Evaluation of two doses of triclabendazole in treatment of patients with combined schistosomiasis and fascioliasis

To determine the safety and efficacy of 2 consecutive doses of triclabendazole [TCBZ] in the treatment of Schistosoma mansoni infection in human cases infected with both S. mansoni and Fasdola spv we conducted afield survey involving 6314 individuals from 15 villages. The overall prevalence of schistosomiasis alone was 15.8%, of fascioliasis alone 2.2%, and of combined infection 0.7%. Treatment with 2 doses of TCBZ was given to the 49 cases with combined infection. Eight weeks after treatment, the cure rate was 96% for fascioliasis and was 32.7% for schistosorniasis. All schistosomiasis cases cured had a low intensity infection. Liver function tests done before I treatment and 8 weeks after substantiate the safety of 2 doses of TCBZ given to those with combined infection. Administration of TCBZ should precede praziquantel in treatment of combined infection, however TCBZ cannot be recommended for infection with S. mansoni alone

Ineffectiveness of myrrh-derivative Mirazid against schistosomiasis and fascioliasis in humans

The present study assessed the schistosomicidal and fasciolicidal actions of the myrrh-derivative Mirazid in an area of low schistosomiasis transmission. A total of 27 patients infected with Schistosoma mansoni and 16 with Fasciola spp. received the maximum recommended dose of Mirazid. Pretreatment egg counts in 4 Kato-Katz slides were compared with similar counts in stool samples collected 1 and 2 months after treatment. Standard procedures and quality control measures were followed. The results revealed that Mirazid used as schistosomicidal or fasciolicidal agent in the maximum recommended dose has a low cure rate and produced a negligible reduction in egg counts. Prescribing such an ineffective drug in Egypt might endanger the achievements of the schistosomiasis control strategy

Intra-specimen and day-to-day variations of Fasciola egg counts in human stools

Intra-specimen and day-to-day variations of Fasciola egg counts in stools were investigated for 16 cases of established fascioliasis. For each case six Kato slides from a single stool sample were examined daily for 5 consecutive days. The results indicated the presence of significant intra-specimen variations in more than one-third of the examined series, while the inter-specimen variation was almost negligible. The sensitivity of the Kato-Katz test for diagnosing Fasciola infection with three Kato slides from the same specimen or on different days ranged from 96.0%-99.1%. The examination of three Kato smears from a single stool specimen, which is more feasible in field studies, would give an accurate diagnosis of fascioliasis. Used as such, the Kato-Katz technique is highly sensitive in the diagnosis of fascioliasis

Specific IgG avidity in acute and chronic human fascioliasis

The detection of IgG avidity in sera is potentially useful in the diagnosis of acute and chronic infection. We studied IgG avidity in 31 patients with fascioliasis, with the aim of evaluating the clinical application of this test to confirm the diagnosis of incubating cases and to distinguish between acute and chronic cases. Of the 31 cases, 13 were incubating and had a mean avidity index of 57.28 +/- 5.79%. The 18 chronic cases had an avidity index of 68.80 +/- 8.92%. The difference was highly significant. We conclude that IgG avidity is a reliable means of identifying the stage of fascioliasis and suggest a cut-off point of 59.90% to distinguish between acute and chronic infection

Triclabendazole in the treatment of established human fascioliasis

The tolerance and efficacy of triclabendazole CGP 23030, specially prepared for human use, were assessed in 50 patients in the chronic phase of fascioliasis. After clinical examination, investigation and ultrasonography of the liver and biliary system, triclabendazole 10 mg/kg, either as a single or split dose, was administered. The clinical picture was studied daily for six days and the investigations were repeated 6, 30 and 60 days after treatment. The drug was tolerated. Its side-effects, which included upper abdominal pain, mild fever and limited derangement of liver function, were considered negligible. The cure rate at 2 months was 94% when assessed by the disappearance of eggs in stools and 88% when assessed by both the absence of eggs in stools and of worms in the biliary system. The use of triclabendazole for the treatment of human fascioliasis was found to be justified

Evaluation of an integrated approach to schistosomiasis control in a resettlement area west of Alexandria

A six-day workshop was conducted to develop trainers in mental health by providing physicians participating în thé programme wtth thé necessary educationa! knowledge and skills. A significant improvement was observed in thé participants' knowledge and skiils after thé workshop. A significant corrélation waa found between thé increase in knowledge and that of performance. The innrease was affected neithar by thé years of work experienca nor by thé postgraduate degree heid This observed benefit and thé satisfaction expressed by participants encourage thé replication of such a programme in order to develop qualified health personnel capable of expanding mental health services for children

Phagocytic activity of neutrophils in human fascioliasis before and after treatment

Neutrophil phagocytic function was studied in 15 patients with chronic fasciolosis and 5 in the incubating phase of the disease. The results were compared with a control group. The chemotactic index, which is the ratio of directed to non-directed migration, the NBT reduction test, which estimated phagocytosis, and the more recent and specific test, the chemiluminescence, which measured phagocytosis, and intracellular killing were performed. The results showed that in fascioliasis chemotactic activity, NBT and chemiluminescence index were significantly increased as compared with control. This increase was more prominent in the acute phase. In this stage, the immature parasites are in close contact with the liver tissue. With chronicity of infection, they reach the bile ducts and inflammation in the liver parenchyma subsides. At this stage, a lower level of metabolites and antigens reach the tissue, while the majority pass with bile to the intestinal lumen. The indices returned to normal level after treatment of fascioliasis. This signifies disappearance of all stimuli responsible for activation of PMV phagocytes

Studies on human fascioliasis in Egypt 1- seasonality of transmission

The present study aimed at investigating the seasonality of human fascioliasis. The monthly distribution of acute infection was studied together with the monthly Lymnaea cailliaudi snail density and infection. Infection was observed in both snail and human host throughout the year. However, maximal snail infection was observed during the months of June and July, while the number of acute human infections peaked in August. It was concluded that summer was the highest transmission season. The clinical incubation period was considered one or two months

Effect of lipopolysaccharide injection on worm load in mice infected with S, mansoni

Salmonellosis bacteriemia in patients with hepatosplenic schistosomiasis is common in endemic areas of Schistosoma and Salmonella infection [Rocha and Brito, 1982]. Bacterial lipopolysaccharide [LPS] which is rich in walls of gram negative bacilli [eg. Salmonella species] causes potyclonal B lymphocyte activation resulting in hyper-grammaglobulinemia and immunecomplex [1C] formation [Rose et al, 1982]. The aim of this work was to study the effect of LPS on the worm load [worm count] in mice infected with S, mansoni Fourteen Swiss albino mice [10-12 weeks old and 25 g weight] [Control group] were infected with S.mansoni using paddling technique [Azim and Watson, 1984], Each mouse was exposed to about 150 cercariae for a period of one hour. Another 20 age- and sex-matched mice [experimental group] were simultaneously infected with S0mansoni and infected intraperitoneally with 150 microg LPS/mouse [LPS:phenol extract from S. typhimurium; Sigma, USA] Six weeks after infection, mice were killed and the hepatic and the mesenteric blood vessels were perfused with citrated saline from the hepatic vein and the descending aorta, respectively. The adult worms were collected from the cut portal vein and counted: [Duvall and BeWitt 1967]. In the experimental group [S. mansoni and LPS], the mean count of adult S. mansoni worm couples was significantly lower than that of the control group [S. mansoni only] [P<0.001] [Table 1]. The significant decrease of worm load in mice infected with LPS may suggest a protective role of LPS in this group of mice. The exact mechanism of this protection is not clear, but it could be speculated: First, LPS might act as an adjuvant [Parant, 1983] leading to augmentation of immune response against S. mansoni Second, antiidiotype antibodies produced by LPS [Rose et al, 1982] may have immunomodulatory effect. In fact these antidodies were found able to protect rats from a challenge with S. mansoni [Grzych et al, 1985]. Third, IC's produced in response to LPS in the experimental group were found to be higher than those in the control group [data not presented]. A protective role of IC's has been previously suggested [Bout et al., 1977]. Whatever the mechanism, the decrease in worm load will lead to decrease in egg deposition and other harmful effects of these worms on different organs resulting in changes in immunopathological and clinical

Parasitological and histopathological studies on the effect of immunosuppressant drugs in experimental schistosomiasis mansoni

The effect of two immunosuppressive drugs [Hydrocortisone and Methotrexate] has been studied on egg-laying and extrusion, in mice infected with Schistosoma mansoni. The drugs were administered at the stage of worm maturation. An increase in worm load, as well as an increase in the granulomata formation was noticed although a decrease in egg extrusion occurred without any effect on the total number of egg laid