A 69-year-old patient from Guinea who had been in Spain for one month.
She came to her primary care doctor for a long time with cough with expectoration, malaise, myalgia, severe pruritus and fever (which was not observed in the consultation).
Physical examination was normal.
Samples were sent to the laboratory for basic biochemistry and blood count.
Only slight anemia 11.3 g/dL hemoglobin and 2.6*1,000/ml can be highlighted.
In reviewing the extent of blood stained with Giemsa, coated microfilariae were observed.
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Given the differences in frequency of appearance of microfilariae in peripheral blood (diurnal and nocturnal), it was decided to enter the patient to take a second blood sample to confirm the diagnosis of filariasis.
In the second sample of peripheral blood, after Knott concentration and Giemsa staining, coated microfilariae without vault were observed.
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The sample was sent to the National Microbiology Center, where they were identified as Loa loa and Mansonella per se.
Treatment was initiated with diethylcarbamycin 6 mg in a single dose and 100 mg mebendazole every 12 hours for 30 days under medical supervision the first days in anticipation of a possible Herxheimer reaction.
Evolution was good, with decreased eosinophil count, improvement of pruritus and disappearance of microfilariae in peripheral blood.
