Identification of the Egyptian species of Fasciola.

Reports on the species of Fasciola present in the Nile Delta, Egypt, appear controversial. Some authors reported the presence of both Fasciola gigantica and Fasciola hepatica, others reported F. gigantica only and mentioned that F. hepatica was found only in imported animals. This study was an attempt to identify the species of Fasciola flukes collected from locally bred animals. Morphologic, morphoanatomic, morphometric, and chemotaxonomic criteria of the fluke isolates were studied. Speciation based on morphologic and morphometric data was not decisive due to overlap in the values of most measurements. Morphoanatomic data proved the presence of both the species, and isoelectric focusing (IEF) of fluke soluble protein confirmed the presence of both F. gigantica and F. hepatica in Egypt.

Intra-specimen and day-to-day variations of Fasciola egg counts in human stools.

Intra-specimen and day-to-day variations of Fasciola egg counts in stools were investigated for 16 cases of established fascioliasis. For each case six Kato slides from a single stool sample were examined daily for 5 consecutive days. The results indicated the presence of significant intra-specimen variations in more than one-third of the examined series, while the inter-specimen variation was almost negligible. The sensitivity of the Kato-Katz test for diagnosing Fasciola infection with three Kato slides from the same specimen or on different days ranged from 96.0%-99.1%. The examination of three Kato smears from a single stool specimen, which is more feasible in field studies, would give an accurate diagnosis of fascioliasis. Used as such, the Kato-Katz technique is highly sensitive in the diagnosis of fascioliasis.

Intra-specimen and day-to-day variations of Fasciola egg counts in human stools

Intra-specimen and day-to-day variations of Fasciola egg counts in stools were investigated for 16 cases of established fascioliasis. For each case six Kato slides from a single stool sample were examined daily for 5 consecutive days. The results indicated the presence of significant intra-specimen variations in more than one-third of the examined series, while the inter-specimen variation was almost negligible. The sensitivity of the Kato-Katz test for diagnosing Fasciola infection with three Kato slides from the same specimen or on different days ranged from 96.0%-99.1%. The examination of three Kato smears from a single stool specimen, which is more feasible in field studies, would give an accurate diagnosis of fascioliasis. Used as such, the Kato-Katz technique is highly sensitive in the diagnosis of fascioliasis

Detection of circulating E/S antigens in the sera of patients with fascioliasis by IELISA: a tool of serodiagnosis and assessment of cure.

An IELISA was developed to evaluate the performance of Fasciola E/S antigens in diagnosis and cure assessment of human Fasciola infection. Twenty patients with acute (prepatent) fascioliasis and another 20 with patent infection were enrolled in the study. Patients were treated with TCZ and followed at 1, 3 and 6 months after therapy. At inspection, the sensitivity of the test to diagnose prepatent cases was 100% compared to 70% for patent infections. There was a gradual decrease of antigenaemia over the follow-up period in acute cases. In chronic cases antigen disappeared from 13 cases (65%) at 1 month; this proportion did not change at 3 or 6 months.

Circulating antibodies and antigens correlate with egg counts in human fascioliasis.

We explored the relationships between specific IgG antibody levels and circulating E/S antigen to intensity of Fasciola infection in the human host. Twenty patients with patent infection and six healthy individuals were enrolled in the study. Intensity of infection was determined by repeated egg counts in stools, while IgG antibodies against adult Fasciola gigantica somatic FI, FII and against E/S antigens were measured as ELISA O.D. readings. The level of circulating E/S antigens was determined by IELISA. Positivity as well as levels of antibodies and antigen correlated with infection intensity. These findings may disclose in the future a relation between morbidity in the acute phase and worm load.

Triclabendazole in the treatment of human fascioliasis: a community-based study.

The efficacy of triclabendazole in the treatment of chronic Fasciola infection was assessed. A total of 134 asymptomatic cases of established Fasciola infection were treated: 68 individuals received a single dose of 10 mg/kg and 66 individuals received 2 doses of 10 mg/kg on 2 consecutive days. Cure was assessed 5 weeks after treatment and 79.4% of the first group and 93.9% of the second group were cured. The drug was well tolerated; no serious side-effects were noted. One patient developed biochemical cholestasis the third day after treatment, but her enzyme profiles returned to normal after 2 months. We conclude triclabendazole is a safe and potent fasciolicidic drug.

Schistosoma mansoni infection and cognitive functions of primary school children, in Kafr El Sheikh, Egypt.

There is growing concern that parasitic infection may detrimentally affect children's mental function. In this study our main objective was to investigate the effects of schistosoma mansoni infection on cognitive functions of school children aged 9-12 years in Kafr El Sheikh Governorate. Out of 2601 children screened parasitologically, 60.7% were S. mansoni positive. Children recruited for the case-control study were 40 with light S. mansoni infection (<100 epg), 40 with heavy infection (>400 epg) and 40 parasite-free served as control. All children were subjected to the Arabic Version of Wechsler Intelligence Scale for Children (WISC) and the Verbal Fluency Test. Though, the general IQ scores of infected children were insignificantly lower than their controls, yet they recorded a significantly lower performance IQ as well as, poorer performance on comprehension, vocabulary and picture completion subtests. Implications for preventive measures will be discussed.

Triclabendazole in the treatment of human fascioliasis: a community-based study

The efficacy of triclabendazole in the treatment of chronic Fasciola infection was assessed. A total of 134 asymptomatic cases of established Fasciola infection were treated: 68 individuals received a single dose of 10 mg/kg and 66 individuals received 2 doses of 10 mg/kg on 2 consecutive days. Cure was assessed 5 weeks after treatment and 79.4% of the first group and 93.9% of the second group were cured. The drug was well tolerated; no serious side-effects were noted. One patient developed biochemical cholestasis the third day after treatment, but her enzyme profiles returned to normal after 2 months. We conclude triclabendazole is a safe and potent fasciolicidic drug

Impact of National Schistosomiasis Control Program in Kafr El-Sheikh governorate, Nile Delta, Egypt: an independent evaluation.

A longitudinal study has been conducted (1991-1997) to evaluate the impact of repeated selective chemotherapy on human transmission indices of Schistosoma mansoni infection. The study population included 8370 individuals inhabiting four villages and their satellites and representing high and low S. mansoni endemicity communities in Kafr EI-Sheikh governorate. A parasitological survey was conducted for three successive years (1991-1992 and 1993). Each time infected received praziquantel (PZQ) chemotherapy. In 1997, a fourth parasitological survey was done. During the period from 1994-1996 only routine diagnosis and treatment of schistosomiasis offered by the Ministry of Health and Population (MOHP) was going on. Study results revealed a decrease in S. mansoni prevalence and intensity of infection in the first three years. The drop was marked after the first year. In 1997, after the cessation of active case finding and treatment by the project team, an upward trend was observed for both prevalence and geometric mean egg count (GMEC) especially for the high prevalence villages. However, all indices were kept at significant low levels as compared to base-line values in 1991.

Human chronic fascioliasis: hepatitis B and C among infected cases.

Sera from one hundred and fifty three chronic Fasciola cases were screened for the presence of HB markers (HBsAg, anti HBc and anti HBs) and anti HCV using ELISA technique. Quantitative stool examination and estimation of liver enzymes (AST-ALT-bilirubin) levels of the study population were performed. HBsAg was present in 5 (3.3%), anti HBs in 13 (8.5%), HBexposed (HBex) in 44 (28.8%) and anti HCV in 13 (8.5%) of examined sera. HBV and HCV markers were significantly higher among older age groups. Concerning familial aggregation of hepatitis markers, 7 (15.9%) of the 44 HBex cases had two individuals per family who had evidence of exposure to HBV. No significant change in Fasciola GMEC and liver function tests have been noticed.

Ecological determinants of intestinal parasitic infections among pre-school children in an urban squatter settlement of Egypt.

Population growth in Egypt has led to the creation of several urban squatter settlements. The aim of the present work was to study the prevalence and some potential risk factors of intestinal parasitic infections among preschool children in a randomly chosen urban squatter settlement in Alexandria, Egypt. A house to house cross-sectional survey was conducted during late 1995. Data were collected through questionnaire interview regarding socio-demographic and environmental conditions from 1324 families residing in the settlement. Stool samples were collected from 658 preschool children below 5 years of age and examined for intestinal parasites. Overall, the prevalence rates of infections with the intestinal Helminths and Protozoa were 47.3 and 31.5 per cent, respectively, which were very high compared to previously reported figures for this age group in Egypt. Multiple logistic regression analysis showed that certain groups of preschool children were much more likely to develop the infection with both groups of intestinal parasites. They included children over 2 years of age (OR = 2.75, 95 per cent CI = 1.23-4.12 and OR = 2.65, 95 per cent CI = 1.70-3.45 for Helminths and Protozoa, respectively), whose families had pools of sewage around houses (OR = 2.13, 95 per cent CI = 1.22-3.19 and OR = 2.83, 95 per cent CI = 1.45-3.95 for helminths and protozoa, respectively) and shared toilets with another family (OR = 1.95, 95 per cent CI = 1.38-2.75 and OR = 1.65, 95 per cent CI = 1.06-2.58 for Helminths and Protozoa, respectively). In addition, certain groups of children were much likely to develop protozoal infections including children whose families lacked tap water inside dwelling (OR = 1.85, 95 per cent CI = 1.26-2.77) and disposed human excreta in septic tank very close to the dwelling (OR = 2.17, 95 per cent CI = 1.43-3.75). Efforts to reduce intestinal parasites should focus on reducing exposures. Improvement in domestic water supplies with the introduction of piped sewerage system is likely to have a marked decreasing effect on the prevalence of infection among this age group.

Evaluation of the Kato-Katz thick smear and formol ether sedimentation techniques for quantitative diagnosis of Schistosoma mansoni infection.

The present study compared the Kato-Katz thick smear and formol ether sedimentation techniques in the diagnosis of Schistosoma mansoni infections. A stool specimen was collected from 915 individuals representing a high prevalence community (63.3%) and from 471 individuals representing a relatively low prevalence village (40%). The overall sensitivity of a single Kato-Katz smear was 70.8%, and it increased with each additional slide to reach 91.7% on examining four smears. However, the sensitivity was 83.3% when using the formol ether sedimentation technique. In terms of quantitative analysis, the geometric mean egg count was 94 eggs per gram (epg) of stool by two Kato-Katz smears, and 43 epg by the sedimentation technique. This means that more than 50% of eggs were missed when using the sedimentation technique, a fact that should be taken into consideration when relating infection level with morbidity.

Circulating anodic antigen for detection of Schistosoma mansoni infection in Egyptian patients.

We evaluated the ability of circulating anodic antigen (CAA) to identify infection with Schistosoma mansoni in a prospective cohort study of 257 Egyptian men, 147 with infection diagnosed by repeated Kato thick smears, and 110 without detectable infection. The CAA levels were obtained and the stool examinations were performed two weeks and one, two, four, and six months after praziquantel therapy for infected men. A CAA enzyme-linked immunosorbent assay was repeated twice on subjects who were otherwise negative for schistosomiasis. Circulating anodic antigen was detected in 117 cases, with an overall test sensitivity before treatment of 0.8. Sensitivity was related to the intensity of infection, ranging from 1.00 with > 400 eggs per gram (epg) of feces to 0.60 for those with < 100 epg. After praziquantel therapy, the level of the antigen was significantly reduced. Specificity was excellent before treatment (1.00, 95% confidence interval = 0.97-1.0), but it decreased to 0.98 four months after treatment. Likelihood ratios were significant for all titers > or = 4. We conclude that CAA has moderate sensitivity and excellent specificity when used to identify infection with schistosomiasis, as well as to monitor the results of therapy after at least one month after treatment.

Human fascioliasis in an Egyptian village: prevalence and some epidemiological determinants.

A cross-sectional survey was conducted in Abis area, 15 kilometers south east of Alexandria city, to determine the prevalence of human fascioliasis and to study some of the epidemiological determinants which may affect the infection. A specially designed questionnaire interview was completed, and a total number of 3475 stool samples were examined. The results revealed a prevalence rate of fascioliasis of 11% in the studied area which was only second to S. mansoni. The prevalence of infection was significantly higher among females in general and specifically in the age group 5 to less than 15 years and 25 to less than 35 years. Family aggregation of fasciola infection was noticed among the studied group. The prevalence and also the risk of infection were significantly higher among children whose mothers were infected. They were, however, insignificantly higher among illiterate, single males, and low social class group. In addition, the prevalence and risk of infection were significantly higher among individuals obtaining their raw green leafy vegetables from multiple sources. From the results it was concluded that human fascioliasis is an important public health problem in Abis area with increased risk of spread of infection to Alexandria city through raw green leafy vegetables which represent the main source of infection.