Periocular Dirofilariasis in a Young Woman: A Case Report

A case of periocular dirofilariasis has been diagnosed in Iran. A 27-yr old female referred with a history of edema and redness in the left eye since 2 wk ago. On slit lamp examination, a moving thread-like worm was seen in the subconjunctival area. Two days later, a 126 mm long, live filaria worm was extracted from the lower lid subcutaneous tissue. The worm was diagnosed as, likelihood, Dirofilaria immitis on microscopic examinations. The present case suggests that D. immitis can cause periocular infections.     

Concurrent subcutaneous and ocular infections with Dirofilaria repens in a Polish patient: a case report in the light of epidemiological data

Dirofilariasis is an emerging zoonosis caused by nematodes of the genus Dirofilaria, most often D. repens and D. immitis . The main final hosts and reservoirs of pathogens are dogs. The intermediate hosts and vectors of infection are female mosquitoes (Culicidae). Human is an accidental host in which the parasite does not usually mature. Over the past 20 years, the range of Dirofilaria spp. in Europe has expanded. We present an unusual case of multifocal dirofilariasis of mixed subcutaneous-ocular course caused by D. repens in a 52-year-old Polish patient who was probably infected in Spain or Croatia, where she stayed one year before the onset of symptoms. Surgical removal of the nematodes followed by treatment with Ivermectin in a single dose of 1200 μg and Doxycycline 200 mg daily for 7 days resulted in complete recovery. We believe that all cases of human dirofilariasis, especially in countries where the disease is not frequent at present, should be registered for epidemiological purposes. Moreover, due to the widening of the range of D. repens and D. immitis occurrence and the possibility of atypical courses of infection with both nematodes, diagnostics should include the species identification of the parasite.     

Identification of immunoreactive proteins of Dirofilaria immitis and D. repens recognized by sera from patients with pulmonary and subcutaneous dirofilariosis

Human pulmonary and subcutaneous dirofilariosis caused by Dirofilaria immitis and Dirofilaria repens are worldwide diagnosed with increasing frequency. These species are responsible for the development of benign pulmonary and subcutaneous nodules, respectively, that can be confused with lung or cutaneous cancer. The aim of the present work was to identify D. immitis and D. repens proteins differentially recognized by serum samples from individuals with human pulmonary and subcutaneous dirofilariosis, using two-dimensional electrophoresis and mass spectrometry. Twenty-three immunoreactive proteins of D. immitis and 15 of D. repens were identified. The results point to the existence of differential antigenic recognition in each species, both in the number and type of proteins recognized. Individuals with pulmonary dirofilariosis recognized, on the proteome of D. immitis, among others, different isoforms of 6 enzymes involved in glycolysis, 3 redox-related proteins with antioxidant capacity and 3 heat shock proteins. Individuals with subcutaneous dirofilariosis recognized on the proteome of D. repens only 3 glycolytic enzymes, one protein involved in redox processes and one heat shock protein. These data suggest that in cases of pulmonary dirofilariosis there exists a wider recognition of immunoreactive D. immitis proteins related to key survival processes, such as energy generation, the struggle against oxidative stress and molecular repair, than in cases of human subcutaneous dirofilariosis against D. repens. This could contribute to explain the differences described in the capacity of D. immitis and D. repens development and in the frequency of occurrence of pulmonary and subcutaneous dirofilariosis in the human host.     

A Case of Human Pulmonary Dirofilariasis in a 48-Year-Old Korean Man

Dirofilariasis is a rare disease in humans. We report here a case of a 48-year-old male who was diagnosed with pulmonary dirofilariasis in Korea. On chest radiographs, a coin lesion of 1 cm in diameter was shown. Although it looked like a benign inflammatory nodule, malignancy could not be excluded. So, the nodule was resected by video-assisted thoracic surgery. Pathologically, chronic granulomatous inflammation composed of coagulation necrosis with rim of fibrous tissues and granulations was seen. In the center of the necrotic nodules, a degenerating parasitic organism was found. The parasite had prominent internal cuticular ridges and thick cuticle, a well-developed muscle layer, an intestinal tube, and uterine tubules. The parasite was diagnosed as an immature female worm of Dirofilaria immitis. This is the second reported case of human pulmonary dirofilariasis in Korea.     

Detection of Wolbachia DNA in blood from dogs infected with Dirofilaria immitis

Dirofilaria immitis is the causative agent of heartworm disease in canines and felines, and pulmonary dirofilariasis in man. It harbors a symbiotic intracellular bacterium from the genus Wolbachia that plays an important role in its biology and contributes to the inflammatory pathology of the heartworm. This endosymbiont is sensitive to the tetracycline family of antibiotics prompting its use in the treatment of filariasis. To track Wolbachia during treatment, primers were designed based on the FtsZ gene from Wolbachia. These primers amplify a single PCR product with the expected size from DNA samples derived from various species of worms that harbor Wolbachia (D. immitis, Brugia malayi and Brugia pahangy). The detection limit of Wolbachia DNA in the assay was 80 pg of D. immitis DNA. Furthermore, the primer set successfully amplified the expected PCR product using blood samples from dogs harboring the heartworm and circulating microfilariae.     

Orbital Dirofilariasis in Iran: A Case Report

Dirofilariasis is a common parasitic disease in both domestic and wild animals around the world, with canines as the principal reservoir host and mosquitoes as the vector. Human ophthalmic dirofilariasis is an uncommon condition, but there have been reports from many parts of the world, including Africa, Australia, the Americas, Europe, and Asia. Ophthalmic involvement with Dirofilaria may present itself as periorbital, subconjunctival, orbital, or intraocular infections. In this report, we present a case of orbital dirofilariasis with lateral rectus muscle involvement. To our knowledge, this is the first orbital dirofilariasis case reported in Iran. Although debulking of the tumor usually leads to resolution, our patient showed an episode of recurrence after biopsy. Complete recovery was achieved after a spontaneous discharge, without the need for systemic medication.     

Prevalence of Dirofilaria immitis in Dogs in Shenyang,Northeastern China

In the present study, we first report the seroprevalence of Dirofilaria immitis in dogs in Shenyang, northeastern China. Sera from 528 randomly selected dogs were examined for D. immitis antigen using SNAP®4Dx test kit; 12.7% tested showed seropositive. No significant difference of infection was observed in different genders and breeds (P>0.05), but the difference was significant in different age groups and rearing conditions (P<0.05). The result suggested that the risk of exposure to D. immitis in dogs is high in Shenyang, and should be given attention.     

Dirofilaria repens in Vietnam: detection of 10 eye and subcutaneous tissue infection cases identified by morphology and molecular methods

From 2006 to 2010, hospitals in Hanoi treated 10 human patients for dirofilariasis. The worms were collected from parasitic places, and identification of the species was completed by morphology and molecular methods. Ten parasites were recovered either from the conjunctiva (n=9) or subcutaneous tissue (n=1). The parasites were 4.0-12.5 cm in length and 0.5-0.6 mm in width. Morphological observations suggested all parasites as Dirofilaria repens. Three of the 10 parasites (1 from subcutaneous tissue and 2 from eyes) were used for molecular confirmation of the species identification. A portion of the mitochondrial cox1 (461 bp) was amplified and sequenced. Nucleotide and amino acid homologies were 95% and 99-100%, respectively, when compared with D. repens (Italian origin, GenBank AJ271614; DQ358814). This is the first report of eye dirofilariasis and the second report of subcutaneous tissue dirofilariasis due to D. repens in Vietnam.     

Dirofilaria immitis: cell-mediated and humoral immune responses in experimentally-infected dogs.

Four dogs were experimentally infected with 30 Dirofilaria immitis infective larvae, four dogs received two such infections and four dogs served as uninfected controls. A partially-purified D. immitis antigen was used in an indirect hemagglutination assay to determine anti-D. immitis antibody titers. Anti-D. immitis antibody was first detected in infected dogs 4 weeks after infection. Titers were highest 2 weeks after the appearance of microfilariae and diminished to low levels thereafter in the single infection group. Antibody levels in the double infection group decreased similarly but were demonstrable throughout the study. Antibody titers were significantly higher in the infected dogs, but there were no differences in titers between single and double infection groups.The responses of peripheral lymphocytes to phytohemagglutinin P and pokeweed mitogen were significantly depressed in infected dogs. Peripheral blood lymphocyte transformation could not be induced with D. immitis antigens. Differences between groups in T-cell function were not demonstrated by total hemagglutinating antibody or 2-mercaptoethanol labile hemagglutinating antibody following immunization with sheep erythrocytes.     

Massive microfilaremia in a dog subclinically infected with Acanthocheilonema dracunculoides

Canine filarioids are worldwide distributed nematodes transmitted by arthropods with variable virulence depending on the species. Dirofilaria immitis is the most virulent and serological antigen tests are commonly employed to detect it. This study reports on the heaviest cavity filariasis recorded so far in a dog, which showed no apparent clinical signs of infection. The 6-year-old male was positive to a D. immitis antigen test. Blood samples collected and analyzed with the modified Knott's test for microfilariae revealed 264,367 microfilariae/ml. In a post-mortem examination 791 adult filarial nematodes were found in the dog's thoracic and peritoneal cavities. Morphological and molecular analysis identified the nematode as Acanthocheilonema dracunculoides and no other species were present. This is evidence that massive A. dracunculoides infections in dogs may not be clinically evident, they may cause serologic cross-reaction with D. immitis infection and become a life-threatening condition if dogs are treated with a microfilaricidal treatment without previously performing an adequate diagnosis.     

Dirofilaria immitis: Parasite-specific humoral and cellular immune responses in experimentally infected dogs

Humoral and cellular immune responses to adult antigens of Dirofilaria immitis were evaluated in experimentally infected dogs during the chronic phase of infection. All infected dogs had significantly elevated IgG (enzyme-linked immunosorbent assay) and IgE (passive cutaneous anaphylaxis) titers against D. immitis adult antigens. However, there was little difference between infected dogs and uninfected controls in cellular-immune responses to D. immitis adult antigen or phytohemagglutinin as assessed by the lymphocyte transformation assay. Although neither cellular nor humoral responses correlated with worm burdens, cellular responses among infected dogs correlated inversely with IgG titers to D. immitis adult antigen. These results are consistent with observations in other nematode and trematode systems which suggest that in chronic tissue helminth infections there is suppression of cellular immune responses to parasite antigens while humoral responses to the same antigens remain relatively preserved.     

Prevalence of Dirofilaria immitis Infection in Stray Cats by Nested PCR in Korea

The purpose of this study was to conduct a survey of Dirofilaria immitis infection among stray cats in Korea using nested PCR. We included 235 stray cats (121 females and 114 males) and evaluated each for the presence of feline heartworm infection. Blood samples were collected from 135 cats in Daejeon, 50 cats in Seoul, and 50 cats from Gyeonggi-do (Province). Of the 235 DNA samples, 14 (6.0%) were positive for D. immitis. The prevalence of infection in male cats (8/114, 7.0%) tended to be higher than that in female cats (6/121, 5.0%), but the difference was not statistically significant. In each location, 8, 2, and 4 cats were positive for infection, respectively, based on DNA testing. No significant differences in the prevalence were observed among the geographic regions, although the rate of infection was higher in Gyeonggi-do (8.0%) than Daejeon (5.9%) and Seoul (4.0%). We submitted 7 of the 14 D. immitis DNA-positive samples for sequencing analysis. All samples corresponded to partial D. immitis cytochrome c oxidase subunit I gene sequences with 99% homology to the D. immitis sequence deposited in GenBank (accession no. {"type":"entrez-nucleotide","attrs":{"text":"FN391553","term_id":"295980069","term_text":"FN391553"}}FN391553). To the best of our knowledge, this is the first survey using nested PCR to analyze the prevalence of D. immitis in stray cats in Korea.     

Subcutaneous phaeohyphomycosis due to Curvularia lunata in a renal transplant patient

BackgroundPhaeohyphomycosis is defined as an infection caused by melanized fungi. It predominates in tropical climate and is currently classified as superficial, allergic, central nervous system or lung infections, and disseminated. Curvularia is one of the many genres which can cause this disease. Phialophora, Alternaria and Exophiala are more commonly isolated from subcutaneous lesions.Case reportA 25-year-old male, renal transplant recipient presents with an ulcer on his left leg. Subcutaneous phaeohyphomycosis due to Curvularia lunata was diagnosed based on mycological examination and histopathological findings. He was successfully treated with systemic itraconazole and surgical resection.ConclusionThe incidence of phaeohyphomycosis has increased in the last decades, especially in immunosuppressed individuals; nevertheless the number of cases does not allow for therapeutic controlled trials to be performed. Hence, we consider that it is important to communicate individual cases and reviews of the literature, to increase awareness of the disease, its clinical presentation and response to treatment.     

Xenomonitoring of Different Filarial Nematodes Using Single and Multiplex PCR in Mosquitoes from Assiut Governorate,Egypt

Wuchereria bancrofti, Dirofilaria immitis, and Dirofilaria repens are filarial nematodes transmitted by mosquitoes belonging to Culex, Aedes, and Anopheles genera. Screening by vector dissection is a tiresome technique. We aimed to screen filarial parasites in their vectors by single and multiplex PCR and evaluate the usefulness of multiplex PCR as a rapid xenomonitoring and simultaneous differentiation tool, in area where 3 filarial parasites are coexisting. Female mosquitoes were collected from 7 localities in Assiut Governorate, were microscopically identified and divided into pools according to their species and collection site. Detection of W. bancrofti, D. immitis, and D. repens using single PCR was reached followed by multiplex PCR. Usefulness of multiplex PCR was evaluated by testing mosquito pools to know which genera and species are used by filarial parasites as a vector. An overall estimated rate of infection (ERI) in mosquitoes was 0.6%; the highest was Culex spp. (0.47%). W. bancrofti, D. immitis, and D. repens could be simultaneously and differentially detected in infected vectors by using multiplex PCR. Out of 100 mosquito pools, 8 were positive for W. bancrofti (ERI of 0.33%) and 3 pools each were positive for D. immitis and D. repens (ERI 0.12%). The technique showed 100% sensitivity and 98% specificity. El-Nikhila, El-Matiaa villages, and Sahel Seleem district in Assiut Governorate, Egypt are still endemic foci for filarial parasites. Multiplex PCR offers a reliable procedure for molecular xenomonitoring of filariasis within their respective vectors in endemic areas. Therefore, it is recommended for evaluation of mosquito infection after lymphatic filariasis eradication programs.     

Inhibition of Dirofilaria immitis in gregarine-infected Aedes aegypti: preliminary observations.

This study examined some of the effects of Ascocystis culicis infections in Aedes aegypti mosquitoes and on the development of dog heartworm, Dirofilaria immitis, in A. culicis-infected A. aegypti. Infections of 100 or more gregarines had an adverse effect on mosquito larvae and the resulting pupae weighed 1 to 2 mg less than the gregarine-free stock mosquitoes. Intensity of gregarine-induced pathology of adult mosquitoes was best estimated by counting the cells of the Malpighian tubules. Larvae infected with approximately 100 gregarines per larva had at least half the number of cells in their tubules destroyed, and development of D. immitis was greatly reduced. Thus, gregarine infections may be useful in reducing populations of aedine mosquitoes and, in areas endemic for heartworm, may interrupt transmission of D. immitis.     

A Rare Human Case of Dirofilaria repens Infection in the Subcutaneous Posterior Thorax with Molecular Identification

The emergence of Dirofilarial infections in Asia including Vietnam is a clinically significant threat to the community. We here report a rare case of subcutaneous Dirofilaria repens infection on the posterior thoracic wall in a young woman presenting a painful, itchy, and palpable nodule. The adult worm was identified by mitochondrial cox1 and nuclear ITS-2 sequence determination. The diagnosis was additionally confirmed by 16S rRNA sequencing of the endosymbiont Wolbachia pipientis commonly co-existing with D. repens. This is a rare case of subcutaneous human infection on the posterior thoracic region caused by D. repens.     

Phenotypic and molecular identification of Coccidioides posadasii in a patient evaluated for bilateral lung transplantation

BackgroundCoccidioidomycosis is an endemic fungal infection caused by Coccidioides immitis and Coccidioides posadasii. It can be particularly severe in transplant recipients that have a current or a previous coccidioidal infection. Fatal case of coccidioidomycosis has been described in this group of patients.AimsWe report a severe case of pneumonia caused by C. posadassi in a 29 year-old white woman that had been admitted to hospital as part of the evaluation for bilateral lung transplantation. The patient was a native and resident of Catamarca, Argentina. Molecular methodologies contributed to the species identification.MethodsClinical, laboratory records and microbiological tests were carried out to diagnose the infection and to identify C. posadasii.ResultsA fungus was isolated from BAL culture. Phenotypic characterization, specific PCR and experimental animal inoculation demonstrated the presence of C. posadasii. The patient responded well to amphotericin B deoxycholate. Lung transplantation was postponed.ConclusionsSpecific PCR can be an important alternative for the correct identification of C. immitis or C. posadasii in laboratories with implemented molecular biology tools. This case emphasizes the need for a systematic assessment in organ transplant units of patients inhabiting endemic areas of coccidioidomycosis.