The inactivation of Ascaris suum eggs by short exposure to high temperatures.

Ascaris sp. is the most prominent and resilient helminth of human health importance found in faecal sludge, making Ascaris sp. an ideal index organism for inactivation testing. Heat treatment destroys helminths,allowingfor safe handling and possible reuse of sludge. Technology developmentfocuses on rapid heating to minimize equipment size and cost. This study evaluates Ascaris suum eggs' viability with short heating time. Ascaris eggs were placed in a water bath at temperatures from 60 to 80 °C for various exposure times (5 seconds to 4 minutes) and were immediately processed and analysed via light microscopy. For all samples within these temperature and time ranges, less than 10% viable eggs were recovered. For 70, 75 and 80 °C, complete inactivation was observed for exposure time of 5 seconds and above.

Paragonimiasis in KwaZulu-Natal Province, South Africa.

Nine cases of paragonimiasis have been reported from cats (4), dogs (2) and children (3) in South Africa, with an additional suspected case in an adult female patient. Details of these cases are reviewed. All nine cases, and perhaps the adult case as well, were from the province of KwaZulu-Natal but locality data are only available for six of them. These six cases represent four localities which all lie below 100 m above sea level in the province's lowlands, suggesting that there may be a focus of transmission here. The molluscan first intermediate host must be one of the two prosobranch snail species present in the area, Melanoides tuberculata or Tomichia natalensis, and the decapod second intermediate host the common river crab Potamonautes sidneyi. All infected cats and dogs had pulmonary infections, while two human cases for which there is sufficient information had extrapulmonary infections. Transmission appears to be ongoing but the invasive snail Tarebia granifera may be competing with both M. tuberculata and T. natalensis. If so, this may bring transmission to an end.

Remote sensing, geographical information system and spatial analysis for schistosomiasis epidemiology and ecology in Africa.

Beginning in 1970, the potential of remote sensing (RS) techniques, coupled with geographical information systems (GIS), to improve our understanding of the epidemiology and control of schistosomiasis in Africa, has steadily grown. In our current review, working definitions of RS, GIS and spatial analysis are given, and applications made to date with RS and GIS for the epidemiology and ecology of schistosomiasis in Africa are summarised. Progress has been made in mapping the prevalence of infection in humans and the distribution of intermediate host snails. More recently, Bayesian geostatistical modelling approaches have been utilized for predicting the prevalence and intensity of infection at different scales. However, a number of challenges remain; hence new research is needed to overcome these limitations. First, greater spatial and temporal resolution seems important to improve risk mapping and understanding of transmission dynamics at the local scale. Second, more realistic risk profiling can be achieved by taking into account information on people's socio-economic status; furthermore, future efforts should incorporate data on domestic access to clean water and adequate sanitation, as well as behavioural and educational issues. Third, high-quality data on intermediate host snail distribution should facilitate validation of infection risk maps and modelling transmission dynamics. Finally, more emphasis should be placed on risk mapping and prediction of multiple species parasitic infections in an effort to integrate disease risk mapping and to enhance the cost-effectiveness of their control.

The influence of transmission season on parasitological cure rates and intensity of infection after praziquantel treatment of Schistosoma haematobium-infected schoolchildren in Mozambique.

Schistosoma haematobium is refractory to praziquantel (PZQ) during the prepatent period of infection. A hypothesis based on this observation is that in areas where S. haematobium transmission is seasonal, the outcome of chemotherapy depends on the timing of the treatment relative to the annual transmission pattern. To examine this hypothesis, a study was carried out in southern Mozambique. Following demonstration of seasonal transmission, PZQ was administered separately to two cohorts of S. haematobium-infected schoolchildren in (1) the high and (2) the low transmission seasons and followed up after two months when levels of infection and intensities were measured. The prevalence of infection decreased from 54.2% and 51.7% in cohorts 1 and 2 to 30.3% and 1.8%, respectively. The geometric mean intensity of infection decreased from 23.3 eggs/10 ml of urine at baseline to 15.6 eggs/10 ml of urine in cohort 1 (treated during high transmission season), and from 23.5 eggs/10 ml urine to 7.3 eggs/10 ml of urine in cohort 2 (treated during low transmission season). The observed cure rates in cohorts 1 and 2 were 69.7% and 98.2%, respectively. Differences in infection between the cohorts in terms of cure rate and level of infection two months post-treatment were statistically significant and indicate that in areas with a seasonal transmission pattern, the effect of PZQ can be enhanced if treatment takes place during the low transmission season. We conclude that appropriately timed PZQ administration will increase the impact of schistosomiasis control programmes.

Geohelminth infection and re-infection after chemotherapy among slum-dwelling children in Durban, South Africa.

The prevalences and intensities of Ascaris lumbricoides, Trichuris trichiura and hookworm (probably Necator americanus) infection were measured in the young children (aged 2-10 years) living in 10 urban slums in Durban, South Africa. Re-infection was assessed at 4-6 and 12 months post-treatment. The baseline prevalences of A. lumbricoides and T. trichiura were 81.7%-96.3% and 54.5%-86.2%, respectively, and the corresponding geometric mean intensities were 960 and 91 eggs/g faeces. Most (85%) of the children found infected with A. lumbricoides and 23% of those found infected with T. trichiura had moderate-heavy infections. A few of the children investigated had intensities of Ascaris and Trichuris infection that were considerably higher than those previously recorded in South Africa. The baseline prevalences of hookworm infection (0%-20% in individual slums, with a mean of 4.7%) and intensities of such infection (geometric mean=17 eggs/g) were relatively low. Albendazole proved very effective against A. lumbricoides and hookworm but less so against T. trichiura. Re-infection by A. lumbricoides and T. trichiura reached pre-treatment prevalences by 4-6 months post-treatment in some of the slums and by 12 months in all the other slums. By 12 months post-treatment, the intensities of A. lumbricoides infection had reached their pre-treatment levels while those of T. trichiura infection were higher than at baseline. Approximately 50% of children had moderate-heavy T. trichiura infections at 12 months post-treatment compared with approximately 23% at baseline. Hookworm infections did not re-appear after treatment. The results show clearly that urban slums should be included in any future helminth-control programmes in South Africa.

Epidemic transmission of intestinal schistosomiasis in the seasonal part of the Okavango Delta, Botswana.

A well documented epidemic of human intestinal schistosomiasis caused by Schistosoma mansoni occurred at Maun in the seasonal part of the Okavango Delta, Botswana, building from very few cases in the 1950s and early 1960s to a peak prevalence of >80% in the 1980s. A retrospective analysis was performed on all available records of the prevalence of S. mansoni in the Maun area and the corresponding flow records of the Thamalakane River. These revealed a statistically significant correlation between prevalence and flow, but only when a lag period was introduced. The correlation was greatest with a lag period of 5-6 years between the rise and fall of discharge and the rise and fall of transmission. Since the hydrological events in the delta follow a cyclical pattern, another epidemic around 2020 appears likely.

Hookworm (Necator americanus) transmission in inland areas of sandy soils in KwaZulu-Natal, South Africa.

This study extended the association between hookworm transmission in KwaZulu-Natal and the sandy coastal plain by investigating the parasite's occurrence in isolated areas of sandy soils further inland. A school-based prevalence survey was carried out in selected inland sandy areas and in surrounding areas dominated by clay soils within a narrow altitudinal range of between 500 and 700 m to reduce the effect of altitude on climate-related factors (rainfall and temperature). Sandy areas situated on the coastal plain were included in the analysis for comparative purposes. Soil samples (0-50 mm depth) were collected from each locality to assess their nematode loadings and to analyse selected physical and chemical properties. Significant differences were found between the moderate prevalence of hookworm infection among children living in inland areas with sandy soils (17.3%) and the low prevalence in surrounding non-sandy areas (5.3%, P < 0.001), and between infection among children living in all inland areas (9.3%) and the high prevalence on the coastal plain (62.5%, P < 0.001). Amounts of fine and medium sand were highest in both the coastal plain soils and in inland sandy areas and these fractions showed a significant positive correlation with hookworm prevalence and nematode loadings. Clay, coarse sand and organic matter contents were highest in surrounding non-sandy soils and showed a significant negative correlation with the nematode variables. No statistically significant correlations were found with soil pH at study localities. We conclude that properties of inland sandy soils, particularly particle size distribution, correlate well with hookworm prevalence and nematode loadings and therefore provide a more suitable habitat for nematodes than surrounding non-sandy areas. These results suggest that particle size distribution of sand fractions, organic matter and clay content in the soil influence the survival of hookworm larvae and hence the parasite's transmission.

Phylogeography of Biomphalaria glabrata and B. pfeifferi, important intermediate hosts of Schistosoma mansoni in the New and Old World tropics.

The historical phylogeography of the two most important intermediate host species of the human blood fluke Schistosoma mansoni, B. glabrata in the New World, and B. pfeifferi in the Old World, was investigated using partial 16S and ND1 sequences from the mitochondrial genome. Nuclear sequences of an actin intron and internal transcribed spacer (ITS)-1 were also obtained, but they were uninformative for the relationships among populations. Phylogenetic analyses based on mtDNA revealed six well-differentiated clades within B. glabrata: the Greater Antilles, Venezuela and the Lesser Antilles, and four geographically overlapping Brazilian clades. Application of a Biomphalaria-specific mutation rate gives an estimate of the early Pleistocene for their divergence. The Brazilian clades were inferred to be the result of fragmentation, due possibly to climate oscillations, with subsequent range expansion producing the overlapping ranges. Within the Venezuela and Lesser Antilles clade, lineages from each of these areas were estimated to have separated approximately 740 000 years ago. Compared to B. glabrata, mitochondrial sequences of B. pfeifferi are about 4x lower in diversity, reflecting a much younger age for the species, with the most recent common ancestor of all haplotypes estimated to have existed 880 000 years ago. The oldest B. pfeifferi haplotypes occurred in southern Africa, suggesting it may have been a refugium during dry periods. A recent range expansion was inferred for eastern Africa less than 100 000 years ago. Several putative species and subspecies, B. arabica, B. gaudi, B. rhodesiensis and B. stanleyi, are shown to be undifferentiated from other B. pfeifferi populations.

The effect of soil type and climate on hookworm (Necator americanus) distribution in KwaZulu-Natal, South Africa.

We investigated environmental factors influencing the distribution of hookworm infection in KwaZulu-Natal, South Africa. Prevalence data were sourced from previous studies and additional surveys carried out to supplement the database. When geo-referenced the data revealed that higher prevalences are limited to areas below 150 m above sea level, and low prevalences to areas above this altitude. Using univariate analysis we investigated the differences in environmental factors in the two areas. The relationship between hookworm prevalence, altitude and climate-derived variables was assessed using Pearson correlation coefficient, and that of soil type using the t-test. Multivariate analysis was used to determine environmental factors that combine best to provide favourable conditions for hookworm distribution. The results revealed that areas 150 m above sea level, i.e. inland, supported low mean hookworm prevalences (x = 6, n = 21), and were characterized by soils with a clay content of more than 45%, variable temperatures and moderate rainfall. Hookworm prevalence also decreased southwards as temperatures became slightly cooler, rainfall remained more-or-less constant and the coastal plain narrowed. In the multivariate model prevalence was most significantly correlated with the mean daily minimum temperature for January followed by the mean number of rainy days for January. This indicates the importance of summer conditions in the transmission of hookworm infection in KwaZulu-Natal and suggests that transmission may be seasonal.

The current status of neurocysticercosis in Eastern and Southern Africa.

Some information has been documented on the epidemiology of neurocysticercosis in Eastern and Southern Africa through the monitoring of hospital-based patients with neurocysticercosis, community-based serological surveys of particular socio-economic groups of people and surveys of porcine cysticercosis. Studies have revealed that non-pork eaters have as great a chance of infection as a pork eater, the Xhosa-speaking people of the Eastern Cape Province have the highest prevalence of cysticercosis/taeniosis in South Africa probably due to the common practice of free-range pig farming and the lack of sanitation in these areas. Several studies have revealed high prevalence rates in children and interestingly, patients with active cysts suffering from epilepsy. A startling mode of transmission is where self-trained healers use Taenia segments either for benevolent (e.g. in the treatment of severe intestinal tapeworm infections) or malevolent (evil) purposes (e.g. women "poisoning" an unfaithful husband or lover by adding the contents of Taenia solium segments to beer).

Praziquantel--quality, dosages and markers of resistance.

The fourth and last meeting of Concerted Action on Praziquantel (PZQ), sponsored by the European Commission, was held in Rome, Italy from 31 March to 1 April, 2001. Highlights of the meeting were new findings on the quality of generic drugs, an initiative to promote the Africa-wide distribution of PZQ and new results in the search for markers of PZQ-resistant schistosomes.

The distribution of helminth infections along the coastal plain of Kwazulu-Natal province, South Africa.

The results of a previous study indicated that, in the province of KwaZulu-Natal, South Africa, Necator americanus and Strongyloides stercoralis were endemic to the coastal lowlands only. The prevalences of these helminths, as well as those of Trichuris trichiura and Ascaris lumbricoides, have now been investigated along a 1000-km-long transect through the coastal plain, at altitudes of < 300 m, from the Mozambique border (26 degrees 57'S) to the border with Eastern Cape province (30 degrees 53'S). Necator americanus was by far the most dominant hookworm species. Although prevalences of N. americanus and S. stercoralis infection decreased with increasing southerly latitude, those of T. trichiura and A. lumbricoides did not. Determinants of these distribution patterns are examined in terms of a suite of temperature- and rainfall-related variables.

A comprehensive evaluation of Agave attenuata, a candidate plant molluscicide in South Africa.

Dried leaf material of a Mexican plant, Agave attenuata, was found to be highly toxic to the target snail, Bulinus africanus, intermediate host of Schistosoma haematobium in South Africa. The molluscicidal potency of the plant underwent seasonal variation, but remained stable over a range of pH values, after exposure to sunlight and organic matter, and during dry storage. It was unstable in aqueous suspension. The toxicity of the molluscicide to crop plants, invertebrates, fish and mammals was lacking or low. Given these properties, A. attenuata may provide a substitute for niclosamide and be used safely for snail control by rural communities.

Schistosomiasis and the use of indigenous plant molluscicides: a rural South African perspective.

In the last decade plant molluscicides have received considerable attention in the search for cheaper alternatives to chemotherapy and synthetic molluscicides in schistosomiasis control. The attraction of a locally grown molluscicidal plant is based on the development of a philosophy of self-reliance and community involvement. This approach is dependent on community recognition of the infection as a public health problem and their acceptance of proposed control measures. The objectives of this study were: (i) firstly, to assess the knowledge of schistosomiasis in a rural community and their attitude to the use of indigenous plant molluscicides; (ii) secondly, to assess the prevalence and intensity of infection in relation to its severity as perceived within the community. Study sites were located at Mtwalume (KwaZulu-Natal, South Africa). Sixty-nine community members were interviewed during six focus-group interviews and two depth interviews. Urine and stool samples (354 and 306, respectively) from children and young adults (2-25 years old) were analysed for Helminth and Protozoal infections. Results indicate that despite a poor understanding of schistosomiasis, it is a primary health concern for those dependent on river-water for their water requirements. Concern for schistosomiasis is indeed matched by a prevalence of 75.14% for Schistosoma haematobium. Oral antischistosomal drugs are inaccessible primarily due to the cost of transport and secondarily, due to the cost of treatment. The concept of molluscicidal control, as an alternative, was enthusiastically received by all respondents.

Mammal toxicity assessment of the plant molluscicide, Apodytes dimidiata (Icacinaceae), in South Africa.

Apodytes dimidiata has recently come to the fore as a potential plant molluscicide for schistosomiasis control in rural communities in South Africa. Prior to field applications of its leaves and extract to waterbodies, selected acute and sub-acute mammal toxicity tests were conducted in accordance with the Organisation of Economic Cooperation and Development (OECD) Guidelines to identify any potential hazards that might arise form the plant's use. Acute and sub-acute mammal toxicity test results classified A. dimidiata as non-toxic and non-irritating. Based on this toxicity evaluation, the dried leaf material and aqueous extracts of this plant are considered safe for use in preliminary field trials.

A semi-quantitative approach to the selection of appropriate candidate plant molluscicides--a South African application.

The high cost of synthetic molluscicides, used in the control of the intermediate snail hosts of schistosomiasis (bilharzia), has resulted in renewed interest in plant molluscicides. The history of the use of plant molluscicides is reviewed. Although screening programmes have been conducted in other African countries, no efforts have been made to identify South African plants which would be suitable for use locally, using appropriate technology. The prohibitive costs (time and financial) of random surveys for activity necessitated the development of an objective selection procedure. A simple scoring system derived for this purpose is described. Of 600 plant species with potential, or recorded activity, 150 occurred in South Africa. Twenty-six taxa were active according to standards set by WHO. A further 37 species, although untested, warrant further investigation. Species were ranked on cumulative scores for: (a) coincidence of the endemic areas of the plant, snail host and disease; (b) ethnomedicinal value which would provide greater incentive for cultivation; (c) molluscicidal activity (if known, a minimum LD90 of < or = 100 ppm). Two lists resulted, those with recorded and those with potential activity. Both are important in prioritizing research on molluscicidal plants in South Africa. Problems inherent to the scoring system and to the development of plant molluscicides are discussed.

The molluscicidal activity of Apodytes dimidiata E. Meyer ex Arn (Icacinaceae), Gardenia thunbergia L.f. (Rubiaceae) and Warburgia salutaris (Bertol. F.) Chiov. (Cannelaceae), three South African plants.

Mollusciciding is still considered the most important means of control of schistosomiasis where the volume of water per caput is small. In rural communities the cost of synthetic molluscicides and/or chemotherapy prohibits their use. Plant molluscicides, applied as crude aqueous suspensions are the source of cheap, effective and environmentally acceptable alternatives. Further, infected communities are likely to accept the use of local indigenous plants, particularly if they have more than one local application, since they are familiar with their properties and growth characteristics. In this study the activity of crude aqueous suspensions of six South African plants were assessed. Suspensions of leaf material were bioassayed for activity using Bulinus africanus. Probit analysis was used to calculate LD50 and LD90 values. Three species would receive priority for further investigations of extract stability and toxicology, i.e. comprehensive evaluation. For this purpose species were ranked on toxicity as aqueous suspensions, the highest toxicity level previously recorded in the literature, and on their cultivation potential. Ranks for each plant were summed and Gardenia thunbergia, Apodytes dimidiata, and Warburgia salutaris had the lowest cumulative rankings (i.e. the highest molluscicidal activity and greatest cultivation potential).