Loiasis B74.30

Author: Prof. Dr. med. Peter Altmeyer

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Last updated on: 29.10.2020

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Synonym(s)

Calabar; Calabar bulb; Calabar swelling; Camera swelling; Cameroon Bump; Loa-Loa; Loa loa filariasis; Loiase

History
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Mongin, 1770; Bayon, 1777; Guyot, 1781; Manson, 1891

Definition
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Infectious disease caused by Loa loa (migrating filiaria), filariae with typical subcutaneous swelling as a sign of a hypersensitivity reaction to the filariae migrating in the subcutaneous connective tissue.

Pathogen
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Loa-Loa (eye worm), migrating filariae. The females are 5-7 cm long, males are smaller. The infectious larvae are transmitted by horseflies of the genus Chrysops.

Occurrence/Epidemiology
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Only indigenous to the West and Central African rainforest zone (Benin, Angola, Western Sudan).

Etiopathogenesis
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Transmission of the approximately 0.2-0.3 cm large L3 larvae through the painful sting of the brake Chrysops demidiata. Chrysops demidiata is dependent on shady, humid biotopes of African rainforests. The larvae transferred during the sting grow into mature adults in 6-12 months (lifetime 15 years in subcutaneous fatty tissue). Microfilariae are cyclically released into the blood by the females, which can then be taken up again by horseflies.

Localization
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Mostly wrists, face, ankles.

Clinical features
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Integument: The metabolic products of the migrating adult worm cause allergic reactions. Usually alternating, reddened, itchy swellings lasting about 3-4 days, depending on the location of the worm (5-7 cm long) in the skin.

Extracutaneous manifestation: Infestation of the conjunctiva of the eye (very painful when filariae are present; pathognomonic).

In rare cases, prolonged infestation with high eosinophilia can lead to chronic inflammatory processes with eosinophilic granulomas, especially on serous skins.

Late complications: endocarditis, renal damage and meningoencephalitis (adult worms can persist in the body for more than 10 years).

Diagnosis
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Travel history

Detection of microfiliaria in the blood smear (usually possible at the earliest 1-2 years after infection). The blood sample should be taken during the day, preferably at noon. Detection of worms in skin or conjunctiva.

Eosinophilia in the blood

DEC provocation test

Serological antibody detection against filarial raw antigen

IgG4 serum antibodies.

Differential diagnosis
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Onchocerciasis; larva migrans; strongyloidosis; gnathostomiasis; fascioliasis, toxic-allergic syndromes.

Internal therapy
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Diethylcarbamazine (e.g. Hetrazan): Start therapy gradually, as severe febrile reactions with danger of shock due to decay of the filariae are possible. Capillary blockage due to microfilariae in the brain, meninges, retina and other areas may occur. Initial dosage: 0.5 mg/kg bw/day (avoidance of serious side effects), then increase to 8-10 mg/kg bw/day (max. 600 mg/day) spread over 3 days (intake after meals) over 3 weeks (total dosage: max. 126 mg/kg bw). As NW it can lead to pruritus, fever, joint pain, dyspnoea, circulatory collapse, etc.

In severe cases reduce combination with betamethasone 3-5 mg/day i.v. 2 days before the 1st DEC-dose and continuously balance.

Alternative: In case of therapy failure Albendazole (400 mg/day for 3 weeks).

Alternative: There are also positive reports of experience with ivermectin (Twum-Danso NA et al. 2003).

Prophylaxis
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Diethylcarbamazine during exposure (only in exceptional cases!). Protection against brakes.

Note(s)
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Diagnosis and therapy should be reserved for tropical medicine.

Literature
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  1. Bayon B (1777-1778) Memoires pour servir a l'histoire de Cayenne et de la Guyane francaise. Paris, France
  2. Eichenlaub D et al (2003) Parasite detection and symptoms of parasitic diseases. 1: Blood parasites. Internist (Berl) 44: 337-346
  3. Huber HG et al (1986) Discovery of Loa ophthalmia by the French ship's surgeon Francois Guyot (1742-1816). Clin Monatsbl Ophthalmology 189: 178-182
  4. Manson P (1891) The Filaria sanguinis hominis major and minor, two new species of haematozoa. Lancet i: 4-8
  5. Mongin A (1770) Sur un trouve sous la conjunctive a Maribarou, isle Saint-Dominique. J Med Chir Pharm 32: 338-339
  6. Takougang I et al (2002) Rapid assessment method for prevalence and intensity of loa loa infection. Bull World Health Organ 80: 852-858
  7. Twum-Danso NA et al (2003) Variation in incidence of serious adverse events after onchocerciasis treatment with ivermectin in areas of Cameroon co-endemic for loiasis. Trop Med Int Health 8: 820-831

Disclaimer

Please ask your physician for a reliable diagnosis. This website is only meant as a reference.

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Last updated on: 29.10.2020