Loiasis is caused by infection with the filaria Loa loa. The disease is endemic in forested and swampy parts of Western and Central Africa. The adult worms, 3–7 cm × 4 mm, chiefly parasitise the subcutaneous tissue of humans, releasing larval microfilariae into the peripheral blood in the daytime. The vector is Chrysops, a forest-dwelling, day-biting fly.
The host response to Loa loa is usually absent or mild, so that the infection may be harmless. From time to time a short-lived, inflammatory, oedematous swelling (a Calabar swelling) is produced around an adult worm. Heavy infections, especially when treated, may cause encephalitis.
The infection is often symptomless. The incubation period is commonly over a year but may be just 3 months. The first sign is usually a Calabar swelling, an irritating, tense, localised swelling that may be painful, especially if it is near a joint. The swelling is generally on a limb; it measures a few centimetres in diameter but sometimes is more diffuse and extensive. It usually disappears after a few days but may persist for 2 or 3 weeks.
A succession of such swellings may appear at irregular intervals, often in adjacent sites. Sometimes, there is urticaria and pruritus elsewhere. Occasionally, a worm may be seen wriggling under the skin, especially that of an eyelid, and may cross the eye under the conjunctiva, taking many minutes to do so.
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