Changing pattern of fascioliasis prevalence early in the 3rd millennium in Dakahlia Governorate, Egypt: an update.

Fascioliasis is an important food- and water-borne parasitic zoonosis caused by liver flukes of genus Fasciola (Digenea: Fasciolidae) of worldwide distribution. In Egypt, fascioliasis was encountered in nearly all Egyptian Governorates, particularly in the Nile Delta and specifically in Dakahlia. All enrolled cases were subjected to complete history taking, clinical examination, routine investigations and abdominal ultrasonography. Stool analysis, IHA and ELISA were used for fascioliasis diagnosis. Rural areas showed highest prevalence of fascioliasis than urban areas, however, but.without significance (x2= 0.042 & P= 0.837). Regarding human fascioliasis in examined the centers, no statistically significant difference (x2 =2.824 & P=0.243) was detected. Regarding gender variation, the difference was statistically insignificant (x2= 0.166 & P= 0.683). The difference between the age groups was statistically insignificant (x2= 3.882 & P=0.274). Clinically, 7 cases (35%) were asymptomatic and another 13 cases (65%) had different clinical pictures. Abdominal pain, anemia, eosinophilia, and tender hepatomegaly were seen in 70%, 80%, 70%, and 10%; respectively. Of them, 1 1cases showed positive abdominal ultrasonographic findings suggestive of fascioliasis.

Evaluation of ELISA and IHAT in serological diagnosis of proven cases of human hydatidosis.

Cystic hydatid disease (Hydatidosis) is the most serious tape-worm infection prevalent in the cattle and sheep raising area of the world. Hydatidosis in man (as an accidental host) is caused by infection with the ova containing larval stage of Echinococcus granulosus. In the last decade, different techniques have been employed for sero-diagnosis of hydatidosis; as IHA, IFA, ELISA, CCLE (Counter Current Immuno-electrophoresis). This paper evaluated the validity of ELISA and IHA. Since whole hydatid cyst fluid was used as a source of antigen for serodiagnosis. Thirty surgical and pathological hydatidosis proven patients were examined. The sensitivity and specificity of ELISA were 96.7% & 97.5% respectively, and that of IHA were 86.7%, &95% respectively.

On the main reservoir host of Fasciola in Dakahlia Governorate, Egypt.

In the present work, a total of 4180 sheep were obtained from different localities at Dakahlia Governorate. One hundred and eighty male sheep were investigated for Fasciola worms (the adult and juvenile forms) at Mansoura governmental abattoir. Four hundred grazing sheep were screened by the coprological examination from ten centers. The mean number of eggs per gm in a group of ten sheep ranged from 2.9-10.8 egg/gm. The number of worms ranged from 5-84. In the Mansoura abattoir, it was found that 37 sheep were infected (20.56%). Fasciola worms were recovered from the livers in 100%, common bile ducts in 60%, gall bladder in 80%, two sites in 50% and three sites in 40% of infected biliary tracts. According to the coprological examination, the infection rate was the highest in El-Manzalla Center (15.75) and the lowest was in Mansoura Center (3.25%). According to the prevalence and egg output results, it is concluded that sheep are the main reservoir host for fascioliasis among the edible animals in Dakahlia Governorate. However, examination of the non-edible animals and the domestic and wild rodents are ongoing and will be published soon elsewhere.

Alkaloids of Haloxylon salicornicum (Moq.) Bunge ex Boiss. (Chenopodiaceae).

Haloxylon salicornicum is a desert plant that contains several alkaloids. From the aerial parts a new piperidyl alkaloid, haloxynine, was isolated and characterized on the basis of mass spectrometry, 1H and 13C NMR. A GLC/MS analysis revealed the presence of 17 additional known alkaloids of which piperidine, halosaline, anabasine, hordenine, N-methyltyramine, haloxine and aldotripiperideine had been previously reported in this genus. Among the 18 identified alkaloids, ten alkaloids were recorded for the first time from this plant and the genus Haloxylon. Haloxynine, halosaline, haloxine, anabasine, and smipine figure as major alkaloids with a relative abundance of more than 5% of total alkaloids. Some of these alkaloids are known be strong agonists at nicotinic acetylcholine receptors and it is thus likely that they serve as chemical defencecompounds against insects and mammalian herbivores.

Erectile dysfunction in chronic renal failure patients undergoing hemodialysis in Egypt.

In clinical practice, the attention given to sexual problems in patients with end-stage renal disease is low. In order to evaluate the erectile function in chronic renal failure patients undergoing hemodialysis (HD) as a renal replacement therapy in upper Egypt, we used the abridged version of the International Index of Erectile Function (IIEF-5). In all, 75 HD patients were subjected to clinical and laboratory investigations. The controls were 948 healthy males representing the general Egyptian population. The prevalence of erectile dysfunction (ED) among the HD patients was 82.5% compared to 30% among controls. The prevalence of ED in HD group was significantly higher than in controls. The prevalence of ED in HD patients <50 y was 80% and it was 88% in those > or =50 y, while the prevalence of ED among controls was 28 and 69.8%, respectively. The prevalence of severe degree of ED was significantly higher in both groups compared to controls, while moderate degree of ED showed a statistical significance compared to controls in age groups <50 y and mild degree of ED showed a statistical significance compared to controls in age groups > or =50 y. [corrected] Age (r=-0.3368, P<0.01), serum urea (r=-0.5974, P<0.001), and creatinine level (r=-0.5804, P<0.001) have a significant negative correlation with the presence of ED among HD patients, while serum hemoglobin (r=0.3396, P<0.001) and years of HD age (r=0.3147, P<0.01) have a significant positive correlation with the presence of ED among the HD patients. In view of the observed high prevalence of ED among the HD patients, we believe that a complete health evaluation of male HD patients should include a discussion about erectile function in the standard clinical care program of patients with renal disease.

Comparative study of the essential oils and extracts of Achillea fragrantissima (Forssk.) Sch. Bip. and Achillea santolina L. (Asteraceae) from Egypt.

Essential oils obtained by steam distillation from the aerial parts of Achillea fragrantissima (Forssk.) Sch. Bip. and the flower, leaf and stem of A. santolina L. as well as their lipophilic constituents obtained by solvent extraction were analysed using GLC and GLC-mass spectrometry. Nineteen constituents in the essential oil of A. fragrantissima were identified, in addition to 41 compounds from its n-hexane-ether extract. The hydrodistilled oil and the solvent extract contain santolina alcohol, artemisia alcohol, artemisia ketone, cis-thujone and trans-thujone as major constituents. In A. santolina altogether 54 volatile components were detected. The major components were 1,8-cineole, fragranol, fragranyl acetate and terpin-4-ol. Furthermore, the essential oils and the n-hexane-ether extracts of the two plants were screened for their antimicrobial activity.

Cellular immune response in giardiasis.

There was statistically significant difference between all groups of giardiasis patients regarding the grade of CD4 lymphocyte infiltration (P<0.001), being more marked in symptomatic group. The prevalence of flatulence, anorexia and vomiting were more frequent in patients with heavy CD4 lymphocyte infiltration in duodenum. A high statistical significant increase was in the mean OD values of anti-Giardia duodenal secretory IgA in patients with marked CD4 infiltration in duodenum. But, a statistical insignificant difference in mean OD values of anti-Giardia total serum Ig in patients with different grades of CD4 infiltration in symptomatic group. There was statistically significant increased in the mean OD values of anti-Giardia total serum Ig in patients with marked intraepithelial CD8 lymphocyte Infiltration in the duodenum In the asymptomatic group, there was statistically insignificant difference in the mean OD values of anti-Giardia total serum Ig in patients with different grade of intra-epithelial CD8 infiltration in symptomatic group. There is statistically significant increased in the mean OD values of anti-Giardia total serum Ig in patients with marked intra-epithelial CD8 lymphocyte infiltration in the duodenum regarding immunohistochemical staining of Giardia antigen in duodenal biopsies. All the 61 symptomatic giardiasis patients revealed Giardia antigen stains in their duodenal biopsies with a sensitivity of 100% while asymptomatic group a sensitivity of 93.181%. None in the controls showed positive Giardia antigen in the duodenal biopsies with 100% specificity.

Nematodes and water pollution in eastern part of Nile Delta.

Examination of some represented water sites revealed presence larvae and eggs of the nematodes infecting man and animals. Eggs in a descending order of abundance were Trichostrongylus, Toxocara canis, T. vitolorum, and Ascaris sp., then Trichocephalus and Ancylostoma sp. Larvae in a descending order were Strongyloides, Trichostrongylus and Ancylostoma sp. No doubt contaminated or polluted water plays an important role as nematode-borne source.

Incidence of Parastrongylus cantonensis larvae in different fresh water snails in Dakahlia Governorate.

Samples of snails were collected from different water bodies in Dakahlia governorate to assess a survey on the naturally infected snails and their infection rate with the Parastrongylus cantonensis larvae. The nematode P. cantonensis is associated in the etiology of eosinophilic meningeoencephalitis of man. Lanistes carinatus showed the highest rate of infection with 19-400 larvae per snail. Biomphalaria alexandrina, B. glabrata, Bulinus truncatus, Lymnaea cailliaudi (natalensis), L. alexandrina, and Cleopatra cyclostomoides were found naturally infected with the larvae of P. cantonensis for the first time in Egypt. The number of larvae per infected snail varied depending on the snail type. The highest rate (39.2%) of infected snails was collected from the end canals at Tanneekh and the lowest in the river Nile (12.5%).

Study of soluble adhesion molecules in some intestinal and tissue helminthes.

Soluble adhesion molecules namely soluble intercellular adhesion molecule-1 (sICAM-1) and soluble E-selectin (sELAM-1) were assayed in hydatid patients with or without complications. It was found that sICAM-1 was significantly increased in patients with hydatid cysts as compared to the control group. In lymphoedemic filariasis cases both sICAM-1 and sELAM-1 showed highly significant increase more than the control group. However, non of both soluble adhesion molecules were significantly elevated in patients with ascariasis, hymenolepiasis, heterophyiasis and strongyloidiasis as compared to controls. The results indicated that SICAM-1 & S ELAM-1 are useful markers for hydatidosis and filariasis, but not for ascariasis, hymenolepiasis, heterophyiasis and strongyloidiasis

A study on Trichomoniasis vaginalis and female infertility.

A total of 280 patients, 240 infertile and 40 pregnant were subjected to thorough history taking, general and local examination for exclusion of organic lesion, laboratory investigations to exclude parasitic, bacterial and fungal infections. Sterile vaginal swab from the posterior fornix was taken, and examined by wet smear preparation, Giemsa staining and cultivation on C.P.L.M. medium for trichomoniasis infection. The mean age of the infertile group was 25.75+/-3.92, and of the control group was 21.6+/-2.38 (in years). The mean duration of infertility was 2.81+/-1.51 (years). Out of 240 infertile women, 18.75% complained of discharge, 17.5% itching, 15.42% dysuria, 14.58% dyspareunia, and 10% had cervical lesion. Of the 40 controls, 5% complained of discharge, 2.5% complained of itching, dysuria, dyspareunia, but none had cervical lesion. Of the total cases (280), 36 (12.9%) had T. vaginalis. The clinical data observed were significantly higher among the infertile group than the control group. Cultures were positive in 14.58% of the infertile group and 2.5% in the control group. The difference between the 2 groups was statistically significant. No doubt, T. vaginalis plays an important role in female infertility.

Studies on patients with Schistosomiasis mansoni, HCV and/or typhoid fever.

Two groups of patients were studied. First one included 50 schistosomiasis mansoni patients, 30 with simple infection, 10 with splenomegaly and with ascites. Second group included 111 patients of whom 20 with pure S. mansoni, 27 with pure HCV infection, 54 with mixed infection of schistosomiasis and HCV and 10 with schistosomiasis, HCV and typhoid fever. Serum transaminases and anti-HCV antibodies performed, showed anti-HCV raised levels in 10% of simple schistosomiasis, 60% in splenomegalic patients, 80% in ascites patients, and 7.1% in controls. Liver function tests in first group were within normal range except in those with ascites. In second group, liver function tests was norma in pure schistosomiasis patients, in pure HCV patients serum bilirubin was normal in 22.2%, AST, ALT and alkaline phosphatase were higher. In mixed infection, serum bilirubin was normal in 18.5%, serum transaminases were higher and alkaline phosphatase was normal among 77.7%. Patients with typhoid fever, HCV and schistosomiasis (12.6%) showed significant increase of liver function as compared with each of pure HCV or HCV and schistosomasis. Results were discussed.

Evaluation of soluble adhesion molecules in the diagnosis of amoebiasis, giardiasis and toxoplasmosis.

A total of 47 patients with toxoplasmosis (21 cases) with amoebic liver abscess (14 cases) and with giardiasis (12 cases) as well as 14 healthy control were subjected to thorough history taking, clinical examination, stool & urine analysis, complete blood picture, ESR, C-reactive protein, ASO, widal test, blood cultures, liver function tests, serum creatinine, hepatitis viral markers, rheumatoid factor, auto-antibodies, stool culture, rectal snip, chest X-ray, abdominal sonar, level of serum adhesion molecules (sICAM-1, sELAM-1), ELISA detection of Toxoplasma antibodies in serum, liver biopsy, detection and counting of Giardia cysts. In toxoplasmosis group, highly significant increase in serum levels of sICAM-1 (P<0.01) and significant increase in serum levels of sELAM-1 (P<0.05) in comparison to control. However, only sICAM-1 levels were significantly increased in IgM cases more than in IgG cases. In amoebic liver abscess group, both sICAM-1 and sELAM-1 significantly increased when compared with control. In giardiasis group, highly significant increase of serum levels of sELAM-1 was noticed than in control group (P<0.01), while sICAM-1 showed no significant difference (P>0.05). There was no correlation between sELAM-1 and number of cysts in the stool (intensity of infection). Soluble forms of adhesion molecules especially sICAM-1 have the potentiality as good markers of endothelial damage, severity of disease and to less extend load of infection.

Clinico-epidemiological study of human fascioliasis in an endemic focus in Dakahlia Governorate, Egypt.

Human fascioliasis is increasing in the Nile Delta particularly in Dakahlia Governorate, where it reached 7.47%. In this study, the tetrad of fascioliasis was established as high eosinophilia (100%), fever (85.6%), painful hepatomegaly (81.93%) and anaemia (100%). The laboratory results showed ESR accelerated in 87%, ALT elevated in 21.5%, AST elevated in 21.9%, S. bilirubin elevated in 16.5%, gamma GT elevated in 80.6%, and SAP elevated in 76.4%. Abdominal ultrasonography showed variable findings, as hepatomegaly, splenomegaly, periportal fibrosis, thickened wall of gall bladder, dilated common bile duct, dilated biliary radicals (partial), dilated common bile duct and biliary radicals (total), Fasciola worms in gall bladder, Fasciola worms in common bile duct, stones in gall bladder, stones in bile duct, cystic lesions in the liver, local lesions in the liver and ascitis. The highest was hepatomegaly in 81.93% of fascioliasis patients and the lowest was biliary dilated radicles (partial) in 0.26%.

Soluble adhesion molecules versus lymphoblast transformation in diagnosis of zoonotic cutaneous leishmaniasis.

Twelve parasitologically proven ZCL patients (one with non-ulcerative lesion and eleven with multiple ulcerative lesions) were subjected to estimation of the levels of lymphoblast transformation (LTT) and soluble adhesion molecules (sICAM-1 & sELAM-1 by ELISA). The results proved high percentage of LTT in relation to number and clinical picture of the ZCL lesions. As to the soluble adhesion molecules, sICAM-1 levels were significantly increased than in normal controls and correlated positively with the number of ulcerative lesions. sELAM-1 levels were not significantly increased than the normal controls, but correlated positively with the number of ulcerative lesions. Consequently, soluble adhesion molecules mainly sICAM-1 is a good marker of endothelial damage in ZCL as related to number and clinical type of lesions.

Coccidiosis among immuno-competent and -compromised adults.

There was significant increase in coccidia positive cases among Hodgkin lymphoma receiving chemotherapy as compared to control group (p < 0.05). The increase was highly significant in the group of acute lymphocytic leukaemia receiving chemotherapy as compared to control group (P < 0.01). The total percent of cases with single type of coccidia were 12.2% compared to multiple coccidial infections (4.3%). The most commonly associated parasite was Cryptosporidium. The total cryptosporidial infections (single and mixed with other coccidia) were 12.1% of the total studied cases. In the immunocompromised the prevalence was 14.3%. In the immunocompetents with diarrhoea, was 8.3% and in control was 5.6%. Microsporidial infections (single and mixed with other coccidia), being the least detected among the four intestinal spores forming coccidia, were 2.4% in the immunocompromised groups. No Microsporidium was detected in the immunocompetent or adult control groups. The total cyclosporal infections (single and mixed with other coccidia) were 6.3% of the total studied cases. In the immunocompromised groups, the prevalence was (8.3%) where in immunocompetent group, was 2.8%. None was detected in the control subjects. Single cyclospora was 3.0% while mixed Cyclospora represented 3.3% of all studied cases. The Isospora infections (single and mixed) were 3.8% of total patients. The prevalence among immunocompromised group was 5.2% and in immunocompetent patients was 2.8%.

The pathogenesis of Demodex folliculorum (hair follicular mites) in females with and without rosacea.

In rosacea patients (ages 11-50 years old) 44% were infested with D. folliculorum as compared to normal controls (23.0%). The difference was significant. The mean +/-SD of mite density ranged between 13.2+/-0.9 to 18.2+/-1.2 as compared to normal controls with mite density ranged between 1.4+/-0.25 to 2.4+/-0.3. Demodex infestation in rosacea patients was 66.1% in squamous, 66.7% in erythemato-telangiectate and 83.3% in papulo-pustular rosacea. The highly infested site was check (27.3%) with mean mite density of 25.3+/-1.3, followed by the area around the orbit (23.4%) with a density of 19.0+/-1.2, the area around the nose (19.5%) with mite density of 7.1+/-1.5, then chin (15.6%) with a density of 8.2+/-1.4 and lastly the area around the mouth (14.1%) with a mite density of 14.2+/-1.3. Undoubtedly, infestation with D. folliculorum particularly in large number causes rosacea.

Evaluation of five stains in diagnosing human intestinal coccidiosis.

Three hundreds cases over the year 1998 complaining of diarrhoea were examined. The stools were examined by the traditional diagnostic methods and confirmed to be free from intestinal parasites. Cryptosporidium parvum, Isospora belli and Cyclospora cayetanensis were detected by using different types of faecal stains namely modified Ziehl-Neelsen, Kinyoun acid-fast, Auramine-rhodamine, Gomori's trichrome and Giemsa. The number of positive cases were 87 C. parvum (29%), 5 cases L. belli (1.7%) and 12 cases C. cayetanensis (4%). This study showed that the sensitivity of modified Ziehl-Neelsen and Kinyoun Acid-fast were very high (100%) in comparison with the other stains.

Histochemical and pathological studies on biopsied materials from patients with Ancylostoma duodenale infection.

Ancylostoma duodenale is still the dominant hookworm species in the Mediterranean area, India, China and Japan. In the present study, biopsied materials were taken from the small intestine of 30 patients infected only with A. duodenale and 12 cross matched controls. The results showed some pathological changes in severely infected cases. However, normal or insignificant changes were seen in the enzymatic activity of the intestinal mucosa.

Studies on culicini larvae in Mansoura Center, Dakahlia Governorate, Egypt.

Culicini larvae were collected from different water bodies in Mansoura Center, mainly Awish El Hagar, Gedilah, Mansoura City, Meet Badr Khames and Sandoub. Ten species of culicini larvae were collected. They were Culex adairi, Cx. antennatus, Cx. deserticola, Cx. pusillus, Cx. pipiens, Cx. univittatus, Aedes caspius, Ae. detritus, Culiseta longiareolata and Uranotaenia uniguiculata. The most common larvae in descending order were those of Cx. univittatus, Cx. antennatus and Ae. caspius. The highly infected area was Meet Badr Khames and the least was Mansoura city. The highly infested water body was the canals and the least was the sewage wells. Rice fields were only infested with Cx. antennatus (P > 0.05). The whole results were discussed.