Question

Case Study 14- E.S, a 34 year old white female came into the doctor's office in late last November complaining of th left arm swelling. She received steroids and after a couple of weeks the swelling had gone down. Upon gathering information, E.S. stated that she had recently traveled to West Africa in the beginning of the summer to see the rainforest. There, she said that the climate was always moist and hot, and she had noticed that there were many flying insects. Since her visit in early summer, she had been experience neither pain nor problems until recently. Now, a vear after visiting Africa and 6 months since the arm swelling, she has been complaining of intense itching, pain and redness in her left eye She has not complained of any loss of vision, but she states that her vision has been blurred since the pain has started. She also complains of major pain on the site where she noticed swelling in her left arm. A blood sample and an aqueous humor sample were taken. The results of the blood sample indicated she had a high level of white blood cells (eosinophilia) and was positive for microfilaria. Skin disease, Many biopsies were also down on the swollen arm, and there were positive for an infectious disease. Many biopsies were also down on the swollen arm, and there were positive for other test such as urine samples, liver function tests and radiological exams were done to rule out the possible disease such as onchocerciasis and steptocerciasis.) The radiological exams showed were no problems with her internal organs, During the examination calabar swellings involving an area of 40 mm long are 400 micrometer wide were seen around the infected eye No signs of blindness have occurred, but there is mild damage to the conjunctiva of the anterior ch that there amber of her left eye, as ell continued blurry vision.) E.S. has no history of any these symptoms occur before in her life. More skin biopsies from the left eye were sent to the lab for further evaluation. What is the infecting microorganism? pidemiology: How does this organism enter the body and how does it spread within the body and go from person to person? How was this disease contracted? Pathogenesis: What are the virulence factors? How does this organism cause pathology? Clinical Manifestations: What are the signs and symptoms of the disease? How does the disease present itself to the health-care professional? Laboratory Finding How would you diagnose this organism? What should you find? Treatment and Prevention: How would you treat this disease, and how would you prevent contraction of this organism?

Answer 1

The infective organism is filarial parasites ,a mosquito, anopheles in Africa leading to microfilaria .It belongs to the family of onchocercidae.

Epidemiology :

The adult  organism are found in the circulatory system of the host which releases the microfilariae in the blood stream.During this stage if a vector bites the host and sucks in the blood ,the microfilariae cinverts inyi infectice larvae which can be transmitted to otger host by the bite of the vector or the mosquito.

Pathogenesis

It can affect the immune response and cause symptoms. It is usually present in the blood and transmitted by mosquito bites.It can affect the lymphatic system and genitals in male patients.

Clinical manifestations

• Chronic swelling at the site
• Chyluria
• Lymphedema or lymphadenopathy
• Nocturnal cough
• Skin exfoliation
• Pain
• River blindness
• Some of the rare manifestation are retinopathy, arthritis,pleural effusion, hear problems, breast calcification

Laboratory finding

• Microscopic examination reveals the presence of microfilariea
• Nocturnal blood test between 10pm to 2am
• Blood film smears
• Skin snips to identify M.streptocerca
• PCR ,antigenic assay to ruke out presence of microfilariea

Treatment

• Mass drug administration (Diethylcarbamazine is the drug choice,Doxycyclin for we days, Foxy +albendazooe for next 7 days)
• Anti inflammatory, antihistamines,
• Symptomatic Treatment pain relief ,antibiotic are given in case of extreme infection
• High protein low fat diet is required
• Elevation of the affected limb in night
• Surgical removal of hydrocele,nodulectomy to reduce skin and eye infection

Prevention

• Use of insect repellent creams when going to prone areas
• Avoid the bites