The distribution of microfilariae in the skin of Guatemalan onchocerciasis patients: an evaluation of diagnostic potentials.

Quantitative examinations for the distribution and density of microfilariae were carried out on male Guatemalan onchocerciasis patients by taking 6 or 13 skin biopsies each from 74 subjects. We found that microfilariae were distributed most frequently on the iliac crest and secondarily in the scapular region; higher detection rates and greater microfilarial densities were seen in these areas. From these results we recommend the taking of biopsies from both of these anatomical regions so as to avoid false negative cases. The infected patients were classified into 3 groups (light, moderate and heavy infections) on the basis of the numbers of negative skin snips out of the 13 biopsies taken. In heavy infections, a higher densities of microfilariae were detected in the head and neck regions, as compared with the densities in the lower extremities (calf). The high concentration of microfilariae in these regions is of importance in relation to the development of eye lesions and/or transmission. Of patients who had microfilariae in the anterior segment of the eye some had negative skin biopsies frm the outer canthus, retroauricular region and neck.