Severe and Rare Case of Human <i>Dirofilaria repens</i> Infection with Pleural and Subcutaneous Manifestations, Slovenia

Biasizzo, Helena; Šoba, Barbara; Ilovski, Frosina; Harlander, Matevž; Lukin, Matej; Blatnik, Olga; Turel, Matjaž; Srpčič, Matevž; Kern, Izidor; Beović, Bojana

doi:10.3201/eid2812.221366

Cited by 3 publications

(5 citation statements)

References 14 publications

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“…A case report of a 40-year-old woman described a multisystemic manifestation of D. repens infection involving the formation of pleural granulomas and a serohemorrhagic effusion. 12 No definitive histopathologic evidence of a granulomatous process was found in the canine patient in our study.…”

Section: Discussioncontrasting

confidence: 59%

“…Hemorrhagic effusions with the presence of filarial organisms have been rarely reported in humans; 8–11 however most of these cases did not receive further molecular confirmation, as conducted in our study. A case report of a 40‐year‐old woman described a multisystemic manifestation of D. repens infection involving the formation of pleural granulomas and a serohemorrhagic effusion 12 . No definitive histopathologic evidence of a granulomatous process was found in the canine patient in our study.…”

Section: Discussioncontrasting

confidence: 54%

“…14 In addition, nodular presentations of dirofilariasis that mimicked neoplasia have been reported previously. 12,15,16 Alternatively, it is possible that, similar to what was speculated in previous reports, circulating filariae extravasated from an internal hemorrhagic episode or underlying condition, and nematode coinfection was a mere incidental finding. This is supported by biopsy evidence of the omental nodule, lymph node, and splenic tissues.…”

Section: Discussionsupporting

confidence: 52%

“…This hypothesis is further supported by the fact that D. immitis antigens have been shown to induce microvascular angiogenesis 14 . In addition, nodular presentations of dirofilariasis that mimicked neoplasia have been reported previously 12,15,16 …”

Section: Discussionmentioning

confidence: 69%

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Can nematode infection cause internal bleeding in dogs? A case of Dirofilaria immitis infection in cavitary fluids

Alonso,

Shapiro,

Camp

2024

Veterinary Clinical Pathol

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A 9‐year‐old dog was presented with weight loss, respiratory effort, and an enlarged abdomen. Imaging studies and exploratory surgery showed pulmonary and splenic masses and bi‐cavitary effusion, later classified as hemorrhage. Cytology of the peritoneal and pleural fluids also revealed several microfilariae. Immunologic and molecular analyses confirmed Dirofilaria immitis infection and histopathology of the spleen indicated a cavernous endothelial proliferation with undefined etiology (hemangiosarcoma vs reaction to parasite infestation). The nematode larvae are speculated to have entered body cavities via erratic migration or via hemorrhage and visceral lesions to be related to parasitism. Nematode infection should be considered as a differential diagnosis for internal bleeding of undetermined origin.

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Section: Discussioncontrasting

confidence: 59%

Section: Discussioncontrasting

confidence: 54%

Section: Discussionsupporting

confidence: 52%

Section: Discussionmentioning

confidence: 69%

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Can nematode infection cause internal bleeding in dogs? A case of Dirofilaria immitis infection in cavitary fluids

Alonso,

Shapiro,

Camp

2024

Veterinary Clinical Pathol

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“…Although pulmonary dirofilariasis is typically asymptomatic, in rare cases, it may manifest with symptoms such as fever, dyspnea, cough and wheezing [ 7 ]. Radiologically, small subpleural nodules, approximately 0.5–4.5 cm in size are commonly observed, which are referred to as ‘coined lesions’ [ 7 , 8 ]. Pleural effusion exists in very rare cases [ 9 , 10 ].…”

Section: Introductionmentioning

confidence: 99%

Dirofilariasis presenting as pleural effusion: a rare case report with unusual manifestations and treatment modalities

Valčiukaitė-Žilinskienė,

Zablockienė,

Zablockis

2024

BMC Pulm Med

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Background We present an extremely rare manifestation of dirofilariasis in the pleural cavity. This is the first human pulmonary dirofilariasis reported in Lithuania; according to our knowledge, only two other patients were documented with this pathology in the world. Case presentation A 72-year-old woman was admitted to the hospital complaining of dyspnea, left-side chest pain, and a dry cough. She was a retiree living alone in the countryside without domestic pets (sometimes stray dogs appear) or a travel history. A complete blood count was within normal limits, with a CRP level of 16.8 mg/l and D-dimer concentration of 900 µg/l, which raised suspicion of pulmonary embolism. In chest computed tomography angiography, pulmonary embolism was excluded, and only left pleural effusion without abnormal lesions was confirmed. Left thoracocentesis was performed, and the pleural fluid was evaluated as an exudate with a predominance of eosinophils (59%), along with the presence of parasites. These parasites exhibited the morphology of Dirofilaria repens. Oral doxycycline (100 mg, twice daily) and albendazole (400 mg, twice daily) were prescribed for a 14-day course. A month later, there were no pathological findings on the chest X-ray, and the patient no longer had respiratory symptoms. However, the patient presented with an emerged, painful palpable right breastmass, where the rash was previously observed. Ultrasound imaging revealed a 1.5 × 2 cm nodule, which was surgically removed. Parasites consistent with Dirofilaria repens were suspected but not definitively identified. Pharmacological treatment for dirofilariasis was not further prescribed. Conclusions This case encourages doctors to be more vigilant because the patient, who neither travelled nor kept any pets, contracted dirofilariasis. Diagnostic and treatment guidelines are lacking, necessitating further research. Treatment with doxycycline and albendazole yielded positive outcomes, suggesting potential efficacy for dirofilarial pleuritis.

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Dirofilariasis Presenting as Pleural Effusion: a Rare Case Report With Unusual Manifestations and Treatment Modalities

Valčiukaitė-Žilinskienė,

Zablockienė,

Zablockis

2024

Preprint

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Background: We present an extremely rare manifestation of dirofilariasis in the pleural cavity. This is the first human pulmonary dirofilariasis reported in Lithuania; according to our knowledge, only two other patients were documented with this pathology in the world. Case presentation: A 72-year-old woman was admitted to the hospital complaining of dyspnea, left-side chest pain, and a dry cough. She was a retiree living alone in the countryside without domestic pets (sometimes stray dogs appear) or a travel history. A complete blood count was within normal limits, with a CRP level of 16.8 mg/l and D-dimer concentration of 900 µg/l, which raised suspicion of pulmonary embolism. In chest computed tomography angiography, pulmonary embolism was excluded, and only left pleural effusion without abnormal lesions was confirmed. Right thoracocentesis was performed, and the pleural fluid was evaluated as an exudate with a predominance of eosinophils (59%), along with the presence of parasites. These parasites exhibited the morphology of Dirofilaria repens. Oral doxycycline (100 mg, twice daily) and albendazole (400 mg, twice daily) were prescribed for a 14-day course. A month later, there were no pathological findings on the chest X-ray, and the patient no longer had respiratory symptoms. However, the patient presented with a newly emerged, painful palpable right axillary region mass. Ultrasound imaging revealed a 1.5 x 2 cm nodule, which was surgically removed. Parasites consistent with Dirofilaria repens were suspected but not definitively identified. Pharmacological treatment for dirofilariasis was not further prescribed. Conclusions: This case encourages doctors to be more vigilant because the patient, who neither traveled nor kept any pets, contracted dirofilariasis. Diagnostic and treatment guidelines are lacking, necessitating further research. Treatment with doxycycline and albendazole yielded positive outcomes, suggesting potential efficacy.

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Severe and Rare Case of Human Dirofilaria repens Infection with Pleural and Subcutaneous Manifestations, Slovenia

Abstract: We report a case of human Dirofilaria repens infection in a woman in Slovenia who had concomitant pleural and subcutaneous manifestations of the infection. This case report illustrates the clinical course of a severe symptomatic parasitic infection that had multisystemic manifestations.

Cited by 3 publications

References 14 publications

Can nematode infection cause internal bleeding in dogs? A case of Dirofilaria immitis infection in cavitary fluids

Can nematode infection cause internal bleeding in dogs? A case of Dirofilaria immitis infection in cavitary fluids

Dirofilariasis presenting as pleural effusion: a rare case report with unusual manifestations and treatment modalities

Dirofilariasis Presenting as Pleural Effusion: a Rare Case Report With Unusual Manifestations and Treatment Modalities

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