Screening For Schistosomiasis Research Articles

Noncirrhotic Portal Hypertension in a Young Alcoholic Male

A 19 year old Hispanic male (AG) presented to the emergency department with a one week history of multiple episodes of coffee ground emesis combined with bright red blood. Past medical history included a four years history of heavy alcohol abuse, otherwise unremarkable. In the emergency department, AG had evidence of ongoing upper GI bleeding with unstable vital signs. Physical exam failed to demonstrate stigmata of chronic liver disease or splenomegaly. Lab results were consistent with iron deficiency anemia (Hgb 4.7, low iron, high TIBC, low ferritin). Additional lab work revealed an INR of 1.36, otherwise, normal hepatic function tests. An urgent upper endoscopy demonstrated portal hypertensive gastropathy with Grade II-III esophageal varices. The patient underwent esophageal variceal ligation without difficulty. Abdominal ultrasound revealed a coarse echotexture throughout the liver, mild splenomegaly and pelvic ascites. Lab evaluation for chronic liver disease including viral hepatitis panel (hepatitis A, B, C), alpha 1 antitrypsin, ceruloplasmin, liver- kidney microsomal antibody, ANA, smooth muscle antibody, ANCA, and alpha-fetoprotein were unremarkable. In addition, screening for schistosomiasis and other ova and parasites were negative. Serum drug and alcohol screening were negative. An ultrasound guided-paracentesis demonstrated a transudative ascites without evidence of malignancy. Liver biopsy showed noncirrhotic portal hypertension, mildly dilated sinusoids without significant fibrosis. Doppler ultrasound disclosed no evidence of thrombosis. Protein C and S were marginally low. Anti-thrombin III was normal. Factor V leiden, serum arsenic, and copper are still pending. This patient presented with variceal bleeding, anemia, splenomegaly with no clinical or pathological evidence of liver cirrhosis or schistomiasis. He has no family or personal history suggestive of hypercoagulable state. The prothrombin screen has been unremarkable. In addition, there is no history of hepatotoxic medication use. Therefore, most likely AG had a form of Idiopathic Portal Hypertension (IPH). IPH, characterized by gastroesophageal variceal bleeding, is not uncommon in young adults, who otherwise have little or no evidence of hepatic dysfunction. Treatments of variceal hemorrhage in patients with IPH are similar to those in patients who bleed from other causes. Although there have been no controlled trials in this setting, primary prophylaxis with a non-selective beta-blocker is reasonable.

IMPACT OF PARASITIC INFECTIONS AND DIETARY INTAKE ON CHILD GROWTH IN THE SCHISTOSOMIASIS-ENDEMIC DONGTING LAKE REGION, CHINA

The simultaneous impacts of parasitic infections and dietary intake on growth patterns were investigated for 427 children aged 10-13 years in the schistosomiasis-endemic Dongting Lake region of China. Height, weight, mid-upper arm circumference, and skinfold thicknesses (triceps, biceps, and subscapular) were measured, and eggs of Schistosoma japonicum, Ascaris lumbricoides, Trichuris trichiura, and Fasciolopsis buski in the collected stool samples of each subject were detected by Kato-Katz thick smear technique. Long-term dietary intake of each subject was assessed with a semiquantitative food frequency questionnaire. The results demonstrate that the study children were retarded in growth compared with the standards of Chinese rural children; among them, the girls were more frequently infected for S. japonicum and had lower intakes of protein and energy. Reduced height, weight, and mid-upper arm circumference were noted in children infected with S. japonicum, most severely in the girls with the least energy and protein intakes. Multiple stepwise regression analysis indicated that growth retardation was significantly and substantially associated with S. japonicum infection and lack of protein-energy intakes. For child health programs, regular schistosomiasis screening and treatment in schoolchildren needs to be complemented by health and nutrition education for both children and parents. Also, special attention should be paid to educating parents about the needs of girls.

Schistosoma mansoniin Family 5 Years after Safari

<i>Schistosoma mansoni</i>in Family 5 Years after Safari

Schistosomiasis screening and health education for children: action research in Nile delta villages.

In Egypt an important component of the national schistosomiasis control policy is the regular screening of school children through the rural health units. In the Nile delta, a major challenge for the programme is the increasing predominance of Schistosoma mansoni, as compared to Schistosoma haematobium over the past 20 years, and the need to adjust strategies to this new reality. The action research project, growing out of an in-depth study of schistosomiasis in two Nile delta villages, is intended to provide recommendations for schistosomiasis control to the Egyptian Ministry of Health and Population. This paper explores the practice of school-based screening. We then describe the designing and testing of a revised screening procedure, which focuses on the collection of stool specimens to diagnose S. mansoni and which is comprehensive and gender-sensitive. Opportunities for health education are discussed briefly, as this is necessary for an effective screening procedure and to prevent reinfection. In conclusion, we mention the need to incorporate screening and health education into an integrated control strategy

Screening for schistosomiasis, filariasis, and strongyloidiasis among expatriates returning from the tropics.

The clinical utility of eosinophil determinations, stool examinations, and serological studies for detection of parasitic infection was examined in an asymptomatic expatriate population by retrospective chart review. The screened population consisted of 1,605 patients attending a tropical medicine clinic. The sensitivity of eosinophil counts as a screening test for infection with filaria, schistosomes, or Strongyloides stercoralis was 38%, and its positive predictive value was 9%. A cost-efficacy analysis of the use of three diagnostic tests in screening for infection with filaria (n = 23), schistosomes (n = 34), or Strongyloides (n = 7) was performed. The use of stool examination and serological screening together had a sensitivity of 89%, at a total cost similar to that of a conventional strategy involving a stool examination and an eosinophil count, which would have picked up only 61% of our cases. In this population, eosinophil counts contribute little to the diagnostic accuracy obtained with stool examination and serological screening, and the low specificity of eosinophil counts generates high costs.

Schistosomiasis: Evaluation of the indirect fluorescent antibody, complement fixation, and slide flocculation tests in screening for schistosomiasis

Foreign Service personnel undergo pertinent parasitologic examinations upon return from foreign duty posts. Under this program, 2800 sera have been evaluated for schistosomiasis in this laboratory. The majority of individuals tested were considered to have limited exposure to schistosomiasis, although a few indigenous people from endemic areas also were screened. Nonindigenous populations usually gave stronger serological reactions than did indigenous populations. A comparison was made between those having protozoan and helminthic infections and those that were negative parasitologically. A number of subjects with tissue-phase helminths were evaluated and consistently gave strong reactions in the indirect fluorescent antibody (IFA) tests. On the other hand, there was no characteristic pattern observed in individuals with low serum titers. The IFA test proved to be highly sensitive and sufficiently specific for screening, provided that low background reactions were disregarded (i.e., when +/− and 1+ reactions were ignored at low serum dilutions). Thus, the IFA test was the method of choice for screening. Recourse to the complement fixation (CF) and slide flocculation (SF) tests, however, was necessary for definitive diagnosis. In view of the differences in the antigens and the serodiagnostic technics used in this survey, absolute correlation of test results could not be expected. Nevertheless, the three procedures (IFA, CF, and SF) showed excellent correlation in proven cases of schistosomiasis.