The lumps under the skin may also be removed by surgery.About 15.5 million people are infected with river blindness. Approximately 0.8 million have some amount of loss of vision from the infection. Most infections occur in sub-Saharan Africa, although cases have also been reported in Yemen and isolated areas of Central and South America. In 1915, the physician Rodolfo Robles first linked the worm to eye disease. It is listed by the World Health Organization (WHO) as a neglected tropical disease. In 2013 Colombia became first country to eradicate this disease. Signs and symptoms
Adult worms remain in subcutaneous nodules, limiting access to the hosts immune system. Microfilariae, in contrast, are able to induce intense inflammatory responses, especially upon their death. Wolbachia species have been found to be endosymbionts of O. volvulus adults and microfilariae, and are thought to be the driving force behind most of O. volvulus morbidity. Dying microfilariae have been recently discovered to release Wolbachia surface protein that activates TLR2 and TLR4, triggering innate immune responses and producing the inflammation and its associated morbidity. The severity of illness is directly proportional to the number of infected microfilariae and the power of the resultant inflammatory response.Skin involvement typically consists of intense itching, swelling, and inflammation.
The pituitary stalk (also known as the infundibular stalk, Fendersons funnel, or simply the infundibulum) is the connection between the hypothalamus and the posterior pituitary. The floor of the third ventricle is prolonged downward as a funnel-shaped recess—the infundibular recess—into the infundibulum, where the apex of the pituitary is attached. It passes through the dura mater of the diaphragma sellae as it carries axons from the magnocellular neurosecretory cells of the hypothalamus down to the posterior pituitary where they release their neurohypophysial hormones, oxytocin and vasopressin, into the blood. This connection is called the hypothalamo-hypophyseal tract or hypothalamo-neurohypophyseal tract. Damage to the pituitary stalk blocks the release of antidiuretic hormone, resulting in polydipsia (excessive water intake) and polyuria (excessive urination). The diameter of the pituitary stalk at the level of optic chiasm is 3.3 mm, and at the pituitary gland insertion site is measured at 1.9 mm. See also
Pituitary stalk interruption syndrome

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