LOIASIS / MedUrgent

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LOIASIS

 This is a filarial disease caused by the filarialworm loa loa which is transmitted by the horse fly, Chrysops. Migration of the larva in the subcutaneous area and deep tissue leads to itching, pain and parasthesia. Immune response to the adult worm leads to formation of Calabar swellings under the skin of the face, eye lids and forearms. These swellings last for several hours to several days and recur at different intervals. The worm can be seen migrating beneath the conjunctiva where it causes severe itching. 






LABORATORY TESTS

• Blood film during the day (unlike W.bancrofti).

• Serology

• High eosinophil count


TREATMENT

1. Diethylcarbamazine: start at a small dose of 1mg/kg/day and build up gradually

2. Steroids to reduce the inflammation

3. In mixed infections with O.volvulus, use Ivermectin instead of DEC for fear of the Mazzotti reaction (tenderness and severe itching of the swelling and the regional lymph nodes associated with malaise and low grade fever)

4. Doxycycline is added to eradicate the endosymbiotic bacteria Wolbachia.

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