Accidental human infections with Dirofilariaresult most commonly in a lung nodule or subcutaneous

mass. Two groups of parasites of the genus Dirofilariaaccidentally infect humans. The clinical
presentations are generally different, which reflects the final location of the adults in the usual
animal host. The adult worms of Dirofilaria immitis, the dog heartworm and the only important parasite
in the first group, reside in the right side of the heart and the right pulmonary vessels; they are most
commonly located in the lungs in humans but may also occur in other areas, mostly the subcutaneous
tissues. D. immitisis transmitted by a mosquito to its most common host, the domesticated dog, and
other related mammals. After development in subcutaneous tissues, the parasites migrate as young
adults to the right side of the heart and the right pulmonary vessels. In humans, the immature filariae
migrate similarly but do not fully develop and die, which causes a local vasculitis leading to
pulmonary infarcts. Histologic examination usually reveals a dead worm in an infarct with vasculitis
and with granulomatous and occasionally eosinophilic inflammation.

- What’s DIROFILARIASIS

Dirofilariasis in humans is caused by Dirofilaria roundworms, which are common parasites of dogs, cats,
raccoons, and other nonhuman mammals. Humans are incidental hosts for Dirofilaria and usually
become infected via the bites of contaminated mosquitoes. The clinical forms in humans are pulmonary,
subcutaneous, ocular, and rarely infection of the cerebrum, testicles, female breast, invariably leading to
an incorrect diagnosis of malignant tumor. Six out of 40 species of Dirofilaria are known to cause
diseases in human which are: Dirofilaria immitis, D. repens, Dirofilaria striata, Dirofilaria
tenuis, Dirofilaria ursi and Dirofilaria spectans.[2] D. immitis is responsible for pulmonary dirofilariasis,
whereas D. repens is responsible for subcutaneous and ocular dirofilariasis. Ocular dirofilariasis is
uncommon; however, there have been few reports from various parts of the world. It may present as
periorbital, subconjunctival, orbital, or intraocular infection. The characteristic feature of Dirofilaria in
humans is that the larvae do not survive after crossing the tissues. Those that manage to survive evolve
into adult helminth which is reproductively inactive and cannot produce microfilariae. Hence, the
infected human will never has filaremia and will always be noncontagious. As Dirofilaria is
reproductively inactive and there is no filaremia as in other filarial worms, antihelminthic drugs are not
indicated. Surgical removal of the parasite or excision of the encapsulated mass with the parasite within
is the only treatment for ocular dirofilariasis. No postexcision systemic workup or medication is
required.

Significantly fewer cases have been reported in the United States,

Anti-helminthic drugs are not indicated because Dirofilaria species are not reproductively active and have a single location . For
prevention of allergic reactions, it should be considered that entire of parasite must be removed.

Hadi Mirahmadi, Alireza Maleki, Raheleh Hasanzadeh, Mohammad Bagher Ahoo, Iraj Mobedi, Ali
Rostami.