RESUMO
PURPOSE: To describe the clinical presentations and results of laboratory analysis of waterborne ophthalmic granulomas of the anterior chamber (AC) in Egyptian patients. PARTICIPANTS: 110 patients with granulomatous anterior uveitis and distinctive AC nodules. DESIGN: Prospective, non-comparative, case series. METHODS: Demographic data including age, gender and place of residence were recorded. A full ophthalmic examination with emphasis on the inflammatory characteristics and systemic workup was performed. The nodules were surgically removed in selected cases and molecular and histopathological analyses were performed. RESULTS: 102 boys and 8 girls were recruited (mean age 11.5 years). All children came from villages along the basin of the River Nile in Egypt and were engaged in swimming in the local fresh water repertoires just prior to the development of the ocular lesions. 99 patients (103 eyes) showed active granulomatous anterior uveitis with distinct pearl-like white nodules in the AC measuring between 2 and 7 mm in diameter. Inactive scarred lesions were noted in 11 patients (12 eyes). Structural complications including cataract, corectopia and phthisis were documented in 29 eyes. PCR detected digenic trematode DNA in 6 out of 14 excised nodules. Histopathological examination showed aggregates of eosinophils and epithelioid cell granulomas. CONCLUSIONS: In Egypt, a unique pattern of granulomatous anterior uveitis in rural children attributable to a waterborne helminthic infection is reported. The River Nile and its fresh water fauna are implicated in our series, and the need for an environmental investigation to further outline best management options in the given endemic areas is highlighted.
Assuntos
Infecções Oculares Parasitárias/diagnóstico , Granuloma/diagnóstico , Infecções por Trematódeos/diagnóstico , Uveíte Anterior/diagnóstico , Adolescente , Criança , Pré-Escolar , Egito/epidemiologia , Infecções Oculares Parasitárias/epidemiologia , Feminino , Granuloma/epidemiologia , Humanos , Masculino , Estudos Prospectivos , Rios , Saúde da População Rural , Microscopia com Lâmpada de Fenda/métodos , Natação , Infecções por Trematódeos/epidemiologia , Uveíte Anterior/epidemiologia , Adulto JovemRESUMO
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.