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170                                                  14  Case Reports

              In order to determine the reservoir animal host of the B. pahangi, blood samples
            were taken from wild monkeys and domestic cats in the suburbia for microscopy
            examination and PCR. None of the 15 monkeys caught were positive for B. pahangi
            mf or COXI. Of the 12 domestic cat blood samples, 5 were positive for B. pahangi
            mf based on their morphology and length. These mf-positive blood samples were
            also positive for B. pahangi COXI but negative for B. malayi COXI. The sequence
            of the PCR product was found to be identical to that of patient 4 and of the larvae in
            the Ar. subalbatus mosquitoes. These findings thus suggest that infected domestic
            cats might be the source of the zoonotic infection in the suburbia.

              Source: Tan, Lian Huat, Mun Yik Fong, Rohela Mahmud, Azdayanti Muslim,
              Yee Ling Lau, and Adeeba Kamarulzaman. “Zoonotic Brugia pahangi filariasis
              in a suburbia of Kuala Lumpur City, Malaysia.” Parasitology International 60,
              no. 1 (2011): 111–3.

            Learning Points
              1.  These cases highlight the importance of clinicians to be aware of zoonotic para-
              sitic infections in pursuing diagnoses.
              2.  The use of PCR helps to confirm diagnosis. The diagnosis would have been
              missed if only conventional diagnostic standards (blood smears) were applied.


            Case 14: Eye Lesion Caused by Filarial Worm
            Case report 1: The patient is a 3-year-old Chinese boy from the East coast of
            Peninsular Malaysia. He presented with a 1-week history of redness and palpebral
            swelling of his right eye. He had no history of travelling overseas and the family
            kept dogs at home. On physical examination, the attending physician only found
            enlarged axillary and inguinal lymph nodes. The patient was later seen by an oph-
            thalmologist, who found a subconjunctival worm in his right eye. Two days after
            being warded, 4 worm fragments, each about 1 cm long were removed from his
            right eye under general anaesthesia. Unfortunately, no attempts were made to iden-
            tify the worm.
              A full blood count revealed eosinophilia (10%). A peripheral blood film exami-
            nation revealed microfilariae.  A thick blood smear was done and stained with
            Giemsa. The microfilariae detected were diagnosed to be that of Brugia malayi. The
            microfilaria is kinky and has a sheath which stained pink with Giemsa. It has over-
            lapping nuclei with two terminal nuclei at the tail end. The cephalic space is 2:1
            (length:breadth). His serum tested positive with a Brugia Rapid test kit. Since there
            was no attempt to identify the adult worm recovered, we assumed that the adult
            worm belongs to B. malayi from the findings of its microfilariae in the blood. The
            patient was treated with diethylcarbamazine.

              Source: Rohela, M., I. Jamaiah, and C. C. Yaw. “Eye lesion caused by adult
              Brugia malayi: a first case reported in a child from Malaysia.” Southeast Asian
              Journal of Tropical Medicine and Public Health (2006): 37(4):652–5.
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