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Loa loa is a blood dwelling nematode that is parasitic in humans. The adult worm wanders through the subcutaneous tissue but is most obvious as it crosses the conjunctiva of the eye hence leading to its common name, the African eye worm.
Like all roundworms, Loa loa is sexual so a male and female worm must be present in the same host for a full infection to ensue. Upon reproduction the female worm produces sheathed eggs called microfilariae which circulate in the blood stream.
Loa loa is endemic to parts of Western Africa, especially in the rainforests of the Congo and Sudan. Symptoms are less serious in natives of these areas with complications occurring mostly in visitors and tourists.
Infection with Loa loa is spread by biting mango flies, a member of the genus Chysops. The American deer fly, Chysops atlanticus, had been reported to be a competent intermediate host of Loa loa and able to spread the worm to monkeys. This is of some public health concern but so far Loa loa has remained isolated to Africa.
Treatment and management strategies are available and described in this website. Loa loa infection in endemic area complicates the mass treatment of Onchoceriasis, the disease of another nematode, with Ivermectin as its use in Loa loa patients might cause encephalitis.
Morphology
Adult worms range in length from 2 to 3.5 cm for males and 5 to 7 cm for females. Both are no more than 0.5 mm wide.
Morphology
Nuclei, as shown above, are found in the tip of the tail and form a continuous row without large spacing between nuclei, differentiating Loa loa from Brugia malayi and Brugia timori, two nematode agents of lymphatic filariasis.
Morphology
Microfilaria are sheathed in a cuticle. The sheath, however, does not stain with Giemsa. Microfilaria have a diurnal periodicity to their concentrations in the bloodstream.
Life Cycle
Vector/Transmission
Chrysops silacea and C. dimidiata are the two species of Mango fly that transmit Loa Loa to humans. Transmission occurs when Chrysops bites humans. Infective larvae from the mango fly are deposited on the skin and enter through the bite puncture.
Vector/Transmission
The mango fly becomes infected through the uptake of Loa Loa microfilariae from a human upon taking a blood meal. The mango fly prefers forested areas and its larvae require wet, muddy places within the forest.
Diagnosis
History in endemic areas, Calabar swellings (see Clinical Presentation), and the presence of worm in the conjunctiva are the main methods of diagnosis. Laboratory tests for elevated eosinophils, C-reactive protein, and IgE quantification can be performed. Checking for microfilarial presence is not a reliable diagnostic test because microfilariae might take years to appear in the blood.
References
http://www.stanford.edu/class/humbio103/ ParaSites2006/Loiasis/Index.html http://en.wikipedia.org/wiki/Loa_loa
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