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A 22 -year-old Female who immigrated From Gabon , Africa, 3 years ago presented to the hospital with sudden pain in her righ t eye. She also Felt that something was movi ng in her sclera. She denied Fever. chil ls, night sweats, weigh t loss . rash, or swelling. Laboratory evaluation showed a leukocyte count of 9. 1 00/,LLL with 22% eosinoph ils, hemoglobin 1 3 .0 g/dl, and platelet 328,000/fil. The peripheral blood smear is shown below.
What is the most likely diagnosis?
- Strongyloides
- Onchorcerciasis
- Mansonella infection
- Loa loa
Medicine
D. The peripheral blood smear shows an obvious microfilaria, and in light of the patient's ethnic background, is most likely Loa loa. Loiasis, known as the African eye worm, is caused by the filarial nematode Loa loa and is transmitted by the bite of the female Chrysops fly, which is endemic in the rain forest of Central and West Africa. After infection, the filarial nematode may migrate across the subconjunctiva of the eye and produce pain and swelling (Calabar swellings). Microfilariae may be detected in the blood smear and are usually 3 to 7 em in length, as seen in the image. Of note, finger stick specimens may provide a better yield of microfilariae than do peripheral venipunctures, whereas late night blood draws are needed to detect nocturnal Wuchereria bancrofti and Brugia malayi ( Clin Lab Med. 1991;11:977-1010).
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