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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.