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Loiasis — SCE Infectious Diseases MCQ

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HardParasitologyLoiasisSCE Infectious Diseases

A 48-year-old man from rural Kenya presents with a slowly enlarging painless subcutaneous nodule on his forehead. On examination, a worm is visible migrating across the subconjunctival space of his left eye. Blood film taken at midday shows sheathed microfilariae. Eosinophil count is 5.1 × 10⁹/L. What is the most appropriate initial management step before definitive treatment?

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Correct answer: D — Assess microfilarial load; if >8,000/mL, use Albendazole to reduce load before Diethylcarbamazine

Loa loa (eyeworm) with high microfilarial load (>8,000/mL) requires careful management. Diethylcarbamazine (DEC) is the definitive treatment but rapid microfilarial killing in high-load infections can cause fatal encephalopathy. Albendazole 200 mg BD for 21 days gradually reduces microfilarial counts without the risk of severe adverse reactions, and should be used first to reduce the load below the safety threshold before DEC is administered. Ivermectin is relatively contraindicated in high-load Loa loa for the same encephalopathy risk.

Reference: WHO 2022 – Loa loa guidelines; UKHSA 2023 – Imported filariasis