Ocular Loiasis
Anish N. Shah, M.B., B.S., and Manuel Saldana, M.D.
N Engl J Med 2010; 363:e16September 9, 2010
A 21-year-old woman presented to our hospital with the sensation of something moving in her eye. She reported having no systemic or visual symptoms. Her medical history was notable only for a trip abroad to Nigeria 6 years earlier. On examination, a live worm, 2 cm in length, was seen in the superior subconjunctival space of the left eye (see the video, available at NEJM.org). It was removed (see video) and identified as a male Loa loa worm. Blood testing revealed microfilaremia and antifilarial antibodies. The patient received systemic therapy with corticosteroids and diethylcarbamazine. L. loa is a nematode whose larvae are introduced into humans (such as our patient) who have been bitten by infected chrysops flies in areas of western equatorial Africa. Over a period of 3 to 4 years, the larvae mature into adult worms, which can then live for up to 17 years in a human host, moving at speeds of up to 1 cm per minute as they roam through the patient's subcutaneous tissues. Although localized inflammation (Calabar swellings) may occur, major tissue damage is rare.
Anish N. Shah, M.B., B.S.
Manuel Saldana, M.D.
St. Thomas' Hospital, London, United Kingdom
open here to see the video and the explanation, and more images in clinical medicine:
http://www.nejm.org/doi/full/10.1056/NEJMicm1002020
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