Onchocerciasis/

onchocercosis/river
h i /i blindness
bli d

Onchocerca volvulus
Causing chronic infection of:
• subcutaneous tissues
• skin
• eyes
2/11/2013 S. Wahyuni, Parasitology Dept, Medical Faculty, Unhas 1
 Clinical sign

2/11/2013 S. Wahyuni, Parasitology Dept, Medical Faculty, Unhas 2

 Epidemiology

• Endemic in 30 African & 6 Latin American

countries
• 18 million
illi people
l liliving
i iin rurall areas are
infected
• 270 000 cases off worldld bli
blindness
d

2/11/2013 S. Wahyuni, Parasitology Dept, Medical Faculty, Unhas 3

 Host
• Defenitive: human
• Intermediate:Simulium
I t di t Si li (black
(bl k fli
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 8-12
12 days
• live for up to 4 weeks
• cover several hundred km
in flight

2/11/2013 S. Wahyuni, Parasitology Dept, Medical Faculty, Unhas 4

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

2/11/2013 S. Wahyuni, Parasitology Dept, Medical Faculty, Unhas 5

 Microfilaria
• 300 x0
0.88 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
y in flies

2/11/2013 S. Wahyuni, Parasitology Dept, Medical Faculty, Unhas 6

How to get infection?

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2/11/2013 S. Wahyuni, Parasitology Dept, Medical Faculty, Unhas 8
 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
36
- usually enclosed in loose
folds of skin
- rate of growth: 1 year

2/11/2013 S. Wahyuni, Parasitology Dept, Medical Faculty, Unhas 9

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

- Manifests
M if t 7-9 7 9 years after
ft
initial infection
2/11/2013 S. Wahyuni, Parasitology Dept, Medical Faculty, Unhas 10
 Diagnosis
• Clinical: nodules,cutaneous manifestations &
ocular lesions
• Routine blood: eosinophilia
p
• Final diagnosis :
- adult worms in the excised nodules
- mf in skin by biopsy or dermal lymph
scarification

2/11/2013 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

2/11/2013 S. Wahyuni, Parasitology Dept, Medical Faculty, Unhas 12

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

2/11/2013 S. Wahyuni, Parasitology Dept, Medical Faculty, Unhas 13

 Epidemiology

2/11/2013 S. Wahyuni, Parasitology Dept, Medical Faculty, Unhas 14

 Host

• Definitive: Human

• Intermediate:
I t di t Chrysops
Ch

- 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

2/11/2013 S. Wahyuni, Parasitology Dept, Medical Faculty, Unhas 15

 Adult

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

2/11/2013 S. Wahyuni, Parasitology Dept, Medical Faculty, Unhas 16

 Microfilaria

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

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2/11/2013 S. Wahyuni, Parasitology Dept, Medical Faculty, Unhas 18
 Life cycle

mf in Chrisops
develop 2 molts (10
(10-12
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
irritation, congestion
congestion, pain
pain, and
impaired vision

2/11/2013 S. Wahyuni, Parasitology Dept, Medical Faculty, Unhas 20

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

2/11/2013 S. Wahyuni, Parasitology Dept, Medical Faculty, Unhas 21

 Symptomatology

• iincubational
b ti l period:
i d vague symptoms
t off slight
li ht
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
itching,
irritation, and Calabar swellings

2/11/2013 S. Wahyuni, Parasitology Dept, Medical Faculty, Unhas 22

 Diagnosis

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

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

2/11/2013 S. Wahyuni, Parasitology Dept, Medical Faculty, Unhas 23

 Management

• control of Chrysops with larvicides

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

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