Forty patients with streptocerciasis were studied. They lived in a small village near Mbandaka in the Republic of Zaire. Microfilariae of Dipetalonema streptocerca were present in the dermal collagen, and the features which distinguish these microfilariae are described and illustrated. The main clinical feature was a dermatitis characterized by pruritus, hypopigmented macules and papules. Microscopically there was incontinence of melanin, fibrosis of dermal papillae, dermal fibrosis, dilated dermal lymphatics, increased mucosaccharides around small dermal vessels and lymphocytes, and eosinophils around dermal appendages and vessels. Adult, gravid D. streptocerca were found for the first time in human tissue. They were in the dermis. Treatment with diethylcarbamazine aggravated the dermatitis and caused a reaction around the adult worms. The inguinal lymph nodes were fibrotic, had decreased germinal activity, marked histiocytic hyperplasia, dilated lymphatics, and were infiltrated by plasma cells and eosinophils. The finding of obstructive lymphadenitis suggests that streptocerciasis may be a factor in the pathogenesis of chronic lymphedema.
Institut Médical Evangélique, Kimpese, Republic of Zaire (formerly Democratic Republic of Congo).
Geographic Pathology Division, Armed Forces Institute of Pathology, Washington, D. C. 20305.
Department of Dermatology, Walter Reed General Hospital, Washington, D. C. 20012.
Iyonda Leprosarium, via Mbandaka, Republic of Zaire.