Human dirofilariasis

Abstract

Introduction. Dirofilariasis is a zoonosis caused by nematodes from the genus Dirofilaria, which is a parasite in dogs and other canids, and humans get infected by a mosquito bite. In Europe, the number of patients outside the endemic area is increasing. So far, more than 2,850 cases of human dirofilariasis have been reported worldwide. In the last 20 years, we have had only two confirmed cases in our institution. The disease is manifested in a cutaneous, visceral, and ocular form. From the initial infection, the first symptoms can take several years to manifest. The diagnosis can be confirmed histologically, morphologically, and/or by molecular techniques. The treatment includes surgical removal of the parasite and antiparasitic therapy. Case outline. The paper presents two cases of Dirophilaria repens infection. The first patient had a migratory nodular facial skin change for several years. After the skin induration incision in the zygomatic region, a 7-cm-long worm was extracted, later identified as Dirophilaria repens. The pathohistological finding of the extirpated change showed that it was a granuloma inflammation. The second case was a patient with a persistent cough and hemoptysis, with a morphologically verified nodular change in the pulmonary parenchyma. The pathohistological finding of the extirpated change showed a chronic granulomatous inflammation and the presence of parasites. The treatment of both patients resulted in a complete recovery without complications. Conclusion. In case of subcutaneous nodules or unclear lung changes, dirofilariasis should be considered. Video-assisted thoracoscopic surgery is the leading diagnostic surgical procedure concerning dirofilariasis, and a significant therapeutic modality.