Connor D H, George G H, Gibson D W
Rev Infect Dis. 1985 Nov-Dec;7(6):809-19. doi: 10.1093/clinids/7.6.809.
Onchocerciasis--infection by Onchocerca volvulus--has four cardinal manifestations: dermatitis, subcutaneous nodules, sclerosing lymphadenitis, and eye disease. The first three are discussed here. The dermatitis begins when microfilariae degenerate in the dermis. This process is accompanied by inflammation, with degranulation of eosinophils and deposition of the major basic protein of the eosinophil granules on the cuticle of the microfilariae. So far as is known, the chronic effects of onchocerciasis are all a consequence of the degeneration of microfilariae. Subcutaneous nodules contain coiled adult worms and have an outer layer of fibrous scar and a central inflammatory cell exudate, which may cavitate. Perfusion of India ink reveals arborization of capillaries around adult worms, which derive nutrition from these networks. Onchocercal lymphadenitis is characterized initially by histiocytic hyperplasia and follicular atrophy and later by fibrosis and obstruction of lymph flow, a condition causing adenolymphocele ("hanging groin") and elephantiasis of the genitalia. Some patients appear to have immune tolerance to degenerating microfilariae, perhaps as a result of exposure in utero to microfilarial antigens in the maternal circulation. In contrast, other patients (Yemenites, for example) have a localized but intense response to a few microfilariae; these patients are hypersensitive--perhaps because they were not exposed to microfilarial antigens in utero. Autopsy data on infection of deep organs are limited.
盘尾丝虫病（由旋盘尾丝虫感染所致）有四种主要表现：皮炎、皮下结节、硬化性淋巴结炎和眼部疾病。本文讨论前三种表现。当微丝蚴在真皮内退化时，皮炎开始出现。这个过程伴有炎症，嗜酸性粒细胞脱颗粒，嗜酸性粒细胞颗粒的主要碱性蛋白沉积在微丝蚴的角质层上。据目前所知，盘尾丝虫病的慢性影响都是微丝蚴退化的结果。皮下结节含有盘绕的成虫，有一层纤维瘢痕外层和中央炎性细胞渗出物，后者可能形成空洞。注入印度墨水显示成虫周围有毛细血管分支，成虫从这些网络获取营养。盘尾丝虫性淋巴结炎最初的特征是组织细胞增生和滤泡萎缩，随后是纤维化和淋巴流阻塞，这种情况会导致腺淋巴管瘤（“悬垂腹股沟”）和生殖器象皮肿。一些患者似乎对退化的微丝蚴具有免疫耐受性，这可能是由于在子宫内接触母体循环中的微丝蚴抗原所致。相比之下，其他患者（例如也门人）对少数微丝蚴有局部但强烈的反应；这些患者过敏——可能是因为他们在子宫内没有接触微丝蚴抗原。关于深部器官感染的尸检数据有限。
