Dirofilariasis Presenting as ABSCESS

Nikhila Raj K2nd MBBS

Primary Case Presentation -•Patient presented with

swelling on the lateral aspect of the distal 1/3'rd of L forearm/E oval swelling of size 3.5x2.5cm, cystic, mildly tender with minimal signs of inflammation.

Past History and Laboratory Evaluations

•Past History of Pulmonary tuberculosis •Present History of Diabetes mellitus under control

•All Laboratory Parameters are in Normal Limits

Decision to Incision and Drinage

•Patient undergoes a Surgical Intervention an Incision and Drainage was done

On macroscopic observation a long parasite was embedded in the pus

On incision and drainage of the abscess an approximately 15 cm long filamentous macroscopic parasite was extracted sent intact in Normal saline, to Microbiology Department

The identified parasite is placed on linen at the site of the Operation

site

A long parasite of 15 cm was extracted without damage to the physical structure •An approximately 15 cm long filamentous macroscopic parasite was extracted sent intact in Normal saline, to Microbiology

Measuring the parasite in the Microbiology Department

•Microbiology Department A primary identification is done as Dirofilariasis spp on the basis of its macroscopic and microscopic appearance,

About the Dirofilasis •Human dirofilariasis is an uncommon zoonotic infection having a widespread geographical distribution. World over 800 cases of Dirofilariasis are on record with highest numbers from Italy, Sri Lanka and republics of the ex-Soviet Union .

The Tail End of the Parasite as seen in the

Photomicrograph

Histopathology sections and Photomicrographs

Histopathology sections and Photomicrograph

As reported from CDC – Atlanta USA

• Based on the images, we agree this is a female Dirofilaria (possibly D. repens in India), as indicated by tall, polymyarian musculature, external cuticular ridges, and paired reproductive tubes.

Few Cases are Presented and

Documented in India

Discussion •Dirofilariasis is a nematode parasite that causes

heartworm disease in dogs, cats and ferrets. Heartworm disease is transmitted by mosquito bites and there are more than 70 species of mosquito that are able to transmit infection; Aedes, Anopheles and Culex are the most common vector species. Heartworm disease has been reported in many countries with temperate climate and is particularly prevalent in the USA, Canada, and southern Europe.

There are Reports of Increasing Incidences of

Dirofilariasis •Though human dirofilariasis as a zoonotic infection is thought to be rare, cases are being increasingly reported in the past few years making it a case for consideration as an emerging zoonosis in many parts of the world .Reference 1

There are Reports of Increasing Incidences of Dirofilariasis

• In India though Dirofilaria cases are being reported occasionally, the number of cases is gradually increasing. While most of the cases reported from India are due to infection with D. repens, some of the D. immitis and D. tenuis infections have also been reported.[9,10] It is the South part of India,( Reference 2)

Patient treated with •Antibiotics•Ivermecitin •Patient made recovery within 1 week of Surgical intervention without any relapse to this date

In Conclusion • There is still a pressing need for effective adulticide

treatment for human and animal filarial infections. Like many filarial nematodes, Dirofilaria immitis, the causative agent of canine heartworm disease, harbours the bacterial endosymbiont Wolbachia, which has been shown to be essential for worm development, fecundity and survival. • High level of clinical suspicion will have a effective Diagnosis and cure with

optimal treatments

The Case Study Supported by my Teachers at Travancore Medical

College Kollam • 1 Dr Joseph Francis Department of Surgery

2 Dr Arun Raj Department of Medicine 3 Dr Subhas Abhraham Department of Pathology 4 Dr.T.V.Rao Department of Microbiology

• I am thankful to Medical Director /Principal/ Vice Principal / Medical Superindent for the support

and encouragment

References • 1 Human dirofilariasis: an emerging zoonosis in India Reshma G. Kini, J. B.

Leena, Prathvi Shetty, Raphael Hart Lyngdoh, D. Sumanth, Lovely George Journal of Parasitic Diseases June 2015, Volume 39, Issue 2, pp 349-354 2 Human dirofilariasis: An emerging zoonosis Maryada Venkatarami Reddy -Trop Parasitol. 2013 Jan-Jun; 3(1): 2–3.• 3 . Human pulmonary dirofilariasis in India: a case report. Badhe BP, Sane

SY. Human pulmonary dirofilariasis in India: A case report. J Trop Med Hyg. 1989;92:425–6.

4Human dirofilariasis.Bhat KG, Wilson G, Mallya S.Bhat KG, WilsonG ,Mallya S. Human dirofilariasis. Indian J Med Microbiol. 2003;21:65