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LETTER TO EDITOR
Year : 2014  |  Volume : 2  |  Issue : 2  |  Page : 113-114

A case of subconjunctival bancroftian filariasis


1 Department of Ophthalmology, Rajiv Gandhi Medical College, C.S.M. Hospital, Thane, Maharashtra, India
2 Department of Microbiology, Grant Medical College and Sir J J Group of Hospitals, Mumbai Maharashtra, India

Date of Web Publication11-Apr-2014

Correspondence Address:
Rakesh K Barot
12, Jyotinagar CHS, Four Banglows, Near RTO, Andheri West, Mumbai - 400 053, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2320-3897.130547

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How to cite this article:
Barot RK, Manglani NH, Pattiwar MS, Chande C. A case of subconjunctival bancroftian filariasis. J Clin Ophthalmol Res 2014;2:113-4

How to cite this URL:
Barot RK, Manglani NH, Pattiwar MS, Chande C. A case of subconjunctival bancroftian filariasis. J Clin Ophthalmol Res [serial online] 2014 [cited 2022 Jan 26];2:113-4. Available from: https://www.jcor.in/text.asp?2014/2/2/113/130547

Sir,

Human ocular infestation by live filarial worm is a rare occurrence. We report a case of subconjunctival adult Wuchereria bancrofti (W. bancrofti) worm, where the worm was removed live and intact. A 61-year-old female resident of Thane district (Maharashtra), presented to ophthalmology clinic with complaint of painless eyelids swelling and redness of the right eye since a week. The right eye revealed lid edema with ptosis, localized chemosis, and congestion of conjunctiva. On slit lamp examination, a slender, whitish, coiled, cord-like structure with movements was seen under the superior bulbar conjunctiva [Figure 1]. Her best corrected visual acuity was 6/9 in both the eyes. She had nuclear sclerosis of grade 1 in both the eyes and rest of the eye examination was normal. Systemic examination of the patient did not reveal any evidence of lymphangitis or any subcutaneous swellings or nodules.

Clinical diagnosis of a subconjunctival worm was made and its surgical removal was planned. After taking a small conjunctival incision over the swelling under subconjunctival infiltration anesthesia, the worm was gently pulled out with plain forceps taking care not to break it [Figure 2]. It appeared as a thread-like, milky white worm with a cylindrical body, and sent to microbiology department for species identification in 10% formal saline (v/v). Blood examination revealed normal hemogram and negative Microfilarial antibody test. Three consecutive night peripheral blood smears did not reveal any microfilariae and stool examination was normal.
Figure 1: Wuchereria bancrofti worm in superior subconjunctival space

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Figure 2: Surgical removal of the worm

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The worm was approximately 11 cm long with a maximum thickness of 0.3 cm with a smooth cuticle [Figure 3]. Although tapering toward both ends, the terminations were bluntly rounded. The posterior end was straight. The head was slightly swollen [Figure 4]. The parasite was identified by detailed morphologic study as an adult female worm of W. bancrofti. The patient was treated with tablet diethylcarbamazine (6 mg/kg/day) for 2 weeks.
Figure 3: Naked eye appearance of the worm

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Figure 4: Anterior end of Wuchereria bancrofti worm under microscope

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Filarial and filarial-like nematodes top the list of the nematodes that affect the eye.

W. bancrofti is a helminth belonging to phylum Nematoda. An estimated 108 million people in tropical and subtropical areas of the world are infected with bancroftian lymphatic filariasis. Usually, pathogenicity of W. bancrofti is limited to lymphangitis and elephantiasis. Rarely, extravascular site like eye is affected. Migration of adult worm to the subconjunctiva is an ocular accident and very rare. The exact mode of entry of the worm in eye is not known. The worm needs urgent removal, live and intact as (a) it is capable of migrating to deeper structures and could cause severe reaction (b) dead parasite may cause severe inflammation. During ocular worm removal, subconjunctival lignocaine may facilitate removal by paralyzing the worm. Gautret et al., and Nanavaty et al., [1],[2] have also reported adult worm of W. bancrofti subconjunctivally as in our case. They found microfilariae in the blood sample at night. In most filarial-like worms only females are seen infecting the human body as in our case. In bancroftian filariasis involvement of eyelids, anterior chamber, retina, uvea and vitreous has also been reported. [3],[ 4] Other worms found in the subconjunctival space are; Loa loa, Mansonella persantans, Thelazia callippoeda, and Guinea worm. [5]

This case highlights the importance of parasitological examination in the absence of microfilariae in blood to reach definitive diagnosis of the parasite. The case is reported to increase awareness of ocular bancroftian filariasis.

 
  References Top

1.Gautret P, Bain O, Gicquel JJ, Hue B, Kauffmann-Lacroix C, Rodier MH, et al. Subconjunctival localization of a Wuchereria bancrofti adult female. Bull Soc Pathol Exot 1999;92:104-6.  Back to cited text no. 1
    
2.Nanavaty MA, Nanavaty AJ, Lakhani JD, Lakhani SJ, Vasavada AR. Subconjuctival adult Bancroftian Filarial Worm. Indian J Ophthalmol 2001;49:195-6.  Back to cited text no. 2
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3.Samarasinghe S, Pathirana S. A juvenile filarial worm, Wuchereria bancrofti, extracted from the vitreous of the eye: The first report in the world literature. Ceylon Med J 2005;50:167-8.  Back to cited text no. 3
    
4.Ganesh SK, Babu K, Krishnakumar S, Biswas J. Ocular filariasis due to Wuchereria bancrofti presenting as panuveitis: A case report. Ocul Immumol Inflamm 2003;11:145-8.  Back to cited text no. 4
    
5.Bowler GS, Shah AN, Bye LA, Saldana M. Ocular loiasis in London 2008-2009: A case series. Eye 2011;25:389-91.  Back to cited text no. 5
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]



 

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