Cryptosporidium species in HIV patients in Alexandria, Egypt: distribution and associated clinical findings.

Cryptosporidium sp. cause opportunistic infections in HIV patients. Molecular differentiation provides a better understanding of the epidemiology and clinical variations of cryptosporidiosis. The present work studied the species of Cryptosporidium in HIV patients and their associated demographic and clinical features. The study included 100 adult HIV patients receiving antiretroviral therapy in Egypt. Cryptosporidium infection was diagnosed by modified Ziehl- Neelsen (MZN) stain and PCR amplification of COWP gene. The infecting species were molecularly identified by restriction fragment length polymorphism (RFLP) and DNA sequencing. Data were analyzed using Kappa ( K) agreement, Mann-Whitney U, odds ratio and the 95% confidence interval, Chi-squared and Monte Carlo significance (MCp) tests. The statistical significance was judged at the 5% level. A total of 16 Cryptosporidium positive cases were detected (16%), with good agreement between PCR and MZN ( K = 0.763). Among 11 PCR positive samples, RFLP identified C. hominis in five samples, C. parvum in three samples, C. meleagridis in two samples, and mixed C. hominis and C. meleagridis in one sample. Eight samples were successfully sequenced and the results confirmed the RFLP classification. C. hominis was found mainly in urban residents while C. parvum and C. meleagridis were significantly associated with rural areas (MC p =0.01). Diarrhoea and nausea/vomiting were recorded only in the presence of C. hominis infection while abdominal pain was the main symptom in C. parvum and C. meleagridis infections. Drinking water sources, contact with animals, and CD4+ count were not related to infection with a particular species. In conclusion, infection with Cryptosporidium sp. is common and frequently symptomatic in HIV patients in Egypt. The predominant species, C. hominis, C. parvum, and C. meleagridis show a distinct distribution in urban and rural residents.

Cryptosporidium species in HIV patients in Alexandria, Egypt: distribution and associated clinical findings

@#Cryptosporidium sp. cause opportunistic infections in HIV patients. Molecular differentiation provides a better understanding of the epidemiology and clinical variations of cryptosporidiosis. The present work studied the species of Cryptosporidium in HIV patients and their associated demographic and clinical features. The study included 100 adult HIV patients receiving antiretroviral therapy in Egypt. Cryptosporidium infection was diagnosed by modified ZiehlNeelsen (MZN) stain and PCR amplification of COWP gene. The infecting species were molecularly identified by restriction fragment length polymorphism (RFLP) and DNA sequencing. Data were analyzed using Kappa (K) agreement, Mann–Whitney U, odds ratio and the 95% confidence interval, Chi-squared and Monte Carlo significance (MCp) tests. The statistical significance was judged at the 5% level. A total of 16 Cryptosporidium positive cases were detected (16%), with good agreement between PCR and MZN (K = 0.763). Among 11 PCR positive samples, RFLP identified C. hominis in five samples, C. parvum in three samples, C. meleagridis in two samples, and mixed C. hominis and C. meleagridis in one sample. Eight samples were successfully sequenced and the results confirmed the RFLP classification. C. hominis was found mainly in urban residents while C. parvum and C. meleagridis were significantly associated with rural areas (MCp =0.01). Diarrhoea and nausea/vomiting were recorded only in the presence of C. hominis infection while abdominal pain was the main symptom in C. parvum and C. meleagridis infections. Drinking water sources, contact with animals, and CD4+ count were not related to infection with a particular species. In conclusion, infection with Cryptosporidium sp. is common and frequently symptomatic in HIV patients in Egypt. The predominant species, C. hominis, C. parvum, and C. meleagridis show a distinct distribution in urban and rural residents.

The epidemiology of schistosomiasis in Egypt: Assiut governorate.

In the Assiut, Egypt Epidemiology 1, 2, 3 investigation, a sample of 14,204 persons in 10 villages, 31 ezbas (satellite communities), and 2,286 households was drawn from a rural population of 1,598,607. Parasitologic examination of urine and stool were made for Schistosoma haematobium and S. mansoni, and physical and ultrasound examinations were made on a 20% subsample. The overall estimated prevalence of S. haematobium was 5.2 +/- 0.5 (+/- SE). This varied considerably by village and ezba, ranging from 1.5% to 20.9%, with ezbas having a slightly higher overall prevalence than villages. The overall estimated geometric mean egg count was 6.6 +/- 0.5 eggs per 10 ml of urine and was consistently low throughout the communities. Infection with S. haematobium was associated with age (peak prevalence of 10.6 +/- 1.5% in 15-19-year-old age group) males, children playing in the canals, a history of blood in the urine, and reagent strip positivity for hematuria and proteinuria. The prevalence of either hepatomegaly or splenomegaly detected by physical examination was low (4.0% and 1.5%, respectively). The prevalence of hepatomegaly determined by ultrasonography was substantially higher, 24.1%. The prevalence of periportal fibrosis (PPF) was 12.0%, but grade II or III PPF was present in less than 1%. Ultrasonography-determined hepatomegaly, in both the midclavicular line and the midsternal line, increased by age to more than 30%. Periportal fibrosis was more common in the age groups in which infection rates were the highest. At the village and ezba level of analysis, the prevalence of hepatomegaly, splenomegaly, and PPF tended to be higher in communities having the highest prevalence of infection with S. haematobium.

The epidemiology of schistosomiasis in Egypt: Qena governorate.

Qena is the southernmost governorate of Egypt included in the Epidemiology 1, 2, 3 national study. A probability sample selected 17,822 individuals from 2,950 households in 34 ezbas and 10 villages from a total rural target population of 1,731,252 (based on the most recent 1986 census of the population by the Egyptian Central Agency for Public Mobilization And Statistics). Parasitologic examination of urine and stool were made for Schistosoma haematobium and S. mansoni, respectively, and physical and ultrasound examinations were made on a 20% subsample. The overall estimated prevalence of S. haematobium was 4.8 +/- 0.7% (+/-SE) and geometric mean egg count (GMEC) was 7.0 ova per 10 ml of urine. Considerable variation in prevalence was observed between the villages and ezbas, ranging from 0.0% to 20%, with the smaller ezbas having a slightly higher overall prevalence. The age- and sex-specific patterns of S. haematobium showed typical peak prevalence in early adolescence, with males having a higher prevalence than females. A history of hematuria was associated with current infection (odds ratio = 3.6, 95% confidence interval = 2.32-5.63). Hepatomegaly and splenomegaly determined by physical examination present in 7.9% and 3.0%, respectively. Ultrasonography-determined hepatomegaly of the left liver lobe was found in 10.1%. Ultrasonography-detected hepatomegaly in both the left and right lobes increased in prevalence from approximately 5% in children to 15-20% in adults. The prevalence of ultrasonography-detected splenomegaly increased slightly with age. Grade III periportal fibrosis was detected in only 2 individuals in the sample. Bladder wall lesions and obstructive uropathy were also very infrequent. Other associations with these measures are given. Most villages and ezbas had an S. mansoni prevalence of less than 1%. The exception was Nag'a El-Sheikh Hamad, where the prevalence was 10.3 +/- 0.5% (GMEC = 57.4 +/- 2.6). Two other communities also had a prevalence >1% (Ezbet Sarhan and Kom Heitin).

The epidemiology of schistosomiasis in Egypt: summary findings in nine governorates.

Health questionnaires and parasitologic examinations of urine and stool were evaluated from a stratified random sample of 89,180 individuals from 17,172 households in 251 rural communities in 9 governorates of Egypt to investigate the prevalence of, risk factors for, and changing pattern of infection with Schistosoma sp. in Egypt. A subset, every fifth household, or 18,600 subjects, had physical and ultrasound examinations to investigate the prevalence of and risk factors for morbidity. Prevalence of S. haematobium in 4 governorates in Upper Egypt in which it is endemic ranged from 4.8% to 13.7% and averaged 7.8%. The geometric mean egg count (GMEC) ranged from 7.0 to 10.0 ova/10 ml of urine and averaged 8.1. Age stratified prevalence of infection peaked at 15.7% in the 10-14-year-old age group and decreased to 3.5-5.5% in all groups more than 25 years of age. Age-stratified intensity of infection peaked at approximately 10.0 ova/10 ml of urine in the 5-14-year-old age groups and was about half that in all groups more than 25 years of age. Males had higher infection rates and ova counts than females in all age groups. Schistosoma mansoni was rare in Upper Egypt, being consequential in only Fayoum, which had a prevalence of 4.3% and an average intensity of infection of 44.0 ova/g of stool. Risk factors for S. haematobium infection were male gender, an age <21 years old, living in smaller communities, exposures to canal water; a history of, or treatment for, schistosomiasis, a history of burning micturition or blood in the urine, and reagent strip-detected hematuria or proteinuria. The more severe grades (II and III) of ultrasonography-detected periportal fibrosis (PPF) were rare (15 of 906) in these schistosomiasis haematobia-endemic governorates. Risk factors for morbidity (ultrasonography-detected urinary bladder wall lesions and/or obstructive uropathy) were similar to those for infection, with the exception that risk progressively increased with age. Subjects with active S. haematobium infections were 3 times as likely as those without active S. haematobium infections to have urinary tract morbidity. The prevalence of S. mansoni in 5 governorates in Lower Egypt, where it is endemic, ranged from 17.5% to 42.9% and averaged 36.4%. The GMEC ranged from 62.6 to 93.3 eggs/g of stool and averaged 81.3. Age-stratified prevalence of infection peaked at 48.3% in the 15-19-year-old age group, but averaged 35-45% in all groups more than 10 years of age. The intensity of infection was highest in the 10-14-year-old age group, and showed a range of 70-85 eggs/g of stool in those > or =5 years of age. Males had higher infection rates and ova counts than females in all age groups. Schistosoma haematobium was rare in these governorates; Ismailia (1.8%) had the highest infection rate. Risk factors for S. mansoni were male gender, an age >10 years old, living in smaller communities, exposures to canal water, a history of, or treatment for, schistosomiasis or blood in the stool, detection of splenomegaly by either physical examination or ultrasonography, and ultrasonography-detected PPF. The more severe grades (II and III) accounted for 463 (13.3%) of the 3,494 having ultrasonography-detected PPF. Risk factors for morbidity (ultrasonography-detected PPF) were similar to those for infection except that inhabitants of smaller communities were not at increased risk. Active S. mansoni infection increased the odds ratio (OR) of having PPF by 1.37. In comparison with others with normal-size livers, subjects having hepatic enlargement in either the midclavicular line or the midsternal line detected by physical examination or ultrasonography had a reduced risk (ORs = 0.64-0.72) of PPF. The prevalences of lesions detected by ultrasonography were 23.7% for enlargement of right lobe of the liver, 11.3% for enlargement of left hepatic lobe, 20.6% for splenomegaly, and 50.3% for PPF. Schistosoma mansoni has almost totally replaced S. haematobium in Lower E

Use of polymerase chain reaction to simultaneously detect and type bovine viral diarrhoea viruses isolated from clinical specimens.

The techniques of indirect immunofluorescence (IF), immuno-peroxidase (IP) staining and the one-step reverse transcriptase polymerase chain reaction (RT-PCR) were compared for detection of 102 isolates of bovine viral diarrhoea virus (BVDV) in infected cell cultures. The BVDV was obtained from bovine clinical specimens, including sera, buffy coats and tissues, submitted from farms located in the States of Iowa and Wisconsin, United States of America. The IF technique detected 88/102 (86.3%) of the viral isolates, whereas IP staining detected an additional 4 isolates (92/102; 90%). The one-step RT-PCR using primers derived from the 5' untranslated region of the BVDV genome detected 102/102 (100%) of the BVDV isolates. A second-round PCR utilising another pair of PCR primers from the 5' untranslated region, allowed rapid genotyping of BVDV. The procedure used showed that the PCR assay based on the 5' untranslated region of the virus genome is the most sensitive indicator for BVDV detection in cell culture, and is also of considerable epidemiological importance since it allowed rapid genotyping of BVDV isolated from clinical specimens. In addition to detection and genotyping of BVDV isolated from clinical specimens, the RT-PCR procedure can be used for routine screening of locally produced and imported biologicals for BVDV contamination. However, the procedure requires further refinement to enable direct application on the clinical specimen.

Colorectal cancer in Egyptian patients under 40 years of age.

Although colorectal cancer is not a common cancer in Egypt, the age distribution of the disease shows that a high proportion occurs in children and adults under 40 years of age. We reviewed the records of 1,608 colorectal cancer patients treated in 4 cancer hospitals in Egypt during a period of 3 to 10 years. The hospitals in which about 85% of all colorectal cancer cases in Egypt were seen included Egypt's 2 major cancer centers, The National Cancer Institute (NCI) in Cairo and Tanta Cancer Center (TCC) in the mid-Nile Delta region, and 2 major university hospitals, Assiut University in South Egypt and Ain Shams University in Cairo. Our review showed that patients younger than 40 years represented 35.6% of all patients in the 4 cancer hospitals, and that these rates were similar among the hospitals and for the years reviewed. The male-to-female ratio increased from 1.0 to 1.7 for the age groups ranging from 0-9 and 30-39 years, and increased from 1.0 to 1.5 for the age groups ranging from 40-49 to over 60 years. More than half of all the patients had rectal tumors, and about 90% of the cancers were adenocarcinomas; 30.6% of patients younger than 40 years, compared with 13.8% of older patients, had mucin-producing tumors. This study confirmed the occurrence of a high colorectal cancer rate in young Egyptians, and it opens the door to future epidemiologic studies to identify causes and risk factors of this disease pattern in Egypt.

Study of noise, hearing impairment and hypertension in Egypt.

This study included 295 workers of Assiut Generation Station (Upper Egypt). Two hundred and twenty-one of the workers were exposed to different levels of noise (80 to 107 dBA) and the remaining 74 were used as a control group. There were no significant differences in risk factors viz age, duration of work, body mass index, weight, height, smoking, and previous work as determined by a questionnaire. The relationship between occupational exposure to noise, the degree of hearing loss and hypertension was determined. The results showed that there were statistically significant differences between the average hearing threshold levels of the two groups (P<0.01) which were more in those workers exposed to noise than in the control group. The mean systolic and diastolic blood pressures were also statistically significantly different in the two groups (P<0.001) and they were positively correlated (P<0.001) to the percentage of impairment of the whole body at 74 and 6 kHz, and hearing disability at 0.5, 1, 2 and 3 kHz. Stepwise multiple regression analysis revealed that age, noise level and body weight could each be used as a predictor of hypertension. A predictive formula was derived between the amount of hearing loss and blood pressure in the subjects exposed to occupational noise.

Relationship between pure Schistosoma haematobium infection in Upper Egypt and irrigation systems. Part 1: methods of study.

Four villages in Assiut Governorate were studied. They were matched for availability and time of introduction of medical services, the size of population and the socioeconomic status. One village had a basin system of irrigation. The other three villages had perennial irrigation introduced at different dates. A sketch map of each village was made showing the location of every house and the irrigation channels. Total coverage was intended in Gezirat El-Maabda (with basin irrigation) and Nazza Karar (with perennial irrigation-recently introduced). In El-Ghorayeb and Garf Sarhan (with older systems of perennial irrigation) systematic random samples were studied. The Study included a full, double check clinical examination of urine and stools samples and a social study. Data about educational level and activities that bring the individual in contact with canal water were recorded. Tables showing the age and sex distribution of the total population and the population studied in each village are presented and show validity of the samples taken from the population.

Relationship between pure Schistosoma haematobium infection in Upper Egypt and irrigation systems. Part II: Host characteristics. The general prevalence of Schistosoma haematobium, age and sex distribution.

The epidemiology of bilharziasis was studied in four villages in Assiut Governorate. These villages were almost similar with respect to their socioeconomic conditions, modes of living, availability and date of introduction of medical services. The first village, Gezirat El-Maabda, has a basin system of irrigation. The other three villages had shifted to the perennial system of irrigation for three years in Nazza Karrar, 26 years in El-Ghorayeb and 95 years in Garf Sarhan and were similar with respect to proximity to water courses. So the only variable of importance between the four villages was the mode of irrigation. Bilharziasis was diagnosed by detection of eggs in urine or faeces. A definitive relationship between the prevalence of S. haematobium infection and the type of irrigation system was further documented. A low prevalence was found in Gezirat El-Maabda (2.95%). In the other three villages a much higher prevalence existed (31.9%, 46.2% & 38.9% in Nazza Karar, El-Ghorayeb and Garf Sarhan respectively). The higher prevalence of S. haematobium in Nazza Karar (31.9%) only three years after introduction of perennial irrigation was a disappointing finding. It can be considered as an evidence against the elaborate measures and precautions planned and incompletely implemented before or after the establishment of Aswan High Dam. Not a single case of S. mansoni was encountered during this study. As regards the age and sex distribution of S. haematobium in the three villages irrigated perennially, a steep rise started at the age group 5-9 years reaching a peak at the age group 10-14 years. In Gezirat El-Maabda the peak was reached at later age (15-19 years). The cause of this difference was explained. Males showed a higher rate of infection than females in almost all age groups of the four village studied.

Relationship between pure schistosoma haematobium infection in Upper Egypt and irrigation systems. Part III: Host characteristics. The prevalence of S. haematobium in relation to religon, occupation, and habits.

Study of the effect of religion on the prevalence of S. haematobium infection revealed that ablution and other Muslims rituals do not represent an important factor in the prevalence of S. haematobium. Data concerning the effect of education on the prevalence of S. haematobium show that it has no significant role when similar age groups were compared. Farming was shown to be the occupation of leading importance with rest to exposure to S. haematobium infection, as farmers and farm labourer constitute a large sector of our rural population. Finishing, although forming a greater danger in this respect, is not a common occupation in the studied villages with the exception of El-Ghorayeb. The study showed that swimming in canal water is one of the most important activities causing infection with bilharziasis.

Study of the pattern of Widal test in infants and children. III. Effect of T.A.B., diphtheria tetanus, pertussis and measles vaccinations on the level of enteric fever agglutinins.

Widal test was done before and 15 days after the last dose of T.A.B. (33 Children) Diphtheria (13) Tetanus (16), Pertussis (7) and Measles (7) vaccinations. The tremendous rise of Widal agglutinin titers after T.A.B. vaccination could not foul up the results of the Widal test if we follow closely the suggested diagnostic Widal criterion combining a titer of 1/80 or more for "O" and 1/60 or more for one"H" agglutinin with the other "H" agglutinins at a lower titer.

Study of the pattern of Widal test in infants and children. I. Pattern of Widal test among apparently normal infants and children.

690 apparently normal infants and children from Assiut-Upper Egypt--were submitted to Widal test. They were 0-15 years old, of both sexes (382 males and 308 females) and from both the urban and rural localities (433 and 257 respectively). --The frequency of single agglutinin titers is discussed. --The dual Widal titer combining "O" agglutinin in a titer of 1/40 or more with "H" agglutinin 1/80 or more, was fulfilled by 252 (36.5%) :-- A--106 (15.3%) showed a simultaneous rise of T."H", paratyphi A "H" and paratyphi B "H" agglutinins suggesting an effect of recent previous T.A.B. vaccination. B--146 persons (21.1%), showed a rise of only one or two "H" agglutinins, probably an effect of natural exposure to enteric fever agents reflecting the endemicity of infection. Further study of this group revealed: 1--There is a past experience with a single enteric fever agent in 63 persons (9.1%) with the following order of frequency : S.typhi (5.2%), S. paratyphi A (2.9%) and S. Paratyphi B. (1.01%). 2--The distribution of the group with rise of only one or two "H" agglutinins, by age, sex and locality is discussed. Apparently there is an initial high rate in the first year of life that declines in the age group 1--5 years to increase in the age group 6--9 years and the older age groups.

Study of the pattern of Widal test in infants and children; II. Pattern of Widal test in children with enteric fevers. An attempt to define the diagnostic titer for upper Egypt.

The study embodied 45 children with enteric fevers proved by bacteriological culture of blood, stools and urine and 20 children with rheumatic fever. Widal test was done for the rheumatic fever cases and was done repeatedly at weekly intervals for the enteric fever cases. The clinical features of children with enteric fevers was discussed. By contrasting the results of Widal test in children with enteric fever with the results in apparently normal infants and children from the same locality, a minimal diagnostic dual Widal titer was suggested. This combines "O" agglutinin in a titer of 1/160 provided that the other "H" agglutinins are at a lower titer. This suggested diagnostic titer improved the specificity of Widal test. This titer is encountered only in 0.58% of normal individuals and in none of 20 children with rheumatic fever. This titer also yielded an excellent sensitivity to diagnose actual enteric fever cases reaching up to 93.3%. Bacterial isolates from enteric fever cases were S. typhi in 55.5%, S. paratyphi A in 33.3% and S. paratyphi B in 11.1%. Chloramphenicol therapy resulted in a higher cure rate and a more rapid defervescence than ampicillin therapy. Regarding the effect of these antibiotic therapies on the rise of Widal agglutinin titers in children with enteric fevers there are two observations : 1--A four fold rise, is uncommon. A two fold rise is the common finding. 2--There is no consistent difference between chloramphenicol and ampicillin as regards their effect on the rise of agglutinin titers.