Diagnosis

The diagnosis of onchocerciasis can be difficult in light infections, which are more common in persons who have travelled to but are not residents of affected areas. There are multiple ways that the diagnosis can be made:

• The most common method of diagnosis is the skin snip. A 1- to 2- mg shaving or biopsy of the skin is done to identify larvae, which emerge from the skin when it is put in physiologic solutions (e.g. normal saline). Typically 6 snips are taken from different areas of the body. Polymerase chain reaction (PCR) of the skin can allow for diagnosis if the larvae are not visualized.
• In patients with nodules in the skin, the nodule can be surgically removed and examined for adult worms.
• Infections in the eye can be diagnosed with a slit-lamp examination of the anterior part of the eye where the larvae or the lesions they cause are visible.
• Antibody tests have been developed to test for infection, though they are not widely available in the United States. These tests cannot distinguish between past and current infections, so they are not as useful in people who lived in areas where the parasite exists, but they are useful in visitors to these areas. Some of the tests are general tests for infection with any filarial parasite and some are more specific to onchocerciasis.

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