ELEVATED SERUM ANGIOTENSIN-CONVERTING ENZYME-ACTIVITY IN ONCHOCERCIASIS

Our objective was to measure serum angiotensin-converting enzyme (ACE) activity in patients with onchocerciasis. Serum ACE activity is commo nly used in the diagnosis and follow-up of patients with sarcoidosis. However, serum ACE activity can also be elevated in a number of other granulomatous disorders. In onchocerciasis, a parasitic disease affect ing millions of people in Africa and Central and South America, granul omatous tissue around adult worms has been identified, yet raised seru m ACE activity has not been reported so far. We measured serum ACE act ivity in serum samples from 42 onchocerciasis patients and 39 endemic controls previously enrolled in two studies concerning the side effect s after ivermectin treatment in Sierra Leone, West Africa. The mean AC E activity in the patient group was 53.8 units/liter (S.D. 19.8) compa red with 35.2 units/liter(S.D. 14.0) in the control group (p < 0.0001) . Nine of 42 patients had elevated ACE activity (mean of the endemic c ontrols +/- 2 S.D.) compared with 1 of 39 controls (p = 0.01). Sensiti vity and specificity of elevated ACE in serum from onchocerciasis pati ents from Sierra Leone was 21 and 97%, respectively. ACE activity was not related to the microfilarial skin load or development of side effe cts after ivermectin treatment. Serum ACE activity can be elevated in onchocerciasis. Clinicians should be aware of this phenomenon when det ermining serum ACE activity in persons from endemic areas.