Japanese Journal of Ophthalmology

, Volume 63, Issue 1, pp 119–125 | Cite as

Management of presumed trematode induced granulomatous uveitis in pediatric patients

  • Rowayda Mohamed AminEmail author
  • Alaa E. Radwan
  • Mohamed B. Goweida
  • Hesham F. El Goweini
  • Ahmed M. Bedda
  • Wael M. Lotfy
  • Ahmed R. H. Ahmed
Clinical Investigation



To outline the management of newly identified trematode induced uveitis in pediatric patients

Study design

Prospective interventional case series


Patients with distinctive uveitis were recruited to either receive steroid monotherapy or undergo surgical excision of the inflammatory lesions based on a scoring system. Outcome measures included best corrected visual acuity (BCVA), intraocular inflammatory activity, and incidence of ophthalmic complications


170 patients (174 eyes) were recruited. Mean age was 11.1 years. Mean initial decimal BCVA (± SD) was 0.58 (± 0.31). Of 116 eyes with disease scores <5, 109 were treated effectively with steroids (93.97%). Surgical excision was offered to 58 patients and proved curative in the treated eyes. Protracted inflammation with persistence of the granulomas was noted in 5 patients refusing surgery. Mean follow up period was 21.5 months. Mean final BCVA was 0.69 (±0.27). A significant change in BCVA was noted (p=0.002). There has not been a need for retreatment in any of the study patients, who were also given instructions on evading exposure to fresh water habitats. Larger lesions, mixed disease morphology, older age at presentation were associated with higher rates of ophthalmic complications and vision loss


A novel waterborne trematode inducing uveitis has been identified in Egypt. A favorable response to steroid monotherapy is demonstrated in low grade disease, while surgical excision was found to be curative in patients with larger lesions or those showing suboptimal response to medical treatment


Infections Granulomatous uveitis Treatment River Nile Egypt 


Conflicts of interest

R. M. Amin, None; A. E. Radwan, None; M. B. Goweida, None; H. F. E-. Goweini, None; A. M. Bedda, None; W. M. Lotfy, None; A. RH. Ahmed, None.


  1. 1.
    Rathinam SR, Cunningham ET Jr. Infectious causes of uveitis in the developing world. Int Ophthalmol Clin. 2000;40(2):137–52.CrossRefGoogle Scholar
  2. 2.
    Khairallah M, Jelliti B, Jenzeri S. Emergent infectious uveitis. Middle East Afr J Ophthalmol. 2009;16:225–38.Google Scholar
  3. 3.
    Rathinam S, Fritsche TR, Srinivasan M, Vijayalakshmi P, Read RW, Gautom R, et al. An outbreak of trematode-induced granulomas of the conjunctiva. Ophthalmology. 2001;108:1223–9.CrossRefGoogle Scholar
  4. 4.
    Rathinam SR, Usha KR, Rao NA. Presumed trematode-induced granulomatous anterior uveitis: a newly recognized cause of intraocular inflammation in children from south India. Am J Ophthalmol. 2002;133:773–9.CrossRefGoogle Scholar
  5. 5.
    Suttorp-Schulten MS, Rothova A. The possible impact of uveitis in blindness: a literature survey. Br J Ophthalmol. 1996;80:844–8.CrossRefGoogle Scholar
  6. 6.
    Tomkins-Netzer O, Talat L, Bar A, Lula A, Taylor SR, Joshi L, et al. Long-term clinical outcome and causes of vision loss in patients with uveitis. Ophthalmology. 2014;121:2387–92.CrossRefGoogle Scholar
  7. 7.
    Sabrosa NA, Cunningham ET, Arevalo JF. Ocular nematode and trematode infections in the developing world. Int Ophthalmol Clin. 2010;50:71–85.CrossRefGoogle Scholar
  8. 8.
    Badir G. Schistosomiasis of the conjunctiva. Br J Ophthalmol. 1946;30:215–21.CrossRefGoogle Scholar
  9. 9.
    Otranto D, Eberhard ML. Zoonotic helminths affecting the human eye. Parasites Vectors. 2011;4:41.CrossRefGoogle Scholar
  10. 10.
    Hoti SL, Tandon V. Ocular parasitoses and their immunology. Ocul Immunol Inflamm. 2011;19:385–96.CrossRefGoogle Scholar
  11. 11.
    Amin RM, Goweida M, Bedda A, Kamel A, Radwan A. Clinical patterns and causes of intraocular inflammation in a uveitis patient cohort from Egypt. Ocul Immunol Inflamm. 2016;1–9.Google Scholar
  12. 12.
    Amin RM, Goweida MB, El Goweini HF, Bedda AM, Lotfy WM, Gaballah AH, et al. Trematodal granulomatous uveitis in paediatric Egyptian patients: a case series. Br J Ophthalmol. 2017;101:999–1002.CrossRefGoogle Scholar
  13. 13.
    Rathinam SR, Arya LK, Usha KR, Prajna L, Tandon V. Novel etiological agent: molecular evidence for trematode-induce anterior uveitis in children. Arch Ophthalmol. 2012;130:1481–4.CrossRefGoogle Scholar
  14. 14.
    Arya LK, Rathinam SR, Lalitha P, Kim UR, Ghatani S, Tandon V. Trematode fluke procerovum varium as cause of ocular inflammation in children, South India. Emerg Infect Dis. 2016;22:192–200.CrossRefGoogle Scholar
  15. 15.
    Mendes MO, Moraes MA, Renoiner EI, Dantas MH, Lanzieri TM, Fonseca CF, et al. Acute conjunctivitis with episcleritis and anterior uveitis linked to adiaspiromycosis and freshwater sponges, Amazon Region, Brazil, 2005. Emerg Infect Dis. 2009;15(4):633–9.CrossRefGoogle Scholar
  16. 16.
    Jabs DA, Nussenblatt RB, Rosenbaum JT, Standardization of Uveitis Nomenclature (SUN) Working Group. Standardization of uveitis nomenclature for reporting clinical data Results of the First International Workshop. Am J Ophthalmol. 2005;140:509–16.CrossRefGoogle Scholar
  17. 17.
    Rajamohan M, Srikanth K, Raghuraman V, Srinivasan R, Jesudasan CAN. Conglomerate tubercle: myth or reality? Tamil Nadu Ophthalmic Assoc J. 1998;38:23–5.Google Scholar
  18. 18.
    Kato-Hayashi N, Kirinoki M, Iwamura Y, Kanazawa T, Kitikoon V, Matsuda H, et al. Identification and differentiation of human schistosomes by polymerase chain reaction. Exp Parasitol. 2010;124:325–9.CrossRefGoogle Scholar
  19. 19.
    Looss A. Further contributions to the knowledge of the trematode fauna of Egypt, with natural organization of the genus Distomum. Zool Jahrb Syst. 1899;12:521–784 (in German).Google Scholar
  20. 20.
    Looss A. A research on the parasitic fauna of Egypt. Mém Inst Égypt. 1896;3:1–252 (in French).Google Scholar
  21. 21.
    Looss A. A research on the parasitic fauna of Egypt. Mém Inst Égypt. 1896;3:1–252 (in French).Google Scholar
  22. 22.
    Díaz Marcos T, Hernández Luz E, Bashirullah Abul K. Experimental life cycle of Philophthalmus gralli. Rev Biol Trop. 2002;50(2):629–41.Google Scholar
  23. 23.
    Waikagul J, Dekumyoy P, Yoonuan T, Praevanit R. Conjunctiva philophthalmosis: a case report in Thailand. Am J Trop Med Hyg. 2006;74(5):848–9.CrossRefGoogle Scholar
  24. 24.
    Dissanaike AS. On an infection of a human eye with Philophthalmus sp. in Ceylon. J Helminthol. 1958;32:115–8.CrossRefGoogle Scholar
  25. 25.
    Rojas D, Soto C, Rojas A. Pathology and first report of natural eye infection with the trematode Philophthalmus gralli (Digenea, Philophthalmidae) in Tinamus major (Tinamiformes, Tinamidae), Costa Rica. Parasitol Int. 2013;62(6):571–4.CrossRefGoogle Scholar
  26. 26.
    Church MI, Barrett PM, Swenson J, Kinsella KM, Tkach VV. Outbreak of Philophthalmus gralli in four greater rheas (Rhea Americana). Vet Ophthalmol. 2013;16:66–72.CrossRefGoogle Scholar
  27. 27.
    Yamaguti S. Synopsis of digenetic trematodes of vertebrates. Tokyo: Keigaku Publishing Co.; 1971.Google Scholar
  28. 28.
    Umadevi K, Madhavi R. Observations on the morphology and life-cycle of Procerovum varium (Onji & Nishio, 1916) (Trematoda: heterophyidae). Syst Parasitol. 2000;46:215–25.CrossRefGoogle Scholar
  29. 29.
    Elsheikha HM, Elshazly AM. Preliminary observations on infection of brackish and fresh water fish by heterophyid encysted metacercariae in Egypt. Parasitol Res. 2008;103(4):971–7.CrossRefGoogle Scholar
  30. 30.
    Deepak S, Kottapalli K, Rakwal R, Oros G, Rangappa K, Iwahashi H, et al. Real-time PCR: revolutionizing detection and expression analysis of genes. Curr Genomics. 2007;8:234–51.CrossRefGoogle Scholar
  31. 31.
    Ashton N, Cook C. Allergic granulomatous nodules of the eyelid and conjunctiva. The XXXV Edward Jackson Memorial Lecture. Am J Ophthalmol. 1979;87:1–28.CrossRefGoogle Scholar
  32. 32.
    Owen HB, Hennessey SF. A note on some ocular manifestations of helminthic origin occurring in natives of Uganda. Trans R Soc Trop Med Hyg. 1932;25:267–73.CrossRefGoogle Scholar
  33. 33.
    Li S, Brownstein S, Gilberg SM, Jackson WB, Shillingford-Ricketts HM. Conjunctival allergic granulomas (Splendore-Hoeppli phenomenon). Ophthalmic Pract. 1996;14:110–3.Google Scholar
  34. 34.
    Simon AK, Hollander GA, McMichael A. Evolution of the immune system in humans from infancy to old age. Proc Biol Sci. 1821;2015(282):20143085.Google Scholar
  35. 35.
    Castle SC. Clinical relevance of age-related immune dysfunction. Clin Infect Dis. 2000;31(2):578–85.CrossRefGoogle Scholar
  36. 36.
    Martin RJ. Modes of action of anthelmintic drugs. Vet J. 1997;154(1):11–34.CrossRefGoogle Scholar

Copyright information

© Japanese Ophthalmological Society 2018

Authors and Affiliations

  • Rowayda Mohamed Amin
    • 1
    • 2
    Email author
  • Alaa E. Radwan
    • 3
    • 4
  • Mohamed B. Goweida
    • 1
  • Hesham F. El Goweini
    • 1
  • Ahmed M. Bedda
    • 1
  • Wael M. Lotfy
    • 5
    • 6
  • Ahmed R. H. Ahmed
    • 7
  1. 1.Ophthalmology Department, Faculty of MedicineAlexandria UniversityAlexandriaEgypt
  2. 2.Central Manchester University NHS Foundation TrustManchesterUK
  3. 3.International Eye ClinicSohâgEgypt
  4. 4.Cortoba Eye CentreCairoEgypt
  5. 5.Parasitology Department, Medical Research InstituteAlexandria UniversityAlexandriaEgypt
  6. 6.Department of Community Health, Faculty of NursingAlexandria University-Matrouh BranchAlexandriaEgypt
  7. 7.Pathology Department, Faculty of MedicineSohag UniversitySohâgEgypt

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