The epidemiology of schistosomiasis in Egypt: Summary findings in nine governorates
The epidemiology of schistosomiasis in Egypt: Summary findings in nine governorates
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DOI：
10.4269/ajtmh.2000.62.88
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发表时间：
2000-02-01
影响因子：
3.3
通讯作者：
Strickland, GT
中科院分区：
文献类型：
--
作者：
El-Khoby, T;Galal, N;Strickland, GT
对来自埃及9个省251个农村社区17,172个家庭的89,180人进行分层随机抽样，评估健康问卷和尿液和粪便寄生虫学检查，以调查埃及血吸虫感染的流行率、危险因素和变化模式。一个子集，每五个家庭，或18 600名受试者，进行了身体和超声波检查，以调查发病率和危险因素。S.在上埃及4个省的地方流行的埃及血吸虫病的范围从4.8%到13.7%，平均7.8%。几何平均卵计数（GMEC）范围为7.0至10.0卵/ 10 ml尿液，平均8.1。按年龄分层的感染率在10-14岁年龄组中达到15.7%的高峰，在25岁以上的所有年龄组中下降到3.5-5.5%。在5-14岁年龄组中，分层感染强度的峰值约为10.0个卵/10毫升尿液，而在25岁以上年龄组中，感染强度约为所有年龄组的一半。在所有年龄组中，男性的感染率和卵细胞计数均高于女性。曼氏血吸虫在上埃及是罕见的，仅在法尤姆地区发生，其患病率为4.3%，平均感染强度为44.0卵/克粪便。S的危险因素血吸虫感染者为男性，年龄10岁，居住在较小的社区，接触运河水，有血吸虫病或便血病史或治疗，通过体格检查或超声检查发现脾肿大，超声检查发现PPF。（II和III）占超声检测PPF的3，494例中的463例（13.3%）。发病率的风险因素（超声波检测PPF）与感染的风险因素相似，只是较小社区的居民的风险并没有增加。活跃的S.与肝脏大小正常者相比，体格检查或超声检查发现锁骨中线或胸骨中线肝肿大者发生PPF的风险降低（OR = 0.64-0.72）。B超检出病变的检出率为肝浅叶增大23.7%、肝左叶增大11.3%、脾肿大20.6%、PPF 50.3%。埃及南部的一种产于下埃及的埃及血吸虫，正在向上埃及的法尤姆蔓延。S.尼罗河三角洲的曼索尼病仍然很高，农村社区的平均感染强度中等。肝脏发病率低于预期，除脾肿大外，与活动性S。在个人或社区中的曼氏感染。感染率和感染强度均高于对照组。在流行的上埃及省，埃及血吸虫病的发病率很低。膀胱和上尿路疾病的患病率较低，但与活动性感染有关。肝肿大、脾肿大和PPF是埃及农村社区的常见结果。它们在曼氏血吸虫病流行区的发生频率是在血吸虫病流行区的1.5-3.5倍，并且不是后者的特异性，因为这些超声检测到的病变与血吸虫病没有关系或关系不大。嗜血杆菌感染和发病率。
Health questionnaires and parasitologic examinations of urine and stool were evaluated from a stratified random sample of 89,180 individuals from 17,172 households in 251 rural communities in 9 governorates of Egypt to investigate the prevalence of, risk factors for, and changing pattern of infection with Schistosoma sp, in Egypt. A subset, every fifth household, or 18,600 subjects, had physical and ultrasound examinations to investigate the prevalence of and risk factors for morbidity. Prevalence of S. haematobium in 4 governorates in Upper Egypt in which it is endemic ranged from 4.8% to 13.7% and averaged 7.8%. The geometric mean egg count (GMEC) ranged from 7.0 to 10.0 ova/ 10 ml of urine and averaged 8.1. Age stratified prevalence of infection peaked at 15.7% in the 10-14-year-old age group and decreased to 3.5-5.5% in all groups more than 25 years of age. Age-stratified intensity of infection peaked at approximately 10.0 ova/10 ml of urine in the 5-14-year-old age groups and was about half that in all,groups more than 25 years of age. Males had higher infection rates and ova counts than females in all age groups. Schistosoma mansoni was rare in Upper Egypt, being consequential in only Fayoum, which had a prevalence of 4.3% and an average intensity of infection of 44.0 ova/g of stool. Risk factors for S. haematobium infection were male gender an age 10 years old, living in smaller communities, exposures to canal water, a history of, or treatment for, schistosomiasis or blood in the stool, detection of splenomegaly by either physical examination or ultrasonography, and ultrasonograghy-detected PPF The more severe grades (II and III) accounted for 463 (13.3%) of the 3,494 having ultrasonography-detected PPF. Risk factors for morbidity (ultrasonography-detected PPF) were similar to those for infection except that inhabitants of smaller communities were not at increased risk. Active S. mansoni infection increased the odds ratio (OR) of having PPF by 1.37.In comparison with others with normal-size livers, subjects having hepatic enlargement in either the midclavicular line or the midsternal line detected by physical examination or ultrasonography had a reduced risk (ORs = 0.64-0.72) of PPF. The prevalences of lesions detected by ultrasonography were 23.7% for enlargement of light lobe of the liver, 11.3% for enlargement of left hepatic lobe, 20.6% for splenomegaly, and 50.3% for PPF Schistosoma mansoni has almost totally replaced S. haematobium in Lower Egypt and is spreading into Fayoum in Upper Egypt. The prevalence of S. mansoni in the Nile Delta remains high with moderate average intensities of infection in rural communities. Hepatic morbidity was less than expected and, with the exception of splenomegaly, correlated poorly with active S. mansoni infections in individuals or in communities. The prevalence and intensity of infection with S. haematobium was low in endemic Upper Egypt governorates. The prevalence of bladder and upper urinary tract morbidity were low but correlated with active infection. Hepatomegaly, splenomegaly, and PPF were common findings in rural communities in Egypt. They occurred 1.5-3.5 times as frequently in areas endemic for schistosomiasis mansoni as in areas endemic for schistosomiasis haematobia, and were not specific for the latter, since these ultrasonography-detected lesions had no or marginal relationships with S. haematobium infection and morbidity.