[Onchocerciasis confirmed by detection of the parasites in the skin and eyes].
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This article briefly reviews the history and distribution of Onchocerca volvulus, and the disease for which it is responsible. The importance is stressed of ophthalmic examination, as opposed to clinical inspection, in determining the incidence of onchocerciasis in a region, such as the Sudan, where eye diseases are common. A description of the ocular manifestations of the infection is given, and their etiology is discussed.
Etiology
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DURING the years 1953-1955, the Medical Field Units of the Ministry of Health, Gold Coast (now Ghana), attempted to control ocular oncho- cerciasis in the Northern Territories by means of Antrypol (Suramin).A series of weekly injections of 1 g. was given to infested subjects for 5 weeks, with the object of eliminating the adult onchocercae.This scheme of treat- ment was initiated by Dr. B. B. Waddy, who was at that time Specialist Epidemiologist in charge of the Medical Field Units.However, in 1956, reports of alarming reactions to the treatment, in the form of generalized oedema or of exfoliative dermatitis, became so numerous that Dr. Waddy's successor, Dr. D. Scott, decided that it would be unwise to continue mass therapy until it could be determined:(a) whether the treatment was effective, (b) if it was effective, whether continuation of treatment was justified in view of the possible toxic effects of the drug.It was therefore decided to conduct a treatment survey in a known infested area, in an attempt to elucidate these problems, and, if possible, to find a safe and effective method of treatment which could be carried out by the unqualified field assistants of the Medical Field Units.A survey team of three, consisting of the writer, a qualified male nurse, and a laboratory assistant, was formed, and headquarters were set up in Bolga- tanga at the beginning of February, 1957.The equipment included a slit lamp capable of operating from a 12-volt car battery, and the main drugs provided were Antrypol (Suramin), Banocide (diethylcarbamazine), and Anthisan (mepyramine maleate).Two regions, the Navronga district and the Nangodi-Sekoti district, which were known centres of infestation and were each situated about 20 miles from Bolgatanga, were chosen as suitable areas, and the treatment survey was carried out there during the following 15 weeks.
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Ocular onchocerciasis was studied within the framework of a comprehensive multidisciplinary epidemiological investigation in an area of the Republic of Chad, Africa, where onchocerciasis was known to be highly endemic. The total population of a village was screened ophthalmologically, and 20% of that population was selected for a detailed ophthalmological examination. The two major eye conditions, blindness and corneal opacities, are examined for association with indices for onchocercal infection, ie, presence of subcutaneous nodules and recovery of microfilariae from skin snips. Blindness in the majority of the cases was due to onchocercal lesions of the anterior segment of the eye and amounted to 39% in persons over 40. The infrequency of posterior ocular lesions among those with ocular onchocerciasis contrasts with previous reports listing such lesions as a regular feature of ocular onchocerciasis.
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Journal Article A case of ocular onchocerciasis in Colombia Get access Georges Assis-Masri, Georges Assis-Masri Auxiliar de Cátedra (Oftalmologia) Departmento de Cirugía, Facultad de Medicina Universidad del Valle, Cali, Colombia, S.A. Colombia Search for other works by this author on: Oxford Academic PubMed Google Scholar M.D. Little M.D. Little Assistant Professor of Parasitology, International Center for Medical Research and Training, Tulane University—Universidad del Valle, Cali, Colombia, S.A. Colombia Search for other works by this author on: Oxford Academic PubMed Google Scholar Transactions of The Royal Society of Tropical Medicine and Hygiene, Volume 59, Issue 6, November 1965, Page 717, https://doi.org/10.1016/0035-9203(65)90108-2 Published: 01 November 1965
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Onchocerciasis in Malawi was first described by Gopsill (I939).This eport and the only other one from Malawi (Harvey, I967) dealt with the general picture and the skin manifestations of this disease.Eye complications have not so far been described.A 3-year onchocerciasis survey in Malawi revealed a large endemic focus in the Cholo district.A previous communication dealt with the epidemiological aspects (Ben-Sira, Ticho, and Yassur, I972).The present report describes the clinical picture based on a comparative study of 500 adults with ocular onchocerciasis.The ocular findings in this group were compared with those of another 500 adults from the same area, in whom skin snips confirmed the absence of infestation with Onchocerca volvulus. Material and methodsThe Cholo district, one of the richest districts in Malawi, offers favourable conditions for carrying out a survey.The majority of the adult population work on the tea estates and earn monthly wages.The soil is very fertile and malnutrition is rare.Two hospitals and several dispensaries cover the whole area.In two large projects, one for leprosy and the other for tuberculosis, the majority of the infected population has been discovered and treated.There are sufficient data concerning the type and prevalence of diseases in this area for it to be possible to establish the clinical picture of ocular onchocerciasis after the exclusion of other factors.During the years I968-I970, villages with a high endemicity rate, as well as villages from the periphery of the focus in the Cholo district, were investigated.The patients, usually adults, were examined for general signs of onchocerciasis.One skin snip from the outer canthus of the eye was taken and teased in normal saline.The specimen was immediately examined under the low-power microscope for living microfilariae (mf) of Onchocerca volvulus.If mf were not found at this examina- tion, a second one was carried out 15 minutes later.If mf were still absent at this stage, a negative result was recorded, and the patient was included in the control series.The ocular examination was carried out in the following way: the visual acuity was tested with a Snellen chart and pinhole.The intraocular pressure was measured with the Schiotz tonometer.Bio-nicroscopy of the anterior segment of the eye was done with the Haag-Streit goo slit lamp.After dilatation of both pupils, the posterior segment was examined with Fison's indirect ophthal- moscope and the Zeiss direct ophthalmoscope, electric current being supplied by Land Rover batteries.If any ocular lesions were found in a control case, an additional six skin-snip examinations were performed to avoid a false negative diagnosis.Altogether 500 cases of onchocerciasis and 500 controls were examined.The average age in each group was approximately 40 years.The ratio of males to females was I 3: .
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Symposium on onchocerciasis IV. Some observations on the ocular complications of onchocerciasis and their relationship to blindness Get access D.P. Choyce, B.Sc., F.R.C.S., D.O.M.S. D.P. Choyce, B.Sc., F.R.C.S., D.O.M.S. Consultant Ophthalmic Surgeon, Hospital for Tropical Diseases, London, UK Search for other works by this author on: Oxford Academic PubMed Google Scholar Transactions of The Royal Society of Tropical Medicine and Hygiene, Volume 52, Issue 2, March 1958, Pages 112–121, https://doi.org/10.1016/0035-9203(58)90033-6 Published: 01 March 1958
Tropical Medicine
Onchocerca
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