What is River Blindness?

River blindness, also called Onchocerciasis, is a disease brought about by a small worm known as Onchocerca volvulus commonly transmitted by an infected black fly that usually attacks the eyes.

Deemed as the second greatest cause of infectious blindness, this disease is called river blindness because the black fly which transmits the disease usually breeds in free-lowing water such as rivers or streams. Other than the eyes, the condition can also cause skin disorders.

The disease proliferates when the fly feeds on humans infected with the disease, and consequently, the fly gets infected. The worm that is now carried by the fly matures over a span of two weeks, and the disease becomes most contagious and communicable to humans. When the infected fly feeds on other humans, infective larvae are passed through its bite, therefore, transmitting the disease.

A Man Showing River Blindness

Signs and Symptoms of River Blindness

People who contract the disease are either symptomatic or asymptomatic. Those who are symptomatic experience common symptoms such as the following:

1. Prickling sensation all over the body
2. Eruptions of the skin
3. Skin blemishes or blotches
4. Abrasions in the eye
5. Protuberances (subcutaneous part of the skin is raised)
6. Glaucoma
7. Blindness

The skin assumes forms of discoloration when the eruptions are treated. The grimmest demonstration of the disease is the abrasion seen in the eye which progresses until the person becomes blind. The worm can even be visualized floating in the front chamber of the eye during the eye examination with the aid of an instrument. Upon reaching the end of their cycle, these worms die, causing inflammatory reactions which result in the inflammation of the uvueal tract, the vitreous chamber, and retina and finally, blindness. Associated glaucoma can also arise due to corneal damage, causing intense inflammation of the keratin of the eye, severe trauma, and sightlessness. The symptoms usually become visible one to three years after acquisition of the disease.

Causes

The only noted cause of river blindness is the parasite Onchocerca volvulus which lives inside the black fly. The transferred parasite develops inside the fly, evolving from infective larvae to full-grown worms, completing the disease cycle. These worms can live inside the human body for 14 to 15 years. The disease is endemic in Africa and in some isolated places in Latin America and Yemen.

Diagnosis

River blindness is diagnosed with a wide array of examination studies which include laboratory work-up, imaging results, and even immunologic tests.

Laboratory Work-up

1. Immunologic diagnosis: This study is done to differentiate current infections from earlier ones.
2. Antigen studies: This test utilizes the urine or tears of an infected person to detect specific infections caused by the parasite.
3. Complete blood count: This is usually done to detect levels of white blood cells which are normally high due to infection.
4. Imaging studies: Although this is not useful in the diagnosis of the disease, it is still used to detect bumps on the skin which are not palpable.

Other Tests

The following are tests that have been used earlier to diagnose the disease:

1. Diethylcarbamazine patch test. This test, which is done by applying DEC cream on the skin, shows reactions on the site of application which is a common reaction of dying parasites.
2. Skin snip procedure: This is done by cutting skin samples from different sites of the body and placing in solution with salt for observation. Results would show that worms arise from the skin samples dipped in the salt solution.
3. Removal of nodules: This is the most obtrusive procedure since it involves the removal of skin nodules. Removal of these nodules also helps to remove the parasite since it is found inside the nodules.

Treatment

The treatment of the disease is aimed at removing the larvae stage of the parasite inside the body of an infected person.

Medical Management

Antiparasitic agents: These drugs help arrest evolution and propagation of the parasites inside the body.

1. Ivermectin (Mectizan): This is the first-class drug for river blindness. Its mechanism of action is known to cause damage on the parasite’s nervous and muscle systems, eradicating the parasite by paralyzing it until it dies. This drug is only effective on the larvae stage of the parasite and has no effect on adult worms but will hinder the larvae production. Hence, this antiparasitic drug helps to prevent people from acquiring the disease and its transfer to other people.
2. Diethylcarbamazine (Hetrazan): Although this drug is rarely used for treating the disease, it is known to elicit deterioration of the parasite’s organs, resulting in the death of their cells.

Antibacterial agents: These drugs are used mainly to stop the growth of other microorganisms that may affect the disease progression.

1. Doxycycline: This antibiotic is utilized to help reduce the number of bacteria living inside the body of an adult worm and break the egg production chain. Despite the effectiveness of this drug, there is difficulty in administering the drug since treatment needs daily dosage for four to six weeks to achieve desired effects.

Surgical Management

Excision or removal of skin nodules is an effective cure of the disease if all of the adult worms are removed. This treatment is not highly recommended since there are patients whose nodules are not distinct whereas others show diverse nodules.

Complications

Untreated and uncontrolled river blindness poses an increased risk of complications which include the following:

1. Eye complications: Complications related to the eye involve blindness which is consequential to inflammation of the conjunctiva, formation of excessive fibrous tissue in the cornea, keratitis, accumulation of vascularised granulation tissue in the cornea, inflamed retina and chorion, glaucoma, and deterioration of the optic nerve.
2. Skin complications: These complications include rashes all over the body, increased skin pigmentation and discoloration, and skin blemishes and blotches. Decreased pigmentation of the skin, loosening of skin elasticity, and severe inflammation of the skin which may be limited to one limb may also occur.
3. Blood and immune system complications: These complications involve a severe and anomalous increase in the size of lymph nodes.

Prevention

There is no specific medicine that will stop people from contracting river blindness and no other ways of prevention other than awareness and health education. It is very important that those living in places where the disease is endemic and those who visiting such places are educated about the disease and ways to avoid being in contact with the black flies. The use of defensive clothing and application of offensive topical agents such as mosquito repellent lotion can be used to avoid being bitten by flies. Another preventive strategy is total black fly elimination and regular prophylactic treatment of antiparasitic drugs in endemic areas.

River Blindness Pictures

Onchocerca Volvulus Parasite that Causes River Blindness

A Black Fly Biting a Person

Skin Blotches with Raised Edges Characteristic of River Blindness

What is Myalgic Encephalomyelitis?

Myalgic encephalomyelitis (ME) is known before as a yuppie flu which was described to affect young office workers located in big cities. It is a mysterious and debilitating kind of illness. ME, which is also called chronic fatigue syndrome (CFS) or post-viral fatigue syndrome, is known to affect the peripheral, central, and autonomic nervous system as well as the muscular system. Those who have this condition usually experience  fatigue that leads to an prolonged period or exhaustion. Contrary to speculations, this is not a rare condition. In the United States alone, approximately 500, 000 have reported to experience such illness.

ME is also defined as a complex, severe, and acquired illness that leads to various symptoms related mainly to the dysfunction of the brain, gastrointestinal, immune, cardiac, and endocrine systems. According to the World Health Organization, it has been classified under neurological diseases.

To clearly define this disease condition, the terms chronic fatigue syndrome and myalgic encephalitis will be analyzed. On the one hand, chronic fatigue syndrome (CFS) is a long-term disease condition that deals with fatigue as a syndrome. On the other hand, myalgic encephalitis (ME)  means muscular pain and inflammation of the brain and spinal cord respectively.

Myalgic Encephalomyelitis Symptoms

As mentioned earlier, those who suffer from ME will manifest a physiological illness which involves the dysfunction in the immune system and neurological endocrine combined with the involvement of the nervous system.  Depending on the intensity, the symptoms which are manifested will vary. Most often the symptoms of this disease condition will produce economical and negative social consequences which may lead to a long-term disability. The following are prominent criteria which distinguish this condition from the rest:

• When a person exercises, the symptoms worsen.
• The person experiences persistent fatigue which does not improve, even with bed rest

Other symptoms include:

• Cognitive symptoms

• Poor memory recall
• Poor concentration
• Difficulty in choosing appropriate words as well as speaking
• Foggy thinking

• Physical symptoms

• Blurred vision
• Pain in the joints
• Poor circulation
• Irritable bowel syndrome
• Lack of energy
• Low blood pressure
• Muscular ache
• Constipation
• Muscle twitching
• Muscular pain and weakness
• Tender swelling of the lymph nodes
• Chronic sore throat
• Rashes
• Headache
• Altered smell and taste
• Sensitivity to food, light, chemicals, touch, pain, perfume and the like
• Frequency in urination
• Dry mucous membrane
• Ulcers in the mouth

• Nervous symptoms

• Depression
• Disoriented feeling
• Anxiety
• Mood swings
• Interruption in sleeping patterns
• Personality changes

Myalgic Encephalomyelitis Causes

The exact cause of ME has not yet been determined, although there have been theories that have linked the illness to the following predisposing factors:

• Viral infection
• Immunization
• Severe physical trauma
• Chemical exposure
• Exposure to pollutants in the environment or heavy metals
• Poor food absorption
• Gut dysbiosis
• Hormonal changes
• Inherited genetic susceptibility

Other researchers would say that the following factors exacerbate the condition:

• Recurrent bacterial or viral infection
• Stress
• Poor diet
• Social isolation
• Depression
• Frustration
• Over-active or under-active behavior

There are also other contributing factors that researchers have pointed out, such as the following:

• Trauma during childhood
• Recent traumatic event
• Mental stress
• Physical exhaustion
• Inherited genetic susceptibility
• Viral infection
• Depression

Myalgic Encephalomyelitis Diagnosis

There are no specific tests that prove a person is, indeed, suffering from this condition. The tests that will be mentioned here are those that are used to rule out other etiological factors that cause fatigue or other symptoms that are associated with this disease. The tests which are done to confirm whether a person is  really experiencing ME include the following:

• Physical examination

Here the doctor will examine the patient’s visible symptoms.

• Medical historical exam

The doctor will ask related questions on the patient’s disease condition.

• Chemical stress and exercising exams

These include a cardiopulmonary exercise test which examines the abnormal heart rate and blood pressure levels that are specific to this disease condition.

• Tilt table examination

A patient’s orthostatic intolerance which may be associated with ME can be seen from this exam.

• 24-hour Holter monitoring test
  

This is a heart monitor which can be carried around by the person. It is used to monitor the abnormal heart waves and heart rhythm which may also be associated with ME.

• Glucose tolerance and insulin level exam

People with ME will experience derangement in response to the insulin level. Furthermore the glucose tolerance levels are often abnormal.

• Erythrocyte sedimentation rate (ESR)
  

This is a blood exam that detects and monitors the inflammation which is based on the rate of red blood cells (RBC). Thos who have a low ESR are often patients with ME.

• RNase L exam

The dysfunction of the 2-5A RNase L antiviral pathway has been seen in patients who suffer from this disease condition.

• Immune system exam

Those who have ME have an abnormal immune system which often mimics the immune system pattern during viral infections.

• Neurological examination

People who suffer from ME will reveal abnormalities in their neurological examination.

• QEEG and EEG brain exam

When a person has abnormal cognitive results in EEG brain maps, it can be associated with ME.

• Neuropsychological exam

This test is used to identify the cognitive dysfunction as well as confirm the diagnosis for this disease condition.

• Brain scan exam via MRI

With the use of MRI, the test may show the demyelination or edema of the subcortical areas of the brain which may be associated with ME.

• Xenon SPECT and SPECT scans of the brain 

This exam shows the decreased blood flow in the cerebral region which is also positively shown in patients who experience ME.

Myalgic Encephalomyelitis Treatment

Medical treatments

Unfortunately, there is no cure for ME at the moment. Doctors will only prescribe medications which provide symptomatic relief in muscular pains, sleeping problems, and depression problems. Others who experience mood changes are given antidepressant medications. The following are the most commonly prescribed medications for people with ME:

• Analgesics
• Antidepressants

Healthy diet and lifestyle

One thing about ME is that this illness can recur. Hence, there is a need for the patient to adapt a nutritious diet and a healthier lifestyle side by side with relaxation techniques and rest which help prevent recurrences in the nearby future.

A person can adopt a healthy diet and lifestyle by performing the following:

• Engaging in moderate exercises
• Having a diet diary to monitor the intake of food and being able to pinpoint which foods cause allergic reactions
• Staying away as much as possible from chemically rich items or foods such as:
  • Aftershaves
  • Scented soaps
  • Perfumes
  • Food chemicals
• Consuming yogurt or cultured dairy foods that contain lactic acid bacteria which are beneficial for patients with ME

Cognitive behavior therapy

It is a psychotherapeutic therapy which affects the person’s attitude, behavior, and overt emotions. Cognitive behavior therapy, which is one of the effective forms of psychotherapy, deals with the way the patient manages his or her disease condition. Results have been effective for patients who have been dealing with ME for a long period of time.

In sum, medications alone will not cure the entity of the person. There has to be a combination of medication, healthy living, and cognitive behavior therapy to provide the optimum needs of the person as he or she will struggle with ME throughout his or her life.

What is Primary Sclerosing Cholangitis?

Primary sclerosing cholangitis (PSC) is a chronic disease condition that affects the liver. Before we go into details, we will describe some of the liver functions. One vital function of the liver is to manufacture bile. Bile, which is vital in the digestion process, is to aid in the digestion of fat and the elimination of toxins from the body.  When the bile ducts are affected, the disorder is given the medical term primary sclerosing cholangitis.

Source – radiologyassistant.nl

PSC, which is a medical condition that affects adults, is characterized by inflammation and fibrosis that affect intrahepatic and extrahepatic bile ducts, causing bile duct obliteration and cirrhosis as the disease progresses.

Sclerosing is a medical term which means the scarring and hardening of bile ducts due to the presence of chronic inflammation, while cholangitis is a medical term which means bile duct inflammation. When not  treated properly, the condition eventually lead to liver failure.

Primary Sclerosing Cholangitis Symptoms

When a person experience this disease in the early stage, he or she will encounter no symptoms at all. Yet, some people, unfortunately, have reported to experience PSC symptoms such as the following:

• Hepatomegaly or enlargement of the liver
• Ascending cholangitis or infection of the bile duct
• Hepatic encephalopathy
• Portal hypertension
• Cirrhosis or scarring of the liver
• Fat Malabsorption
• Steatorrhea
• Weight loss
• Severe jaundice
• Intense pruritus or intense itching
• Chronic fatigue
• Upper abdominal pain
• Fever
• Chills

Primary Sclerosing Cholangitis Causes

The specific cause of PSC is still not known. According to statistics, most of the reported cases of this disease occur in men. According to research, the disease condition exists due to the following:

• Presence of viral infection
• Presence of bacterial infection
• Immune system disorder
• Genetic factors

A study was conducted, and it showed that people who acquired PSC are those who have other medical conditions such as inflammatory bowel disease. The link between these two diseases is still undergoing study.

Primary Sclerosing Cholangitis Pathophysiology

Due to the presence of inflammation, PSC  causes the distruction of the bile ducts both inside and outside the liver. The inflammation will cause scarred bile ducts to hinder the flow of bile, leading to cholestatis, a condition where the bile cannot flow normally from the liver to the duodenum.  The presence of bile stasis and the back flow pressure lead to the induction of epithelial cell proliferation and the destruction of the parenchyma of the liver, causing formation of bile lakes. When there is a chronic form of biliary obstruction, portal tract fibrosis and biliary cirrhosis occur, and eventually, in a worse-comes-to-worst case scenario, liver failure. When a person has cholestatis, there will be fat malabsorption as well as fat soluble vitamin deficiencies, which include those of vitamin A, D, E,and K.

Primary Sclerosing Cholangitis Diagnosis

As mentioned earlier, people with PSC most often have no symptoms. The only way to confirm that they have this disease is through diagnostic tests like the following:

• Liver function blood exam

It is an exam which tests the function of the liver, including the liver enzyme level.

• Magnetic resonance cholangiopancreatography

It is a non-invasive exam that gives a clear picture of the bile ducts, pancreas, and liver.

• Liver biopsy
  

A portion of the liver is culled, and a sample of the tissue is examined under the microscope which is done in the laboratory.

• Cholangiography

It is an X-ray exam that examines the bile ducts through the use of a dye which is injected through a needle or  an endoscope.

• Endoscopic retrograde cholangiopancreatography

It is an exam that uses a combination of fluoroscopy and endoscopy to diagnose as well as treat the problems of the pancreatic ductal or biliary systems.

• Bilirubin level exam

This is an exam which indicates the level of bilirubin. People with PSC will show a grossly elevated Bilirubin level.

• Renal function test

This is an exam which indicates the state of the kidneye and the person’s renal physiological state.

• Fecal fat determination test

It is an exam or test that determines the condition of the fat malabsorption, possibly causing steatorrhea (excessive fat in the feces).

Primary Sclerosing Cholangitis Treatment and Diet

The good news about PSC is that it is can be treated symptomatically through the following treatments:

Pharmacological treatment

Medications that are often prescribed to patients with PSC are as follows:

Treatment for itching

• Bile acid drugs such as cholestyramine
• Antihistamine

Treatment for infection

• Antibiotics

Ttreatment for malnutrition

• Multivitamins
• Vitamin supplements

Surgical treatment

Depending on the degree of the disease, the surgeon will determine the type of surgical procedure that needs to be done. The common surgical procedures that are performed are as follows:

• Bile duct surgical procedure
• Balloon dilation and placement of stent
• Liver transplantation

Diet modification

Since the target of PSC is the liver, particularly the production of bile, it is advised that the affected person avoids fat-rich foods and consumes raw vegetables and fruits. Protein can be obtained from fresh fish or organic poultry. Furthermore, it is also recommended that the person avoids alcoholic beverages.

Primary Sclerosing Cholangitis Prognosis

The prognosis of people with PSC varies. According to studies, the expected life span of people who have this disease condition is approximately 25 years. Moreover, compared to those who experience symptoms, people who experience no symptoms have a better outlook. Another study that was conducted showed that one out of ten is at risk of  having bile duct cancer and colon cancer. Furthermore, it has been estimated that the survival is about 12 years from the diagnosis in PSC patients. Prolongation of life then depends on the need for liver transplantation and the response of the body towards the given treatment.