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Infection with Onchocerca (especially O. volvulus, a filarial nematode transmitted from person to person by black flies of the genus Simulium), marked by nodular swellings forming a fibrous cyst enveloping the coiled parasites (onchocercoma); microfilariae move freely out of the nodule and escape into the intercellular lymph in the dermis. Dermatologic changes often develop in those affected, especially in patients in Africa, resulting in intense pruritus, scaly or lichenoid skin, depigmentation, and destruction of elastic fibers. Most important are the ocular complications that may develop after a long chronic course, with blindness frequently occurring in advanced cases, caused by the presence of living or dead microfilariae seen by slitlamp biomicroscopy.
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