Subconjunctival Dirofilaria masquerading as nodular scleritis.

A man in his late 50s presented with a gradually enlarging, painless, reddish mass on the white portion of his left eye for 2 weeks. His best-corrected visual acuity was 20/20 in both eyes. Slit-lamp examination showed a congested, nodular, elevated lesion on the temporal bulbar conjunctiva with two pustule-like elevations. Anterior segment optical coherence tomography showed a subconjunctival solid mass rather than an abscess or a cyst. Scleral deroofing was performed and a long thread-like object resembling a dead worm was identified. The worm was removed intact, and its histopathology confirmed the diagnosis of Dirofilaria Peripheral blood smear did not show any microfilariae. No recurrences or new lesions were observed during the follow-up examinations at 1 and 5 months post-surgery. This case highlights the importance of considering a parasitic aetiology in cases of nodular or infectious scleritis.

Subcutaneous dirofilariasis in a 25-year-old male patient in Belgium on ultrasonography: a case report.

BACKGROUND: Subcutaneous dirofilariasis is a parasitic zoonosis commonly described in Canidae but rarely seen in humans. Most physicians are unfamiliar with this disease, especially in nonendemic areas, which can lead to medication error and diagnostic and treatment delay. To the best of our knowledge, no previous case of subcutaneous dirofilariasis preoperatively diagnosed on ultrasound has been described in Western Europe. CASE PRESENTATION: A 25-year-old Belgian male patient presented with a subcutaneous nodule in the epigastric region. Ultrasound investigation showed a typical cystic lesion with an internal serpiginous structure with echogenic lines, and there was active twirling movement of this serpentine structure during investigation, pathognomonic for subcutaneous dirofilariasis. Surgical extirpation was performed, and the diagnosis was histopathologically confirmed. CONCLUSION: Subcutaneous dirofilariasis has a characteristic appearance on ultrasound but is not well known in nonendemic areas, often leading to diagnostic delay and initial incorrect treatment. More knowledge of this disease and of its characteristic ultrasound appearance will hopefully lead to better patient care.

Spontaneous pneumothorax in a dog with a history of successfully treated heartworm disease: A case report.

OBJECTIVE: To describe a dog presented with spontaneous pneumothorax secondary to chronic pulmonary changes associated with a history of resolved canine heartworm disease. CASE OR SERIES SUMMARY: A 7-year-old 25.2kg female spayed German Shepherd mix was presented for management of spontaneous pneumothorax. The dog had a history of heartworm disease that underwent therapy prior to adoption, and the dog was heartworm antigen negative (SNAP 4Dx) during hospitalization for the pneumothorax. An exploratory thoracotomy was performed due to an unresolving pneumothorax requiring multiple thoracocenteses. Perioperatively, the lungs did not expand with positive pressure ventilation and diffuse, multifocal to coalescing areas of darkened tissue that were grossly consistent with necrosis and/or hemorrhage were noted. The dog was euthanized intraoperatively due to an assumed poor prognosis. Histopathologic examination findings were consistent with chronic reactive changes related to previous heartworm infection. No neoplastic or infectious etiologies were identified. NEW OR UNIQUE INFORMATION PROVIDED: Spontaneous pneumothorax is a known complication of active heartworm infection. However, this case represents the first report of spontaneous pneumothorax secondary to chronic pulmonary changes caused by resolved heartworm infection.

[A case of pleuropulmonary dirofilariasis caused by Dirofilaria repens. Case report].

The differential diagnosis of neoplasms of various localizations is the primary task in clinical practice of all physicians. We present a description of the case of invasion with Dirofilaria repens in the lung of a 68-year-old patient. In 2016 the patient was diagnosed with cancer of the left kidney and underwent a left-sided nephrectomy. During the dynamic observation in 2019, a lump was found in the left lung, which was regarded as a metastasis. An atypical SIX resection of the left lung was performed. Microscopy of the removed lump revealed the presence of a nematode of the genus Dirofilaria, presumably D. repens. The species identity of D. repens was confirmed by polymerase chain reaction using species-specific primers. It is known that the morphological identification of parasites up to the species in the surgical material presents certain difficulties and requires high professional training of the researcher. Therefore, the diagnosis of dirofilariasis in atypical localizations of nematodes in the human body is of great importance in the differentiation of malignant and benign formations, and the use of the polymerase chain reaction method can significantly increase the accuracy in establishing the final diagnosis.

Dirofilariosis infestation of pectoralis major muscle in Italy, a case report.

Abstract: Zoonotic dirofilariasis infestation, caused by Dirofilaria Repens, is described worldwide in different countries. A 31-years-old male patient presented thoracic muscle pain after growth of an ovoidal undefine cyst in left parasternal region. Patient reported several contacts with different species of animals for a familiar activity. In absence of blood inflammatory indices and systemic symptoms, imaging studies showed a suspected muscle cyst infection. Surgical excision was performed and microbiology confirmed parasite nature. Dirofilaria Repens, probably adult female, was identified. Treatment resulted to be definitive and any other clinical and surgical approach was needed. Healing time was uneventful and follow-up showed no further systemic relapses. The case highlights the effectiveness of surgical treatment in this subcutaneous infestation for an increasing number of human cases reported in endemic areas such as Central Italy.

Live Intraoral Dirofilaria repens of Lower Lip Mimicking Mucocele-First Reported Case from Croatia.

Dirofilariasis is an endemic infestation in tropical and subtropical countries caused by about 40 different species. It rarely occurs in the oral cavity and is mostly presented as mucosal and submucosal nodules. Differential diagnoses include lipoma, mucocele, and pleomorphic adenoma. We report a rare case of oral dirofilariasis mimicking mucocele in a 41-year-old male patient from Croatia without an epidemiological history of travelling outside the country. He came in because of non-painful lower lip swelling that had lasted for two months. The parasite was surgically removed from the lesion. This is the first reported case of oral dirofilariasis in Croatia. It is important to point out this rare diagnosis in order to make dentists aware of the possibility of the presence of such an infestation in common lesions of the oral mucosa.

Human Pulmonary Dirofilariasis: A Review for the Clinicians.

Human pulmonary dirofilariasis (HPD) is a rare zoonotic disease caused by Dirofilaria immitis, the nematode responsible for canine cardiopulmonary dirofilariasis (dog heartworm). The incidence of HPD is on the rise throughout the world due to increased awareness and factors affecting the vector (mosquito). Humans are accidental hosts for D. immitis. Most patients are asymptomatic and present with an incidental pulmonary nodule that mimics primary or metastatic pulmonary malignancy. Some patients suffer from pulmonary and systemic symptoms in the acute phase of pneumonitis caused by pulmonary arterial occlusion by the preadult worms resulting in pulmonary infarction and intense inflammation. These patients may have ill-defined pulmonary infiltrate on chest radiology. Pulmonary nodules represent the end result of initial pneumonitis. There are no specific clinical, laboratory, or radiologic findings that differentiate HPD from other causes of a pulmonary nodule. Although serologic tests exist, they are usually not commercially available. The majority of patients are diagnosed by histopathologic identification of the decomposing worm following surgical resection of the lesion.

Rare cause of floaters: A motile live worm in vitreous cavity.

Ocular filariasis commonly presents as subconjunctival or eyelid nodules. We report a rare case of a live, motile worm causing floaters. The worm was isolated from the vitreous cavity and revealed to be Dirofilaria repens. Correct recognition of the worm is necessary as human dirofilariasis does not present as microfilaremia and does not require systemic therapy; in contrast to other causes of ocular filariasis, which require systemic therapy. As ophthalmologist may be the first physician to encounter such patients, a high index of suspicion is required for timely and adequate management.

Subconjunctival Dirofilariasis Presenting as Orbital Cellulitis.

Human ocular Dirofilariasis is a relatively rare, zoonotic disease, caused by a filarial nematode, Dirofilaria repens. This parasitic infestation usually presents as a subconjunctival nodule with hyperemia. The authors present a case of subconjunctival dirofilariasis in a 91-year-old gentleman, who presented with manifestations of orbital cellulitis. The live worm was surgically removed and identified to be D. repens.

There is a worm in my eye! Ocular dirofilariasis.

INTRODUCTION: To report a case of ocular dirofilariasis in Central Italy (Pisa, Tuscany) and review the previous cases of ocular dirofilariasis reported in Italy. CASE DESCRIPTION: A 67-year-old man complained about recurrent ocular redness and discomfort previously treated as conjunctivitis. The slit-lamp examination showed a round, translucent cystic swelling under the bulbar conjunctiva of the right eye, near the lateral canthus. Inside this lesion was observed the presence of a motile worm. A surgical procedure was immediately performed, excising a thin, segmented, greyish worm identified as Dirofilaria repens. After the excision, no recurrence of the symptomatology was recorded. CONCLUSION: Ocular dirofilariasis can lead to misdiagnosis due to its rare ocular manifestations and it is considered an emergent zoonosis in European countries. In Italy from 2001 to January 2018, seven new cases were reported in the literature. In our opinion, it is critical to record all the new cases to assess the epidemiological situation and increase the awareness of this rare infection.

Epididymal Dirofilariasis in a Child: First Case Report from Bulgaria.

OBJECTIVE: To present case of a child with epididymal dirofil-ariasis. CLINICAL PRESENTATION AND INTERVENTION: An 11-year-old boy was admitted to the Clinic of Pediatric Urology for elective surgery treatment of epididymal cyst on the left side. After removal, the cyst was sent for histological examination. Microscopic examination of the histological slides revealed cross-sections of a nematode belonging to Dirofilaria spp., differentiated morphologically as D. repens. After surgery, the patient recovered completely. CONCLUSIONS: In most parts around the world, dirofilariasis is a rare and neglected infection. Nevertheless, the clinicians and pathologists must be informed about it.

A rare case of human pulmonary dirofilariasis with nodules mimicking malignancy: approach to diagnosis and treatment.

BACKGROUND: Human pulmonary dirofilariasis is a rare zoonosis caused by the dog worm Dirofilaria spp., a parasite transmitted by mosquitos and resulting in peripheral lung nodules. The filarial nematode enters the subcutaneous tissue, travels to the right ventricle and dies causing a small pulmonary infarction that may embolize through the pulmonary vessels and may appear as a solitary nodule. These nodules are usually incidentally identified in asymptomatic patients undergoing chest imaging studies, and are generally interpreted to be malignant. CASE PRESENTATION: We present the case report of a human dirofilariasis in a patient with multiple pulmonary nodules resected using video-assisted thoracic surgery (VATS). According to our literature review, this is the first case with double synchronous lung nodules reported in Italy. CONCLUSIONS: Minimally invasive resection with histologic examination may be the best approach for the diagnosis and treatment of pulmonary dirofilariasis. Polymerase Chain Reaction testing may provide a more accurate etiological diagnosis in case of an inconclusive pathology result.

[Orbital case of ocular dirofilariasis]. / Sluchaĭ orbital'nogo dirofiliarioza.

AIM: to report a clinical case of orbital dirofilariasis with attention to peculiarities of disease presentation, diagnostic measures, and treatment results. MATERIAL AND METHODS: A patient with a history of spontaneously subsiding recurrent oedema of the lower eyelid suspicious of parasitic cyst formation. The diagnosis was confirmed preoperatively by orbital ultrasound. Surgical intervention included orbitotomy with microsurgical excision of the parasitic cyst via a percutaneous approach through the lower eyelid skin crease. RESULTS: Ultrasonography of the orbits appeared to be the most informative diagnostic method in this case. Thorough surgical planning allowed us to avoid complications in the postoperative period and to achieve good cosmetic results. CONCLUSION: A painless solid mass lesion with recurrent perifocal oedema and hyperaemia without inflammatory infiltration of surrounding tissues is characteristic of parasitic cysts of the orbit. Amond other infectious diseases, a parasitic cyst stands out for symptomatic relapses and spontaneous regression, irrespective of the treatment received. The use of ultrasound allowed preoperative identification of the sac and the living helminth.

Intradural Dirofilariasis in a Dog with Chronic Cervical Pain.

A 7 yr old female spayed Yorkshire terrier was referred to the author's institute for a 5 mo history of recurrent cervical spinal pain. Neurologic examination did not reveal any deficits. Hematologic and serum analyses were within normal limits. Thoracic radiographs that incorporated the cervical spine did not show structural abnormalities. Magnetic resonance imaging of the cervical spine demonstrated a contrast enhancing, intradural extramedullary lesion at the level of the C2 vertebra. Hemilaminectomy was performed, during which a long, narrow nematode was visualized upon opening of the dura mater. The parasite was alive when removed during surgery, and the dog recovered with complete resolution of symptoms. The parasite was submitted and confirmed as a male adult Dirofilaria immitis. This is a novel case of an intradural D. immitis infection in the dog with a magnetic resonance imaging description of spinal D. immitis.

Dirofilaria immitis in a child from the Russian Federation.

An immature female worm, Dirofilaria immitis, was isolated from the scrotum of a 14-month-old child. This is the first identification of human dirofilariosis caused by D. immitis in a relatively Northern region (Moscow) of the Russian Federation. The parasite was diagnosed by means of morphological examination of the worm, confirmed by PCR assay. This case raises questions about the range of the D. immitis distribution among humans in Russia. To better understand the geographical distribution of dirofilarioses, detailed clinical and epidemiological information should be collected from human cases with appropriate laboratory confirmation.

Human pulmonary dirofilariasis masquerading as a mass.

Pulmonary dirofilariasis, caused by Dirofilaria immitis, rarely affects humans and is usually asymptomatic, but may present as chest pain, cough, hemoptysis, wheezing, low-grade fever, and malaise. The dead and dying worms obstruct branches of the pulmonary artery, causing infarction and a granulomatous reaction. Coin lesions are apparent on radiography, raising concern of malignancy. Complete surgical excision is the treatment of choice and an anthelmintic can be administered if residual lesions are present or the patient is from an endemic area. We present two cases of pulmonary dirofilariasis presenting as coin lesions in the lung, which were clinically suggestive of malignancy.

18-FDG Uptake in Pulmonary Dirofilariasis.

Solitary pulmonary nodules are a common finding on chest radiography and CT. We present the case of an asymptomatic 59-year-old male found to have a 13 mm left upper lobe nodule on CT scan. The patient was asymptomatic and the CT was performed to follow up mediastinal and hilar lymphadenopathy that had been stable on several previous CT scans. He had a history of emphysema and reported a 15 pack-year smoking history. PET-CT was performed which demonstrated mild 18-FDG uptake within the nodule. Given his age and smoking history, malignancy was a consideration and he underwent a wedge resection. Pathological examination revealed a necrobiotic granulomatous nodule with a central thrombosed artery containing a parasitic worm with internal longitudinal ridges and abundant somatic muscle, consistent with pulmonary dirofilariasis. Dirofilaria immitis, commonly known as the canine heartworm, rarely affects humans. On occasion it can be transmitted to a human host by a mosquito bite. There are two major clinical syndromes in humans: pulmonary dirofilariasis and subcutaneous dirofilariasis. In the pulmonary form, the injected larvae die before becoming fully mature and become lodged in the pulmonary arteries.