A Zoonotic Disease: Human Dirofilariasis

A Zoonotic Disease: Human Dirofilariasis 1

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Ajeng Eka Putri Widianti, Alif Kufari, Almas Fahrana, Dheis Anindhita S Ziharviardy, Fanny 1

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Novira Chairunnisa, Iza Billa Fahmi, Laras Sri Salisna Maulida, Mira Haninda Ramadhanty, 1

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Muhammad Ahda A.R, Muhammad Alif Taryafi, Rr. Sefa Ikhsani, Widhiasari Normaningtyas 2

and Yudha Nurdian 1

Medical Student, Faculty of Medicine, University of Jember, Indonesia Faculty of Medicine, University of Jember, Indonesia Corresponding author: Mira Haninda Ramadhanty, [email protected]; [email protected] 2

Abstract Background Heartworm disease is caused by the nematode Dirofilaria immitis. This parasite is spread to dogs by mosquito bites, causing heart failure in the definitive host canine. Besides infecting dogs, D. immitis can infects cats, wolfs, foxes, and orangutan. D. immitis is a zoonotic parasite and causes aberrant ocular, subcutaneous and pulmonary infections in man. Humans are a dead-end host, and they might acquire an infection via mosquito bites. Several mosquitoes can serve as vectors, like Aedes, Culex, Mansonia and Anopheles genera, which are the main vector of the disease. Human dirofilariasis has been widely reported in South Europe. However, the worldwide distribution constantly changes. D. immitis has been reported in dogs of the South and the Far East of Russia. In recent years, both animal and human dirofilariosis has spread toward the North of Russia. These zoonotic nematodes are reported more frequently in the Moscow, Tyumen, and Novosibirsk regions, and in the Primorskiy and Khabarovskiy krays, where the environment favors their natural cycles. Microfilariae, shed into the bloodstream by adult females, are ingested by a mosquito (various species, including Aedes, Anopheles, and Culex spp.) where they develop into thirdstage larvae (L3) and migrate to the labium. Feeding by an infected mosquito introduces L3 into the skin. In the definitive host, the L3 larvae undergo two more molts into L4 and adults. Adults reside in pulmonary arteries, and are occasionally found in the right ventricle of the heart. In the heart, the female worms are capable of producing microfilariae over their lifespan. The microfilariae are found in peripheral blood. In humans, D. immitis larvae tend to follow the same migratory pathway as in the canine host, ending up in the lungs, where they

often lodge in small-caliber vessels, causing infarcts and typical “coin lesions” visible on radiographs. Rarely, humans play accidental hosts to this parasite and are not suitable environment for the nematode to live. As the parasite dies in the pulmonary vessels it embolizes the vessels causing infarction and eventual nodule formation in the lungs. Occasionally there can be

multiple

pulmonary nodules

mimicking

metastatic

disease

or fungal

or

mycobacterial infection. Therefore, Dirofilaria infection in human does not result in the production of microfilariae and humans are not able to transmit the infection to other host. Most reported cases of D. immitis infection in humans have been in persons with no symptoms. People with symptoms can have cough (including coughing up blood), chest pain, fever, and pleural effusion (excess fluid between the tissues that line the lungs and the chest cavity). Rarely, D. immitis worms have been found in humans at outside the lungs, including the brain, eye, and testicle. Diagnosis of D. immitis in dogs is generally performed by finding microfilariae or antigens in blood. In human, diagnosis of dirofilariasis can take a thorough history and see the clinical symptoms of the patient. In addition, several methods were carried out such as laboratory examinations, serology tests, and PCR tests. It also can assess the infected tissue, if it infects the lung can be seen with X-Ray and there is lession coin formation. This appearance is resulted by areas of inflammation induced by dying adult worms in pulmonary arteries. Furthermore, diagnosis of Dirofilariasis can be made by a Dirofilaria-specific antibody, through enzyme-linked immunosorbent assay (ELISA). However, the assay is not commonly available. In addition, the ELISA assays are not known to be particularly accurate with problems of cross-reactivity between D. immitis and other filariases . The majority of cases are diagnosed by microscopy which shows a central core of necrosis surrounded by a granulomatous zone of tissues. The definitive treatment of Dirofilaria infection in humans is surgical removal of lung granulomas and nodules under the skin; this treatment is also curative. In many cases, no treatment with medicines is necessary because the infection rarely causes problems and people are "dead end" hosts, meaning they cannot pass on the infection. (Unlike in dogs, infected people don’t have the parasite microfilaria in their blood, which is how the infection is passed on to mosquitoes and other animals).

Patients with dirofilariasis may be at risk for other parasites. After treatment, patients should be monitored for other symptomology characteristic of parasitic infections. Dirofilariasis can be

prevented by avoiding mosquito bites in areas where mosquitoes may be infected with Dirofilaria larvae. The risk of such mosquito bites can be reduced by leaving as little skin exposed as possible, by the use of insect repellent when exposed to mosquitoes, and by sleeping under an insecticide-treated bednet in areas where Dirofilaria-infected mosquitoes bite at night and have access to sleeping areas. Conclusion Heartworm disease or Dirofilariasis is a zoonotic that is caused by Dirofilaria immitis. This parasite spread by mosquito bites and there are several species who can be the vector, like Aedes, Culex, Mansonia and Anopheles genera. Dogs are the definitive host and humans are the dead-end host which can not infect another humans. Although Dirofilaria infections are rare, health care practitioners, surgeons, and pathologists should be aware of their possibility, so that the parasite can be precisely identified, especially in endemic areas.

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