Imported loiasis in France: a retrospective analysis of 167 cases with comparison between sub-Saharan and non sub-Saharan African patients.

BACKGROUND: Imported loiasis is a rare cause of consultation at the return of stay in central Africa, which often poses difficult diagnostic and therapeutic questions to practitioners especially those who are unaccustomed to tropical medicine. These difficulties can lead to risks for the patients especially if inappropriate treatment is given. Large series of imported loiasis are scarce. METHODS: We retrospectively studied the data including outcome in patients diagnosed with imported loiasis between 1993 and 2013 in the Paris area on the basis of a parasitological diagnosis (microfilaremia > 1/ml and/or serologic tests). We compared sub-Saharan and non sub-Saharan African patients. RESULTS: Of the 177 identified cases, 167 could be analysed. Sex ratio was 1, mean age 41 years and 83% were sub-Saharan Africans. Cameroon was the main country of exposure (62%). Incubation time may be long (up to 18 months). Of the 167 cases, 57% presented with characteristic symptoms (Calabar swellings, creeping dermatitis, eyeworm) whereas 43% were diagnosed fortuitously. Microfilaremia was evidenced in 105 patients (63%), and specific antibodies in 53%. Compared to sub-Saharan Africans, other patients were presenting less frequently with eyeworm migration and microfilaremia whereas they had higher eosinophilia and positive serology. Prevalence of Calabar swellings was not significantly different between the two groups. Cure rates were 52% with ivermectin alone, and 77% with ivermectin followed by diethylcarbamazine. No severe adverse event was reported. CONCLUSIONS: Presentation of imported loiasis varies according to ethnicity. A systematic screening should be recommended in patients with potential exposure in endemic country. Treatment with ivermectin followed by diethylcarbamazine could be a valuable option.

Absence of Loa loa Microfilaremia among Newly Arrived Congolese Refugees in Texas.

The Centers for Disease Control and Prevention recommends that refugees at risk of Loa loa infection be tested for microfilaria before treatment with ivermectin. We report observational results of this approach in African refugees in Texas. Daytime blood smears were performed for microfilaria on at-risk African refugees who arrived in Texas from July 1, 2014 through December 30, 2016. Clinics were asked if there were any adverse events reported among those who received ivermectin. Of the 422 persons screened, 346 (82%) were born in L. loa-endemic countries, with 332 (96%) of these being born in the Democratic Republic of Congo. No smears detected microfilaria, and all received presumptive ivermectin with no reports of significant adverse events. In this investigation, the prevalence of significant microfilarial load in sub-Saharan African refugees appeared to be low, and ivermectin treatment was safe and well tolerated.

Imported loiasis in Italy: an analysis of 100 cases.

BACKGROUND: loiasis is a neglected filariasis, affecting millions of individuals living in the rainforest areas of West and Central Africa. Aim of this study was to compare clinical and parasitological manifestations of loiasis between subjects born in endemic areas and expatriates/travelers. METHODS: we report clinical and parasitological manifestations of 100 patients with imported loiasis seen between 1993 and 2013 at the Center of Tropical Diseases, Negrar, Italy. RESULTS: among the 100 patients, 30 were African immigrants, 70 were Europeans (59 long-term expatriates and 11 travelers). Thirty-five patients (19 Africans and 16 Europeans) had positive microfilaremia. Calabar swellings were twice as frequent in Europeans (90%) than in Africans (46.7%), while a history of "eyeworm" was recorded in a higher proportion of Africans (43.3%) than in Europeans (17.4%). The median duration of exposure in the non-endemic group was also fairly long (14.6 years). Different drug regimens were used for treatment. CONCLUSIONS: we suggest that the differences between Africans and Europeans are more likely to be related to genetic differences, rather than to chronicity. Moreover the management of imported loiasis needs standardization.

Loiasis: a case of an unusual ocular foreign body.

Loiasis is a parasitic illness that is endemic in parts of Central and West Africa. In the United States, infection with Loa loa is seen in natives from that region of Africa and in those who have traveled to the area, often in the distant past. There can be significant differences in clinical manifestations between the two groups. We present a case of loiasis in an African native as well as a discussion of Loa loa infection in natives and non-natives and current treatment strategies.