ONCHOCERCIASIS
RIVER BLINDNESS
Onchocerciasis (river blindness) is a chronic parasitic disease affecting skin and eyes.
The adult worms live inside fibrous nodules in subcutaneous tissues. The fertilized female
worms release thousands of microfilariae that migrate through the lymphatic vessels and
cause inflammatory reactions responsible for the skin and eye lesions while they die and
degenerate.
The causative agent for onchocerciasis is a parasitic filarial worm Onchocerca
volvulus, of the family filaridae, which lives in the human body for up to 14
years.
Each adult female worm is capable of producing millions of microscopic
prelarvae (microfilariae) throughout its life span.
Onchocerciasis is transmitted by the bite of infected black flies of the genus
Simulium.
Black flies breed in fast flowing streams and rivers because of the demand for
highly oxygenated water during the maturation of the larvae. Females require
a blood meal for ovulation, and they transmit infective-stage (3rd stage) larvae
as well as ingest microfilariae during the blood meal. Humans are the only
definitive host of Onchocera volvulus harboring adult filarial worms.
LIFE CYCLE OF ONCHOCERCA VOLVULUS
The gravid adult female worm releases microfilariae which then migrate out
of the nodule and throughout the tissues of the host, concentrating in the dermis.
Microfilariae are ingested from the host skin by the bite of a female black fly (Simulium
species) during its blood meal.
The microfilariae migrate from the gut into thoracic muscles of the black fly; then develop
into infective larvae within 6-10 days. The infective larvae migrate to the mouthparts of
black fly, and will infect a second human host in the process of taking a blood meal.
Infective larvae develop into adult worms in humans over a period of 1 to 2 years.
The adult worms pair and mate in the human host, and, unlike most nematodes that
produce eggs, the female Onchocerca gives birth daily to thousands of microscopic
larvaeknown as microfilariae.
Those microfilariae migrate to tissues and induce inflammatory reaction when they die.
The life span of microfilariae is 6-30 months. The adult worms may survive from 5 to 13
years during which time they release millions of microfilariae. The adult female worm
reaches 40 to 45 cm in length while the microfilaria reach 0.3 mm in length.
Onchocerciasis is the second-leading infectious cause of blindness worldwide:
approximately 1.15 million people have vision loss due to onchocerciasis.
It affects over 20.9 million people worldwide, of which 99% reside in Africa.
Clinical manifestation
1. Skin nodules : Are caused by adult worms. Are firm and non tender ranging from
3mm to 3 cm in diameter.
2. Dermatitis: This are caused by presence of microfilariae in epidermis and
manifests as severe itchy papules. Later the skin become loose, scaly, atrophic
and depigmented
3. River blindness: Is the serious complication caused by presence of microfilariae in
cornea and the anterior chamber of the eye. At first there is edema of the
conjunctiva, small opaque spots on the cornea are formed. These spots are often
accompanied by redness of the conjunctiva. At a later stage, the cornea becomes
permanently cloudy, which results in vision loss. In infections that produce
blindness, not only the cornea gets damaged but all anatomical parts of the eye
are also affected, including the posterior part of the eye and the optic nerve.
Diagnosis
The most common method of laboratory diagnosis used
to identify microfilariae is a biopsy of the skin called a
skin snip.
Microfilariae emerge when the skin snip is placed in a
saline solution.
Nodules can also be surgically removed to identify adult
worms
A physical examination of the patient can detect
localized dermatitis or subcutaneous nodules
MEDICAL MANAGEMENT
• First line treatment is ivermectin orally either yearly or bi-
annually. Ivermectin kills circulating microfilariae as well
as those that are still in adult female worms; this reduces
the numbers of microfilariae in the skin and the
production of new microfilariae by adult worms so the
disease does not progress
• Control itching with antihistamines
• Emollients to prevent dryness of skin
• Antibiotics for secondary bacterial infection
COMPLICATIONS
It leads to blindness.
PREVENTION AND CONTROL
• Community based administration of ivermectin every 6-12 months.
• Vector control: usually ground larviciding using environmentally safe
insecticides in breeding places
• Personal protection measures against biting insects by wearing long sleeves and
trousers during the day when blackflies bite, and wearing permethrin- treated
clothing
