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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