Ocular onchocerciasis: current management and future prospects

摘要: This paper reviews the current management of onchocerciasis and its future prospects. Onchocerciasis is a disease affecting millions people in Africa, South Central America, Yemen. It spread by blackfly as vector caused filarial nematode, Onchocerca volvulus. A serious attempt was made Control Program between 1975 2002 to eliminate eleven endemic countries West with remarkable success. Formerly, treatment diethyl carbamazine for microfilaria suramin adult worm. These drugs are now known be toxic unsuitable mass distribution. In particular, they precipitate optic nerve disease. With discovery ivermectin, much safer microfilaricide, decision Merck distribute drug free charge long needed, strategy control switched administration through community-directed ivermectin. So far, have received this annual or biannual African Elimination Americas. However, problem ivermectin that it monotherapy microfilaricide which has limited effect on worm, thus will need continued life span may last up 15 years. There also early reports resistance. Serious encephalopathy death occur when used subjects heavily infested loiasis. seems unlikely break transmission Africa because population migrations highly efficient vector, but Americas some such Columbia Oaxaca focus Mexico reported eradication. Vector only applicable selected situations, particularly nuisance value blackfly. Trials ongoing alternatives Candidate include moxidectin, macrofilaricide, doxycycline targets Wolbachia endosymbiont, flubendazole, shows promise newer oral cyclodextrin formulation.