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OnchocerciasisOnchocerciasis – General InformationOnchocerciasis is a parasitic disease provoked by the filarial worm Onchocerca volvulus. Through the bites of infected blackflies of Simulium species, the disease is transmitted, which carry immature larval forms of the parasite from human to another human. In the human body, the larva forms nodules in the subcutaneous tissue, where they become adult worms. After mating, the female adult worm can release up to 1000 microfilariae a day. These move through the whole body, and then they die, causing a variety of conditions, including skin rashes, lesions, intense itching and skin depigmentation. In a number of countries, the disease has been controlled through spraying of blackflies forming sites with insecticide. In addition, a drug is available that kills the microfilariae, lowering the symptoms and reducing transmission. Onchocerciasis is the world’s second leading infectious cause of blindness. It is rarely life-threatening. The disease causes chronic suffering and severe disability. For example, in Africa, it constitutes a serious obstacle to socioeconomic development. It is often called river blindness because of its most extreme manifestation and because the blackflies that transmit the disease abound in riverside areas, where they grow in fast-flowing waters. Fertile river areas are usually abandoned due to fear of the disease. Most cases of the disease are found in Africa. The endemic area extends from south of the equator to Angola in the west and Tanzania in the east. The geographic distribution of Onchocerciasis in Latin America is encountered, also in Guatemala, Ecuador, Venezuela, Mexico, Colombia, and the northern Brazil.Onchocerciasis – SymptomsOnchocerciasis manifestations begin to appear in persons one to three years after the had been contaminated with the infective larva. Each female worm can reproduce millions of microfilariae during her lifetime, and the worms can live for 10-15 years. Infected persons may be without symptoms. Those with symptoms will usually have one, two, three or more manifestations. Because the microfilariae migrate throughout all over the body, the most common symptoms are rashes, lesions, intense itching and depigmentation of the skin, also lymphadenitis, which results in hanging groins and elephantiasis of the genitals, general debilitation and serious visual impairment. Onchocerciasis is the world’s second cause of blindness, and it is often called "river blindness" because it is the final symptom in extreme cases, and because the blackfly, which carries it, abounds in fertile riverside areas. If the skin is affected, this can cause intense itching, and leads to the skin becoming swollen and chronically thickened, a condition usually called lizard skin. The skin can also become lax due to the loss of elastic fibers. Over time the skin may lose some of its pigment. On dark skin this gives reason to a name called as leopard skin. If you think you might have Onchocerciasis, see your health care provider who may order skin biopsies, or snips. However, examination of skin snips does not always show the parasites. Serologic testing for antibodies is available, but a positive result does not necessarily indicate an active case of the disease.Onchocerciasis – TreatmentThere’s no vaccine but chemoprophylaxis effective enough to prevent the apparition of the disease. Protective measures include avoidance of black fly habitats and the use of personal protection measures against biting insects (the one that cause the disease by day). The treatment of Onchocerciasis consists in medications. In this medications treatment take part: Ivermectin, suramin, DEC. The disease can be also treated by some therapies like vector control and nodulectomy. Ivermectin, or Mectizan, or Stromectol, is the first choice in treating Onchocerciasis. It is a semi synthetic braod-spectrum anthelmintic drug that was isolated from S. avermitilis. The medicine affects the parasite by binding selectively with glutamate-gated chloride-ion channels in invertebrate muscle and nerve cells. This causes cell death in the microfilariae once the drug has been metabolized by the liver, but does not kill the adult worms. In mass treatment programs, a single dose can be given once a year and will reduce microfilariae to low levels for up to 2 years. If an individual needs more intensive therapy, he or she may receive doses every three months. There are also some risks involved using this medication, because, even if is the safest drug available to treat the parasite, it has a lot of adverse effects. The second drug used to treat Onchocerciasis is Suramin, or Metaret, or Antrypol. This drug was originally developed as an antiparasitic drug to treat central nervous system trypanosomiasis. This medicine is the only drug available that is effective in killing the adult worms. Test doses of 100-200 mg are usually given; even it has some side effects. Short term side effects include nausea, vomiting, shock, loss of consciousness, and skin reactions. If the patient’s reaction is not severe, he is given 66.7 mg total dose in a 6 week trial through a slow intravenously injection. Over this period, patients can experience delayed effects including skin eruptions, fever, paresthesia, and hematuria. Because of the difficulty in using an intravenously medication in public health initiatives and the numerous side effects, Suramin has largely been replaced by Ivermectin in this disease treatment. Suramin is now only used in extreme cases of hyper reactive onchodermatitis. DEC is an anthelmintic drug used as a microfilaricide before the invention of Ivermectin. It is taken orally, by dose, and often produces the severe Mazzotti reaction. The severity of the effects depends of each person. These effects include itching, rash, headache, fever, joint pain, swollen lymph nodes, and vertigo. There can also be severe ocular effects due to the mobilization of the microfilariae. From the appearing of Ivermectin, which produce fewer side effects, DEC is less used as a treatment of Onchocerciasis. Onchocerciasis can be also treated by nodulectomy. This method of treatment is not recommended as a world-wide intervention because it has a high cost of surgery and trained doctors are unavailable. Nodules around the head were particularly targeted to reduce the microfilarial load near the eyes. This kind treatment can be effective to patients already being treated with Ivermectin. |
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