Emerging human pulmonary dirofilariasis in Hungary: a single center experience.

BACKGROUND: Human pulmonary dirofilariasis (HPD) is rare in Hungary, and it stems from Dirofilaria immitis, mainly transmitted through mosquito bites, with dogs as primary hosts. Despite its prevalence in veterinary settings, human cases are infrequent. Historically, Mediterranean countries report most HPD cases, but sporadic cases occur in temperate European regions. Radiologically, HPD often manifests in a non-specific manner, resembling pulmonary neoplasms, leading to unnecessary surgery and patient distress. METHODS: This study presents a notable case series from Hungary, encompassing a 12-year period, documenting 5 instances of HPD with the aim to provide baseline estimate of occurrence for future comparison. RESULTS: Among the patients studied, all were of middle age (median: 52 years, range: 37-69) and exhibited tumor-like lesions, primarily localized to the right lung, necessitating lobectomy or wedge resection. Histological examination consistently revealed a necrotizing granulomatous response characterized by remnants of helminths, without the presence of ovules. Furthermore, rigorous diagnostic procedures excluded other potential infectious agents through specialized staining techniques. Polymerase chain reaction analysis definitively confirmed the diagnosis of HPD in each case. CONCLUSIONS: This case series highlights HPD as a seldom zoonosis, with a probable escalation in its occurrence within temperate regions. Therefore, clinicians should maintain a heightened awareness of HPD in the differential diagnosis of pulmonary coin lesions. Early recognition and diagnosis are paramount for appropriate management and prevention of potential complications associated with this increasingly recognized infectious entity.

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.

Clinical Characteristics of Human Pulmonary Dirofilariasis in Japan: An Uncommon Differential Diagnosis of a Solitary Pulmonary Nodule.

Human pulmonary dirofilariasis (HPD) is a zoonotic disease caused by Dirofilaria immitis. Most HPD cases are asymptomatic and are either detected during annual health checkups or incidentally identified during the investigation of other diseases, particularly primary or metastatic pulmonary lung cancers. However, the frequency and clinical features of Japanese patients with HPD remain unclear. We analyzed data from the Japanese Medical Abstract Society database and identified 69 cases between 1978 and 2022. The incidence of HPD increased until the 2000s but declined markedly in the 2010s. The incidence is higher in the southwestern region and lower in the northeastern region of Japan. Health checkups are the primary diagnostic opportunities. The Chugoku and Shikoku regions have had high incidence rates per population. The diagnosis of HPD using a noninvasive procedure is typically difficult because of the absence of specific clinical symptoms, and approximately 70% of the cases are detected using video-assisted thoracoscopic surgery. Climate change may increase the incidence of HPD in the northeastern region of Japan, and travel to countries with poor vector control may be a risk factor for HPD transmission. Physicians should consider this parasitic infectious disease when examining patients presenting with solitary lung nodules.

A case of recurrent human Dirofilaria repens infection in Uzbekistan.

Dirofilaria repens is a zoonotic mosquito-borne filarioid that parasitizes in the subcutaneous tissues of carnivores, that has been incriminated in the great majority of human dirofilariasis cases reported throughout the Old World. From the Republic of Uzbekistan, recent data showed that this parasite is endemic in domestic and wild carnivores. In contrast, information regarding human infection is scarce and mostly outdated, with a single case report being published during the last decades. The present paper reports a case of recurrent autochthonous infection with D. repens in a patient living in the rural area of the Sirdaryo Region of Uzbekistan and having no international travel history. The first diagnosis was in 2019, when the patient presented with what was suspected to be a tumour of the left breast. Three years later, in 2022, she presented for a consultation after experiencing redness, occasional swelling and persistent itching in the umbilical region of the abdomen. The ultrasound indicated the presence of a living, motile nematode. Following anthelmintic therapy, the parasite was surgically removed and identified as a female D. repens. The present report highlights the possibility of human re-infection with D. repens and further underlines the necessity of raising public awareness and implementing of solid control strategies in carnivores.

Dirofilarial nodule as a differential diagnosis for subcutaneous lumps in children.

PURPOSE: Subcutaneous nodules in children are commonly caused by pilomatrixoma, dermoid cysts, soft tissue tumors, etc. Parasitic infections are reported to cause subcutaneous nodules and are infrequently described, mostly in the adult literature. We aim to describe the clinicopathological features of subcutaneous lumps caused by dirofilarial infestation in children in an endemic country. METHODS: A retrospective analysis was performed of all patients presenting with the above condition to Lady Ridgeway Hospital from 2018 to 2022 and their relevant details were captured in a proforma. RESULTS: There were 55 patients with a male to female ratio of 2:1. The mean age at presentation was 50 months (7-156 months). The mean duration was 97 days (1-820 days). The common sites involved were scrotum (30.9%), back (14.5%), abdominal wall (102.7%) and face (10.9%). The majority had a painless nodule (70.9%), while ten (18.2%) had features of acute inflammation. Thirty (55.5%) had preoperative ultrasonography which showed features of parasitic nodules in 26 (47.3%). Parasite was demonstrated in histopathological analysis only in 30 patients (54.5%). CONCLUSION: Dirofilarial nodule should be considered in the differential diagnosis of subcutaneous lumps in children, especially in the endemic areas.

Dirofilaria repens Testicular Infection in Child, Italy.

Testicular Dirofilaria repens infection was identified and confirmed by sequence analysis in a child in northeastern Italy. Because human dirofilariasis is emerging in southern and eastern Europe, this parasitic infection should be considered in the differential diagnosis of scrotal swelling in disease-endemic countries to avoid unnecessary interventions, such as orchiectomy.

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.

Human dirofilariosis in the 21st century: A scoping review of clinical cases reported in the literature.

Human dirofilariosis is a clinical entity caused by infection with nematode species of the genus Dirofilaria. The traditional picture depicts the disease as a sporadic event associated with the presence of a single immature worm causing a nodular lesion. With the aim to reassess this paradigm, establishing a more accurate picture of the disease and homogenize criteria, a scoping review was conducted by searching, screening and analysing published clinical cases of human dirofilariosis worldwide during the 21st century. After extracting data from 305 publications containing 576 case reports, results showed that human dirofilariosis is currently caused by five Dirofilaria species (mainly D. repens). Maturation was not uncommon, since 42.95% of the parasites recovered were described as mature worms, most of them females, 26.42% of which contained micofilariae in the uterus. Moreover, six microfilaremic cases have been described. The predominant clinical manifestation was the presence of a worm encapsulated within a nodule, but there is a considerable variety of accompanying symptoms depending on anatomical location and type of dirofilariosis. Parasites/nodules were found in 71 different anatomical locations, being the traditional nomenclature of human dirofilariosis unable to properly cover this complex situation. Delay in seeking medical assistance (patient perception) and the frequency of wrong clinical suspicions (doctor knowledge), strongly influenced clinical management. The initial suspicion in cases of subcutaneous and pulmonary dirofilariosis is predominantly a tumour, while in the ocular dirofilariosis a parasite (but not directly Dirofilaria) is mostly suspected. Surgery is usually applied, regardless of the use of non-invasive techniques during preoperative management and although its use is still limited, molecular approach is the most accurate technique to establish a species-level diagnosis. Accurate epidemiological, parasitological and clinical information while handling and reporting human clinical cases is a need for physicians and researchers to improve and standardize the clinical management of human dirofilariosis.

Dirofilarioses in two cats in southern Italy.

Two cats infected by Dirofilaria immitis and Dirofilaria repens, respectively, were taken to two different private practitioners for a clinical examination. The analyses conducted on the first cat revealed a microfilaraemia due to D. repens of 66 mfs/mL by a modified Knott's test. No clinical signs of D. repens infection were observed in the cat. The animal was euthanised because of a lymphoma condition, and two adult females of D. repens were found in the subcutaneous tissue of the lumbar and left scapular regions at the post-mortem examination. The second cat showed severe abnormalities in the white blood cells, including eosinophil count. Microfilariae of D. immitis were detected in the blood smear, with an average length (n = 2) of 296.2 µm. These clinical cases represent the first reports of feline dirofilarioses in southern Italy and are indicative of a common occurrence of dirofilarial infection in the local canine population.

Infection with Dirofilaria immitis and Other Infections in Cats and Dogs from Rio de Janeiro, Brazil: The Need for Prophylactic Enforcement.

PURPOSE: Dirofilaria immitis, a mosquito-borne nematode that primarily infects dogs, can equally infect cats. Although there have been numerous studies on canine heartworm prevalence in Brazil, there have been few studies on feline infections. Feline immunodeficiency virus (FIV) and feline leukemia virus (FeLV) are both life-threatening retroviruses transmitted directly between cats. Infections with Ehrlichia spp. and Anaplasma spp. are highly prevalent among dogs in Brazil, with Rhipicephalus sanguineus being the main vector for both bacteria. This study aimed to gather information on these infections among dogs and cats in the metropolitan area of Rio de Janeiro by performing rapid point-of-care tests for prophylactic enforcement. METHODS: Surplus samples of serum or plasma from private laboratories were tested by enzyme-linked immunosorbent assay (ELISA) (SNAP Feline Triple Test or SNAP 4Dx Plus Test). RESULTS: The prevalence of heartworm disease was 7% among dogs and 0.9% among cats, the latter being 12.9% of the former. The prevalence of FIV and FeLV was 4.3 and 11.9%, respectively. Among dogs, the seroprevalence of Ehrlichia spp. and Anaplasma spp. was 27.1 and 9.8%, respectively, and Borrelia burgdorferi was not detected. CONCLUSION: Given that such infections circulate among pets, prophylactic measures should be encouraged by small animal practitioners.

Seroprevalence of viral and vector-borne bacterial pathogens in domestic dogs (Canis familiaris) in northern Botswana.

BACKGROUND: Domestic dogs (Canis familiaris) have the potential to act as disease reservoirs for wildlife and are important sentinels for common circulating pathogens. Therefore, the infectious disease seroprevalence among domestic dogs in northern Botswana may be indicative of pathogen exposure of various wildlife species. The objective of this study was to assess the seroprevalence of Ehrlichia spp., Borrelia burgdorferi, Anaplasma spp., Dirofilaria immitis, canine adenovirus, canine parvovirus, and canine distemper virus in domestic dogs as proxies of disease prevalence in the local wildlife in the Okavango Delta region of Botswana. Statistical analysis assessed crude and factor-specific seroprevalence proportions in relation to age, sex, and geographical location as predictors of seropositivity. Logistic regression was used to identify adjusted predictors of seropositivity for each of the pathogens of interest. RESULTS: Samples from 233 dogs in a total of seven locations in Maun, Botswana, and surrounding villages were collected and serologically analyzed. No dogs were seropositive for B. burgdorferi, while low seroprevalence proportions were observed for Anaplasma spp. (2.2%) and D. immitis (0.9%). Higher seroprevalence proportions were observed for the tick-borne pathogen Ehrlichia spp. (21.0%), and 19.7% were seropositive for canine adenovirus (hepatitis). The highest seroprevalence proportions were for canine parvovirus (70.0%) and canine distemper virus (44.8%). The predictors of seropositivity revealed that adults were more likely to be seropositive for canine adenovirus, canine distemper virus, and canine parvovirus than juveniles, and location was a risk factor for canine adenovirus, canine distemper virus, canine parvovirus, and Ehrlichia spp. CONCLUSIONS: Results indicate that increasing tick control and vaccination campaigns for domestic dogs may improve the health of domestic animals, and potentially wildlife and humans in the Okavango Delta since viral and vector-borne bacterial pathogens can be transmitted between them.

Dirofilaria immitis infection in dogs in Algodoal Island, Brazilian Amazon / Infecção por Dirofilaria immitis em cães na Ilha de Algodoal, Amazônia brasileira

Dirofilaria immitis, a parasite that mainly infects domestic or wild canids, but can infect felines or humans as well, is frequent in many Brazilian areas. The main objective of this research was to determine the prevalence of natural canine infection at the Algodoal-Maiandeua Island complex, in the coastal region of the state of Pará, Brazil. A total of 67 dogs were sampled for blood microfilariae detection and for D. immitis DNA detection. Microfilaria and D. immitis DNA could be detected in 35.8% (24/67) of the animals. In one dog's sample no microfilariae were detected, but the PCR was positive, suggesting that either larvae recently were eliminated or adults died shortly before sample collecting. Therefore, it can be concluded that the occurrence of D. immitis is a health threat for domestic and wild canids at the Island of Algodoal, as well as for feline or human health.(AU)

Dirofilaria immitis, um parasito que infecta principalmente canídeos domésticos ou selvagens, embora também possa infectar felinos e humanos, é frequente em muitas áreas do Brasil. O objetivo deste estudo foi determinar a ocorrência da infecção natural em cães provenientes do complexo da Ilha de Algodoal-Maiandeua, região litorânea do estado do Pará, Brasil. Um total de 67 cães tiveram o sangue coletado para detecção de microfilárias de D. immitis e seu DNA. Microfilárias e o DNA de D. immitis foram detectados em 35,8% (24/67) dos animais. Na amostra de um animal, não foram observadas microfilárias, mas o seu DNA foi detectado, sugerindo que as larvas tenham sido recentemente eliminadas ou os adultos tenham morrido antes da coleta da amostra. Portanto, pode-se concluir que a ocorrência de D. immitis é uma ameaça à saúde de canídeos domésticos no complexo da Ilha de Algodoal-Maiandeua, bem como para felinos e seres humanos.(AU)

The Diversity of Human Dirofilariasis in Western Sri Lanka.

BACKGROUND: Human dirofilariasis is an emerging zoonosis in many countries. Dirofilariasis caused by Dirofilaria repens may present with diverse clinical manifestations in humans due to aberrant localization of worm lesions causing diagnostic dilemmas. The aim of this retrospective study was to describe and update the demography and clinical spectrum of human dirofilariasis in western Sri Lanka. Nematode or nematode fragments isolated from excision biopsies that were confirmed as D. repens at the Department of Parasitology, Faculty of Medicine, University of Kelaniya, Sri Lanka, between 2012 and 2018 were included. Data on age, gender, and clinical details were obtained from case files. Identity of worms was established by morphometry and cuticle characteristics on wet-mount preparation. Specimens from unusual case presentations were further analyzed by PCR with specific primers for internal transcribed spacer region 2 (ITS2) of the ribosomal DNA. RESULTS: Sixteen nematode specimens isolated from subconjunctiva (n=2), subcutaneous (n=13) and intramuscular (n=1) locations were identified as D. repens by morphometry (average length 11.5 cm) and the characteristic longitudinal striations on cuticle visualized by microscopy. The age distribution of cases ranged from 1 to 65 years with a mean of 21.5. Females were more frequently affected (n=10, 62.5%) and worm locations were commonest in the orbital region (5/16) and scrotum (3/16). Imaging techniques were of use in detecting infections in deeper tissue levels. PCR analysis of DNA extracted from a worm in an intramuscular granuloma of the temporal region elicited the expected band at 484bp for D. repens. CONCLUSIONS: Human dirofilariasis is on an upward trend in incidence. Imaging techniques were of use in clinical diagnosis and molecular speciation in establishing the species identity in unusual case presentations. We suggest a more conservative approach in the management of human dirofilariasis and recommend a one health approach for control.

Clinical and pathological effects of Dirofilaria repens and Dirofilaria immitis in a dog with a natural co-infection.

Canine dirofilarioses are mosquito-borne zoonotic diseases with a continuous expansion of their geographical distribution, as a consequence of different climatic and ecological factors. Dirofilaria immitis, the aetiological agent of heartworm disease, has gained a major veterinary interest, mainly due to its severe clinical implication. In the last decades, D. repens, despite of being regarded as a less pathogenic species, regained attention due to its recognized zoonotic potential. Romania has been traditionally regarded as a non-endemic country, but recent epidemiological surveys are highlighting the presence of both D. repens and D. immitis. The present case report describes the clinical and pathological features of a natural co-infection with D. repens and D. immitis in 5year old male Boxer from north-western Romania. Based on clinical and laboratory investigations, a diagnosis of kidney failure and chronical cystitis was established. The parasites were identified by morphology and confirmed by PCR and sequencing. To the best of our knowledge this is the first worldwide report of the ectopic presence of D. repens adults in the pelvic cavity and mesentery by natural infection and first report of the ocular localization of this parasite for Romania. The clinical and paraclinical findings suggest the implication of D. repens microfilariae in the aetiology of histopathological lesions. Further investigations are needed in order to establish the actual pathogenic potential of D. repens, a frequently neglected parasite.

Dirofilaria immitis exposure status in client-owned cats with or without lower airway/lung-associated signs: case-control study in a canine heartworm-endemic area.

Objectives Heartworm-associated respiratory disease (HARD) is a recently recognised pathological manifestation in cats caused by Dirofilaria immitis exposure. This study aimed to estimate the percentage of cats at risk of developing HARD in a heartworm-endemic area (Taipei, Taiwan), and to test the correlation of heartworm exposure and the presence of lower airway/lung clinical signs (LA/L signs). Methods This was a prospective case-control study. The study design called for the enrolment of at least 80 cats with LA/L signs and at least 80 cats without such clinical signs in a 1 year period. The D immitis antibody seroprevalence of the two cohorts was compared. Results From February 2014 to January 2015, 187 client-owned cats were prospectively enrolled: 83 clinical cases with LA/L signs and 104 cats without such signs. Antibody seropositivity was approximately twice as frequent in cats with LA/L signs (13.3%) than in cats without signs (7.8%) (odds ratio [OR] 1.814); nevertheless, no statistically significant difference between the two cohorts ( P = 0.22) was found. We used 41 frozen samples from free-roaming cats to examine the possibility of different exposure rates to mosquito bites between client-owned cats and stray cats, finding the seroprevalence to be 7.5% in free-roaming cats - a result not statistically different to that in client-owned cats ( P = 0.60). Outdoor access was a significant risk factor for heartworm exposure in client-owned cats (OR 3.748; P = 0.03); however, living entirely indoors did not provide complete protection from exposure/infection. Conclusions and relevance Our results did not show statistically significant differences in antibody seroprevalence between cats with and without LA/L signs. LA/L signs were not always present under conditions of natural exposure. However, exposure to D immitis is not rare among client-owned cats, suggesting that heartworm prophylactics should be a part of routine care in all cats living in areas endemic for canine heartworm.

Update on Dirofilaria immitis epidemiology in South America and Mexico: literature review / Atualização sobre a epidemiologia de Dirofilaria immitis na América do Sul e no México: revisão de literatura

Dirofilaria immitis (Leidy, 1856; Raillet & Henry 1911) is a parasite that is widely disseminated around the globe, with a higher prevalence in warm, humid climates. The first report of its occurrence in South America is from 1878 in Brazil. At that time, reports were scarce and difficult to retrieve ­ therefore, gathering them will facilitate record-keeping over time. Four databases were searched (Scopus, MEDLINE, LILACS, and PubMed) and the search keywords were "Dirofilaria" or "heartworm" and the countries' names. Four countries lacked reports (Bolivia, Ecuador, French Guiana, and Uruguay) and other three (Suriname, Guyana, and Paraguay) had only old reports. Chile was the only country in which studies were conducted over time, and no infected dogs were registered. For the other six countries (Mexico, Peru, Colombia, Venezuela, Argentina, and Brazil), reports showed that the infection frequency varied over time and with the surveyed area. Therefore, the information indicates that D. immitis is established, and veterinarians must institute preventive programs to optimally care for their patients and protect the health of their families.(AU)

Dirofilaria immitis é um nematoide de ampla distribuição geográfica, que ocorre com maior frequência em áreas quentes e úmidas do planeta. O primeiro registro de sua ocorrência na América do Sul foi realizado em 1878, no Brasil. Naquela época os registros eram poucos e raramente de fácil obtenção, razão pela qual reuni-los facilitará a recuperação da memória ao longo dos anos. Quatro bases de dados (Scopus, MEDLINE, LILACS e PubMed) foram estudadas utilizando-se as palavras-chave "Dirofilaria" ou "heartworm", os nomes dos países da América do Sul e o México. Nenhum registro foi encontrado para quatro países (Bolívia, Equador, Guiana Francesa e Uruguai) e para outros três (Suriname, Guiana e Paraguai) os registros eram antigos. Apenas o Chile é o território onde houve estudos registrados com ausência do parasita. Os outros países (México, Peru, Colômbia, Venezuela, Argentina e Brasil) apresentam registros com frequência variável no tempo ou no espaço. Assim, as informações reunidas indicam que infecções por D. immitis ocorrem na maior parte da América do Sul e no México e que os médicos veterinários devem instituir programas preventivos para garantir cuidados médicos de qualidade aos pacientes e para proteger a saúde destes e de suas famílias.(AU)

Toxoplasma gondii, Dirofilaria immitis, feline immunodeficiency virus (FIV), and feline leukemia virus (FeLV) infections in stray and pet cats (Felis catus) in northwest China: co-infections and risk factors.

This study was conducted to estimate the prevalence of Toxoplasma gondii, Dirofilaria immitis, feline immunodeficiency virus (FIV), and feline leukemia virus (FeLV) infections among stray and pet cats in Lanzhou, northwest China, and to identify the influence of age, gender, and regions on seropositivity. T. gondii antibodies were examined in cat sera by the modified agglutination test (MAT). The circulating antigens of D. immitis and FeLV and specific antibodies to FIV were examined using kits commercially available. The overall prevalence of T. gondii, FIV, FeLV, and D. immitis was 19.34, 9.12, 11.33, and 3.04 %, respectively. For the genetic characterization of T. gondii genotypes in cats, genomic DNA was extracted from the seropositive cats and the T. gondii B1 gene was amplified using a semi-nested PCR. DNA samples giving positive B1 amplification were then genotyped using multilocus PCR-RFLP. Two T. gondii genotypes (ToxoDB#9 and ToxoDB#1) were identified. Results of the multivariate logistic regression analysis showed that older cats are more likely to be seropositive than juveniles for T. gondii, FIV, FeLV, and D. immitis. This is the first report of T. gondii genotypes in cats in northwest China. Moreover, the present study is the first study of retrovirus and D. immitis seroprevalence in cats in China. The results revealed that T. gondii, FIV, and FeLV infections are common in stray and pet cats in northwest China.

Dirofilariasis involving the oral cavity: report of the first case from South America.

Oral dirofilariasis is very rare with non-specific clinical manifestations. Here, we report the case of a 65-year-old South American woman with a submucosal nodule on her right buccal mucosa. The nodule was slightly tender and painful. Differential diagnoses included mesenchymal (lipoma or fibrolipoma, solitary fibrous tumor, and neurofibroma) or glandular benign tumors (pleomorphic adenoma) with secondary infections. We performed excisional biopsy. A histopathological examination revealed a dense fibrous capsule and a single female filarial worm showing double uterus appearance, neural plaque, well-developed musculature and intestinal apparatus. Dirofilariasis was diagnosed, and the patient was followed-up for 12 months without recurrence.

Dirofilariasis involving the oral cavity: report of the first case from South America

Oral dirofilariasis is very rare with non-specific clinical manifestations. Here, we report the case of a 65-year-old South American woman with a submucosal nodule on her right buccal mucosa. The nodule was slightly tender and painful. Differential diagnoses included mesenchymal (lipoma or fibrolipoma, solitary fibrous tumor, and neurofibroma) or glandular benign tumors (pleomorphic adenoma) with secondary infections. We performed excisional biopsy. A histopathological examination revealed a dense fibrous capsule and a single female filarial worm showing double uterus appearance, neural plaque, well-developed musculature and intestinal apparatus. Dirofilariasis was diagnosed, and the patient was followed-up for 12 months without recurrence.