Search

The article presents a study which examines the impact of schistosomiasis on human pappilomavirus (HPV) and on the development of cervical neoplasia in Zimbabawean women who are at high-risk of HPV. The women were reexamined after five years for cell atypia, genital schistosomiasis, and lavage and cervix brush samples. Results show that 46 percent of the women have HPV. The study suggests that genital schistosomiasis may play a role in the development of high-grade cervical lesions.

A cross-sectional study was conducted on 544 women living in Mupfure rural area of Zimbabwe to determine whether infection with urinary schistosomiasis is associated with HIV infection. Schistosoma haematobium infection was examined in urine samples and HIV infection was determined in sera. The prevalence of S. haematobium infection was highest (60%) in women below 20 years of age and declined to 29% in the oldest age group (test for trends, P<0.001). Overall, women infected with urinary schistosomiasis had an HIV prevalence of 33.3%, whilst women without urinary schistosomiasis had an HIV prevalence of 25.6% (chi(2), P=0.053). Women above the age of 35 years and infected with urinary schistosomiasis had a significantly higher HIV prevalence (37.5%) than those without urinary schistosomiasis (16.8%; chi(2), P<0.001).

The endod (Phytolacca dodecandra)-based schistosomiasis mansoni control project was implemented in Ethiopia between 1994 and 1999. The aim was to develop an effective, cheap and sustainable method of controlling schistosomiasis. First, different formulations of the Ethiopian endod strain 44 (E-44) were compared for potency in the laboratory. Secondly, spray and drip-feeding methods were compared for simplicity and effectiveness in the field. Lastly, the efficacy of endod powder soap was compared with the endod spray method. In Bati stream, endod powder soap was distributed to the residents every weekend at laundry sites. In Worke stream, endod was sprayed along a 1-km stretch of the stream at 3-month intervals. No endod was applied in Harbu stream. The immediate and long-term effects of endod application on the snail population and schistosomal infection were determined. Using the spray method, 100% snail mortality could be obtained, and it was simpler and more effective than the drip-feeding method. Snail mortality ranged from 20 to 100% using endod soap. There was a progressive decline in the snail population and infection in Bati stream compared with Worke stream, mainly due to sustained use of endod soap. The advantages and disadvantages of the different endod delivery systems are discussed.

Objectives: To record the effect of Endod soap and spraying of soaked Endod suspension on the prevalence of human schistosomiasis., Design: A cross-sectional epidemiological study in which pre- and post-intervention parasitological results were compared., Setting: Kemise, Bati and Harbu towns in northeastern Ethiopia., Subjects: The study subjects included all members of the five per cent households systematically selected from the three towns., Results: In Kemise town, where suspension of ground Endod was sprayed on the stream containing infected snails, the prevalence of the disease was reduced from 59% to 53% and the mean intensity of infection was reduced from 239 eggs per gram (EPG) of faeces to 99 EPG (p < 0.05). In Bati town where Endod soap approach was used, the respective reduction in the prevalence and intensity of infection was from 51% to 43% and from 195 EPG to 162 EPG (p < 0.05). There was also a significant reduction of the disease in the control town probably due to the effects of praziquantel treatment and other factors., Conclusion: The reduction achieved in the prevalence and intensity of schistosomiasis after an intervention period of four years was limited. This observation corroborates the fact that molluscicides must always be considered as supplementary to chemotherapy in the control of schistosomiasis. Although both approaches can be used, the spraying approach appears to be simpler and more feasible because two or three times yearly application of Endod suspension would suppress snail population and reduce transmission. Nevertheless, the choice as to what approach to use must be made on the basis of community preference, and for some soap-effect of Endod would be attractive

A cross-sectional epidemiological survey was made on intestinal schistosomiasis due to Schistosoma mansoni in Wondo Genet, southern Ethiopia, in 1999 to generate preintervention parasitological and malacological baseline data to be used as a reference in evaluation of community-based pilot control trial to be launched using wild-growing Endod. A total of 3000 stool specimens were collected from schoolchildren enrolled in 14 schools and microscopically examined using Kato method. The overall prevalence and intensity of schistosomiasis mansoni was 34.6% and 184 eggs per gram of stool (EPG), respectively. Children excreting Schistosoma mansoni eggs were found in all of the 14 schools surveyed with a prevalence of infection ranging from 1.9% in Abaye School to 80.6% in Shesha Kekele School. The overall prevalence of S. mansoni infection among males and females was 38.4% and 27.3%, respectively (P = 0.0001, 95% C.I = 7.5%-14.7%) where as the intensity of infection was 186 EPG and 181 EPG, respectively (P = 0.8045, 95% C.I = 1.17%-1.23%). Malacological surveys of 27 water contact sites revealed the occurrence of Biomphalaria pfeifferi in 8 sites out of which 3 harbored infected snails shedding schistosome cercariae. The necessity for initiating community-based sustainable control programme is discussed.

As part of a pre-intervention baseline data collection the epidemiological characteristics of schistosomiasis mansoni were studied in 3 endemic communities (Kemise, Harbu and Bati towns) in northeast Ethiopia in April and May 1994. The objective was to generate data based on which post-intervention differences (in changes), if any, in transmission level could partly be explained for the 3 towns. After calculating the sample size required for each town 132, 75, 158 households were selected by systematic random sampling from Kemise, Harbu and Bati, respectively and all members of the selected households stool was examined by the Kato's thick smear method. Eighty eight and 85% of the houses harboured one or more cases of Schistosoma mansoni in Kemise and in Bati, respectively, all members of the households being positive in 27% in Kemise and in 28% in Bati. The overall prevalences were 59%, 33% and 51% in Kemise, Harbu and Bati, respectively, with the corresponding geometric mean egg counts (epg) of 240, 123 and 195 for positives and 26.5 and 15 for the whole populations. All ages combined, there were no significant differences due to sex both in prevalence and intensity of infection. By age, children in the 10-14 years age group were most affected (p = 0.007), their prevalences reaching 86%, 52% and 66% in Kemise, Harbu and Bati, respectively and their corresponding geometric mean epg being 377, 157 and 401, respectively. Heavy infection (> 100 epg) reached 42%, 32% and 16% in Kemise, Bati and Harbu, respectively, reaching an average of 55% among the 10-14 years of age. The implications of the epidemiological findings and the possible use of the household approach for rapid assessment of schistosomiasis magnitude in an area are discussed.

With up to 100 million cases annually, dengue fever is today's most important arboviral disease. Dengue fever is endemic in many parts of South-East Asia, the Indian subcontinent, Oceania and the Americas. The disease mainly affects the local population, but occasionally also visitors from non-endemic areas. In this article we present epidemiological and clinical data on all 26 cases with serological confirmed dengue fever diagnosed in Norway in 1991-1996. 21 patients (81%) were infected in Asia. Typical exanthema, leucopenia, and thrombocytopenia were seen in 71%, 79% and 84% of the cases, respectively. A 37-year-old Indian-born woman developed dengue haemorrhagic fever grade 1 after a visit to New Delhi, while the remaining 25 patients had classical dengue fever. Postinfectious complications were common, and four weeks after the acute illness, hair loss, mental depression and asthenia were reported by 45%, 50% and 100% of the cases, respectively.

In the 1950s dengue fever left its home in South-East Asia. The result, as we see it 40 years later, is terrifying. From being an almost unknown infection, dengue fever is today's most common arboviral disease with up to 100 million cases annually. In addition, the clinical picture has changed from a benign influenza-like disorder (classic dengue fever) to a serious disease with bleeding and hypovolemic shock (dengue hemorrhagic fever). In this article the authors give an overview of the present epidemiology, prognosis and possible preventive measures against dengue fever.

Based on assumptions about the pathophysiology of egg-related lesions in the lower reproductive tract, putative indirect disease markers were investigated in vaginal fluids from 54 Malawi adolescent girls and women infected with S. haematobium. These women received a careful gynecological examination during which biopsies were taken from the cervix, and, if present, also from suspicious lesions in the vagina and the vulva. If the biopsies, either in wet crushed preparations or in histological sections, contained eggs the patients were considered to have female genital schistosomiasis (FGS; n = 33). The remainder (n = 21) were classified as having urinary schistosomiasis only. Eosinophil cationic protein (ECP), a cytotoxic granule protein of eosinophils, neopterin, a second messenger molecule generated during the activation of macrophages, and IgA as an indicator of local B-cell activation were quantitatively determined in vaginal fluid. To clarify the origin of ECP, this protein was also looked for in histological sections by an immunohistochemical method. In order to explore whether such disease markers can be detected after absorption to a tampon-like material, ECP and IgA were also assessed after elution from a non-porous, polypropylene fibre web impregnated with vaginal fluid. The concentration of ECP in vaginal fluid and the degree of immunohistochemical staining in histological sections were significantly higher in patients with FGS than in women with urinary schistosomiasis only. The amount of ECP detected in histological sections correlated to the number of eggs/mm2 of compressed genital tissue (rho = 0.36, P = 0.02), and the concentration of ECP in vaginal fluid correlated to the concentration of neopterin as well as to that of IgA (rho = 0.52, P = 0.004 and rho = 0.37, P = 0.02, respectively). Median neopterin concentration in vaginal fluid was also higher in the FGS group, but the difference was not statistically significant. ECP could also be detected in eluates from impregnated fibre webs, but the concentration was approximately one power of 10 less than in the original vaginal fluid. These results demonstrate that indicators of immunological mechanisms related to the egg-granuloma might be useful as indirect disease markers for women with FGS if assessed in vaginal washings or swab eluates.

The epidemiology, clinical presentation, diagnosis and treatment of typhoid fever has been studied retrospectively in 50 hospitalized patients. Typhoid fever is increasing in Norway, owing to more travel, especially by immigrants visiting their home countries. Among 50 patients admitted to hospital for typhoid, we found no fatal complications. Fever was a main symptom, and 13 of the 50 patients had additional concomitant infections. The standard treatment was chloramphenicol for 14 days. In 1990 and 1991, however, most cases were caused by multi-resistant strains of Salmonella typhi. The adults were therefore treated with ciprofloxacin and the children with third generation cephalosporins. All the multiresistant infections had been contracted in Pakistan or India. There were no secondary cases among the more than 214 family contacts in the 47 families involved. The increase in resistant strains of typhoid fever may affect future treatment and control strategies.

We describe a small epidemic of typhoid fever in a family who came originally from Pakistan. In 1992 six members (mother and five children) of a family of ten were admitted to our department with typhoid fever within a nine-day period. The index case was an 18 months old girl who had been hospitalized and treated elsewhere for typhoid fever. Two weeks after completing antibiotic treatment she was admitted to our hospital with a relapse. The source of her first infection is unknown. The rapid spread of typhoid fever in the family was most likely due to insufficient hygienic precautions and inadequate antibiotic treatment of the index case. Several coexisting factors such as poor housing conditions and cultural barriers may also have influenced the outcome. There is obviously a need for strict guidelines and proper coordination of treatment and follow-up of this and other similar contagious diseases.

Widespread use and misuse of antiinfectiva have resulted in a problem of drug resistance linked to treatment of infectious diseases. In developing countries especially, the sale of such drugs is poorly controlled and the pharmaceutical industry is dumping obsolete products. Intensive marketing, lack of diagnostic facilities and receptive local cultural attitudes to new "wonder drugs" such as antibiotics, have resulted in dramatic unnecessary use of such. Therefore the ideal strategies for treatment of infectious diseases guided by microbiological diagnosis and resistance pattern are violated in most developing countries, leading to excessive use of antiinfectiva and development of resistance. This has serious consequences for the infections that cause most cases of infant mortality, namely malaria, diarrhoeas and infections of the respiratory tract. Improvements in this vicious circle of drug use and resistance can only be made by attacking several factors simultaneously. There is a need for general information, stricter legislation, essential drug lists, national drug policies, better knowledge of local resistance patterns, better diagnostic facilities, better knowledge about local beliefs about drugs and better communication to local health workers and the community.

We have developed a new magnetic bead antigen capture enzyme-linked immunoassay for the detection of schistosomal circulating anodic antigen. The assay utilizes IgG1 monoclonal antibody coated monodisperse magnetic beads in microtitre trays fitted to a special magnet. The total test time was found to be 1-2 h, using 0.05 mg beads per well. The lower detection level was 0.7 ng AWA-TCA per ml (approximately 0.07 ng CAA per ml). Validation by sera from uninfected and Schistosoma mansoni infected Africans and Norwegians resulted in an assay specificity of 100% and sensitivity was close to 90% for cases excreting more than 100 eggs per gram faeces. At such clinically relevant levels the inter-assay CV was below 10% and photometric absorbance correlated to antigen levels was nearly linear. There was a significant correlation between the magnetic bead EIA absorbance values and the titres obtained using the previously established ELISA. The new bead assay, however, was easier and less laborious because TCA pretreatment and the titration of positive results were unnecessary.

The magnetic bead antigen capture enzyme-linked immunosorbent assay (MBAC-EIA) has been applied to detect schistosomal circulating anodic antigen (CAA) in pre- and post-treatment sera from 55 individuals in a Schistosoma mansoni control project in the Blue Nile valley of western Ethiopia. The amounts of CAA detected by this assay were positively correlated with the numbers of eggs per gram of faeces (epg). A significant reduction in CAA levels as measured by the MBAC-EIA was observed after mass chemotherapy. The sensitivity was 88-89% in clinically significant cases excreting more than 100 epg. In light infections, however, the sensitivity was lower. None of 32 uninfected Norwegian blood donors or 12 Ethiopian immigrants to Norway were positive. The specificity was thus estimated to be 100%. The test is rapid (1-2 h) and simple to perform without sophisticated equipment and could therefore, with slight modification, be used as a reliable method of diagnosis at field level in endemic areas undergoing mass chemotherapy campaigns or population surveys.

Widespread use and misuse of anti-infective agents have resulted in a problem of drug resistance linked to treatment of infectious diseases. In developing countries especially, the sale of such drugs is poorly controlled and the pharmaceutical industry is dumping obsolete products. Intensive marketing, lack of diagnostic facilities and receptive local cultural attitudes to new "wonder drugs" such as antibiotics, have resulted in dramatic unnecessary use of such. Therefore the ideal strategies for treatment of infectious diseases guided by microbiological diagnosis and resistance pattern are violated in most developing countries, leading to excessive use of anti-infective agents and development of resistance. This has serious consequences for the infections that cause most cases of infant mortality, namely malaria, diarrhoeas and infections of the respiratory tract. Improvements in this vicious circle of drug use and resistance can only be made by attacking several factors simultaneously. There is a need for general information, stricter legislation, essential drug lists, national drug policies, better knowledge of local resistance patterns, better diagnostic facilities, better knowledge about local beliefs about drugs and better communication to local health workers and the community.