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Onchocerciasis in the Esmeraldas Province of Ecuador
Published in Max J. Miller, E. J. Love, Parasitic Diseases: Treatment and Control, 2020
Onchodermatitis was relatively common in the hyperendemic area (Table 3). Acute and chronic lesions with their characteristic features were found in both races. During the rainy season it is not uncommon to see patients with reactions to the fly bites. Clinical manifestations of the disease due to longstanding infection were rare. There were a few cases of elephantiasis of the scrotum, and atrophy of the skin. These, as well as all inguinal lymphatic complications, were only seen in the Black race.
Infectious and parasitic causes of hypopigmentation
Published in Electra Nicolaidou, Clio Dessinioti, Andreas D. Katsambas, Hypopigmentation, 2019
Serena Gianfaldoni, Aleksandra Vojvodic, Nooshin Bagherani, Bruce R. Smoller, Balachandra Ankad, Leon Gilad, Arieh Ingber, Fabrizio Guarneri, Uwe Wollina, Torello Lotti
Blood exams show hypereosinophilia and elevated erythrosedimentation rate, total IgE and IgG.40,41 During acute papular onchodermatitis, histopathology shows microfilariae in the upper dermis, with infiltration of macrophages, eosinophils and neutrophils around dead or degenerating ones, but little reaction against live ones. Ortho-parakeratotic hyperkeratosis, acanthosis and dermal fibrosis are characteristic of chronic papular onchodermatitis. Microfilariae can also be detected by examining skin-snip biopsies incubated in saline solution for 30 minutes.44,47
Suramin
Published in M. Lindsay Grayson, Sara E. Cosgrove, Suzanne M. Crowe, M. Lindsay Grayson, William Hope, James S. McCarthy, John Mills, Johan W. Mouton, David L. Paterson, Kucers’ The Use of Antibiotics, 2017
Onchocerciasis is a chronic parasitic infection caused by the filarial nematode Onchocerca volvulus. Larval forms are transmitted by the bite of an infected black fly of the Simulium genus (WHO, 1995; Simonsen, 2009). The term “river blindness” is used because the habitat for black fly breeding is in areas near fast-flowing streams and rivers. The disease is endemic across large parts of Africa and Yemen. Over 6–12 months, the larvae develop into adult worms that live in deep subcutaneous or intramuscular layers (Murdoch, 2016). The adult female produces microfilariae which migrate through subcutaneous tissues causing the clinical manifestations of onchocerciasis, including skin nodules, pruritic dermatitis, and the most devastating symptoms of ocular onchocerciasis. Each female can produce 1000–3000 offspring per day over a lifetime, which can be up to 15 years (Murdoch, 2016). Infection results in skin disease (onchodermatitis) and eye disease (affecting both the anterior and posterior segments of the eye).
Moxidectin: an oral treatment for human onchocerciasis
Published in Expert Review of Anti-infective Therapy, 2020
Philip Milton, Jonathan I. D. Hamley, Martin Walker, María-Gloria Basáñez
On 13 June 2018, the FDA approved the use of moxidectin for the treatment of human onchocerciasis in patients aged 12 years and older [15]. The posology is an 8 mg dose (specifically four 2-mg tablets), not dependent on the weight of the recipient and without regard to food. (By contrast, ivermectin can be used for those aged ≥5 years, and doxycycline for patients aged ≥8 years.) The FDA approval does not give any explicit contra-indications for moxidectin but notes the lack of sufficient data to establish its safety during pregnancy, lactation, and ages less than 12 years, and provides warnings of Mazzotti reactions, worsening of onchodermatitis, symptomatic orthostatic hypotension, and SAEs in patients with loiasis. The FDA approval package for the drug outlined two post-marketing requirements for moxidectin, namely: (i) evaluation of pre- and post-natal toxicity assessment in rats, and (ii) conduction of a prospective, randomized, ivermectin-controlled trial of repeated doses of 8 mg moxidectin for onchocerciasis control [15].