Sentinel surveillance for patients with acute hepatitis in Egypt, 2001-04.

Viral hepatitis is a major problem in Egypt. To define the epidemiology of the disease, sentinel surveillance was established in 5 hospitals in diverse areas of the country in 2001. Data were completed for patients meeting the case definition for viral hepatitis. Of a total of 5909 patients evaluated, 4189 (70.9%) showed positive antibody markers for hepatitis. Out of those, 40.2% had evidence of hepatitis A virus (HAV) infection, 30.0% hepatitis B virus (HBV) and 29.8% hepatitis C virus (HCV) infection. This surveillance system was useful in identifying the variable endemicity of acute HAV infection in different regions and for better understanding the epidemiology of HBV and HCV infection.

Intestinal capillariasis in Egypt: a case report.

Capillaria philippinensis eggs, larvae, and adults were identified in the stool of a 41-year-old female physician from Cairo, Egypt, who had never traveled abroad. She had eaten local and imported fish. She suffered from borborygmi, abdominal pain, severe diarrhea, vomiting, and loss of weight for greater than 3 months. Treatment with Flubendazole (R17889-Janssen) 200 mg twice daily for 30 days resulted in clinical and parasitological cure.

Use of a partially purified Fasciola gigantica worm antigen in the serological diagnosis of human fascioliasis in Egypt.

Crude extracts of Fasciola gigantica adult worms, when used as an antigen in indirect hemagglutination (IHA) and counterimmunoelectrophoresis (CIEP) tests, detected all independently diagnosed human F. gigantica and F. hepatica infections but cross-reacted with sera of patients with schistosomiasis and amebiasis. Fractionation of this crude worm extract using Sephadex G-200 chromatography demonstrated four major protein peaks. Antigen from the crest and descending portion of peak II (mol. wt. approximately 20 x 10(3)) and all of peak III (mol. wt. approximately 6 x 10(3)) were pooled and used as a source of partially purified antigen. This partially purified fraction, when used in the CIEP test, reacted with sera from patients with fascioliasis but not those from schistosomiasis or amebiasis patients, whether undiluted or concentrated fivefold, but failed to react by IHA with fascioliasis sera. It reacted with undiluted sera from all individuals passing F. gigantica eggs except one, a possibly spurious infection, and with eight of 20 sera from individuals passing F. hepatica eggs, while the remaining 12 sera became positive after fivefold concentration. It also reacted with two sera from individuals passing eggs of both Fasciola species and with five of 11 sera from individuals negative microscopically but positive serologically with the crude antigen.

Praziquantel in the treatment of Schistosoma mansoni infection: comparison of 40 and 60 mg/kg bodyweight regimens.

Two different regimens of praziquantel, 40 mg/kg in a single dose and 60 mg/kg in two divided doses administered 6 hr apart, for the treatment of Schistosoma mansoni infection were compared in Abu Homos, Egypt. Participants in this study included 1,588 subjects of both sexes between five and 50 years old from two rural communities; 730 from Farshout and 858 from Om El-Laban. The prevalence of S. mansoni infection was 57.9% in Farshout and 69.0% in Om El-Laban. Infected subjects received 60 mg/kg of praziquantel in two divided doses 6 hr apart at Farshout and 40 mg/kg in a single dose at Om El-Laban. Eight to ten weeks after treatment, three stool samples were collected from each treated subject on three consecutive days and evaluated quantitatively by the modified Kato technique. The failure rate was significantly higher at Om El-Laban than at Farshout (14.5% versus 4.1% (odds ratio [OR] = 3.95, P < 0.0001). A significantly higher failure rate was consistent after adjustment for age and number of excreted S. mansoni eggs per gram of feces before treatment (OR = 3.75, P < 0.0001). In spite of differences among cure rates between the two regimens, we recommend 60 mg/kg on an individual basis but not for population treatment, since administration of a single dose of a drug is more practical than two doses given 6 hr apart.

Immunogenicity of recombinant hepatitis B vaccine among infants of mothers with active schistosomiasis.

A study of the immunogenicity of a recombinant hepatitis B vaccine was conducted among 385 Egyptian infants, 191 (49.6%) of whom were born to mothers with moderately active Schistosoma mansoni infection (mean egg count = 224 eggs/g of feces). All mothers were seronegative for hepatitis B surface antigen (HBsAg) and hepatitis B e antigen. Infants were vaccinated with a 2.5-microg dose of this vaccine, given along with diphtheria, tetanus, and pertussis (DTP) vaccine, at the ages of two, four, and six months. Serum samples taken from each infant at nine months of age were tested for HBsAg, antibody to hepatitis B core antigen, and quantitatively for antibody to hepatitis B surface antigen (anti-HBs). There was no significant difference (P = 0.1) between anti-HBs titers in infants of S. mansoni-infected mothers (mean = 539 mIU/ml) and in infants of noninfected mothers (mean = 377 mIU/ml). This study shows that there was no apparent effect of maternal schistosomiasis infection on the immune response of these infants to vaccination.

Evaluation of a twice-a-week application of 1% niclosamide lotion in preventing Schistosoma haematobium reinfection.

A randomized double-blind trial was conducted to assess the efficacy of a twice-a-week application of 1% niclosamide lotion for prevention of Schistosoma haematobium reinfection. Six hundred farmers in Fayoum, Egypt, 18-40 years of age, were treated to cure their S. haematobium infection, then randomly assigned to self-apply niclosamide or placebo lotion to their limbs, neck, and torso. Subjects were exposed to schistosomal-infested water during routine irrigation activities from April to October 1992. Three hundred fifty subjects met the inclusion criteria and completed the trial, 169 (48.3%) in the niclosamide group and 181 (51.7%) in the placebo group. The subjects assigned to the niclosamide-treated group were comparable with those in the placebo group in age (27.2 versus 27.8 years), total water contact (101.9 versus 109.0 hr), lotion application compliance (93.5% versus 90.6%), and avoidance of whole body water contact (94.7% versus 96.7%). The reinfection rate with S. haematobium was 30.8% in the niclosamide-treated group and 28.2% in the placebo group. Niclosamide lotion applied to the limbs and trunk twice a week failed to prevent S. haematobium reinfection.

Epidemiology of cutaneous leishmaniasis at a focus monitored by the multinational force and observers in the northeastern Sinai Desert of Egypt.

A longitudinal epidemiologic study of cutaneous leishmaniasis (CL) transmission was conducted between July 1989 and June 1991 in a 1,200-km2 sector of the northeastern Sinai Desert monitored by the Multinational Force and Observers (MFO), an international peace keeping mission between Egypt and Israel. The occurrence of human cases, sand fly density, rodent collection, and isolations of Leishmania confirmed only one of four surveyed locations as a significant focus of CL transmission. Phlebotomus papatasi, the only anthropophilic sand fly species encountered at this focus, comprised more than 96% of the sand fly population and attained human landing densities exceeding 100 sand flies/person/hr during 1990. Seasonal activity of this species ranged from April to November, with highest densities occurring during the period May-September. A peak promastigote infection rate of 2.4% (13 of 534) was observed in P. papatasi during July 1990. Twelve of the 60 (20%) persons at risk during the six months of intense sand fly activity at this site developed lesions consistent with CL; L. major was isolated from nine (75%) of these cases. Leishmania major infection was acquired by two of 22 (9%) sentinel hamsters used during the same period. More than 97% of the 897 wild rodents trapped at this site were desert gerbil species. Leishmania major was the only Leishmania isolated from human, sand fly, wild rodent (Gerbillus pyramidum), and sentinel hamster infections that originated at site Check point 1-Delta, the focus of CL transmission within jurisdiction of the MFO. The altered ecology of this area, created by construction of a dam, may contribute significantly to the transmission dynamics of CL at this focus.

Evaluation of a rapid-format antibody test and the tuberculin skin test for diagnosis of tuberculosis in two contrasting endemic settings.

OBJECTIVE AND SETTING: We evaluated a rapid-format antibody card test and the tuberculin skin test for diagnosis of active tuberculosis (TB) in high (Cairo, Egypt) and low (St. Louis, USA) prevalence areas. DESIGN: Prospective study of hospitalized TB patients and controls with other chest diseases. RESULTS: Test performance varied significantly in the two study sites. The antibody test detected 87% of 71 smear-positive pulmonary TB cases (86% of smear-negative pulmonary cases and 48% of TB meningitis cases) in Egypt; specificity was 82%. The tuberculin test was highly sensitive in Egypt in subjects with pulmonary TB (100%) but not in those with meningitis (23%); specificity was 70%. The sensitivity and specificity of the antibody test in St. Louis were 29% and 79%, respectively; 50% of St. Louis TB cases and 15% of controls had positive tuberculin tests. CONCLUSIONS: This convenient antibody card test may have value for diagnosis of patients suspected of having TB in high prevalence areas like Egypt. However, the specificity of the test is too low for it to be useful as a screening test. Our results suggest that neither the antibody test nor the tuberculin test have much diagnostic utility in low prevalence settings like St. Louis.

A purified Fasciola gigantica worm antigen for the serodiagnosis of human fascioliasis.

Partially purified Fasciola gigantica worm antigens were evaluated in an enzyme-linked immunosorbent assay (ELISA) for the specific serological diagnosis of fascioliasis. The diagnostic potential of 10 antigen fractions derived from gel-filtration peaks (II & III) were evaluated individually or in combination against a panel of admission sera obtained from 50 patients subsequently diagnosed as having a variety of systemic parasitic diseases, and from 10 healthy volunteers with no recent history of parasitic infections. Fractions 2 and 10 were highly specific for Fasciola infection and failed to react with sera from any patient with other parasitic diseases or from controls. All other fractions exhibited reactivity with the majority of sera from the fascioliasis patients, but also with some sera from patients infected with other parasites. Based on these results, the ELISA, as outlined here, should be considered as a rapid and specific technique for the diagnosis of fascioliasis and also as an epidemiological surveillance technique in areas endemic for F. gigantica infection.

Early diagnosis of human fascioliasis by the detection of copro-antigens using counterimmunoelectrophoresis.

We have reported the use of partially purified Fasciola gigantica worm antigens (peaks II and III separated by Sephadex G-200) in counterimmunoelectrophoresis (CIEP) for the specific and early detection of antibodies in sera of fascioliasis patients. In the present study, we report the use of hyperimmune serum from rabbits immunized with these partially purified worm antigens in CIEP for the detection of parasite antigens in saline extracts of patients' stools. This test was conducted on stool specimens from 144 patients with systemic or intestinal parasitic infections, 5 from persons with spurious Fasciola infections, and 10 from healthy negative controls. All saline extracts from fascioliasis patients developed 2-5 precipitin bands. No precipitin band developed with stool extracts of patients with spurious Fasciola infection or other parasitic infections, or from negative controls. This assay proved to be simple, rapid, sensitive, and specific for the diagnosis of early as well as established fascioliasis infections.

Feeding patterns of Phlebotomus papatasi and Phlebotomus langeroni (Diptera: Psychodidae) in El Agamy, Egypt.

Blood meals from 602 Phlebotomus papatasi (Scopoli) and 49 Phlebotomus langeroni Nitzulescu were collected in El Agamy, Egypt, and were identified using counterimmunoelectrophoresis. Blood meals were tested against specific antisera of eight vertebrate hosts (human, cat, dog, rat, sheep, goat, general avian, and general bovine). Of 597 P. papatasi collected indoors, 594 contained human blood and three had mixed blood meals (human-dog, human-rat, and human-avian). Four of five P. papatasi collected outdoors contained human blood and one contained avian blood. All 39 P. langeroni collected indoors had fed on humans. Six of 10 outdoor-collected P. langeroni had fed on human blood, 2 on dog, 1 on cat, and 1 on rat blood. Both P. papatasi and P. langeroni feed predominantly on humans in El Agamy, Egypt. The documented feeding on humans and dogs by P. langeroni supports the role of this species as the primary vector of visceral leishmaniasis at the El Agamy focus.

Evaluation of crude and purified Toxocara canis antigens in serodiagnosis of human toxocariasis.

Three serological tests: Immunodiffusion (ID), Counterimmunoelectrophoresis (CIEP) and Enzyme-linked immunosorbent assay (ELISA) were used to study the role of crude adult worm antigen (CAWA) of Toxocara canis and each of its purified fractions in the serodiagnosis of human toxocariasis. Sensitivities of the three tests were lower in the ocular than in the visceral group, using different antigens. Purified fraction 1 showed more sensitive and specific reactions in the three tests, compared to CAWA or purified fraction 2 (P-F2) antigen. The other purified fractions (P-F3, P-F4 and P-F5) gave no positive reactions in any of the three tests. Using P-F1 antigen, ELISA was the most sensitive technique for diagnosis of both visceral and ocular toxocariasis followed by CIEP and then ID and the difference was statistically significant. However, CIEP was the most specific test followed by ELISA and lastly ID test. The ELISA test using Excretory-Secretory (E-S) larval antigen of Toxocara canis was less sensitive than the ELISA test using P-F1, although it was 100% specific. Thus, ELISA test using P-F1 is the test of choice for diagnosis of human toxocariasis, but when the specificity of a reaction is in doubt, CIEP test using the same antigen can be of value.

Serum copper and haematological values of sheep of different physiological stages in the dry and wet seasons of central trinidad.

A study was conducted to determine serum copper (Cu) concentrations and hematological values of 174 sheep from four medium sized farms, pertaining to physiological stage, in the late dry and late wet seasons of Central Trinidad. Serum Cu was significantly lower in the dry than in the wet season (P < 0.001) with a corresponding high percentage of samples with low Cu levels in the former. 31% of dry nonpregnant sheep exhibited a nonregenerative anaemia. Also, hemoglobin and packed cell volume values varied (P < 0.001) including lymphocyte (P < 0.01) counts, among growing animals compared with other physiological stages. Significant variations also occurred among neutrophil (P < 0.05) and eosinophil (P < 0.05) values in sheep. Highest haemoglobin and packed cell volume, white blood cell counts, and lymphocyte values in growing sheep compared with other stages were probably age related.

Laboratory-based surveillance of patients with bacterial meningitis in Egypt (1998-2004).

Laboratory-based surveillance for bacterial meningitis was conducted in a network of infectious disease hospitals in Egypt to better understand the epidemiology of this infection. Healthcare and laboratory personnel were trained in basic surveillance and microbiologic processing of cerebrospinal fluid (CSF) specimens. All bacterial isolates from CSF were confirmed and tested for antimicrobial susceptibility. PCR testing was performed on a random subset of purulent, culture-negative CSF specimens. Of 11,070 patients who met criteria for the case definition, 843 (8%) were culture positive (42% positive for Streptococcus pneumoniae, 20% for Haemophilus influenzae serotype b, 17% for each of Neisseria meningitidis and Mycobacterium tuberculosis, and 6% for other bacteria). Of 1,784 (46%) CSF specimens tested by PCR, 232 (13%) were positive for the first three major pathogens. Of N. meningitidis isolates, 52% belonged to serogroup A, 35% to serogroup B, and 4% to serogroup W135. S. pneumoniae isolates comprised 46 different serotypes, of which 6B, 1, 19A, 23F, and 6A were the most predominant. The overall case-fatality rate for culture-positive cases was 26% and was highest among patients with M. tuberculosis (47%). Factors significantly associated with death (p < 0.05) included admission to rural hospitals, long prodromal period, referral from other hospitals, antibiotic treatment prior to admission, and clear CSF (<100 cells/mm3). Susceptibility to ampicillin and ceftriaxone was observed in 44 and 100% of H. influenzae serotype b isolates and in 52 and 94% of S. pneumoniae isolates, respectively. This surveillance highlights the significant mortality and morbidity associated with bacterial meningitis in Egypt. Decision makers need to review current treatment guidelines and introduce appropriate vaccines for prevention and control of the disease.

Leishmania tropica in Egypt: an undesirable import.

Cutaneous as well as visceral leishmaniasis has been previously reported in Egypt. The former clinical manifestation is attributed to Leishmania major, the latter to L. infantum. In this study, L. tropica was isolated from an Egyptian labourer returning from Saudi Arabia. Amastigotes were detected by both Giemsa staining and indirect immunofluorescence using rabbit anti-gp63. Promastigotes from Schneider's medium were typed isoenzymatically as L. tropica. In view of the emerging threat of visceralization of L. tropica, the potential risk for its transmission in Egypt is discussed.

Free-living amoebae in Egypt. 1. Naegleria gruberi and Naegleria fowleri.

Two Naegleria species were isolated and identified from various water sources in Lower and Upper Egypt. Identification was based on the morphology, nuclear division and the excystation and flagellation tests. The trophic, cystic and flagellate forms of N. gruberi are larger than those of N. fowleri and the cyst of the former species has one or more pores while that of the latter species has no pores and has an outer gelatinous layer. The size and the morphological characteristics of these two free-living amoebae from Egypt were in complete agreement with those previously described for amoebae of this same genus and species endemic to other geographical areas.