Biomedical subjects
Publications and source records attributed to A M Polderman.
The measuring and monitoring of morbidity are essential components of schistosomiasis control programmes. Bruno Gryseels and Anton Polderman assess the objectives, difficulties and importance of morbidity control of schistosomiasis mansoni in subsaharan Africa.
Infection with Oesophagostomum sp. is normally considered a rare zoonosis and up to this time its diagnosis has been based on the demonstration of larvae and young adult worms in the typical nodules formed in the intestinal wall. Only in Dapaong, in North Togo, and Bawku, North Ghana, have larger series of clinical cases been described. In the rural areas around these towns, a survey was made in which stool samples were collected and cultured. Third-stage larvae of Oesophagostomum sp. could be found after 5-7 days of incubation at room temperature, and the prevalence of infection with this parasite was often high but varied from one village to another. It was over 30% in seven villages out of the 15 villages surveyed. Anthelmintic treatment resulted in the evacuation of adult males and females of O. bifurcum. It is concluded that O. bifurcum is a locally common parasite of humans, not requiring an animal reservoir for completion of its lifecycle.
We investigated in a retrospective study the application of an enzyme-linked immunosorbent assay (ELISA) for the quantitative detection of the schistosome circulating anodic antigen (CAA) to the diagnosis of schistosomiasis in our laboratory. CAA-titres were compared with IgG-titres as determined with an ELISA using soluble egg antigen (SEA) and IgM-titres as determined in an immuno fluorescence assay (IFA) on sections of Rossman's fixed schistosomes. Pre- and post-treatment serum samples of 182 individuals, suspected for schistosomiasis, were used for this study, including 100 control samples. CAA was detected in 20.7% of all patients who were positive in either IFA or SEA-ELISA or both. CAA-titres did not correlate with either IgM-titres or IgG-titres. No significant drop in IgG level was found after specific treatment (Wilcoxon's P = 0.35). In contrast, a significant fall in both IgM-titre (P less than 0.01), and CAA-level (P less than 0.01) was observed. All CAA-titres became negative after chemotherapy.
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Schistosomiasis is a very frequent import infection in the Netherlands. The serotesting for schistosomiasis in Leyden affords reasonable insight into the prevalence of this import infection among different groups of the population in the Netherlands. Out of 3032 serum samples submitted in the period from 1983 to April 1986, 40% was positive. Most people with positive serum tests were of Surinam origin. Currently, there is a shift toward more infections among Dutch travellers. Many of these patients have high IFA titres indicating a recently incurred infection. Often no ova are found in spite of positive serotest: this phenomenon was seen in 36% of the Dutch travellers and in 48% of the Surinam people.
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A 46-year-old patient with acute myelogenous leukaemia developed lethal disseminated toxoplasmosis 8 weeks after allogeneic bone marrow transplantation. Clinical features included pulmonary infiltrates, respiratory insufficiency and neurological signs. Post-transplantation toxoplasma serological tests were characterised by declining IgG titres and failure to detect IgM, whereas titres of IgG against the various herpes viruses remained constant and even increased over the same period. Circulating toxoplasma antigen could not be detected. Post mortem, specific immune complexes were identified in serum. Autopsy revealed widely disseminated toxoplasmosis with several foci in the brain, lungs and various other organs as well as concomitant infection with cytomegalovirus.
In serum and urine specimens collected from a group of Schistosoma mansoni infected individuals from Makundju, Zaire, the schistosome circulating anodic antigen (CAA) and the circulating cathodic antigen (CCA) were quantitatively determined using an indirect hemagglutination reaction with sheep erythrocytes sensitized with mouse IgM monoclonal antibodies directed against these circulating antigens. Levels of CAA in serum (up to 5 ng/ml) and CCA in serum and urine (up to 50 ng/ml) were strongly correlated with egg excretion and with each other. No correlation was found between egg excretion and antibody levels against the circulating antigens. Antigen was detectable only in patients excreting greater than 500 eggs per gram of feces.
Eight to ten years of follow-up the impact of targeted mass treatment, given to heavily infected people in Maniema's tin-mining district in Zaire, showed that the prevalence and intensity of infection were almost the same as before control. The high frequence of hepatomegaly, and to a lesser extent of splenomegaly, which were shown to be related to schistosome infection, however, have disappeared. For the evaluation of the impact of control, other parameters than egg counts only need further development.
Sera of individuals from Burundi excreting eggs of Schistosoma mansoni (prevalence 35%; 178 subjects) and of similar individuals from Maniema, Zaire (prevalence 95%; 99 subjects), and of 159 Dutch and 81 Zairean non-infected controls, were screened by enzyme-linked immunosorbent assay for the presence of schistosome circulating anodic antigen (CAA). No false positive results were obtained. The sensitivity of the test was 75% in Burundi and 93% in Zaire, a significant difference (P less than 0.05). However, in matched egg output classes the test results did not differ significantly; 60% and 67%, respectively, of those excreting 1-100 eggs per gram of faeces (epg), 86% and 100% of those excreting 101-400 epg, and 100% of those excreting over 400 epg were detected. The efficiency of the assay was 91% in Burundi and 93% in Zaire. The Spearman rank coefficient of correlation between antigen titre and egg output (determined by 3 consecutive Kato egg counts) was 0.61 in Burundi and 0.82 in Zaire. The sensitivity of the test compared well with a single egg count. In addition, preliminary data showed that occasionally CAA was detectable in serum of individuals not excreting schistosome eggs. As CAA is found only in the presence of living worms, such cases reflect active infections.
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Two patients with cysticercosis received praziquantel (PZQ) 75 mg/kg/day orally together with 30 mg prednisone daily for 3 weeks. The first patient presented with grand-mal seizures, a pyramidal tract syndrome and subcutaneous cysticerci, and the other had internal hydrocephalus necessitating drainage. Serial plasma samples were taken after the first dose of PZQ. Lumbar CSF was obtained from the first patient and ventricular CSF from the second. Subcutaneous cysticerci were removed from the first patient. PZQ in the specimens was assayed by GLC. For distribution between plasma and CSF a rate constant of 4.9 h-1 for free PZQ, corresponding to a t1/2 of 8 min or less for the non-protein bound fraction was calculated for Patient 1. In the second patient the distribution was so rapid that the rate constant could not be calculated. The difference in distribution rate might have been due to use of different sampling times or to a time lag in the entry of PZQ between the ventricles and the lumbar sac. The rate constant for distribution of the drug between plasma and parasites was 1.4 h-1, corresponding to a t1/2 of 30 min or less. Thus PZQ penetrates rapidly into the CSF. It enters the parasite more slowly, although still more rapidly than the plasma half-life of PZQ (1-1 1/2 h).
The morbidity of schistosomiasis mansoni was assessed in Makundju (population 547; prevalence 96%, mean egg load 791 epg) and Massimelo (pop. 363; prev. 19%, mean egg load 39 epg), 2 similar villages in the forest zone of Maniema, Zaire. The prevalences of other parasites including malaria (holoendemic) were comparable. "Intermittent diarrhoea" (mostly bloody) was a complaint of 55% and 3% of the populations, respectively, "intermittent abdominal pain" of 63% and 25%, and "fatigue" of 33% and 19%. Enlargement of the left liver lobe was present in 45% and 9% of the populations, right lobe hepatomegaly in 32% and 3%, splenomegaly in 29% and 9%. Hepatomegaly and splenomegaly in Makundju were often very impressive, and most frequent in the 6- to 18-year-old group. Anaemia (haematocrit less than or equal to 35%) was present in 30% and 9% of males and 36% and 21% of females. Mean length and weight were lower in Makundju for boys aged 11 to 18 years. Ergometric results (Astrand cyclometer, male adults only) were comparably low in both villages (mean VO2max. 19.3 and 18.9). Analysis of the data according to egg load within the Makundju community revealed a significant relationship only in the following cases: higher frequencies of diarrhoea, abdominal pain and fatigue in those excreting more than 200 epg compared with those excreting fewer; left lobe splenomegaly gradually increased with egg load in children under 18; in people over 40 it occurred at a higher frequency in those excreting more than 2000 epg than in those excreting fewer.(ABSTRACT TRUNCATED AT 250 WORDS)
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The high prevalence (greater than 90%) and intensity of infection (50% of those infected excreted greater than 600 eggs per gram of faeces) of schistosomiasis in a tin mining area in eastern Zaire is related to extensive man-made ecological changes and intensive man/water contact. Construction of latrines, water supply and availability of diagnosis and treatment through occupational health services have been used in control efforts. The integration of environmental measures is limited by their high costs. The control of schistosomiasis in this area of intense transmission would require repetitive chemotherapy and other measures which are beyond available resources.
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