[Retinal hemorrhages after ivermectin treatment for onchocerciasis in a patient with Loa loa microfilaremia]. / Survenue d'hémorragies rétiniennes lors du traitement de l'onchocercose par l'ivermectine chez une patiente co-infectée par la loase.

A case of retinal hemorrhages with special features and degradation of the general condition is reported in a 27-year-old female patient, following the ingestion of ivermectin for the treatment of onchocerciasis. The patient was infested by both Onchocerca volvulus and Loa loa. A bilateral peripheral temporal location of the retinal lesions was observed. The role of L. loa microfilarial load in the occurrence of the retinal lesions as well as the transient character of the lesions are discussed, based on the clinical observation and with reference to the literature. The authors call for setting up a rapid therapeutic system to take care of serious adverse reactions following treatment with ivermectin in areas with a high prevalence of L. loa infestation.

Novel, sensitive and low-cost diagnostic tests for 'river blindness'--detection of specific antigens in tears, urine and dermal fluid.

Sensitive, specific and low-cost diagnostic tests for onchocerciasis are indispensable for monitoring the efficacy of control programs, as well as for preventing blindness (when the tests are combined with efficacious chemotherapy. Three new tests to detect Onchocerca-specific antigens in tears, dermal fluid and urine employ antibodies to O. volvulus-specific recombinant proteins, Oncho-C27 and OvD3B, encoded by genes within the immunodominant Onchocerca OV 33-3 gene family, and expressed in yeast and in E. coli, respectively. In these assays, Onchocerca-specific antigens in test samples are bound onto a solid surface and revealed using appropriate enzyme-labelled antibodies. Proteins in the samples are first transferred to Hybond-N + membrane disks or nitrocellulose paper using either a transblot or a dotblot machine, and then reacted with specific O. volvulus antibodies. Bound antibodies are revealed with species-specific peroxidase-labelled antibodies and peroxidase substrate. Positive tests give a brown colour. In one of the two assays developed to detect Onchocerca antigens in tears, the sensitivity was enhanced by first adsorbing the specific antibodies onto the membrane surface in order to immobilize and concentrate the Onchocerca-specific antigen molecules on the membrane. The specificity of the recombinant proteins for Onchocerca volvulus had been verified by ELISA, classical Western blot and modified DSIA. The tests are a dipstick immunobinding assay for ocular microfilariae (DSIA), a transblot immunobinding assay for the detection of skin microfilariae (TADA) and a dot-blot immunobinding assay for detecting urinary microfilariae and their antigens (DIA). Their specificity and sensitivity were evaluated in the field on 110 subjects with proven ocular microfilariae, 130 subjects with clinical and parasitological evidence of onchocerciasis, 25 subjects infected with other helminths and 120 normal controls. The minimal detection limits of Oncho-C27 protein by DSIA, TADA and DIA were 500 ng/ml, 154 ng/ml and 508 ng/ml, respectively By contrast, their sensitivities were: 100% for DSIA and 82.5% for TADA employed on samples of tears; 97% for TADA skin test and 96% for DIA used on urine samples.

Limbal vernal kerato-conjunctivitis in Yaounde, Cameroon. A clinico-immunology study.

Limbal Vernal kerato-conjunctivitis is the 6th most frequent diagnosis in the Ophthalmology service of CHU, Yaounde, Cameroon, and accounts for 2.8% of all clinic consultations. Only grades I and II of the disease (Diallo's classification) are found in this forest zone of Africa. Advanced stages which may cause corneal blindness being probably due to absence of xerophthalmia in this part of Africa. Both sexes are equally affected. Association with other allergic diseases is very rare and there is no hereditary tendency. Serum and tear Immunoglobulin assays in patients and controls of the same parent-hood showed no statistical differences (P > 0.05). Mast cell immunocytological studies might be more rewarding. Relief of pruritus is best with sodium cromoglycate and Naaga. However, in severe cases interrupted systemic steroids (not exceeding one week each time) are utilized. Poor drug compliance, due to costs is frequent; probably cautious cryo application in severe cases, might together with infrequent Naaga or sodium cromoglycate, procure longer remissions.

Epidemic acute haemorrhagic conjunctivitis in Lagos, Nigeria.

Enterovirus 70 has recently emerged as a causative agent of epidemic acute haemorrhagic conjunctivitis ( AHC ). This paper is a report of the first association of enterovirus 70 with epidemic AHC in Nigeria. Despite numerous symptoms, including reduction in visual acuity, eventual recovery in 2 to 3 weeks with no functional loss was the rule except in 11 patients. Five of these patients ended up with superficial corneal scarring. Two had evisceration for unresolving panophthalmitis, while 4 went blind from ruptured corneal abscesses or ulcers. All the 11 patients had treated themselves or used traditional medications. None of the patients had signs of involvement of the central nervous system.

Orbital Burkitt's tumor presenting as advanced retinoblastoma.

A case of orbital Burkitt's tumor is reported. It was misdiagnosed as advanced retinoblastoma because of globe invasion and destruction. The correct diagnosis was obtained from histology of the extenterated eye. Preoperative therapeutic trial was chemotherapeutic agents in such cases is suggested to avoid unnecessary exenteration.

Tuberculous panophthalmitis.

The case of a one-year-old Nigerian with tuberculous panophthalmitis is reported. He presented initially with a localised episceleral mass which was thought to be retinoblastoma due to rapid spread over the fundus induced by subconjunctival depromedrol. Histological examination of the enucleated eye showed that the lesion was due to tuberculosis. The subsequent favorable response of the ocular and radiological chest lesions to antituberculous therapy was quite remarkable. In contrast, there was an adverse response to radiotherapy which had followed enucleation on the strong suspicion of retinoblastoma. Not unnaturally, ocular tuberculosis was not thought of because of the rarity of ocular involvement with this disease. To our knowledge, this is the first case of its type reported from the African Continent.