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Dipetalonematosis

Dipetalonematosis, also known as acanthocheilonematosis, is a helminthiasis from the group of filariasis, which is caused by Dipetalonema (Acanthocheilonema) perstans, occurring with allergic manifestations and characterized by abdominal and chest pains, dizziness , skin itching.

The disease occurs mainly in countries in Africa and South America.

What are the causes?

Two causative agents of Dipetalonema perstans and D. streptocerca have been described. Outbreaks of filariasis caused by D. Perstans are predominantly in countries in West Africa, where the incidence among the population reaches 50-90% and in some countries in Latin America /Venezuela, Brazil, Argentina/, D. Streptocerca is found in humid areas of Ghana, Nigeria, Cameroon, Congo.

The male parasite is about 40-45 mm long, 0.06-0.08 mm wide, the female 70-80 mm, 0.12-0.14 mm wide.

Sexually mature D. Perstans individuals inhabit the mesentery, adrenal and retroperitoneal adipose tissue, pericardium, pleural cavity, D. Streptocerca adults – the skin, where their maturation occurs.

The larvae /microfilariae/ D. Perstans, born from the adult helminths, parasitize in the peripheral blood, not developing and not reaching sexual maturity. D. Streptocerca microfilariae inhabit the skin.

The source of invasion by D. Perstans is man, the definitive host, and the reservoir of D. Streptocerca is apes and, extremely rarely, man.

The vector of the causative agent and the intermediate host are mosquitoes of the genus Culicoides. Microfilariae, which have entered the insect’s body during bloodsucking, pass into an invasive form after 7-10 days.

Pathogenesis – what changes occur in the human body during the progression of acanthocheilonematosis?

Through which stages the parasitic disease proceeds and how this affects the human body morphologically is not sufficiently well studied.

Microfilariae, located within the lymphatic vessels, cause stagnation of the lymphatic fluid, expansion of the lymphatic vessels of the affected organs, microabscesses of the liver. Of greatest importance is the hypersensitivity of the human organism to the waste products of the filaria’s metabolism.

What are the symptoms?

The most important clinical manifestations are skin and joint allergic syndromes. Pronounced skin itching, characteristic erythematous or spotted-papular rashes, lymphadenitis, joint pain and painful sensations in the heart area.

Swelling of the face, limbs and scrotum in men is also sometimes observed. Even febrile attacks, pain in the limbs, in the abdominal area and dizziness occur. Development of meningoencephalitis is possible.

In such cases, microfilariae are found in the spinal cord. A complete blood count reveals moderate or significant eosinophilia. The described symptomatology, however, is characteristic of people who do not have developed immunity to filaria, that is, they have never come into contact with them.

In local residents, that is, in the regions where the disease is endemic, clinical manifestations are more often absent or expressed quite weakly, so that they create very insignificant and even imperceptible discomfort.

At the same time, it is precisely among the population that lives in the regions of habitat of Dipetalonema perstans and D. Streptocerca that most often develop hydrocele and elephantiasis caused by this invasion of these parasites.

Diagnosis

Final diagnosis is based on the detection of microfilariae in the blood.

Treatment of dipetalonematosis

Etiotropic therapy for this parasitic disease is carried out most often with diethylkabazine /ditrazine/ and less often with neostibuzan. The first drug is effective not only against microfilariae, but also against other forms of helminth development.

It is also mandatory to prescribe desensitizing preparations, and in case of pronounced allergic reactions – corticosteroids.

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