Human dirofilariasis. A report of the first case of ocular dirofilariasis in the Netherlands and a review of the literature.
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Study of dirofilariasis in a selected area in the Western Province.
INTRODUCTION: Human dirofilariasis is a zoonotic infection caused by the filarial worm, Dirofilaria (Nochtiella) repens, whose primary host is the dog. This infection is on the increase over the past decade in Sri Lanka and the prevalence of canine dirofilariasis in the country is also believed to be high. We present here a study on public awareness of dirofilariasis and the prevalence of this infection in dogs in Negombo, an urban area that has a high domestic canine population. OBJECTIVE: To assess the awareness of dirofilariasis infection among residents and study the prevalence of this infection in domestic dogs in Negombo. DESIGN: Prospective study. SETTING: Department of Parasitology, Faculty of Medicine, University of Colombo, Colombo 8, Sri Lanka. METHODS: A descriptive cross-sectional study within the city of Negombo during September and November 2003 using a pre-tested, interviewer-administered questionnaire with cluster sampling was done. Two hundred seventy adults, including 132 dog owners, were included in the study. Data analysis was done using the Epilnfo programme. The prevalence of canine dirofilariasis was studied in a group of 65 dogs over the age of 1 year. They were selected by cluster sampling with random choice of the streets within the study area. Stained thick blood films, made following an earlobe-prick at any time during the day, were microscopically examined for the presence of microfilariae. RESULTS: Forty nine of the respondents (18%) were aware of the existence of canine dirofilariasis while human dirofilariasis was known only to 6%. Awareness was related to the level of education. Knowledge of canine filariasis was better among pet owners (32/132) when compared to others (18/138; p < 0.05). Veterinary surgeons were acknowledged as the source of information by 38% of those who were aware of the disease. Forty five per cent (n = 29) of the dogs screened were positive for microfilariae. Out of these 18 and two dogs were infected with D repens. and B. ceylonensis, respectively, while nine others were co-infected with the two parasites. CONCLUSIONS: The knowledge of dirofilariasis is extremely poor in the study area. The high prevalence of filarial infections in dogs highlights the importance of improving the public awareness of this disease, especially among the dog owners. Proper management of this condition in dogs-the reservoirs of infection for human dirofilariasis, is important for the control of this zoonotic infection.
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Human pulmonary dirofilariasis in Taiwan.
Pulmonary dirofilariasis is a rare zoonotic disease in the United States. Most reported cases were from the southeastern or Gulf states. The disease is caused by Dirofilaria immitis (dog heartworm), a filarial nematode, and is transmitted to humans by mosquitoes. A 69-year-old asymptomatic man was found to have a pulmonary nodular lesion on chest x-ray during routine health examination. The lesion was resected, and pulmonary dirofilariasis was diagnosed based on histological findings. Postoperatively, recovery was uneventful. This is the second reported case of human pulmonary dirofilariasis in Taiwan. Awareness of this entity is important, since the clinicoradiographic presentation of human pulmonary dirofilariasis may mimic lung neoplasia. This case may help alert clinicians, radiologists, or pathologists that pulmonary dirofilariasis should be included in the differential diagnosis when a subpleural 'coin-like' lesion is observed on chest x-ray.
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What is happening outside North America regarding human dirofilariasis?
The etiologic agents of human dirofilariasis in the Old World are Dirofilaria immitis, which cause pulmonary and subcutaneous nodules, and Dirofilaria repens, which cause ocular lesions. Although reports of new cases of dirofilariasis are sporadic in other parts of the world, a considerable amount of information is generated in Europe regarding human dirofilariasis. Most cases have been detected in the Mediterranean countries, Ukraine, and Russia; however, isolated or short series of cases have been reported in the Balkan Republics and central and northern European countries. Seroepidemiologic studies have provided evidence that humans living in endemic areas present rates of infection similar to those of the autochthonous canine populations. Antibodies against endosymbiont Wolbachia bacteria have been demonstrated recently in human Dirofilaria infections. During D. immitis infections, preadult worms and third- and fourth-stage larvae are often destroyed by the host reaction, releasing a considerable amount of Wolbachia, and a Th1-type response against Wolbachia and/or filarial antigens is mounted. On the contrary, infections with D. repens, in which worms frequently remain intact, no Th1-type response has been observed. As humans are resistant hosts, the Th1-response could have a role in the resistance against parasites. The causes for the rise in the incidence of human dirofilariasis as well as the possible application of Wolbachia antigens in the serodiagnosis of human infections are discussed.
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Pseudo-tumor of the lung, a rare clinical presentation of dirofilariasis.
INTRODUCTION: Pulmonary dirofilariasis is an uncommon entity. Known as a zoonotic disease it can affect humans as a secondary host. A pseudo-tumor of the lung called "coin" lesion is usually detected while performing a chest X-ray for another reason. OBSERVATION: We present a case of pulmonary dirofilariasis due to Dirofilaria sp. in a 72 year old immunocompetent patient who underwent surgery for suspicion of a neoplasm. DISCUSSION: Human pulmonary dirofilariasis should be evoked in asymptomatic patient from endemic area of canine dirofilariasis presenting with a pseudo tumor of the lung.
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Human dirofilariasis.
Although canine dirofilariasis has been recognized for over 300 years human dirofilariasis has received relatively little attention. Although human beings are dead-end hosts they can become infected and develop lesions associated with infection. Although these lesions are typically benign they may be misdiagnosed as more important disease and prompt unnecessary diagnostic procedures with attendant cost, discomfort and morbidity. In heavily endemic areas human dirofilariasis should be considered as a differential diagnosis for solitary pulmonary "coin" lesions. More widespread serologic screening and epidemiologic surveys are necessary to ascertain the importance of human dirofilariasis.
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Case report. Pulmonary dirofilariasis in man.
A case of pulmonary dirofilariasis in a 69-year-old woman is presented. A review of the literature revealed 56 documented cases. As in most cases of pulmonary dirofilariasis, our patient presented roentgenologically a single noncalcified coin lesion and required thoracotomy for diagnosis. The gross and histologic characteristics of the lesion, the life cycle of the parasite, the subcutaneous form of human dirofilariasis, and the possible role of the immunologic tests in establishing the diagnosis are briefly discussed. The incidence of pulmonary dirofilariasis appears to be increasing. Awareness that such entity exists is important since correct preoperative diagnosis can alleviate unnecessary surgical intervention.
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Human dirofilariasis.
BACKGROUND: Subcutaneous and pulmonary dirofilariasis in humans appears to be a frequent disease in endemic areas, notably the Mediterranean region. Following increased air travel in recent years, the incidence of human dirofilariasis has increased in tourists as well. METHODS: The clinical and parasitologic aspects in a series of six patients with cutaneous and pulmonary dirofilariasis, seen in a German unit for infectious and tropical diseases, are reviewed. RESULTS: Four patients presented with subcutaneous tumors due to infection with Dirofilaria repens, whereas two patients had pulmonary infiltrates due to the canine heartworm, D, immitis. All infections were acquired in the Mediterranean region. Symptoms were only slight and nonspecific. Eosinophilia in the blood was absent in all patients. The serum IgE levels were normal and signs of a specific humoral response to antigens of Dirofilaria spp. were absent, although slightly elevated antibody levels to antigens of Onchocerca volvulus could be demonstrated in all patients. The diagnosis was established in all patients by the surgical removal of adult worms from the lesions. Oral treatment with diethylcarbamazine (DEC) (2 mg per kg t.i.d.) over a period of 4 weeks was added to the surgical treatment in all patients. In one patient this therapy was preceded by oral ivermectine (150 mg per kg). CONCLUSIONS: Dirofilariasis has to be considered as a differential diagnosis in patients presenting with subcutaneous or pulmonary tumors after travels to endemic areas within the last few years. Effective therapy is possible by surgical removal of the adult worms and oral ivermectine plus diethylcarbamazine.
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Human pulmonary dirofilariasis: a case report and review of the recent Japanese literature.
Human pulmonary dirofilariasis is a rare zoonotic infection caused by the dog heartworm Dirofilaria immitis, which is transmitted via a vector/intermediate host, generally the mosquito. The authors present a case of histologically diagnosed human pulmonary dirofilariasis, in which the lesion was resected using video-assisted thoracic surgery (VATS). The authors also review 24 cases of such zoonosis reported in Japan from 1998 to 2004. Of these 24 patients with human pulmonary dirofilariasis, 12 (50%) were men (mean age 54 years, range 29-80 years) and 67% were asymptomatic. Most patients (83%) had a solitary lung nodule, 95% of the lesions were <30 mm and 13% had a pleural effusion. VATS was performed to obtain a histopathological diagnosis in the majority (61%) of patients whom the authors reviewed. VATS would appear to be the best method for diagnosing pulmonary dirofilariasis.
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Pulmonary dirofilariasis. The largest single-hospital experience.
Pulmonary dirofilariasis caused by Dirofilaria immitis, the dog heartworm, is a rarely reported pulmonary lesion. It most often appears as a solitary pulmonary nodule, often mistaken for a primary or metastatic lung tumor, and the diagnosis is not often established until thoracotomy with excisional lung biopsy is performed. Sporadic reports of pulmonary dirofilariasis in the United States total only 87 cases. The ten resections of pulmonary dirofilariasis at the Methodist Hospital in Houston, Tex, represent the largest reported series of cases originating at a single hospital. We present an overview of the pathogenesis of this disease, its clinical manifestations and epidemiologic features. The prevalence of pulmonary dirofilariasis appears to be increasing. Thus, surgeons and pathologists need to be aware of this etiology of granulomatous pulmonary lesions.
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The first Korean case of human pulmonary dirofilariasis.
Human pulmonary dirofilariasis has been documented from many parts of the world, but not in Korea so far. We experienced a patient of pulmonary dirofilariasis who had visited a local clinic because of chest pain for 1 month. On chest radiograph, a coin lesion of 2 cm diameter and enlargement of the mediastinal lymph node were shown. An exploratory lung resection was done. Pathologically the lesion was a pulmonary dirofilariasis complicated with necrotic pneumonia, fibrosis, and infarction. At the center of the lesion, degenerated nematode sections with multilayered cuticle, thick musculature, and bilateral internal ridges on each side were found, which was identified to be Dirofilaria immitis. This is the first report of human pulmonary dirofilariasis in Korea.
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[Autochthonous subcutaneous dirofilariasis in Israel].
BACKGROUND: Canine dirofilariasis has been recognized for over 300 years, but human dirofilariasis has received relatively little attention. Sporadic cases of human dirofilariasis have been reported in Israel. Dogs, cats and foxes are the reservoir, mosquitoes of the genera Culex and Aedes are the vectors and humans are the accidental hosts. CASE REPORT: We present a case of human dirofilariasis (Dirofilaria repens) in a young Israeli patient. The thickness of the multilayered cuticle of the worm, the size of the body and the form and numbers of the longitudinal ridges on its surface are used in the histological diagnosis of the parasite. CONCLUSIONS: Since our patient had never been abroad, this case must be considered an autochthonous infection. Furthermore, since the reservoir and the vectors are abundant in Israel, the potential for human infection exists, but probably this pathology is underdiagnosed in primary care practice.
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Case of the month. A case report of human pulmonary dirofilariasis in Arkansas.
Our patient, a resident of Arkansas, presented with a solitary pulmonary nodule for lung resection to rule out primary lung cancer. However, pathologic examination showed the lung nodule to be a granuloma secondary to dirofilariasis. Human pulmonary dirofilariasis is a rare zoonotic disease caused by Dirofilariasis immitis (dog heartworm) that is usually transmitted from dogs to human by mosquito bite. To our knowledge, human pulmonary dirofilariasis has previously not been reported in Arkansas. In addition, awareness of this entity in the appropriate clinical and epidemiologic setting is important in the differential diagnosis of solitary pulmonary nodules.
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[Conjunctival dirofilariasis due to Dirofilaria Repens. A new Tunisian case].
INTRODUCTION: Dirofilariasis due to Dirofilaria repens is a parasitic disease affecting domestic animals and transmitted to man by mosquito bites. Human infestation is rare and involves benign subcutaneous and ocular manifestations. The diagnosis is made by excisional biopsy, which is also the sole recommended treatment. There are few reports of human infection in Tunisia. CASE REPORT: We report herein the second case of conjunctival dirofilariasis in a 21-year-old woman residing in Tunis (Tunisia). The clinical presentation evoked orbital cellulites. Clinical and radiological investigations did not provide a diagnosis. Surgical excision and histological examination established the diagnosis by the presence of an adult female worm identified as Dirofilaria repens. Parasite extraction allowed successful treatment. CONCLUSION: Dirofilariasis is rare in Tunisia, with only seven cases reported. The true incidence of dirofilariasis is probably greater than recognized. This can be explained by the apparent benign nature of the lesions that may not warrant excision.
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[Conjunctival dirofilariasis, a case discovered in the Kairouan region].
A case of conjunctival dirofilariasis was reported in a 55 years old patient, from Kairouan. The human dirofilariasis comes always and only from animals. In most cases, the dirofilariasis is localised under the skin; the ocular localisation of the disease is rare or exceptional. The authors discuss the epidemiology and describe the possible ocular localisation of the dirofilariasis.
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[The usefulness of immunologic methods for diagnosis and follow-up study of a case of pulmonary dirofilariasis].
Nearly 70 cases of dirofilariasis have been reported in Japan. A case operated for pulmonary dirofilariasis is reported, together with useful immunologic diagnostic and follow-up study. A 62-year-old woman was admitted to our hospital with complaints of cough and right chest pain. A chest X-ray film revealed a mass approximately 4 cm in diameter in the right S9 region. Histological examination of the mass by TBLB revealed necrotic tissue containing eosinophils and Charcot-Leyden crystals. Around the area of necrosis there was granuloma with infiltrating neutrophils, eosinophils and lymphocytes. Therefore, immunologic examinations were performed on the suspicion of a parasitic disease. Ouchterlony's test was done with positive reaction against Dirofilaria immitis antigen. Results of the ELISA indicated a high antibody titer (1:12800) to Dirofilaria immitis antigen. Histological examination of a surgically removed mass gave the final pathologic diagnosis of pulmonary dirofilariasis caused by Dirofilaria immitis. A follow-up study by ELISA revealed a remarkable decrease of the antibody titer to 1:3200 at 1 month after surgery, to 1:200 at 6 months and to negative after 9 months. These results suggest that the ELISA could be used to judge the healing of the disease by drug therapy. Thus immunologic studies by Ouchterlony's test and the ELISA were considered to be useful for the diagnosis and follow-up study of dirofilariasis.
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Pulmonary dirofilariasis. The largest single-institution experience.
Pulmonary dirofilariasis caused by Dirofilaria immitis, the dog heartworm, is a rarely reported pulmonary lesion. It appears as a solitary pulmonary nodule, and the diagnosis is not established until thoracotomy and subsequent histologic examination of the specimen are performed. Sporadic reports of pulmonary dirofilariasis in the United States total only 70 cases. The six resections of pulmonary dirofilariasis at the Ochsner Clinic represent the largest reported series of cases originating at a single institution. We present an overview of the pathogenesis of this disease, its clinical manifestations, pathologic and epidemiologic features, and geographic distribution. The prevalence of pulmonary dirofilariasis appears to be increasing; hence, thoracic surgeons and pathologists need to be alert to this cause of granulomatous pulmonary lesions.
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Pulmonary dirofilariasis in a patient with multisystem Langerhans cell histiocytosis--the first reported case in Thailand.
Despite a high prevalence of canine dirofilariasis, there is no case of pulmonary dirofilariasis reported from Thailand. We herein report a case of multisystem Langerhans cell histiocytosis who had an incidental pulmonary dirofilariasis found at the time of autopsy as a solitary nodule at the periphery of the right lower lobe. This is the first reported case in Thailand. Association between pulmonary dirofilariasis and Langerhans cell histiocytosis has not been described before in the literature.
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