Trevor A. Crowell, M.D., Paul G. Auwaerter, M.D.


  • Onchocerciasis is caused by filarial worm Onchocerca volvulus.
  • Epidemiology: the world’s second-leading cause of blindness.
    • Approximately 18 million people live with onchocerciasis, and over one million have severe visual impairment or blindness.
    • 99% of onchocerciasis cases occur in Africa.
    • The disease is endemic in 31 sub-Saharan African countries, including Venezuela, Brazil, and Yemen.
      • WHO certified the elimination of human onchocerciasis in Columbia (2013), Ecuador (2014), Mexico (2015), and Guatemala (2016).
    • Prevalence is higher among young boys as compared to girls.
  • O. volvulus is transmitted to humans by blackflies (Simulium damnosum), which breed in fast-flowing rivers and streams.
  • Life cycle:
    • Infected blackfly transmits third-stage filarial larvae onto the human host’s skin during a blood meal.
    • Larvae penetrate the subcutaneous tissues and develop into adult microfilariae over 6-12 months.
    • Adults persist in subcutaneous nodules for about 15 years, with females producing 1,000-3,000 microfilariae daily for up to 9 years.
    • Blackfly ingests microfilariae during a blood meal.
    • Microfilariae penetrate the blackfly midgut and migrate to thoracic muscles, developing into first-stage larvae and third-stage larvae.
    • Third-stage larvae migrate to the blackfly proboscis and can infect another human host during a blood meal.

There's more to see -- the rest of this topic is available only to subscribers.

Last updated: June 18, 2023