Ocular parasitiasis. PARASITOLOGY DEPARTMENT University of Sumatera Utara. Nurfida Khairina Arrasyid

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1 Ocular parasitiasis PARASITOLOGY DEPARTMENT University of Sumatera Utara Nurfida Khairina Arrasyid

2 Ocular Helminthiasis Toxocara cani Angiostrongylus cantonensis Onchocerca volvulus Loa loa Thelazia sp

3 Ocular toxocariasis cani Older children No history of pica Small dose of infection Posterior painless lesion near optic disc granuloma asymptomatic visual defects unilateral loss of vision

4 PATHOGENESIS Larva in an eye cause chronic inflamation of the inner chamber or retina or provoke dangerous granulomas of the retina This reactions can lead to blindness in the affected eye Ocular involvement has been reported in 245 patients with an average age of 7.5 years

5

6 Diagnosis Treatment Liver biopsy granuloma Laser photocoagulation

7 Ocular angiostrongyliasis Defenitive host : rodent (Rattus norvegitus and Rattus rattus) Habitat : pulmonary artery of rodents Intermediate host : snail (Achatina, Pila) Distribution : Southeast Asia, India, Taiwan, China, Japan, Australia and Egypt

8 Mode of Human Infection Ingested 3 rd stage larvae by consuming intermediate host (snail) or paratenic host (exp. crabs, fresh water shrimp). Ingested 3 rd larvae from water which was contaminated by dead mollusc/snail, or vegetables by secretions of mollusc

9 Patology & Symptoms Larvae in eye Ocular angiostrongyliasis blind Headache and stiff neck Vomiting Severe case : paresthesia and paralysis Eosinophilic meningitis or eosinophilic meningoencephalitis Diagnosis Anamnese eating mollusc Clinical signs and symptoms Finding larvae (young adult worm) in spinal fluid or other organs by surgery Serological test

10 Therapy Supportive Thiabendazole, Albendazole Prevention Cooking all potential intermediate and paratenic host before eat.

11 Ocular onchocerciasis Causative agent: Onchocerca volvulus Insect vector: Black flies, Simulium sp. Also known as River blindness 5% infected are blind (2 million) Distribution: Tropical Africa, Central America, spread to Arabian Peninsula.

12 Pathology/Pathogenesis Live microfilaria invade many parts of the eye, but here again they cause little reaction, their death leads to lessions Chronic inflamatory cells with eosinophils & neutrophils surround death worms, follow by fibroblast proliferation & chronic inflamatory infiltrates The most important cause of blindness is sclerosing keratitis a hardening inflamation of the cornea

13 Pathology/Pathogenesis Blindness Any part of the eye : punctate keratitis, sclerosing keratitis, chorioretinitis, optic atrophy. Most often in savanna Africa & Guatemala Punctate keratitis is most common snowflake opacities due to inflamatory reaction to dying microfilariae

14 Diagnosis & Treatment Diagnosis Slit-lamp examination Serological method PCR has role in monitoring chemotherapy

15 Ocular loiasis Caused by the eye worm of Africa, Loa loa Transmitted by mango flies, Chrysops sp. Endemic only in rainforest areas of central and west Africa Nigeria, Cameroon, Zaire (Congo), Angola, Gabon, Chad & Sudan Mf in peripheral blood shows diurnal periodicity. Mf has been shown in primate but has nocturnal periodicity, probably a different species

16 Pathology, Pathogenesis & Clinical manifestations Occusianally adult worms migrate through the conjunctiva & cornea with swelling of the orbit

17 Pathology, Pathogenesis & Clinical manifestations Endemic patient Hypo-responsiveness 90% positive for Mf Lower eosinophilia, parasitespecific IgG & lymphocyte proliferation Nurfida Kh. Arrassyid

18 Pathology, Pathogenesis & Clinical manifestations Non-endemic population Hyper-responsiveness Low positivity for Mf (10%) Higher level of eosinophilia (60-80%), parasite-specific IgG & lymphocyte proliferation More severe & recurrent calabar swelling

19 Diagnosis & Treatment Diagnosis Blood smear for Mf (mid-day sample) Biopsy Serological test (ELISA, IFA Treatment DEC 8-10mg/kg in divided doses x 21 days

20 Ocular thelaziasis Pathogenesis, Pathology & Symptomatology Thelazia produces damage to the tissues associated with the eye. Its presence in the conjunctival sac provokes excess flow of lacrimal fluid. Its repeated migration across the corneal conjunctiva irritates this layer & eventually results in scarification & fibrous opacity of the region

21 Pathogenesis, Pathology & Symptomatology Paralysis of the muscles of the lower eyelid, with ectropion, has been attributed to the worms. The presence & movement of the parasites in the conjunctival sac cause surprisingly mild symptoms consisting of excessive lacrimation, itching or pain.

22 Diagnosis & Treatment Diagnosis : The presence of creamy white threaworm masses coiled in the conjunctival sac Treatment : Removal the worm with forceps

23 OCULAR PROTOZOIASIS Nurfida Khairina Arrasyid

24 Ocular protozoiosis Acanthamoeba sp Toxoplasma gondii

25 Ocular acanthamoebiasis Free living amoeba widely distributed in nature Facultative parasite of man and animal Causes infection : 1. CNS (Granulomatous Amebic Encephalitis GAE) 2. Cornea (Keratitis) 3. Skin ulcers

26 Recent increase in the number of cases of CNS infection as well as cases of keratitis Problems with diagnosis and effective treatment

27

28 Keratitis Inflammation of the cornea painful, vision threatening disease resulting in blindness if untreated painful eye, redness, photophobia infiltration of corneal epithelium leading to ulceration, perineuritis, hypopyon very resistant to treatment resulting in tx failure

29 increasing no. of cases throughout the world related to contact lens wear (>80%) increasing usage of contact lenses but poor lens hygienic care related to trauma (injury to the eyes by soil, sand, contaminated water, mud splashing, foreign bodies) progressive disease which resembles herpes simplex

30 Risk factors Contact lens wear esp extended wear Trauma to the eye Use of home made saline Use of tap water to rinse lens Swimming while wearing CL Poor hygienic care of CL system

31 Diagnosis Hx of CL wear or injury to the eye Poor hygienic care of CL system Use of tap water or homemade saline Clinical presentation and finding of perineuritis Clinical spesimen is corneal scrappingor biopsy which should be cultured onto NNA overlay with E. coli Both trophozoite and cyst can be identified

32

33 Other specimens include contact lens, CL casing, CL saline and disinfectant, tap water used to rinse lens The specimens should also be cultured for Acanthamoeba using NNA overlay with E. coli Examine under inverted microscope daily until 14 days before a negative result is confirmed

34 Ocular toxoplasmosis Ocular toxoplasmosis is allegedly the most common cause of posterior uveitis in immunocompetent individuals. In most patients it is presumed to be a reactivated congenital condition, but instances of acquired infection have also been reported.

35 Pathogenesis, Pathology, Symptoms A white, sharp-edged but irregular neuroretinal inflammatory focus is usually seen, frequently in association with an old scar. In recurrent ocular toxoplasmosis, acute inflammation may be restricted to a discrete zone at the margin of an old scar.

36 Pathogenesis, Pathology, Symptoms Chronic active or relapsing infections of retinal cells by tachyzoites causes blinded spot & extensive infection of the central macular area, which may lead to blindness Cysts & cyst rupture in the retina can also lead to blindness Pathologic findings: necrotizing retinitis and uveitis

37 Signs, Symptoms, Diagnosis & Treatment Acute retinochoroiditis include blurred vission, scotoma,photophobia and pain Pathology : coagulative necrosis of the retina with inflamatory infiltrates & loose granulomas in the choroid Funduscopic : vitritis

38

39 REFERENCE Beaver, P.C., Jung, R.C Clinical parasitology. 9 th ed. Philadelphia, Lea & Febringer. p ; 345 Gillespie, S., Pearson, R.D Principle and practice of clinical parasitology.john Wiley & Son Ltd. p.124 Miyazaki, I An illustrated book of helminthic zoonosis. Tokyo : International Medical Foundation of Japan, p ; 366; Schimidt, G.D., Roberts, L.S Foundation of parasitology. 7 th ed. Mc Graw Hill. p ; ; ; 458;

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