Colaboración campesina contra la distomiasis hepática

Villagers exposed to liver fluke infection in north-east Thailand were advised to pay for diagnosis and treatment. On the basis of the response obtained a project for the control of the parasite in seven provinces has been planned, within the framework of a primary health care scheme

Schistosoma japonicum-like infection in Phichit province, northern Thailand: a case report.

A case of human schistosomiasis from Phichit Province is presented. Schistosome eggs were found in the ileo-caecal mass of a 44-year old woman, native of Sak-Lek, Muang District. Histologic pictures revealed an early acute granulomatous lesion which consisted of predominantly eosinophils without multinucleated giant cells and fibrotic change suggesting a recent infection. On the basis of the shape and microscopic appearance of the eggs, they are smaller than those described previously for Schistosoma japonicum, probably those of S. mekongi, a related species. This is the third histologic-confirmed case of schistosomiasis in this locality. Addendum: At the time of the manuscript preparation, another case of schistosomiasis was diagnosed. A 55-year old man who lives entirely in the very close adjacent village to the present case was admitted to the Ramathibodi Hospital, Bangkok with chronic hepatosplenomegaly in January 1986. Amyloidosis was suspected and rectal biopsy revealed schistosome eggs, some contained miracidia with varying degrees of degeneration, some were empty and/or fragmented shells and were surrounded with fibrotic changes and chronic cellular infiltration (Fig. 5). They were identical to those of Schistosoma japonicum. Several fecal examinations, miracidium hatching and COPT yielded negative results. This finding showed significantly that all schistosomiasis cases reported from this locality, except the second one, were in the old age group of 40 and above. Further epidemiologic investigation is in progress to delineate this locality as a potential endemic area for this infection.

Infection and re-infection rates of opisthorchiasis in the water resource development area of Nam Pong project, Khon Kaen Province, northeast Thailand.

A one-year investigation on re-infection rates of opisthorchiasis was carried out in three villages in the Nam Pong Water Resource Development Project, Thailand. In the two villages where selective population chemotherapy was combined with improvements in sanitation and health education aimed at changing food habits, the mean monthly re-infection rate was 2.0% and the annual cumulative rate was 21.5%. In the third village, where only selective population chemotherapy was carried out, the monthly re-infection rate was 5.0% and the annual cumulative rate was 55.5%. Studies on new infections in initially negative individuals were also carried out in the three villages, with inconclusive results.

A pilot project for controlling O. viverrini infection in Nong Wai, Northeast Thailand, by applying praziquantel and other measures.

In a pilot control project of Opisthorchis viverrini in the village of Nong Wai Irrigation Area, Khon Kaen, Northeast Thailand, selected population based chemotherapy with a single dose of 40 mg/kg of praziquantel (2 - cyclohexylcarbonyl-1,2,3,6,7,11 b-hexahydro-4H-pyrazino [2,1-a]isoquinolin-4-one,EMBAY8440,Biltricide) was given to the stool positive cases once a year for a period of 3 years commencing May 1981. Two villages (pop 942) with a prevalence of 58.3% were used as tests villages and another one (pop. 442) with a prevalence of 55.1% served as control. The project programme integrated chemotherapy, sanitation improvement and health education, whilst only chemotherapy was applied in the control village. Among the 736 cases of all villages, 666 were treated in the first year and the parasitological cure rate after one month was 95.9%. Side effects of praziquantel were minor and were minimized by changing the time of drug intake from morning to after dinner. After one year the prevalence of opisthorchiasis was 36.8% in the test villages and 54.8% in the control village. The study on re-infection rate revealed that the average monthly incidence rate among the population in the test villages was 2.0% per month (range 1.1-5.0%) whereas it was 5.0% per month (range 1.9-10.3%) in the control village. In May 1982, second treatment was given again to the positive cases in the three villages with the same dose. The second year evaluation is in progress.

Leptospirosis in man and rodents in North and Northeast Thailand.

A seroepidemiological study of leptospirosis in man and rodents in the North and Northeast Thailand revealed that 0.27% of the rural people from three different ecologic areas were positive. The positivity rate has dropped dramatically when compared to a previous survey (28%). Of 1,135 wild rodents studied, 42 of 365 (11.5%) B. indica and 50 of 676 (7.4%) R. rattus were serologically positive. Others were negative. Only two of 157 R. rattus had positive cultures in which L. javanica and L. autumnalis were isolated. The study shows that wild rats are naturally implicated in human disease as a common reservoir and that the yearly rat eradication campaigns attributed as one of the effective factors in a major reduction of disease to a level of non significant public health hazard.

Schistosoma incognitum and its zoonotic potential role in Phitsanulok and Phichit provinces, northern Thailand.

A study on Schistosoma incognitum, a blood fluke of a variety of mammals, was conducted in different ecological conditions in Phitsanulok and Phichit, northern Thailand. The intermediate host of S. incognitum in permanent water habitats studied, i.e; swamps and ditches is Radix (Lymnaea) auricularia rubiginosa. Of 44,412 mollusks representing 13 different species collected from 24 water habitats studied, 7,186 were R. a. rubiginosa. S. incognitum infection rate in the snails was 2.1%. 483 Rattus rattus, 8 R. argentiventer, 280 Bandicota indica and 65 B. savilei were found infected with S. incognitum with an overall infection rate of 41.7%. R. argentiventer and B. savilei are reported as new mammalian hosts of the parasite. Also, 3.9% of dogs in the study area were found excreting S. incognitum eggs in their stools for the first time. The possibility of S. incognitum as a zoonotic potentiality to humans is discussed and is still an equivocal issue deserving further study.

Seroepidemiology of amoebiasis in the villagers in Phichit Province and urban slum dwellers in Bangkok, Thailand.

A serological survey was conducted in the villages of Phichit Province, Northern region and in the urban slum communities in Bangkok to determine whether amoebiasis was endemic in the areas and to determine the prevalence rates. Six rural villages, ethnically and culturally alike with a population of 3,019 and two urban slums with a population of 1,510 were surveyed. Sera were tested for indirect hemagglutination antibody (IHA) to Entamoeba histolytica and the stools examined for the parasite by direct smear method. Positive IHA titres (greater than or equal to 1:128) were detected in 482 (11%) and 176 (20%) sera, and E. histolytica found in 639 (2%) and 208 (3%) stool specimens of rural and urban slum populations respectively. Out of a total of 88 persons who showed significant levels of IHA antibodies to E. histolytica antigen, 5 had E. histolytica cysts in their stool specimens. The survey confirmed, serologically and parasitologically, that amoebiasis is endemic in the lower socio-economic areas. Substandard living and sanitary conditions within the areas were considered responsible for the transmission of the disease.

Mass treatment of opisthorchiasis in Northeast Thailand.

In an attempt to control opisthorchiasis, a single dose of 40 mg/kg of Praziquantel was given to 666 people in the three villages of Nam Pong Water Resource Development Project, Khon Kaen, Northeast Thailand. The results showed a cure rate after 1 month was 95.9%. The side effect was minimized by alternation of the time of treatment from after breakfast to after dinner. The use of Praziquantel for the mass treatment in control of opisthorchiasis is possible. However, to achieve the objective of control programme other measures such as environmental sanitation improvement, health education and change in eating habits must be integrated into the programme.

Potential health hazards of the water resources development: a health survey in the Phitsanulok Irrigation Project, Nan River Basin, Northern Thailand.

A health survey was carried out among residents of 33 villages under the Phitsanulok Irrigation Project Area, Nan River Basin, Northern Thailand, whereby general health conditions were examined including intradermal tests for schistosomiasis japonica, stools for intestinal parasites and sera tested by circumoval precipitin test for antibodies to S. japonicum and by agglutination test for leptospiral infection. Health investigations revealed that 913 (60.9%) of 1,499 people examined had experienced gastro-intestinal disorders, 254 (17%) had poor oral hygiene and a few had mild anemia. 799 (62%) of 1,298 examined had intestinal parasites. Hookworm (45%) was most common, followed by Opisthorchis viverrini (20%), Entamoeba coli (10%), Ascaris lumbricoides (6%), intestinal flukes (2%), Enterobius vermicularis (1%) and Giardia lamblia (1%). 149 (10%) of 1,422 people gave positive skin reaction to crude S. japonicum antigen. Circumoval precipitin test was strongly positive in 7 (1.6%) persons out of 449 tested for schistosome infection and 6 (4.0%) out of 1,358 people were positive for leptospiral infection. The significant endemic diseases as potential health problems in this water resources development are discussed.