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      River Blindness: A Success Story under Threat?

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          Abstract

          The success of the Onchocerciasis Control Programme is undeniable and exemplary, say the authors, but it is too early to claim victory against river blindness.

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          Most cited references71

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          The role of endosymbiotic Wolbachia bacteria in the pathogenesis of river blindness.

          Parasitic filarial nematodes infect more than 200 million individuals worldwide, causing debilitating inflammatory diseases such as river blindness and lymphatic filariasis. Using a murine model for river blindness in which soluble extracts of filarial nematodes were injected into the corneal stroma, we demonstrated that the predominant inflammatory response in the cornea was due to species of endosymbiotic Wolbachia bacteria. In addition, the inflammatory response induced by these bacteria was dependent on expression of functional Toll-like receptor 4 (TLR4) on host cells.
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            An investigation of persistent microfilaridermias despite multiple treatments with ivermectin, in two onchocerciasis-endemic foci in Ghana.

            If ivermectin-based programmes for the control of human onchocerciasis are to be successful, the drug must remain effective for as long as necessary. In an open, case-control study, an attempt was made to determine if the persistent, significant, Onchocerca volvulus microfilaridermias seen in some individuals who had received at least nine treatments with ivermectin were the result of the development of drug resistance in the parasite. Twenty-one of these 'sub-optimal' responders (cases) were matched, by age, weight, number of treatments, locality and skin microfilarial counts, with seven amicrofilaridermic responders and 14 ivermectin-naive subjects. The number of treatments taken, any potential drug interactions and significant underlying disease were determined from detailed clinical and laboratory studies. Each subject was treated with ivermectin during the study, so that plasma concentrations of the drug could be determined for 72 h from the time of dosage. The microfilarial and adult-worm responses to this treatment were assessed from skin microfilarial counts (obtained before the treatment and at days 8, 90 and 365 post-treatment), day-90 embryogrammes, and the results of fly-feeding experiments. Parasite-sensitivity criteria for various time-points were derived from earlier data on skin microfilaridermias and the effects of ivermectin on the adult worms. The results indicate that the significant microfilaridermias that persist despite multiple treatments with ivermectin are mainly attributable to the non-response of the adult female worms and not to inadequate drug exposure or other factors. The possibility that some adult female worms have developed resistance to ivermectin cannot be excluded. These results justify the routine monitoring of treatment efficacy in any ivermectin-based programme of disease control.
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              Relationship between onchocerciasis and epilepsy: a matched case-control study in the Mbam Valley, Republic of Cameroon.

              Studies conducted during the past 10 years to investigate the possible relationship between onchocerciasis and epilepsy have led to contradictory results. In 1991-92 and 2001 we investigated 14 villages in central Cameroon to evaluate the relationship, at the community level, between the prevalence of epilepsy and the endemicity level of onchocerciasis. A case-control study compared the microfilarial loads of 72 epileptic and 72 non-epileptic individuals, matched according to sex, age, and village of residence. The prevalence of epilepsy and the community microfilarial load (CMFL) were closely related (P < 0.02), and the case-control study demonstrated that the microfilarial loads (microfilariae per snip) in the epileptic group (arithmetic mean = 288, median = 216) were significantly higher (P < 10(-4)) than in the control group (arithmetic mean = 141, median = 63). The results strongly support the existence of a link between onchocerciasis and epilepsy. The fact that such a relationship has not been found recently in some other West and Central African areas is probably due to the lowered endemicity of onchocerciasis following vector- and ivermectin-related control measures applied over the past 5-25 years. The socio-economic and demographic impact of onchocerciasis-related epilepsy should be evaluated, and taken into account as part of all onchocerciasis control programmes.
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                Author and article information

                Journal
                PLoS Med
                pmed
                PLoS Medicine
                Public Library of Science (San Francisco, USA )
                1549-1277
                1549-1676
                September 2006
                26 September 2006
                : 3
                : 9
                : e371
                Author notes
                * To whom correspondence should be addressed. E-mail: m.basanez@ 123456imperial.ac.uk
                Article
                06-PLME-ND-0110R1
                10.1371/journal.pmed.0030371
                1576321
                17002504
                47e502c5-fe58-4726-b887-6871079c353c
                Copyright: © 2006 Basáñez et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
                History
                Page count
                Pages: 7
                Categories
                Neglected Diseases
                Infectious Diseases
                Epidemiology/Public Health
                Health Policy
                Ophthalmology
                Parasitology
                Infectious Diseases
                Microbiology
                Medicine in Developing Countries
                Ophthalmology
                Public Health
                Custom metadata
                Basáñez M-G, Pion SDS, Churcher TS, Breitling LP, Little MP, et al. (2006) River blindness: A success story under threat? PLoS Med 3(9): e371. DOI: 10.1371/journal.pmed.0030371

                Medicine
                Medicine

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