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      Ultrasonographic screening of urinary schistosomiasis infected patients in Agulu community, Anambra state, southeast Nigeria

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      1 , , 2 , 1
      International Archives of Medicine
      BioMed Central

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          Abstract

          Background

          The pathology of Schistosoma haematobium infection in 60 infected primary school children in Agulu community, Anambra State, southeast Nigeria, with over 50 ova/10 ml urine was assessed.

          Methods

          The ultrasonographic examination was done using a sector scanner with convex probe. World Health Organisation method was used for classification and scoring of lesions. T-test and Coefficient of determination were used in analysis.

          Results

          The pathologic effects due to S. haematobuim identified among the study group included irregularity of the bladder wall (25%), thickening of the bladder wall (10%) and massing of the bladder wall (3.3%). About 4(6.7%) and 1(1.7%) of the patients had the right pelvis and left pelvis of their kidney moderately dilated respectively. Identified bladder wall lesions had 69 scores while kidney dilation had 30 scores. The number of individuals with lesions correlated with intensity of infection. Male pupils (65.2%) had more lesions than females (34.8%). The difference observed in lesion distribution among males and females was found to be significant (df = 6, p < 0.05). All bladder and kidney lesions responded favorably to treatment with praziquantel (40 mg/kg-body weight).

          Conclusion

          Health education campaign including showing the community members evidence of damages to the organs (from the ultrasound pictures) will go a long way in the control and prevention of the disease in this community.

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          Most cited references13

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          Evolution of Schistosoma haematobium-related pathology over 24 months after treatment with praziquantel among school children in southeastern Tanzania.

          Little is known about the dynamics of pathology due to schistosomiasis following treatment. Public health authorities in endemic areas require such information to decide on the timing of treatment and re-treatment schedules. A study to assess the rate of clearance and reappearance of pathologic lesions due to Schistosoma haematobium using ultrasound has now been carried out in two schools in southeastern Tanzania, an area of moderate-to-high transmission. Baseline data collection found urinary tract pathology in 67% of 533 children. Lesions of the bladder were significantly associated with egg positivity and microhematuria. The attributable fraction estimate of major bladder lesions due to S. haematobium was 75%. In a cohort study, 224 infected children were examined by ultrasound and then treated with a standard dose of 40 mg of praziquantel/kg of body weight. They were re-examined at two, four, six, 12, 18, and 24 months after treatment. Before treatment, 76% had pathologic lesions of the urinary tract. The proportion showing lesions decreased sharply during the first months after treatment to 11% at six months. At 24 months, lesions were detected in 57%, and 11% had developed new severe pathology. In 18 cases, pathology was present throughout, and 34 did not show any pathology throughout the study. This study provides the first detailed report on the evolution of urinary tract pathology due to S. haematobium infections at the community level. The results will help in making decisions on treatment and re-treatment schedules and more generally will provide a basis for designing control strategies in areas of moderate-to-high transmission.
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            Chemotherapy-based control of schistosomiasis haematobia. I. Metrifonate versus praziquantel in control of intensity and prevalence of infection.

            To determine the effect of targeted field administration of oral chemotherapeutic agents on the prevalence, intensity, and morbidity of Schistosoma haematobium infections, we initiated a long-term school-based program in the Msambweni area of Kwale District, Coast Province, Kenya. Prior to treatment, 69% of the children examined (ages 4-21, n = 2,628) were infected; 34% had moderate or heavy infections (greater than 100 eggs/10 ml urine). Infected individuals were randomized to receive, during one year, either metrifonate (10 mg/kg x 3 doses) or praziquantel, (40 mg/kg x 1 dose). At the end of the first year, prevalence of infection fell to 19%; only 2% of the pupils remained in the moderately and heavily infected groups. Corresponding decreases in the prevalence of hematuria (54% in 1984 vs. 16% in 1985) and proteinuria (56% in 1984 vs. 26% in 1985) were noted. These were associated with significant declines in bladder thickening and irregularities noted during ultrasound examinations, but not with decreases in hydronephrosis. There was no significant difference in the post-treatment prevalence or intensity of infection after treatment with metrifonate as compared with praziquantel. These results demonstrate that field-applied chemotherapy with either agent offers a practical strategy for the control of S. haematobium infection and its associated morbidity.
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              Morbidity from urinary schistosomiasis in relation to intensity of infection in the Natal Province of South Africa.

              Morbidity from urinary schistosomiasis was assessed on clinical, radiological, parasitologic and biochemical evidence in 510 schoolchildren living in a Schistosoma haematobium endemic area. The results were viewed against the background of the prevalence and intensity of infection in the subjects. Clinical morbidity correlated well with the intensity of infection, the latter in turn being influenced by factors such as water contact pattern, sex and water source. A surprisingly high prevalence (42%) of abnormalities was observed in the urinary tract of subjects, but no relationship could be demonstrated between the intensity of infection and structural damage to the urinary tract. Urographic changes were more severe in the 11-15 year age group than in the 6-10 year group. Significant rectal involvement (76%) in S. haematobium-infected subjects was regarded as a reflection of the heavy worm burdens borne by these children. The morbidity described in this study indicates a definite degree of pathology in the infected children but the impression was that they suffered only mild disability. However, given the structural lesions seen on urography and the limited sensitivity of the biochemical tests used for the assessment of renal function, renal pathology cannot be ruled out. Further studies on the renal status of these subjects are essential.
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                Author and article information

                Journal
                Int Arch Med
                International Archives of Medicine
                BioMed Central
                1755-7682
                2009
                28 October 2009
                : 2
                : 34
                Affiliations
                [1 ]Department of Parasitology and Entomology, Nnamdi Azikiwe University Awka, Anambra State, Nigeria
                [2 ]Dept. of Zoology, University of Nigeria, Nsukka, Enugu State, Nigeria
                Article
                1755-7682-2-34
                10.1186/1755-7682-2-34
                2775025
                19863804
                adab7b47-ee8a-4cd1-bb96-72efe8618bf6
                Copyright © 2009 Ekwunife et al; licensee BioMed Central Ltd.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 26 June 2009
                : 28 October 2009
                Categories
                Original Research

                Medicine
                Medicine

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