A case of pleuropulmonary dirofilariasis caused by Dirofilaria repens. Case report

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Abstract

The differential diagnosis of neoplasms of various localizations is the primary task in clinical practice of all physicians. We present a description of the case of invasion with Dirofilaria repens in the lung of a 68-year-old patient. In 2016 the patient was diagnosed with cancer of the left kidney and underwent a left-sided nephrectomy. During the dynamic observation in 2019, a lump was found in the left lung, which was regarded as a metastasis. An atypical SIX resection of the left lung was performed. Microscopy of the removed lump revealed the presence of a nematode of the genus Dirofilaria, presumably D. repens. The species identity of D. repens was confirmed by polymerase chain reaction using species-specific primers. It is known that the morphological identification of parasites up to the species in the surgical material presents certain difficulties and requires high professional training of the researcher. Therefore, the diagnosis of dirofilariasis in atypical localizations of nematodes in the human body is of great importance in the differentiation of malignant and benign formations, and the use of the polymerase chain reaction method can significantly increase the accuracy in establishing the final diagnosis.

About the authors

Sergey S. Kozlov

Pediatric Research and Clinical Center for Infectious Diseases; Saint Petersburg State Pediatric Medical University; Kirov Military Medical Academy

Author for correspondence.
Email: infectology@mail.ru
ORCID iD: 0000-0003-0632-7306

доктор медицинских наук, профессор, врач клинической лабораторной диагностики ФГБУ ДНКЦИБ, профессор ФГБОУ ВО СПбГПМУ, профессор ФГБВОУ ВО «ВМА имени С.М. Кирова»

Russian Federation, Saint Petersburg; Saint Petersburg; Saint Petersburg

Larisa A. Ermakova

Rostov Research Institute of Microbiology and Parasitology

Email: infectology@mail.ru
ORCID iD: 0000-0002-8918-2271

кандидат медицинских наук, зав. клиникой инфекционных и паразитарных болезней, врач-инфекционист

Russian Federation, Rostov-on-Don

Yuri V. Lobzin

Pediatric Research and Clinical Center for Infectious Diseases; Kirov Military Medical Academy; Mechnikov North-Western State Medical University

Email: infectology@mail.ru
ORCID iD: 0000-0002-6934-2223

академик РАН, профессор, президент ФГБУ ДНКЦИБ, гл. научный советник научно-исследовательского центра, зав. кафедры инфекционных болезней

Russian Federation, Saint Petersburg; Saint Petersburg; Saint Petersburg

Sergey A. Nagorny

Rostov Research Institute of Microbiology and Parasitology

Email: infectology@mail.ru
ORCID iD: 0000-0001-8487-2313

кандидат биол. наук, вед. научный сотрудник лаб. санитарно-паразитологического мониторинга, медицинской паразитологии и иммунологии

Russian Federation, Rostov-on-Don

Igor V. Kornienko

Federal Research Center Southern Scientific Center of the Russian Academy of Sciences; Southern Federal University

Email: infectology@mail.ru
ORCID iD: 0000-0003-0274-3302

доктор биол. наук, гл. научный сотрудник, зав. научной лаборатории

Russian Federation, Rostov-on-Don; Rostov-on-Don

Victoriya O. Telicheva

Rostov Research Institute of Microbiology and Parasitology

Email: infectology@mail.ru
ORCID iD: 0000-0003-4593-3982

биолог клиники инфекционных и паразитарных болезней

Russian Federation, Rostov-on-Don

Mariia A. Kaliuzhina

Rostov Research Institute of Microbiology and Parasitology

Email: infectology@mail.ru
ORCID iD: 0000-0001-6778-4426

мл. научный сотрудник лаб. санитарно-паразитологического мониторинга, медицинской паразитологии и иммунологии

Russian Federation, Rostov-on-Don

Natalia Yu. Pshenichcnaya

Central Research Institute of Epidemiology

Email: infectology@mail.ru
ORCID iD: 0000-0003-2570-711X

доктор медицинских наук, профессор

Russian Federation, Moscow

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2. Fig. 1. Computed tomography of the chest with a lesion in the lower lobe of the left lung.

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3. Fig. 2. Histological section of the removed lung tissue with fragments of the parasite. Stained with hematoxylin and eosin. ×100.

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4. Fig. 3. Histological specimen of the removed lung tissue with fragments of the parasite (comb-shaped outgrowths on the cuticle of the nematode and the characteristic structure of the skin-muscular sac are clearly visible). Stained with hematoxylin and eosin. ×400.

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5. Fig. 4. Results of real-time polymerase chain reaction analysis: 1 – a positive control 1 with D. repens DNA with D. repens-specific primers; 2 – a test sample with D. repens-specific primers; 3 – a positive control 2 with D. immitis DNA with D. immitis-specific primers; 4 – a test sample with D. immitis-specific primers.

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6. Fig. 5. Amplicon melting curves: 1 – a positive control sample 1 with D. repens DNA with primers specific to D. repens; 2 – a test sample with primers specific to D. repens; 3 – a positive control sample 2 with D. immitis DNA with primers specific to D. immitis; 4 – a test sample with primers specific to D. immitis.

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