Ocular Loiasis in France: A Recent Case Report

Ocular Loiasis in France: A Recent Case Report | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Short Report Ocular Loiasis in France: A Recent Case Report Sarah KERKOURI, Thomas MONFORT, Dorothée QUINIO, Béatrice Cochener-Lamard This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4354759/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 06 Nov, 2024 Read the published version in Journal of Ophthalmic Inflammation and Infection → Version 1 posted 8 You are reading this latest preprint version Abstract We report the case of a 21-year-old Cameroonian woman residing in France for one year, who presented in our department for left eye discomfort and itching. Examination revealed a mobile translucent cord beneath the nasal-inferior conjunctiva, prompting suspicion of loiasis. Anesthesia was administered for extraction, revealing a 31 mm male Loa loa. Positive serology confirmed the diagnosis and diagnostic workup excluded other locations. Treatment with diethylcarbamazine was well-tolerated. This case highlights the importance of considering loiasis in non-endemic regions and underscores the need for interdisciplinary collaboration in its diagnosis and management. loiasis subconjonctival infection Figures Figure 1 Figure 2 Main Text Loiasis, or African eye worm, is a chronic parasitic infection affecting approximately 20 million individuals(1) worldwide in endemic areas, with sporadic cases reported elsewhere. We report the case of a 21-year-old Cameroonian woman who has been a student and resident in France for one year, with no travel history to endemic regions since her arrival. In September 2023, she presented to the ophthalmic emergency department of Brest University Hospital with discomfort and itching in her left eye. Visual acuity was 10/10 in the right eye and 7/10 in the left eye. Examination revealed a mobile translucent cord beneath the nasal-inferior conjunctiva of the left eye (figure 1 and video in supplementary file). The anterior chamber was quiet, and the right eye examination was unremarkable. In this case, due to the patient's anxiety and discomfort, short general anesthesia was administered for the extraction procedure. One living nematode was extracted. Parasitological examination identified a male Loa loa of 31 mm length (figure 2). While the patient had no eosinophilia, diurnal microfilarial serology was positive, with a blood smear showing microfilariae <0.05/mL. No other locations of Loa loa were found. Following a three-week wait for medication delivery, the patient was hospitalized in infectious diseases department to monitor diethylcarbamazine treatment tolerance. Treatment began with 1/32 tablet of 100 mg, progressively doubled to an effective dose of 200 mg twice daily from day 8. The total diethylcarbamazine duration was 28 days. The treatment was well-tolerated, with mild headaches managed by acetaminophen. Ophthalmic follow-up was uneventful. This case underscores the need to consider loiasis in at-risk individuals in non-endemic areas, highlighting interdisciplinary collaboration with microbiologists and infectiologists and reconsideration of treatment availability in non-endemic areas. Loiasis, currently not on the WHO list of neglected tropical diseases, warrants attention, as recent studies show a 14.5% attributable mortality risk(2), which could change thanks to the MorLo projects. Declarations Author Contribution S.K. wrote the main manuscript text.D.Q and T.M. prepared figures and video.B.C-L. supervised the manuscript.All authors reviewed the manuscript. Acknowledgement The patient who gave its informed consent for this publicationRaphael PARET, MD, Service de maladies infectieuses, CHU de Brest, Brest, France. References Ramharter M, Butler J, Mombo-Ngoma G, Nordmann T, Davi SD, Zoleko Manego R (2024) The African eye worm: current understanding of the epidemiology, clinical disease, and treatment of loiasis. Lancet Infect Dis 1 mars 24(3):e165–e178 Chesnais CB, Takougang I, Paguélé M, Pion SD, Boussinesq M (2017) Excess mortality associated with loiasis: a retrospective population-based cohort study. Lancet Infect Dis janv 17(1):108–116 Additional Declarations No competing interests reported. Supplementary Files video.mp4 Cite Share Download PDF Status: Published Journal Publication published 06 Nov, 2024 Read the published version in Journal of Ophthalmic Inflammation and Infection → Version 1 posted Editorial decision: Revision requested 06 Aug, 2024 Reviews received at journal 07 May, 2024 Reviewers agreed at journal 07 May, 2024 Reviewers agreed at journal 07 May, 2024 Reviewers invited by journal 07 May, 2024 Submission checks completed at journal 02 May, 2024 Editor assigned by journal 02 May, 2024 First submitted to journal 01 May, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4354759","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Short Report","associatedPublications":[],"authors":[{"id":299667167,"identity":"755c6b69-20e3-497c-be12-e077eb216361","order_by":0,"name":"Sarah KERKOURI","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA40lEQVRIiWNgGAWjYDACHgYGxgYgzcbeQLIWnsMMDAcgAkRqYZBIJlKLfM/hYx9nVBzO55N8f0z6Q80dOXv2A4wfPubg1mJwti155oYzhy3bpJPZJA4ce2bMw5PALDlzGx4t/DzGjA/bDhuwgbWwHU7sYUhgY+bFo0W+n/8zRIvkYaCWf0At/A/wa2E428PMuBGkRYKZTeJgG1CLBAFbDM4cM2accSbdgI0n2djibN9hY54bD5vx+kW+J/kxY0+FtYF8+8GHNyq+HZZj708++OEjPodhAZB4GgWjYBSMglFAAQAAZi1OlokUfaIAAAAASUVORK5CYII=","orcid":"","institution":"Centre Hospitalier Régional Universitaire de Brest","correspondingAuthor":true,"prefix":"","firstName":"Sarah","middleName":"","lastName":"KERKOURI","suffix":""},{"id":299667168,"identity":"f67e14dd-e9b3-43e9-87e7-aa533451e988","order_by":1,"name":"Thomas MONFORT","email":"","orcid":"","institution":"Centre Hospitalier Régional Universitaire de Brest","correspondingAuthor":false,"prefix":"","firstName":"Thomas","middleName":"","lastName":"MONFORT","suffix":""},{"id":299667169,"identity":"65193eed-8001-4469-8b51-0d8decd40b57","order_by":2,"name":"Dorothée QUINIO","email":"","orcid":"","institution":"Centre Hospitalier Régional Universitaire de Brest","correspondingAuthor":false,"prefix":"","firstName":"Dorothée","middleName":"","lastName":"QUINIO","suffix":""},{"id":299667170,"identity":"a52087e2-1cef-4577-a18f-077b3a072f30","order_by":3,"name":"Béatrice Cochener-Lamard","email":"","orcid":"","institution":"Université de Bretagne Occidentale","correspondingAuthor":false,"prefix":"","firstName":"Béatrice","middleName":"","lastName":"Cochener-Lamard","suffix":""}],"badges":[],"createdAt":"2024-05-01 14:23:32","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4354759/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4354759/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12348-024-00437-7","type":"published","date":"2024-11-06T15:57:33+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":56410108,"identity":"03cc5a19-9073-4e71-bd4a-d82b40b35e1c","added_by":"auto","created_at":"2024-05-13 20:15:52","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":3068332,"visible":true,"origin":"","legend":"\u003cp\u003eSlit lamp examination of the left eye revealing a translucent cord beneath the nasal-inferior conjunctiva, suggestive of a diagnosis of loiasis.\u003c/p\u003e","description":"","filename":"figure1.png","url":"https://assets-eu.researchsquare.com/files/rs-4354759/v1/ecd3dc5e9bd346a986b6f916.png"},{"id":56410115,"identity":"b87ea03d-6c1e-4bd0-a1ef-f9bd5357ed8f","added_by":"auto","created_at":"2024-05-13 20:15:55","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":15958862,"visible":true,"origin":"","legend":"\u003cp\u003eParasitological direct examination showing a 31 mm male Loa loa with its terminal end, characterized by a crossed shape, identifying its male sex.\u003c/p\u003e","description":"","filename":"figure2.png","url":"https://assets-eu.researchsquare.com/files/rs-4354759/v1/a3ffd56bd39110f1cb32b810.png"},{"id":68749929,"identity":"b4317327-821e-42bd-a4d8-d7357faff620","added_by":"auto","created_at":"2024-11-11 16:07:39","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":22184012,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4354759/v1/28e79d7a-6647-4c94-850e-e68063dea08c.pdf"},{"id":56410120,"identity":"6ec67321-03b9-474a-a10e-071658be5659","added_by":"auto","created_at":"2024-05-13 20:15:56","extension":"mp4","order_by":4,"title":"","display":"","copyAsset":false,"role":"supplement","size":292595456,"visible":true,"origin":"","legend":"","description":"","filename":"video.mp4","url":"https://assets-eu.researchsquare.com/files/rs-4354759/v1/76aa92e054764e68d65e57b5.mp4"}],"financialInterests":"No competing interests reported.","formattedTitle":"Ocular Loiasis in France: A Recent Case Report","fulltext":[{"header":"Main Text","content":"\u003cp\u003eLoiasis, or African eye worm, is a chronic parasitic infection affecting approximately 20 million individuals(1) worldwide in endemic areas, with sporadic cases reported elsewhere. We report the case of a 21-year-old Cameroonian woman who has been a student and resident in France for one year, with no travel history to endemic regions since her arrival. In September 2023, she presented to the ophthalmic emergency department of Brest University Hospital with discomfort and itching in her left eye. Visual acuity was 10/10 in the right eye and 7/10 in the left eye. Examination revealed a mobile translucent cord beneath the nasal-inferior conjunctiva of the left eye (figure 1 and video in supplementary file). The anterior chamber was quiet, and the right eye examination was unremarkable. In this case, due to the patient\u0026apos;s anxiety and discomfort, short general anesthesia was administered for the extraction procedure. One living nematode was extracted. Parasitological examination identified a male Loa loa of 31 mm length (figure 2). While the patient had no eosinophilia, diurnal microfilarial serology was positive, with a blood smear showing microfilariae \u0026lt;0.05/mL. No other locations of Loa loa were found. Following a three-week wait for medication delivery, the patient was hospitalized in infectious diseases department to monitor diethylcarbamazine treatment tolerance. Treatment began with 1/32 tablet of 100 mg, progressively doubled to an effective dose of 200 mg twice daily from day 8. The total diethylcarbamazine duration was 28 days. The treatment was well-tolerated, with mild headaches managed by acetaminophen. Ophthalmic follow-up was uneventful. This case underscores the need to consider loiasis in at-risk individuals in non-endemic areas, highlighting interdisciplinary collaboration with microbiologists and infectiologists and reconsideration of treatment availability in non-endemic areas. Loiasis, currently not on the WHO list of neglected tropical diseases, warrants attention, as recent studies show a 14.5% attributable mortality risk(2), which could change thanks to the MorLo projects.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eS.K. wrote the main manuscript text.D.Q and T.M. prepared figures and video.B.C-L. supervised the manuscript.All authors reviewed the manuscript.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eThe patient who gave its informed consent for this publicationRaphael PARET, MD, Service de maladies infectieuses, CHU de Brest, Brest, France.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eRamharter M, Butler J, Mombo-Ngoma G, Nordmann T, Davi SD, Zoleko Manego R (2024) The African eye worm: current understanding of the epidemiology, clinical disease, and treatment of loiasis. Lancet Infect Dis 1 mars 24(3):e165\u0026ndash;e178\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChesnais CB, Takougang I, Pagu\u0026eacute;l\u0026eacute; M, Pion SD, Boussinesq M (2017) Excess mortality associated with loiasis: a retrospective population-based cohort study. Lancet Infect Dis janv 17(1):108\u0026ndash;116\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"journal-of-ophthalmic-inflammation-and-infection","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"joii","sideBox":"Learn more about [Journal of Ophthalmic Inflammation and Infection](http://joii-journal.springeropen.com)","snPcode":"12348","submissionUrl":"https://submission.nature.com/new-submission/12348/3","title":"Journal of Ophthalmic Inflammation and Infection","twitterHandle":"@SpringerOpen","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"loiasis, subconjonctival infection","lastPublishedDoi":"10.21203/rs.3.rs-4354759/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4354759/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eWe report the case of a 21-year-old Cameroonian woman residing in France for one year, who presented in our department for left eye discomfort and itching. Examination revealed a mobile translucent cord beneath the nasal-inferior conjunctiva, prompting suspicion of loiasis. Anesthesia was administered for extraction, revealing a 31 mm male Loa loa. Positive serology confirmed the diagnosis and diagnostic workup excluded other locations. Treatment with diethylcarbamazine was well-tolerated. This case highlights the importance of considering loiasis in non-endemic regions and underscores the need for interdisciplinary collaboration in its diagnosis and management.\u003c/p\u003e","manuscriptTitle":"Ocular Loiasis in France: A Recent Case Report","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-05-13 20:15:16","doi":"10.21203/rs.3.rs-4354759/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-08-06T14:01:09+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-05-07T10:46:48+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"292142196109825868140641728774826870602","date":"2024-05-07T09:41:22+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"320183109510781234951601204892425220166","date":"2024-05-07T09:14:23+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-05-07T09:10:52+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-05-02T06:59:18+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-05-02T06:59:18+00:00","index":"","fulltext":""},{"type":"submitted","content":"Journal of Ophthalmic Inflammation and Infection","date":"2024-05-01T14:22:23+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"journal-of-ophthalmic-inflammation-and-infection","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"joii","sideBox":"Learn more about [Journal of Ophthalmic Inflammation and Infection](http://joii-journal.springeropen.com)","snPcode":"12348","submissionUrl":"https://submission.nature.com/new-submission/12348/3","title":"Journal of Ophthalmic Inflammation and Infection","twitterHandle":"@SpringerOpen","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"18d66437-fb2a-47be-bedf-f085838ec4bb","owner":[],"postedDate":"May 13th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2024-11-11T16:01:16+00:00","versionOfRecord":{"articleIdentity":"rs-4354759","link":"https://doi.org/10.1186/s12348-024-00437-7","journal":{"identity":"journal-of-ophthalmic-inflammation-and-infection","isVorOnly":false,"title":"Journal of Ophthalmic Inflammation and Infection"},"publishedOn":"2024-11-06 15:57:33","publishedOnDateReadable":"November 6th, 2024"},"versionCreatedAt":"2024-05-13 20:15:16","video":"","vorDoi":"10.1186/s12348-024-00437-7","vorDoiUrl":"https://doi.org/10.1186/s12348-024-00437-7","workflowStages":[]},"version":"v1","identity":"rs-4354759","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4354759","identity":"rs-4354759","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}