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Subcutaneous dirofilariosis (Dirofilaria repens): an infection spreading throughout the old world
Open accessAbstract
BACKGROUND: Two main Dirofilaria species infect dogs: D. immitis and D. repens. While D. immitis has a worldwide distribution, D. repens is currently found only in Europe, Asia, and Africa. Adult D. repens are located in subcutaneous tissues of natural hosts where they survive for long periods of time. First-stage larvae, microfilariae, circulate in the peripheral bloodstream, where they are taken up by the mosquito intermediate hosts. Infected mosquitoes then transmit infective third-stage (L3) larvae to new hosts through the blood meal. In dogs, most infections are asymptomatic, although cutaneous disorders such as pruritus, dermal swelling, subcutaneous nodules, and ocular conjunctivitis can be observed. Currently, two factors have increased the concerns about this parasitic infection 1) its spread throughout the European countries and to other continents and its prevalence in dog populations, where in some cases it has overcome D. immitis; and 2) its zoonotic potential, which is much greater than that of D. immitis. RESULTS: Different hypotheses can be put forward to explain these concerns. First, climate change has allowed more favorable conditions for survival of culicid vectors. Second, accidental hosts such as humans may have a less efficient immune reaction against a parasite that is located in subcutaneous tissues, and thus less exposed to the host's immune response than, for instance, D. immitis. Furthermore, the absence of clinical signs in the majority of canine infections and the difficulty in diagnosing the infection, due to the lack of serologic tests and thus the reliance on the identification of microfilariae and differentiation from D. immitis to confirm the presence of the parasite, favor the further spread of this species. Finally, among the macrocyclic lactones currently used to prevent heartworm infection, only moxidectin has been found to be fully effective against the infective larvae transmitted by mosquitoes and partially effective (efficacy 96%) against adult D. repens in experimental studies. CONCLUSIONS: Dirofilaria repens infection is much more difficult than D. immitis to diagnose and control in the reservoir population (microfilaremic dogs). In addition, lack of familiarity with D. repens infection could lead to lack of vigilance underestimation for this parasite. The number of human cases in Europe and Asia is currently a serious public health concern. Medical doctors and veterinarians must collaborate closely for better control and surveillance of D. repens infection.
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“D. repens affects dogs and other carnivores, causing subcutaneous dirofilariasis [44,45].”
From Emergent and Neglected Equine Filariosis in Egypt: Species Diversity and Host Immune Response (2022) · cites this paper as [44]
In the citing paper
“Several epidemiological reviews carried out in this regard [1,2,4,9,168] discussed some of these factors, such as the movement of microfilaremic reservoirs from endemic areas or travel of pets from heartworm-free regions to endemic areas.”
From What has happened to heartworm disease in Europe in the last 10 years? (2022) · cites this paper as [168]
In the citing paper
“The number of publications reporting Dirofilaria spp. infections have increased in the last two decades compared to the previous century [18, 22].”
From Vectors, host range, and spatial distribution of Dirofilaria immitis and D. repens in Europe: a systematic review (2025) · cites this paper as [18]
In the citing paper
“Additionally, rapid tests are only available for D. immitis and not D. repens.”
From Vectors, host range, and spatial distribution of Dirofilaria immitis and D. repens in Europe: a systematic review (2025) · cites this paper as [18]
In the citing paper
“Furthermore, it has been proposed that D. repens is more difficult to control, because, as mentioned above, rapid tests are only available for D. immitis and current preventative and curative treatments are designed for D. immitis and are not as effective against D. repens [18].”
From Vectors, host range, and spatial distribution of Dirofilaria immitis and D. repens in Europe: a systematic review (2025) · cites this paper as [18]
In the citing paper
“Typically, there are no inflammatory reactions or capsules located around the parasite, which actively moves under the connective tissue layers (Genchi and Kramer 2017).”
From Current trends in canine dirofilariosis in Austria-do we face a pre-endemic status? (2020) · cites this paper as Genchi and Kramer 2017
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Barlozzari, G., Felice, T., Salvato, L., Conti, R., Liberato, C. D., Furzi, F., Gabrielli, S., & Scarpulla, M. (2020) · Parasitology Research · doi:10.1007/s00436-020-06926-7 · Cited by 7
Becker, Z., Holló, N., Farkas, R., Gyurkovszky, M., Reiczigel, J., Olaszy, K., Vári, Z., & Vörös, K. (2022) · Acta Veterinaria Hungarica · doi:10.1556/004.2022.00006 · Cited by 8
Veterinary Diagnosis of Filarial Infection
Evans, C. C., Pilotte, N., Williams, S. A., & Moorhead, A. R. (2022) · Wiley eBooks · doi:10.1002/9783527823413.ch6 · Cited by 6
Uncovering human Dirofilaria repens infections: new cases in Southern Italy
Ciucă, L., Gabrielli, S., Forgione, P., Napoli, E. D., Paciello, O., Panariello, M. V., Ascierto, M., Petrullo, L., Montella, M. O., Maurelli, M. P., et al. (2025) · Parasitology · doi:10.1017/s0031182025000290 · Cited by 6
Dirofilaria repens in dogs and humans in Slovenia
Kotnik, T., Rataj, A. V., & Šoba, B. (2022) · Journal of Veterinary Research · doi:10.2478/jvetres-2022-0008 · Cited by 7
Dagley, J. L., DiCosty, U., Fricks, C., Mansour, A., McCall, S. D., McCall, J. W., Taylor, M. J., & Turner, J. D. (2024) · F1000Research · doi:10.12688/f1000research.149854.1 · Cited by 6
Several Cases of Ocular Dirofilariasis in Bulgaria
Velev, V. R. (2020) · Medical Principles and Practice · doi:10.1159/000508960 · Cited by 6
Dirofilariosis caused by Dirofilaria immitis in the south of Kerman province, Iran
Naderi, A., Sharifi, I., Aflatoonian, M. R., Mostafavi, M., Parizi, M. H., Mashayekhi, J., Mashayekhi, M., Nikpour, S., & Bamorovat, M. (2021) · Microbial Pathogenesis · doi:10.1016/j.micpath.2021.104863 · Cited by 6
Dirofilaria repens Infection Mimicking Lung Melanoma Metastasis
Oliva, A., Gabrielli, S., Pernazza, A., Pagini, A., Daralioti, T., Mantovani, S., Mattiucci, S., d’Amati, G., & Mastroianni, C. M. (2019) · Open Forum Infectious Diseases · doi:10.1093/ofid/ofz049 · Cited by 5
First Molecular Detection of Dirofilaria immitis and D. repens in Dogs from Kyrgyzstan
Aydın, M. F., Altay, K., Aytmirzakizi, A., & Dumanlı, N. (2020) · Acta Parasitologica · doi:10.1007/s11686-020-00245-8 · Cited by 6
Ferrara, M. C., Maglione, R., Ciccarelli, D., Mundis, S. J., Loria, A. D., de Carvalho, M. P., & Santoro, D. (2022) · Journal of Helminthology · doi:10.1017/s0022149x22000062 · Cited by 5
Mus, E., Viani, A., Domenis, L., Maradei, F., Valastro, A., Marucci, G., Giacomazzi, C., Magnani, S. C. M., Imparato, R., Cometto, A., et al. (2025) · Pathogens · doi:10.3390/pathogens14050423 · Cited by 5
Proceedings of 6th European Dirofilaria and Angiostrongylus Days
Carta, S., Corda, A., Tamponi, C., P., P. A., Genchi, M., Dessì, G., Manunta, L., Varcasia, A., & Antonio, S. (2018) · Parasites & Vectors · doi:10.1186/s13071-018-3183-z · Cited by 5
Dirofilaria repens in a Pediatric Patient—First Case Report from Switzerland
Rose, R., Kleitsch, K.-U., Born, D., & Heye, P. (2023) · European Journal of Pediatric Surgery Reports · doi:10.1055/s-0043-1768706 · Cited by 5
Păstrav, I. R., Ionică, A. M., Peștean, C. P., Nováková, E., Modrý, D., & Mihalca, A. D. (2018) · Veterinary Parasitology · doi:10.1016/j.vetpar.2018.05.017 · Cited by 5
Cafarelli, C., Russo, G., Mathis, A., & Silaghi, C. (2019) · International Journal for Parasitology · doi:10.1016/j.ijpara.2019.04.008 · Cited by 5
Gutiérrez-Jara, J. P., Salazar-Viedma, M., González, C. R., & Cancino‐Faure, B. (2021) · Acta Tropica · doi:10.1016/j.actatropica.2021.106230 · Cited by 6
Emergent and Neglected Equine Filariosis in Egypt: Species Diversity and Host Immune Response
Abo-Aziza, F. A. M., Hendawy, S. H. M., Abdullah, H. H. A. M., El Namaky, A., Laidoudi, Y., & Mediannikov, O. (2022) · Pathogens · doi:10.3390/pathogens11090979 · Cited by 4
“repens affects dogs and other carnivores, causing subcutaneous dirofilariasis [44,45].”
BackgroundHuman Dirofilariasis Infection in the Forehead: A Case Report
Mohammadkhani, M., Abdi, N., & Sharifi‐Sarasiabi, K. (2023) · Iranian Journal of Public Health · doi:10.18502/ijph.v52i12.14330 · Cited by 4
Bednarikova, S., Daněk, O., Dundarova, H., Němcová, M., Piaček, V., Zukalová, K., Zukal, J., & Pikula, J. (2025) · Frontiers in Veterinary Science · doi:10.3389/fvets.2025.1546353 · Cited by 4
Szostakowska, B., Ćwikłowska, A., Marek‐Józefowicz, L., Czaplewski, A., Grzanka, D., Kulawiak-Wasielak, N., & Sulima, M. (2021) · Parasitology International · doi:10.1016/j.parint.2021.102481 · Cited by 4
Dirofilaria repens in a dog imported to Denmark: A potential for emerging zoonotic disease
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Is dirofilariosis an emerging conservation threat in wild carnivores across the Palearctic?
Szentiványi, T., & Garamszegi, L. Z. (2024) · Mammal Review · doi:10.1111/mam.12353 · Cited by 4
Pękacz, M., Basałaj, K., Młocicki, D., Kamaszewski, M., Carretón, E., Morchón, R., Wiśniewski, M., & Zawistowska‐Deniziak, A. (2024) · Scientific Reports · doi:10.1038/s41598-024-63523-9 · Cited by 4
Zoonotic Endoparasites in Dogs from the Bosnian-Podrinje Canton, Bosnia and Herzegovina
Omeragić, J., Alagić, D., Šerić–Haračić, S., Kapo, N., Soldo, D. K., Šabić, E., Crnkić, Ć., Hadžijunuzović-Alagić, D., Aganović, E., & Škapur, V. (2021) · Macedonian Veterinary Review · doi:10.2478/macvetrev-2021-0011 · Cited by 4
Subcutaneous and cardiopulmonary dirofilariasis in a dog.
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Huggins, L. G., Atapattu, U., Khieu, V., Traub, R. J., & Colella, V. (2025) · Microbiology Spectrum · doi:10.1128/spectrum.01990-25 · Cited by 4
The seroprevalence of canine dirofilariosis in dogs in the eastern coastal areas of China
Cai, D., Tian, B., Liu, Y., Rehman, M. U., Ranucci, D., Veronesi, F., Varcasia, A., Jia, W., & Liu, J. (2023) · Heliyon · doi:10.1016/j.heliyon.2023.e17009 · Cited by 3
Migratory Soft-Tissue Swelling Owing to Subcutaneous Dirofilariasis
Sereeaphinan, C., Hanamornroongruang, S., Sitthinamsuwan, P., Sarasombath, P. T., & Rujitharanawong, C. (2025) · American Journal of Tropical Medicine and Hygiene · doi:10.4269/ajtmh.24-0799 · Cited by 3
Dirofilaria spp. Do They Get Under Your Skin (Or into Your Heart)?
Vismarra, A., Genchi, M., Cattabiani, C., & Kramer, L. H. (2020) · Parasitology research monographs · doi:10.1007/978-3-030-53230-7_11 · Cited by 3
Self-citationAlbuminuria and proteinuria in dogs infected with Dirofilaria repens : A cross-sectional study
Falus, F. A., Szabo, K. J., Becker, Z., Müller, L., Fok, É., Balogh, N., & Manczur, F. (2023) · Journal of Veterinary Internal Medicine · doi:10.1111/jvim.16712 · Cited by 2
Case report: Dirofilarial infection of the face
Schneider, A., Fasse, J., Tappe, D., Lübbert, C., & Trawinski, H. (2025) · IDCases · doi:10.1016/j.idcr.2024.e02142 · Cited by 3
Not a Dead-End Host: First Confirmed Persistent Microfilaremia in Human Dirofilaria repens Infection
Vranjković, M. P., Havliček, A. V., Kramar, M., Topić, M. B., Beck, D., Jurković, D., Gagović, E., & Beck, R. (2025) · Microorganisms · doi:10.3390/microorganisms13102263 · Cited by 2
Ivanescu, L. M., MÎNDRU, R., Bodale, I., MARTINESCU, G.-V., ANDRONIC, L., Hristodorescu, S. G., Azoicăi, D., & Miron, L. D. (2025) · Life · doi:10.3390/life15101612 · Cited by 2
Wilcock, J. N., Pritt, B. S., & Norgan, A. P. (2024) · Journal of Clinical Microbiology · doi:10.1128/jcm.00308-23 · Cited by 2
Metadata
- Authors
- Genchi, C., & Kramer, L.
- Affiliations
- University of Milan (IT)
- University of Parma (IT)
- Corresponding author
- Genchi, Claudio
- ORCID
- Kramer, Laura
- Venue
- Parasites & Vectors
- Published
- 2017-11
- Volume
- 10
- Issue
- S2
- Pages
- 517-517
- ISSN
- 1756-3305 (ISSN-L)
- PMC
- PMC5688444
- OpenAlex
- W2767740195
- Cited by
- 159
- References
- 56
- Citations by year
- 2026: 12 · 2025: 21 · 2024: 11 · 2023: 20 · 2022: 22 · 2021: 19 · 2020: 22 · 2019: 22 · 2018: 10
- FWCI
- 2.25
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by
- Locations
- Parasites & Vectors (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
- Topics
- Health Sciences › Medicine › Infectious Diseases › Parasitic Diseases Research and Treatment
- Life Sciences › Immunology and Microbiology › Parasitology › Helminth infection and control
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Research on Leishmaniasis Studies
- Keywords
- Dirofilaria repens, canine heartworm disease, Dirofilaria immitis, zoonotic transmission, macrocyclic lactones, microfilariae, serological diagnosis, disease surveillance, public health problem, dogs as reservoir
- MeSH terms
- Africa, Animals, Asia, Dirofilariasis, Dog Diseases, Dogs, Europe, Humans, Subcutaneous Tissue, Dirofilaria repens
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