Eczema in North West of Libya

The life style and demographic structure of Libyan society is changing; and this could affect the epidemiology of certain diseases; including eczema. The aim of this study was to assess the burden of eczema among a selected patient population in the Zliten area in the northwest of Libya. We conducted a retrospective study by reviewing case notes and records in public and private dermatology practices in the Zliten area. The frequency of eczema among patients attending dermatology clinics in the Zliten area was 12.8; and the male to female ratio was almost 1:1. The most affected age group among patients was 20-29 years. Eczema represented a larger proportion of dermatologic conditions during spring and summer. Of all cases of eczema; 72.6were endogenous and 24.9were exogenous (p0.001). The most common type of eczema was contact dermatitis (22.7of all cases); followed by atopic dermatitis (19.7) and pityriasis alba (10.5). In conclusion; eczema is a public health problem in Zliten-Libya; and this necessitates prospective studies to determine its incidence and prevalence

IgG-subclass antibody responses and the natural history of hepatic cystic echinococcosis in asymptomatic patients.

Given that cystic echinococcosis (CE) is a serious clinical problem in endemic countries, there is still relatively little information available on the natural history of the human disease. The aim of the present study was to correlate serological status with pathology, in ultrasound-characterised, asymptomatic cases of human CE. Serum concentrations of IgG reacting with antigen B from cyst fluid and of similarly specific IgG1, IgG2, IgG3 and IgG4 were determined by ELISA and further investigated by immunoblotting. CE cases with simple cysts (Type I), or cysts with clear laminations and daughter cysts (Types II and III) exhibited elevated IgG4 seropositivity, whereas concentrations of specific IgG1 and IgG4 declined in CE cases characterised by cyst infiltration or calcifications (Types IV and V). The responses of each specific IgG subclass were used, in association with an ultrasound classification, to try to develop an immunoserological natural-history profile of CE in asymptomatic patients. Specific IgG4 antibody responses were particularly associated with the evolutive phase of CE (Types I, II and III), whereas the IgG1, IgG2 and IgG3 responses tended to be associated with the involutive phase (Types IV and V). These results indicated that an IgG4 antibody response was associated with (or was a marker for) cystic development, growth and disease progression, whereas the IgG1, IgG2 and IgG3 responses occurred predominantly when cysts became infiltrated or were destroyed by the host. The findings support the view that evolutive and subsequent involutive phases occur in untreated CE.

IgG1 and IgG4 serum antibody responses in asymptomatic and clinically expressed cystic echinococcosis patients.

IgG1 and IgG4 subclass antibody responses were investigated in two clinically different groups of hepatic cystic echinococcosis (CE) patients. One group consisted of surgically proven CE cases (clinically expressed hospitalized cases) and a second group comprised asymptomatic CE patients (first time community detected cases) diagnosed by portable ultrasound and serology in four different endemic communities. Fifty eight sera from surgically proven CE patients and 133 sera from asymptomatic ultrasound diagnosed CE cases were screened by ELISA using purified human hydatid cyst fluid antigen B for total specific IgG, IgG1 and IgG4 antibodies. Fifty sera from healthy individuals from within endemic regions were used as control negatives. Compared to control negatives total IgG antibody levels were elevated in both surgically proven (85%) and asymptomatic CE cases (77%) but there was no significant difference between the two groups. IgG1 subclass antibody levels were also elevated in both surgically proven (55%) and asymptomatic cases (58%) compared to endemic controls and similarly the difference in this response was not significant between these two groups. In contrast the prevalence of IgG4 antibodies in surgically confirmed chronic CE patients was greater (71%) than the respective IgG1 antibody levels (55%). The greatest difference in specific antibody response, between advanced surgically confirmed CE patients and ultrasound detected asymptomatic CE cases, was observed for IgG4 antibody levels which were detected in 71% of symptomatic compared to only 23% of asymptomatic patients (P < 0.0001). These observations confirm that IgG4 is an important diagnostic parameter for clinically expressed cystic echinococcosis in humans and suggest that a switch from a predominant IgG1 response to IgG4 might occur in CE patients as the disease progresses.

Immunoblot evaluation of the 100 and 130 kDa antigens in camel hydatid cyst fluid for the serodiagnosis of human cystic echinococcosis in Libya.

Two high molecular weight antigens with molecular masses approximately 100 kDa and 130 kDa were identified by immunoblotting camel hydatid cyst fluid, with 94% sensitivity in sera from surgically confirmed Libyan cystic echinococcosis cases. 40% of sera from surgically confirmed alveolar echinococcosis cases cross-reacted with the 100 and 130 kDa antigens, as did 5.3% of sera from human Taenia solium cysticercosis patients. No cross-reaction occurred with sera from human schistosomiasis mansoni or onchocerciasis patients. In addition, all sera from patients with non-hydatid space-occupying lesions (i.e. simple liver cysts, kidney cysts, lung tuberculosis, pulmonary carcinoma, pulmonary empyema, and lung abscess) were seronegative against the same antigens, as were control serum samples from healthy individuals. The 100 and 130 kDa antigens were strongly recognized by sera from cystic echinococcosis patients when camel or horse hydatid cyst fluid was used in immunoblotting but were only weakly recognized if sheep or human hydatid cyst fluid was used. Camel hydatid cyst fluid could be an important source of diagnostic antigens for human cystic echinococcosis in the Middle East endemic region.

Prevalence of human hydatid disease in northwestern Libya: a cross-sectional ultrasound study.

A total of 4103 people were screened in an ultrasound survey of the prevalence of hydatid disease (Echinococcus granulosus) in five areas of northwestern Libya; hydatid cysts were seen in 57 (1.4%), an overall prevalence of approximately 2.0% when adjusted for the likelihood of the occurrence of cysts in other sites in the body. All ultrasound-positive cases were confirmed by dot-blot ELISA. The prevalence of hydatid cysts increased with age, and differed between the sexes except in the five to 14 age group. All diagnosed cases, even those with large cysts, were asymptomatic. This study demonstrates the value of ultrasonography for screening field populations for hydatid disease. The technique was well received locally, facilitating the rapid collection of prevalence data from all ages and both sexes. Libyan people keep guard dogs, but there is little direct human:dog contact. Many people own a single dog, invariably kept outside and often chained up. Stray dogs are common, roaming the countryside to scavenge sheep carcases etc., and such dogs could be the main reservoir of E. granulosus in Libya. Because of the minimal direct human:dog contact, transmission of hydatid disease in Libya is probably indirect by ingestion of eggs from contaminated vegetables or drinking water.