Phlyctenular eye disease in association with Hymenolepis nana in Egypt.

Resolution of childhood recurrent corneal phlyctenulosis following eradication of an intestinal parasite

“…3,4 In the Arab world, however, neither tuberculoprotein nor staphylococcal antigen appears to be a significant factor in the delayed hypersensitivity reaction that causes phlyctenular eye disease; rather, the eye findings are often associated with intestinal worm infection. 5,6 In the Qualyobia province of Egypt, the incidence of stool parasitic infection (typically H. nana) in children with phlyctenular eye disease is significantly higher than in controls (77% vs 24%, respectively), particularly for recurrent cases. 5 A parasite with a complex antigenic mosaic during its lifecycle, H. nana is a likely provocation for phlyctenular eye disease in a susceptible host.…”

“…5,6 In the Qualyobia province of Egypt, the incidence of stool parasitic infection (typically H. nana) in children with phlyctenular eye disease is significantly higher than in controls (77% vs 24%, respectively), particularly for recurrent cases. 5 A parasite with a complex antigenic mosaic during its lifecycle, H. nana is a likely provocation for phlyctenular eye disease in a susceptible host. 5,6 Although we are unaware of any studies that specifically address the results of parasite treatment on ocular manifestations, it seems logical that eradication of the intestinal parasite would lead to resolution of the inflammatory eye disease (as occurred in our patient, as of last follow-up, and in 2 previous case reports that received no topical treatment).…”

“…5 The possibility of a hypersensitivity reaction from an intestinal parasite infection should be considered in any child with aggressive recurrent phlyctenular eye disease, particularly if he or she is from an endemic area. 5 …”

“…5 A parasite with a complex antigenic mosaic during its lifecycle, H. nana is a likely provocation for phlyctenular eye disease in a susceptible host. 5,6 Although we are unaware of any studies that specifically address the results of parasite treatment on ocular manifestations, it seems logical that eradication of the intestinal parasite would lead to resolution of the inflammatory eye disease (as occurred in our patient, as of last follow-up, and in 2 previous case reports that received no topical treatment). 5 The possibility of a hypersensitivity reaction from an intestinal parasite infection should be considered in any child with aggressive recurrent phlyctenular eye disease, particularly if he or she is from an endemic area.…”

Phenotypic characterization of inflammatory cells in phlyctenular eye disease

“…On subsequent contact either by the blood stream, by tears or by direct exogenous inoculation, the typical lesion is formed [3]. Other causes involved in the pathogenesis of the disease are candida albicans, coccidioides immitis, the agent of lymphogranuloma venereum [4], ascariasis [5], helminthiasis [6], and Hymenolepis nana [7]. In recent years it has been demonstrated experimentally that hypersensitivity to staphylococcal cell walls could evoke the disease [8,9].…”