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ULTRASOUND DIAGNOSTICS OF HUMAN SUBCUTANEOUS DIROFILARIASIS- CASE REPORT AND REVIEW OF THE LITERATURE /
ULTRAZVUČNA DIJAGNOSTIKA HUMANE SUBKUTANE DIROFILARIJAZE- PRIKAZ SLUČAJA I PREGLED LITERATURE.

Authors

 

Miroslav Mišović1,2, Dejan Kostić1,2, Boban Krstić1, Jelena Golubović1, Tijana Kosanović3

1 Institute for Radiology, Military Medical Academy, Belgrade, Serbia
2 Faculty of Medicine, University of Defense, Belgrade, Serbia
3Department of Radiology, General Hospital Pančevo, Pančevo, Serbia

 

UDK: 616.995.132


The paper was recieved / Rad primljen: 21.02.2018.

Accepted / Rad prihvaćen: 28.03.2018.

 


Corresponding to:


Dr Miroslav Mišović,
Vojnomedicinska akademija
Crnotravska 17, Beograd
+381 60 011 11 77
e-mail: miki_misic@yahoo.com

 

 

Abstract:

 

Introduction: Human dirofilariasis is a rare zoonotic disease caused by parasite Dirofilaria species. It usually presents as a nodular lesion in the subcutaneous tissues, lung or eyes. The natural hosts for the Dirofilaria species that most frequently cause disease in humans are mainly dogs and cats as well as other carnivores like wolves, bears, foxes and raccoons. Humans are infected with Dirofilaria larvae through mosquito bites. Subcutaneous dirofilariasis have been reported from endemic areas in Europe countries such as Italy, France, Spain and from India mostly from the state of Kerala. Autochthonous cases of human subcutaneous infection had been found in Poland, Slovakia, Czech Republic Montenegro and Serbia. Purpose: Display of ultrasonography possibilities in the diagnosis of subcutaneous changes caused by Dirofilaria repens. Material and methods: 43-year-old patient, from Belgrade, came for an examination because of a swelling in the region of the left Achilles tendon, accompanied by itching. It is alleged that the swelling appeared a year ago in the left upper thigh and descended to the region of the left Achilles tendon where it has remained in the last two months with an emergence of itching. Results: During examination of the left Achilles tendon region, a swelling of about 2 cm in diameter was observed with a livid colouring of the skin. Through ultrasound, in the subcutaneous adipose tissue above the Achilles tendon, an oval, clearly circumscribed, avascular change, of 12x10x5 mm diameter was observed. Inside of the lesion there are curvilinear echogenic structures with a diameter of 0.7 mm, which are moving. The change was removed in its entirety, while parasitological analysis has proven that it was Dirofilaria repens. Conclusion: Subcutaneous dirofilariasis can mimic various benign and malignant lesions. The difficulties arise in the differential diagnosis because subcutaneous nodules are suspected to be malignant neoplasm or other pathologies such as sebaceous cysts, tuberculosis, fungal infections, abscesses, and so on. High resolution ultrasound is very helpful in the differential diagnosis of these changes.

 

 

Key words:

human subcutaneous dirofilariasis, ultrasound, color Doppler.

 

 

Sažetak:

 

Uvod: Humana dirofilarijaza je retka zoonoza uzrokovana parazitom Dirofilaria species. Uobičajeno se javlja u formi nodularne promene u potkožnom tkivu, plućima ili očima. Prirodni domaćin za Dirofilaria species, koje najčešće izazivaju bolest kod ljudi, najčešće su psi i mačke, ali i drugi mesožderi kao što su vukovi, medvedi, lisice i rakuni. Larva dirofilarije se prenosi na ljude najčešće ujedom komarca. Subcutana forma dirofilarijaze registrovana je u endemskim područjima Evrope: Italija, Francuska, Španija, i u Indiji, najčešće u državi Kerala. Autohtoni slučajevi humane subkutane infekcije prijavljeni su i u Poljskoj, Slovačkoj, Češkoj, Crnoj gori i Srbiji. Cilj: Prikazati mogućnosti ultrazvuka u dijagnostici subkutanih promena uzrokovanih parazitom Dirofilaria repens. Materijal i metode: pacijent starosti 43 godine, iz Beograda, dolazi na pregled zbog otoka u regiji leve Ahilove tetive, udruženog sa svrabom. Navodi da se otok pojavio pre godinu dana u gornjoj natkolenici odakle se spuštao do regije leve Ahilove tetive gde se nalazi poslednja dva meseca, kada se pojavio i svrab. Rezultati: tokom pregleda regije leve Ahilove tetive uočava se otok promera oko 2 cm sa lividnom prebojenošću kože. Ultrazvučnim pregledom, u potkožnom masnom tkivu iznad Ahilove tetive, uočava se ovalna, jasno ograničena, avaskularna promena promera oko 12x10x5 mm. Unutar opisane promene uočava se lučna, linearna, hiperehogena struktura promera oko 0.7 mm, koja se tokom pregleda pokreće. Promena je hirurškim putem odstranjena u celosti, a parazitološkom analizom je dokazano da se radi o parazitu Dirofilaria repens. Zaključak: Subkutana dirofilariaza može imitirati veći broj benignih i malignih promena. Problem nastaje u diferencijalnoj dijagnozi pošto subkutani čvorovi mogu biti suspektni na maligne tumore, ali i na druga patološka stanja kao što su sebacealne ciste, tuberkuloza, gljivične infekcije, abscesi, itd. Ultrazvučni pregled visokofrekventnim sondama je od velike pomoći u diferencijalnoj dijagnozi ovakvih promena.

 

 

Ključne reči:

humana subkutana dirofilariaza, ultrazvuk, kolor Dopler.

 

 

Literature:

 

  1. Glavan N, et al. Dirofilaria repens infection in a ten- year- old boy from the Istria Peninsula: case report. Acta Clin Croat. 2013; 52(4): 533-6.
  2. Simón F, Siles-Lucas M, Morchón R, González-Miguel J, Mellado I, Carretón E., and  Montoya-Alonso JA. Human and Animal Dirofilariasis: the Emergence of a Zoonotic Mosaic. Clin Microbiol Rev. 2012; 25(3): 507-544.
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PDF Mišović M. et al. • MD-Medical Data 2018;10(2): 111-113

 

 

 

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