Animal reservoirs of leishmaniasis in Marigat, Baringo District, Kenya.

A total of 1128 rodents belonging to seven genera were examined for leishmanial parasites over a period of sixteen months. Parasites were isolated from 36 (12.5%) Tatera robusta, 3 (0.5%) Arvicanthis niloticus, and 2 (0.8%) Mastomys natalensis. All isolates were characterised by isoenzyme analysis using nine enzymes. The enzymes examined were: malate dehydrogenase (MDH), phosphoglucomutase (PGM), glucose phosphate isomerase (GPI), isocitrate dehydrogenase (ICD), nucleoside hydrolase (NH), glucose 6-phosphate dehydrogenase (G6PD), mannose phosphate isomerase (MPI), malic enzyme (ME) and 6-phosphogluconate dehydrogenase (6PGD). The enzyme profiles from these isolates were compared with those from Leishmania reference strains and also with isolates of Leishmania major from man and sandfly, P. duboscqci from the same area. All the isolates except one from a Mastomys were identified as L. major. The isolate from Mastomys was trypanosome-like and remains unidentified. The results in this study show that Tatera robusta is the main reservoir of cutaneous leishmaniasis in Baringo District. None of the animals trapped were found infected with Leishmania donovani suggesting that rodents do not play a role in the transmission of visceral leishmaniasis in this area.

Vaccination of the vervet monkey (Cercopithecus aethiops) against infection with Schistosoma mansoni.

Pilot experiments were carried out to assess the immunizing potential of radiation-attenuated cercariae of S. mansoni. Groups of 4 monkeys each were vaccinated 4-5 times at 3-5-week intervals using cercariae which had received 10, 20, 40 or 60 krad of gamma radiation. Animals were vaccinated with 1000 or 2000 cercariae per kilogram of body weight. Overall the difference in worm burdens between the vaccinated and unvaccinated groups was highly significant (P greater than 0.01). The highest level of protection achieved was 44.4%. This was in monkeys which were immunized five times with 2000, 20-krad cercariae at 3-4-week intervals. Protection levels of 33.3%, 36.6% and 37.0% were achieved in groups which had received, respectively, 1000 20-krad cercariae, 1000 10-krad cercariae, 2000 40-krad cercariae and 2000 60-krad cercariae. Vaccination reduced faecal egg counts markedly and intestinal tissue egg counts by 20-40%. Antischistosomular antibody was detectable in vitro 3 weeks after the first vaccination. Schistosomule kill rates of up to 60% were observed in vitro.

Efficacy of alternating therapy with oxamniquine and praziquantel to treat Schistosoma mansoni in children following failure of first treatment.

Two hundred children infected with Schistosoma mansoni were treated with either 20 mg/kg oxamniquine or 60 mg/kg praziquantel. Cure rates (about 85%) were similar as was the percentage reduction (80%) in egg counts in uncured children. Treatment with the alternative drug of children not cured with the first treatment resulted in negative stools in 11 of 12 cases examined one month after the second round of therapy. In order to minimize the risk of the development of drug resistance, our data suggest that infected patients be treated with one drug, and therapeutic failures with another. Evidence from experiments in mice with isolates obtained after failures of one treatment in children suggests that therapeutic failure does not necessarily indicate the presence of drug-resistant schistosomes. The value of using mice to assess drug resistance in schistosomes is questioned.

The significance of variation in the susceptibility of Schistosoma mansoni to the antischistosomal drug oxamniquine.

Clinical and laboratory evidence is reviewed which shows that there is a great deal of variation in the susceptibility of Schistosoma mansoni to oxamniquine. This variation occurs both among endemic regions and within endemic regions in Brazil and Kenya. It is genetically controlled. It is suggested that the parasite possesses a large capacity for developing resistance to the drug and that resistance will develop where sufficient drug pressure is maintained.

Tolerance of Kenyan Schistosoma mansoni to oxamniquine.

Although 30 mg/kg oxamniquine produced high levels (85.5 to 99.5%) of egg reduction in Kenyan children infected with Schistosoma mansoni after a single oral treatment, cure rates from children at Mwea in Kirinyaga district were lower than those from Machakos (58% v. 74%). Redosing uncured children confirmed this lower cure rate (36% v. 83%). Isolates from infected children were passaged into mice and dosed with oxamniquine. Lower than expected reductions in worm numbers were obtained, suggesting that oxaminiquine tolerant S. mansoni are present in the normal worm population in Kenya. It is concluded that mass use of oxamniquine at 30 mg/kg may produce problems of drug resistance.

The significance of variation in the susceptibility of Schistosoma mansoni to the antischistosomal drug oxamniquine

Clinical and laboratory evidence is reviewed which shows that there is a great deal of variation in the susceptibility of Schistosoma mansoni to oxamniquine. This variation occurs both among endemic regions and within endemic regions in Brazil and Kenya. It is genetically controlled. It is suggested that the parasite possesses a large capacity for developing resistance to the drug and that resistance will develop where sufficient drug pressure is maintained.

Distribution in Kenya of intermediate hosts of Schistosoma.

A major factor in the geographical distribution of endemic schistosomiasis in Kenya is the discontinuous distribution of intermediate hosts. Biomphalaria pfeifferi is the main transmitter of S. mansoni and is found in the altitude zone 300-2,300 m; its absence from the costal region results in the absence of endemic schistosomiasis mansoni amongst the large human population in the coastal region. Snails belonging to the Bulinus africanus group appear to be responsible for all transmission of S. haematobium; they occur from near sea-level to an altitude of about 1,800 but are discontinuously distributed. There appears to be considerable potential for increase in the areas in which each form of schistosomiasis is endemic, taking into account existing patterns of snail distribution and likely developments in irrigation and water conservation. New localities reported here considerably extend the known distribution in western Kenya of B. truncatus, which could serve as an effective intermediate host for S. haematobium if a suitable strain were to become established in Kenya.