Indian Journal of Medical Microbiology, (2006) 24 (1):67-9 Case Report A CASE OF HUMAN THELAZIASIS FROM HIMACHAL PRADESH *A Sharma, M Pandey, V Sharma, A Kanga, ML Gupta Abstract Small, chalky-white, threadlike, motile worms were isolated from the conjunctival sac of a 32 year-old woman residing in the Himalaya mountains. They were identified as both male and female worms of Thelazia callipaeda. To the best of our knowledge, this is the second case report of human thelaziasis from India. Key words: Human thelaziasis, Oriental eyeworm Thelazia callipaeda was first reported by Railliet and Case Report Henry in 1910 from a Chinese dog and it is also known as Oriental eyeworm. The first human case was reported by During autumn of 2004 a 32 year old woman from a rural Stucky in 1917, who extracted four worms from the eye of a mountainous region presented with the complaint of small, coolie in Peiping, China. Since then a number of species of white, threadlike worms in her right eye. She was suffering eyeworm have been reported in certain animals and birds from with foreign body sensation and itching in her right eye for a different countries of the world.1 The two important species few days. On looking in the mirror, she noticed moving worms infecting human eye are Thelazia callipaeda and, rarely, in her eye. She could remove three worms with the help of a Thelazia californiensis. T. callipaeda is found in China, India, cotton wick. On her visit to the hospital, on examination, no Thailand, Korea, Japan and Russia. Recently it has been worms were seen in the conjunctival sac. Conjunctiva was reported from Northern Europe and Southern Italy. Whereas, mildly congested. Patient was prescribed decongestant and T.californiensis occurs exclusively in Western United States.2,3 was asked to report after one week. The patient belonged to a family rearing livestock and had a pet dog. In Asia, this spiruroid nematode is seen in the conjunctival sac, lacrimal gland and lacrimal duct of dogs, cats, cows, On her second visit, thorough and careful examination of rabbits, badgers, deers, foxes and monkeys.4 Man is an her eye revealed five worms coiled together in the upper accidental host. Transmission occurs through face flies. fornix. They were removed with the help of forceps after Several species of the genera Amiota and Musca autumnalis instilling 4% lignocaine. The worms were motile and were (pest of livestocks) act as intermediate hosts. They ingest sent to microbiology laboratory for identification. They were embryonated eggs when they feed on eye/nasal secretions of identified as T.callipaeda, there were two male and three a sleeping host. Larvae develop in the body cavity of the fly female worms. Adult male worms measured up to 0.75 x and are deposited on the conjunctiva of a new host. The larvae 13.00 mm and female worms measured 0.85 x 17.00 mm. take 3-6 weeks to reach maturity. Female worm lays eggs in Transverse cuticular striations covered whole surface of the the conjunctival and lacrimal sac of the host.2 worm (Figure). The most common clinical presentations are mild The number of transverse cuticular striations at esophageal conjunctival irritation, foreign body sensation, excessive level, midportion and tail end helped in differentiating the two lacrimation, follicular hypertrophy and less often species (T. callipaeda and T. californiensis) and also male hypersensitivity to light, ocular pain, corneal opacities and from female. Microscopically the buccal cavity was trapezoid, ectropion.1,2 Secondary bacterial infections can worsen the located anteriorly with no lips or teeth-like structures (Fig. symptoms, but the worms are generally not very pathogenic.5 a,c). Males were ventrally curved, there were nine pairs of Nearly 250 cases of T.callipaeda infestation in humans have preanal and three pairs of postanal papillae, in (Fig. d) all of been reported worldwide.2 Only two cases have been the preanal papillae were not seen because of the spiral coiling reported from India.6 of the tail. In females, vaginal opening was anterior to oesophagointestinal junction and numerous, disc shaped encysted larvae lying in a row were seen in the distal uterus. *Corresponding author (e-mail: <[email protected]>) In the posterior half of the body, unembryonated eggs filled Department of Microbiology ( AS, VS, AK, MLG) and Department the uterus.2,7,8 of Opthalmology (MP), Indira Gandhi Medical College and Hospital, Shimla – 171 002, Himachal Pradesh, India The patient’s all routine investigations including total Received: 05-04-05 leucocyte count, differentiated leucocyte count and peripheral Accepted: 11-05-05 smears were within normal limits. Removal of worms was www.ijmm.org 68 Indian Journal of Medical Microbiology vol. 24, No. 1 sufficient to ameliorate the symptoms and there was no recurrence. Discussion Friedmann reported cases of Human Thelaziasis from India in 1948.1 Singh et al reported two cases in 1993 from Manipur, which is a hilly state.6 In this case report patient belongs to remote areas of Himalayan region. In other cases reported from China and Korea, a correlation with visiting the mountainous region has been seen.1,7 Our patient probably acquired infection from the livestock or the dog. a There may have occurred many unreported cases, since extraction of the worm from the eye is all the treatment required. Clinicians should be made aware of the existence of this infestation as repeated migration of worms across the conjunctiva can result in scarification and fibrous opacity of the cornea.1 The presence of white, threadlike, coiled masses in the conjunctival sac or migrating worm over the cornea are suggestive. Eggs and larvae can be seen in tears or eye secretions microscopically. Presence of embryonated eggs and fourth stage larvae in the conjunctival sac during the different parts of the year indicate seasonality in the reproductive activity of T.callipaeda, coinciding with the presence of vector b from early spring to early autumn.3 Though, symptoms resolve immediately after the removal of the worms, irrigation with lugol’s iodine or 2-3% boric acid can be used to remove worms from the lacrimal duct. Levamisole and ivermectin have shown to cure similar infestations in Asia and Europe. There is no vaccine for thelaziasis. Public health and prevention strategies are important in India, where high infestation rate is found among dogs.2 References 1. Choi WY, Lee WK, Lee OR. A case of Human Thelaziasis in Seoul. Korean J Parasitol 1977;15:127–32. c 2. Thelaziasis DE. Parasites and Pestilence: Infectious Public Health Challenges. Stanford University. Human Biology 103. [Google.com] 3. Otranto D, Lia RP, Buono V, Traversa D, Giangaspero A. Biology of Thelazia callipaeda ( Spirurida, Thelaziidae) eyeworms in naturally infected definitive hosts. Parasitol 2004;129:627–33. 4. Koyama Y, Ohira A, Kono T, Yoneyama T, Shiwaku K. Five cases of thelaziasis. Br J Ophthalmol 2000;84:439. 5. Gibson DI. Nature and classification of parasitic helminthes, Chapter 24, Vol. 5. In: Topley & Wilson’s Microbiology and Microbial infections, 9th ed. Leslie Collier, Albert Balows, Max d Sussman, Editors. Oxford University Press: Arnold, NewYork; 1998. p. 474. Figure: Photomicrograph shows anterior (a,c) and posterior ends (b,d) 6. Singh TS, Singh KN. Thelaziasis: report of two cases. Br J of adult female and male thelazia worm, respectively (100x). Ophthalmol 1993;77:528–9. www.ijmm.org January 2006 Sharma et al – A Case of Human Thelaziasis from Himachal Pradesh 69 7. Hong ST, Lee SH, Kim SI. A Human case of Thelazia callipaeda 8. Hong ST, Park YK, Lee SK, Yoo JH, Kim AS, Chung YH, et Infection with Reference to its internal structures. Korean J al. Two human cases of Thelazia callipaeda infection in Korea. Parasitol 1988;26:137–9. Korean J Parasitol 1995;33:139–44. IJMM on Web http://www.journalonweb.com/ijmm IJMM now accepts articles electronically. It is Facilities easy, convenient and fast. 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