pars plana com a remoção do verme. Concluindo, este é o primeiro relato de caso de angiostrongilíase intravítrea na América do Sul, possivelmente relacionado com a disseminação de uma espécie de lesma exótica neste continente.

Human ocular angiostrongyliasis: a literature review.

Human ocular angiostrongyliasis caused by Angiostrongylus cantonensis infection in the eye is a very rare condition. Until now, there has been no comprehensive analysis of this disease. We searched and analysed the references found on the Internet that refer to human ocular angiostrongyliasis and reviewed the aetiology, clinical manifestations, diagnosis, epidemiology and treatment of the condition. Twenty-six references were found reporting 35 patients from 10 countries that were diagnosed with human ocular angiostrongyliasis. People are usually infected by eating raw or undercooked intermediate hosts of the parasite such as snails or contaminated vegetables. The most common symptom was visual loss. Although several treatments have been used, ocular angiostrongyliasis can still result in permanent visual impairment and may even cause blindness. As the eye is the site of infection and direct visualization is possible, ocular examination is crucial for diagnosis. The therapeutic success depended on early and complete surgical removal.

Surgical extraction of an intraocular infection of Parelaphostrongylus tenuis in a horse.

CASE DESCRIPTION: A 4-year-old Hanoverian gelding was evaluated because of a mobile worm-like structure in the right eye. CLINICAL FINDINGS: Ophthalmologic examination of the right eye revealed a white, thin, coiled, mobile parasite, which was presumed to be a nematode, located in the ventral portion of the anterior chamber of the eye; there also were vitreal strands located temporally and inferiorly near the margin of the pupil. Results of ophthalmologic examination of the left eye were unremarkable. TREATMENT AND OUTCOME: The horse was treated with a neomycin-polymyxin B-dexamethasone ophthalmic solution applied topically (1 drop, q 8 h) to the right eye and penicillin V potassium (22,000 U/kg [10,000 U/lb], IV, q 6 h). The horse was anesthetized. A stab incision was made in the cornea, and a viscoelastic agent was infused around the parasite. The parasite was extracted via the incision by use of an iris hook and tying forceps. The horse had an uncomplicated recovery from the procedure and retained vision in the right eye. Gross and microscopic examination was used to identify the parasite as an adult metastrongyloid nematode consistent with a fully developed male Parelaphostrongylus tenuis. CLINICAL RELEVANCE: To the authors' knowledge, this is the first report of intraocular parelaphostrongylosis in a horse. This report provided evidence that vision could be retained after treatment for intraocular P tenuis infection in a horse.

Angiostrongylus costaricensis egg antigen for the immunodiagnosis of abdominal angiostrongyliasis.

Angiostrongylus costaricensis is the aetiological agent of human abdominal angiostrongyliasis, a parasitic disease reported from the United States to Argentina, with a widespread occurrence of the nematode throughout Central and South America. This study assesses the performance of A. costaricensis eggs as antigen in an enzyme-linked immunosorbent assay (ELISA), for the determination of parasite-specific IgG1 antibodies. The specificity and the sensitivity of the method were 87% and 90.5%, respectively. Through this test it was possible to demonstrate a sharp and early decline in IgG1 antibody in serum samples taken from patients with histopathological diagnosis of abdominal angiostrongyliasis at different time points after surgical treatment. The present work demonstrated the usefulness of the egg antigen in the development of a specific diagnostic test for abdominal angiostrongylosis.

Human infection by Angiostrongylus costaricensis in Venezuela: first report of a confirmed case.

A proven case of human infection caused by Angiostrongylus costaricensis is reported for the first time in Venezuela. The patient was a 57-year-old female surgically operated because of signs of peritonitis with a palpable mass at the lower right quadrant of the abdomen. WBC count reported 16,600 cells/mm3, with 46% eosinophils. The tumoral aspect of ileocolic area and peritoneal lymph nodes prompted the resection of a large area of the terminal ileum, cecum, part of the ascending colon and a small part of the jejunum, where a small lesion was found. The pathology showed thickened areas of the intestinal wall with areas of hemorrhage and a perforation of the cecum. Histology showed intense eosinophil infiltration of the whole intestinal wall, granulomas with giant cells and eosinophils. Some of the granuloma surrounded round or oval eggs with content characterized by a large empty area, cells or embryo in the center, and sometimes nematode larvae. A cross section of an adult nematode worm was observed inside a branch of mesenteric artery. The intestinal affected area, the characteristics of the lesions, the presence of eggs in the submucosa with nematode larvae inside, and the observation of a nematode inside a mesenteric artery, makes sufficient criteria for the diagnosis of an infection by Angiostrongylus costaricensis.

Human infection by Angiostrongylus costaricensis in Venezuela: first report of a confirmed case

A proven case of human infection caused by Angiostrongylus costaricensis is reported for the first time in Venezuela. The patient was a 57-year-old female surgically operated because of signs of peritonitis with a palpable mass at the lower right quadrant of the abdomen. WBC count reported 16,600 cells/mm³, with 46 percent eosinophils. The tumoral aspect of ileocolic area and peritoneal lymph nodes prompted the resection of a large area of the terminal ileum, cecum, part of the ascending colon and a small part of the jejunum, where a small lesion was found. The pathology showed thickened areas of the intestinal wall with areas of hemorrhage and a perforation of the cecum. Histology showed intense eosinophil infiltration of the whole intestinal wall, granulomas with giant cells and eosinophils. Some of the granuloma surrounded round or oval eggs with content characterized by a large empty area, cells or embryo in the center, and sometimes nematode larvae. A cross section of an adult nematode worm was observed inside a branch of mesenteric artery. The intestinal affected area, the characteristics of the lesions, the presence of eggs in the submucosa with nematode larvae inside, and the observation of a nematode inside a mesenteric artery, makes sufficient criteria for the diagnosis of an infection by Angiostrongylus costaricensis.

Un caso comprobado de infección humana por Angiostrongylus costaricensis es reportado para la literatura por vez primera en Venezuela. El paciente fue una mujer de 57 años de edad intervenida quirúrgicamente debido a signos de peritonitis, con una masa palpable en la fosa ilíaca derecha del abdomen. El recuento de leucocitos reportó 16.600 células/mm³ con 46 por ciento eosinófilos. El aspecto tumoral del área íleocólica y las adenopatías peritoneales encontradas motivó la resección de un área grande del ileon terminal, ciego, parte del colon ascendente y una pequeña parte del yeyuno donde se encontró una pequeña lesión interpretada como metastásica. La patología mostró áreas engrosadas de la pared intestinal con zonas de hemorragia y perforación del ciego. El estudio histológico mostró una intensa infiltración eosinofílica de toda la pared intestinal, granulomas con células gigantes y eosinófilos. Algunos de los granulomas rodeaban huevos ovales o redondos con un contenido caracterizado por una gran área vacía, células o embriones en el centro, y en algunos casos una larva de nematodo. Un corte transversal de un verme nematodo adulto se observó dentro de una arteria mesentérica. El área intestinal afectada, las características de las lesiones, la presencia de huevos en la submucosa con larvas de nematodo dentro, y la observación de un nematodo dentro de una arteria mesentérica, aportan suficientes criterios para el diagnóstico de una infección por Angiostrongylus costaricensis.

Abdominal angiostrongyliasis: a case with severe evolution

É relatado um caso de abdome agudo causado por angiostrongilíase abdominal. Um paciente de 42 anos, previamente hígido, apresentou queixa de nove dias de dor abdominal, constipação, disúria, febre e uma massa palpável na fossa ilíaca direita. Uma laparotomia exploradora foi realizada. Após o tratamento cirúrgico o paciente apresentou graves complicações.

Ternidens deminutus infection: first pathological report of a human case in Asia.

This is a report of Ternidens deminutus infection in a 33 year old Thai female who was admitted to the hospital because of abdominal pain and a right lower quadrant mass. Exploratory laparotomy revealed an omental mass with attached terminal ileum. Resection of the mass together with the terminal ileum and the right sided colon was performed. Pathologically, the omental mass was an abscess with an immature male Ternidens deminutus identified. The parasite usually is found in the intestine of primates in Africa and Asia. Human infection occurs when food contaminated with infective filariform larvae is ingested. The larvae molt in the intestinal wall and become adults. They pass eggs in feces. Eggs in contaminated soil hatch and become rhabditiform larvae and then infective filariform larvae.

Abdominal angiostrongyliasis: a case with severe evolution.

A case of acute abdomen disease caused by abdominal angiostrongyliasis is reported. A 42-year-old otherwise healthy patient presented with a complaint of nine days of abdominal pain, constipation, disury, fever and right iliac fossa palpable mass. Exploratory laparotomy was performed. After surgical treatment the patient presented serious complications.

Intravitreal angiostrongyliasis: report of 2 cases.

Two male patients presented with unilateral blurred vision. A small motile worm was found in the vitreous cavity in both cases. In one case, another dead, disintegrated worm was noted in the inferior portion of the vitreous cavity. On each eye, vitreous surgery was performed and the worm was removed by an aspirator. Both worms were identified as Angiostrongylus cantonensis. Since both patients had no signs of meningitis, lumbar puncture was not done. Long-term follow-up confirmed the benefit and safety of the vitreous surgery. Fluorescein angiography revealed severe pigmentary alteration, probably from inflammation of the choroid and retina due to subretinal migration of the worm prior to access into the vitreous cavity.

[Ocular angiostrongylus cantonensis in a female Vietnamese patient: case report]. / Okuläre Angiostrongyliasis cantonensis bei einer vietnamesischen Patientin: ein Fallbericht.

BACKGROUND: Angiostrongylus cantonensis is largely responsible for human cases of eosinophilic meningitis and meningoencephalitis in the South Pacific and South-East Asia regions. Ocular manifestations of angiostrongylus are relatively rare. We report intraocular infestation and successful removal of a worm from the anterior chamber of a patient in Vietnam. PATIENT AND METHODS: A 3-year old patient was referred to the eye hospital in Ho Chi Minh city, Vietnam, in December 2001 with clinical signs of acute iridocyclitis. The child and his family lived near the Mekong river. The medical history reported by the parents said that the girl had eaten raw snails two weeks before. After a week she developed high fever and for 3 days the right eye was red and painful. Her 8-year old brother was proven to have eosinophilic meningitis at the same time. RESULTS: At first examination, biomicroscopically a 10 mm long and actively mobile, white, round worm was detected in the anterior chamber. Marked hyphema was also present. Routine blood examination showed pronounced eosinophilia. Preoperative treatment with systemic steroids and constriction of the pupil with 1 % pilocarpine were initiated. After immobilising the worm by use of a viscoelastic agent in the anterior chamber, it was successfully removed via a clear-corneal incision. The worm was identified as a male Angiostrongylus cantonensis. Postoperative ophthalmoscopic examination showed an inactive organised cyst at the optic disc border. The child was discharged from the hospital after a week with a visual acuity of 0.6. CONCLUSION: Parasitic infestation is a major health problem in tropical countries. This is the first description of ocular infestation of Angiostrongylus cantonensis in children. No antiparasitic drugs are yet available to treat ocular involvement, thus therapeutic success depends upon early and complete surgical removal of the parasite.

[A case of canine angiostrongylosis]. / A propos d'un cas d'angiostrongylose canine.

A six-month old bitch presenting a sub-lingual mucocele and hematoma associated with coagulation disorders died four days after the surgical treatment of the mucocele. The necropsy revealed a canine angiostrongylosis, a disease rarely seen in Switzerland. This article summarizes the biology of Angiostrongylus vasorum and describes the lesions and symptoms caused by this cardio-pulmonary helminthosis, as well as its diagnosis and treatment. The connections between angiostrongylosis and coagulation disorders are also discussed.

Jejunal perforation caused by abdominal angiostrongyliasis.

The authors describe a case of abdominal angiostrongyliasis in an adult patient presenting acute abdominal pain caused by jejunal perforation. The case was unusual, as this affliction habitually involves the terminal ileum, appendix, cecum or ascending colon. The disease is caused by the nematode Angiostrongylus costaricensis, whose definitive hosts are forest rodents while snails and slugs are its intermediate hosts. Infection in humans is accidental and occurs via the ingestion of snail or slug mucoid secretions found on vegetables, or by direct contact with the mucus. Abdominal angiostrongyliasis is clinically characterized by prolonged fever, anorexia, abdominal pain in the right-lower quadrant, and peripheral blood eosinophilia. Although usually of a benign nature, its course may evolve to more complicated forms such as intestinal obstruction or perforation likely to require a surgical approach. Currently, no efficient medication for the treatment of abdominal angiostrongyliasis is known to be available. In this study, the authors provide a review on the subject, considering its etiopathogeny, clinical picture, diagnosis and treatment.