Loiasis ocular en paciente con hipereosinofilia crónica / Ocular loiasis in a patient with chronic hypereosinophilia

CASO CLÍNICO: Se presenta un caso de loiasis ocular con una filaria subconjuntival de 5,5 cm de longitud y una microfilaremia grave de una microfilaria/ml, en una paciente previamente asintomática, procedente de Guinea Ecuatorial, con antecedente de hipereosinofilia crónica en estudio. DISCUSSIÓN: La loiasis ocular es una infestación importada y poco frecuente en nuestro medio. No obstante, las parasitaciones crónicas procedentes de inmigrantes de zonas endémicas de África, pueden convertir la loiasis en una enfermedad emergente en nuestro medio

CASE REPORT: We present a case of ocular loiasis with a subconjunctival filaria, 5.5 cm long, and a severe microfilaremia, 1 microfilaria/ml, on a previously asymptomatic woman from Equatorial Guinea, with a past medical history of hypereosinophilia of unknown origin. DISCUSSIÓN: Ocular loiasis is an imported infestation with a very low rate in our country. Nevertheless, chronic infestation in immigrants coming from endemic areas of Africa may increase the rate of this disease in our country (AU)

Loiasis ocular. Valoración de nuestra actuación / Ocular loiasis. An assessment o our management

Caso Clínico: varón de 24 años procedente de Guinea Ecuatorial que durante su ingreso por una tuberculosis pulmonar resistente al tratamiento refiere molestias oculares. Las analíticas de control revelaron una gran eosinofilia. Fue remitido a consulta al referir gran sensación de cuerpo extraño en el ojo izquierdo sobre todo por las noches. A la exploración evidenciamos hiperemia conjuntival y epiescleral y la presencia de un gusano adulto a nivel subconjuntival que fue retirado en quirófano. Ante la gran sospecha de loiasis se toman muestras de hemocultivo confirmando la presencia de microfilarias. Tras la recuperación de la enfermedad pulmonar se procede al tratamiento sistémico contra el Loa-loa. Discusión: debemos resaltar que la loiasis ocular es una parasitosis bastante frecuente en las zonas endémicas del centro de África, sin embargo en España se está convirtiendo una patología emergente debido al aumento de la población inmigrante (AU)

Case Report: 24-year-old male from Equatorial Guinea income for treatment- resistant pulmonary tuberculosis. He referred eye discomfort. Ancillary tests revealed strong eosinophilia. He was sent for consultation because of large strange body sensation in the left eye, especially at night. Ophthalmic examination showed episcleral and conjunctival hyperemia and the presence of an adult worm under the conjunctiva, which was removed in surgery. Due to the high suspicion of loiasis we took blood samples for cultivation which confirmed the presence of microfilariae. After he recovered of his lung disease we scheduled systemic therapy against Loa-loa. Discussion: we must emphasize that ocular loiasis is a fairly common parasite infection in endemic areas of central Africa, but in Spain is becoming an emerging pathology due to the increase in the immigrant population (AU)

Analysis of the mdr-1 gene in patients co-infected with Onchocerca volvulus and Loa loa who experienced a post-ivermectin serious adverse event.

Ivermectin (IVM) is exceptionally safe in humans, and is used for mass treatment of onchocerciasis and lymphatic filariasis. However, cases of encephalopathy, sometimes fatal, have been reported in a small number of individuals who harbored large numbers of Loa loa microfilariae (mf). A loss-of-function mutation in the mdr-1 gene in some dog breeds and in mice leads to accumulation of the drug in the brain, causing coma and death. This hypothesis was tested in four individuals from Cameroon who experienced a post-IVM serious adverse event (SAE) and in nine non-SAE matched controls. No loss-of-function mutation was detected in mdr-1 in any subject. However, haplotypes, associated with altered drug disposition, were present as homozygotes in two of the SAE patients (50%), but absent as homozygotes in the controls (0%). An association of high Loa mf load and a genetic predisposition to altered IVM distribution could be involved in IVM SAEs.

[Analysis of the prevention of post-ivermectin Loa loa encephalopathy by administration of initial low dose]. / Essai de prévention des encéphalopathies à Loa loa post-ivermectine par l'administration d'une faible dose initiale.

A number of cases of Loa-encephalopathy have been reported following ivermectin (Mectizan) treatment for onchocerciasis in patients with high Loa microfilaraemia. A possible explanation for these severe reactions is the formation of micro-emboli in small brain vessels as a result of massive paralysis of Loa microfilariae in the blood. This suggests that encephalopathy might be prevented by giving an initial low dose of ivermectin to induce a more gradual action on the Loa microfilariae. To test this hypothesis, a trial was conducted on 23 adult patients in Cameroon. Patients were divided into two groups. One group received the recommended dose of 150 micrograms/Kg. The other group received a lower dose of 50 micrograms/Kg (one 3 mg tablet of Mectizan). Blood smears were made daily from day 1 to 7 after treatment and then on days 15 and 30. Results showed no difference in the effect of the dosage level on Loa microfilaraemia. This finding suggests that an initial low dose of 3 mg Mectizan will not prevent encephalopathy following treatment for onchocerciasis.