Cases reported "Eye Infections, Parasitic"

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1/12. Palpebral myiasis.

    myiasis is most prevalent in mexico, central and south america, tropical africa, and the southwestern united states. Although dermal myiasis is rare in most of the United States, it is a disorder that may be seen in international travelers. In the United States, external myiasis is usually caused by the cattle botfly. We report here a case of ophthalmomyiasis involving the left upper eyelid of a child. We examined a six-year-old boy who presented to the massachusetts eye and ear Infirmary (MEEI) in September 1998. He complained of persistent swelling of his left upper eyelid for the previous ten days. The edema and erythema were unresponsive to warm compresses and oral antibiotics. Ocular examination revealed a mild preseptal cellulitis of the left upper eyelid with a small draining fistula. On slit-lamp examination, we found one larva protruding intermittently from the fistula site. The larva was extracted with forceps, wrapped in a moist towel and sent in a jar to the parasitology laboratory. The specimen was identified as a Cuterebra larva by a parasitologist at the Harvard School of public health. One week later, the patient's eyelid edema and erythema had completely resolved.
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2/12. An outbreak of trematode-induced granulomas of the conjunctiva.

    PURPOSE: To describe the epidemiologic, clinical, and histopathologic features of trematode granulomas of the conjunctiva, eyelid, and anterior chamber in pediatric patients. DESIGN: Prospective noncomparative case series. PARTICIPANTS: Forty-one children from a southern Indian village with conjunctival granulomas. methods: The village of Sellananthal was selected for a field visit after analysis of earlier hospital-based allergic conjunctival granuloma cases. Children with ocular diseases were examined, and histories of exposure to assumed risk factors and clinical findings were evaluated. Selected patients were brought to the base hospital for excisional biopsy. Serial sections obtained from the excised nodules were examined for the presence of a parasite. MAIN OUTCOME MEASURES: Histopathologic examination of excised conjunctival lesions or response of lesions to local medical therapy. RESULTS: In this year-long prospective study, 41 children (16 years or younger; 38 boys and 3 girls) with clinical features of allergic conjunctival granulomas were examined. Thirty-four patients were from a single village located in the southern Indian state of Tamil Nadu; the remaining 7 were from various parts of the same state. All children swam in their village's freshwater pond. Twenty patients with nodules less than 5 mm in diameter received medical treatment; 13 with larger nodules underwent surgical excision of the lesions. Nine of these 13 cases revealed a zonal granulomatous inflammation admixed with eosinophilic leukocytes; 4 of these 9 displayed fragments of the tegument and internal structures of a trematode and Splendore-Hoeppli phenomenon. The remaining 4 of the 13 cases revealed nongranulomatous inflammation made up of lymphocytes, histiocytes, and eosinophils. Eight patients refused surgical treatment. CONCLUSIONS: In southern india, one cause of allergic conjunctival granulomas in children seems to be trematode infection. The clustering of cases in a single village and exposure to a village freshwater pond indicate the need for an epidemiologic investigation and study of the parasite's life cycle. Sporadic cases from other parts of the state with similar histories of exposure to their local pond or river water suggest a widespread distribution of the etiologic agent.
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3/12. Case report: ophthalmomyiasis externa in Dallas County, texas.

    Ophthalmomyiasis externa is an uncommon condition in north america. If not recognized and managed accordingly, it can be complicated by the potentially fatal condition ophthalmomyiasis interna. Ophthalmomyiasis externa is mainly caused by the sheep bot fly Oestrus ovis; thus, it is more common in farming communities. We report a case of ophthalmomyiasis externa in a young woman from Dallas County, texas, who had no known history of contact with farm animals.
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4/12. Internal ophthalmomyiasis presenting as endophthalmitis associated with an intraocular foreign body.

    Ophthalmomyiasis interna infestation by fly larva can present in various forms. A 3-year-old girl with a 15-day history of pain, redness, and tearing of the right eye was referred to our clinic with the diagnosis of endophthalmitis associated with an intraocular foreign body, based on clinical and ultrasonographic findings. The patient underwent pars plana vitrectomy, during which an 8-mm long larva was encountered within the vitreous cavity. It was removed and identified as a cattle botfly. The patient developed a retinal detachment 1 month postoperatively, but the family refused further treatment and the patient was lost to follow-up. Ophthalmomyiasis should be included in the differential diagnosis of endophthalmitis and intraocular foreign bodies in patients from rural areas.
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5/12. Ophthalmomyiasis caused by the reindeer warble fly larva.

    Two boys with ophthalmomyiasis caused by the first instar larva of the reindeer warble fly Hypoderma tarandi are reported. Both were 9 years old and came from the coast of northern norway. One had ophthalmomyiasis interna posterior and one eye had been removed because of progressive pain and blindness. Histological examination showed the remains of a fly larva. The second boy had ophthalmomyiasis externa with a tumour in the upper eyelid, and histological examination showed a warble with a well preserved larva. Identification of the parasite in the histological material was based on the finding of cuticular spines and parts of the cephalopharyngeal skeleton identical with those of the first instar larva of H tarandi.
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6/12. Ophthalmomyiasis interna lentis.

    An examination in 1981 of a 62-year-old white woman, who had had decreased vision in the right eye since she was 11 years old, revealed the typical retinal findings of ophthalmomyiasis. The larval exoskeleton was found imbedded temporally in the lens. On reexamination in 1989 no change was found.
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7/12. Acute posterior ophthalmomyiasis interna treated with photocoagulation.

    PURPOSE/methods: We studied a patient with subretinal myiasis with pain and rapidly progressive visual loss and found that prompt photocoagulation resulted in marked visual improvement. A 16-year-old boy had subconjunctival hemorrhage and periocular pain associated with progressive visual loss of 6/200 over a four-day period. RESULTS/CONCLUSIONS: A live maggot found crawling in the subretinal space was promptly photocoagulated with an argon green laser. Within one month, the visual acuity improved to 20/50. Laser treatment of a subretinal larva does not generally induce marked inflammation and often results in good visual recovery.
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8/12. An unusual retinal pigment epitheliopathy endemic to the island of guam.

    An unusual retinal pigment epitheliopathy resembling ophthalmomyiasis interna posterior (OMI) is endemic to guam. Sixteen percent of a sample of the indigenous population were found to have the retinopathy. Fifty-two percent of a group of individuals suffering from amyotrophic lateral sclerosis/Parkinsonism-dementia complex (ALS/PDC) were found to have the same retinopathy. Although the retinal appearance is similar to that caused by a subretinal parasite, a definite etiology has not been identified. Three case reports are presented as samples of the clinical presentation of the condition.
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9/12. Pathologic findings in the retinal pigment epitheliopathy associated with the amyotrophic lateral sclerosis/parkinsonism-dementia complex of guam.

    BACKGROUND: A pigment epitheliopathy that resembles ophthalmomyiasis interna occurs in approximately 10% of a large sample of the Chamorro population of guam age 39 years or older; the rate is approximately 50% among those who have amyotrophic lateral sclerosis or Parkinsonism-dementia complex (lytico bodig). methods: Since publication of an earlier clinical report of affected patients, several of them have died of their neurologic disease, and their eyes were obtained for pathologic study. This is the first pathologic report of the retinal pigment epitheliopathy seen in the setting of amyotrophic lateral sclerosis/Parkinsonism-dementia complex of guam and is based on examination of 13 eyes from 7 patients. RESULTS/CONCLUSION: Focal areas of attenuation of the retinal pigment epithelium in association with a reduced amount of intracellular pigment correlated with the funduscopic and gross appearance. No larvae were seen, and there was no evidence of inflammation. The pathogenesis of this pigment epitheliopathy remains undetermined.
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10/12. Pars plana vitrectomy for retinal detachment due to internal posterior ophthalmomyiasis after cataract extraction.

    BACKGROUND: The authors report a case of posterior internal ophthalmomyiasis causing vitreous haemorrhage and retinal detachment after uncomplicated cataract extraction. CASE REPORT: The patient suffered an abrupt vitreous haemorrhage 9 days after ECCE and posterior chamber IOL implantation. After 2 months the haemorrhage did not clear up and a retinal detachment arose. The patient underwent encircling scleral buckle, pars plana vitrectomy and fluid-gas exchange. In course of intervention the surgeon removed from the vitreous chamber a 14-mm-long round worm subsequently identified as a dipterous larva of the sarcophagidae family. DISCUSSION: The patient showed no sign of subretinal tracking or retinal breaks or holes. The sclerocorneal surgical wound seems the most likely site of entrance of the parasite, and this would then be the first reported case of myiasis with no RPE tracking.
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