[Loiasis (African eye worm): about a case]. / Une loase oculaire: à propos d'un cas.

The purpose of our study is to report a case of loiasis producing ocular manifestations in a patient living in the Sahel region, (non-endemic area). The study involved a 25-year old man admitted to ophthalmology consultation with foreign body sensation in the right eye. Ophthalmological examination objectified a tortuous, motile, translucent worm measuring around 4cm under the bulbar conjunctiva of the right eye. After surgical non-traumatic extraction, parasitological examination confirmed the diagnosis of loiasis, a parasitosis mainly occurring in African forests. As a result of population movements, it can occur everywhere in the world. It is essential to recognize it during consultations.

Confrontation with a live subretinal parasite.

BACKGROUND: Parasitic infestation of the eyes are a major cause of ocular diseases across the globe. Filarial and filarial-like nematodes top the list of the nematodes that affect the eye. CASE: A rare case of live sub retinal worm is reported in a 25 years old apparently healthy young male. The case presented with unilateral loss of vision and floaters in the affected eye. Upon examination a live subfoveal worm was identified with continuous wriggling movements and diffuse retinal edema. The worm was removed surgically and sent for parasitological examination. OBSERVATION: The worm was identified microscopically as Loa Loa. However detailed histopathological examination could not be incorporated. The patient's vision improved to 6/12 (0.30 Log MAR) from the initial presentation of 3/60 (1.30 Log MAR) after three months follow-up. CONCLUSION: The rare sub retinal live worm presents a challenge in management. The management depends upon the location and viability of the parasite. Surgical management is aimed at worm removal and vision preservation.

Removal of adult subconjunctival Loa loa amongst urban dwellers in Nigeria.

Loiasis is a neglected tropical disease caused by infection with the filarial parasite Loa loa. It is a disease considered by many to be benign. Several reports of trans border importation of the Loa loa worm amongst immigrants and visitors from endemic regions of the world exist. In most cases an adult subconjunctival worm is removed from the patient. An interventional case series is reported and examines the practice of removal of subconjunctival adult Loa loa worms amongst urban dwellers in Nigeria. Four cases of ocular loiasis seen amongst urban dwellers in Nigeria exemplify the different presentations and removal methods of the subconjunctival adult worm. There were 2 males and 2 females aged 35years, 23years, 25years and 30years respectively. Each patient gave a history of having been raised in a rural community in childhood years, during which they were exposed to streams and muddy farm land; and then migrated to the urban community in later years. They all present with the finding of a subconjunctival adult worm, which was successfully removed and identified to be Loa loa. There are more urban dwellers in Nigeria who present with symptoms of foreign body sensation that may be related to the manifestation of a subconjunctival worm and are not recognized. This is because the emphasis on this disease has erstwhile been on the rural, village dwellers and not on urban dwellers. Eye care practitioners working in urban centers need to be aware of the possibility of this presentation, and be ready to remove any subconjunctival worm when it presents.

Cuerpo extraño intraocular tras un viaje a Camerún / Intraocular foreign body after a trip to Cameroon

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Loa loa in the vitreous cavity of the eye.

A 25-year-old man presented with painful diminution of vision (20/160), accompanied by redness, pain and floaters, over a period of 2 weeks, in his left eye. On examination, the anterior segment revealed moderate inflammation. Posterior segment examination showed a grade one vitreous haze with a fairly long live worm moving around in a haphazard and relentless manner throughout the vitreous cavity. The media was slightly hazy due to corneal oedema. The worm was clearly visible in the fundus photo taken. So we planned the patient for vitrectomy, and removal of the worm was performed under steroid cover. The worm was sent to the microbiology department for examination and it was found to be the species of Loa loa. The patient was administered a course of diethylcarbamazine and, on follow-up after 2 weeks, his vision had improved to 20/40.

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)

Ocular loiasis in London 2008-2009: a case series.

PURPOSE: To report three cases of Loa loa infestation presenting over the course of 12 months to ophthalmology departments in the South West Thames region around London. METHODS: Case series (three case histories are described) and literature review. RESULTS: All three patients had a history of travel to West Africa. All had worms surgically removed and were referred to an infectious diseases hospital, where these were confirmed as adult Loa loa nematodes and treatment was initiated. CONCLUSIONS: Although ocular loiasis is endemic in West Africa, European ophthalmologists in areas of diverse ethnicity should be aware that it is presenting increasingly frequently, that there is often no history of recent travel abroad, and that loiasis is a differential diagnosis for any 'at-risk' patient with an unexplained foreign body sensation.

A technique for capturing migratory periocular worms: a case series and review of literature.

PURPOSE: To describe the clinical presentation of migratory nematodes and to outline a simple strategy to ensure capture. METHODS: Retrospective case series. RESULTS: Two consecutive patients with suspected migratory nematodes were treated promptly by strategic placement of a pharmacological barrier in the forniceal conjunctiva using 1% lidocaine with epinephrine to block the routes of retreat and to immobilize the worms for controlled retrieval. Two live nematode worms, one subcutaneous dirofilaria and one subconjunctival Loa loa, were successfully removed. CONCLUSIONS: A sense of urgency is conveyed to isolate the migratory worm while it is still visible and residing in a location for easy surgical removal. The retreat of the worm to the deeper, inaccessible orbit is prevented by strategic placement of a perimeter of anesthetic.

A rare case report of Loa loa ocular filariasis.

PURPOSE: We report a case of ocular worm treated surgically and confirmed by microbiological identification. METHODS: A 33-year-old Swiss woman presented to the ophthalmic unit, complaining of pain and foreign body sensation in the left eye. Slit-lamp examination disclosed a subconjunctival amber -colored cord in the conjunctival fornix. Presentation, clinical and histopathologic evaluation, and treatment are described. RESULTS: At the time of surgery, an alive and still intact worm was extracted through conjunctival incision. Histopathology confirmed the presence of filariasis. CONCLUSIONS: As the flow of immigrants from endemic areas of Europe increases, ocular manifestation of loiasis is becoming more frequent and ophthalmologists need to be aware of this diagnosis.

Surgical management of conjunctival loiasis.

An increase in world travel has resulted in the appearance of tropical and third-world diseases in nonendemic locations. We report a case from New York City of an adult African eye worm, Loa loa, and the technique of its paralysis and removal from the epibulbar conjunctiva.

Paciente procedente de la República del Congo con dolor ocular intermitente / Patient from the Republic of Congo with intermittent ocular pain

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[Loiasis. Approach to a form of ocular parasitosis]. / Loiasis. Aproximación a una forma de parasitosis ocular.

CASE REPORT: We present the case of a man from Cameroon who was referred because of the presence of a worm in both eyes, intermittently, over a five-year period. Slit-lamp examination revealed a creeping worm under the conjunctiva. Its surgical removal enabled microbiologic confirmation of a mature form of Loa-Loa. DISCUSSION: Loiasis is a parasitic disease endemic in Africa. Because of the increase of African emigration to Spain, the possibility of this condition must be considered in Spain.

Loiasis. Aproximación a una forma de parasitosis ocular / Loiasis. Approach to a form of ocular parasitosis

Caso clínico: Presentamos el caso de un camerunés que refiere la presencia de un gusano en ambos ojos de forma intermitente desde hace 5 años. El examen biomicroscópico reveló la existencia de un gusano reptante subconjuntival. El análisis microbiológico tras su extracción quirúrgica confirmó que se trataba de una forma adulta de Loa-Loa. Discusión: La loiasis es una enfermedad parasitaria endémica en África. El reconocimiento de la enfermedad tiene interés debido al incremento de la emigración africana hacia España

Case report: We present the case of a man from Cameroon who was referred because of the presenceof a worm in both eyes, intermittently, over afive-year period. Slit-lamp examination revealed a creeping worm under the conjunctiva. Its surgical removal enabled microbiologic confirmation of amature form of Loa-Loa. Discussion: Loiasis is a parasitic disease endemic in Africa. Because of the increase of African emigration to Spain, the possibility of this condition must be considered in Spain

Loa loa macrofilariasis in the eyelid: case report of the first periocular subcutaneous manifestation in Germany.

PURPOSE: We report a case of periocular subcutaneous macrofilariasis as an initial sign of a systemic Loa loa infection. METHODS: Thorough history, eye examination and surgical intervention. Parasitological and serological analysis. RESULTS: A periocular adult Loa loa worm was extracted from the left upper eyelid in an African student living in Germany after presenting to our department with intermittent attacks of painful lid swelling. Four weeks later he presented with Calabar swellings in his arms without serological evidence of microfilaria and was treated with diethylcarbamazine. CONCLUSION: Due to increasing migration of populations to Europe rare manifestations of ocular loiasis are becoming more common. Intermittent painful eyelid swelling in patients who visited or have lived in Africa should always raise the suspicion of systemic loiasis.