| A case is reported of a 32-year-old traveller with loiasis, schistosomiasis and African trypanosomiasis. The patient had been working in oil exploration in nigeria and gabon and presented with Calabar swellings and carpal tunnel syndrome. serology for all 3 diseases was positive but microfilariae of loa loa and ova of schistosomiasis were not found. Treatment with diethylcarbamazine and praziquantel was given for loiasis and schistosomiasis respectively. Trypanosomes were isolated from a lymph node aspirate only after repetition of the procedure 2 months later and the patient was treated with suramin. He developed a drug induced nephritis and was then treated successfully with alpha-difluoromethylornithine. There is a discussion of the difficulties encountered making these diagnoses in Europeans particularly where there are atypical clinical features. The risks of rural work in West africa are noted and the importance of considering all parasitic diseases relevant to the travel/occupational history is emphasised. ( info) |
| Five cases of encephalitis following treatment with diethylcarbamazine (DEC) were observed in Congolese patients with loa loa filariasis. Two cases had a fatal outcome and one resulted in severe sequelae. The notable fact was that this complication occurred in three patients hospitalized before treatment began, with whom particularly strict therapeutic precautions were taken, i.e., initial dose less than 10 mg of DEC, very gradual dose increases, and associated anti-allergic treatment. This type of drug-induced complication may not be that uncommon in highly endemic regions. It occurs primarily, but not exclusively, in subjects presenting with a high microfilarial load. The relationship between the occurrence of encephalitis and the decrease in microfilaremia is evident. The pathophysiological mechanisms are discussed in the light of these observations and the few other comments on this subject published in the literature. ( info) |
13/36. Microfilarial polyarthritis in a massive loa loa infestation. A case report. A Cameroonian affected with massive loa loa infection developed febrile arthritis with involvement of both knees and the left ankle. Although the patient was first seen by us after one month of treatment with indomethacin, at this time the joints were still inflamed and microfilariae of loa loa were found in the synovial fluid. No other etiological mechanism was identified. Following the articular puncture and treatment with ketoprofen, the arthritis subsisted within a week. This is the first case to be studied in which arthritis during loasis has been explicitly documented by the presence of intra-articular microfilariae. ( info) |
14/36. Occular loiasis in a Zambian woman. Asymptomatic infection with loa loa, an eye worm, is reported in a 32-year old Zambian woman. The patient revealed up to 28% eosinophilia but microfileraemia was not noticed. One gravid female parasite 56 X 0.56 mm, extracted from lower lid of left eye of the patient, is described. Treatment with diethylcarbamazine (DEC) extended over three weeks was successful against another parasite in tissues. ( info) |
15/36. Calcifications in the breast in Filaria loa infection. A 40-year-old patient underwent mammography for evaluation of a mass. Atypical calcifications were observed in the opposite breast. Two types of calcification were observed: one type was spiral-shaped and the other type rod-shaped. These calcifications were caused by Filaria loa. Parasitic calcifications in the breast are uncommon. ( info) |
16/36. loa loa in a Sri Lankan expatriate from nigeria. A worm was extracted from the subconjunctival space of the left eye in a 14-year old Sri Lankan girl, who returned to sri lanka in 1983 after spending six years in nigeria. It was identified as a male loa loa. A history of evanescent (Calabar) swellings was obtained. She also had significant eosinophilia. Microfilariae were not detected in the blood. This is the first case of loa loa infection reported from sri lanka. ( info) |
17/36. Loaiasis (loa loa) in an African student in indiana. Loaiasis was seen in an African student in indiana, who had non-specific complaints, leukocyte count of 8,400/mm3, a 47% eosinophilia, and a high loa loa microfilaremia. Successful treatment with diethylcarbamazine (Hetrazan) produced no allergic manifestations and no reactions to the adult parasites were evident. ( info) |
18/36. Treatment of recurrent, filarial, Calabar-type oedema with mebendazole. A case of recurrent, severe filarial Calabar-type oedema, causing acute discomfort in the patient, is described in a male Caucasian. An adult loa loa worm but no microfilariae were present while dipetalonema perstans microfilaraemia was extremely low. Treatment with mebendazole (1.5 g per day) for 21 days led to the disappearance of the clinical symptoms and microfilariae, and to a decrease of eosinophilia to normal values. ( info) |
19/36. loiasis in an expatriate American child: diagnostic and treatment difficulties. On the basis of this experience, we recommend the following when faced with possible filariasis in an expatriate from Western Central africa: (1) Attempt a clinical differentiation between L loa and other filarial infections present in West africa. It is important to suspect loiasis because this is the only filarial infection that is readily curable; (2) ophthalmologic assessment to diagnose onchocerciasis; (3) if L loa is suspected, thick blood smears should be obtained from midmorning to midafternoon and stained with Giemsa or hematoxylin stains, after a concentration technique is used. Nighttime blood specimens should be obtained if the patient has been in an area where W. bancrofti is prevalent; (4) skin snip biopsies prepared as follows: Bilateral symmetrical skin snips should be taken. In the case of suspected West African filariasis, the pelvic girdle, iliac crest, and back of scapula are thought to have the highest yield. One snip from each of six different sites should be obtained. Each skin snip should be approximately 2 to 3 mm (a cornealoscleral biopsy forceps can be used). Each skin snip is placed in 100 microL (approximately one drop) of normal saline in a flat-bottomed microtiter plate. The plate is incubated at room temperature and checked periodically for 24 hours under a dissecting microscope (X20 to X40). If present, the small worms will be seen wiggling and squirming in the drop of saline; (5) serologic diagnostic methods are most efficient if human filarial antigens are used; (6) if treatment is with diethylcarbamazine, the initial dose should be small.(ABSTRACT TRUNCATED AT 250 WORDS) ( info) |
20/36. loiasis: "Calabar" swellings and involvement of deep organs. The authors report clinical and histopathologic changes in six patients with symptomatic loiasis. One patient had cutaneous swellings, three patients presented with hydrocele, one patient developed bowel obstruction, and one had generalized fatal loiasis. The first five patients had localized lesions provoked by adult worms; all were surgically removed. The sixth patient died of disseminated loiasis that included a severe loal encephalitis. The authors discuss the mechanism of "Calabar" swellings, the reaction to adult loa loa worms and loal encephalitis. ( info) |