A rare case of subconjunctival Onchocerca volvulus

Siddharth Kumar; Antarlin Ghosal; Ramamani Dalai; Dharitri Mohapatra; Soumya Nayak

doi:10.4103/ijo.IJO_2311_20

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Year : 2021 | Volume : 1 | Issue : 2 | Page : 186-187

A rare case of subconjunctival Onchocerca volvulus

Siddharth Kumar¹, Antarlin Ghosal¹, Ramamani Dalai¹, Dharitri Mohapatra², Soumya Nayak²
¹ Regional Institute of Ophthalmology, Srirama Chandra Bhanja Medical College and Hospital, Cuttack, Odisha, India
² Department of Microbiology, Srirama Chandra Bhanja Medical College and Hospital, Cuttack, Odisha, India

Date of Submission	15-Jul-2020
Date of Acceptance	27-Oct-2020
Date of Web Publication	01-Apr-2021

Correspondence Address:
Dr. Siddharth Kumar
Regional Institute of Ophthalmology, Srirama Chandra Bhanja Medical College, Cuttack - 753 012, Odisha
India

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijo.IJO_2311_20

Abstract

Keywords: Onchocerciasis in India, subconjunctival worm, Subconjunctival Onchocerciasis

How to cite this article:
Kumar S, Ghosal A, Dalai R, Mohapatra D, Nayak S. A rare case of subconjunctival Onchocerca volvulus. Indian J Ophthalmol Case Rep 2021;1:186-7

How to cite this URL:
Kumar S, Ghosal A, Dalai R, Mohapatra D, Nayak S. A rare case of subconjunctival Onchocerca volvulus. Indian J Ophthalmol Case Rep [serial online] 2021 [cited 2021 Apr 14];1:186-7. Available from: https://www.ijoreports.in/text.asp?2021/1/2/186/312368

Case Report

A 50-year-old female patient from Biridi, Jagatsinghpur district of Odisha, India came with complaints of redness, itching, and watering of the left eye for 2 days. On examination, it was discovered that the symptoms were due to a live subconjunctival worm [[Figure 1]a, [Figure 1]b and Video clip 1]. On literature review, we found that similar presentations have been reported with Brugia malayi, Wuchereria bancrofti, and Dirofilaria repens from different parts of the country, therefore keeping in mind the periodicity of different filarial species blood samples were collected at 8 am, 4 pm and 10 pm.^[1],[2] Microfilariae with features suggestive of Onchocerca volvulus were identified in all the three samples [Figure 2]. Skin snip biopsy was not done since microfilariae were identified in the blood smear. The worm was extracted and was sent for microbiological examination [Video clip 2]. It was identified as a filarial worm with well-marked annular and oblique striations on the cuticle, blunt at both ends with tapering and curved posterior end [Figure 3]a, [Figure 3]b, [Figure 3]c, [Figure 3]d. The features of the worm were consistent with that of Onchocerca volvulus. The sample started disintegrating before molecular confirmation could be done. The patient was treated with Tablet Ivermectin and Doxycycline 100 and was asymptomatic on follow-up.

Figure 1: Congestion and chemosis on diffuse illumination (a) and slit-lamp microphotograph showing subconjunctival worm (white arrow) (×16) (b)

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Figure 2: Microphotograph showing microfilaria in the peripheral blood smear (×40)

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Figure 3: Microphotograph of the worm (×40) showing annular and oblique cuticular striations (a), blunt anterior end (b), blunt and tapering posterior end, (c) and curved posterior end of the worm (d)

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Discussion

Onchocerciasis is caused by Onchocerca volvulus, which is transmitted by blackfly Simulium. In 2017, there were 20.9 million prevalent Onchocerca volvulus infections worldwide mostly in sub-Saharan Africa, Latin America, and Yemen. Also, only two cases of Onchocerciasis have been reported from India till now.^[3],[4] Onchocerciasis mostly affects eyes and the skin. In the eyes, it commonly affects the cornea and has also known to cause Iridocyclitis, chorioretinitis, and optic neuropathy.

The message from this report is that India despite being a nonendemic country, the possibility Onchocerciasis should not be ruled out without proper evaluation.

Acknowledgement

We would like to thank Prof. Subhabrata Parida, Head of the department, Regional Institute of Ophthalmology and Dr Nirupama Chayani, Head of the Department Microbiology of Srirama Chandra Bhanja Medical College and Hospital, Cuttack and for their constant support and guidance.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

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