• Papular, itchy skin lesions (onchocercal dermatitis).
• Hyperpigmented or depigmented skin patches.
• Severe itching, leading to secondary bacterial infections.
• “Elephantine” skin thickening, especially on the legs and scrotum.

Eye Involvement

• Microfilariae migrate to the eyes, causing inflammation (onchocercal keratitis).
• Loss of vision, including blindness, due to corneal scarring, optic atrophy, and retinal detachment.
• Severe itching and burning in the eyes.

Onchocercomas

• Firm, subcutaneous nodules that contain adult worms.
• Located in various parts of the body, including the head, neck, limbs, and buttocks.
• Often painful and can cause pressure on nearby nerves or organs.

Lymphatic Involvement

• Swelling of lymph nodes and lymphedema.
• Chronic inflammation of the lymph system.

General Symptoms

• Fever
• Headache
• Fatigue
• Joint pain
• Loss of appetite
• Weight loss

Diagnosis and Investigations

• Skin Biopsy: Examination of skin samples for microfilariae under a microscope.
• Slit-lamp Examination: Examination of the eyes to detect microfilariae and eye damage.
• Nodule Biopsy: Biopsy of onchocercomas to confirm the presence of adult worms.
• ELISA (Enzyme-Linked Immunosorbent Assay): Blood test to detect antibodies against Onchocerca volvulus.

Prevention

• Vector Control:
  • Reducing blackfly populations through insecticides and larvicides.
  • Using insect repellents and protective clothing.
  • Avoiding areas with high blackfly density.
• Mass Drug Administration (MDA):
  • Regular administration of antiparasitic drugs (ivermectin) to kill microfilariae.
  • Typically given every 6 months to all individuals in endemic areas.
  • Ivermectin 150 micrograms/kg once yearly for 10-14 years

Management

Aims of Management

• To eliminate microfilariae and reduce the number of adult worms.
• To prevent further transmission of the disease.
• To manage complications and improve quality of life.

Medical Management

• Antibiotics: For treating secondary bacterial infections.
• Doxycycline: 100 mg twice a day for 6 weeks followed by;
• Antiparasitic Drugs:
  • Ivermectin: Kills microfilariae but does not eliminate adult worms.
  • Ivermectin 150 micrograms/kg single dose.
• Anti-Inflammatory Medications: For managing eye inflammation and other inflammatory conditions.

Surgical Management

• Excision of Onchocercomas: Surgical removal of nodules can be considered for symptomatic nodules or those causing pressure on nearby structures.

Nursing Care

• Symptom Management:
  • Provide comfort measures for itching and pain.
  • Administer medications as prescribed.
  • Monitor for side effects of medications.
• Eye Care:
  • Teach patients proper eye hygiene and care.
  • Monitor for signs of eye infection and vision loss.
• Skin Care:
  • Provide soothing baths and lotions for itching.
  • Encourage the use of insect repellents.
• Education:
  • Educate patients about the disease, transmission, and prevention.
  • Encourage adherence to treatment and follow-up appointments.