Page 178 - Medical Parasitology_ A Textbook ( PDFDrive )

14 Case Reports 171

Case report 2: The patient is a 42-year-old Chinese male, from Kuching, Sarawak.
He worked as a contractor and his only trip out of Malaysia was to China. His hobby
is hunting and he likes eating meat from wild game. He has only one pet dog.
He seeked treatment for a 1-day history of redness and itchiness over the tempo-
ral aspect of his left eye. His eyes were normal except for congestion of the left
temporal bulbar conjunctiva. Slit lamp examination showed a live mobile worm just
beneath the conjunctiva. It was removed immediately under local anaesthesia. The
worm was put in formalin and sent for identification to the Department of
Parasitology, Faculty of Medicine, University of Malaya. On examination, the spec-
imen was found to be an immature female nematode worm measuring 11.5 cm long,
with a maximum width of 400 μm. The worm was rounded at both ends, the anterior
end being wider than the posterior. The head was rounded with evidence of papillae
arranged in two circles. The vulva opening was 2400 μm from the anterior end. The
width of the vulva opening was 260 μm. The tail length was 110 μm and the width
at the anus was 120 μm. The cuticle had longitudinal ridges and circular annula-
tions. Based on the morphological characteristics, the worm was identified as an
immature Dirofilaria repens.
Physical examination showed no skin rash. Examination of both eyes showed a
normal retina and vitreous fluid bilaterally. His vision was 6/6 in both eyes. There
were no other positive findings except for the laboratory test which showed that he
was hepatitis B positive.

Source: Rohela, M., I. Jamaiah, T. T. Hui, J. W. Mak, I. Ithoi, and A. Amirah.
“Dirofilaria causing eye infection in a patient from Malaysia.” Southeast Asian
Journal of Tropical Medicine and Public Health 40, no. 5 (2009): 914–8.

Learning Points
1. Exposure to animals and pets is a relevant history in arriving at a diagnosis.
2. Clinicians have to consult parasitologist when a worm is detected in a patient for
further lab test to confirm the species and determine the diagnosis.

Case 15: Taeniasis saginata and Neurocysticercosis
Case report 1: The patient is a 57-year-old French businessman. He was seen for
abdominal discomfort for the past 1 year. He claimed to have expelled worms in his
stools. He had seen several doctors and was given albendazole but the symptom and
passing of worms persisted. Patient gave a history of travelling to countries in
Southeast Asia in the course of his work. During his travelling, he consumed many
types of local delicacies including raw meat. Physical examination showed a healthy
man weighing 100 kg. He was afebrile and his vital signs were all normal. Abdominal
examination showed no mass. There was absence of subcutaneous nodules and no
history of headache, seizures, or visual impairment. Patient has a history of recur-
rent lower limb deep vein thrombosis (DVT) over the past few years and is still on
Warfarin. There was no other significant medical history. A full blood count, renal
and liver functions and chest X-ray were normal. Stool examination was negative
for ova and cyst.