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. 2020 Apr 6;147(9):909–921. doi: 10.1017/S003118202000058X

Table 1.

Characteristics of human filariasis case report studies in Iran up to 1 December 2019

Reference Sex/ age/ city or province/ year of report/ ref Symptoms/signs Genus and species of parasite diagnostic methods Outcome
Subcutaneous Dirofilariasis
Ashrafi et al. (2010) F/ 39 y/Rasht, Guilan/ 2010/

  1. Itching

  2. Highly erythematous subcutaneous

  3. Tender nodule on her right thigh.

 Dirofilaria repens

  1. A dermatologist as a suspected case of cutaneous fascioliasis

  2. Microscopic examination of the excised nodule revealed the presence of D. repens.

 Cure
Subcutaneous Dirofilariasis
Negahban et al. (2007) M/ 40 y/ Shiraz, Fars/ 2007

  1. Firm mass, 2.5 × 2.5 cm2, at the lateral aspect of his right forearm.

  2. History of mosquito bite and swelling of forearm

  3. Antibiotic therapy resolved swelling but firm, painless mass was remained at dorsolateral.

 Dirofilaria repens

  1. Fine needle aspiration (FNA); was performed on 2 occasions using a 22-gauge needle. Three ethanol-fixed and 1 air-dried smear were stained by Papanicolaou and Wright stain, respectively. Many well-preserved microfilariae on the first attempt and eggs with microfilariae on the second occasion were detected in the FNA smears.

  2. Surgical excision; the presence of adult worms in tissue sections confirmed the diagnosis.

  3. MRI: Oval, hypersignal nodule in subcutaneous tissue in T2-weighted images associated with surrounding oedema.

 Cure
Subcutaneous Dirofilariasis
Athari (2003) M/ 22 y/ Chalus, Mazandaran/ 2003/

  1. With a transient nodule measuring 2 cm within the

  2. Subcutaneous tissues of the forehead

  3. Mild headache, weakness and paraesthesia of both lower limbs

 Dirofilaria repens

  1. Surgical excision; the nodule was surgically removed under local anaesthesia and a living and coiled filarial worm, more than 12 cm long, emerged intact from the lesion.

  2. Microscopic examinations: characteristics are typical of the genus Dirofilaria and suggest a mature female of D. repens.

 Cure
Subcutaneous Dirofilariasis
Maraghi et al. (2006) M/ 34 y/ Ahvaz, Khuzestan/ 2006/

  1. A single, firm and moveable nodule on the right cheek

 Dirofilaria repens

  1. Excisional biopsy; an adult Dirofilaria measured 120 mm in length with white colour was removed.

  2. Nodule histopathology showed intense inflammatory cell reaction.

 Cure
Subcutaneous Dirofilariasis
Maraghi et al. (2006) M/ 37 y/ Ahvaz, Khuzestan/ 2006/

  1. A single and moveable nodule measuring 15 mm in diameter on his chest.

 Dirofilaria repens

  1. The patient pressed the nodule and a white worm 130 mm in length was observed and identified as D. repens

  2. No microfilaria was observed in peripheral blood, in nodule or inside worm.

 Cure
Ocular Dirofilariasis
Jamshidi et al. (2008) M/ 49 y/ Tehran, Tehran/ 2010/

  1. Redness, tearing, blepharospasm, swelling of lids

  2. Photophobia

  3. Cystic swelling on the temporal side of bulbar conjunctiva of right eye.

 Dirofilaria repens

  1. Histopathologic examination: extracted worm was recognized as immature D. repens of 18 mm length and 280-μm width based on longitudinal ridges.

 NR
Ocular Dirofilariasis
Mirahmadi et al. (2017) M/ 2 y/ Chabahar, Sistan & Baluchistan/ 2017/

  1. Redness, irritation, pain and foreign body sensation in the right eye.

  2. Presence of anaemia and history of pica.

  3. Visual acuity and fundus were normal.

 Dirofilaria immitis

  1. Slit lamp examination demonstrated a thread-like whitish nematode in the anterior chamber of the right eye that twisted around it.

  2. PCR amplification and sequence analysis of mitochondrial 12S rDNA confirmed that recovered worm was D. immitis.

 Cure
Ocular Dirofilariasis
Rouhani and Athari (2003) M/ 20 y/ Mazandaran/ 2003/

  1. A nodule in his right eye. The nodule measured approximately 5 × 5 mm2, and had grown slowly in the past year.

  2. Complain of itching, epiphora and mild pain in right eye

 Dirofilaria, but the species could not be identified Microscopically; the presence of longitudinal cuticular ridges, a thick muscle cell layer, the presence of internal organs, consisting of intestine and reproductive organs and the presence of nuclei per histological section in the lateral cord, led to identify the specimen as a Dirofilaria, without species identification. NR
Ocular onchocerciasis
Mowlavi et al. (2014) M/ 20 y/ Qom, Qom/ 2013/

  1. Yellowish conjunctival nodular lesion in the left eye.

  2. The lesion had been present for 1 year and caused a mild foreign body sensation with a minor conjunctival hyperemia over the affected part of the eye.

  3. No history of travel to other cities.

  4. Uncorrected visual acuity (20/20) with normal intraocular pressure and eye movements.

 Onchocerca lupi

  1. Microscopic examination of the worm revealed a multilayered cuticle with typical prominent undulated ridges on the external layer and transverse striae on the internal layer. Absence of striae might be due either to inappropriate preparation of tissue samples or lack of fine contrast adjustment. The distances between annular outer ridges were 38–40 mm on a segment of worm 210 mm wide, with two striae per ridge interval. These features are indicative of female worms of the genus Onchocerca.

  2. PCR assay: The 12S rRNA gene showed 99% homology with O. lupi of canine onchocerciasis from Portugal and O. lupi involved in human eye infection from Turkey.

 Cure
Orbital Dirofilariasis
Tavakolizadeh and Mobedi (2009) F/ 24 y/ Tehran, Tehran/ 2009

  1. Complaining of a slightly painful mass near the temporal area of the right eye

  2. Unresponsive to topical steroids and palliative therapy.

  3. No history of trauma or insect bite.

 Dirofilaria repens

  1. Histological examinations: revealed multiple sections of a nematode with central eosinophilic and neutrophilic infiltration surrounded by granulomatous and fibrous tissues.

  2. Morphologic evaluation: showed a nematode with multilayer thick cuticles, indistinct intestinal cells, numerous external ridges, distinct dorsal and ventral fields of divided coelomyarian somatic musculature, internal longitudinal ridges with broad lateral chords, heavy musculature, and didelphic uterine tubes with a small extra branch empty of microfilariae.

    These findings suggested it to be a mature female D. repens.

 Cure
Ophthalmic Dirofilariasis
Maraghi et al. (2016) F/ 54 y/ Abadan, Khuzestan/ 2016/

  1. Tearing, irritation, swelling and itching of the right eye

 Dirofilaria repens

  1. In ophthalmoscopy, a live worm was observed in sub-conjunctival space. The worm was removed and sent to the laboratory. The worm was white in colour with a length of 105 mm. Based on morphological characterization identified as Dirofilaria repens

 NR
Subconjunctival Dirofilariasis
Tabatabaei et al. (2017) M/ 59 y/ Tabriz, East Azerbaijan/ 2017/

  1. Diurnal foreign body sensation, localized tenderness and eye redness during the day in right eye since 5 days ago.

  2. No history of travel, trauma, allergy and visual acuity was normal.

 Dirofilaria immitis

  1. Ocular examination showed moderate chemosis and injection at that temporal conjunctiva. After careful slit lamp examination, a

    U-shaped moving lesion was visible under the conjunctiva at the site of redness and injection. In fact, when the light focused on the conjunctival surface, the worm started to move.

  2. Parasitological examination: extracted worm was reported to be an immature female worm with 100 mm length and 0.5 mm width belonging to D. Immitis family.

  3. Proof of identity was based on the morphological appearance and reliable diagnostic clues were completed with observing smooth laminated cuticle, narrow hypodermal lateral cords and long muscle cells

 Cured, except for faint temporal conjunctival scar.
Subconjunctival Dirofilariasis
Maraghi et al. (2006) M/ 35 y/ Ahvaz, Khuzestan/ 2006/

  1. Itching, swelling and redness of the right eye.

 Dirofilaria repens

  1. Examination noticed a living worm with the length of 110 mm which was removed from the subconjunctival space.

 Cure
Subconjunctival Setariasis
Nabie et al. (2017) F/ 15 y/ Tabriz, East Azerbaijan/ 2017/

  1. A 24 h history of redness, itching, swelling and foreign body sensation in her left eye.

  2. History of insect bite 1-year ago without history of travel.

 Setaria equina

  1. Slit lamp examination: a thread-like cylindrical worm was moving in the subconjunctival area. The worm was extracted, stained and measured 110 mm in length 510 μm in width. The isolated worm was identified as adult female S. equina based on morphometric criteria.

  2. PCR: identification of the species of the worm was confirmed using molecular methods.

 Cure
Periocular Dirofilariasis
Jamshidi et al. (2008) F/ 27 y/ Bandar Abbas, Hormozgan/ 2008

  1. Redness and swelling of the left eye since 10 years ago.

  2. Redness and swelling of right eye and frontal area since 2 days ago.

  3. No history of bites and normal haematological and biochemical parameters.

 The worm was diagnosed as, likelihood, Dirofilaria immitis

  1. Microscopic examinations: live worm (126 × 0.75 mm2) was surgically extracted from the lower lid subcutaneous tissue. The parasite was sent to Department of Parasitology, Tehran University of Medical Sciences for further identification.

    The worm was at a juvenile stage, body was smooth, and the tail was round. The whole oesophagus from the anterior end measured 1.25 mm. The vulva opening was situated in the anterior part of the esophagus 2.2 mm from the frontal region behind the muscular esophagus. Microfilariae were detected in the uterus, and the worm was possibly D. immitis.

 Cure
Dirofilaria in Hydrocele
Salahi-Moghadam and Banihashemi (2016) M/ 5 y/ Bandar Abbas, Hormozgan/ 2016/

  1. Main compliant of left inguinal pain

  2. Ultrasonography of testes was normal.

  3. A well-defined heterogeneous lesion was seen in superior aspect of left testis.

 Dirofilaria immitis

  1. According to ultrasonic imaging, diagnosis was based on incarcerated inguinal hernia and hydrocele. During surgery, a worm was removed from spermatic cord.

  2. Macroscopic features: 60 mm long milky nematode, with conic

    head and end, and without other notable macroscopic features

  3. Microscopy: overview of worm body indicated a kind of filarial; and seeing vulva in anterior portion and bifurcate uterus terminal and the form of oesophagus and cuticle caused the detection of D. immitis. Large amount of cells were seen in this worm's uterus.

 Cure
Breast Dirofilariasis
Maraghi et al. (2015) F/ 40 y/ Abadan, Khuzestan/ 2015/

  1. A nodule on her right breast

 Dirofilaria repens

  1. Ultrasound and mammography revealed a nodule diagnosed as parasitic lesion.

  2. Histopathological examination, cross-section of a worm surrounded with necrotic tissue, associated with infiltration of Neutrophils, Eosinophils and foreign body giant cells observed which was morphologically compatible with Dirofilaria repens

 Cure