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Dirofilariasis Presenting as
ABSCESS
2nd MBBS
Primary Case Presentation -
• Patient presented with
swelling on the lateral
aspect of the distal 1/3'rd
of L forearm/E oval
swelling of size
3.5x2.5cm, cystic, mildly
tender with minimal
signs of inflammation.
Past History and Laboratory Evaluations
•Past History of Pulmonary tuberculosis
• Present History of Diabetes mellitus under control
• All Laboratory Parameters are in Normal Limits
Decision to Incision and Drinage
•Patient undergoes
a Surgical
Intervention
an Incision and
Drainage was
done
On macroscopic observation a long parasite
was embedded in the pus
On incision and drainage of the
abscess an approximately 15 cm long
filamentous macroscopic parasite
was extracted sent intact in Normal
saline, to Microbiology Department
The identified parasite is placed on linen at the
site of the Operation site
A long parasite of 15 cm was extracted without
damage to the physical structure
•An approximately 15
cm long filamentous
macroscopic
parasite was
extracted sent intact
in Normal saline, to
Microbiology
Measuring the parasite in the Microbiology
Department
•Microbiology
Department A primary
identification is done
as Dirofilariasis spp on
the basis of its
macroscopic and
microscopic
appearance,
About the Dirofilasis
•Human dirofilariasis is an uncommon
zoonotic infection having a widespread
geographical distribution. World over
800 cases of Dirofilariasis are on record
with highest numbers from Italy, Sri
Lanka and republics of the ex-Soviet
Union .
The Tail End of the Parasite as seen in the
Photomicrograph
Histopathology sections and
Photomicrographs
Histopathology sections and
Photomicrograph
As reported from CDC – Atlanta USA
• Based on the images, we agree this
is a female Dirofilaria (possibly D.
repens in India), as indicated by tall,
polymyarian musculature, external
cuticular ridges, and paired
reproductive tubes.
Few Cases are Presented and
Documented in India
Discussion
• Dirofilariasis is a nematode parasite that causes
heartworm disease in dogs, cats and ferrets.
Heartworm disease is transmitted by mosquito bites
and there are more than 70 species of mosquito that
are able to transmit infection; Aedes, Anopheles and
Culex are the most common vector species.
Heartworm disease has been reported in many
countries with temperate climate and is particularly
prevalent in the USA, Canada, and southern Europe.
There are Reports of Increasing Incidences
of Dirofilariasis
•Though human dirofilariasis as a zoonotic
infection is thought to be rare, cases are
being increasingly reported in the past few
years making it a case for consideration as
an emerging zoonosis in many parts of the
world .Reference 1
There are Reports of Increasing Incidences of
Dirofilariasis
•In India though Dirofilaria cases are being
reported occasionally, the number of cases is
gradually increasing. While most of the cases
reported from India are due to infection with D.
repens, some of the D. immitis and D. tenuis
infections have also been reported.[9,10] It is
the South part of India,( Reference 2)
Patient treated with
•Antibiotics
•Ivermecitin
•Patient made recovery within 1 week of
Surgical intervention without any
relapse to this date
In Conclusion
• There is still a pressing need for effective adulticide
treatment for human and animal filarial infections.
Like many filarial nematodes, Dirofilaria immitis, the
causative agent of canine heartworm disease,
harbours the bacterial endosymbiont Wolbachia,
which has been shown to be essential for worm
development, fecundity and survival.
• High level of clinical suspicion will have a effective Diagnosis and cure with
optimal treatments
The Case Study Supported by my Teachers at
Travancore Medical College Kollam
• 1 Dr Joseph Francis Department of Surgery
2 Dr Arun Raj Department of Medicine
3 Dr Subhas Abhraham Department of Pathology
4 Dr.T.V.Rao Department of Microbiology
• I am thankful to Medical Director /Principal/ Vice
Principal / Medical Superindent for the support
and encouragment
References
• 1 Human dirofilariasis: an emerging zoonosis in India Reshma G. Kini, J.
B. Leena, Prathvi Shetty, Raphael Hart Lyngdoh, D. Sumanth, Lovely
George Journal of Parasitic Diseases June 2015, Volume 39, Issue 2, pp
349-354
2 Human dirofilariasis: An emerging zoonosis Maryada Venkatarami
Reddy -Trop Parasitol. 2013 Jan-Jun; 3(1): 2–3.
• 3 . Human pulmonary dirofilariasis in India: a case report. Badhe BP,
Sane SY. Human pulmonary dirofilariasis in India: A case report. J Trop
Med Hyg. 1989;92:425–6.
4Human dirofilariasis.Bhat KG, Wilson G, Mallya S.Bhat KG, WilsonG
,Mallya S. Human dirofilariasis. Indian J Med Microbiol. 2003;21:65
Dirofilariasis Presenting as  ABSCESS presented by Nikhila Raj K 2nd MBBS Travancore medical College Kollam Kearla

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Dirofilariasis Presenting as ABSCESS presented by Nikhila Raj K 2nd MBBS Travancore medical College Kollam Kearla

  • 2. Primary Case Presentation - • Patient presented with swelling on the lateral aspect of the distal 1/3'rd of L forearm/E oval swelling of size 3.5x2.5cm, cystic, mildly tender with minimal signs of inflammation.
  • 3. Past History and Laboratory Evaluations •Past History of Pulmonary tuberculosis • Present History of Diabetes mellitus under control • All Laboratory Parameters are in Normal Limits
  • 4. Decision to Incision and Drinage •Patient undergoes a Surgical Intervention an Incision and Drainage was done
  • 5. On macroscopic observation a long parasite was embedded in the pus On incision and drainage of the abscess an approximately 15 cm long filamentous macroscopic parasite was extracted sent intact in Normal saline, to Microbiology Department
  • 6. The identified parasite is placed on linen at the site of the Operation site
  • 7. A long parasite of 15 cm was extracted without damage to the physical structure •An approximately 15 cm long filamentous macroscopic parasite was extracted sent intact in Normal saline, to Microbiology
  • 8. Measuring the parasite in the Microbiology Department •Microbiology Department A primary identification is done as Dirofilariasis spp on the basis of its macroscopic and microscopic appearance,
  • 9. About the Dirofilasis •Human dirofilariasis is an uncommon zoonotic infection having a widespread geographical distribution. World over 800 cases of Dirofilariasis are on record with highest numbers from Italy, Sri Lanka and republics of the ex-Soviet Union .
  • 10. The Tail End of the Parasite as seen in the Photomicrograph
  • 13. As reported from CDC – Atlanta USA • Based on the images, we agree this is a female Dirofilaria (possibly D. repens in India), as indicated by tall, polymyarian musculature, external cuticular ridges, and paired reproductive tubes.
  • 14. Few Cases are Presented and Documented in India
  • 15. Discussion • Dirofilariasis is a nematode parasite that causes heartworm disease in dogs, cats and ferrets. Heartworm disease is transmitted by mosquito bites and there are more than 70 species of mosquito that are able to transmit infection; Aedes, Anopheles and Culex are the most common vector species. Heartworm disease has been reported in many countries with temperate climate and is particularly prevalent in the USA, Canada, and southern Europe.
  • 16. There are Reports of Increasing Incidences of Dirofilariasis •Though human dirofilariasis as a zoonotic infection is thought to be rare, cases are being increasingly reported in the past few years making it a case for consideration as an emerging zoonosis in many parts of the world .Reference 1
  • 17. There are Reports of Increasing Incidences of Dirofilariasis •In India though Dirofilaria cases are being reported occasionally, the number of cases is gradually increasing. While most of the cases reported from India are due to infection with D. repens, some of the D. immitis and D. tenuis infections have also been reported.[9,10] It is the South part of India,( Reference 2)
  • 18. Patient treated with •Antibiotics •Ivermecitin •Patient made recovery within 1 week of Surgical intervention without any relapse to this date
  • 19. In Conclusion • There is still a pressing need for effective adulticide treatment for human and animal filarial infections. Like many filarial nematodes, Dirofilaria immitis, the causative agent of canine heartworm disease, harbours the bacterial endosymbiont Wolbachia, which has been shown to be essential for worm development, fecundity and survival. • High level of clinical suspicion will have a effective Diagnosis and cure with optimal treatments
  • 20. The Case Study Supported by my Teachers at Travancore Medical College Kollam • 1 Dr Joseph Francis Department of Surgery 2 Dr Arun Raj Department of Medicine 3 Dr Subhas Abhraham Department of Pathology 4 Dr.T.V.Rao Department of Microbiology • I am thankful to Medical Director /Principal/ Vice Principal / Medical Superindent for the support and encouragment
  • 21. References • 1 Human dirofilariasis: an emerging zoonosis in India Reshma G. Kini, J. B. Leena, Prathvi Shetty, Raphael Hart Lyngdoh, D. Sumanth, Lovely George Journal of Parasitic Diseases June 2015, Volume 39, Issue 2, pp 349-354 2 Human dirofilariasis: An emerging zoonosis Maryada Venkatarami Reddy -Trop Parasitol. 2013 Jan-Jun; 3(1): 2–3. • 3 . Human pulmonary dirofilariasis in India: a case report. Badhe BP, Sane SY. Human pulmonary dirofilariasis in India: A case report. J Trop Med Hyg. 1989;92:425–6. 4Human dirofilariasis.Bhat KG, Wilson G, Mallya S.Bhat KG, WilsonG ,Mallya S. Human dirofilariasis. Indian J Med Microbiol. 2003;21:65