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| Year : 2014 | Volume
: 25
| Issue : 4 | Page : 546-547 |
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| Live dirofilaria in buccal mucosa |
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SM Balaji
Director, Balaji Dental and Craniofacial Hospital, Teynampet, Chennai, Tamil Nadu, India
Click here for correspondence address and email
| Date of Web Publication | 10-Oct-2014 |
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How to cite this article:
Balaji S M. Live dirofilaria in buccal mucosa. Indian J Dent Res 2014;25:546-7 |
Sir,
I read with a great interest the recent article on orofacial dirofilarisis. [1] In this regard, I wish to add my personal experience and a pathognomonic feature of this condition. My patient was an otherwise healthy 19-year-old girl seeking treatment for painless swelling of left buccal mucosa for 5-month. The swelling often increased and regressed in size spontaneously. There was a solitary, mobile, diffuse, soft, nontender, compressible nodule about 1 Χ 1. 5 cm in diameter, 2 cm lateral and superior to left angle of the mouth. No surface changes were observed. The swelling was best palpable when the buccinator was tensed. I considered sialolithisasis, lymph node, granulomatous diseases, adenoma, deep lipoma and mucocle as my differential diagnosis. Her full blood count was normal except that 35% of all white blood cell in differential count smear were eosinophils while the erythrocyte sedimentation rate (ESR) was 17 mm/h. The serum glutamic-pyruvic transaminase (SGPT) was 36 U/L.
The lesion was explored through an intra-oral approach. After the incision, the underlying buccal pad of fat was divided and mass identified by exploration. A live wriggling worm emerged from the tissues [Figure 1]a. The surrounding tissues along with tags of fat were removed [Figure 1]b. The worm was carefully extirpated in toto and the worm preserved for studies [Figure 1]c]. The wound was closed in layers and healing was uneventful. | Figure 1: (a) Intra-operative exicisional biopsy picture during extirpation of worm. (b) Tissue with tracts, (c) the worm (d) photomicrograph of tissue biopsy. Note the multiple pseudocystic cavities formed by connective tissue. Also note the compressed adipocytes, localized mixed inflammatory cell infiltrate and degenerating connective tissue elements (H and E, ×4) (e) photomicrograph of the worm. Note the thick, multi-layered, striated cuticle, a central intestinal tube and extremely well-developed somatic musculature limiting the pseudocoele cavity (H and E, ×40)
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Microscopic examination of the tissue specimen showed multiple pseudocystic cavities (tracts) lined by surrounding compressed connective tissue, with chronic inflammatory cell infiltrate localized to certain foci [Figure 1]d]. The morphological and histological features of the worm [Figure 1]e were suggestive of Dirofilaria repens. Systemic microfilariae presence was ruled out.
Dirofilaria is canine parasites that are passed as larva to humans via arthropods. After being deposited in exposed areas of humans in subcutaneous tissue by arthropod, larvae migrate to adjoining areas and reach maturity. [2],[3],[4],[5] The host humoral defense mechanism often neutralize the worm. Hence microfilaremia is often absent as observed in the present case. [3]
Oral/perioral dirofilariasis is an extremely rare phenomenon with only 18 cases reported from Indian subcontinent. All these cases identified a single parasite, often as dead or degenerating, and no live worm extirpation has been reported from an intra-oral site. [2],[3],[4],[5] As the worm was alive, it has evoked a peripheral eosinophila, elevated ESR and probably the tissue damage has caused marginal increase in SGPT. The tissue section has also exhibited features suggesting of a live worm with no intense generalized inflammatory reaction, pus or similar features.
Through this case, I would like to bring to the attention of the reader about possibility of living worm extirpated from an otherwise innocuous swelling of buccal mucosa. Shifting global climate has promoted vector-spread diseases and zoonotic diseases. Frequency and variation in presentation of such diseases is expected. Alert surgeon should include oral dirofilarisis in the differential diagnosis for a subcutaneous nodule.
 References | |  |
| 1. | Janardhanan M, Rakesh S, Savithri V. Oral dirofilariasis. Indian J Dent Res 2014;25:236-9. 
[PUBMED]  |
| 2. | Joseph E, Matthai A, Abraham LK, Thomas S. Subcutaneous human dirofilariasis. J Parasit Dis 2011;35:140-3.
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| 3. | Permi HS, Veena S, Prasad HK, Kumar YS, Mohan R, Shetty KJ. Subcutaneous human dirofilariasis due to Dirofilaria repens: Report of two cases. J Glob Infect Dis 2011;3:199-201.
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| 4. | Baliga M, Ramanathan A, Uppal N. Oral filariasis - a case report. Br J Oral Maxillofac Surg 2010;48:143-4.
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| 5. | Khurana S, Singh G, Bhatti HS, Malla N. Human subcutaneous dirofilariasis in India: A report of three cases with brief review of literature. Indian J Med Microbiol 2010;28:394-6.
[PUBMED] |
Correspondence Address:
S M Balaji
Director, Balaji Dental and Craniofacial Hospital, Teynampet, Chennai, Tamil Nadu
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/0970-9290.142581
[Figure 1] |
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