Onchocercoma of the scalp: A case report

Onchocerciasis or river blindness is a parasitic disease caused by Onchocerca volvulus transmitted to humans by the byte of a black fly of the species Simulium. This pathology, which is a part of the Neglected tropical Disease (NTDs), has been resurgent for some years in certain regions of Burkina Faso. We report a case of onchocercoma with the aim of describing the anatomopathological aspects of this pathology. These were two (02) biopsy fragments from a scalp nodule in an 8-year-old boy, received in the pathology laboratory for examination. In this case study, we recall that onchocerciasis is manifested mainly by skin lesions, subcutaneous nodules and ocular lesions. Histologically, the skin lesions present as a dermatitis with adult worms in the superficial dermis within a predominantly eosinophilic inflammatory infiltrate. Nodules or onchocercomas, usually subcutaneous, consist of fibrous, inflammatory tissue with a predominance of eosinophils and adult worms including females containing microfilariae. Ocular lesions begin with punctate keratitis with a snowflake image. Sclerosis with opacification of the cornea progressively sets in, causing blindness.

Individuals living in an onchocerciasis focus and treated three-monthly with ivermectin develop fewer new onchocercal nodules than individuals treated annually

BACKGROUND

Little information is available on the effect of ivermectin on the third- and fourth-stage larvae of Onchocerca volvulus. To assess a possible prophylactic effect of ivermectin on this parasite, we compared the effects of different ivermectin regimens on the acquisition of onchocercal nodules.

METHODS

We analyzed data from a controlled randomized clinical trial of ivermectin conducted in the Mbam Valley (Cameroon) between 1994 and 1998 in a cohort of onchocerciasis infected individuals. The number of nodules that appeared between the start and the end of the clinical trial was analyzed, using ANOVA and multivariable Poisson regressions, between four treatment arms: 150 µg/kg annually, 800 µg/kg annually, 150 µg/kg 3-monthly, and 800 µg/kg 3-monthly.

RESULTS

The mean number of nodules that appeared during the trial was reduced by 17.7% in subjects treated 3-monthly compared to those treated annually (regardless of the dose). Poisson regression model, adjusting on subject's age and weight, initial number of nodules and intensity of O. volvulus infection in his village of residence, confirmed that the incidence of new nodules was reduced in 3-monthly treatment arms compared to annually treatment arms, and that the dosage of ivermectin does not seem to influence this effect. Furthermore, the number of newly acquired nodules was positively associated with the initial number of nodules. Analysis of disappearance of nodules did not show any significant difference between the treatment groups.

CONCLUSIONS

To our knowledge, these results suggest for the first time in humans, that ivermectin has a partial prophylactic effect on O. volvulus. Three-monthly treatment seems more effective than annual treatment to prevent the appearance of nodules.