Ocular Brugia pahangi Filariasis Complicated by Severe Macular Damage in Thailand: Case Report and Literature Review

Narut Suphap Division of Infectious Diseases, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand;
Center of Excellence for Pediatric Infectious Diseases and Vaccines, Chulalongkorn University, Bangkok, Thailand;

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Thanapong Somkijrungroj Center of Excellence in Retina, Department of Ophthalmology, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand;

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Wijak Kongwattananon Center of Excellence in Retina, Department of Ophthalmology, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand;

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Wajamon Supawatjariyakul Department of Ophthalmology, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand;

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Thanapat Pataradool Center of Excellence in Vector Biology and Vector-Borne Disease, Chulalongkorn University, Bangkok, Thailand;
Department of Parasitology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand

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Kanyarat Kraivichian Center of Excellence in Vector Biology and Vector-Borne Disease, Chulalongkorn University, Bangkok, Thailand;
Department of Parasitology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand

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Watsamon Jantarabenjakul Division of Infectious Diseases, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand;
Center of Excellence for Pediatric Infectious Diseases and Vaccines, Chulalongkorn University, Bangkok, Thailand;

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Wasee Tulvatana Department of Ophthalmology, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand;

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Kanok Preativatanyou Center of Excellence in Vector Biology and Vector-Borne Disease, Chulalongkorn University, Bangkok, Thailand;
Department of Parasitology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand

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ABSTRACT.

Extralymphatic filariasis caused by filaria of zoonotic origins has been frequently reported in Thailand over recent years. Here, we report the first case of ocular filariasis in a 7.5-year-old Thai boy who initially presented with progressive conjunctival redness and blurred vision in his right eye. A small, slender, coiled worm was found and surgically removed from the right anterior chamber. Histopathological examination illustrated predominant eosinophilic inflammation surrounding the parasite, which showed smooth and thin cuticle, prominent lateral chords, flat and broad muscle cells, one intestine, and two reproductive tubes with unsegmented ova, typically characteristic of a female adult Brugia filarial nematode. The parasite was also molecularly identified as B. pahangi, based on mitochondrial cytochrome c oxidase subunit I sequence analysis. The patient was then empirically prescribed albendazole, systemic prednisolone, and topical methylprednisolone. Unfortunately, his vision did not recover after 2 months due to severe maculopathy, most likely resulting from parasitic infestation and subsequent vitreous inflammation. To the best of our knowledge, this is the first case of ocular infestation by B. pahangi with visual complications that occurred outside a filariasis-endemic area of Thailand. Furthermore, this report provides clinical data on preceding cases of B. pahangi filariasis formally reported in southeast Asian countries, including Thailand and Malaysia, which facilitate a better understanding of the epidemiology of this sporadic zoonotic infection for effective disease elimination.

Author Notes

Financial support: This study was funded by the Thailand Science Research and Innovation Fund Chulalongkorn University (HEA663000035), Chulalongkorn University, Bangkok, Thailand.

Authors’ addresses: Narut Suphap and Watsamon Jantarabenjakul, Division of Infectious Diseases, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand, and Center of Excellence for Pediatric Infectious Diseases and Vaccines, Chulalongkorn University, Bangkok, Thailand, E-mails: game.mvsk@gmail.com and watsamon.j@chula.ac.th. Thanapong Somkijrungroj and Wijak Kongwattananon, Center of Excellence in Retina, Department of Ophthalmology, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand, E-mails: thanapongmd@gmail.com and joejer6124@gmail.com. Wajamon Supawatjariyakul and Wasee Tulvatana, Department of Ophthalmology, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand, E-mails: quinnkw119@gmail.com and wasee.t@chula.ac.th. Thanapat Pataradool, Kanyarat Kraivichian, and Kanok Preativatanyou, Center of Excellence in Vector Biology and Vector-Borne Disease, Chulalongkorn University, Bangkok, Thailand, and Department of Parasitology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand, E-mails: thanapat.p@chula.ac.th, iamteaw@yahoo.com, and kanok.pr@chula.ac.th.

Address correspondence to Kanok Preativatanyou, Faculty of Medicine, 18th Floor, AorPorRor Bldg., Chulalongkorn University, Rama IV Rd., Bangkok 10330, Thailand. E-mail: kanok.pr@chula.ac.th
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