This study is concerned with the relationship between palpable onchocercal nodules and Onchocerca volvulus microfilarial loads in the skin. The number of microfilariae in clinically normal skin decreases as the distance from the nodule increases. Surgical removal of nodules reduces the microfilarial loads in 40 of 46 patients studied over a period of five months, with an average reduction of 65.4% of the prenodulectomy microfilarial load at the iliac crest. Complete elimination of detectable parasites was seen in some patients. Five individuals had increased microfilarial loads, all of which had developed new palpable nodules. Also, nodulectomy had a significant effect on ocular tissue, reducing the levels of parasites in the cornea and anterior chamber in 10 of 15 patients observed with no new nodules developing during the observation period. Both dermal and ocular clinical manifestations of onchocerciasis were reduced in a proportion of the patients. These parasitological and clinical findings provide evidence that nodulectomy is a beneficial procedure to O. volvulus infected patients in Ecuador by reducing both microfilarial loads and the degree of pathology.
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