Interruption of infection transmission in the onchocerciasis focus of Ecuador leading to the cessation of ivermectin distribution.

INTRODUCTION: A clinically significant endemic focus of onchocerciasis existing in Esmeraldas Province, coastal Ecuador has been under an ivermectin mass drug administration program since 1991. The main transmitting vector in this area is the voracious blackfly, Simulium exiguum. This paper describes the assessments made that support the decision to cease mass treatment. METHODOLOGY AND PRINCIPLE FINDINGS: Thirty-five rounds of ivermectin treatment occurred between 1991-2009 with 29 of these carrying >85% coverage. Following the guidelines set by WHO for ceasing ivermectin distribution the impact on parasite transmission was measured in the two vector species by an O-150 PCR technique standard for assessing for the presence of Onchocerca volvulus. Up to seven collection sites in three major river systems were tested on four occasions between 1995 and 2008. The infectivity rates of 65.0 (CI 39-101) and 72.7 (CI 42-116) in 1995 dropped to zero at all seven collection sites by 2008. Assessment for the presence of antibodies against O. volvulus was made in 2001, 2006, 2007 and 2008 using standard ELISA assays for detecting anti-Ov16 antibodies. None of total of 1810 children aged 1-15 years (between 82 and 98% of children present in the surveyed villages) tested in the above years were found to be carrying antibodies to this antigen. These findings were the basis for the cessation of mass drug treatment with ivermectin in 2009. SIGNIFICANCE: This fulfillment of the criteria for cessation of mass distribution of ivermectin in the only known endemic zone of onchocerciasis in Ecuador moves the country into the surveillance phase of official verification for national elimination of transmission of infection. These findings indicate that ivermectin given twice a year with greater than 85% of the community can move a program to the final stages of verification of transmission interruption.

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

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.