Management of onchocerciasis. Personal observations

During a 12-month period (1977 - 1978) of employment in the river forest area of the Ivory Coast, an isolated area hyperendemic for onchocerciasis, a unique opportunity arose to study the disease in depth. Personal observations and experiences with the disease did not necessarily correlate with textbook statements. Although onchocerciasis may involve almost any area of the body it more commonly involves the skin, eyes, lymphatics and groin area. The disease does not appear to cause premature or direct death, but is often acutely and chronically disabling. Diethylcarbamazine and suramin are effective in preventing disabling complications and in diminishing or controlling the progression of complications, but are nephrotoxic. Surgery is utilized to excise microfilaria-producing nodules in order to minimize or control disease progression and for the repair of the frequently occurring complication of inguinal or femoral hernias and hydroceles. A high percentage of patients had microfilarial eye infiltrates but blindness was uncommon. The disease should therefore be known as 'river eye disease' rather than the current 'river blindness'. There is no known method of effective prevention of the disease that is acceptable on a long-term basis.