Imported Loa loa filariasis: three cases and a review of cases reported in non-endemic countries in the past 25 years.
OBJECTIVE
The aim of this study was to highlight the increasing chance of Western physicians encountering patients (both immigrants and expatriates/travelers) seeking help for loiasis.


METHODS
We describe three cases of imported loiasis observed at two hospitals in Italy and France, and present a review of all previously published cases in the medical literature in the last 25 years (1986-2011). The search was performed using PubMed and Scopus databases using the terms "Loa loa" AND "loiasis".


RESULTS
We reviewed 101 cases of imported loiasis of which 61 (60.4%) were reported from Europe and 31 (30.7%) from the USA. Seventy-five percent of infestations were acquired in three countries: Cameroon, Nigeria, and Gabon. Overall, peripheral blood microfilariae were detected in 61.4% of patients, eosinophilia in 82.1%, eye worm migration in 53.5%, and Calabar swellings in 41.6%. However, Calabar swellings and eosinophilia were more common among expatriates/travelers, whereas African immigrants were more likely to have microfilaremia. Eye worm migration was observed in a similar proportion in the two groups. Only 35 patients (including the three described here) underwent clinical follow-up for a median period of 10.5 months (range 1-84 months); clinical relapse occurred in three of these patients and persistence or reappearance of blood microfilaria in another two.


CONCLUSIONS
Due to increasing travel and the migration of people from the endemic countries of West Africa to Europe and the USA, we speculate on the possible emergence of loiasis. Western physicians should be aware of the typical (eye worm migration and Calabar swellings) as well as unusual clinical presentations.
Department of Clinical Sciences L Sacco, Section of Infectious Diseases and Immunopathology, Università degli Studi di Milano, Via GB Grassi, 74, 20157 Milan, Italy. spinello.antinori@unimi.it
Spinello
S
Antinori
Luca
L
Schifanella
Matthieu
M
Million
Laura
L
Galimberti
Laurenzia
L
Ferraris
Luca
L
Mandia
Giuseppe
G
Trabucchi
Viviana
V
Cacioppo
Gaspare
G
Monaco
Antonella
A
Tosoni
Philippe
P
Brouqui
Maria Rita
MR
Gismondo
Giuseppe
G
Giuliani
Mario
M
Corbellino
D000328:Adult; D000354:Africa, Western / Q000208:ethnology; D000818:Animals; D000871:Anthelmintics / Q000008:administration & dosage*; D018509:DNA, Helminth / Q000737:chemistry / Q000235:genetics; D005128:Eye Diseases / Q000188:drug therapy / Q000453:epidemiology* / Q000469:parasitology*; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008117:Loa / Q000235:genetics / Q000302:isolation & purification*; D008118:Loiasis / Q000188:drug therapy / Q000453:epidemiology* / Q000469:parasitology; D008297:Male; D008875:Middle Aged; D016133:Polymerase Chain Reaction; D011247:Pregnancy; D014195:Travel
D000871:Anthelmintics; D018509:DNA, Helminth