Shaker Narooz

Incidence and risk factors for hepatitis C infection in a cohort of women in rural Egypt

A prospective cohort study of the incidence and risk factors for hepatitis C virus (HCV) infection was performed in 2171 pregnant women in three rural Egyptian villages who were HCV antibody (anti-HCV) and RNA (HCV-RNA) negative at baseline. During an average of 2.2 years follow up, 25 incident cases were observed, giving an estimated HCV incidence of 5.2/1000 person-years (PY). The infection rate correlated with community anti-HCV prevalence in pregnant women, while the perinatal incidence rate of 11.2/1000 PY was almost five times that of the non-perinatal rate (2.3/1000 PY). The data suggested iatrogenic perinatal risk factors were associated with infection in one village, while health education reduced infections in another. Among the 25 incident cases, eight were HCV-RNA negative when they were first found to be anti-HCV positive and one-third of the 15 viraemic cases with follow-up data available cleared their HCV-RNA after an average of 1.3 years. None of the 25 incident cases were jaundiced or had symptoms of hepatitis but elevated serum alanine aminotransferase levels confirmed hepatitis in nine. Our data suggest that asymptomatic HCV infections frequently occurred during the perinatal period but often cleared and that educating medical personnel on safe practices possibly reduced HCV transmission.

Sonographic studies of schoolchildren in a village endemic for Schistosoma mansoni

Parasitological, clinical, and sonographic examinations were performed on 309 school children in a village endemic for schistosomiasis mansoni. Data from the 255 denying treatment within the previous 2 years were analysed separately. On a single Kato examination 42% were uninfected; the remainder had light (26%), moderate (21%), or heavy (11%) infections with Schistosoma mansoni. Hepatomegaly (53%) and palpable spleens (35%) were common but clinical and parasitological findings often were unrelated. Abdominal sonography also demonstrated a high frequency of hepatomegaly (82%) and splenomegaly (49%). Sonographically determined liver span and spleen size correlated with the egg count. Sonographic lesions of periportal fibrosis of schistosomiasis mansoni with thickening of portal tracts and portal vein walls were frequently present and more common in infected than in uninfected children, and were correlated with the number of S. mansoni ova in the stool. Ultrasonographically detected periportal fibrosis was a reliable measurement of the prevalence and morbidity of schistosomiasis mansoni in this population, and provided very useful information, even when the parasitological and clinical findings were equivocal.

Schistosoma haematobium infection in Egyptian schoolchildren: Demonstration of both hepatic and urinary tract morbidity by ultrasonography

Parasitological, clinical and ultrasonographical studies were performed upon 422 schoolchildren aged 12-16 years living in a village in the Fayoum where Schistosoma haematobium, but not S. mansoni, was transmitted. Over half of the children gave a history of receiving praziquantel therapy during the preceding 2 years. Symptoms (e.g., haematuria, burning micturition), signs (e.g., hepatomegaly, splenomegaly) and urinary findings (e.g., haematuria, proteinuria) correlated better with the presence and intensity of S. haematobium infection after correcting for this variable. Renal obstructive lesions detected by ultrasound were 2 and 3 times as common in those with moderate and heavy infections as in those with no or light infections, and urinary bladder wall lesions were far more frequent in those with moderate and heavy infections. A mild grade of periportal fibrosis, hepatomegaly and splenomegaly were present in some children in all groups. However, the prevalence of splenomegaly correlated directly with the intensity of infection; liver lesions occurred much more frequently in children with infection or a history of treated infection than in non-infected children denying recent treatment; and no child had hepatomegaly or splenomegaly in the absence of periportal fibrosis.