Onchocerciasis/

onchocercosis/river blindness

Onchocerca volvulus
Causing chronic infection of:
• subcutaneous tissues
• skin
• eyes
9/19/2018 S. Wahyuni, Parasitology Dept, Medical Faculty, Unhas 1
 Clinical sign

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 Epidemiology

• Endemic in 30 African & 6 Latin American

countries
• 18 million people living in rural areas are
infected
• 270 000 cases of world blindness

9/19/2018 S. Wahyuni, Parasitology Dept, Medical Faculty, Unhas 3

 Host
• Defenitive: human
• Intermediate:Simulium (black flies)
- S. damnosum and S. neavei in Africa
- S. ochraceum, S. callidum, S. metallicum in Guatemala & Mexico

• Highlands area
• Along streams and river
• eggs are laid in the water
of fast flowing rivers
• adults emerge 8-12 days
• live for up to 4 weeks
• cover several hundred km
in flight

9/19/2018 S. Wahyuni, Parasitology Dept, Medical Faculty, Unhas 4

 Adult
• White, transparent &
transverse striation in the
cuticle
• male: 2-3 cm
• female: 3-8 cm
• tighly coiled in couples in
subcutaneous tissues
and in nodules
• female produce 1000-
3000 mf/day
• have a longevity of 10-15
years

9/19/2018 S. Wahyuni, Parasitology Dept, Medical Faculty, Unhas 5

 Microfilaria
• 300 x 0.8 mm
• sheathless with sharply
pointed, curved tails.
• found free in the fluid
within the nodules and in
the dermal layers of skin
• can be found in the blood
& eye in heavy infections.
• live about 10 days in flies

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How to get infection?

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 Skin manifestation
Lesions are produced by:
-the adult worms
-dead microfilariae
-augmented by the allergic
-response of the host.
Subcutaneus nodules
- 5-25 mm in size
- may appear in any part of the
body in area exposure of air
& sunlight
- nodules per patient 3-6
- usually enclosed in loose
folds of skin
- rate of growth: 1 year

9/19/2018 S. Wahyuni, Parasitology Dept, Medical Faculty, Unhas 9

 Eye manifestation
ocular symptoms ocular pathology has been
-First: photophobia, attributed to:
lacrimation,blepharospasm, (1) mechanical action/
& sensation of a foreign secretory products of the
body living mf
(2) toxins from dead mf
-Early manifestations of (3) toxins from the adult worm
serious involvement: (4) supersensitiveness of the
conjunctival hyperemia, patient.
iritis, & small areas
of corneal opacity

- Manifests 7-9 years after

initial infection
9/19/2018 S. Wahyuni, Parasitology Dept, Medical Faculty, Unhas 10
 Diagnosis
• Clinical: nodules,cutaneous manifestations &
ocular lesions
• Routine blood: eosinophilia
• Final diagnosis :
- adult worms in the excised nodules
- mf in skin by biopsy or dermal lymph
scarification

9/19/2018 S. Wahyuni, Parasitology Dept, Medical Faculty, Unhas 11

 Management

• Removal of sources of infection: by

extirpation of nodulus
• Chemoteraphy:
- Ivermectin to kill adult worm
- DEC for mf
- Doxycycline to kills Wolbachia
• Control of the vector
• Protection of susceptible persons

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 Loa loa
Loasis, eye worm,
fugitive swellings, calabar swellings

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 Epidemiology

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 Host

• Definitive: Human

• Intermediate: Chrysops

- live in forest swamp land

- breed in muddy streams & swamps
- attack the ankles, back of leg and
outer side of the hand
- bite Negroes more than whites

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 Adult

- White
- Tapers towards the cephalic en
- Mouth is provided with 1 pair of
lateral papillas and 2 pairs of
submedian papillas
- males : 3- 4 cm,
- females: 5-7 cm (vulva in
cervical region)

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 Microfilaria

• sheathed
• relatively dense nuclear column
• tail tapers and is frequently
coiled
• nuclei extend to the end of the
tail

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 Life cycle

mf in Chrisops
develop 2 molts (10-12 days)

Man is infected by the escape of the infective larvae
from the membranous labium to the skin of
Chrisops near the bite wound

In 1 hour larvae penetrate to the subcutaneous &
muscular tissues

become adult in 2 months
may live for >= 15
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 Pathogenicity

• no serious damage to the host

• trouble when passing in front of the eyeball or
across the bridge of the nose
• Marked by eye irritation, congestion, pain, and
impaired vision

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 fugitive or Calabar swellings
• Temporary inflammatory reactions
• manifestations of supersensitiveness to the
parasite or its products
• painless, nonpitting, subcutaneous swellings
• may reach the size of a hen's egg
• most frequently observed on the hands
• appear spontaneously at irregular intervals
• disappear in 3 days

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 Symptomatology

• incubational period: vague symptoms of slight

fever,paresthesia, pruritus, sometimes urticaria
• first signs: Calabar swellings or appearance of
the worm under the conjunctiva
• clinical symptoms attributable to the wandering
worm
• common manifestations of infection: itching,
irritation, and Calabar swellings

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 Diagnosis

Clinical :
-the worm under the conjunctiva
-Calabar swellings,
-eosinophilia

Laboratory:
-recovering the adult worms
-microfilariae in the blood during the day
-microfilariae detectable only in 20-30% of patients

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 Management

• control of Chrysops with larvicides

• elimination of carriers by treatment DEC
• protection of persons from the flies by
nets, screens, and repellents.

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