GUATEMALAN ONCHOCERCIASIS: SKIN SNIPPING METHODS AND MICROFILARIAL DENSITIES IN A GIVEN MINUTE AREA OF THE SKIN
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概要
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To establish a convenient and reliable method for diagnosis and epidemiological surveys on Guatemalan onchocerciasis, three skin biopsy instruments were evaluated in 108 volunteers. The German-made Holth type, the Japan-made Walser type corneoscleral punches and a lancet and disposable scalpels were used for the purposes of taking skin snips. Better results were obtained with the lancet and scalpel, indicating a higher detection rate or a lower false negative rate for the patients. This method, however, showed some disadvantages in the present study. The volunteers had various complaints and/or rejected our examinations because of the painfulness of the scalpel procedure. On the other hand, the Holth punch was better than the Walser punch which indicated a relatively high false negative case and was rather troublesome in handling. From the results obtained, we recommend the Holth punch as the skin snip apparatus in Guatemala. To examine the microfilarial densities in a given minute area of the skin, six skin snips each (12 snips in total), 0.5 cm apart, were taken by the Holth punch from 33 subjects. In this study, there were considerable numbers of negative skin snips, especially in those patients who had a relatively low density of microfilariae. This would be of importance for diagnosis and epidemiological surveys for Guatemalan onchocerciasis. The results seem to indicate that if one skin snip was taken from the patients of a low endemic area in Guatemala, the prevalence of onchocerciasis in the area might be underestimated with false negative skin snips. Moreover, there was a great variation in the microfilarial densities in the 12 skin snips from each subject. The maximum to minimum rate of microfilarial densities in average was 1 : 9.7 in the left scapula and 1 : 7.1 in the left iliac crest of the 33 subjects. These facts offer some useful suggestions for us, when we examine the intensity of infection in an endemic area or investigate a diurnal or seasonal variation of microfilarial densities of <I>Onchocerca volvulus</I> in Guatemala.
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