Clinical features, tissue smear and competitive enzyme linked immunosorbent assay as dignostic and prognostic procedures for visceral leishmaniasis in Yemen.

Twenty six Yemeni patients with clinically visceral leishmaniasis (VL) and laboratory abnormalities were subjected to L. donovani species-specific monoclonal antibody (D2) and a competitive enzyme-linked immunosorbent assay (C-ELISA). The results were compared with those obtained by microscopy Giemsa stained tissue smears of bone marrow or splenic aspiration. Of the patients, 51 (82.3%) were positive and 3 (4.8%) were negative by both microscopy and C-ELISA. An additional 8 (12.9%) who were negative by microscopy were positive by C-ELISA. 59 patients were treated with sodium antimony gluconate, 45 (76.3%) were drug responsive and 14 (23.7%) were drug resistant. The C-ELISA of 17 patients before and after chemotherapy showed a significant decrease in percent inhibition of monoclonal antibodies D2 in drug responsive patients. In drug-unresponsive patients the percent inhibition of D2 was unchanged or slightly increased. The results indicate that C- ELISA is more sensitive and specific than microscopy, especially for early diagnosis of VL and to evaluate the success of drug treatment.

The epidemiology of schistosomiasis in Egypt: Gharbia Governorate.

Health questionnaires and parasitologic examinations of urine and stool were performed upon a stratified random sample of 14,344 individuals from 1,952 households in 34 rural communities in Gharbia Governorate of Egypt to investigate the prevalence of, risk factors for, and changing pattern of infection with Schistosoma sp. A subset, every fifth household, of 1,973 subjects had physical and ultrasound examinations to investigate prevalence of and risk factors for morbidity. Community prevalence of Schistosoma mansoni ranged from 17.9% to 79.5% and averaged 37.7%. The geometric mean egg count (GMEC) was 78.9 eggs/gram of feces. The prevalence and intensity of infection was 40-50% and 70-100 eggs/gram of feces in those > or =10 years of age. Schistosoma haematobium was detected in 5 of the 34 communities. The maximum infection rate was 2.8% and mean GMEC in the five communities was 2.1/10 ml of urine. The overall prevalence of S. haematobium in the governorate was 0.3%. Risk factors for infection with S. mansoni were male gender, an age >10 years, living in smaller communities, exposures to canal water, prior therapy for schistosomiasis, or blood in the stool (in children only). Morbidity detected by physical examination or ultrasonography did not correlate with S. mansoni infection in individuals with the exception of periportal fibrosis (PPF, odds ratio [OR] = 1.25). Periportal fibrosis was detected in more than half of the subjects by ultrasonography; 5.3% had grade II lesions and 1.0% had the most severe grade III changes. Risk factors for morbidity as manifested by ultrasonographically detected PPF were similar to those for infection. Periportal fibrosis had a negative relationship with abdominal pain (OR = 0.45) and hepatomegaly detected by physical examination and ultrasonography (ORs = 0.72 and 0.68), but it was associated with splenomegaly (ORs = 4.14 and 3.55). The prevalence of PPF, hepatomegaly, and splenomegaly increased with age. There was no relationship between community burden of schistosomiasis mansoni and any measurements of morbidity with the exception of splenomegaly detected by physical examination (r = 0.40). Schistosoma mansoni has almost completely replaced S. haematobium in Gharbia, which has a high prevalence and moderate intensity of S. mansoni infection. Periportal fibrosis was detected by ultrasonography in more than half of the subjects, and 1 in 16 had grade II and III lesions. The only relationship between PPF and other morbidity findings was its positive relationship with splenomegaly and negative association with hepatomegaly. Hepatic morbidity is common in communities in Gharbia but the role of schistosomiasis mansoni in this is uncertain.

Plasma levels of nitric oxide in association with severe Plasmodium falciparum in Yemen.

One hundred and five patients with Plasmodium falciparum were included, forty-three with cerebral malaria and sixty-two without cerebral manifestations. The main clinical presentations in cerebral malaria patients were fever (76.4%), pallor (72%), splenomegaly (60.5%), deep coma (39.5%), jaundice (18.6%), pulmonary oedema (13.9%), subconjunctival haemorrhage (13.9%), severe anemia (Hb<5mg/l) (53.5%), hypoglycemia (glucose<40mg/dl) (67.4%) and haemoglobinuria (6.9%) while in non cerebral malaria patients the clinical presentations were fever (83.8%), pallor (67.7%), splenomegaly (66%), jaundice (9.7%), severe anemia (Hb<5gm/dl) (51.6%) and hypoglycemia (glucose<40mg/dl) (3.2%). Nine patients from cerebral malaria group died after admission. Serum level of nitric oxide (nitrite plus nitrate) were assayed for all patients, serum level of nitric oxide were highly significant in patients with cerebral malaria than those without (34.6 +/- 2.3n. mol/ml VS 12.9 +/- 1.3n. mol/ml; P<0.01). In cerebral malaria, nitric oxide levels were highly elevated in patients with deeper coma than those with lighter coma (48.2 +/- 3.1n. mol/ml VS 24.4 +/- 1.3n. mol/ml; P<0.001) and also higher among patients with longer duration of coma (>72 hours) than among patients with shorter duration of coma (<72 hours) (54.5 +/- 2.8 n. mol/ml V.S. 23.6 +/- 3.1n. mol/ml; P<0.001). Also, nitric oxide levels were correlated with clinical outcome, fatal cases (9 patients) having significantly higher nitric oxide levels than survivors (56.2 +/- 3.1 n. mol/ml VS 32.5 +/- 1.3 n. mol/ml; P<0.001). Thus, higher levels of nitric oxide are associated with indices of disease severity and may predict outcome in-patients with cerebral malaria. These data are consistent with the hypothesis that nitric oxide is involved in the pathogenesis of cerebral malaria.

Prevalence and morbidity of schistosomiasis among rural fishermen at two Egyptian villages (Gharbia Governorate).

210 fishermen and 210 farmers from two Egyptian villages (Gharbia Governorate) were selected. Their main clinical manifestations were terminal haematuria in 17.1% and 10%, dysuria in 16.7% and 6.7%, renal colic in 13.3% and 2.4%, dysentery in 10.5% and 3.8%, bloody stool in 8.1% and 2.9%, pallor in 28.8% and 15.2%, hepatomegaly in 10.5% and 4.3% and splenomegaly in 8.6% and 3.8% in fishermen and farmers respectively with significant values among fishermen when compared with farmers. Abdominal ultrasonography of fishermen showed higher morbidity rates than farmers as regards hepatosplenomegaly, grades of periportal fibrosis, portal vein diameter, stones in Kidneys and urinary bladder as well as calcification of urinary bladder. S. mansoni prevalence was 72.4% in fishermen and 4.57% in farmers with highly significant value in fishermen when compared with farmers (P < 0.01). Geometric egg count (gm/stool) was 430 +/- 259 and 236 +/- 161 in fishermen and farmers respectively with highly significant difference (P < 0.001). All urine samples were negative for S. haematobium. The socioeconomic status of all individuals showed no significant difference between the two groups. It was concluded that fishermen had a higher S. mansoni prevalence, infection intensity and morbidity than farmers. This may be due to more water contact activities. A snail population survey of the river and main canals was recommended.

Effect of rice cultivation on the prevalence and infection rates of Schistosoma intermediate host.

In this study, it was aimed to explore the effect of rice cultivation on the prevalence, density and infection rates on the snail intermediate hosts of human schistosomiasis. A village was chosen and examine for the main water canal supplying the rice field by making three successive scoops at 10.20, 30, 40 and 50 meters up stream the site of the pump supplying the rice field. The same was done in the large irrigation canal supplying 50 feddans of rice up to 100 meters (i.e. 10 sampling sites). Also the drains in between the rice fields were examined at 10 meters distance throughout the drain. The hunted snails were sorted, the Biomphalaria alexanderina and Bulinus truncatus were separated, their age was determined then crushed to look for immature stages under the microscope. Also the vegetations coming in the scoops were examined. The results showed that rice cultivation and irrigation is a suitable site for the prevalence and intensity of snails. Both species of snails were found in the main canal, irrigation canal and drains. All Bulinus truncatus snails were free from infections. The number of infected Biomphalaria alexanderina snails was significantly higher in the irrigation canal and drains than main canal which may be attributed to pollution of the drain water and irrigation canal by micturition and defecation or to the use of water in ablution.