结膜肉芽肿形式的眼丝虫病--来自印度非流行区的罕见病例报告

Annesha Sarkar, Dipankar Das, Saidul Islam, Apurba Deka
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摘要

丝虫病是一种以淋巴为主的疾病,在印度次大陆的丝虫病流行区和少数非流行区很少会累及眼部。东南亚国家也有报道。在印度,引起丝虫病的线虫是班氏武氏虫(Wuchereria bancrofti)和马来亚布鲁氏虫(Brugia malayi)。眼部受累的范围很广,包括泪腺、结膜和穹窿、角膜、前房和玻璃体腔。我们报告了一例结膜肉芽肿内有丝虫成虫(马来丝虫)的病例,患者是一位来自该国非流行区农村的女士。这位女士有短暂的眼部不适和发红病史。临床检查发现结膜上有一个小的肉芽肿样病变,周围有炎症。前段和后段的其他部位都相当正常。病史和临床检查均不支持寄生虫感染,因此医生将病变视为过敏性疾病。然而,病变仍未得到解决,于是进行了手术切除。手术时,在病灶内发现了一条活的蠕虫。对虫体进行的寄生虫学评估证实为成虫(马来丝虫)。患者接受了口服乙胺嗪和阿苯达唑的综合治疗。
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Ocular filariasis in the form of a conjunctival granuloma – A rare case report from non-endemic part of India
Filariasis, a predominantly lymphatic disease can rarely have ocular involvement in endemic as well as a few non-endemic zones of the Indian subcontinent. It has also been reported from countries of South East Asia. In India, Wuchereria bancrofti and Brugia malayi are the nematodes causing filariais. Ocular involvement can happen in a wide spectrum, involving lacrimal glands, conjunctiva and fornices, cornea, anterior chamber, and vitreous cavity. We report a case of adult filarial worm (B. malayi) inside a conjunctival granuloma in a lady hailing from a rural, non-endemic part of the country. The lady presented with a short history of ocular irritation and redness. Clinical examination revealed a small granuloma-like lesion with surrounding inflammation over the conjunctiva. The rest of the anterior segment as well as the posterior segment was fairly within normal limits. The history as well as clinical examination was not supportive of a parasitic infestation, leading the doctors to treat the lesion as an allergic disease. However, the lesion remained unresolved, and surgical excision was undertaken. On surgical intervention, a live worm was spotted inside the lesion. Parasitological evaluation of the worm was confirmatory of adult filaria (B. malayi). The patient responded to a combination therapy of oral diethylcarbamazine and albendazole.
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