How does Onchocerciasis primarily present in patients?

Onchocerciasis, commonly known as river blindness, is primarily caused by the parasitic infection from the nematode Onchocerca volvulus. The hallmark presentation of this infection includes skin changes, intense itching (pruritus), and the development of nodules, which are often referred to as onchocercomas.

Infected individuals may experience dermatitis characterized by rashes and changes in skin pigmentation due to the inflammatory response elicited by the adult worms and their microfilariae. The intense itching can lead to secondary infections as patients scratch the affected areas, and the skin nodules can be palpable under the skin, predominantly found on the scalp, back, and other areas.

The other options do not accurately represent the primary symptoms of onchocerciasis. Fever and chills are not typical, as the disease is more chronic and does not usually present with systemic febrile symptoms. Joint pain and swelling could be related to other conditions and are not directly associated with this parasitic infection. Breathing difficulties also do not align with the classic presentation of onchocerciasis, which predominantly affects the skin and, in advanced cases, can lead to visual impairment due to the migration of microfilariae to the