Chronic Papular Onchodermatitis Research Articles

Persistence of onchocerciasis and associated dermatologic and ophthalmic pathologies after 27 years of ivermectin mass drug administration in the middle belt of Ghana.

There is a pressing need to regularly evaluate the progress of onchocerciasis elimination programmes to timely identify and mitigate potential risks hindering the reaching of the 2030 targets proposed by the World Health Organization (WHO) in its roadmap on neglected tropical diseases (NTDs). We determined the prevalence of onchocerciasis and associated dermatological and ophthalmological manifestations in six endemic communities in the Bono Region of Ghana after 27 years of ivermectin mass treatment. In a cross-sectional study, 564 participants aged ≥5 years were enrolled (49.1% females), with a median age of 26 (range: 5-89) years. In 54% and 47%, skin-snip microscopy and Ov16 rapid diagnostic tests were performed, respectively. Skin disease was determined using the WHO Skin NTD App. Visual function assessments included tests of visual acuity. The overall microfilarial prevalence was 12.5% (38/305) and Ov16 seroprevalence was 24.2% (64/265). Severe itching was recorded in 24.3%, acute papular onchodermatitis in 52.8%, chronic papular onchodermatitis in 12.5%, lichenified onchodermatitis in 0.7%, skin atrophy in 11.3%, depigmentation in 1.7% and palpable nodules in 5.3%. Of the 301 persons in which visual acuity was examined, 17% were visually impaired and 5.3% were blind and 47.3% presented with cataract. Chronic papular onchodermatitis, lichenified onchodermatitis, depigmentation and visual impairment were significantly associated with the presence of skin microfilariae and Ov16 seropositivity. The persistence of Onchocerca volvulus infection and onchocerciasis-associated dermatological and ophthalmological pathologies after prolonged treatment is of concern. There is a need to include morbidity management in onchocerciasis elimination programmes and understand better patterns of treatment coverage, adherence and actual intake of ivermectin.

Pre-control relationship of onchocercal skin disease with onchocercal infection in Guinea Savanna, Northern Nigeria

BackgroundOnchocerca volvulus infection can result in blindness, itching and skin lesions. Previous research concentrated on blindness.MethodsA clinical classification system of the cutaneous changes in onchocerciasis was used for the first time in this study within the context of an early ivermectin drug trial in the savanna region of Kaduna State, northern Nigeria. Skin examinations were performed in 6,790 individuals aged 5+ years in endemic communities and 1,343 individuals in nonendemic communities.Results / DiscussionThere was increased risk for all forms of onchocercal skin disease in endemic communities with the most common finding being the presence of nodules (1,438 individuals, 21.2%), followed by atrophy (367, 6.1% of those < 50 years), acute papular onchodermatitis, APOD (233, 3.4%), depigmentation (216, 3.2%) and chronic papular onchodermatitis, CPOD (155, 2.3%). A further 645 individuals (9.5%) complained of pruritus but had completely normal skin. APOD was more common in males whereas atrophy, hanging groin and nodules were more common in females. After controlling for age and sex, microfilarial positivity was a risk factor for CPOD, depigmentation, hanging groin and nodules (OR 1.54, p = 0.046; OR 2.29, p = 0.002; OR 2.18, p = 0.002 and OR 3.80, p <0.001 respectively). Comparable results were found using presence of nodules as the marker for infection. Microfilarial load showed similar, though weaker, results. A total of 2621(38.6%) endemic residents had itching with normal skin, or had one or more types of onchocercal skin disease including nodules, which may be considered as a composite index of the overall prevalence of onchocercal skin disease.ConclusionSignificant levels of onchocercal skin disease were documented in this savanna area, which subsequently resulted in a reassessment of the true burden of skin disease in onchocerciasis. This paper represents the first detailed report of the association of onchocercal skin disease with markers for onchocercal infection.

Is There Blinding Onchocerciasis in Northern Uganda?

Background: Onchocerciasis is a filarial nematode Onchocerca volvulus transmitted by female black flies which breeds in fast flowing rivers. Clinical manifestations is ocular or skin lesions. The long-term armed conflict in northern Uganda deprived research on onchocerciasis and no attempts have been made to establish the clinical manifestation of the disease in the region. Objective: To establish whether Simulium damnosum transmitted onchocerciasis in this region was blinding. Participants: Persons from thirteen endemic parishes in Pader district in northern Uganda were examined for clinical, parasitological and ocular manifestations of onchocerciasis. Results: A total of 675 persons were examined and microfilaria prevalence in skin snips was 28%, while nodules and onchodermatitis were 30% and 29% respectively. The commonest skin lesion was Chronic Papular Onchodermatitis (17.5%). However, the prevalence of both microfilaria in the anterior chamber of the eye and reversible ocular lesions was 4%. The reversible ocular lesions of onchocerciasis observed were punctate keratitis stage B (0.1%), punctate keratitis stage D (0.1%) and punctate keratitis stage E (3.7%). While 16.1% of the respondents had irreversible ocular lesions attributed mainly to Optic atrophy (6.4%) and sclerosing keratitis (5.2%). There was significant association between irreversible onchocerciasis lesions and visual loss (p< 0.0001). Conclusion: This study confirmed the occurrence of blinding onchocerciasis in Pader district, the first ever reported in indigenous populations in Uganda.

Onchocerciasis in Anambra State, Southeast Nigeria: endemicity and clinical manifestations

BackgroundA cross-sectional study was performed to determine the current endemicity of onchocerciasis in Ayamelum Local Council, Anambra State, Southeast Nigeria, where community-directed treatment with ivermectin has been implemented for over...

Clinical and parasitological aspects of onchocercal skin diseases in Nigeria

An assessment of onchocercal skin disease (OSD) conducted in 38 rural communities in the Imo River Basin, Nigeria, between March 1999 and September 2000, showed that depigmentation (DPM) was the most prevalent lesion in persons with skin microfilariae (mf) (26.3%), followed by chronic papular onchodermatitis (CPOD) (18.1%) and acute papular onchodermatitis (APOD) (15.5%). There was no significant difference (P > 0.05) in sex-related prevalence of OSD. While CPOD, lichenified onchodermatitis (LOD) and DPM were more prevalent in subjects over 30 years old, APOD was associated more with those aged less than 30 years. OSD occurred with concomitant itching in nearly 50% of subjects. The geometric mean intensity of infection was 13 mf/mg per skin snip.

Onchocerciasis: the clinical and epidemiological burden of skin disease in Africa.

An attempt was made to assess the true public-health importance of onchocercal skin disease throughout the African region and hence provide an objective basis for the rational planning of onchocerciasis control in the area. The seven collaborative centres that participated in the study (three in Nigeria and one each in Ghana, Cameroon, Tanzania and Uganda) were all in areas of rainforest or savannah-forest mosaic where onchocercal blindness is not common. A cross-sectional dermatological survey was undertaken at each site following a standard protocol. At each site, the aim was to examine at least 750 individuals aged 5 years and living in highly endemic communities and 220-250 individuals aged 5 years and living in a hypo-endemic (control) community. Overall, there were 5459 and 1451 subjects from hyper-and hypo-endemic communities, respectively. In the highly endemic communities, the prevalence of itching increased with age until 20 years and then plateaued, affecting 42% of the population aged 20 years. There was a strong correlation between the prevalence of itching and the level of endemicity (as measured by the prevalence of nodules; r=0.75; P<0.001). The results of a multivariate logistic regression analysis showed that, at the individual level, the presence of onchocercal reactive skin lesions (acute papular onchodermatitis, chronic papular onchodermatitis and/or lichenified onchodermatitis) was the most important risk factor for pruritus, with an odds ratio (OR) of 18.3 and 95% confidence interval (CI) of 15.19-22.04, followed by the presence of palpable onchocercal nodules (OR=4.63; CI=4.05-5.29). In contrast, non-onchocercal skin disease contributed very little to pruritus in the study communities (OR=1.29; CI=1.1-1.51). Onchocercal skin lesions affected 28% of the population in the endemic villages. The commonest type was chronic papular onchodermatitis (13%), followed by depigmentation (10%) and acute papular onchodermatitis (7%). The highest correlation with endemicity was seen for the prevalence of any onchocercal skin lesion and/or pruritus combined (r=0.8; P<0.001). Cutaneous onchocerciasis was found to be a common problem in many endemic areas in Africa which do not have high levels of onchocercal blindness. These findings, together with recent observations that onchocercal skin disease can have major, adverse, psycho-social and socio-economic effects, justify the inclusion of regions with onchocercal skin disease in control programmes based on ivermectin distribution. On the basis of these findings, the World Health Organization launched a control programme for onchocerciasis, the African Programme for Onchocerciasis Control (APOC), that covers 17 endemic countries in Africa.

Gale filarienne

‘River blindness’ is the main problem of onchocerciasis. Despite a high prevalence of onchocerciasis in endemic countries, cases of imported cutaneous or ocular onchocerciasis in France are rare. Case report. – We report the case of a chronic papular onchodermatitis with voluminous lymphadenopathy in a Cameroonian child, resolving with a treatment of ivermectin. Conclusion. – The main symptom of cutaneous onchocerciasis is pruritus, which symptom may alert physicians when dealing with patients who come from endemic countries for onchocerciasis. Cutaneous aspects may vary depending on length of exposure to antigens and immune responses by the host against microfilariae. Nowadays, onchocerciasis is treated with a single dose of ivermectin, which is sufficient for eye and cutaneous symptoms. However, this therapy is efficient only against microfilariae, and treaments have to be repeated many times to avoid relapses linked to persistence of adult worms.

Clinical and parasitological aspects of itching caused by onchocerciasis in Morogoro, Tanzania

A clinical and parasitological assessment of onchodermatitis was conducted in a rural area of Morogoro district, Tanzania. The study population consisted of 1,005 individuals aged > or = 5 years: 749 from a hyper-endemic community and 256 from a hypo-endemic. The prevalence of troublesome itching was 67.0% in the hyper-endemic community but only 5% (13/256) in the hypo-endemic. The corresponding prevalences of nodules among the adult male subjects were 77.7% (171/220) and 2.3% (2/86). The most common onchocercal skin lesion in the hyper-endemic community was chronic papular onchodermatitis (CPOD) manifested by itching, which was often very severe. There was a strong association between skin itching and endemicity (r = 0.75; P < 0.001). The prevalence of CPOD in the hyper-endemic community was significantly higher in males than females (P< 0.001). CPOD was only observed in subjects aged > or = 7 years. Many of the subjects were checked for microfilaridermia, by skin-snipping. The prevalence of microfilaridermia [58.2% (393/675) v. 6.2% (3/48)] and its geometric mean intensity (8.9 v. 1.0 microfilariae/mg skin snip) were both higher in the hyper-endemic community than the hypo-endemic. Itching appears to be related to reactive onchodermatitis.

Clinical and parasitological aspects of itching caused by onchocerciasis in Morogoro, Tanzania

A clinical and parasitological assessment of onchodermatitis was conducted in a rural area of Morogoro district, Tanzania. The study population consisted of 1005 individuals aged ≥ 5 years: 749 from a hyper-endemic community and 256 from a hypo-endemic. The prevalence of troublesome itching was 67.0% in the hyper-endemic community but only 5% (13/256) in the hypo-endemic. The corresponding prevalences of nodules among the adult male subjects were 77.7% (171/220) and 2.3% (2/86). The most common onchocercal skin lesion in the hyper-endemic community was chronic papular onchodermatitis (CPOD) manifested by itching, which was often very severe. There was a strong association between skin itching and endemicity (r = 0.75; P< 0.001). The prevalence of CPOD in the hyper-endemic community was significantly higher in males than females (P< 0.001). CPOD was only observed in subjects aged ≥7 years. Many of the subjects were checked for microfilaridermia, by skin-snipping. The prevalence of microfilaridermia [58.2% (393/675) v. 6.2% (3/48)] and its geometric mean intensity (8.9 v. 1.0 microfilariae/mg skin snip) were both higher in the hyper-endemic community than the hypo-endemic. Itching appears to be related to reactive onchodermatitis.

Gender and ethnic differences in onchocercal skin disease in Oyo State, Nigeria.

During preparation for a study on the effects of ivermectin treatment on onchocercal skin disease in the Ifeloju Local Government Area of Oyo State, Nigeria, 1032 adults aged 20 years and older were examined for skin lesions and palpable nodules. It was found that for 4 types of skin lesions, acute papular onchodermatitis (APOD), chronic papular onchodermatitis (CPOD), lichenified onchodermatitis (LOD) and depigmentation (leopard skin), as well as for subcutaneous nodules, females had a significantly higher prevalence than males. Although the area is inhabited primarily by the Yoruba people, the study also included some of the cattle-herding Fulani ethnic group. The reactive skin lesions, APOD, CPOD and LOD, were found to be more common among the Fulani, although there were no significant differences in leopard skin and nodules between both groups. While there is need for further research on both immunological and behavioural factors that may lead to these differences in disease. The need to achieve equity in health programming by ensuring that women and ethnic minorities receive full disease control services is of more immediate concern.

Human onchocerciasis in Nigeria: isotypic responses and antigen recognition in individuals with defined cutaneous pathology.

Antigen (Ag)-specific isotype responses to Onchocerca volvulus Ag (OvAg) were assessed by enzyme-linked immunosorbent assay and immunoblot in 123 residents of a mesoendemic area in northern Nigeria and 16 Nigerians from a nonendemic area. Individuals from an endemic area were divided into six groups on the basis of cutaneous onchocercal pathology: acute papular onchodermatitis (APOD), chronic papular onchodermatitis (CPOD), lichenified onchodermatitis (LOD), atrophy (ATR), depigmentation (DPM) and normal skin, high microfilarial load (NSHMF). Immunoglobulin (Ig)G1-4 levels were all significantly associated with residence in an endemic area after controlling for age and sex (all P values = 0.0001). Both IgG1 and IgG3 were significantly associated with onchocercal clinical category after controlling for age, sex, and microfilarial load (P = 0.0031 and 0.0035, respectively). The IgG1 and IgG3 responses were both highest in LOD and lowest in NSHMF and ATR, respectively. A significant inverse association was found between IgG1 levels and microfilarial load after controlling for age, sex, and clinical category (P = 0.0061). On immunoblotting, 20 (44.4%) of 45 individual onchocerciasis sera contained IgG4 antibodies against a band of 29-31 kD, which was not recognized by pooled sera from individuals with other filarial infections. There was heterogeneity of antigen recognition within each of the onchocercal clinical groups, which together with the small numbers examined by immunoblotting, limits interpretation. Nevertheless, some differences in patterns of antigen recognition were found between the onchocercal groups. The LOD group demonstrated prominent immunoreactivity in IgG1 and IgG3 while a general paucity of low molecular weight reactivity was seen with NSHMF in IgG1-3 subclasses, but there was no specific banding pattern that differentiated NSHMF from those with pathology. Comparison of microfilariae-positive (mf+) and mf- individuals with onchocercal skin disease revealed significantly higher levels of all IgG subclasses and higher overall scores on semiquantitative assessment of immunoblots for IgG1, IgG2, and IgG4 for mf+ individuals. Differing isotypic responses may play a role in the pathogenesis of the clinical spectrum of cutaneous onchocerciasis.