Most patients living in an endemic area are familiar with infection, either personally or within their family, and have no doubt of the diagnosis when, or just before, the first signs appear. These are a burning pain at the site of a small blister, usually accompanied by intense itching and possibly urticaria. If cold water is placed on the ulcer following the bursting of the blister and examined under a lower power microscope, actively moving larvae can be seen.
Recently, immunodiagnostic methods have been evaluated and can possibly detect infection for a few months before patency (Saroj-Bapha and Renapurkar, 1996) but are not useful in practice. The FAST-ELISA and EITB techniques, using a 16 000 MW adult protein (DM16) as antigen, was positive just before patency and became negative 2 months after explusion of worms (Fagbemi and Hillyer, 1990).
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