Loiasis with Peripheral Nerve Involvement and Spleen Lesions

Gobbi, Federico; Boussinesq, Michel; Mascarello, Marta; Angheben, Andrea; Gobbo, Maria; Rossanese, Andrea; Corachán, M; Bisoffi, Zeno

doi:10.4269/ajtmh.2011.10-0458

Cited by 13 publications

(13 citation statements)

References 26 publications

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“…For example, subconjunctival females containing microfilariae are frequently removed from patients who had no detectable microfilariae in the blood a few years previously (Carme et al, 1989). Other clinically significant signs, such as neuropathies, are more frequent in people exposed to the parasite during adulthood, as reported for other signs of loiasis (Gobbi et al, 2011). In a study comparing the population living in endemic areas and visitors, only 10% of temporary residents were microfilaraemic, whereas 95% of these individuals had oedema (Klion et al , 1991).…”

Section: Discussionsupporting

confidence: 65%

The relationship between microfilaraemic and amicrofilaraemic loiasis involving co-infection with Mansonella perstans and clinical symptoms in an exposed population from Gabon

et al. 2015

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The relationship between the frequency of loiasis objective symptoms and microfilaraemic or amicrofilaraemic infection was assessed in 1148 exposed patients also infected, or not, with Mansonella perstans. Filarial infections were detected by direct microscopy, leucoconcentration and serology, with prevalence values of 39.5% Loa loa, 5.6% M. perstans and 3.4% co-infection with both filarial species. Amicrofilaraemic or occult loiasis (OL) predominated among L. loa-infected individuals, with a prevalence of 58.2%. Hypermicrofilaraemia (>8000 microfilariae (mf)/ml) was found in 18.4% of L. loa microfilaraemic patients, with 25.7% of them harbouring more than 30,000 mf/ml. Up to 34% of patients with OL showed evidence of Calabar swelling, compared with 26.3% of microfilaraemic patients (P= 0.03). Overall 5.3% of patients presented with adult worm migration across the eye, representing 16.3% of microfilaraemic individuals and 11.4% of amicrofilaraemic patients (P= 0.13). This symptom was similarly found in patients with more than 30,000 mf/ml (22%), those with microfilaraemia between 8 and 30,000 mf/ml (15.4%) and also in individuals with low or without microfilaraemia (16.1%) (P= 0.7). Five (14.3%) hypermicrofilaraemic patients did not present any L. loa-specific objective symptoms, as well as all the patients with single M. perstans infection. The presence of adult eye worm migration as a strong predictor of high microfilaraemia density would obscure the real burden of L. loa hypermicrofilaraemia in exposed individuals. For epidemiological purposes and control strategies, the mapping of L. loa in endemic areas should also take into account the group of patients with occult loiasis.

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Section: Discussionsupporting

confidence: 65%

The relationship between microfilaraemic and amicrofilaraemic loiasis involving co-infection with Mansonella perstans and clinical symptoms in an exposed population from Gabon

et al. 2015

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“…These 52 cases, plus the expatriate patient described in the case reports above, are summarized in Table 2. Sixty-one cases (60.4%) were reported from Europe 8,12,16,17,[19][20][21]24,[26][27][28][29][31][32][33][34][35][36][37]42,43,[45][46][47][48][51][52][53][54]56,59,61,63,64,67,69,70,[72][73][74]77,[79][80][81][82][83][86][87][88][90][91]<...>…”

Section: Literature Reviewmentioning

confidence: 99%

Imported Loa loa filariasis: three cases and a review of cases reported in non-endemic countries in the past 25 years

Antinori

Schifanella

Million

et al. 2012

International Journal of Infectious Diseases

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The aim of this study was to highlight the increasing chance of Western physicians encountering patients (both immigrants and expatriates/travelers) seeking help for loiasis. Methods: We describe three cases of imported loiasis observed at two hospitals in Italy and France, and present a review of all previously published cases in the medical literature in the last 25 years . The search was performed using PubMed and Scopus databases using the terms ''Loa loa'' AND ''loiasis''. Results: We reviewed 101 cases of imported loiasis of which 61 (60.4%) were reported from Europe and 31 (30.7%) from the USA. Seventy-five percent of infestations were acquired in three countries: Cameroon, Nigeria, and Gabon. Overall, peripheral blood microfilariae were detected in 61.4% of patients, eosinophilia in 82.1%, eye worm migration in 53.5%, and Calabar swellings in 41.6%. However, Calabar swellings and eosinophilia were more common among expatriates/travelers, whereas African immigrants were more likely to have microfilaremia. Eye worm migration was observed in a similar proportion in the two groups. Only 35 patients (including the three described here) underwent clinical follow-up for a median period of 10.5 months (range 1-84 months); clinical relapse occurred in three of these patients and persistence or reappearance of blood microfilaria in another two. Conclusions: Due to increasing travel and the migration of people from the endemic countries of West Africa to Europe and the USA, we speculate on the possible emergence of loiasis. Western physicians should be aware of the typical (eye worm migration and Calabar swellings) as well as unusual clinical presentations.

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“…Although the overwhelming majority of L. loainfected individuals are clinically asymptomatic, Calabar swelling (transient, localized angioedema), and the subconjunctival migration of an adult worm ("eyeworm") are the most common clinical manifestations (3)(4)(5). Rarely, nephropathy, cardiomyopathy, retinopathy, neuropsychiatric complications, and encephalopathy (6)(7)(8)(9)(10)(11)(12) can occur as a consequence of chronic infection. Among the 8 filarial infections of humans, L. loa infection has largely been neglected as a public health concern in Africa, though it has gained prominence of late because of the neurologic serious adverse events (SAEs) that have occurred, occasionally leading to death, in highly microfilaremic individuals following exposure to ivermectin (IVM) given during mass drug administration (MDA) for control of Onchocerca volvulus and/or Wuchereria bancrofti in regions where these filarial species and L. loa are coendemic.…”

mentioning

confidence: 99%

Loop-Mediated Isothermal Amplification for Rapid and Semiquantitative Detection of Loa loa Infection

et al. 2014

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cRapid and accurate tests are currently needed to identify individuals with high levels of Loa loa microfilaria (mf), so that these individuals may be excluded from mass ivermectin administration campaigns against onchocerciasis and lymphatic filariasis being conducted in areas where Onchocerca volvulus, Wuchereria bancrofti, and L. loa are coendemic. To address this need, colorimetric loop-mediated isothermal amplification (LAMP) assays targeting the L. loa-specific gene sequences LLMF72 and LLMF342 were developed for the detection and quantification of L. loa microfilaremia. Both LAMP assays were highly specific (100%) for L. loa infection compared to the absence of infection or infection with related filarial pathogens. The LLMF72-based LAMP assay showed greater analytic sensitivity (limit of detection, 0.1 pg/ml of genomic DNA [gDNA] and/or 5 mf/ml) than the LLMF342-based LAMP assay (10 pg/ml of gDNA and/or 50 mf/ml), and its analytic sensitivity was similar to that of LLMF72-based quantitative PCR (qPCR). A high level of correlation was observed between microfilaria counts as determined by LLMF72-based qPCR and time to positivity by the LAMP assay, and performance measures of sensitivity, specificity, and positive and negative predictive values were similar for both assays when applied to field-collected clinical samples. By simply varying the run time, the LAMP assay was able to accurately distinguish individuals at risk for serious adverse events (SAEs) after exposure to ivermectin, using thresholds of >5,000 mf/ml and >30,000 mf/ml as indicators of increasing levels of risk. In summary, LLMF72 LAMP represents a new molecular diagnostic tool that is readily applicable as a point-of-care method for L. loa microfilarial detection and quantification in resource-limited countries where L. loa infection is endemic.

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Loiasis with Peripheral Nerve Involvement and Spleen Lesions

Cited by 13 publications

References 26 publications

The relationship between microfilaraemic and amicrofilaraemic loiasis involving co-infection with Mansonella perstans and clinical symptoms in an exposed population from Gabon

The relationship between microfilaraemic and amicrofilaraemic loiasis involving co-infection with Mansonella perstans and clinical symptoms in an exposed population from Gabon

Imported Loa loa filariasis: three cases and a review of cases reported in non-endemic countries in the past 25 years

Loop-Mediated Isothermal Amplification for Rapid and Semiquantitative Detection of Loa loa Infection

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