Cryptosporidium gastroenteritis in Egyptian children with acute lymphoblastic leukemia: magnitude of the problem.

PURPOSE: Cryptosporidium species is considered to be an important cause of significant morbidity in immunocompromised individuals. A prospective case-control study of sporadic diarrhea due to Cryptosporidium infection was conducted on children with acute lymphoblastic leukemia (ALL). METHODS: Forty children with ALL on maintenance chemotherapy according to the Berlin-Frankfurt-Munster (BFM-90) protocol and 45 sex- and age-matched controls were studied. The ALL group included 25 patients with acute diarrhea and 15 without diarrhea, and the control group included 30 children with acute diarrhea and 15 without. Collected stool specimens were examined using modified Ziehl-Neelsen (MZN) and modified trichrome stains. Serum Cryptosporidium Parvum immunoglobulin G (IgG) antibodies were detected by enzyme-linked immunosorbent assay. RESULTS: Cryptosporidium oocysts, pathogenic Gram-negative organisms, Giardia lamblia, and Entamoeba histolytica were identified in the stool samples (fecal specimens) of six (24%), eight (32%), four (16%), and two (8%), respectively, of the 25 patients with ALL and actute diarrhea and in one (3%), two (6.5%), six (20%), and five (16.5%), respectively, of the 30 control patients with diarrhea. Serum IgG antibodies were positive in four of the six ALL patients and in one of the control group patients with Cryptosporidium diarrhea who tested positive for oocysts in the stool. Diarrhea duration and severity were greater in ALL patients with stool-positive Cryptosporidium oocysts than in those with non-Cryptosporidium-positive diarrhea (p < 0.000). CONCLUSIONS: Cryptosporidium infection should be considered in children with ALL presenting with prolonged or severe watery diarrhea during chemotherapy, especially those treated with methotrexate and 6-mercaptopurine. Since Cryptosporidium is not routinely tested for in stool examination, a MZN stain is recommended.

Toxoplasma antibodies in normal and complicated pregnancy.

A total of 70 women with complicated pregnancy and 20 ones with normal pregnancy were selected. They were all RH positive and free from syphilis, brucellosis and malignany. Both groups were subjected to detection of anti-Toxoplasma antibodies levels by the indirect haemagglutination tests (IHAT-IgG) and by ELISA (IgG and IgM). The results showed that all controls (normal pregnancy) were IHA-IgG and ELISA-IgM negative. However, two of the controls (10%) were ELISA. IgG positive. As to the women with complicated pregnancy 68/70 or 97.1% were IHAT positive. When using ELISA, 57/70 or 81.4% were IgG positive and 42/70 or 60% were IgM positive. The results revealed a significant difference between the complicated cases and controls. The diagnosis of abortion, stillbirth, premature labour, or neonatal death due to Toxoplasma infection needs careful and laborious evaluation. The use of ELISA (IgG & IgM) is a must, as it is more sensitive and specific than IHAT.

Diagnosis of toxoplasmosis in children with malignancy.

The study aimed at the diagnosis of toxoplasmosis in 73 children with malignancy; 31 with lymphoma (22 with Hodgkin's and 9 with non-Hodgkin's lymphoma) and 42 with leukemia (34 with acute lymphoblastic leukemia and 8 with acute myelogenic leukemia). In positive cases toxoplasmosis was manifested by any of the following; fever, lymph node enlargement, neurological manifestations and/or hepatosplenomegaly. The indirect hemagglutination test (IHA) for toxoplasmosis detected 4 (5.4%) positive cases with malignancy, 2 with Hodgkin's lymphoma, one with non-Hodgkin's lymphoma and one with acute lymphoblastic leukemia. The immunoglobulin M enzyme-linked immunosorbent assay (IgM ELISA) detected only one (1.4%) case with Hodgkin's lymphoma. Immunoglobulin G (IgG) ELISA detected 6 (8.2%) positive cases, 3 with Hodgkin's lymphoma, one with non-Hodgkin's lymphoma and 2 cases with acute lymphoblastic leukemia. Polymerase chain reaction for detection of parasite DNA in blood (PCR) was the most useful in diagnosing toxoplasmosis with malignancy, as it was able to detect 9 (12.3%) positive cases; 5 (6.8%) with Hodgkin's lymphoma, one (1.4%) with non-Hodgkin's lymphoma and 3 (4.1%) with acute lymphoblastic leukemia. No positive toxoplasmosis cases were detected with acute myelogenic leukemia by any of the above methods.

A preliminary screening study on human cystic echinococcosis in Cairo slaughter house personnel.

A descriptive serological screening study was done on human cystic echinococcosis (CE) in high risk groups selected from Cairo slaughter house employees and the household nearby using indirect haemagglutination (IHA) and enzyme-linked immunoelectrotransfer blot (EITB) tests. Characterized camel hydatid cyst fluid (HCF) antigen by 12.5% sodium dodecyl sulphate polyacrylamide gel electrophoresis (SDS-PAGE) was used. Three asymptomatic clinical cases (1.3%) were seropositive using EITB assay (reacting with six HCF protein bands of molecular weights approximately 7, 21, 28, 35, 127 and 210 kilodaltons 'kDa') but one case was seronegative by the IHA test. All three cases had typical lesions of CE in liver and lung revealed by abdominal ultrasonography (US), computerized tomography (CT) scan and chest X-ray. The prevalence of CE in Cairo slaughter house workers was 1.6% versus 1.1% in the household nearby.

Human taenaisis and cysticercosis in slaughtered cattle, buffaloes and pigs in Egypt.

Human taeniasis and cysticercosis are zoonotic parasites of considerable public health problem. A total of 6434039 slaughtered animals over a period of four years (1994-1997) showed 0.72% cysticercosis (bovis and cellulosae) infections. Individual animal species infection was 0.23% in native breed cattle, 7.25% in imported cattle, 0.14 in buffaloes and 0.09% in pigs. The highly infested parts were the heart (64.2%) followed by the head (34.5%), the whole body (1.1%) and lastly, the quarter (0.2%) in both types of cattle and the heart (64.3%), the head (34.9%), the whole body (0.6%) and the quarter (0.2%) in buffaloes. In pigs, the highly infested parts were the whole body (55.4%) followed by the heart (37.8%) and lastly the head (6.8%). Some interesting cysticercosis were macroscopically and microscopically parasitologically and histopathologically studied. A general discussion on taeniasis and cysticercosis was given.

Role of recombinent interleukin-12 as an adjuvant on vaccine-induced immunity in murine Schistosoma mansoni infection.

In the present work, the role of recombinent Interleukin-12 (rIL-12) as an adjuvant to soluble worm antigen preparation (SWAP) in protection against primary murine S. mansoni infection, using certain immunization protocol, was studied. A highly significant statistical increase in resistance (P<0.001) was observed between the group immunized with SWAP and rIL-12 (group I) and those immunized with SWAP only (group II), when each was compared to the infection control group (group III). Moreover, resistance to challenge infection was higher in group I (73.6%) than in group II (66.1%). In comparison to group III, histopathological examination of liver sections of groups I and II showed marked reduction in granuloma sizes, with more reduction in group I to the extent that some ova were seen without cellular reaction around them. Liver necrosis and fibrosis were detected only in the infection control group. In contrast to group III, sections in the small intestine did not show any granulomatous reaction in groups I and II. rIL-12, when administered with SWAP could inhibit mesangial cells proliferation in the kidney glomeruli of mice in group I. However, minimal mesangial cells proliferation was observed in the kidney sections from mice in group II, when compared to the prominent proliferation seen in group III. rIL-12 has a prominent role when administered as an adjuvant to SWAP, against primary murine S. mansoni infection and for preventing granulomatous reaction, decreasing worm burden and increasing resistance to infection.

An enzyme-linked immunoelectrotransfer blot assay for diagnosis of human cystic echinococcosis.

An enzyme-linked immunoelectrotransfer blot (EITB) test was assessed for diagnosis of 47 pulmonary cystic echinococcosis (CE) cases admitted to Ain Shams University Hospitals for Surgery. Diagnosis of these cases was established on clinical examination, X-ray, sonography and indirect hemagglutination (IHA) test, which was negative in four cases (sensitivity 91.5%). Sera from patients with other parasitic infections, carcinomas or normal sera were used as controls. Human and Camel hydatid cyst fluids were used as antigens after separation and characterization of their antigenic components using 12.5% SDS-PAGE under reducing conditions. Six molecular weight antigens with molecular masses approximately 7, 20, 28, 35 and 127 kDa were of diagnostic importance. They were strongly recognized by sera of all CE patients specially with camel hydatid cyst fluid (HCF) giving a 100% sensitivity to the EITB test. Sera of patients with other parasitic infections as well as carcinomas and normal control sera couldn't recognize any of the above antigens and therefore were negative for the test. This results in 100% specificity of the EITB test. These data support the concept that EITB using camel hydatid fluid is a good diagnostic test for cystic echinococcosis.

Schistosoma mansoni hepatic fibrosis in Syrian golden hamsters: effect of dose and duration of infection as shown by immunohistopathological studies.

In this work, 180 Syrian golden hamsters were infected with Schistosoma mansoni and 30 cross matched for age and sex served as control. Infected hamsters were divided into six main groups according to the number of infected cercariae (20, 50, 100, 150, 200 and 250 cercariae). Each group was sub-divided into 5 subgroups, according to the duration of infection after which animals were sacrificed (4, 6, 8, 12 and 24 weeks). Control and infected hamsters were subjected to laboratory evaluation of serum albumin, S. globulin and A/G ratio and histopathological examination of the liver and splenic tissues. A significant reduction of albumin was observed in Schistosma infected hamster (50 cercariae or more) but not in the control ones and those infected with 20 cercariae. There was a significant correlation between these changes and the duration of infection and the number of adult worms recovered from the mesenteric circulation at the end of the experiments. Histopathologic evaluation showed appearance of the circulating schistosome antigens, circulating anodic antigen (CAA), and circulating cathodic antigen (CCA) deposits in the liver by the 14th week after infection; liver granuloma, amyloid deposits, fibrosis, Schistosma pigments as well as inflammatory infiltration was observed at 8-12th week and amyloid deposits, CAA & CCA in the spleen was observed nearly at the same time.

Studies on the most reactive purified antigen for immuno-diagnosis of hydatid disease.

Fourty hydatidosis patients and 36 patients with various parasitic diseases taken from Ain Shams University Hospitals and 15 normal controls as well were subjected to clinical examination, stool and urine examination, serological examination using indirect hemagglutination (IHA), counterimmunoelectrophoresis (CIEP) and enzyme-linked immunosorbent assay (ELISA) tests with crude and partially antigens for hydatidosis. Partial purification of crude hydatid fluid antigen abolished reactions in IHA test, reduced in ELISA or had no effect on cross reactions in the CIEP test. The crude antigen was more sensitive than the purified antigen in all tests applied. Using crude antigen, IHA (83%) was the most sensitive test followed by ELISA (68%) and then CIEP (60%) tests. In case of partially purified hydatid fluid antigen, CIEP was the most sensitive (58%) test with the purified peak I antigen followed by IHA test with peak III (48%) then ELISA with purified peak I (45%). In all serological tests applied, hepatic hydatidosis cases gave the highest reactions followed by cases of combined hepatic and pulmonary infections and then pulmonary cases alone.

Assignment of the crystal toxin genes of the mosquitocidal bacterium, Bacillus thuringiensis israelensis to a specific plasmid.

Bacillus thuringiensis israelensis 4Q1-WT and the prepared mutants, 4Q1-72 and 4Q1-81 were bioassayed against Aedes caspius larvae. The strain -4Q1-WT, which contains all plasmid arrys and the strain 4Q1-72 which contains the 108 kb plasmid gave 100% mortality, while stain 4Q1-81 which contains no plasmids gave 0% mortality. Crystals from all tested strains were isolated, solubilized and characterized using PAGE to detect any homology or difference in crystal production, properties, and the relatedness to the plasmid profile.

On the efficacy of Co-trimoxazole as an oral treatment for pediculosis capitis infestation.

No doubt, pediculosis capitis or Pediculus h. capitis infestation is an increasing health problem particularly among Egyptian children. Many chemical pediculocides are used with a variety of effectiveness and side effects. Meanwhile, Co-trimoxazole (Trimethoprim and sulphamethoxazole) have shown some pediculocidal action. In this paper, Co-trimoxazole was given to patients infested with pediculosis capitis. Prolonged course was needed to free the patients from adult and nymphal stages but not the eggs (nits). The results were discussed. It was concluded that until the discovery of cheap, safe and effective oral drug, topical application of pediculocides as ointment or shampoo is the method of choice.

Evaluation of different serological tests in mansonian schistosomiasis and correlation to hepatitis B virus infection.

A total of 70 bilharzial mansonian patients (Group I: 20 early intestinal mansonian patients, Group II: 20 hepatosplenic mansonian patients without ascites, Group III: 30 hepatosplenic mansonian patients with ascites) and 30 normal controls were studied. Using the circumoval percipitin test (COPT), there was a statistically significant difference between sensitivities in Group I and Group III with higher sensitivity for Group I. Using either the indirect haemagglutination test (IHA) or the indirect fluorescent antibody test (IFAT), there was no statistically significant difference between the sensitivities in the different bilharzial groups. No statistically significant difference was found between the 3 tests in Group I, II respectively. A statistically significant difference was found between the sensitivities of COPT and IHA in Group III. A highly significant difference was found between the sensitivities of COPT and IFAT in Group III also. No statistically significant difference was found between the sensitivities of IFAT and IHA in Group III. There was no statistically significant difference between the percentages of positivity of hepatitis B surface antigen (HBSAg) in the different bilharzial groups while each of the 3 groups showed highly statistically significant difference with the control group. No statistically significant difference was found between the positivities of HBSAg and the different titers of either IHA of IFAT in each group.