Current Status of Schistosomiasis in Egypt : Parasitologic and Endoscopic Study in Sharqia Governorate

Tarik Zaher 1 , Mohieddin Abdul-Fattah 2 , Amany Ibrahim 3 , Hossam Salah 4 , Mona El-Motyam 2 , Walid A Abdel-Dayem 1 , Mohamed M Refaey 1 . Endemic and Tropical Medicine Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt. Parasitology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt. Internal Medicine Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt. Clinical Pathology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt.


INTRODUCTION
Schistosomiasis is one of the most widespread parasitic infections of man [1].Egypt is a cradle of civilization, but has been plagued by schistosomiasis since at least the Middle Kingdom period (1,500 BC) [2].It was traditionally the most important public health problem [3,4].This study aimed to evaluate the current status of schistosomiasis in Egypt.

Sedimentation technique of stool:
The technique standardized by Hoffman et al. [5] involves the filtration of saline-feces mixture through a metal sieve to remove larger fecel residues and to allow the remainder to sediment spontaneously.A sample of the sedimented material is then examined between a slide and cover slip.

RESULTS
Eggs of Schistosoma haematobium were encountered in urine samples of 6 ones (0.02%) of the 30,000 outpatients.Eggs of Schistosoma mansoni were encountered in stool samples of 99 ones (0.33%) of the 30,000 outpatients.Eggs were also found in 12 ones (4.8%) (2 with living Schistosoma mansoni eggs, 1 with dead Schistosoma haematobium eggs and 9 with dead Schistosoma mansoni eggs) out of the 250 patients contributing to rectal biopsy samples.

DISCUSSION
In this study; eggs of Schistosoma mansoni were encountered in 0.33% of stool samples and eggs of Schistosoma haematobium were encountered in 0.02% of urine samples.Schistosoma eggs were also found in 4.8% of patients contributing to rectal biopsy samples.
In agreement with our results; Rabello [6] who concluded that a single rectal biopsy resulted in the diagnosis of more individuals than a single fecal examination by Kato/Katz method.
In 1937; Scott [7] reported the results of parasitologic examination performed on 2 million patients seen between 1932 and 1934 in government treatment centers, and on results of examination of stool and urine samples collected from 40,000 subjects.He found that 60% of the rural population in north and east of the Nile delta were infected with S. haematobium and about the same proportion was infected with S. mansoni.In the south central delta, the prevalence of S. haematobium was 60%, but only 6% had S. mansoni.S. mansoni was not found in Upper Egypt and S. haematobium was found in 60% of patients in areas under perennial irrigation.In areas under basin irrigation, only 5% were infected by S. haematobium.
An increase in the prevalence of S. mansoni infections with their snails and decrease in prevalence of S. haematobium infections with their snails were noticed after construction of the High Dam in the 1960s because of reclamation of the land, conversion of annual flooding into perennial irrigation and other ecological factors as changes in the water-flow pattern [8].In 1977, El Alamy and Cline [9] found that the prevalence of S. mansoni infection was 40.5%, and the prevalence of S. haematobium infection was 27% in Qalyub region in the south of Nile Delta.In 1979; Abdel-Wahab et al. [10] found that the prevalence of Schistosoma mansoni infection had increased from 3.2% to 73%, whereas S. haematobium infection which had very common in 1935 (74%), had almost disappeared (2.2%) in the same village in the Nile delta surveyed by Scott in 1935.
In 1982, King et al. [11] found that the prevalence of Schistosoma haematobium in six rural villages of the Qena governorate was 37.1%.
In the nineties, El-Kohby et al. [4] found that the prevalence of S. mansoni and S. haematobium in Ismailia governorate was 42.9% and 3.5% respectively, Kafr-El-Sheikh; 39.1% and 2.5%, Gharbia: 37.7% and 2.06%, Monofia: 28.49% and 5.5%, Qalubia: 17.47% and 1.53%, Fayoum: 4.3% and 9.95%, Minya: 1.04% and 8.47%, Assiut: 0.42% and 6.63% and Qena: 0.44% and 7.04%.In this study, the prevalence of S. mansoni and S. haematobium depending on stool and urine examination in Tenth of Ramdan Charity Hospital, Tenth of Ramadan city which is an urban city in Sharqia Governorate was 0.33% and 0.02% respectively.In comparison with our study; el-Badawy et al. [12] in 1996 who found that the prevalence of S. mansoni and S. haematobium depending on stool and urine examination in urban Sharqia Governorate was 6.8% and 0.09%.In this study, S. haematobium eggs were found in rectal biopsy sample of one patient.In agreement with our finding; Abdel-Wahab et al. [13] who found a mild grade of periportal fibrosis, hepatomegaly and splenomegaly in school children with S. haematobium infection in a village in the Fayoum.

Conclusion:
The present findings revealed a decrease in the prevalence of schistosomiasis that may be explained by the current policy of schistosomiasis control in Egypt.Further studies in different localities in Egypt are needed to reflect the actual prevalence of schistosomiasis.Much more strict programs to control schistosomiasis hoping at complete eradication of this disease are recommended.Conflicts of interest:Non declared.Funding:Non Ethical approval:Approved.