Oncocercosis (Enfermedad de Robles). Andrade G. Un caso de onchocercosis y lesiones oculares. Gaxiola V. Aspectos clinicos de la oncocercosis. Teniasis, cisticercosis, ascariasis, fasciolasis, oncocercosis. Diagnostico diferencial hirschsprungneurodisplasia. A rticulo o riginal diagnostico diferencial . Title: La Oncocercosis en Venezuela y en el Foco Sur o Amazónico: Aspectos e inmunológico es discutido a través de la presentación de un caso clínico.

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This story starts in March, when Dr. Rodolfo Robles, who was then 37 years old and dedicated to his private practice, was completely unaware that one day soon a very young patient would bring him the luck of being the discoverer of a disease which, hidden in the mountainous regions of Guatemala, was depriving hundreds of human beings of their sight.

Some authors refuse to believe that the discovery which brought fame to Dr. Robles was the result of chance, but it has been said that chance comes only to the prepared mind [ 13 ]. There were a total of three communication cliico by Robles, and of these, the first has never been reproduced when discussing the history of the disease. It is rather surprising that Dr. This information which appears as a news item in the cited newspaper must be considered as the first scientific report by Dr.

Robles to the medical community, through his friend, clknico chief editor of the newspaper, Dr. There are those who refuse to accept incocercosis publications as scientific one, but when the discoverer of a scientific fact is the one who personally makes the communication, as in the case of Robles, there is no reason to doubt the validity of the information.

The third communication, the definite and more complete one, was read before the Society for Exotic Pathology of Paris and published by that Society in issue No. The publication describes the July 9, session where Robles made his presentation. The newspaper article reads as follows:. The patient research of a distinguished physician has resulted in the identification of Filaria onchocerca.

It is believed that there are a large number of patients suffering from this disease in the Pacific Coast area.

Our personal interest leads us necessarily to investigate with care and fondness the advances that medical science in its several and ample manifestations achieve in Guatemala. The news that a disease thus far unknown not only in Guatemala, but in the American Continent has been diagnosed made such an impression on us that as soon as the working day was over we headed for the clinic of our close friend, the competent physician Dr.

Rodolfo Robles to obtain further information. From the interview we concluded that the facts are correct and that the news is accurate: I treated the patient to the best of my knowledge as other physicians consulted by her family had done before. The disease, however, proved to be resistant to all therapeutic measures, and two years have since passed.

This patient came from the same region of the country as the first one did.

I made the same tests and probably would have been as unsuccessful as before were it not for the fact that the patient asked me to excise a small tumor in his forehead. This tumor gave me the clue to a matter that is probably going to be the subject of much attention; it is undoubtedly a very significant finding which will allow us to fight under better and more advantageous conditions against a new enemy. One day on thinking about the first case, Dr.

1) The Discovery of Robles Disease

Robles suspected it might be a case of filariasis. Filaria loa dwells in the conjunctiva membrane of the eye where it forms a nococercosis resulting in symptoms similar to those found in vlinico two patients examined by him. Following this theory, Dr. Robles proceeded to examine both eyes with negative results: After excising the tumor, which was a matter of secondary importance, Dr.

Robles being puzzled by oncocegcosis fibrous consistency of the tumor, sliced it open with a scalpel and was astounded to find, coiled inside like a very fine thread or human hair, a female filaria. She was brought to the sites at first, but looking for the tumors causing the symptoms.

They were not located in the forehead, but in the scalp of the occipital region.

An excision was indicated and I performed it. Once the tumors were opened he found, as in the first case, the filarias coiled inside. In this case they were tiny males. Being nearsighted we could not see the parasites at first, but on looking closer we could see shapes like circumflex accents which due to the movement imparted to the vial, moved downward in the confined space where they had been imprisoned.

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If the parasites were the direct agents causing the lymphatic symptoms, it was logical to assume that excision of the tumors would result in a remission of the symptoms of the erysipelas—let us call it that. I can only say that there are many more similar cases and that the endemia at present attacks more than a thousand individuals of different ages and sex.

I do not know why the disease prevails in that region, or whether filariasis is generalized in other regions of the country. It would be very useful if local doctors would collaborate in a survey to locate cases of filariasis, which undoubtedly are abundant in warm and humid regions. The disease, as you know, has been found in Africa by Belgian, French and English doctors.

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It is believed to be transmitted by a fly; this matter should be studied in Guatemala. It is also believed that the disease follows the course of certain rivers, but in our country nothing can be confirmed as yet in that respect.

I am planning a field trip and upon my return, I will be very happy to discuss my findings with you. Undoubtedly, the study of this new enemy whose presence has been such a surprise to the dedicated doctor, and that will continue to be a surprise to the readers of this article, will be very important and in onocercosis future should lead to the definition of special prophylactic measures.

Robles is satisfied with his investigations. Men of pncocercosis see the appearance of a new disease—which careful observations and study will later unmask—with a certain healthy eagerness, because it is undoubtedly a personal success that evidences uncommon powers of observation and judgment.

PAHO/WHO – Oncocercosis

The people from Patulul, on the other hand will now have to face a fiiarialis phobia, and any tumor they may have will be suspected of harboring—like a snake of capricious coils—an Onchocerca filaria whose name, despite its exotic sound, will soon become familiar. To the scientific world, the complete observation of the endemia, its origin, geographical distribution, manner of transmission, etc. Because it is almost certain that this filaria must be present in other countries and physicians who are aware of those findings in Guatemala will attach more significance to oncocsrcosis tumors associated with symptoms such as lymphangitis.

We are ococercosis pleased to have been able to transmit to our readers the first fruits of these studies and to honor Dr.

This was therefore the first news published for the scientific world that onchocerciasis had been discovered in the American continent. Several national authors have committed errors, of little importance, regarding the sex of the two first patients seen by Robles and the historical sequence of the discovery, errors which have been adopted by foreign authors and which we would like to rectify here. Sometimes, both the name and the sex of a person on which a disease, a symptom or a reaction is discovered is important because it is customary to name these medical phenomena after the person or the place where the discovery was made.

In spite of the fact that the disease that concerns us to day bears the name of the discoverer, for the sake of historical accuracy we are going to rectify some of those errors.

With the first patient Robles did not reach a diagnosis at all, but he noted that the symptoms were similar to those of erysipelas, without it being specifically that disease, that is to say, something completely unknown to him. The second patient was at the time, an 8 year-old child. He is still alive and is a member of the Guatemalan forum. This second patient had a tumor and his family asked Robles to excise it. Robles thought that it was just a benign tumor, a wen may be, and so his surprise was great on finding inside the tumor a filaria which later in turned out to be Onchocerca volvulus.

Undoubtedly worried because of his failure to reach a diagnosis in these two cases whose symptomatology was so alike, he thought that they could be suffering from Filaria loa. American onchocercosis had casi thus oncocrrcosis. From then on, his only thought was to look for tumors and with the consent of the owners he went to a plantation.

He was lucky in finding many patients who made it possible for him to continue with oncocetcosis studies, which soon would lead him to the firm belief that the skin and ocular symptoms of many patients were due to the filaria he had recently discovered in March or February.

From then on it was not luck that guided him, but rather his keen powers of observation and his scientific background. From the first two cases Robles concluded that the symptoms were those of a kind of erysipelas produced by an obstruction of the lymphatic ducts. The small tumor of the second patient was relatively unimportant, and the enigma would have been left unsolved it not for the fact that the family requested Robles to excise ds tumor.

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It is interesting to record the memories of those days of the small boy, now a lawyer, whom Robles treated. A personal communication from him follows: Regarding the discovery of filaria by Dr.

Robles the scant information I can give you is the following: I do not remember the year, but it must have been aboutthat a tumor was excised from my forehead by the professional you refer to. When the doctor first examined me, he told my parents that it was only a sebaceous cyst. On this occasion I told the doctor that my vision had improved, since for a long time I had been suffering from photophobia which prevented me from leaving the house, especially in strong light.

The doctor showed a great deal of interest in this, and I remember that he started asking me many questions and asking me to come to his clinic almost every day.

He observed that the purple hue of my skin subsided gradually. All this led Dr. My mother had told Robles that in the plantation there were many people with symptoms similar to mine and that the Indians used to rub toad bellies on the skin to obtain some relief, treatment which, as I recall, was not used in my case.

Taking advantage of the Holy Week holidays Dr. Robles accompanied by Dr. Faustino Gonzalez Sierra went to the plantation and he excised a large number of cysts. They improvised an operating table in one of the corridors of the main house, operating on all field hands who presented tumors and whose heads had been previously shaved.

Gonzalez Sierra, who at the time was a medical student and Dr. I want to make clear though that when I was operated on, only Dr. Robles and Gonzalez Sierra were present since my mother and a friend who accompanied her refused to witness the operation.

I understand that there is the belief that filariasis was brought from Mexico by pilgrims going to Esquipulas, but that belief seems farfetched to me since, at least in the region I mentioned above, we never saw pilgrims from Mexico.

I enclose a photograph of the main office of the plantation where the makeshift operating table was set up; in the background is the volcano Atitlan with coffee covered slopes. I regret that this is the only photograph available of the office but this is the place where the first filarias were extracted. This letter from Lic. Once filarial was discovered and with the experience acquired from the examinations and treatment of a large number of patients, Robles reached the conclusion that the skin disorders, which from then on he called Erysipelas of the Coast, and the ocular lesions were a consequence of parasitic infestations by filaria, conclusion which was also arrived at by Castellani in when after studying the disease in Guatemala he expressed the opinion that the nodules, the eye symptoms, and Coastal erysipelas were all manifestation of onchocerca infestation [ 22 ].

The discovery is of great importance even for the zoological classification of filaria. At the beginning Brumpt and Robles themselves thought that this was a different filarial to which they gave the scientific name Onchocerca caecutions [ 23 ].

Onchocerca volvulus Leuckart, The problems arising from the discovery were gradually solved when other Guatemalan investigators began research on the subject, before outstanding men of science started investigating in Mexico.

Once the causative agent of Coastal Erysipela was discovered, Robles continued investigating the different problems which arose due to his discovery and with almost genial intuition he left oncocegcosis way paved for their solution.

Besides leaving behind the description of the clinical forms, having studied the characteristics of endemic regions in Guatemala and having pointed out the true transmitters of the disease, he also left treatment clinicp the disease through excision surgery and by intratumoral injections, treatments which have not been surpassed to this date, in spite of trials and experimentation with innumerable chemical compounds.

All of this can be considered as the greatest Guatemalan contribution to American pathology, with a profound repercussion on tropical pathology. But the other two main manifestations of the disease, the ocular and cutaneous symptoms, soon drew the attention of other Guatemalan investigators, notably Dr. He was able to diagnose parasite infestation by a simple eye examination, even without seeing any tumors or asking the patient whether he came from an endemic region.