DOI: 10.1111/j.1365-3164.2009.00795.
Cutaneous periocular Habronema infection in a
dromedary camel (Camelus dromedarius)
Debbie A. Myers*, Chris D. Smith*, Ellis C.
Greiner*, Ellen Wiedner†, Jeffrey Abbott*,
Rosanna Marsella* and Catherine Nunnery*
*University of Florida, College of Veterinary Medicine, Veterinary
Medical Teaching Hospital, PO Box 100101, Gainesville,
FL 32610-0101, USA
†
Ringling Brothers and Barnum & Bailey Center for Elephant Conser-
vation, Polk City, FL 33868, USA
Correspondence: Debbie A. Myers, University of Florida, Gainesville,
FL 32610-0101, USA. E-mail: dmyersvet@yahoo.com
Sources of Funding
This study is self-funded.
Conflict of Interest
None declared.
Abstract
A 6-year-old castrated dromedary camel (Camelus
dromedarius) presented with a non-healing, severely
pruritic, ulcerative fibrotic plaque located at the
medial canthus. Histological examination of surgical
biopsies identified degenerating nematode larvae
within eosinophilic granulomas. Treatment involved
repeated debridement of the lesion, injectable iver-
mectin and anti-inflammatory therapies, and inject-
able and topical antibiotics. A specially constructed
mask with goggles to prevent the camel from contin-
uing to self-traumatize the eye and lesion was
also placed. Full recovery occurred approximately
1 month after diagnosis. Because of the location of
the lesion, time of year, the gross and microscopic
characteristics of the lesion, the presence of a likely
nematode larva and the response to treatment, a
diagnosis of cutaneous habronemiasis was made.
Accepted 27 March 2009
Introduction
Several cutaneous parasites occur in camels including
three species of Onchocerca: Onchocerca fasciata,
O. gutturosa and O. armillatta. Ochocerca gutturosa and
O. armillata are both accidental and rare parasites and the
infection is usually aborted and unable to develop to
patency.1 Onchocerca fasciata is a specific and prevalent
parasite of camelids with 26% of camels infected in Saudi
Arabia. The disease is characterized by the presence of
asymptomatic nodules in the subcutaneous tissues of
the head and neck regions and is less common in the fas-
cia of the nuchal ligament. The camel eye worm, Thelazia
ª 2010 The Authors. Journal compilation ª 2010 ESVD and ACVD, Veterinary Dermatology, 21, 527–530.
leesei, causes parasitism of the conjunctival sac and is
seen in Africa, Russia and India. The parasite is not very
common in the camel population, and does not cause
clinically significant disease.1
Habronema and Draschia are genera of nematodes in
the order Spirurida. Habronema spp. and Draschia spp.
occur worldwide, and in the United States are found most
commonly in the southeast.2 The organisms primarily
affect equids including horses, donkeys, mules, and
zebras, and cutaneous habronemiasis has also been iden-
tified in dogs.3 No species of Habronema or Draschia
have ever been documented to parasitize either new or
old world camelids.
Habronema spp. have an indirect lifecycle. The spirurid
larvae L1s hatch from eggs during passage through the
stomach of infected horses or other equids. After being
excreted in the manure, they are ingested by the interme-
diate hosts, which are maggots of houseflies and stable
flies. The larvae then develop concurrently with their fly
hosts. After 2 weeks, the flies mature and carry the lar-
vae – now infective L3s – to open wounds on horses or
other equids. At this point, the affected animal either
ingests the larvae, or develops cutaneous habronemiasis
(also called ‘summer sores’). In the stomach, adult
worms can cause gastritis, gastric ulceration, and colic
and some infected individuals may not develop skin
lesions, but will present with poor hair coat, ill thrift, and
indigestion.4
Cutaneous lesions are typically non-healing and pruritic,
and are characterized by granulation tissue containing
numerous eosinophils. In equids, common sites for infec-
tion are the limbs, ventral aspect of the abdomen, pre-
puce, external genitalia in males, ocular and periocular
areas and commissure of the lips. When the L3 larvae are
deposited near the eyes, inflammation, excess lacrima-
tion, photophobia, oedema, and conjunctivitis often
ensue. Periocular habronemiasis is well documented
in horses.5–8 Diagnosis by faecal examination is often
unsuccessful because the thin-walled eggs and delicate
larva can be easily overlooked. Cutaneous habronemiasis,
however, can generally be diagnosed by identification of
larvae in skin biopsies or scrapings.
This case report describes a dromedary camel with clin-
ical and histopathological findings compatible with cuta-
neous habronemiasis.
Case report
A privately owned 6-year-old, 600 kg, castrated drome-
dary camel (Camelus dromedarius) presented for evalua-
tion in June of 2007 for severe periocular swelling,
blepharospasm, and a purulent lesion at the medial
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canthus of the right eye. The camel was otherwise
healthy, was pastured in southern Florida where it was
born and had never travelled outside the state. The camel
was wormed monthly with an unknown amount of oral
equine formulation ivermectin paste. The animal had
been seen previously by a veterinarian for a periocular
lesion of 2 weeks duration. A biopsy of the lesion taken
by the veterinarian showed multiple granulomas, areas of
patchy ulceration, and proliferative granulation tissue with
moderate eosinophilic inflammation extending from the
dermis to the subcutaneous muscle. A few coccoid
bacteria were seen, but no other aetiologic agent could
be identified. At that time, the veterinarian treated the
camel with a single subcutaneous dose of ivermectin
(0.2 mg ⁄ kg; Ivomec, Merial Limited, Duluth, GA, USA).
A topical insecticide and long-acting steroid were also
administered.
The camel did not improve after treatment and was
referred 2 weeks later to the University of Florida, Col-
lege of Veterinary Medicine for further evaluation. On pre-
sentation, there was a 1.5 · 4 cm fibrotic ulceration
extending ventral and rostral from the medial canthus of
the right eye. The lesion was mildly proliferative with a
raised rim suggestive of granulation tissue and was par-
tially covered by a haemorrhagic crust (Figure 1). The ani-
mal was observed rubbing and scratching the lesion
repeatedly.
For all diagnostic and therapeutic procedures, the
camel was sedated with xylazine (0.25 mg ⁄ kg) (Anased;
Lloyd Incorporated, Shenandoah, IA, USA) and butor-
phanol (0.1 mg ⁄ kg) (Torbugesic; Fort Dodge Animal
Health, Fort Dodge, IA, USA) intramuscularly and
reversed with atipamezole intramuscularly (0.005 mg ⁄ kg)
(Antisedan; ZooPharm, Fort Collins, CO, USA).
On initial physical examination, no abnormalities were
seen with the exception of the integument and ocular
Figure 1. A dromedary camel (Camelus dromedarius) with a
1.5 · 4 cm fibrotic and ulcerated lesion extending ventral and rostral
from the medial canthus of the right eye is shown. The lesion was
mildly proliferative with a raised rim, suggestive of granulation tissue,
and was partially covered by a haemorrhagic crust.
528 ª 2010 The Authors. Journal compilation ª 2010 ESVD and ACVD, Veterinary Dermatology, 21, 527–530.
systems. Blood samples were taken for haematology and
serum biochemistry. Serum biochemistry was within
normal limits. The complete blood count showed
leukocytosis (23 920 ⁄ lL; reference 10 200–21 500 ⁄ lL),
eosinophilia (1310 ⁄ lL; reference 200–1200 ⁄ lL), and
neutrophilia (19 000 ⁄ lL; reference 3780–17 400 ⁄ lL).9,10
Faeces were collected and rare trichostrongyle ova were
identified by faecal flotation.
An ophthalmologic examination showed mild conjuncti-
vitis. Gram stain of the purulent exudate covering the
lesion showed many Gram-positive and a few Gram-neg-
ative rod bacteria. Samples of the exudate were also sub-
mitted for aerobic, anaerobic, and fungal cultures.
Aerobic culture, yielded scant to moderate growth of a
mixed bacterial flora. No anaerobic organisms were iden-
tified on culture and no fungal organisms were identified
from fresh biopsy tissue. Fresh skin tissue was also sent
to the University of Georgia for polymerase chain reaction
(PCR) testing for specific fungal organisms (i.e. Aspergil-
lus spp., Candida albicans, Fusarium spp., Cryptococcus
neoformans) and the results were also negative.
After local anaesthesia with 2% lidocaine administrated
subcutaneously as a ring block, three 5 mm punch biop-
sies of the lesion were taken, placed in 10% buffered for-
malin, and submitted for histopathology. Histologically,
the lesion consisted of broad ulcerations covered by mod-
erate to extensive granulation tissue and serocellular
crusts composed predominantly of degenerating eosin-
ophils. The granulation tissue was infiltrated by numerous
eosinophils and fewer mast cells. Occasional small aggre-
gates of coccoid bacteria were scattered on the ulcerated
surface and trapped within the crusts. Multifocal eosino-
philic granulomas were distributed in the mid to deep der-
mis often underlying the granulation tissue (Figure 2). The
inflammatory infiltrate was centred on ovoid cross sec-
tions of larvae with a cuticle and lack of internal structures
(Figure 3). The larvae ranged in size from 45 to 52 lm in
diameter. This size and the presence of a cuticle sug-
gested nematode larvae. Calcareus corpuscles seen with
cestode larvae were not present. Chitin seen with arthro-
pods was not noted histologically. The round body in
Figure 2. Photomicrograph of dromedary camel (Camelus dromeda-
rius) skin. Note the broad ulceration, cellular crust, granulation tissue,
and eosinophilic granulomas in the underlying dermis. Haematoxylin
and eosin.

Figure 3. Photomicrograph of dromedary camel (Camelus dromeda-
rius) skin. Note large numbers of eosinophils centred on a cross sec-
tion of a nematode larva with a cuticle consistent with Habronema
spp. There is loss of detail of the larva due to significant degenera-
tion. Haematoxylin and eosin. Bar = 150 lm.
cross section was consistent with the shape seen with
nematodes and uncharacteristic of trematodes which are
larger in size. Moreover, the eosinophilic granuloma was
characteristic of Habronema spp. and uncommonly, if
ever, seen in cestode and trematode larval infections.
The location of the larvae in the deep dermis is also con-
sistent with Habronema spp.11
For three consecutive days, the lesion was surgically
debrided and flushed with copious amounts of dilute
povidone-iodine solution. Silver sulfadiazine cream 1%
(Silvadene; Marion Laboratories Inc., Kansas City, MO,
USA) and fly ointment repellent (Flys-off Ointment;
Farnam Pet Products) were applied topically. Ceftiofur
sodium (2.2 mg ⁄ kg intramuscularly once daily for 7 days)
(Naxcel; Pfizer Animal Health) was given to treat the sec-
ondary infection. Flunixin meglumine (1.25 mg ⁄ kg intra-
muscularly once daily for 7 days) (Banamine; Intervet
Schering-Plough Animal Health), was given to reduce the
inflammation and for analgesia. A Duoderm patch (Bristol-
Myers Squibb, New York, NY, USA) was applied over the
eye. Duoderm dressing consists of a highly flexible poly-
urethane outer foam layer and an adhesive skin contact
layer that contains a hydrocolloid to absorb liquid and
wound exudate. The dressing maintains a moist environ-
ment for optimal wound healing. Also, to prevent the
camel from further traumatizing the eye, an equine fly
mask was altered to fit the camel and was placed with a
plastic bowl over the eye. A single dose of ivermectin
0.2 mg ⁄ kg was administered subcutaneously and full
resolution of the lesion occurred within 1 month. The
case was then lost to follow-up.
Discussion
In this case, a diagnosis of granulomatous dermatitis
associated with Habronema or Draschia larvae was estab-
lished on the basis of clinical and histopathological
findings. The microscopic features of the larvae and the
inflammatory response were similar to those previously
reported in equine cutaneous habronemiasis.4 A nested-
ª 2010 The Authors. Journal compilation ª 2010 ESVD and ACVD, Veterinary Dermatology, 21, 527–530.
Cutaneous habronemiasis in a camel
PCR has been published for the diagnosis of equine
habronemiasis and would have helped in the identification
of the larvae in this case; however, the size of the larvae
and the presence of cuticle are characteristics of
nematode parasites and the clinical presentation and
components of the inflammatory infiltrate suggested
habronemiasis.12 Moreover, other cutaneous parasitic
diseases of camelids such as Onchocerca species infec-
tions have different clinical presentation and typically do
not develop in the periocular area.1 Other gross differen-
tial diagnoses such as squamous cell carcinoma, trauma
associated with exuberant granulation tissue, microfilarial
dermatitis, bacterial and fungal granulomas, and foreign
body sequestration have histopathological findings that
are not consistent with the pathology seen in this case.
The exact pathogenesis of cutaneous habronemiasis is
unknown, however, a hypersensitivity reaction to the
dead or dying larvae and the marked tissue eosinophilia
are presumed to be involved.2 The larvae were degener-
ated at the time the biopsy was performed, possibly as a
result of the marked tissue eosinophilia induced by the
parasite and the ivermectin dose given previously by the
referring veterinarian. It is also possible that the larvae
died spontaneously and the need for treatment could be
questioned in this case.13 However, the parasite caused a
severe periocular inflammation and the marked pruritus
experienced by the camel resulted in self-inflicted trauma
and secondary infection warranting treatment. Treatment
for this camel was similar to that used in equine habrone-
miasis2,14 with anti-inflammatory therapies, ivermectin,
injectable antibiotic, and topical fly repellent. In horses
the disease is often treated with anti-inflammatories and
antibiotics for 3 weeks or longer. However, in this case
the camel became aggressive after 1 week of treatment
and the decision was made to discontinue treatment
because the lesion was starting to improve. A fly mask
adapted to fit the camel was also necessary to prevent
additional self-trauma.
This camel was wormed regularly with an oral ivermec-
tin paste which did not prevent the development of cuta-
neous habronemiasis. This occurrence is also noted in
llamas, a new world camelid, where oral treatment with
ivermectin paste has been shown to be ineffective at
reaching adequate blood serum concentrations.15 In
dromedaries, there are conflicting reports regarding the
efficacy of both oral and parenteral ivermectin administra-
tion.16 Pharmacokinetic studies of subcutaneous iver-
mectin in dromedary camels have shown that at the
ruminant dose of 0.2 mg ⁄ kg, lower ivermectin plasma
concentrations develop as compared to cows and
sheep.17 Dromedaries also have a slower rate of ivermec-
tin absorption compared to ruminant species.17 However,
side effects have been reported in this species with
higher doses of ivermectin and repeated doses of the
drug, rather than increased amounts are probably safer in
camelids.18
In this camelid, the histopathological findings of multi-
focal eosinophilic granulomas centred on ovoid cross sec-
tions of larvae that had a cuticle and ranged in size from
45 to 52 lm in diameter were compatible with an infec-
tion caused by the nematode Habronema spp. or Draschi-
a spp. Cutaneous habronemiasis should be considered as
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a differential diagnosis for camels with pruritic and
ulcerative lesions in geographic regions where this condi-
tion is prevalent.
References
1. Bihari S. The camel in health and disease. British Veterinary Jour-
nal 1985; 141: 315–26.
2. Yarmut Y, Brommer H, Weisler S et al. Ophthalmic and cutane-
ous habronemiasis in a horse: case report and review of the liter-
ature. Israel Journal of Veterinary Medicine 2008; 63: 87–90.
3. Sanderson TP, Niyo Y. Cutaneous habronemiasis in a dog. Veter-
inary Pathology 1990; 27: 208–9.
4. Jacobs DE. The Stomach. In: Jacobs DE, ed. A Colour Atlas of
Equine Parasites. Philadelphia: Lea and Febiger, 1986: 412–5.
5. Gasthuys FM, van Heerden M, Vercruysse J. Conjunctival habro-
nemiosis in a horse in Belgium. Veterinary Record 2004; 154:
757–8.
6. Mohamed FH, Abu Samra MT, Ibrahim KE et al. Cutaneous hab-
ronemiasis in horses and domestic donkeys (Equus asinus
asinus). Revue D’Elevage et de Medecine Veterinaire des Pays
Tropicaux 1990; 42: 535–40.
7. Pusterla N, Watson JL, Wilson WD et al. Cutaneous and ocular
habronemiasis in horses: 63 cases (1988–2002). Journal of the
American Veterinary Medical Association 2003; 222: 978–82.
8. Rebhun WC, Mirro EJ, Georgi ME et al. Habronemic blepharo-
conjunctivitis in horses. Journal of the American Veterinary
Medical Association 1981; 179: 469–72.
9. Fowler M. Camelidae. In: Fowler ME, Miller RE, eds. Zoo and
Wild Animal Medicine, 5th edn. Philadelphia: W.B. Saunders,
2003: 612–25.
10. Teare A. International Species Information System Physiological
Data Reference Values CD-ROM. Camelus dromedarius. Apple
Valley, MN: International Species Information System (ISIS),
2002.
11. Gardiner CH, Poynton SL. Atlas of Metazoan Parasites in Animal
Tissues. Washington DC: American Registry of Pathology, 1999;
34–54.
12. Traversa D, Iorio R, Petrizzi L et al. Molecular diagnosis of equid
summer sores. Veterinary Parasitology 2007; 150: 116–21.
13. Scott DW, Miller WH Jr. Parasitic diseases. Equine Dermatol-
ogy. Philadelphia: Saunders, 2003: 357.
14. Klei TR, Rehbein S, Visser M et al. Re-evaluation of ivermectin
efficacy against equine gastrointestinal parasites. Veterinary
Parasitology 2001; 98: 315–20.
15. Jarvinen J, Miller J, Oehler D. Pharmacokinetics of ivermectin in
llamas (Lama lama). Veterinary Record 2002; 150: 344–6.
16. Boyce W, Kollias G, Courtney C et al. Efficacy of ivermectin
against gastrointestinal nematodes in dromedary camels. Jour-
nal of the American Veterinary Medical Association 1984; 185:
1307–8.
17. Oukessou M, Badri M, Sutra P et al. Pharmacokinetics of iver-
mectin in the camel (Camelus dromedarius). Veterinary Record
1996; 138: 424–5.
18. Ali B. A survey of some drugs commonly used in the camel.
Veterinary Research 1988; 12: 67–75.

Résumé Un dromadaire (Camelus dromedarius) stérilisé de 6 ans présentait une plaque ne cicatrisant
pas, sévèrement prurigineuse, fibrotique, ulcérative localisée au canthus médial. L’examen histologique
des biopsies a révélé la présence de larves dégénérées de nématode au sein de granulomes éosinophili-
ques. Le traitement consistait en des débridements répétés de la lésion, de l’ivermectine injectable, des
anti-inflammatoires ainsi qu’une antibiothérapie topique et injectable. Un masque spécialement fabriqué à
cet usage à l’aide de lunettes a été posé sur l’animal pour éviter l’automutilation de l’œil et de la lésion.
Une complète guérison a été observée un mois après le diagnostic. Vu la localisation, les caractéristiques
macroscopiques et microscopiques de la lésion, la période de l’année, la présence de larves de nématodes
et la réponse au traitement, un diagnostic d’habronémose cutanée a été porté.

Resumen Un dromedario castrado de seis años de edad (Camelus dromedarius) se presentó con una
placa fibrótica, muy prurı́tica, ulcerada y que no cicatrizaba, localizada en el canto medial de un ojo. El exa-
men histológico de la biopsia mostraba larvas de nematodos degeneradas dentro de granulomas eosinofı́li-
cos. El tratamiento incluyó extirpación parcial de la lesión, ivermectina inyectaba, terapia antiinflamatoria, y
antibióticos tópicos e inyectados. Se aplicó una máscara especial con gafas de protección para prevenir
que el dromedario continuara traumatizando el ojo y la zona de la lesión. Se observó una recuperación total
aproximadamente un mes tras el diagnostico. Dada la localización de la lesión, la época del año, las cara-
cterı́sticas macroscópicas e histológicas, la presencia de probables larvas de nematodo y la respuesta al
tratamiento se dio un diagnostico de habronemiasis cutánea.

Zusammenfassung Ein sechs Jahre altes Dromedar (Camelus dromedarius) wurde mit einer schlecht-
heilenden, stark juckenden, ulzerierten fibrotischen Plaque im Bereich des medialen Kanthus vorgestellt.
Bei der histologischen Untersuchung der chirurgischen Biopsien wurden degenerierte Nematodenlarven
inmitten eosinophiler Granulome identifiziert. Die Behandlung bestand aus wiederholtem Debridement der
Veränderung, injizierbarem Ivermectin und einer entzündungshemmenden Therapie, sowie injizierbaren
und topischen Antibiotika. Eine speziell konstruierte Maske mit einer Schutzbrille, um das Dromedar daran
zu hindern, das Auge und die Läsion weiterhin selbst zu traumatisieren, wurde ebenfalls verwendet. Etwa
einen Monat nach der Diagnose kam es zur vollständigen Heilung. Aufgrund der Lokalisation der Verände-
rung, der Jahreszeit, der makroskopischen und mikroskopischen Charakteristika der Läsion, des Vorkom-
mens einer vermeintlichen Nematodenlarve und des Behandlungserfolges wurde die Diagnose einer
Habronemiasis gestellt.

530 ª 2010 The Authors. Journal compilation ª 2010 ESVD and ACVD, Veterinary Dermatology, 21, 527–530.