The importance of racial factors in the epidemiology and clinical manifestations of onchocercosis in the Afro-Ecuadorian and Chachi indigenous races, two distinct ethnic groups in the hyperendemic area of the Ecuadorian onchocercal focus, were evaluated. No difference in the disease prevalence among the two races was noted, although the Chachi had a significant higher dermal microfilariae intensity. Approximately 72.2% of the Afro-Ecuadorians presented with onchocercal skin lesions, as compared to 56.4% of the Chachi. Pretibial depigmentation, sowdah, scrotal elephantiasis and hydrocele were only documented in the Afro-Ecuadorians. Greater prevalence of palpable nodules was found in the Chachi (51.4% vs. 43.0%). Chachi presented with more nodules in the head (25.6% vs 17.6%) and iliac crest (40.1% vs. 30.3%) regions while the Blacks had more nodules in the sacrococcygeal region (18.2% vs 10.8%). Microfilariae in the anterior chamber was seen more frequently in the Chachi (51.9% vs 34.2%). However, a higher prevalence of chorioretinitis and optic atrophy was seen in the Afro-Ecuadorians (17.6% vs 11.2% and 8.5% vs 0.5% respectively). Several possible causes for these differences are discussed

Se evaluó la importancia de los factores raciales en la epidemiología y las manifestaciones clínicas de la oncocercosis en la raza Negra y la raza indígena Chachi, dos grupos étnicos diferentes del área hiperendémica del foco oncocercótico ecuatoriano. Los Chachi presentaron una significativa mayor densidad de microfilarias en la piel. De los Negros, 72,2% presentaron lesiones oncocercóticas en la piel comparado con 56,4% en los Chachi. Se encontró mayor prevalencia de nódulos palpables en los Chachi (51,4% vs. 43,0%). La presencia de microfilarias en la cámara anterior del ojo fue más frecuente en los Chachi (51,9% vs. 34,2%), pero se evidenció una mayor prevalencia de corioretinitis y atrofia del nervio óptico en los Negros (17,6% vs 11,2% y 8,5% vs. 0,5%, respectivamente)

O efeito macrofilaricida da infiltração local, com uma alta concentração de cloroquina, dentro da cápsula do nódulo oncocercótico sobre o verme adulto de Onchocerca volvulus foi determinado. Seis semanas depois da infiltração, estudos histopatológicos de nódulos simple demonstraram todos os vermes adultos mortos. Em conglomerados de nódulos a ação da cloroquina foi só sobre os vermes adultos do nódulo infiltrado, não acontecendo a difusão da droga aos nódulos adjacentes. A infiltração de cloroquina a nódulos novos ou de recente formação reduz a carga de vermes adultos dos indivíduos parasitados e pode ser uma alternativa para os altos custos das nodulectomias.

The macrofilaricidal effects of local infiltration of high concentrations of chloroquine into the capsule of onchocercal nodules on adult worms of Onchocerca volvulus was determined. Six weeks post infiltration, histological examination of single nodules showed all adult worms to be dead. With nodule conglomerates, there was localized action of chloroquine only on the adult worms in the infiltrated nodule, with no diffusion of the drug to adjacent nodules. Chloroquine infiltration of young, recently formed nodules to reduce the adult worm load of infected individuals may be an alternative method to costly nodulectomy.

The prevalence of onchocerciasis infection was determined in communities on 7 rivers located in the northern area of the cantón San Lorenzo, province of Esmeraldas. Diagnosis of the infection was obtained by skin biopsies and recombinant-antigen based-serology. No evidence of infection was detected in 9 communities studied along the Río Mataje, which forms the frontier between Ecuador and Colombia, nor in 10 adjacent communities located on 5 interior rivers. Evidence for Onchocerca volvulus infection was found in 4 communities on the Río Tululví with the following prevalence: La Boca (3.5% by biopsy and 3.9% by serology), Guayabal (9.1% by both biopsy and serology), La Ceiva (51.5% by biopsy and 53% by serology), and Salidero (4% by biopsy and 7.7% by serology). A few individuals in these communities were seropositive for O. volvulus in the absence of detectable dermal microfilariae: these might harbor very light or prepatent infections. No clinical disease attributable to onchocerciasis was found. The infected communities will be included in the ivermectin-based National Control Program for the disease, with no evidence of the infection having extended north of the Ecuadorian-colombian border

Trends in prevalence rates of onchocercal ocular lesions were examined over the period 1980 to 1990 using data from two cross-sectional surveys. There was evidence for increasing prevalence of anterior chamber microfilariae, iridocyclitis, optic atrophy, and chorioretinopathy. Large increases in prevalence, in particular, were seen for posterior segment lesions: optic atrophy increased from 2.7% to 6.4% and chorioretinopathy from 8.8% to 35.6%. Greatest increases in these lesions were seen in the Chachi which was attributed to the large increases in prevalence of microfilariae in the anterior chamber particularly in those aged 30 years or greater. The study findings suggest that ocular onchocerciasis is evolving in parallel with the well documented parasitological changes.