In a recent case study published in JAMA Ophthalmology, a 28-year-old woman presented with a gradually expanding mass in the inside corner of her left eye. Dr. Grégoire Van Acker and his colleagues from Cliniques Universitaires Saint-Luc in Brussels were faced with the task of determining the cause of this unusual occurrence. The patient had been on a humanitarian mission in the Democratic Republic of Congo, where she had been consuming crocodile meat as part of her regular diet. The physical examination revealed a subconjunctival foreign body, which upon further investigation turned out to be a larva of Armillifer grandis, a pentastomid parasite.
According to Van Acker and his co-authors, pentastomiasis is a rare zoonotic disease caused by the larval stages of pentastomid parasites. This infection typically occurs in individuals living or traveling in tropical and subtropical regions. However, ocular pentastomiasis is particularly rare, with very few reported cases in ophthalmologic literature. The infection is often asymptomatic, but symptoms may arise as the larvae grow, migrate, or cause inflammation in the affected organs.
Armillifer species, known to have snakes as their final hosts, are common causes of pentastomiasis in Africa and Asia. In this particular case, the patient’s consumption of crocodile meat may have been the source of the infection. Crocodiles can also be infected by pentastomids, potentially leading to contamination of the meat. The rarity of ocular pentastomiasis makes it a challenging condition to diagnose and treat, as demonstrated by the unique nature of this case.
Surgical removal of the larvae is considered the preferred treatment for pentastomiasis, as antiparasitic medications may induce a severe immune response as the larvae die off. Preventative measures focus on maintaining good hygiene practices and avoiding contact with potentially contaminated sources, such as parasitized snake hosts or undercooked reptile meat. While diagnostic methods like PCR tests targeting specific parasite genes are reliable, access to such resources can be limited in endemic regions.
The case of ocular pentastomiasis presented in this study highlights the importance for ophthalmologists to consider rare infectious diseases, especially in patients from endemic regions. Despite its infrequency, awareness of pentastomiasis and its potential ocular manifestations is essential for accurate diagnosis and timely intervention. By staying informed and vigilant, healthcare professionals can better address the challenges posed by unusual and often overlooked conditions like pentastomiasis.
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