Geographic region: West and Central Africa
Other microfilaria in geographic region:
(1) Onchocerca volvulus (large cephalic space)
(2) Mansonella perstans (straight tail with prominent terminal nucleus)
(3) Loa loa (sheathed, straight tail, column of nuclei in the tail that do not extend to tip)
(4) Wuchereria bancrofti (sheathed)
Vector: midge (Culicoides grahamii)
Clinical findings:
(1) pruritis
(2) papular rash
(3) nonanesthetic, hypopigmented macules, especially over the thorax and upper torso
(4) bilateral inguinal lymphadenopathy
(5) eosinophilia without leukocytosis
(6) treatment with diethlycarbamazine (DEC) is followed in 24-48 hours by increased pruritis, urticaria, fever, headaches, myalgias, arthralgias, nausea and vomiting .
Diagnosis:
(1) Skin snips demonstrate microfilaria that are 270 x 5 microns, sheathless, with a taped hooked-shaped tail ("shepherd's crook") and nuclei extending all the way to the end of the tail.
(2) The microfilaria should be absent in the peripheral blood smear.
Differential diagnosis:
(1) onchocerciasis
(2) leprosy
