Very High Fascioliasis Intensities in Schoolchildren from Nile Delta Governorates, Egypt: The Old World Highest Burdens Found in Lowlands.

M Victoria Periago,M Dolores Bargues,Santiago Mas-Coma,Verónica H Agramunt,Patricio Artigas,Filippo Curtale,M Adela Valero

doi:10.3390/pathogens10091210

Abstract

Quantitative coprological analyses of children were performed in Alexandria and Behera governorates, Egypt, to ascertain whether individual intensities in the Nile Delta lowlands reach high levels as those known in hyperendemic highland areas of Latin America. Analyses focused on subjects presenting intensities higher than 400 eggs per gram of faeces (epg), the high burden cut-off according to WHO classification. A total of 96 children were found to shed between 408 and 2304 epg, with arithmetic and geometric means of 699.5 and 629.07 epg, respectively. Intensities found are the highest hitherto recorded in Egypt, and also in the whole Old World. A total of 38 (39.6%) were males and 58 (60.4%) were females, with high intensities according to gender following a negative binomial distribution. The high burden distribution shows a peak in the 7–10 year-old children group, more precocious in females than males. Results showed high burdens in winter to be remarkably higher than those known in summer. The fascioliasis scenario in Egyptian lowlands shows similarities to highlands of Bolivia and Peru. Diagnostic methods, pathogenicity and morbidity in high burdens should be considered. The need for an appropriate quantitative assessment of heavy infected children to avoid post-treatment colic episodes is highlighted.

Highlights

Fascioliasis is a disease caused by two trematode species: Fasciola hepatica andF. gigantica
On the contrary, infected subjects detected in surveys in human endemic areas of developing countries such as Egypt, Bolivia and Peru, are mainly in the advanced stage of chronicity, when not already re-infected due to the high contamination risk [65,68]
As the liver fluke is able to survive many years in human beings and liver fluke infection may occur very early in life, even in small children aged less than 1 year [57], pronounced high burdens as those found in Egypt in children of less than 14 years old mostly suggest accumulative reinfections rather than the ingestion of numerous metacercariae at once

Summary

Introduction

Fascioliasis is a disease caused by two trematode species: Fasciola hepatica andF. gigantica. Whereas in Europe, the Americas and Oceania only F. hepatica is present, the distribution of both species overlaps in many areas of Africa and Asia [1] This disease is transmitted by freshwater lymnaeid snails [2,3] and infects mainly herbivore mammals, among which sheep, cattle, goats, buffaloes and equines are the most important reservoirs. The amphibious characteristics and marked environment dependence of the lymnaeid snail vectors and the management, movements and transport of livestock underlie the great impact of climate change and global change on this disease, respectively [5,6] These changes are linked to the increasing number of human fascioliasis reports and higher infection risk in endemic areas of low-income countries and in developed countries [7]

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