Multifocal Chorioretinitis with Serous Macular Detachment in Diffuse Unilateral Subacute Neuroretinitis (DUSN): Unique Presentation and a Diagnostic Dilemma.

PURPOSE: To report a case of multifocal chorioretinitis with serous macular detachment in diffuse unilateral subacute neuroretinitis (DUSN) and its diagnostic dilemma. DESIGN: Case report. METHOD: A 43-year-old woman presented with painless diminution of vision of right eye for 1 week. Dilated fundoscopy showed mild disc edema, multiple deep grey-white retinitis lesions in posterior pole with mild vitritis. Optical coherence tomography revealed serous macular detachment. Fundus fluorescein angiography was suggestive of active retinitis. Comprehensive workup was unremarkable. Six days later, a live subretinal worm was noticed in inferotemporal retina. A diagnosis of DUSN was made and treated with laser photocoagulation followed by antihelminthic therapy. One month later, patients vision improved and chorioretinal lesions also healed. CONCLUSION: This report presents a unique scenario of serous macular detachment in DUSN in addition to commonly seen multifocal deep retinitis lesions. Prompt treatment with laser, antihelminthic agent can prevent irreversible vision loss.

Subconjunctival nodule due to Setaria equina erratic migration in a horse: First case report.

An 18-month-old Arabian-English filly resident in southwest France was referred for evaluation of a conjunctival mass in the right eye (OD). A pink, solid, and mobile nodular formation, measuring approximately 1.2 × 0.8 cm was found under the superior nasal bulbar conjunctiva during an ophthalmic examination that was otherwise normal. The mass was surgically removed using a standing procedure. Cytological examination of fine-needle aspirates from the mass revealed a mixed eosinophilic-lymphocytic inflammation. Histological examination confirmed the dense and diffuse eosinophilic-lymphocytic infiltrate of the mass, and it revealed several cross sections of a parasitic nematode. The morphometric diagnosis identified an immature form of a filarial worm, and molecular analysis of the mitochondrial cytochrome c oxydase subunit 1 (cox1) and 12S rRNA gene sequences led to further identification of the specimen as Setaria equina. Microfilaremia was not observed on fresh blood smears. There have been no signs of local recurrence after 18 months, nor any evidence of intraocular involvement. To the authors' knowledge, this is the first documented case of subconjunctival setariasis due to S equina in a horse.

Learning Cultural Humility Through Stories and Global Service-Learning.

Service-learning experiences are utilized by nursing programs to increase cultural learning for students. Through storytelling, the concept of cultural humility can be explained to students preparing for upcoming intercultural experiences. This case study describes the experience of nursing students and educators on their first service-learning trip to Kenya, and how intercultural issues were navigated as students developed cultural humility. The story now is shared in preparation for subsequent international student nursing trips. The utilization of storytelling can be a model for others preparing for service-learning experiences.

Diffuse Unilateral Subacute Neuroretinitis From Raccoon Exposure Resistant to Laser Photocoagulation.

Diffuse unilateral subacute neuroretinitis (DUSN) is an ocular disease caused by a subretinal nematode worm. The authors present a unique case of a 9-year-old girl with DUSN due to presumed Baylisascaris procyonis, given the size of the worm and previous raccoon exposure. The worm was located in the inner retina and treated with laser photocoagulation and albendazole. At the 1-week follow-up, the worm was still mobile despite being inactive immediately after the initial laser treatment and required a more prolonged laser session. This case serves to highlight the importance of close follow-up in patients with DUSN to ensure the worm is inactivated. [Ophthalmic Surg Lasers Imaging Retina. 2016;47:686-690.].

Intracranial migration of Eucoleus (Capillaria) boehmi in a dog.

A 4-year-old, spayed-female great Dane was referred for surgical treatment of a suspected meningioma, diagnosed on magnetic resonance imaging 10 days prior to presentation. The suspected meningioma was removed via image-guided stereotactic craniotomy. Histopathological diagnosis was severe, locally extensive, chronic meningoencephalitis with an intralesional nematode egg. The egg was morphologically consistent with Eucoleus boehmi, and aberrant migration into the cranial cavity was the presumed cause of this lesion. Three faecal samples were collected and revealed 4+ E. boehmi eggs. Treatment involved 110 mg/kg fenbendazole (Panacur, Intervet) orally twice daily for 14 days. Nematodes including E. boehmi are a previously un-recognised source of intracranial disease in dogs, and should be considered as a differential for mass-like lesions visualised by magnetic resonance imaging.

Clinical features of 121 patients with diffuse unilateral subacute neuroretinitis.

PURPOSE: To describe the determinant clinical signs to diagnose diffuse unilateral subacute neuroretinitis (DUSN) and the main features related to identification of the live worm. DESIGN: Retrospective study performed at the Federal University of Rio Grande do Norte, Rio Grande do Norte, Brazil, between 2003 and 2008. METHODS: Patients with early- or late-stage diffuse unilateral subacute neuroretinitis were included. All patients underwent complete ophthalmologic examination and had a minimum of 6 months of follow-up. RESULTS: A total of 121 patients were included. Most patients were younger than 20 years (69.42%). Visual acuity was 20/400 or worse in 86 patients (71.7%). Nine patients (7.43%) presented in the early stage and 112 (92.57%) patients presented in the late stage. Subretinal tracks (91.7%), focal alterations of the retinal pigment epithelium (89.3%), small white spots (80.2%), and optic nerve atrophy (76.9%) were the most frequent clinical features. The subretinal worm was identified in 48 patients (39.66%), and laser treatment to destroy it was performed in all cases. The most common location of the nematode was the posterior pole (21 patients). It was observed that the younger the age, the higher the indices of larvae identification (P=.022). Multifocal yellow-white lesions and vitritis were correlated with identification of the worm (P=.001). Mean logarithm of the minimal angle of resolution visual acuity was 1.466 (20/600) and 1.281 (20/400) before and after laser treatment, respectively (P<.005). CONCLUSIONS: Identification of clinical signs and diagnosis of diffuse unilateral subacute neuroretinitis in its early stage, followed by prompt location and destruction of the worm by photocoagulation, may improve the vision of affected patients.

Gnathostomiasis: a rare nematode infection.

Gnathostoma, primarily an animal nematode, can infect human by the third stage larva by consumption of undercooked or raw fish, poultry, or pork. In Bangladesh gnathostomiasis is a very rare condition. The first case, an ocular infection by gnathostoma was reported in 2001 from Rangpur, a northern district. This is the second case report of gnathostomiasis which also is an ocular infection, occurred in an area of greater district of Rangpur. A female patient of 32 year of age of the northern district, Nilphamari has got infected with a species of Gnathostoma, manifested by the appearance of a live larva near the right lateral margin of anterior surface of iris of her right eye. The larva was removed surgically from her eye and the patient was cured from symptoms.

An unusual parasitological finding in a subcutaneous mammary nodule.

While examining some histological sections of a clinically suspected neoplastic nodule in a woman's breast, sections of Dirofilaria repens were noted in the same nodule along with sections of a different nematode. The latter appeared to be a specimen possibly belonging to the genus Anatrichosoma (family Trichosomoididae), a parasitic group of helminths rarely reported in humans. In view of the diagnostic interest in an exceptional event, such as a double parasitic infection in the same nodule, we report the details of the case and the morphological findings.

Diffuse unilateral subacute neuroretinitis: report of a case from the Indian subcontinent and the importance of immediate photocoagulation.

PURPOSE: To report a case of DUSN from the Indian subcontinent and emphasize the importance of immediate photocoagulation. METHOD: Review of case record. RESULT: The referring ophthalmologist had photographed the subretinal worm but had not undertaken laser photocoagulation. On presentation to us the patient had features typical of DUSN but no worm could be detected despite repeated examinations. Failure to localize the worm at subsequent examinations resulted in only partial recovery of vision. CONCLUSION: Whenever the nematode is detected, immediate laser photocoagulation of the worm is necessary as the migratory worm may be difficult to identify later on. This is necessary to prevent the otherwise natural decline in vision.

Early-stage diffuse unilateral subacute neuroretinitis: improvement of vision after photocoagulation of the worm.

PURPOSE: To evaluate the visual outcome after direct laser photocoagulation of the worm in patients with early-stage diffuse unilateral subacute neuroretinitis (DUSN). METHODS: We report on four patients with DUSN diagnosed in its early stage, in whom the worm was identified and destroyed by laser photocoagulation. RESULTS: In all the four cases, resolution of the inflammatory multifocal lesions was achieved within 1 month of treatment. After that period and during follow-up (mean 11.5 months), visual acuity improved in three eyes and remained unchanged in one eye. CONCLUSION: The diagnosis of DUSN in its early stage followed by prompt location and destruction of the worm by photocoagulation may improve vision of affected patients.

Multifocal electroretinography response after laser photocoagulation of a subretinal nematode.

PURPOSE: To describe multifocal electroretinography findings before and after laser photocoagulation of a subretinal nematode in diffuse unilateral subacute neuroretinitis. METHOD: Observational case report. A 45-year-old woman with left eye inflammation, subretinal tracts superior and temporal to the fovea, and a subretinal coiled mobile parasite was treated with laser photocoagulation to destroy the nematode. Multifocal electroretinography was performed before and after laser photocoagulation. RESULTS: In the left eye, multifocal electroretinography before treatment showed decreased foveal response density and increased parafoveal and perifoveal waveform amplitudes. Two months after laser photocoagulation, multifocal electroretinography showed full recovery of normal findings and the visual acuity remained 20/20. CONCLUSION: Multifocal electroretinography appears to be useful in evaluating the retinal findings after photocoagulation of a parasite associated with diffuse unilateral subacute neuroretinitis.

Identifying live nematodes in diffuse unilateral subacute neuroretinitis by using the scanning laser ophthalmoscope.

OBJECTIVE: To describe use of the scanning laser ophthalmoscope (SLO) to identify live nematodes in patients with diffuse unilateral subacute neuroretinitis. METHODS: Infrared, red, and blue illumination (780, 633, and 488 nm, respectively) in an SLO were used to image and evaluate functional retinal status in patients with late-stage diffuse unilateral subacute neuroretinitis. An examination to identify live nematodes was performed in the affected eyes. RESULTS: Using blue illumination, the ocular fundus appeared dark and provided a high-contrast background for the white image of the worm. The red laser was used to perform red-on-red perimetry. We also used perimetry stimulus to stimulate the worm's movement and pinpoint its location. We precisely defined the relation between the fixation point and the worm to plan accurate laser treatment. The infrared laser is safe and comfortable for prolonged examination. Using the SLO, several physicians simultaneously visualized the ocular fundus. Video output from the SLO provided temporal information, excellent for enhancing detection of worms, which was displayed dynamically on video. CONCLUSIONS: Although examination with a fundus contact lens by skilled ophthalmologists is the method of choice, the SLO provides a new examination modality with distinct advantages for identifying live worms in young patients with diffuse unilateral subacute neuroretinitis.

Diffuse bilateral subacute neuroretinitis: first patient with documented nematodes in both eyes.

OBJECTIVE: To describe the first patient with documented evidence of diffuse unilateral subacute neuroretinitis (DUSN) in both eyes. METHODS: A 10-year-old healthy Brazilian girl was first seen with signs of late-stage DUSN in both eyes. A careful search for a nematode was performed in each eye. RESULTS: A motile 550- to 660-microm nematode was found in the inferotemporal retina of the left eye. A similar-sized motile nematode was found in the superotemporal retina of the right eye. Both nematodes were treated with argon green laser applications with bilateral improvement of visual function. CONCLUSION: Although most patients with DUSN do not develop the disease in the fellow eye, this case demonstrates that DUSN can occasionally affect both eyes.