eMedicine Specialties > Infectious Diseases > Parasitic Infections

Onchocerciasis: Follow-up

Author: Mary Nettleman, MD, MS, Chair, Department of Medicine, Michigan State University
Coauthor(s): Apoorv Kalra, MD, Assistant Professor of Medicine, Michigan State University
Contributor Information and Disclosures

Updated: Apr 16, 2009

Follow-up

Inpatient & Outpatient Medications

Patients with onchocerciasis should receive ivermectin 150 mcg/kg every 3-6 months.

Deterrence/Prevention

  • Travelers to endemic area can avoid onchocerciasis by avoiding vector contact with protective clothing and repellants.
  • Population-based prevention strategies in some of the endemic areas of Africa and South America are based on elimination of blackfly vector and regular (every 6-12 mo) mass ivermectin treatment of affected individuals.

Complications

  • Ocular complications of onchocerciasis include blindness secondary to keratitis, pannus formation, and corneal fibrosis. Posterior segment complications include chorioretinitis, intraretinal deposits, open-angle glaucoma, and optic atrophy.
  • Cutaneous complications of onchocerciasis include skin atrophy, depigmentation, and sowda (chronic popular dermatitis limited to one limb). A loss of skin elasticity (hanging groin) may also occur.
  • Hematologic and immunologic complications of onchocerciasis include chronic lymphadenopathy.

Prognosis

  • Some eye manifestations and dermatitis resolve in patients undergoing ivermectin treatment every 6-12 months for the lifetime of the adult worm (approximately 12 y).
  • Blindness, skin atrophy, and depigmentation do not improve with treatment. The life expectancy in blind persons is decreased secondary to difficulty coping with activities of daily living.

Patient Education

  • Travelers to areas where onchocerciasis is endemic should be counseled to use protective clothing and insect repellants.
  • Patients, particularly those with high microfilarial load and ocular involvement, should be cautioned on the potential complications of ivermectin therapy that may result from dying microfilaria.
 


More on Onchocerciasis

Overview: Onchocerciasis
Differential Diagnoses & Workup: Onchocerciasis
Treatment & Medication: Onchocerciasis
Follow-up: Onchocerciasis
Multimedia: Onchocerciasis
References
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Further Reading

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Keywords

onchocerciasis, onchocercosis, river blindness, volvulosis, craw-craw, Robles disease, Onchocerca volvulus, O volvulus, Simulium fly, blinding disease, papular dermatitis, leopard skin, sowda, sowdah, Nakalaga syndrome, ocular onchocerciasis, ocular onchocercosis, onchodermatitis, onchocercomata

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Contributor Information and Disclosures

Author

Mary Nettleman, MD, MS, Chair, Department of Medicine, Michigan State University
Mary Nettleman, MD, MS is a member of the following medical societies: American College of Physicians, Association of Professors of Medicine, Central Society for Clinical Research, Infectious Diseases Society of America, and Society of General Internal Medicine
Disclosure: Nothing to disclose.

Coauthor(s)

Apoorv Kalra, MD, Assistant Professor of Medicine, Michigan State University
Disclosure: Nothing to disclose.

Medical Editor

Daniel R Lucey, MD, MPH, Chief, Fellowship Program Director, Department of Internal Medicine, Division of Infectious Diseases, Washington Hospital Center; Professor, Department of Internal Medicine, Uniformed Services University of the Health Sciences
Daniel R Lucey, MD, MPH is a member of the following medical societies: Alpha Omega Alpha and American College of Physicians
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

John W King, MD, Professor of Medicine, Section of Infectious Diseases, Louisiana State University Health Sciences Center; Director, Viral Therapeutics Clinics for Hepatitis; Consulting Staff, Department of Infectious Diseases, Overton Brook Veterans Affairs Medical Center
John W King, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians, American Federation for Medical Research, American Society for Microbiology, Association of Subspecialty Professors, Infectious Diseases Society of America, and Sigma Xi
Disclosure: emedicine $50.00 author of chapter

CME Editor

Eleftherios Mylonakis, MD, Clinical and Research Fellow, Department of Internal Medicine, Division of Infectious Diseases, Massachusetts General Hospital
Eleftherios Mylonakis, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians, American Society for Microbiology, and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

Chief Editor

Burke A Cunha, MD, Professor of Medicine, State University of New York School of Medicine at Stony Brook; Chief, Infectious Disease Division, Winthrop-University Hospital
Burke A Cunha, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

 
 
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