Onchocercal lymphadenitis: Clinicopathologic study of 34 patients

Clinicopathological studies on lymph nodes of 32 Africans with onchocerciasis--some complicated by hanging groin and elephantiasis of the genitalia--revealed atrophic lymphoid tissue, lymphoedema, chronic inflammation and fibrosis. We identified microfilariae of Onchocerca volvulus in nodes of 24 of 32 Africans (75%). There microfilariae were most numerous in the capsule and in the fibrous tissue of the medulla, but smaller numbers were also found within lymphoid tissue, in dilated lymphatics and in blood vessels. We believe that in Africians, antigens released from microfilariae of O. volvulus lead to the deposition of immune complex in tissues, which in turn causes inflammation and fibrosis and eventually obstructive lymphadenitis. This causes hanging groin and, possibly, also elephantiasis. A distinctive pattern of perivascular fibrosis contains "fibrinoid material" that we interpret as immune complexes involving microfilarial antigens. In contrast, nodes from two Yemenites with severe onchocercal dermatitis of the lower limbs (sowda) had hyperplastic follicles, minimal fibrosis and no microfilariae.