What is Loa Loa?

   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.
Common Name : Eye Worm
Scientific Name: Loa Loa
 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.
 Signs and Symptoms
Worms are often unnoticed as they travel
through subcutaneous tissues but can be
painful as pass over the eyeball or bridge of
the nose. Swelling of the conjunctiva and eye
lid sometimes accompanies the worm's
presence. Patients may describe literally seeing
something crawl across their eye.
Signs and Symptoms
 Signs and Symptoms
Calabar swellings or local edema of the
subcutaneous tissue, are caused by an allergic
reaction to dead worms or the metabolic
products of the worms. The swellings are
typically several inches in diameter and subside
after a few days to a few weeks. They can be
tender and painful. Calabar swellings can occur
anywhere on the body but are often found on
the forearms and wrists.
Signs and Symptoms
 Signs and Symptoms
Complications may arise if worms lodge in
unusual sites. Scrotal swelling, bowel
obstruction, inflammation of renal glomeruli,
endocarditis, retinopathy, arthritis, and
peripheral neuropathy have all been seen in
persons infected with Loa loa.
 Signs and Symptoms
As is true with many parasites, Loa loa often
increases the numbers of eosinophils, the
immune cell that fights parasitic infections, in
the blood.
Loa loa does not cause serious long term
damage to humans.
 Signs and Symptoms
Loa loa parasites infect human hosts by
travelling through subcutaneous tissues such
as the back, chest, groin, scalp, and eye. These
parasites cause inflammation in the skin
wherever they travel. If a parasite stops in one
place for a short period of time, the human
host will suffer from local inflammation
known as Calabar swellings.
 Signs and Symptoms
These often occur in the wrist and ankle joints
but disappear as soon as the parasite begins to
move again. Parasites can also travel through
and infect the eye, causing the swelling of the
eye. Common symptoms include itching, joint
pain, fatigue, and death.
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.
Management and Therapy
“Worm Removal”
 Management and Therapy
  Surgical removal of the worm from the eye is
easily performed after paralyzing the worm
with a few drops of cocaine (4%). Patients can
be treated with either DEC (Diethyl-
carbamazine) or Ivermectin. However, both
drugs may cause severe encephalitis, coma, or
death in persons with high microfilariae loads.
 Management and Therapy
Typical doses of DEC are 2mg/kg body weight
three times a day for 3 weeks. Ivermectin is
usually given at 200 mcg/kg body weight
every 3 months for 2 years. Both drugs kill the
microfilariae but not the adult worms.
DEC can be taken as a prophylactic at 300mg
once a week.
 References
http://www.stanford.edu/class/humbio103/
ParaSites2006/Loiasis/Index.html
http://en.wikipedia.org/wiki/Loa_loa
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