Loa loa Onchocerca volvulus

Loiasis

Onchocerciasis = river blindness

Epidemiology
Only found in the tropical central and West
Africa, the habitat of the vector Chrysops

Epidemiology
Millions of pple affected in Africa and Central America
Major cause of blindness

Biting flies develop in rivers
Pple who live along these rivers are affected

Infection rates >80% in endemic infection areas



Route of infection
Adult worms in sc tissues
mf released into blood

Taken up by Chrysops spp (biting fly)
humans are infected by the bite of the deer
fly which deposits infective larvae on the skin

Larvae enter the bite wound

Larvae then wander around in the body and
develop into adults

Females release microfilm which enter the
blood during the day

Microfilariae are taken up by the fly during
blood meal and differentiate into infective
larvae which continue cycle

Transmitted to next human host


Route of infection
Adult worms free in sc tissues or in nodules

mf pass into skin (NOT BLOOD)
female produces mf which are ingested by another biting
fly.

MF develop into infective larvae to complete cycle

Acquired by Simulium species (biting fly) Transmitted by
the biting fly

Deposits infective larvae while biting
Larvae enter the wound and migrate into subcutaneous
tissues where they differentiate into adults usually within
dermal nodules.



Humans are the only definitive hosts




Signs and symptoms
Painful or itchy swellings in sc tissues:
Calabar swellings

There is NO inflammatory response to the
microfilariae or the adults

BUT a hypersentivity reaction causes
transient, localized, non-erythematous,
subcutaneous edema (Calabar swellings)

Bumps formed in the skin

Infection can also involve the eye

Worm may pass across conjunctiva:
irritation, pain, swelling
Can see worm squirming across the cornea

The most dramatic finding is an adult worm
crawling across conjunctiva of eye harmless
Signs and symptoms
Inflammation occurs in Sc tissue and puritic nodules and
papules form in response to adult worm proteins
Loss of sc elastic fibers leads to wrinkled skin which is
called hanging groin when it occurs in inguinal lesion

Thickening, scaling and dryness of skin accompanied by
SEVERE itching manifstations of a dermatitis called lizard
skin



Mf migrate through Sc tissue ultimately concentrating in the
eyes


but disconcerting



Diagnosis
Examine blood for mf
Do blood smear



Serology
Apparently no useful sero tests from
levinsons

Diagnosis
Skin snip transferred to saline, fluid examined after
incubation filaria swim out of the skin snip



Adult worms visible in removed nodules

Examination of the blood is NOT useful because mf not
circulate in blood

Sero not useful

Treatment
Diethylcarbamazine may precipitate
dangerous encephalitis

Eliminates the microfilariae and may kill the
adults

Removal of worms in eye (can see the
worms squirming across the cornea)


Treatment
Ivermectin

New nodules can develop
Surgical cure unlikely in areas of endemic infection


Prevention

Control the fly with insecticides
Prevention

Control biting fly with insecticides

Ivermectin prevents the disease