Studies on nodules and adult Onchocerca volvulus during a nodulectomy trial in hyperendemic villages in Liberia and Upper Volta. I. Palpable and impalpable onchocercomata.

In hyperendemic onchocerciasis areas of West Africa nodulectomy trials were performed. 163 nodule carriers from four villages in the Liberian rain-forest and 52 nodule carriers from a savanna village in Upper Volta were operated on. During the surveys in the villages in Liberia and Upper Volta, an average of three and five nodules respectively per patient were palpated. Before each operation a further palpation was done and two more nodules per patient from both countries were found. The nodulectomies revealed 75% more nodules in the Liberian patients and 53% more in the patients from Upper Volta than were palpated immediately before. Half of these additional subcutaneous nodules extirpated in Liberians were superficially located, the other half deeper and impalpable through the skin. In the patients from Upper Volta two thirds of the additional nodules were seated in the depth of the subcutis. In both countries an average of three deep subcutaneous nodules per patient were found and this was equivalent to 20% of all extirpated onchocercomata. Most of these deep subcutaneous nodules were at those sites where most of the superficial nodules were located.