a rare case of dirofilaria

8/3/2019 A Rare Case of Dirofilaria

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N ame -Mahesh mallik Age-30 yrs sex-male

Address -morioni khatogodi T.E,JorhatHospital no. -312646/08MRD no.-31652/08Marital status -married

Children -2, both male,4yr &8yrOccupation CTC machine driverOPD Visit -30-08 2008


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Cond

CHEIF COMPLAIN

TSSwelling &discomfort below left lower lid since 2 yr

HISTORY OF PRESEN T ILLN ESS:Pt was asymptomatic till 2yr back when he noticed swelling below leftlower lid,around a size of peas,not associated withpain,redness,itching,ocular movement restriction&diminution of vision.There was no h/o fever and any other swelling in body,no h/o of wtloss. He went to local doctor was prescribed some medicine, X-ray orbit

was done (both AP &lateral ) and was found normal.After that swellingslowly increases in size and then subsides spontaneously with in 2days.Since then swelling was on &off in nature.On august 25,2008,he wentto some practitioner in jorhat and was referred to AMCH, dibrugarh.


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COND .

Personal history -Tobacco chewer ,occ.alcoholicN onvegeterian(chicken,mutton,fish,pork)

Water from tank supply.Drug history- N o h/o antihelminthic drug

Family history -N o h/o similar complaint in any family member.N o h/o major illness(TB,DM,HT N )

Pet animals -Hen,Duck,Cow


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y General examination

Averagely built Weight-65kg Height-5ft7inchPulse-86/min B.P-130/86mm of HgCVS-heart sound normal,no murmurRS-N ADP/A- N ADCN S-N AD


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Local examinationInspection - swelling 2x1cm in size,oval in shape, at left

lateral infraorbital margin,indistinctedges,smooth surface,mobile ,not adherent tooverlying skin.

Palpation -Inspectory finding are confirmed.swelling 2x1 cm,oval in shape,firm in

consistensy,illdefined edges,mildtenderness,compressible no

fluctuation,no fluid thrill,notranslucency, no impulse oncoughing,no pulsality,not fixed tounderlying bone and overlying skin.

no regional lymph node enlarged.


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INVEST IGATIONSROUTIN E BLOOD-

WBC, TLC- 6900/cmm,DLC- N -80,L-20,E-0,M-0,B-0

ESR-5mm/hr(westergreen )RBS-76mg%BT-2min10secCT-5min15 sec

COMPLETE HEMOGRAM:Hb-14%PCV-44%

RBC-5.87million/cmmMVC-78.5cu,MCH-25.5cu,MCHC-32.6cu


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Cond

STOOL EXAMIN

ATION

: Few RBC&Pus cellsN o ova,parasite&cyst

X- RAY CHEST: N ormal

X-RAY LEFT ORBIT(AP&LATERAL)N ormal

USG OF LEFT EYE:Cystic swelling in left

infraorbital region,size 2x1 cm(gain-81db,dyn- 67db)


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SUR GICALPROCEDUREy The skin over the swelling was carefully incised after a

subcutaneous injection of a local anaesthetic agent, thecoiled worm was seen immediately beneath the skin .the

worm was gently extracted and sent for morphologicalexamination


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M ORPHOLOGICAL STUDY OF PARASITE :Dirofilaria species

Length:12cm Breadth:0.6cmshowed active movement on removal

Idetified by thick laminated cuticle,broad lateral chords andlarge muscle cells


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y POST OPERATIVE : Inj voveron sos

Tab ciplox 500mg twice daily Tab orthobid plus twice daily Ciplox eye ointment

Tab DEC 6mg/kg body wt

F OLLOW UP:

- stitch were removed after 1 wk-N o swelling, no ocular movement restriction.


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D iscussi on

y

Dirofilariasis , a disease commonly found in carnivorusmammals ,is uncommon in human.y Two important species involving eye are D.tenuis and D.

repens.

In India only 3 cases of subcutaneous Dirofilaria inhuman has been reported till today .Out of them in only one case live worm wasremoved.

y First case in 1976 (Joseph),second in 2000(Sekar) ,and thirdin 2003(mallick and Ittyerah) ,all cases were reported fromkerala.

y Dirofilarial worm are identified by their thick laminated

cuticle, broad lateral chords and large muscle cells.


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D iscussi on cond ..

y Surgical removal of worm is tretment of choice andgenerally further treatment is not recommended.


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a rare case of dirofilaria

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