Monday, October 1, 2018

Case of the Week 513

This week features our monthly case from Idzi Potters and the Institute of Tropical Medicine, Antwerp. A Nigerian male patient, returns to Belgium, after having visited his relatives. He presents at the hospital, where a worm was extracted from his eye (length: 5 cm).
In a drop of blood, live “larvae” were seen.
A KNOTT concentration was made and stained with Carazzi’s to visualize the details.
The “larvae” are measuring (on average) 280 ┬Ám in length.

Diagnosis please?


Anonymous said...

For sure this is a classical "eye worm" of Central West Africa. The microfilarium is sheathed, the sheath does not stain with Giemsa stain, the empty cephalic space is relatively short. A long empty caudal space is present. The terminal caudal nuclei though faint can be discerned at the end of the tail inside the sheath.
This make the organism consistent with Loa loa.
Florida Fan

Anonymous said...

Naive question: By "in a drop of blood" does that mean that many drops were examined and this one contained "larvae" or that they are so ubiquitous that pretty much any drop will show the parasite?

Idzi P. said...

Good question!
The larvae would be found in every drop of blood! They were quite abundantly present!
(4232 larvae per mL!!!)

Andrea Zambrano said...

Loa loa??

Old One said...

Adult filarid who's length falls within the range of both male and female Loa loa. Several images of sheathed microfilaria which are in the size range of those of Loa loa. The infection could well have been picked up while visiting Nigeria (endemic for Loa loa).

I believe the infection is from Loa loa

Old One said...

Question? Do the microfilaria have a noticeable periodicity and is that normally taken into consideration when sampling patients?

Anonymous said...

Onchocerca volvulus

Blaine A. Mathison said...

Yes, this time it is Loa loa (Idzi sure has an 'eye' for parasites).

Old One, this species has diurinal periodicity, with the optimal time to take blood between 10AM and 2PM (give or take).

Agnes said...

That is Loaloa with the characteristic body nuclei up to the tail end.