Murdoch Michele E, Murdoch Ian E, Evans Jennifer, Yahaya Haliru, Njepuome Ngozi, Cousens Simon, Jones Barrie R, Abiose Adenike
St. John's Institute of Dermatology, London, United Kingdom.
Department of Dermatology, Watford General Hospital, West Herts Hospitals NHS Trust, Watford, Herts., United Kingdom.
PLoS Negl Trop Dis. 2017 Mar 29;11(3):e0005489. doi: 10.1371/journal.pntd.0005489. eCollection 2017 Mar.
Onchocerca volvulus infection can result in blindness, itching and skin lesions. Previous research concentrated on blindness.
A clinical classification system of the cutaneous changes in onchocerciasis was used for the first time in this study within the context of an early ivermectin drug trial in the savanna region of Kaduna State, northern Nigeria. Skin examinations were performed in 6,790 individuals aged 5+ years in endemic communities and 1,343 individuals in nonendemic communities.
RESULTS / DISCUSSION: There was increased risk for all forms of onchocercal skin disease in endemic communities with the most common finding being the presence of nodules (1,438 individuals, 21.2%), followed by atrophy (367, 6.1% of those < 50 years), acute papular onchodermatitis, APOD (233, 3.4%), depigmentation (216, 3.2%) and chronic papular onchodermatitis, CPOD (155, 2.3%). A further 645 individuals (9.5%) complained of pruritus but had completely normal skin. APOD was more common in males whereas atrophy, hanging groin and nodules were more common in females. After controlling for age and sex, microfilarial positivity was a risk factor for CPOD, depigmentation, hanging groin and nodules (OR 1.54, p = 0.046; OR 2.29, p = 0.002; OR 2.18, p = 0.002 and OR 3.80, p <0.001 respectively). Comparable results were found using presence of nodules as the marker for infection. Microfilarial load showed similar, though weaker, results. A total of 2621(38.6%) endemic residents had itching with normal skin, or had one or more types of onchocercal skin disease including nodules, which may be considered as a composite index of the overall prevalence of onchocercal skin disease.
Significant levels of onchocercal skin disease were documented in this savanna area, which subsequently resulted in a reassessment of the true burden of skin disease in onchocerciasis. This paper represents the first detailed report of the association of onchocercal skin disease with markers for onchocercal infection.
盘尾丝虫感染可导致失明、瘙痒和皮肤病变。以往的研究主要集中在失明方面。
在尼日利亚北部卡杜纳州热带稀树草原地区进行的一项早期伊维菌素药物试验中，本研究首次使用了盘尾丝虫病皮肤变化的临床分类系统。对流行社区中6790名5岁及以上个体和非流行社区中1343名个体进行了皮肤检查。
结果/讨论：流行社区中所有形式的盘尾丝虫性皮肤病风险均增加，最常见的表现是出现结节（1438例，21.2%），其次是萎缩（367例，<50岁者中的6.1%）、急性丘疹性盘尾性皮炎（APOD，233例，3.4%）、色素脱失（216例，3.2%）和慢性丘疹性盘尾性皮炎（CPOD，155例，2.3%）。另有645名个体（9.5%）主诉瘙痒，但皮肤完全正常。APOD在男性中更常见，而萎缩、腹股沟下垂和结节在女性中更常见。在控制年龄和性别后，微丝蚴阳性是CPOD、色素脱失、腹股沟下垂和结节的危险因素（比值比分别为1.54，p = 0.046；2.29，p = 0.002；2.18，p = 0.002和3.80，p <0.001）。以结节的存在作为感染标志物时发现了类似结果。微丝蚴负荷显示出类似但较弱的结果。共有2621名（38.6%）流行地区居民有皮肤正常的瘙痒，或患有包括结节在内的一种或多种盘尾丝虫性皮肤病，这可被视为盘尾丝虫性皮肤病总体患病率的综合指标。
该热带稀树草原地区记录到了显著程度的盘尾丝虫性皮肤病，这随后导致对盘尾丝虫病中皮肤病的真实负担进行了重新评估。本文是盘尾丝虫性皮肤病与盘尾丝虫感染标志物关联的首份详细报告。
