EGYPTIAN EOSINOPHILIC AND INFECTIOUS MENINGOENCEPHA- LITIS AND THEIR IMPACT ON PSYCHOLOGICAL ASPECTS.

Meningoencephalitis is an acute inflammation of the brain and spinal cord & their covering protective membranes. Meningitis can be life-threatening because of the inflammation's proximity to the brain and spinal cord; therefore, the condition is classified as a medical emergency. The commonest symptoms of meningitis are headache and neck stiffness associated with fever, confusion or altered consciousness, vomiting, and an inability to tolerate light (photophobia) or loud noises (phonophobia). Children often exhibit only nonspecific symptoms, such as irritability and drowsiness. If a rash is present, it may indicate a particular cause of meningitis; for instance, meningitis caused by meningococcal bacteria may be accompanied by a characteristic rash. A broad variety of allergic, infectious, neoplastic, and idiopathic diseases are associated with increased blood and/or tissue eosinophilia and range in severity from self-limited conditions to life-threatening disorders. Although accepted upper limits of normal blood eosinophil numbers vary somewhat, a value above 600 eosinophils /microL of blood is abnormal in the vast majority of cases. Generally speaking, there are several possible causes of eosinophils in the CSF; undoubtedly parasitic infection is one of the main causes.

TICK-BORNE INFECTIOUS DISEASES WITH REFERENCE TO EGYPT.

Ticks are hematophagous ectoparasites of man, domestic and street animals, and birds of health and economic hazard worldwide. They transmit many micro-organisms and protozoan infectious diseases and their toxins cause different signs and symptoms that may be fatal according to the infesting tick saliva protein. In Egypt where there are many rural and urban areas, so many genera and species of ticks are encountered. The Egyptian veterinary and agricultural authorities deal with ticks from econom- ic point of view. But from medical point of view, ticks have specific role in transmission of zo- onotic infectious diseases as well as their saliva causes tick paralysis. When dealing with chil- dren from tick infested areas, tick paralysis should be considered in differential diagnosis of the clinically confused diseases as poliomyelitis, myasthenia gravis; Guillain-Barre; paralytic rabies botulism; transverse myelitis and /or the diphtheritic polyneuropathy. Tick-borne relapsing fever is a zoonosis and is endemic in many countries. The two main Borrelia spp. involved in. North America are B. hermsii (in the mountainous West) and B. turicatae (in the southwest). Crimean Congo hemorrhagic fever (CCHF), babesiosis and infantile tick paralysis were identified as emerging diseases disaster. Also, Lyme disease is the commonest worldwide and encountered in Egypt since a long tilne. And now what about other tick-borne diseases, taking into consideration the tick populations is endemic riot only in Egypt but worldwide vectors.

ASEPTIC MENINGITIS IN ADULTS CAUSING BY VIRUS, BACTERIA, DRUG WITH SPECIAL REFERENCES TO ZOONOTIC PARASITES.

Diagnosis of a patient with aseptic meningitis may be so-difficult because of the large vanety of potential etiologic agents as viruses, fungi, parasites and some drugs and the overlap between self-limited viral illnesses and potentially fatal bact~nial infections.

PROTOZOA CAUSING FOOD POISONING.

Food poisoning also called foodbome illness, or illness caused by eating contaminated food is a term used to cover an unpleasant range of illnesses. Food poisoning symptoms vary with the source of contamination. Most types of food poisoning cause one or more of the following signs and symptoms: nausea, vomiting, watery diarrhea, abdominal pain and cramps and fever Signs and symptoms may start within hours after eating the contaminated food, or they may begin days or even weeks later. Sickness caused by food poisoning generally lasts from a few hours to several days.

ALLERGIC REACTIONS CAUSED BY VENOM OF HYMENOPTEROUS STINGING INSECTS AND THE ROLE OF HEALTH CARE WORKERS.

The Hymenoptera are the third largest order of insects, comprising the sawflies, wasps, bees and ants. Worldwide, over 150,000 species are recognized, with many more remaining to be described. The name refers to the wings of the insects, but the original derivation is ambiguous. The Ancient Greek υµÎ·ν (hymen) for membrane provides a pLusible etymology for the term because these insects have membranous wings. However, a key characteristic of this order is that the hind wings are connected to the fore wings by a series of hooks called hamuli. Thus, another plausible etymology involves, Hymen, the Ancient Greek god of marriage, as these insects have "married wings" in flight. Stinging insects and the medical risk associated with their venoms are complex topics, and presentation of information pertaining to them requires the use of technical terms. The most common reactions to these stings are transient pain and redness at the site lasting a few hours (local reaction), and exaggerated swelling lasting a few days (large local reaction). The most dangerous immediate reaction is anaphylaxis, which is potentially fatal.

THE ARTHROPOD-BORNE ONCHOCERCIASIS: IS IT DESERVED TO BE NEGLECTED?.

Onchocerciasis a filarial parasitic nematode, also known as river blindness and Robles disease, is a neglected tropical disease infecting more than 18 million people mainly in sub-Saharan of Africa, the Middle East, South and Central America and many other countries. Disease infectivity initiates from Onchocerca volvulus (Filarioidea: Onchocercidae) transmitted by the blackfly, Simulium sp. which introduces the infective stage larva with its saliva into the skin. Within human body, adult females (macrofilaria) produce thousands of larvae (microfilariae) which migrate in skin and eye. Infection results in severe visual impairment or blindness for about 2 million, as being the world's second-leading cause of blindness after trachoma, as well as skin onchocercomata.

Zoonoses from pets horses, donkeys and mules: with special references to Egypt.

A zoonosis is an animal disease that is transmissible to humans. Humans are usually an accidental host that acquires disease through close contact with an infected animal, who may or may not be symptomatic. Children are at highest risk for infection because they are more likely to have close contact with pets. Pets are responsible for transmission of an extensive array of bacterial, fungal, and parasitic zoonotic pathogens. The route of transmission can be through the saliva (e.g., bites or contaminated scratches), feces, respiratory secretions, direct contact, or by the animal acting as a vehicle and source of tick or flea exposure. Although pets have been implicated in transmission of zoonoses to their owners, risk of transmission from contact with pets is low and may be further reduced by simple precautions.

Zoonoses from cats: with special reference to Egypt.

A zoonosis is an animal disease that is transmissible to humans. Humans are usually an accidental host that acquires disease through close contact with an infected animal, who may or may not be symptomatic. Children are at highest risk for infection because they are more likely to have close contact with pets. Cats are responsible for transmission of an extensive array of bacterial, fungal, and parasitic zoonotic pathogens. The route of transmission can be through the saliva (e.g., bites or contaminated scratches), feces, respiratory secretions, direct contact, or by the cat acting as a vehicle and source of tick or flea exposure. Although cats have been implicated in transmission of zoonosis to their owners, risk of transmission from contact with cats is low and may be further reduced by simple precautions. There is a need for education on zoonotic disease prevention practices for pet-owning households with individuals at higher risk of infection, and to educate future veterinarians during their early years in veterinary school about the risks associated with their future jobs. Also, zoonotic disease awareness training is a valuable service to animal shelter workers.

Entomophobia, acarophobia, parasitic dermatophobia or delusional parasitosis.

Entomophobia or acarophobia, parasitic dermatophobia (PD) or delusional parasitosis (DP) is a disorder in which affected individuals has the mistaken but unshakable belief (delusion) that they are infected by insects, spiders, scorpion, ticks, mites, parasitic worms, bacteria, or other living organisms. As with all delusions, this belief cannot be corrected by reasoning, persuasion, or logical argument. To avoid them, they may always be cleaning rooms, floors, doors, windows and scratching. Many affected individuals are quite functional; for the minority, delusions of parasitic infection may interfere with usual activities. However, most insects are not harmful to humans and pose no threat, those who suffer with this phobia experience extreme anxiety at the mere thought or sight of an insect. Most patients consult dermatologists, veterinarians, pest control specialists, or entomologists. The DP cases are increasing worldwide; it remains an extremely unrepeatable disorder.

Zoonoses from dogs with special reference to Egypt.

A zoonosis is an animal disease that is transmissible to humans. Humans are usually an accidental host that acquires disease through close contact with an infected animal, who may or may not be symptomatic. Children are at highest risk for infection because they are more likely to have close contact with pets. Dogs are responsible for transmission of an extensive array of bacterial and parasitic zoonotic pathogens. The route of transmission can be through the feces, urine, saliva (eg, bites or contaminated scratches), or respiratory secretions of the animal, or by the dog or cat acting as a vehicle and source of tick or flea exposure or reservoir for vector borne disease. Although dogs have been implicated in transmission of zoonoses to their owners, risk of transmission from contact with dogs is low and may be further reduced by simple precautions.

Threat of dengue fever and dengue haemorrhagic fever to Egypt from travelers.

Dengue (DF) and dengue hemorrhagic fevers (DHF) are present in urban and suburban areas in the Americas, South-East Asia, the Eastern Mediterranean and the Western Pacific, but dengue fever is present mainly in the rural areas of Africa. Several factors have combined to produce epidemiological conditions in developing countries in the tropics and subtropics that favour viral transmission by the main mosquito vector, Aedes aegypti as the rapid population growth, rural-urban migration, inadequate basic urban infrastructure (eg. the unreliable water supply leading householders to store water in containers close to homes) and the increase in volume of solid waste, such as discarded plastic containers and other abandoned items which provide larval habitats in urban areas. Geographical expansion of the mosquito has been aided by the international commercial trade particularly in used car-tyres which easily accumulate rainwater. Increased air travel and the breakdown of vector control measures have also contributed greatly to the global burden of dengue and DH fevers. The presence of Ae. aegypti and endemicity of DF and DHF in the neighbor- ing regional countries must be in mind of the Public Health Authorities.

Maternal brucellosis and human pregnancy.

Brucellosis is a worldwide zoonotic gram-negative bacterium of worldwide distribution. Its role in causing miscarriage in animals is well documented. Data on its role in human abortion are very few. This paper was carried out on selected women with abortion or history of abortion to clarify the role of brucellosis in human abortion. A total of 129 women were selected from Al-Zahraa University Hospital and other obstetric and gynecological hospitals in the vicinity of Greater Cairo. The patients were subjected to clinical, gynecological, and serodiagnosis (STAT and ELISA) of brucellosis. Also, routine urine (Nuclepore technique) and stool (Kato thick smear) was done as well as skin tests and ELISA for common hepatic parasites. The results showed that 59 had brucellosis, 27 had toxoplasmosis, 15 had fascioliasis and 29 had other cause(s) of abortion. Meanwhile, none had visceral leishmaniasis or schistosomiasis mansoni. the signs and symptoms of all patients were hepatosplenomegaly (31.1%), lower back abdominal pain (23.13%), lassitude, headache (each, 21.7%), lymphadenopathy (20.1%), vomiting (17.1%), loss of appetite, myalgia or diarrhea or constipation (each, 15.42 %), weight loss (14.6%), chest pain (13.9%), night sweating or dizziness (11.65%), fever or right sided abdominal pain (each, 10.7%), chills (7.71%), urticaria or monoarthralgia (each, 3.85%). These signs and symptoms were confusing for specific clinical picture of brucellosis. Brucellosis patients were successfully treated with a combination of Rifampicin 600 mg. once daily and Septrin 800 mg twice daily for 6 weeks. Cure was achieved clinically and serologically. Patients with toxoplasmosis or fascioliasis were also treated with Fasinex and Mirazid respectively. Other parasites were also treated.

Zoonotic brucellosis: an underestimated or misdiagnosed disease in Egypt.

Over six months, 329 suggestive consecutive brucellosis human cases were diagnosed in attending the out-patients clinics of Al-Azhar and Ain Shams Universities Hospitals and Giza Governorate Farmers. They were 100 females and 229 males with ages ranged between 15-65 years old. A total of 213 (64.75%) were working in dairy farm and/or consumed raw milk, 16 (14.85%) used home slaughtering of sheep, and 100 (30.4%) were working in Giza Government slaughter-house. Clinically and by ELISA-IgM 259 out of 329 the subjects were proven brucellosis patients (77.8%). Besides, other patients had toxoplasmosis, or schistosomiasis mansoni or fascioliasis. Double infection was encountered with toxoplasmosis and either schistosomiasis or fascioliasis. The causes of endemic liver parasitosis that may give false-clinical diagnosis were excluded. Signs and symptoms of brucellosis patients were fever (91.5%), chills (84.1%), Myalgia (69.5%), headache (58.2%), fatigue (77.2%), anorexia (54.1%), tachycardia (38.6%), hepato-and/or splenomegaly (46.2%), lymphadenopaqthy (19.6%) lower back abdominal pain (8.8%) and/or constitutive symptoms (13.1%).

Clonorchis sinensis a new report in Egyptian employees returning back from Saudi Arabia.

Clonorchis sinensis, or Chinese liver fluke, is a parasite of the fish-eating mammals endemic in the East Asia, Far East, particularly in China, Japan, Taiwan, Vietnam, and Korea and among immigrant refugees to European Union and Eastern Mediterranean Countries. This paper reported infection among Egyptian family who practice consumption of imported fishes from the Far East. Diagnosed was based on detection of its characteristic eggs, positive specific ELISA, radiological and family behavior and feeding habit history. Patients were successfully treated.

Aedes aegypti re-emerging in Egypt: a review and what should be done?

Mosquitoes are main vectors of varieties of pathogenic agents affecting man and animals. There-emergencein Aswan and approach of Aedesa egypti, the vector of the Dengue hemorrhagic fever, Yellow fever and Chikungunya fever, which are encountered in Africa, needs to alert for this public health threat. The presence of Dengue and dengue hemorrhagic fever in Saudi Arabia is another issue.

A study on the prevalence of house dust mites in Al-Arish city, North Sinai Governorate, Egypt.

Free living mites comprise a huge and various groups of tiny arthropods in the class Arachida, mainly of the Pyroglyphidae family. Exposure to allergens derived from house dust mite (HDM) feces is a postulated risk factor for allergic sensitization, asthma development and asthma morbidity. However, practical and effective method to mitigate these allergens in low-income, urban home environments remains elusive. It well known that (HDM) physiology is greatly affected by hydrothermal microclimatic condition. El Arish has subtropical climate and warm humid summer, such situation are favourable to proliferate house dust mites. As no valid data are available for house dust mites fauna of El Arish, this study was carried out to determine the prevalence and contamination rates of homes in El Arish city. Samples of house dust collected in 2008 from 50 houses in El Arish city were subjected to acarological examination. Acri were found in (34.6 %) of the samples collected from these homes. Results indicated that dust mites were present in all humid environments. Also, hypersensitivity to dust mites was common among patients with asthma.

Mirazid in treatment of three zoonotic trematodes in Beni-Sweif and Dakhalia Governorates.

A total of 60 patients with schistosomiasis (40), fascialiosis (15) and heterophyiasis (5) were selected Beni-Sweif and Mansoura Districts and subjected to history taking, clinical examination, Kato thick smear, sedimentation and hatching test (for schistosomiasis cases) at the beginning of the study, 2 & 3 months after treatment with Oleo-resin of Myrrh (Mirazid) in a dose of 10 mg/kg/day for 6 consecutive days an hour before breakfast. The results showed a significant improvement in symptoms with minimal negligible or no side effects. The cure rates, 2 & 3 months after treatment were 80.7%% & 11.8%% for schistosomiasis, 93.3% & 6.6% for fascioliasis, and 100% for heterophyiasis. The clinical picture of schistosomiasis before treatments were easy fatigability, anorexia, nausea, vomiting, epigastria pain, abdominal distention, right upper guardant pain, colicky abdominal pain, left upper and/or lower guardant pain, abdominal rumbling, dysentery, diarrhea, rectal bleeding, constipation, and alternating bowel habit. Those of fascioliasis were abdominal distention, dripping of saliva, right upper guardant, colicky abdominal pain, weight loss, easy fatigability, intermittent jaundice, anorexia, nausea, vomiting, epigastria, left upper and/or lower quadrant pain, right layer quadrant pain, loin pain, abdominal rumbling, diarrhea, constipation, and alternating bowel habit. The safety and efficacy of C. molmol extract in treating heterophyiasis (100%), fascioliasis (100%) and schistosomiasis (92.5%) were documented.

Zoonotic ectopic fascioliasis: review and discussion.

Ectopic fascioliasis (EF) has direct and indirect effects on both humans and animals. The phenomenon of EF was individual cases in the period from 1950 up to the end of last century. From the period of 2000 up to 2006, plenty of researches were on EF in the developed and undeveloped countries. Nineteen EF cases infected with the immature and few with the mature worms were 13 females and 6 males. Three cases of lymphatic, pleural and breast fascioliasis reached the adults and laid their eggs in a lymph node in the cervical region pleural cavity and breast tissues. Until recent, knowledge about the ectopic fascioliasis pathway is little. Fasciola hepatica was the commonest species in most cases. The effect of fascioliasis might be direct to liver as ectopic foci or indirect on other organs due to the metabolites and secretory excretory products. All ages and both sexes were EF infected. Watercress topped the list of water plants born encysted metacercariae followed by lettuce, mint, and alfalfa. Nearly 24 million Egyptians at risk and about 800,000 were infected. On the global scale, about 180 million are at risk of infection.

Lupus nephropathy: clinical, immunohistochemistry and quantitative morphometric analysis studies.

Lupus nephritis includes a wide range of parenchymal injuries and severity. Better predictors to outcome are needed for patients newly diagnosed with lupus nephritis, so that an appropriate management strategy may be selected. This study aimed to determine whether the ratio of hepatocyte growth factor (HGF) to transforming growth factor beta 1 (TGF beta1) in lupus nephritis could be a prognostic factor for response to therapy with cyclophosphamide and steroids at six months. Also, to determine whether a simple automated system for objective scoring of biopsies of lupus nephritis could be a prognostic factor for response to therapy with cyclophosphamide and steroids at 6 months. Consequently, renal biopsy findings and clinical parameters of thirty parasites-free patients with new onset lupus nephritis were recorded. Histopathologic, clinical, immune-histochemical and morphometric data at baseline served to define the predictive value for outcome after 6 months of therapy. The results showed a significant positive relationship between response to therapy and HGF IS (P= 0.007), HGF ES (P= 0.026), HGF IS/ TGFbeta1 IS ratio (P= 0.022) and HGF ES/ TGFbeta1 ES ratio (P= 0.001). A significant inverse relationship was proved between response to therapy and TGFbeta1 IS (P= 0.025) as well as TGFbeta1 ES (P= 0.017). Also, a significant inverse relationship was present between response to therapy and nuclear index, tubular index and matrix index (P = 0.03, 0.03 and 0.029 respectively).