A Short History of Onchocerciasis

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A short History of Onchocerciasis

by Guido Kluxen

Discovery of the microfilariae

In 1874, John O’Neill, a British naval surgeon attahed to !"# $eoy at %a&e %oast %astle in theGold %oast 'Ghana( bea)e intrigued by an irritating and intratable s*in disease so)e+hatrese)bling sabies +hih alited )any &eo&le living in &arts o the -est %oast o .ria/ !edeter)ined to loo* or the ause o this &euliar ondition, +hih +as *no+n loally as 0ra+ra+2,

by studying a nu)ber o &atients in .ddah 3ort !os&ital under the are o $r/ ho)&son o theGlover 5x&edition/ he ondition +as harateri6ed by &a&ules, vesiles and &ustules/ O’Neillexa)ined the ontents o &ustules and vesiles under a )iroso&e but ound nothing other thanleuoytes/ -hen he turned his attention to &a&ules, suess attended his eorts or he ound anorganis) +hih he had no doubt, +as the ause o the o)&laint/ !e re&orted his observations in187/

-hen s&ei)en +ere exa)ined in a dro& o +ater under a )iroso&e, )iroilariae that +ereeasily detetable by virtue o their violent ontortions +ere oten seen 0.t the head, or blunted

extre)ity, t+o s)all dots are notied, but their nature ould not be deter)ined2 '3ig/ 1( 'O’Neill187(/

Fig. 1:Unsheathed microfilariae from “craw-craw”

of O’Neill at the Gold Coast, Ghana Original from !he "ancet 1#$%&.

Discovery of the adult worm

In 189:, an unna)ed Ger)an dotor +or*ing in the Gold %oast 'Ghana(, -est .ria, re)oved t+otu)ours, eah about the si6e o a &igeon’s eggs, one ro) the sal& and the other ro) the hest,ro) t+o o the loal inhabitants/ On exa)ining the s&ei)ens, he ound that they ontained +or)sand sent the) to ;udol


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si6e> they +ere oiled together to or) a ball +hih +as very diiult to unravel/ he )ass o +or)s +as situated in a avity +hih ontained luid laden +ith e)bryos/


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iritis o the anterior seg)ent o the eye '?aheo


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Fig. 3: 4n 1+1%, (odolfo (oles was cons)lted this women

with an ersielas of the face as the reason was still )n*nown.

Bru)&t gave a detailed desri&tion o the &arasite 'Bru)&t 1919(, and ater o)&aring it +ith thes&ei)ens olleted by hi) in the %ongo, deided that it +as a dierent s&eies +hih he na)ed O/aeutiens to indiate that the &arasite aused blindness 'ro) the


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Fig. %: 5mile 6r)mt 1#$$-1+%1&

It +as the ithing and onseuent srathing +hih led to the redisovery by "ont&ellier and


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Fig. 7: G8le filarienne Original from 9ontellier and "acroi 1+';&


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Fig. $:


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Fig. #:


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Fig. +: =im)li)m damnos)m !heoald Ahoto: @. !roan&

The o!servations of Hissette radically changed the way of looking at onchocerciasis

he early investigators o onhoeriasis ro) 187419E: in .ria )ade no )ention at all o aono)itant severe eye disease/ ?ubliations o the observations in %entral .)eria by ;odolo;obles and )ile Bru)&t in 19171919 &ro)&ted so)e s&eialists in tro&ial )ediine to loo* or

eye disease assoiated +ith .rian onhoeriasis/ !o+ever, there did not see) to be any eyedisease leading to blindness '3lleborn 19D4(/ Only Ou6illeau and his olleagues reorded in 19D1that one o the 1= ineted &ersons o D7 inhabitants they had ound in a village near Bra66aville had*eratitis/ Bla*lo* '19D7( re&orted that he ould ind no evidene o eye disease in &atients +ithonhoeriasis in #ierra


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Fig. 1;: (i/erlind eole from the =an*)r) (egion 1+0;

Fig. 11: 9icrofilariae of Onchocerca /ol/)l)s in the Chorioidea of an en)cleated ee from the =an*)r) (i/er 1+01 Original histolog Dean @issette, microfilariae are lac* and stretched&


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Fig. 1': !he =an*)r) (i/er (egion and UEle (i/er (egion of the 6elgian Congo

!issette’s indings &ro)&ted rene+ed eorts to ind oular o)&liations o onhoeriasis in other&arts o .ria, no+ *no+n as river blindness/ In 1944, !arold ;idley ound that slightly )ore thanone third o &atients +ith onhoeriasis in a region o the Gold %oast 'Ghana( had evidene oeither anterior or &osterior disease o the eye, +ith nearly hal o the) being blind or nearly blind/;idley’s )onogra&h Oular onhoeriasis '194( +as o onsiderable suess in river blindnessresearh/

he nu)erial distribution o )iroilariae o Onhoera volvulus in the s*in o )an ollo+s a lear&attern +hih is related to the distribution and severity o the s*in and eye lesions/ 3or the eye

hanges and blindness this is es&eially the region o the head and ne* 'Kersha+ et al/ 194(/

%hoye '198( onir)ed that the sared undus, hitherto thought to be due to onhoeriasis, +asidential +ith the horioidal slerosis desribed by #orsby '19E9(/ his ould be the at inBonFongo, %a)eroons +here he ound suh hanges indistinguishable or hi)/ #orsby’s horioidalslerosis is a geneti disease trans)itted in a do)inant ashion/ No evidene +as ound o vita)in . deiieny as a ause o horioretinitis in onhoeriasis '-oodru et al/ 19=E(/

Onhoera volvulus has not been trans)itted ex&eri)entally to hu)ans by ineted lies, bute&ide)iologial evidene suggests that the &re&atent &eriod is bet+een E to 18 )onths/ he adult


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+or)s )ay live or 1 years and are a&able o &roduing )iroilariae or u& to ten years ';obertset al/ 19=7(, +hile )iroilariae )ay &ersist or ro) = )onths to E years '$u*e 19=8(/

On Otober D1, 1987, "er* oiials '"#$ "er* #har& $oh)e( said that they +ould be donatingtheir drug Iver)etin to aeted areas 0or as long as it )ight be needed2/ $iethylarba)a6ine andsura)in aused severe side eets in so )any individuals/ Iver)etin an be given as a tablet on a

one a year basis and has )ini)al side eets/ he drug is distributed by "er*, in loseollaboration +ith -!O, an inde&endent o))ittee o ex&erts in tro&ial )ediine, he -orldBan*, he %arter %entre in .tlanta, GeorgiaL#., and about a do6en NG$O’s 'nongovern)entaldevelo&ing organi6ations( in several dierent ountries/

"ost o the evidene su&&orting a role or -olbahia in the &athogenesis o ilarial diseases ste)sro) adverse reations in ineted individuals/ 3or exa)&le, syste)i treat)ent o onhoeriasis&atients +ith diethylarba)a6ine '$5%( auses ra&id death o the )iroilariae in the s*in and eyes,resulting oten severe &ost treat)ent side eet the so alled 0"a66otti reation2/ he severity o the0"a66otti reation2 is de&endent on the nu)ber o )iroilariae ontaining -olbahia in the s*inand eyes '!oerau and ?arr D::7(/ .nd this +as also the at +hen !issette indued the erysi&elasin a little 1D year old boy at the LMle in 19EE '!issette 19EE, Kluxen D:11( by needling his headnodules and *illing the +or)s in it/ ;eations inlude ever, headahe, di66iness, )yalgia,arthralgia, tahyardia, iliary inFetion, severe &ruritus, enlarge)ent o ly)&h nodes and erysi&elaso the oast/

-hile alive, the )iroilariae a&&ear to ause little or no inla))ation, even being in the anteriorha)ber/ !o+ever, +hen they die, either by natural attrition or ater he)othera&y, the hostres&onse to degenerating +or)s an result in oular inla))ation '*eratitis, uveitis, horioretinitis,o&ti neuritis( that auses &rogressive loss o vision/ Blindness thereore tends to our in adulthoodater )any years o inetion/

A Short History of Onchocerciasis

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