PCR-coupled sequencing achieves specific diagnosis of onchocerciasis in a challenging clinical case, to underpin effective treatment and clinical management.

This study demonstrates the utility of a PCR-based DNA sequencing approach to make a specific diagnosis of onchocerciasis in a returned traveller. Although a clinical diagnosis was not possible, the surgical excision of a suprascapular nodule from this patient, combined with an histological examination of this nodule and PCR-based sequencing of DNA from a nematode from this lesion solved the case. The analysis of DNA sequence data confirmed the presence of Onchocerca volvulus infection, supporting an effective treatment-clinical management strategy for the patient.

Case report of an epidural cervical Onchocerca lupi infection in a 13-year-old boy.

A 13-year-old boy presented with fever and neck pain and stiffness, which was initially misdiagnosed as culture-negative meningitis. Magnetic resonance images of the brain and cervical spine demonstrated what appeared to be an intradural extramedullary mass at the C1-3 level, resulting in moderate cord compression, and a Chiari Type I malformation. The patient underwent a suboccipital craniectomy and a C1-3 laminectomy with intradural exploration for excisional biopsy and resection. The lesion containing the parasite was extradural, extending laterally through the C2-3 foramina. Inflammatory tissue secondary to Onchocerca lupi infection was identified, and treatment with steroids and doxycycline was initiated. At the 6-month follow-up, the patient remained asymptomatic, with MR images demonstrating a significant reduction in lesional size. However, 10 weeks postoperatively, the infection recurred, necessitating a second operation. The patient was treated with an additional course of doxycycline and is currently maintained on ivermectin therapy. This is the second reported case of cervical O. lupi infection in a human. In the authors' experience, oral doxycycline alone was insufficient in controlling the disease, and the addition of ivermectin therapy was necessary.

A five-year-old child with a subcutaneous forehead nodule.

We describe a case of a 5-year-old girl with onchocerciasis. The patient was recently adopted from Ethiopia and presented with a firm, raised nodule on the midportion of the forehead. Initially, Langerhans cell histiocytosis with bone involvement was suspected; however, histopathologic analysis of the excised nodule revealed the presence of a young-adult, female Onchocerca volvulus worm. This case exemplifies the importance of recognizing the key morphologic characteristics of adult O. volvulus worms isolated from pediatric patients in nonendemic areas to ensure adroit clinical management.

Ocular manifestations of systemic disease: ocular parasitosis.

PURPOSE OF REVIEW: To highlight recent advances in basic research, diagnostic as well as therapeutic advances in ocular parasitosis and to evaluate their application in medical practice. RECENT FINDINGS: Knowledge relating to immunoreactivity in ocular parasitology has grown impressively in past few years. The outcome of infection is the result of a set of interactions involving host and parasite genetic background, environmental and social factors. Immunopathogenesis of parasite-mediated host cell lysis is better understood. Studies on newer drugs with cophylogenetic techniques are in horizon. There are success stories on control of transmission in some countries. SUMMARY: Much has been achieved; however, much more effort is needed in the area of translational research from bench to bedside. There is a need to enhance the awareness of risk factors of parasitic diseases in the population. Newer molecular diagnostic techniques need to be standardized for field application. Steps needed to be taken by the ophthalmologist when a parasite is seen in ocular tissues including identification, search for systemic involvement, treatment for elimination and sequelae and public health notification. Lack of methodological uniformity in management emphasis the need for standardization including construction of management algorithm for ophthalmologists.

Tratamiento de la escabiasis con ivermectina por vía oral / Treatment of scabiasis with oral ivirmectina

Se reporta un estudio clínico, doble ciego, controlado, para evaluar la eficacia y seguridad de ivermectina por vía bucal a la dosis de 200 mcg/kg de peso para el tratamiento de la escabiasis, efectuado en 55 pacientes. Los resultados informaron que 26 pacientes (79.3 por ciento) curaron con ivermectina en su primera visita de control, en comparación con cuatro (16 por ciento) del grupo que recibió placebó (X²= 77.07, p<0.001). Al final 37 pacientes de 50 (74 por ciento tratados con ivermectina curaron comparados con cuatro de 26 (16 por ciento) manejados con placebo. Esta diferencia es significativa (X²=23.66, p<0.001). Se concluyó que la ivermectina por vía oral efectiva y segura en el tratamiento de la escabiasis

Immunoregulation in onchocerciasis. Functional and phenotypic abnormalities of lymphocyte subsets and changes with therapy.

To help define the immunoregulatory defects in patients with onchocerciasis, flow cytometric analysis of circulating lymphocyte subpopulations was performed in parallel with functional assays. No significant differences in CD4/CD8 ratios were seen when microfilariae-positive individuals from Guatemala were compared with Guatemalan controls. However, the infected individuals had significantly increased numbers of circulating CD4+CD45RA+ lymphocytes (mean 38.3%) when compared with controls (mean 16.0%). Coexpression of the activation marker HLA-DR was significantly increased on CD4+ cells from infected individuals. In contrast, no up-regulation of HLA-DR was seen on CD8+ or CD19+ cells. At 1 year after initiation of treatment with semiannual doses of the microfilaricide ivermectin, there were significant increases (P less than 0.05) in the percentage of CD4+CD45RA- cells, the percentage of CD4+HLA-DR+ cells, and mitogen-induced lymphokine production (IL-2, IL-4). Despite these changes, parasite-specific IL-2 and IL-4 production which had been undetectable before treatment did not manifest itself even by the 2-yr follow-up. Defects in the T-cell activation pathway in Onchocerca volvulus-infected individuals may thus exist at several independent points; a state of parasite antigen-specific tolerance appears to remain even after the relative reversal of other generalized immunoregulatory defects.

Afecciones cutáneas granulomatosas tropicales / Tropical granulomatous cutaneous affections

Exponemos aquí las características más resaltantes de diversas enfermedades granulomatosas de la piel propias del medio tropical. Mostramos las Técnicas esenciales del diagnóstico y tratamiento. En varias de estas enfermedades los carácteres clínicos, histológicos y el pronóstico dependen de la defensa inmunológica especifica del huésped frente al agente causal. También es de importancia la procedencia geográfica del paciente y su habitat para el diagnóstico y prevención de la enfermedad. Señalamos la dirección de las futuras investigaciones necesarias

La oncocercosis en América / The onchocerciasis in América

Las comunicaciones científicas presentadas en el Seminario hacen enfoque de las peculiaridades epidemiológicas, inmunológicas y parasitológicas de la oncocercosis en América. Incluye revisión de los progresos efectuados en el campo de la terapéutica, análisis de la relación riesgo/beneficios generados por el uso de la quimioterapia. Reseña las opiniones y conceptos de especialistas de los 6 paises Latinoamericanos donde la oncocercosis existe en forma endemica, así como también de los expertos de Francia, Inglaterra y OMS, quienes examinaron la información disponible sobre las manifestaciones de la helmintiasis en el Continente Americano

[Robles' disease (onchocerciasis). Presentation of the first confirmed case in Ecuador]. / Enfermedad de Robles (oncocercosis). Presentación del primer caso comprobado en Ecuador.

For the first time a case of "onchocercosis " was found in Ecuador. The patient is a coloured person which was examined in the Dermatology Department of the "Luis Vernaza" Hospital. The diagnosis was established on the bases of a biopsy of a thoracic nodule. The principal lesions which were established are the following: intense and generalized pigmentation of violet tones; a very accentuated ictiosiform statey specially on the trunk; hardened accematous plaques in the fore-arms; eruptions on the buttocks nodules in the region of the iliac bone and zones of vitiligo on the anterior part of the legs; linfatic nodules were also observed. Elefantiasis of the penis and scrotum. With this case we have established an endemic focus of onchocercosis in Esmeraldas, Ecuador.