Melsom Henrik A, Kurtzhals Jørgen A L, Qvortrup Klaus, Bargum Ralph, Barfod Toke S, la Cour Morten, Heegaard Steffen
Department of Ophthalmology, Copenhagen University Hospital, Glostrup, Denmark.
Open Ophthalmol J. 2011;5:21-4. doi: 10.2174/1874364101105010021. Epub 2011 Apr 14.
To present a case of subconjunctival infestation with Dirofilaria repens which is very rare in Northern Europe.
A 61-year-old male presented with a swelling and redness of the left supraorbital region migrating to the eyelid and the left eyeball resulting in conjunctival injection, proptosis and diplopia. The patient underwent incisional extraction of a nine cm long worm, which was analysed histologically.
The worm was structureless, greyish-white in colour and measuring nine cm in length and 0.5 mm in diameter. Histopathological examination of the worm showed an outer thick, multi-layered cuticle with longitudinal ridges. Beneath the cuticle, a thick muscle layer was observed and internally the intestine and a single reproductive tube containing spermatozoa were noted. Scanning electron microscopy of the worm showed tapered ends, transverse striations and longitudinal ridges at the anterior end. The tail was relatively short with spirally coiled ridges indicating a male Dirofilaria repens.
Humans are an uncommon and accidental host of Dirofilaria repens which is rarely seen in Northern Europe but should be considered as a differential diagnosis to other nematode ocular infections. A travel history is helpful in diagnosing the potential involved organisms. No further treatment is necessary beyond surgical removal since this organism fails to mature and thereby does not cause microfilariaemia in humans.
报告一例结膜下感染匐行恶丝虫的病例，该病例在北欧非常罕见。
一名61岁男性患者，左眶上区域出现肿胀和发红，病变蔓延至眼睑和左眼球，导致结膜充血、眼球突出和复视。患者接受了手术切除一条9厘米长的蠕虫，并对其进行了组织学分析。
该蠕虫无结构，灰白色，长9厘米，直径0.5毫米。对该蠕虫的组织病理学检查显示，其外层为厚的多层角质层，有纵向嵴。在角质层下方，观察到一层厚的肌肉层，内部可见肠道和一条含有精子的单一生殖管。该蠕虫的扫描电子显微镜检查显示两端逐渐变细，前端有横向条纹和纵向嵴。尾部相对较短，有螺旋状盘绕的嵴，表明为雄性匐行恶丝虫。
人类是匐行恶丝虫罕见的偶然宿主，在北欧很少见，但应被视为其他线虫性眼部感染的鉴别诊断。旅行史有助于诊断可能涉及的病原体。手术切除后无需进一步治疗，因为这种病原体在人体内无法成熟，因此不会引起微丝蚴血症。
