Onchocerciasis: Manifestations, Risks, Complications, Medications

Onchocerciasis is one of the biggest global threats in the field of infectious diseases. Why?

  • 19 million people have already caught this infection;
  • 240 million people are now exposed to a serious risk of catching it;
  • 15 million people have completely lost their sight irreversibly;
  • 6 million people face complications on the part of the skin.

Luckily, as of today, due to effective mass prophylaxis measures, this disease occurs in Africa predominantly — around 99%. Also, there is a risk for people living or traveling to Latin America and Yemen.

What is Onchocerciasis?

It is an infectious disease, which is caused by a worm, which is called Onchocerca volvulus. This parasite gets into one’s body (namely, under one’s skin) after one is bitten by a blackfly. Namely, it is transmitted with repeated and subsequent bites, i.e. the parasite is spread from an infected person to a healthy one. Consequently, in a human body, an adult worm reproduces, and its microfilariae spread around one’s organism. Their top targets are skin and eyes — therefore its second name is river blindness. Still, other organs are under threat as well. Again, this parasite is mainly spread in African countries. As for blackflies they ordinarily live on the benches of rivers and streams with a fast flow.

What Are the Symptoms?

As we’ve already mentioned, in the first place, one suffers from adverse reactions on the part of skin and eyes:

  • skin: nodules, itching, rash, thinning, abnormalities in pigmentation;
  • eyes: itching, sensitivity to light, cataracts, permanent sight loss.

Other reactions registered — swollen lymph glands and enlarged/inflamed groin. Fortunately, this infection does not directly cause any fatal consequences. Still, due to blindness, infected people frequently become disabled to continue working and earning their living. Note that it may take up to 18 months for the infection to manifest itself. Thus, stay cautious even after returning from an endemic region.

What Should One Do If One Notices Any Symptoms?

  1. Stay patient and schedule a consultation with your doctor.
  2. For the purpose of diagnosing, the doctor may recommend you go through a skin biopsy — a doctor will either take small particles of skin from different parts of your body and check them for microfilariae or cut out one of the nodules and check it for adult worms. Another method is examining the front part of the eyes. In some cases, blood tests are applied.
  3. Afterward, if the doctor diagnoses the infection, he will prescribe a treatment course. It will probably include more than one drug (see more details below).
  4. It is your responsibility to inform the doctor about all the diseases you have and all the drugs and dietary supplements you take so that he can recommend an optimal therapy scheme to you.
  5. You must follow the doctor’s instructions concerning the dose and regimen strictly, otherwise, that may reduce the effectiveness of the course.
  6. If recommended you must pass a repeated course in a year (or another period). As a rule, one must pass several courses to fully get rid of the infection.
  7. Again, you must not leave the infection untreated as there is a high risk that it will lead to a complete and irreversible loss of sight in such a case.

What Are the Treatment Options?

The most well-known and commonly applied formulation for onchocerciasis is the active substance Ivermectin (which is widely sold in the USA as Stromectol but is legitimately available under other trade names as well). For information, this drug has been actively used for mass therapy in African (and other) countries initiated by international organizations like the WHO or ESPEN. The point is that most regions affected by this infection also face severe problems with access to decent healthcare. Thus, they need help in controlling and eliminating such dangerous diseases.

Now, let us provide a few facts about the medication mentioned:

  • It kills microfilariae and sterilizes adult parasites.
  • It works from the first dose, but most patients need to repeat it in a year.
  • It is not toxic to patients. If one notices any toxic reactions, one must know that they are provoked by parasites themselves, especially when they die.
  • To fully get rid of adult worms, one usually needs to administer one dose per year for several years.
  • It is sold both as a brand product and as cheap generics.

Still, if you are interested in this disease, we recommend you search for more information about this drug. Here is a link to a large review about it.

Taking into account that the medicine specified does not kill adult worms, but only sterilizes them for some period, experts insist that it must be combined with Doxycycline.

Here are its most essential properties:

  • It does not work against microfilariae, but its action is targeted at bacteria, which are used by adult parasites for survival. Hence, they become incapable of surviving and reproducing.
  • It cannot quickly remove the adverse symptoms of the disease, thus, it is combined with Ivermectin.
  • These two medications are not administered simultaneously because of probable side effects. Instead, they are used in turn.
  • Doxycycline is also marketed as both brand and generic products.

Now, let us discuss the cost issues as we know that for many patients they play a significant role. Luckily, as it was noted above, both medications can be bought as generics, i.e. identical copies, which are produced by companies other than the ones which have originally developed them. In practice, that means that, if you cannot afford brand products — namely, Stromectol and Doryx — you can just buy generic Ivermectin and Doxycycline instead and save about 75%. For example, brand Stromectol (8mg) costs $99.96 per 20 pills, while an identical pack of generic tablets costs $28.72 only. As for Doxycycline (100mg) is sold for $23.15 for 20 tablets, its generic alternative — for $6.35 only.

You must understand that there is no other significant difference between brand and generic medications, except for the trade name they are marketed under. As they contain the same dose of the same active ingredient, their action and effects are identical. Hence, if you want to reduce the costs, feel free to ask your doctor or pharmacist about the generic version of the drug prescribed.

Safety Tips

  1. Mind that, if you live in an endemic area or have stayed there for a long time, you are at special risk of catching this infection. Watch out for its symptoms for at least 18 months after returning home. If you suspect that you are infected, see a doctor without a delay — do not let it cause complications to your skin or sight.
  2. When living in an endemic area, avoid river basins and farm fields nearby, as well as other places where blackflies commonly occur. They are most active during the day hours.
  3. Opt for long pants and long-sleeve shirts to leave minimum skin open and vulnerable to bites.
  4. Protect open areas of your skin with DEET repellents.
  5. Apply a Permethrin spray to your clothes and mosquito nets — it will kill all the insects as soon as they get in contact with it.
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