[THE FIRST CASE OF OCULAR THELAZIASIS IN CROATIA].
Acta medica Croatica : casopis Hravatske akademije medicinskih znanosti(2015)
摘要
The first case of ocular thelaziasis in a human male patient in Croatia is presented. Thelaziasis is a zoonosis caused by
nematodes of the genus Thelazia, parasites of the conjunctival bags or tear ducts of mammals and birds. Two types of
the genus Thelazia (T.) have been described as causes of infection in humans, T. callipaeda and T. californiensis. To date,
less than 300 thelaziasis cases in humans have been reported. This zoonosis is very rare in humans in European countries,
with a high incidence in Asian countries, especially in China, Thailand and Japan. Because of the high prevalence of the
parasites in the Far East, T. callipaeda is called ‘Oriental eye worm’. The first case of thelaziasis in Europe was described in
2008 in Italy and France, where cases in animals had already been reported. Seasonal occurrence of thelaziasis in Europe
depends on the presence of the vector, fruit flies of Drosophilidae family, Phortica variegate as the most common type.
Adult worm is milky white, females grow to 20 mm and males up to 12 mm. Dogs and cats are the most common sources of
infection for humans, which occurs as unilateral ocular infection. The clinical picture of infection is similar to bacterial and
allergic conjunctivitis with tearing and foreign body sensation. After removal of worms, clinical signs quickly disappear and
there is no need for anthelmintic treatment. In the treatment of secondary infections, local antibiotics and corticosteroids
can be applied.
The 82-year-old male patient presented to outpatient ophthalmology clinic for occasional sensation of pain, itching, redness
and tearing in his left eye during the last few days. His left eye was blind due to previous retinal detachment and had severe
conjunctival and ciliary infection with large corneal abscess. Worm-like movement in the lateral canthus was observed.
After topical anesthesia, seven worms were removed. Upon surgical extirpation of the parasite, the diagnosis of thelaziasis
was verified by microbiological identification. Only two cases of Thelazia in dogs were reported in Croatia, in December
2013 and January 2014. It is important to bear in mind this cause of eye infections, especially when caused by larval stages
that are difficult to identify. Untimely diagnosis and inadequate treatment lead to extended illness and complications. The
appearance of this parasite in Croatian patients suggests the need for inclusion of the pathogen in the differential diagnosis
of bacterial or allergic conjunctivitis.
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