- Email: [email protected]
Intraocular filariasis due to Wuchereria bancrofti
MICROBIAL
317
KERATITIS
transplantation. Spectrum of pathogens, graft survival, and visual prognosis. Ophthalmology, 95, 1450-1457. Lamensdorf, M., Wilson, L. A., Waring, G. 0. III & Cavanagh, H. D. (1982). Microbial keratitis after penetrating keratoplasty. Ophthalmologv, 89 (supplement), 124. Paton, D. (1976). The prognosis of penetrating keratoplasty based upon cornea1 morphology. Ophthalmic Surgery, 7, 36-45. Robin, J. B., Gindi, J. J., Koh, K., Schanzlin, D. J., Rao, N. A., York, K. K. & Smith, R. E. (1986). An update of the indications for penetrating keratoplasty. Archives of Ophthalmology, 104, 87-89. Tavakkoli, H. & Sugar, J. (1994). Microbial keratitis following penetrating keratoplasty. Ophrhalmic Surgey, 25, 356-360.
TRANSACTIONS
Intraocular bancrofii
OF THE ROYAL
filariasis
SOCIETY
OF TROPICAL
MEDICINE
due to Wuchereria
Elizabeth Mathai’* and Sarada David’ Departments of ‘Microbiology and ‘Ophthalmology, Christian Medical College and Hospital, Vellore 632004, India Keywords: tilariasis, report, adult, India
Wuchereria bancrofti, intraocular,
case
Wuchereria bancrofii and Brugia malayi are common agents of lymphatic filariasis. However, even in endemic areas, ocular filariasis due to these worms is extremely rare (BEAVER, 1989). There are very few reports in the world literature in which this worm has been extracted from the eye and identified. We present the clinical features and parasitological findings in a patient with intraocular filariasis.
Tseng, S. H. & Ling, K. C. (1995). Late microbial keratitis after cornea1 transplantation. Cornea, 14,591-594. Tuberville, A. W. & Wood, T. 0. (1981). Cornea1 ulcers in comeal transplants. Current Eye Research, 1,479-485. Varley, G. A. & Meisler, D. M. (1991) Complications of penetrating keratoplasty: graft infections. JoumaZofRefractive and Comeal Surgery, 7,62-66. Wilson, S. E. & Kaufman, H. E. (1990). Graft failure after penetrating keratoplasty. Survey of Ophthalmology, 34, 325-356.
Received 27 August 1999; revised 15 December 1999; acceptedfor publication 15 December 1999 AND HYGIENE
(2000) 94,317-318
was a string of exudate connecting the worm and the anterior lens capsule. The posterior segment showed diffuse retinal pigmentepithelial disturbance and a patch of chorioretinitis infero-temporal to the disc. In the left eye, anterior and posterior segments were normal. The worm was removed surgically. Two clear cornea1 paracenteses were made, one at the 10 and the other at the 4 o’clock position. The pupil was constricted with intracameral pilocarpine. Methylcellulose was injected into the anterior chamber through one of the paracenteses and an anterior chamber maintainer was fixed. The worm was aspirated with a single-port cannula through the other paracentesis. The worm was a white nematode measuring about 2 cm X 0.1 mm. Both ends were bluntly rounded. The mouth was unarmed (Fig. 2) and the head had sessile papillae which were not very distinct. The posterior end (Fig. 3) was curved ventrally and showed unequal spi-
Case report A 20-year-old man presented to the Ophthalmology Clinic of Christian Medical College and Hospital, Vellore, with complaints of redness, irritation and diminished vision of l-week duration, in the right eye. On examination, vision was 6112 in the right eye and 61 6 in the left eye. Ocular motility was normal. The anterior segment showed cells, flare and keratic precipitates. An actively motile worm was seen bound to the anterior surface of the iris at the 5 o’clock position (Fig. 1). There Fig. 2. Anterior (X200).
end of W. bancrojii showing unarmed mouth
Fig. 1. W. bancrofti in the anterior chamber of the eye, as seen using slit lamp. *Author for correspondence: [email protected]
e-mail [email protected]
or
Fig. 3. Posterior (X200).
end of W. bancrofti showing
the spicules
318
ELIZABETH MATHAI AND SARADA DAVID
cules and thickening of the posterior wall of the cloaca. Hence the worm was identified as an adult male W. bancrofn’. The patient was given topical steroids and cycloplegics. He also received a course of diethylcarbamazine (DEC). The iridocyclitis subsided within 1 week of extraction of the parasite and the patient regained visual acuity of 616. Discussion
The exact sequence of events following entry of I%? larvae into the body is not yet clear. It is believed that they become localized in the lymphatic system and develop into adults. It is probable that the adults are capable of migration to different parts of the body (FAUST et al., 1970). The entry to the eye has to be haematogenous since the eye has no lymphatics. In this case,abnormalities were noted in both the posterior and anterior chambers. Whether the abnormalities were due to migration through these parts or to reactive inflammation is not clear. Intraocular filariasis is extremely rare. A recent review has counted 42 such cases, over a period of more than 100 years (BEAVER, 1989). Of these, only 1 case was positively identified as due to an adult W. bancroft; 4 others could have been due to an adult W. bancroft. Although a few more reports offinding W. bancrofn’in the eye exist, they lack supporting evidence of its identification. Of the 42 reports of intraocular filariasis, at least 11, including the confirmed W. bancrofn’ infection, are from different parts of India. At our centre, adult W. bancrofn’ worms were extracted from 2 other patients during the past 10 years (unpublished data). The worms can localize in different parts of the eye (BEAVER,1989). Eight of the previously reported Indian cases(WRIGHT, 1934; BHAGAWAT et aE., 1973; JOSEPH & RAJU, 1980; BEAVER, 1989), the 2 identified earlier in our institution and the present caseinvolved the anterior chamber. Infection may be asymptomatic, or may pre-
sent with impaired vision (THOMAS et al., 1978) as in our patient. Although some of the earlier reports record successful use of DEC treatment alone (THOMAS et al., 1978) it is possible that inflammation may be aggravated with the death of the worm (RODGER, 1987). Therefore extraction ofthe worm will be the ideal mode oftreatment. This is easily done if the worm is in the anterior chamber. Spontaneous disappearance of the worm is also described (BEAVER, 1989).
bancrofii
/ Announcement
Acknowledgement The authors thank John Williams and David Warhnrst of the Parasitic Diagnostic Laboratory, London School of Hygiene and Tropical Medicine, for confirming the identity of the worm. References Beaver, P. C. (1989). Intraocular filariasis-a brief review. AmericanJoumalof Tropical Medicine and Hygiene, 40,40-45. Bhagawat, R. O., Rao, L. K. & Deodhar, L. P. (1973). Parasite in the anterior chamber of eye. A casereport. IndianJournaZof Ophthalmology, 21,34-35. Faust, E. C., Russell, P. F. & Jung, R C. (1970). Phasmid nematode parasites of man. In: Craig and Faust’s Clinical ParasitoZogy.Philadephia: Lea and Febiger, pp. 361-404. Joseph, A. & Raju, N. S. D. (1980). Immamre stage of W. bancrofn’in human eye. Indian Journal of Ophthalmology, 28, 89-90. Rodger, F. C. (1987). Eye diseases. In: Manson’s Tropical Diseases, 19th edition, Manson-Bahr, P. E. C. & Bell, D. R. (editors). London: Bailliire-Tindall, pp. 1133-l 182. Thomas, A., Oommen, M. M. & Alexander, J. A. (1978). Intraocular filariasis. Zndian Journal of Ophthalmology, 25, 43-45. Wright, R. E. (1934). Adult filaria ( Wuchereria bancrofi) in the anterior chamber. British 3oumal of Ophthalmology, 18, 646-650. Received
16 November
1999; accepted for publication
January 2000
1
Utilising Advance
the Genome Sequence of Parasitic Protozoa Notice of a Royal Society Discussion Meeting 21-22 March 2001
Organized by K. Vickerman, FRS, J. Blackwell, C. Newbold and C. M. R. Turner For further information contact Mike Turner, Institute of Biomedical and Life Sciences, Division of Infection and Immunity, Joseph Black Building, University of Glasgow, Glasgow G12 8QQ, UK; e-mail [email protected]
14
317
KERATITIS
transplantation. Spectrum of pathogens, graft survival, and visual prognosis. Ophthalmology, 95, 1450-1457. Lamensdorf, M., Wilson, L. A., Waring, G. 0. III & Cavanagh, H. D. (1982). Microbial keratitis after penetrating keratoplasty. Ophthalmologv, 89 (supplement), 124. Paton, D. (1976). The prognosis of penetrating keratoplasty based upon cornea1 morphology. Ophthalmic Surgery, 7, 36-45. Robin, J. B., Gindi, J. J., Koh, K., Schanzlin, D. J., Rao, N. A., York, K. K. & Smith, R. E. (1986). An update of the indications for penetrating keratoplasty. Archives of Ophthalmology, 104, 87-89. Tavakkoli, H. & Sugar, J. (1994). Microbial keratitis following penetrating keratoplasty. Ophrhalmic Surgey, 25, 356-360.
TRANSACTIONS
Intraocular bancrofii
OF THE ROYAL
filariasis
SOCIETY
OF TROPICAL
MEDICINE
due to Wuchereria
Elizabeth Mathai’* and Sarada David’ Departments of ‘Microbiology and ‘Ophthalmology, Christian Medical College and Hospital, Vellore 632004, India Keywords: tilariasis, report, adult, India
Wuchereria bancrofti, intraocular,
case
Wuchereria bancrofii and Brugia malayi are common agents of lymphatic filariasis. However, even in endemic areas, ocular filariasis due to these worms is extremely rare (BEAVER, 1989). There are very few reports in the world literature in which this worm has been extracted from the eye and identified. We present the clinical features and parasitological findings in a patient with intraocular filariasis.
Tseng, S. H. & Ling, K. C. (1995). Late microbial keratitis after cornea1 transplantation. Cornea, 14,591-594. Tuberville, A. W. & Wood, T. 0. (1981). Cornea1 ulcers in comeal transplants. Current Eye Research, 1,479-485. Varley, G. A. & Meisler, D. M. (1991) Complications of penetrating keratoplasty: graft infections. JoumaZofRefractive and Comeal Surgery, 7,62-66. Wilson, S. E. & Kaufman, H. E. (1990). Graft failure after penetrating keratoplasty. Survey of Ophthalmology, 34, 325-356.
Received 27 August 1999; revised 15 December 1999; acceptedfor publication 15 December 1999 AND HYGIENE
(2000) 94,317-318
was a string of exudate connecting the worm and the anterior lens capsule. The posterior segment showed diffuse retinal pigmentepithelial disturbance and a patch of chorioretinitis infero-temporal to the disc. In the left eye, anterior and posterior segments were normal. The worm was removed surgically. Two clear cornea1 paracenteses were made, one at the 10 and the other at the 4 o’clock position. The pupil was constricted with intracameral pilocarpine. Methylcellulose was injected into the anterior chamber through one of the paracenteses and an anterior chamber maintainer was fixed. The worm was aspirated with a single-port cannula through the other paracentesis. The worm was a white nematode measuring about 2 cm X 0.1 mm. Both ends were bluntly rounded. The mouth was unarmed (Fig. 2) and the head had sessile papillae which were not very distinct. The posterior end (Fig. 3) was curved ventrally and showed unequal spi-
Case report A 20-year-old man presented to the Ophthalmology Clinic of Christian Medical College and Hospital, Vellore, with complaints of redness, irritation and diminished vision of l-week duration, in the right eye. On examination, vision was 6112 in the right eye and 61 6 in the left eye. Ocular motility was normal. The anterior segment showed cells, flare and keratic precipitates. An actively motile worm was seen bound to the anterior surface of the iris at the 5 o’clock position (Fig. 1). There Fig. 2. Anterior (X200).
end of W. bancrojii showing unarmed mouth
Fig. 1. W. bancrofti in the anterior chamber of the eye, as seen using slit lamp. *Author for correspondence: [email protected]
e-mail [email protected]
or
Fig. 3. Posterior (X200).
end of W. bancrofti showing
the spicules
318
ELIZABETH MATHAI AND SARADA DAVID
cules and thickening of the posterior wall of the cloaca. Hence the worm was identified as an adult male W. bancrofn’. The patient was given topical steroids and cycloplegics. He also received a course of diethylcarbamazine (DEC). The iridocyclitis subsided within 1 week of extraction of the parasite and the patient regained visual acuity of 616. Discussion
The exact sequence of events following entry of I%? larvae into the body is not yet clear. It is believed that they become localized in the lymphatic system and develop into adults. It is probable that the adults are capable of migration to different parts of the body (FAUST et al., 1970). The entry to the eye has to be haematogenous since the eye has no lymphatics. In this case,abnormalities were noted in both the posterior and anterior chambers. Whether the abnormalities were due to migration through these parts or to reactive inflammation is not clear. Intraocular filariasis is extremely rare. A recent review has counted 42 such cases, over a period of more than 100 years (BEAVER, 1989). Of these, only 1 case was positively identified as due to an adult W. bancroft; 4 others could have been due to an adult W. bancroft. Although a few more reports offinding W. bancrofn’in the eye exist, they lack supporting evidence of its identification. Of the 42 reports of intraocular filariasis, at least 11, including the confirmed W. bancrofn’ infection, are from different parts of India. At our centre, adult W. bancrofn’ worms were extracted from 2 other patients during the past 10 years (unpublished data). The worms can localize in different parts of the eye (BEAVER,1989). Eight of the previously reported Indian cases(WRIGHT, 1934; BHAGAWAT et aE., 1973; JOSEPH & RAJU, 1980; BEAVER, 1989), the 2 identified earlier in our institution and the present caseinvolved the anterior chamber. Infection may be asymptomatic, or may pre-
sent with impaired vision (THOMAS et al., 1978) as in our patient. Although some of the earlier reports record successful use of DEC treatment alone (THOMAS et al., 1978) it is possible that inflammation may be aggravated with the death of the worm (RODGER, 1987). Therefore extraction ofthe worm will be the ideal mode oftreatment. This is easily done if the worm is in the anterior chamber. Spontaneous disappearance of the worm is also described (BEAVER, 1989).
bancrofii
/ Announcement
Acknowledgement The authors thank John Williams and David Warhnrst of the Parasitic Diagnostic Laboratory, London School of Hygiene and Tropical Medicine, for confirming the identity of the worm. References Beaver, P. C. (1989). Intraocular filariasis-a brief review. AmericanJoumalof Tropical Medicine and Hygiene, 40,40-45. Bhagawat, R. O., Rao, L. K. & Deodhar, L. P. (1973). Parasite in the anterior chamber of eye. A casereport. IndianJournaZof Ophthalmology, 21,34-35. Faust, E. C., Russell, P. F. & Jung, R C. (1970). Phasmid nematode parasites of man. In: Craig and Faust’s Clinical ParasitoZogy.Philadephia: Lea and Febiger, pp. 361-404. Joseph, A. & Raju, N. S. D. (1980). Immamre stage of W. bancrofn’in human eye. Indian Journal of Ophthalmology, 28, 89-90. Rodger, F. C. (1987). Eye diseases. In: Manson’s Tropical Diseases, 19th edition, Manson-Bahr, P. E. C. & Bell, D. R. (editors). London: Bailliire-Tindall, pp. 1133-l 182. Thomas, A., Oommen, M. M. & Alexander, J. A. (1978). Intraocular filariasis. Zndian Journal of Ophthalmology, 25, 43-45. Wright, R. E. (1934). Adult filaria ( Wuchereria bancrofi) in the anterior chamber. British 3oumal of Ophthalmology, 18, 646-650. Received
16 November
1999; accepted for publication
January 2000
1
Utilising Advance
the Genome Sequence of Parasitic Protozoa Notice of a Royal Society Discussion Meeting 21-22 March 2001
Organized by K. Vickerman, FRS, J. Blackwell, C. Newbold and C. M. R. Turner For further information contact Mike Turner, Institute of Biomedical and Life Sciences, Division of Infection and Immunity, Joseph Black Building, University of Glasgow, Glasgow G12 8QQ, UK; e-mail [email protected]
14