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Subconjunctival Dirofilaria repens Infestation: A Light and Scanning Electron Microscopy Study.

Melsom HA, Kurtzhals JA, Qvortrup K, Bargum R, Barfod TS, la Cour M, Heegaard S - Open Ophthalmol J (2011)

Bottom Line: The tail was relatively short with spirally coiled ridges indicating a male Dirofilaria repens.A travel history is helpful in diagnosing the potential involved organisms.No further treatment is necessary beyond surgical removal since this organism fails to mature and thereby does not cause microfilariaemia in humans.

View Article: PubMed Central - PubMed

Affiliation: Department of Ophthalmology, Copenhagen University Hospital, Glostrup, Denmark.

ABSTRACT

Background: To present a case of subconjunctival infestation with Dirofilaria repens which is very rare in Northern Europe.

Methods: A 61-year-old male presented with a swelling and redness of the left supraorbital region migrating to the eyelid and the left eyeball resulting in conjunctival injection, proptosis and diplopia. The patient underwent incisional extraction of a nine cm long worm, which was analysed histologically.

Results: The worm was structureless, greyish-white in colour and measuring nine cm in length and 0.5 mm in diameter. Histopathological examination of the worm showed an outer thick, multi-layered cuticle with longitudinal ridges. Beneath the cuticle, a thick muscle layer was observed and internally the intestine and a single reproductive tube containing spermatozoa were noted. Scanning electron microscopy of the worm showed tapered ends, transverse striations and longitudinal ridges at the anterior end. The tail was relatively short with spirally coiled ridges indicating a male Dirofilaria repens.

Conclusions: Humans are an uncommon and accidental host of Dirofilaria repens which is rarely seen in Northern Europe but should be considered as a differential diagnosis to other nematode ocular infections. A travel history is helpful in diagnosing the potential involved organisms. No further treatment is necessary beyond surgical removal since this organism fails to mature and thereby does not cause microfilariaemia in humans.

No MeSH data available.


Related in: MedlinePlus

(a) The 61-year-old patient with slight periorbital swelling and conjunctival injection of the left eye. (b) Close-up showing the worm coiled up in the subconjunctival space of the left eye. (c) Anterior end with mouth (arrow) in scanning electron microscopy (SEM). (d) The tail of the worm showing transverse striations and longitudinal ridges in SEM. Note spiral coiling indicating a male worm and cloaca (arrow). (e) The posterior end of the worm showing the cloaca (arrow) in SEM. (f). Transverse section of the worm with a characteristic multi-layered outer cuticle and external longitudinal ridges (arrow). Beneath the cuticle a thick muscle layer (arrowhead) is observed and internally the intestine and a single reproductive tube (star) (Haematoxylin eosin, X100 original magnification).
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Figure 1: (a) The 61-year-old patient with slight periorbital swelling and conjunctival injection of the left eye. (b) Close-up showing the worm coiled up in the subconjunctival space of the left eye. (c) Anterior end with mouth (arrow) in scanning electron microscopy (SEM). (d) The tail of the worm showing transverse striations and longitudinal ridges in SEM. Note spiral coiling indicating a male worm and cloaca (arrow). (e) The posterior end of the worm showing the cloaca (arrow) in SEM. (f). Transverse section of the worm with a characteristic multi-layered outer cuticle and external longitudinal ridges (arrow). Beneath the cuticle a thick muscle layer (arrowhead) is observed and internally the intestine and a single reproductive tube (star) (Haematoxylin eosin, X100 original magnification).

Mentions: The patient was treated by his private ophthalmologist for left sided periorbital and conjunctival inflammation with Pivampicillin 700 mg twice daily and six times daily with topical treatment of the affected eye with hydrocortisone, oxytetracycline and polymyxin B. Four days later the patient was referred to the ophthalmological department due to continuous symptoms, demonstrating a slight periorbital oedema, moderate conjunctival injection and a temporal subconjunctival undulating vermiform mass of the left eye (Fig. 1a, b). Decreased elevation and abduction of the left eye along with four mm left sided proptosis was noted.


Subconjunctival Dirofilaria repens Infestation: A Light and Scanning Electron Microscopy Study.

Melsom HA, Kurtzhals JA, Qvortrup K, Bargum R, Barfod TS, la Cour M, Heegaard S - Open Ophthalmol J (2011)

(a) The 61-year-old patient with slight periorbital swelling and conjunctival injection of the left eye. (b) Close-up showing the worm coiled up in the subconjunctival space of the left eye. (c) Anterior end with mouth (arrow) in scanning electron microscopy (SEM). (d) The tail of the worm showing transverse striations and longitudinal ridges in SEM. Note spiral coiling indicating a male worm and cloaca (arrow). (e) The posterior end of the worm showing the cloaca (arrow) in SEM. (f). Transverse section of the worm with a characteristic multi-layered outer cuticle and external longitudinal ridges (arrow). Beneath the cuticle a thick muscle layer (arrowhead) is observed and internally the intestine and a single reproductive tube (star) (Haematoxylin eosin, X100 original magnification).
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3104560&req=5

Figure 1: (a) The 61-year-old patient with slight periorbital swelling and conjunctival injection of the left eye. (b) Close-up showing the worm coiled up in the subconjunctival space of the left eye. (c) Anterior end with mouth (arrow) in scanning electron microscopy (SEM). (d) The tail of the worm showing transverse striations and longitudinal ridges in SEM. Note spiral coiling indicating a male worm and cloaca (arrow). (e) The posterior end of the worm showing the cloaca (arrow) in SEM. (f). Transverse section of the worm with a characteristic multi-layered outer cuticle and external longitudinal ridges (arrow). Beneath the cuticle a thick muscle layer (arrowhead) is observed and internally the intestine and a single reproductive tube (star) (Haematoxylin eosin, X100 original magnification).
Mentions: The patient was treated by his private ophthalmologist for left sided periorbital and conjunctival inflammation with Pivampicillin 700 mg twice daily and six times daily with topical treatment of the affected eye with hydrocortisone, oxytetracycline and polymyxin B. Four days later the patient was referred to the ophthalmological department due to continuous symptoms, demonstrating a slight periorbital oedema, moderate conjunctival injection and a temporal subconjunctival undulating vermiform mass of the left eye (Fig. 1a, b). Decreased elevation and abduction of the left eye along with four mm left sided proptosis was noted.

Bottom Line: The tail was relatively short with spirally coiled ridges indicating a male Dirofilaria repens.A travel history is helpful in diagnosing the potential involved organisms.No further treatment is necessary beyond surgical removal since this organism fails to mature and thereby does not cause microfilariaemia in humans.

View Article: PubMed Central - PubMed

Affiliation: Department of Ophthalmology, Copenhagen University Hospital, Glostrup, Denmark.

ABSTRACT

Background: To present a case of subconjunctival infestation with Dirofilaria repens which is very rare in Northern Europe.

Methods: A 61-year-old male presented with a swelling and redness of the left supraorbital region migrating to the eyelid and the left eyeball resulting in conjunctival injection, proptosis and diplopia. The patient underwent incisional extraction of a nine cm long worm, which was analysed histologically.

Results: The worm was structureless, greyish-white in colour and measuring nine cm in length and 0.5 mm in diameter. Histopathological examination of the worm showed an outer thick, multi-layered cuticle with longitudinal ridges. Beneath the cuticle, a thick muscle layer was observed and internally the intestine and a single reproductive tube containing spermatozoa were noted. Scanning electron microscopy of the worm showed tapered ends, transverse striations and longitudinal ridges at the anterior end. The tail was relatively short with spirally coiled ridges indicating a male Dirofilaria repens.

Conclusions: Humans are an uncommon and accidental host of Dirofilaria repens which is rarely seen in Northern Europe but should be considered as a differential diagnosis to other nematode ocular infections. A travel history is helpful in diagnosing the potential involved organisms. No further treatment is necessary beyond surgical removal since this organism fails to mature and thereby does not cause microfilariaemia in humans.

No MeSH data available.


Related in: MedlinePlus