Medication Summary

Treatment involves microfilaricidal or macrofilaricidal agents. No known nontoxic macrofilaricidal agent is available to kill adult worms effectively.

Class Summary

These agents inhibit growth and proliferation of parasites.

Ivermectin (Mectizan, Stromectol)

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Drug of choice for onchocerciasis. Derived from the soil actinomycete Streptomyces avermitilis. Metabolized in liver and excreted in feces over 12 d. Plasma half-life is 18 h. Its activity is the result of increased nerve and muscle cell permeability to chloride channels, leading to hyperpolarization and paralysis due to the drug's high affinity binding to glutamate-gated and gamma aminobutyric acid–gated chloride ion channels.

Moxidectin

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Moxidectin, a macrocyclic lactone, is an anthelmintic indicated for the treatment of onchocerciasis due to Onchocerca volvulus in patients aged 12 years and older. Plasma half-life is 20-43 days and thereby reduces and maintains low skin microfilarial density effectively. Moxidectin does not kill adult O volvulus. Follow-up evaluation is advised. Safety and efficacy of repeat administration has not been studied.

Diethylcarbamazine (Hetrazan)

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Diethylcarbamazine (DEC) is never used in the treatment of onchocerciasis. DEC is rarely used for diagnostic purposes, when low test doses are given and patients are observed for the Mazzotti reaction, which, in mild cases, results in pruritus, dermal edema, maculopapular eruptions, lymphadenopathy, and fever and, in severe cases, results in meningismus, severe prostration, and/or death. The mechanism of action of DEC is secondary to direct effect on microfilariae by causing organelle damage and apoptosis.

Class Summary

Empiric antimicrobial therapy must be comprehensive and should cover all likely pathogens in the context of the clinical setting.

Doxycycline (Bio-Tab, Doryx, Doxy, Periostat, Vibramycin, Vibra-Tabs)

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May be used to reduce or eliminate the endosymbiotic bacteria Wolbachia. This disrupts production of microfilariae by the adult female worm.

Follow-up

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Media Gallery

Simulium fly (black fly).
Histopathology of an Onchocerca volvulus nodule. Courtesy of the CDC and Dr. Mae Melvin.
Simplified life cycle of Onchocerciasis volvulus.
Subcutaneous nodule on hip caused by encysted Onchocerca volvulus.
Man blinded by microfilariae of Onchocerca volvulus.
Bleeding on skin due to scratching of itchy skin (onchodermatitis).
One anatomic quarter of body (leg) markedly affected by edema and papule formation of onchodermatitis.
Skin of a West African person with leopard spot depigmentation.
Patient from Cameroon with sowdalike lesions.
Microfilaria of Onchocera volvulus stained from skin biopsy. Courtesy of Cali Colombia, D Scott Smith, MD, and Gloria Palma, MD, PhD.
Taking a skin snip from the hip with a 5-microgram iris scissors for quantitatively diagnosing Onchocerca volvulus infection (Rio de Micay, Colombia). Courtesy of D Scott Smith, MD.
Taking a skin snip from the hip with a 5-microgram iris scissors for quantitatively diagnosing Onchocerca volvulus infection (Rio de Micay, Colombia). Courtesy of D Scott Smith, MD.
Adults blinded by onchocerciasis. This is the WHO/New York Times photo that inspired World Bank funding for River Blindness control programs and then the bronze statue in front of the WHO in Geneva Switzerland. Courtesy of Otis Historical Archives, National Museum of Health and Medicine.

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Author

Darvin Scott Smith, MD, MSc, DTM&H, FIDSA Chief of Infectious Diseases and Geographic Medicine, Department of Internal Medicine, Kaiser Permanente Medical Group

Darvin Scott Smith, MD, MSc, DTM&H, FIDSA is a member of the following medical societies: American Medical Association, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, International Society of Travel Medicine

Disclosure: Nothing to disclose.

Coauthor(s)

Muzzammil Imran Muhammad Shittu Graduate Student, CHPR, Stanford University

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

John W King, MD Professor of Medicine, Chief, Section of Infectious Diseases, Director, Viral Therapeutics Clinics for Hepatitis, Louisiana State University School of Medicine in Shreveport; Consultant in Infectious Diseases, Overton Brooks Veterans Affairs Medical Center

John W King, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians, American Federation for Medical Research, American Society for Microbiology, Association of Subspecialty Professors, Infectious Diseases Society of America, Sigma Xi, The Scientific Research Honor Society

Disclosure: Nothing to disclose.

Chief Editor

Michael Stuart Bronze, MD David Ross Boyd Professor and Chairman, Department of Medicine, Stewart G Wolf Endowed Chair in Internal Medicine, Department of Medicine, University of Oklahoma Health Science Center; Master of the American College of Physicians; Fellow, Infectious Diseases Society of America; Fellow of the Royal College of Physicians, London

Michael Stuart Bronze, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, American Medical Association, Association of Professors of Medicine, Infectious Diseases Society of America, Oklahoma State Medical Association, Southern Society for Clinical Investigation

Disclosure: Nothing to disclose.

Additional Contributors

Daniel R Lucey, MD, MPH, MD, MPH

Daniel R Lucey, MD, MPH, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians

Disclosure: Nothing to disclose.

Mary D Nettleman, MD, MS, MACP Professor and Chair, Department of Medicine, Michigan State University College of Human Medicine

Mary D Nettleman, MD, MS, MACP is a member of the following medical societies: American College of Physicians, Association of Professors of Medicine, Central Society for Clinical and Translational Research, Infectious Diseases Society of America, Society of General Internal Medicine

Disclosure: Nothing to disclose.

Apoorv Kalra, MD Assistant Professor of Medicine, Michigan State University

Disclosure: Nothing to disclose.

Sections Onchocerciasis (River Blindness)
Overview
Presentation
DDx
Workup
Treatment
Guidelines
Medication
Follow-up
Media Gallery
References

Onchocerciasis (River Blindness) Medication

Medication Summary

Anthelmintics