study on prevalence of drug resistance in drug default pulmonary tuberculosis

The emergence of resistance to drugs used to treat tuberculosis [TB], and particularly multidrug-resistant TB [MDR-TB], has become a significant public health problem in a number of countries and an obstacle to effective global TB control. This is a prospective randomized cross sectional study to estimate the magnitude of MDR tuberculosis in two hospitals in Khartoum, Sudan. 111 patients who had defaulted their tuberculosis treatment on previous occasions and had presented to the hospital with several symptoms were studied. All patients provided sputum, which was examined for the presence of acid fast bacilli [AFB] by Ziehl- Neelsen stain. Sputa were also sent to the reference laboratory for mycobacterial culture and drug susceptibility testing. All culture positive sputa had drug sensitivity tested to the first line anti-TB drugs used in Sudan namely Streptomycin, Isoniazid, Rifampicin and Ethambutol. Out of the 111 patients, 297% [n=33] were AFB sputum smear positive and 40.5% [n=45] were sputum culture positive for mycobacterium. Sensitivity testing revealed that 48.9% [n=22] were resistant to Streptomycin, 62.2% [n=28] were resistant to Isoniazid, 55.6 [n=25] were resistant to Rifampicin and 37.8% [n=17] were resistant to Ethambutol. 42% [n19] of the patients were resistant to Rifampicin and Isoniazid only, while 26.6% [n=12] were resistant to all the first line drugs [Streptomycin, Isoniazid, Rifampicin and Ethambutol] this study showed that the prevalence of MDR tuberculosis among the defaulters in Kartoum is much higher than what was reported previously. This study highlights the extent of the problem of drug resistance in Khartoum and emphasizes the need for proper treatment and strengthening of the short course direct observed therapy strategy

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

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

Kupffer cell count and plasma fibronectin level in hepatic schistosomiasis with and without virus hepatitis

The aim of this work was to study some kupffer cell receptors which influence their immunophagocytic capacity in relation to the levels of circulating immune complexes [CICs] and plasma fibronectin [PFN] in four groups of patients: early or late schistosomiasis and schistosomiasis associated with virus B or C infection as compared to a control group. Patients were diagnosed on clinical basis together with ultrasonography and various laboratory tests. Liver biopsies were obtained to confirm the diagnosis and provide Kupffer cells. After dispersion, total nucleated cells and liver macrophage counts were found to be elevated in early schistosomiasis compared to the other groups. The number and percent of Kupffer cells carrying Fc or complement receptors were significantly higher in early schistosomiasis as compared to all other groups, yet by referring to normal values as reported in the literature the percent carrying, receptors could be considered lower than normal. The CICs were higher in all groups than control. The levels were lower in early Schistosomiasis and highest in patients with mixed infection particularly in those with HBV. There was a negative correlation between CICs levels and the number and proportion of Kupffer cells carrying receptors. Plasma fibronectin [PFN] showed a significant increase in early schistosomiasis patients and a significant decrease in patients with schistosomiasis combined with virus hepatitis particularly HCV; compared to controls. Positive correlation was detected between PFN level and the number and percent of Kupffer cells carrying Fc and complement receptors. No correlation was found between PFN and CICs in all groups. It could be concluded that during early schistosomiasis, there is an increase in the immunophagocytic function of Kupffer cells. In chronic schistosomiasis a decreased activity was noted probably due to immunomodulation and fibrosis. In schistosomiasis associated with HBV or HCV, the function of Kupffer cells was markedly decreased. This is probably due to affection of the hepatocytes leading to lower FN level and increased CICs which may block the receptors. The marked lowering of PFN in schistosomiasis associated with HCV could be explained by the direct cytopathic effect of the virus

IL-10, IFN-gamma and TNF-alpha in acute and chronic human fascioliasis

The 3 cytokines [IL-10 [Th2 product], IFN-gamma [Th1 product] and TNF- alpha] were studied. The present work was undertaken to study the level of these cytokines during the acute and chronic stages of human fascioliasis in an attempt to assess the involvement of Th1 and Th2 cells in regulation of the immune response in this disease. Sera of 26 Fasciola patients were obtained and divided into 2 groups: 12 with acute and 14 with chronic fascioliasis, sera of a control group were studied simultaneously. During the acute stage, a significant increase was observed in IL-10, IFN-gamma as well as TNF-alpha and specific antibody level. In the chronic phase, a significant increase of IL-10 level was observed. IFN-gamma showed a lower level as compared to the acute stage, but TNF-alpha was still high. Accordingly, in fascioliasis in the early phase of infection B cells, macrophages, Th1 and Th2 cells were all activated. They cooperate in overcoming the parasite and work to the benefit of the host. With time and after maturation of the evading worms, Th2 action predominates. IL-10 [Th2 cytokine] which is antagonistic to IFN-gamma [Th1 product] and consequently to TNF-alpha limits the immunopathology that may be caused by the latter

Human fasciolosis: a study on the relation of infection intensity and treatment to hepatobiliary affection

Seventeen patients with established fasciolosis and ten normal controls were enrolled in this study. The fasciola patients were divided according to infection intensity into two groups [four patients with high intensity and thirteen patients with low intensity] as assessed by egg counts coupled with ultrasonography for detecting worms in the biliary system. Aspartate and alanine aminotransferases [AST and ALT] levels were similar to those of the controls within the accepted normal limits before and after treatment, denoting the absence of hepatocellular injury. Total serum bile acids, individual bile acids [cholic acid [CA] and chenodeoxycholic acid [CDCA], gamma glutamyl transpeptidase [GGT] and serum alkaline phosphatase [SAP]] were significantly higher among all patients as compared to controls, denoting a degree of cholestatic lesion in those patients. Patients with high infection intensity revealed higher parameters than those with low intensity, the difference was not significant. One month after treatment, there was a significant improvement in the cholestasis indicating parameters in all fasciola cases compared to the pretreatment ones. This indicated the effective role of the drug on the hepatobiliary function. However, the levels were still different from the controls. In fasciola infection, total and individual serum bile acids in conjunction with GGT and SAP evaluated the hepatobiliary status and detected any minor abnormalities, especially in anicteric subjects

Prevention of human fascioliasis: a study of the role of acids detergents and potassium permanganate in clearing salads from metacercariae

Prevention of human fascioliasis could depend on clearing the leafy salads from the metacercariae. The present work evaluated the role of some chemicals in detaching and killing this infective stage. It was observed that washing in running water for 10 minutes detached only 50% of the metacercariae. Citric acid in the concentration of [10 ml/L], commercial vinegar [120 ml/L], liquid soap [12 ml/L] and KMnO4 [24 mg/L] detached all metacercariae after 10 minutes exposure. The use of vinegar and KMnO4 was recommended; the former is lethal to other parasites in the vegetables, the second destroyed the metacercariae. Vegetable leaves were not softened and remained fresh

Pattern of serum bile acids in patients with hepatic fascioliasis

The study included 20 patients with established Fasciola infection and 10 normal healthy control subjects. Total serum bile acids and the individual bile acids; cholic acid [CA], chenodeoxycholic acid [CDCA] and deoxycholic acid [DCA] were estimated using reversed phase high performance liquid chromatography. Total serum bile acids, CA levels and their percentage from the total were significantly increased in thefasciola group than in the controls. There was also a significant decrease in the percentage of DCA from the total bile acids as well as its ratio to CA. This decrease might be due to the absence of DCA in some fasciola patients [55%] and to the significant increase in CA which favours more a cholestatic lesion in such patients. All the results of liver function tests were within the accepted normal limits. It could be concluded that, in cases of fascioliasis in the absence of abnormalities in the usual liver function tests especially in anicteric subjects, evaluation of total serum bile acids, CA, DCA levels and the ratio DCA/CA should be considered to demonstrate any minor abnormalities in hepatobiliary system

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

Molecular weight determination of fasciola antigens specific for diagnosis of acute fascioliasis

Acute human fascioliasis depends on its diagnosis on detecting specific antibodies in the sera of patients. It was observed that both somatic fraction I and crude E/S products of adult Fasciola gigantica worm gave sensitive and specific results. Using IgM ELISA, the cut off OD was 0.6 and 0.3 nm and the accuracy was 93% and 98% for the two antigens, respectively. Determination of the molecular weight of these two antigens was undertaken by SDS-PAGE. The molecular weight of the somatic fraction I ranged from 17.5 to 43.9 kD, that of the crude E/S products ranged from 12.5 to 14.7 kD. These results were compared with those of previous works performed on antigens of F. hepatica

Studies on lymnaea snails and their trematode parasites in Abis village, Alexandria

Lymnaea snails in Abis II Village were studied as regard to their species, monthly distribution, density and infection rates in different water bodies. The trematode parasites in L. cailliaudi, the only species of Lymnaea in Abis II Village were Xiphidio in 40% of snails and Fasciola in 10%. Echinostome cercariae were detected from few snails outside Abis II Village. The morphological characters of the different larval stages of the detected parasites were described