Is Schistosoma mansoni replacing Schistosoma haematobium in the Fayoum?

Schistosoma mansoni is progressively replacing S. haematobium along the Nile River in Egypt. This change has occurred in the past 15-20 years following construction of the Aswan High Dam in the 1960s. The cause is a shift in relative abundance of the snail vectors Biomphalaria alexandrina and Bulinus truncatus. Biomphalaria is increasing while the latter has disappeared from a village in the Fayoum where formerly only schistosomiasis haematobia was endemic. A cross-sectional household survey in this village in 1991 showed the following prevalence values: S. mansoni, 22.3%; S. haematobium, 3.4%; and mixed infections, 2.8%. Only two children less than 10 years of age had S. haematobium infections. A review of the local Ministry of Health records showed that 1) both species were parasitologically diagnosed during the past 7.5 years, 2) Biomphalaria had been abundantly present in the local waterways for the past 10 years and has been found infected with S. mansoni since 1985, 3) Bulinus has not been detected in the local canals and drains since 1986 and the few found between 1981 and 1985 were not infected, and 4) Biomphalaria in this village and in two others in the Fayoum were believed infected by laborers from the Delta who helped build schools in 1984. This change in the distribution of schistosomiasis will impact upon public health and medical practice in Middle and Upper Egypt as it already has in Lower Egypt.

Studies on liver profile after prolonged praziquantel courses for schistosomiasis mansoni in Egyptian children on a field level.

The effect of prolonged praziquantel courses on the clinical, sonographic and functional aspects of the liver in bilharzial and nonbilharzial school-children on village level was investigated in this study. Bilharzial--positive school--children were divided into three groups according to Praziquantel regimes. Each case received an initial dose of 40 mg/Kg. PZQ. Subsequently the first group received 6-monthly full dose, the second group received 3-monthly half doses and the third group received monthly half doses. Another 3 groups of bilharzial negative children were used as a control receiving oral vitamin B complex as placebo. Clinico-parasitological and sonographic examinations as well as liver function tests were done before and after drug administration. It was concluded according to our results that healing of hepatic pathology was slower than parasitological cure. Moreover complete reversibility of hepatic size required frequent praziquantel doses (from 3 to 7). Hepatic healing is dose related. Less doses are required for parasitological cure.

Progress in the control of schistosomiasis in Egypt 1985-1988.

Continuing epidemiological evaluation of schistosomiasis intervention measures applied in Middle and Upper Egypt since 1985 indicate that a large measure of control of Schistosoma haematobium has been achieved in relation to both prevalence and intensity of the infection and incidence of new infections. Transmission control has, however, been inadequate in many areas, since numerous re-infections occurred in treated schoolchildren. Variable compliance rates in the chemotherapy delivery system were probably, in part, an important contributory factor, and short-comings of the selective and/or focal mollusciciding strategy were also probably responsible for many new cases and re-infections. Chemotherapy delivery has now been improved following the introduction of single dose treatments with praziquantel and it is expected that there will be an increased demand for treatment following the introduction of a new information-education-communication campaign. In communities with geometric mean egg-output of less than 50 per 10 ml of urine, acceptable control of the potential for development of schistosomal disease can be expected. It is concluded, therefore, that the future maintenance control strategy in this project area may call for more frequent chemotherapy treatments in identified foci of high prevalence and intensity, with complementary focal mollusciciding and/or targeted treatment of schoolchildren, in order to prevent the serious consequences of infection. In 1988 the annual cost of schistosomiasis control measures per person throughout the project area (2 million irrigated feddans (c .800,000 hectares] containing 12 million people) was 0.5 Egyptian pounds (LE) (US$ 0.20), representing 5.2% of the annual expenditure per person in Egypt (LE 9.6) for all health services.

1983 Nile Delta schistosomiasis survey: 48 years after Scott.

To determine whether the sharply declining Schistosoma haematobium infection rates in parts of the Nile Delta could be generalized to the entire region, and to update the status of S. mansoni infection rates, a large scale survey was undertaken in 1983 in 70 of the 71 districts of the Nile Delta. In a house-to-house survey, greater than 91% of the sample population of 16,675 participated by providing stool and/or urine specimens which were examined qualitatively by Kato thick smear and sedimentation techniques, respectively. After the 1935 survey by Scott, the prevalence of S. mansoni appeared to change little, from 33% in 1935 to 39% in 1983, but a more sensitive diagnostic technique in 1983 strongly suggested that the actual prevalence had decreased between the 2 surveys. In contrast, the prevalence of S. haematobium infection decreased from 56% to 5%, with a similar decline in all 8 governorates. The dramatic decline in S. haematobium prevalence has been accompanied temporally with a sharp decrease in the population density of Bulinus truncatus. S. mansoni has become the predominant human schistosome species in the Nile Delta.