Advertisement
Case Report| Volume 19, ISSUE 3, 104505, March 2023

Cases of Loiasis Among a Congolese Family: Screening for Loiasis Among Newly Arrived Refugees From Endemic Areas

Published:January 27, 2023DOI:https://doi.org/10.1016/j.nurpra.2022.11.015

      Highlights

      • Although not commonly seen in the United States, loiasis is important to consider in primary care settings that care for refugees from West and Central Africa.
      • Understanding diagnosis and treatment basics is key to recognizing loiasis in refugee populations.
      • Loiasis can present nonspecifically and requires high clinical suspicion.

      Abstract

      Loiasis is a parasitic infection caused by the filarial nematode Loa loa within endemic regions of West and Central Africa. These regions include areas co-endemic for other nematode infections. Although loiasis is rarely seen in the United States, primary care providers who regularly see refugees from endemic areas should be aware of its clinical presentation, diagnostic workup, and initial management. Given the challenges of diagnosing loiasis, especially in low-prevalence settings, we present cases of 4 family members, 2 of whom were diagnosed with loiasis, and discuss an approach to screening populations from endemic regions during their initial Refugee Health Examination upon arrival to the United States.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to The Journal for Nurse Practitioners
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Zouré H.
        • Wanji S.
        • Noma M.
        • et al.
        The geographic distribution of Loa loa in Africa: results of large-scale implementation of the Rapid Assessment Procedure for Loiasis (RAPLOA).
        PLoS neglected tropical diseases. 2011; 5e1210https://doi.org/10.1371/journal.pntd.0001210
        • Metzger W.
        • Mordmüller B.
        Loa loa—does it deserve to be neglected?.
        Lancet Infect Dis. 2014; 14 (2014 Apr): 353-357https://doi.org/10.1016/S1473-3099(13)70263-9
        • Chesnais C.
        • Takougang I.
        • Paguélé M.
        • Pion S.
        • Boussinesq M.
        Excess mortality associated with loiasis: a retrospective population-based cohort study.
        Lancet Infect Dis. 2017; 17: 108-116https://doi.org/10.1016/S1473-3099(16)30405-4
        • Legrand F.
        • Herrick J.
        • Makiya M.
        • et al.
        A randomized, placebo-controlled, double-blind pilot study of single-dose humanized anti-IL5 antibody (reslizumab) for the reduction of eosinophilia following diethylcarbamazine treatment of Loa loa infection.
        Clin Infect Dis. 2021; 73: e1624-1631https://doi.org/10.1093/cid/ciaa1365
        • Veletzky L.
        • Hergeth J.
        • Stelzl D.
        • et al.
        Burden of disease in Gabon caused by loiasis: a cross-sectional survey.
        Lancet Infect Dis. 2020; 20: 1339-1346https://doi.org/10.1016/S1473-3099(20)30256-5
        • Kamgno J.
        • Pion S.D.
        • Mackenzie C.D.
        • Thylefors B.
        • Boussinesq M.
        Loa loa microfilarial periodicity in ivermectin-treated patients: comparison between those developing and those free of serious adverse events.
        Am J Trop Med Hyg. 2009; 81: 1056-1061https://doi.org/10.4269/ajtmh.2009.09-0356
        • Despommier D.
        • Gwadz R.
        • Hotez P.
        Loa loa (Cobbold 1864). Parasitic Diseases.
        3rd ed. Springer, 1995: 53-57
        • Richardson E.
        • Luo R.
        • Fink D.
        • Nutman T.
        • Geisse J.
        • Barry M.
        Transient facial swellings in a patient with a remote African travel history.
        J Travel Med. 2012; 19: 183-185https://doi.org/10.1111/j.1708-8305.2012.00612.x
        • Burbelo P.
        • Ramanathan R.
        • Klion A.
        • Iadarola M.
        • Nutman T.
        Rapid, novel, specific, high-throughput assay for diagnosis of Loa loa infection.
        J Clin Microbiol. 2008; 46: 2298-2304https://doi.org/10.1128/JCM.00490-08
        • Loasis Antibody Test
        Drugs & Diagnostics for Tropical Diseases website.
        http://www.ddtd.org/loa-antibody-test
        Date accessed: May 3, 2022
        • Fink D.
        • Kamgno J.
        • Nutman T.
        Rapid molecular assays for specific detection and quantitation of Loa loa microfilaremia.
        PLoS Negl Trop Dis. 2011; 5e1299https://doi.org/10.1371/journal.pntd.0001299
        • Centers for Disease Control and Prevention
        CDC—Loiasis—Resources for Health Professionals.
        • Seybolt L.
        • Christiansen D.
        • Barnett E.
        Diagnostic evaluation of newly arrived asymptomatic refugees with eosinophilia.
        Clin Infect Dis. 2006; 42: 363-367https://doi.org/10.1086/499238
        • Twum-Danso N.
        Loa loa encephalopathy temporally related to ivermectin administration reported from onchocerciasis mass treatment programs from 1989 to 2001: implications for the future.
        Filaria J. 2003; 2: S7https://doi.org/10.1186/1475-2883-2-S1-S7
        • Francis H.
        • Awadzi K.
        • Ottesen E.
        The Mazzotti reaction following treatment of onchocerciasis with diethylcarbamazine: clinical severity as a function of infection intensity.
        Am J Trop Med Hyg. 1985; 34: 529-536https://doi.org/10.4269/ajtmh.1985.34.529
        • Klion A.
        • Massougbodji A.
        • Horton J.
        • et al.
        Albendazole in human loiasis: results of a double-blind, placebo-controlled trial.
        J Infect Dis. 1993; 168: 202-206https://doi.org/10.1093/infdis/168.1.202
        • Klion A.
        • Horton J.
        • Nutman T.
        Albendazole therapy for loiasis refractory to diethylcarbamazine treatment.
        Clin Infect Dis. 1999; 29: 680-682https://doi.org/10.1086/598654
        • Chesnais C.
        • Pion S.
        • Boullé C.
        • et al.
        Individual risk of post-ivermectin serious adverse events in subjects infected with Loa loa.
        EClinicalMedicine. 2020; 28: 100582https://doi.org/10.1016/j.eclinm.2020.100582
        • Gardon J.
        • Gardon-Wendel N.
        • Demanga-Ngangue
        • Kamgno J.
        • Chippaux J.
        • Boussinesq M.
        Serious reactions after mass treatment of onchocerciasis with ivermectin in an area endemic for Loa loa infection.
        Lancet. 1997; 350: 18-22https://doi.org/10.1016/S0140-6736(96)11094-1
        • Brito M.
        • Paulo R.
        • Van-Dunem P.
        • et al.
        Rapid integrated clinical survey to determine prevalence and co-distribution patterns of lymphatic filariasis and onchocerciasis in a Loa loa co-endemic area: the Angolan experience.
        Parasite epidemiology and control. 2017; 2: 71-84https://doi.org/10.1016/j.parepi.2017.05.001
      1. Guidelines for rapid assessment of loa loa.
        • Montour J.
        • Lee D.
        • Snider C.
        • Jentes E.
        • Stauffer W.
        Absence of Loa loa microfilaremia among newly arrived Congolese refugees in Texas.
        Am J Trop Med Hyg. 2017; 97: 1833-1835https://doi.org/10.4269/ajtmh.17-0337
        • Brodine S.
        • Thomas A.
        • Huang R.
        • et al.
        Community based parasitic screening and treatment of Sudanese refugees: application and assessment of Centers for Disease Control guidelines.
        Am J Trop Med Hyg. 2009; 80: 425-430
        • Herrick J.
        • Metenou S.
        • Makiya M.
        • et al.
        Eosinophil-associated processes underlie differences in clinical presentation of loiasis between temporary residents and those indigenous to loa-endemic areas.
        Clin Infect Dis. 2015; 60: 55-63https://doi.org/10.1093/cid/ciu723
        • Vinkeles-Melchers N.
        • Coffeng L.
        • Boussinesq M.
        • et al.
        Projected number of people with onchocerciasis-loiasis coinfection in Africa, 1995 to 2025.
        Clin Infect Dis. 2020; 70: 2281-2289https://doi.org/10.1093/cid/ciz647
        • Noma M.
        • Zouré H.
        • Tekle A.
        • Enyong P.
        • Nwoke B.
        • Remme J.
        The geographic distribution of onchocerciasis in the 20 participating countries of the African Programme for Onchocerciasis Control: (1) priority areas for ivermectin treatment.
        Parasit Vectors. 2014; 7 (07/22/2014) (article 325)https://doi.org/10.1186/1756-3305-7-325
        • Slater H.
        • Michael E.
        Mapping, bayesian geostatistical analysis and spatial prediction of lymphatic filariasis prevalence in Africa.
        PloS One. 2013; 8e71754https://doi.org/10.1371/journal.pone.0071574
        • Schär F.
        • Trostdorf U.
        • Giardina F.
        • et al.
        Strongyloides stercoralis: global distribution and risk factors.
        PLoS Negl Trop Dis. 2013; 7: e2288https://doi.org/10.1371/journal.pntd.0002288
        • Churchill D.
        • Morris C.
        • Fakoya A.
        • Wright S.
        • Davidson R.
        Clinical and laboratory features of patients with loiasis (Loa loa filariasis) in the U.K.
        J Infect. 1996; 33: 103-109https://doi.org/10.1016/s0163-4453(96)93005-4

      Biography

      Shalini Subbarao, MD, Resident Physician, School of Medicine, University of Virginia, Charlottesville, VA, contact at: [email protected]

      Biography

      Reagan Thompson, DNP, FNP-C, Family Nurse Practitioner, School of Nursing, Department of Population Health, University of Virginia, Charlottesville, VA.

      Biography

      Amy Klion, MD, Senior Clinical Investigator, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD.

      Biography

      Fern R. Hauck, MD, Professor, Department of Family Medicine, University of Virginia, Charlottesville, VA.

      Biography

      Tania A. Thomas, MD, MPH, Associate Professor, Division of Infectious Diseases and International Health, Department of Medicine, University of Virginia, Charlottesville, VA.