CLINICAL PATTERNS AND DIAGNOSTIC GAPS OF HUMAN DIROFILARIASIS: SCOPING REVIEW WITH IMPLICATIONS FOR INDONESIA
Indonesia 
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Human Dirofilariasis, One Health, Vector-Borne Disease, Zoonosis
Abstract
Human dirofilariasis is an emerging mosquito-borne zoonosis caused by Dirofilaria spp.. Increasing reports from Southern Europe and Southeast Asia contrast with the literature from other regions of Asia, which are underreported. Identifying patterns in clinical presentation, species distribution, and case management could expose diagnostic gaps and direct resources to target these deficiencies. This review conducted a scoping review to establish the clinical presentation and species distribution of human dirofilariasis cases worldwide and propose a preliminary conceptual framework correlating species with anatomical predilection to guide clinical suspicion. Searches in PubMed, Scopus, and Google Scholar were performed following the PRISMA-ScR on May 13, 2023, resulting in 15 case reports (1989–2022) with morphological and/or molecular species confirmation. Identified cases suggest that while D. repens infections lead to subcutaneous involvement, D. immitis infections are primarily pulmonary and ocular, with one report of D. hongkongensis causing an ocular infection. These findings suggest an association between species and anatomical predilection; however, this pattern should be interpreted cautiously because of the limited number of confirmed cases and potential publication bias. Molecular confirmation of species is sparse, and excision remains the primary mode of management. An important finding was the absence of reported human cases from Indonesia, despite cases in neighboring countries. Given the reported canine infections and suitable vector conditions, this may represent a potential underdiagnosis requiring verification through active surveillance. Our findings highlight persistent diagnostic challenges and support strengthened molecular diagnostics and One Health Surveillance.
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References
Alam, S. I., Nepal, P., Lu, S. C., Elramadi, A., & Sapire, J. M. (2021). Imaging Findings of Subcutaneous Human Dirofilariasis. Current Problems in Diagnostic Radiology, 50(5), 755–757. https://doi.org/10.1067/j.cpradiol.2019.07.001
Aung, S. T., Bawm, S., Chel, H. M., Htun, L. L., Wai, S. S., Eshita, Y., Katakura, K., & Nakao, R. (2023). The first molecular confirmation of Culex pipiens complex as potential natural vectors of Dirofilaria immitis in Myanmar. Medical and Veterinary Entomology, 37(3), 542–549. https://doi.org/10.1111/mve.12652
Bennett, I. C., Furnival, C. M., & Searle, J. (1989). Dirofilariasis in Australia: Unusual Cause of a Breast Lump. Australian and New Zealand Journal of Surgery, 59(8), 671–673. https://doi.org/10.1111/j.1445-2197.1989.tb01654.x
Briscoe, S., Abbott, R., Lawal, H., Shaw, L., & Coon, J. T. (2023). Feasibility and desirability of screening search results from Google Search exhaustively for systematic reviews: A cross-case analysis. Research Synthesis Methods, 14(3), 427–437. https://doi.org/10.1002/jrsm.1622
Campana, I., Fania, L., Samela, T., Campana, L., Zecchi, V., Ricci, F., & Abeni, D. (2022). A case of human Dirofilaria repens in Rome, Italy: A clinical and radiological challenge. Dermatology Reports, 14(3), 1–3. https://doi.org/10.4081/dr.2022.9354
Capelli, G., Genchi, C., Baneth, G., Bourdeau, P., Brianti, E., Cardoso, L., Danesi, P., Fuehrer, H., Giannelli, A., Ionic?, A. M., Maia, C., Modrý, D., Montarsi, F., Krücken, J., Papadopoulos, E., Petri?, D., Pfeffer, M., Savi?, S., Otranto, D., … Silaghi, C. (2018). Recent advances on Dirofilaria repens in dogs and humans in Europe. Parasites & Vectors, 11(663), 1–21. https://doi.org/10.1186/s13071-018-3205-x
Chocobar, M. L. E., Schmidt, E. M. dos S., Weir, W., & Panarese, R. (2024). The Distribution, Diversity, and Control of Dirofilariosis in Brazil: A Comprehensive Review. Animals, 14(17), 1–20. https://doi.org/10.3390/ani14172462
Choudhury, P. Das, Raja, D., & Sarma, V. (2023). Human subcutaneous dirofilariasis: A diagnostic dilemma. Tropical Parasitology, 13(2), 1–4. https://doi.org/10.4103/tp.TP_117_20
Dang, T. C. T., Nguyen, T. H., Do, T. D., Uga, S., Morishima, Y., Sugiyama, H., & Yamasaki, H. (2010). A human case of subcutaneous dirofilariasis caused by Dirofilaria repens in Vietnam: Histologic and molecular confirmation. Parasitology Research, 107(4), 1003–1007. https://doi.org/10.1007/s00436-010-1961-4
Dayanti, M. D., Batan, I. W., Margaretha, A., & Tama, K. T. (2021). Canine and Feline Dirofilariasis Currently Spreads in Indonesia Damaging Pulmonary Arteries and Lungs: A Literature Review. Indonesia Medicus Veterinus, 10(5), 814–829. https://doi.org/10.19087/imv.2021.10.5.814
Dimzas, D., Aindelis, G., Tamvakis, A., Chatzoudi, S., Chlichlia, K., Panopoulou, M., & Diakou, A. (2024). Dirofilaria immitis and Dirofilaria repens: Investigating the Prevalence of Zoonotic Parasites in Dogs and Humans in a Hyperenzootic Area. Animals, 14(17), 1–13. https://doi.org/10.3390/ani14172529
Falidas, E., Gourgiotis, S., Ivopoulou, O., Koutsogiannis, I., Oikonomou, C., Vlachos, K., & Villias, C. (2016). Human subcutaneous dirofilariasis caused by Dirofilaria immitis in a Greek adult. Journal of Infection and Public Health, 9(1), 102–104. https://doi.org/10.1016/j.jiph.2015.06.005
Franzò, A., Maria, A., Messina, I., Bruno, R., Bellocchi, B., Pistarà, E., Cosentino, F., Spampinato, S., Maurizio, B., Bruno, C., Cacopardo, S., Nunnari, G., Marino, A., Marino, A., & Franzò, A. (2026). Genital Dirofilaria: A Comprehensive Review of Clinical Presentations, Diagnosis and Management Introduction. Acta Parasitologica, 71(121), 1–12. https://doi.org/10.1007/s11686-026-01271-8
Gabrielli, S., Mangano, V., Furzi, F., Oliva, A., Vita, S., Poscia, R., Fazii, P., Paolo, J. Di, Marocco, R., Mastroianni, C. M., Bruschi, F., & Mattiucci, S. (2021). Molecular Identification of New Cases of Human Dirofilariosis (Dirofilaria repens) in Italy. Pathogens, 10(2), 1–7. https://doi.org/10.3390/pathogens10020251
Genchi, C., & Kramer, L. (2017). Subcutaneous dirofilariosis (Dirofilaria repens): an infection spreading throughout the old world. Parasites & Vectors, 10(Suppl 2), 1–6. https://doi.org/10.1186/s13071-017-2434-8
Hattendorf, C., & Lühken, R. (2025). Vectors, host range, and spatial distribution of Dirofilaria immitis and D. repens in Europe: a systematic review. Infectious Diseases of Poverty, 14(58), 1–11. https://doi.org/10.1186/s40249-025-01328-2
Kondrashin, A. V, Morozova, L. F., Stepanova, E. V, Turbabina, N. A., Maksimova, M. S., & Morozov, E. N. (2020). Anthology of dirofilariasis in Russia (1915–2017). Pathogens, 9(4), 1–13. https://doi.org/10.3390/pathogens9040275
Labu, S., Subramanian, S., Cheseto, X., Akite, P., Kasangaki, P., Chemurot, M., Tanga, C. M., Salifu, D., & Egonyu, J. P. (2022). Agrochemical contaminants in six species of edible insects from Uganda and Kenya. Current Research in Insect Science, 2. https://doi.org/10.1016/J.CRIS.2022.100049
Mendoza-Roldan, J. A., Gabrielli, S., Cascio, A., Manoj, R. R. S., Bezerra-Santos, M. A., Benelli, G., Brianti, E., Latrofa, M. S., & Otranto, D. (2021). Zoonotic Dirofilaria immitis and Dirofilaria repens infection in humans and an integrative approach to the diagnosis. Acta Tropica, 223, 106083. https://doi.org/10.1016/j.actatropica.2021.106083
Miterpáková, M., Antolová, D., Rampalová, J., Undesser, M., Kraj?ovi?, T., & Víchová, B. (2022). Dirofilaria immitis Pulmonary Dirofilariasis, Slovakia. Emerging Infectious Diseases, 28(2), 482–485. https://doi.org/10.3201/eid2802.211963
Mom?ilovi?, S., Gabrielli, S., Golubovi?, M., Smili?, T., Krsti?, M., ?eni?, S., Ran?elovi?, M., & Tasi?-Otaševi?, S. (2019). Human dirofilariosis of buccal mucosa – First molecularly confirmed case and literature review. Parasitology International, 73(August). https://doi.org/10.1016/j.parint.2019.101960
Mom?ilovi?, S., Jovanovi?, A., & Gasser, R. B. (2025). Human dirofilariasis - a potentially significant nematode zoonosis in an era of climate change. Journal of Infection, 90, 1–22. https://doi.org/10.1016/j.jinf.2025.106460
Mus, E., Viani, A., Domenis, L., Maradei, F., Valastro, A., Marucci, G., Giacomazzi, C. G., Magnani, S. C. M., Imparato, R., Cometto, A., Casulli, A., Orusa, R., & Ventre, L. (2025). First Case of Human Ocular Dirofilariasis in the Aosta Valley Region: Clinical Management and Morphological- Molecular Confirmation. Pathogens, 14(5), 1–10. https://doi.org/10.3390/pathogens14050423
Palicelli, A., Veggiani, C., Rivasi, F., Gustinelli, A., & Boldorini, R. (2022). Human Pulmonary Dirofilariasis Due to Dirofilaria immitis: The First Italian Case Confirmed by Polymerase Chain Reaction Analysis, with a Systematic Literature Review. Life, 12(10), 1–8. https://doi.org/10.3390/life12101584
Perles, L., Dantas-Torres, F., Krücken, J., Morchón, R., Walochnik, J., & Otranto, D. (2024). Zoonotic dirofilariases: one, no one, or more than one parasite. Trends in Parasitology, 40(3), 257–270. https://doi.org/10.1016/j.pt.2023.12.007
Peters, M. D. J., Marnie, C., Colquhoun, H., Garritty, C. M., Hempel, S., Horsley, T., Langlois, E. V, Lillie, E., Brien, K. K. O., Tunçalp, ?, Wilson, M. G., Zarin, W., & Tricco, A. C. (2021). Scoping reviews: reinforcing and advancing the methodology and application. Systematic Reviews, 10(263), 1–6. https://doi.org/10.1186/s13643-021-01821-3
Pollock, D., Davies, E. L., Peters, M. D. J., Tricco, A. C., Alexander, L., Mcinerney, P., Godfrey, C. M., Khalil, H., & Munn, Z. (2021). Undertaking a scoping review: A practical guide for nursing and midwifery students, clinicians, researchers, and academics. Journal of Advanced Nursing, 77(4), 2102–2113. https://doi.org/10.1111/jan.14743
Pollock, D., Peters, M. D. J., Khalil, H., Mcinerney, P., Alexander, L., Tricco, A. C., Evans, C., Moraes, É. B. de, Godfrey, C. M., Pieper, D., Saran, A., Stern, C., & Munn, Z. (2023). Recommendations for the extraction, analysis, and presentation of results in scoping reviews. JBI Evidence Synthesis, 21(3), 520–532. https://doi.org/10.11124/JBIES-22-00123
Pollock, D., Tricco, A. C., Peters, M. D. J., Mclnerney, P. A., Khalil, H., Godfrey, C. M., Alexander, L. A., & Munn, Z. (2022). Methodological quality, guidance, and tools in scoping reviews: a scoping review protocol. JBI Evidence Synthesis, 20(4), 1098–1105. https://doi.org/10.11124/jbies-20-00570
Rohela, M., Jamaiah, I., Hui, T. T., Mak, J. W., Ithoi, I., & Amirah, A. (2009). Case report: Dirofilaria causing eye infection in a patient from Malaysia. Southeast Asian Journal of Tropical Medicine and Public Health, 40(5), 914–918. https://citeseerx.ist.psu.edu/document?repid=rep1&type=pdf&doi=b63d8121196ecc00c1b3ec2ae89eeae6b0c1693f
Shekhar, K. C., Pathmanathan, R., & Krishnan, R. (1996). Human infection with Dirofilaria repens in Malaysia. Journal of Helminthology, 70(3), 249–252. https://doi.org/10.1017/s0022149x00015480
Simón, F., Diosdado, A., González-miguel, J., Siles-lucas, M., & Kartashev, V. (2022). Human dirofilariosis in the 21st century: A scoping review of clinical cases reported in the literature. Transboundary and Emerging Diseases, 69(5), 2424–2439. https://doi.org/10.1111/tbed.14210
Somsap, Y., Boonroumkaew, P., Somsap, A., Rodpai, R., Sadaow, L., Sanpool, O., Maleewong, W., & Intapan, P. M. (2021). Ocular Dirofilariasis Case in Thailand Confirmed by Molecular Analysis to Be Caused by Dirofilaria immitis. The American Journal of Tropical Medicine and Hygiene, 106(1), 204–207. https://doi.org/10.4269/ajtmh.21-0764
Stoyanova, N. S. (2018). A Case of Subconjunctival Dirofilariasis in Bulgaria. Folia Medica, 60(2), 323–327. https://doi.org/10.1515/folmed-2017-0097
Sukudom, P., Phumee, A., & Siriyasatien, P. (2018). First report on subconjunctival dirofilariasis in Thailand caused by a Dirofilaria sp. closely related to D. hongkongensis. Academia Journal of Scientific Research, 6(3), 114–116. https://doi.org/10.15413/ajsr.2017.0179
Suresh, R., Janardhanan, M., Savithri, V., & Aravind, T. (2022). A Rare Case of Intra-Oral Dirofilariasis Manifesting on The Buccal Mucosa. Iranian Journal of Pathology, 17(3), 376–380. https://doi.org/10.30699/ijp.2022.548111.2829
Szentivanyi, T., González, L. V, Klein, Á., Soltész, Z., & Garamszegi, L. Z. (2025). Complementing community science with xenomonitoring: Understanding the eco?epidemiology of Dirofilaria immitis infection in dogs and mosquitoes. Parasites & Vectors, 18(233), 1–8. https://doi.org/10.1186/s13071-025-06882-0
Thilakarathne, S. S., Yuen, N. K. Y., Hassan, M. M., Yahathugoda, T. C., & Abdullah, S. (2023). Animal and Human Dirofilariasis in India and Sri Lanka: A Systematic Review and Meta-Analysis. Animals, 13(9), 1–17. https://doi.org/10.3390/ani13091551
Wijekoon, N., Antony, D., Muhunthan, T., & Samarasinghe, M. (2022). Dirofilarial nodule as a differential diagnosis for subcutaneous lumps in children. 39(1), 55. https://doi.org/10.1007/s00383-022-05348-z
Winn, J. G., Hao, T., Hardaway, J. W., & Oh, H. Y. (2024). Redefining searching in non-medical sciences systematic reviews: The ascendance of Google Scholar as the primary database. Journal of Librarianship and Information Science, 57, 964–973. https://api.semanticscholar.org/CorpusID:270577419
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