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Ocular Angiostrongylis Cantonesis in a Vietnamese Patient - A Case Report

1Tran T. P., 1Le T. L., 1Pham H., 2Nguyen N. X., 2Küchle M.,
1Zentrum für Augenheilkunde (Ho Chi Minh Stadt)
2Friedrich-Alexander-Universität, Augenklinik (Erlangen)

Angiostrongylus cantonensis is largely responsible for human cases of eosinophile menigitis and meningoencephalitis in South Pacific and South-East Asia. Ocular manifestations of angiostrongylis are relatively rare. We report intraocular infestation and successful remove of a worm from the anterior chamber of a patient in Vietnam.
Patient and Methods: An 3-year-old patient was referred to the eye hospital in Ho Chi Minh city, Vietnam, in December 2001 with clinical signs of a iridocyclitis. The child and his family live near the Mekong river. The medical history reported by the parents said that the girl had eaten raw snails two weeks before. After a week she had high fever and for 3 days the right eye was red and painful. Her 8-year-old brother was proved to have eosinophilic meningitis at the same time.
Results: At first examination biomiscroscopically a 10 mm long and actively mobile, white, round worm was detected in the anterior chamber. Marked hyphema was also present. Routine blood examination showed pronouced eosinophilia. Preoperative treatment with sytemic steroids and constriction of the pupil with pilocarpine 1% was initiated. An clear-corneal incision at 12 o'clock was performed, then the worm was immobilized by use of viscoelastic agent in the anterior chamber. An second cornea incision was done at 6 o'clock. With a large volume of viscoelastic agent the worm was extracted intoto from the anterior chamber. The worm was identified as a male Angiostrongylus cantonensis. Postoperative ophthalmoscopic examination showed an inactive organised cyst at the optic disc border. The child was discharged from the hospital after a week with a visual acuity of 0.6.
Conclusion: Parasitic infestation is a major health problem in tropical countries. No antiparasitic drugs are yet available to treat ocular involvement, and therapeutic success depends upon early and complete surgical removal of the parasite..