Esteban Jose-Guillermo, Gonzalez Carolina, Curtale Filippo, Muñoz-Antoli Carla, Valero Maria Adela, Bargues Maria Dolores, el-Sayed Mabrouk, el-Wakeel Aly A W, Abdel-Wahab Yehia, Montresor Antonio, Engels Dirk, Savioli Lorenzo, Mas-Coma Santiago
Departamento de Parasitología, Facultad de Farmacia, Universidad de Valencia, Valencia, Spain.
Am J Trop Med Hyg. 2003 Oct;69(4):429-37.
Coprologic surveys were carried out in villages of the Behera Governorate in the Nile Delta region of Egypt to characterize the epidemiologic features of human fascioliasis caused by Fasciola hepatica and F. gigantica in this lowland endemic area by comparison with fascioliasis caused by only F. hepatica in areas hyperendemic for human disease in the Andean highlands of South America. The fascioliasis prevalences detected (range = 5.2-19.0%, mean = 12.8%) are the highest obtained in Egypt. The comparison with previous results suggests that in the Nile Delta, fascioliasis is spreading from an original situation of sporadic human cases in well-known endemic foci for animal disease to an endemic distribution in humans, which may be characterized as a mesoendemic region that includes several hyperendemic areas for human disease. As in Andean countries, a relationship with sex was found, although in Egypt prevalences, but not intensities, appeared to be significantly higher in females. All ages appear to be susceptible to liver fluke infection, with prevalences and intensities being lower before and after school age, a situation that is consistent with that detected in Andean countries, although the peak in the 9-11-year-old age group appears less pronounced in Egypt. The intensities were very high when compared with those found in subjects sporadically infected in areas endemic for animal disease, but relatively low for a hyperendemic situation, although the intensities may not be conclusive because of the transmission seasonality of fascioliasis in the Nile Delta. The marked similarities in the qualitative and quantitative spectrums of protozoans and helminths, multiparasitisms, and associations between liver flukes and other parasitic species suggest physiographic-hydrographic and behavioral-social characteristics similar in all areas hyperendemic for human fascioliasis, which are independent of other factors such as climate, altitude, and cultural or religious features. The significant positive association between liver fluke infection and schistosomiasis mansoni detected in one locality has never been described elsewhere, and must be considered relevant from clinical, pathologic, diagnostic, and therapeutic points of view. Interestingly, the relationships of schistosomiasis prevalences and intensities with sex and age follow patterns similar to those found in fascioliasis.
在埃及尼罗河三角洲地区的贝赫拉省各村开展了粪便学调查，以描述由肝片吸虫和巨片吸虫引起的人体片形吸虫病在该低地流行区的流行病学特征，并与南美洲安第斯高地人类疾病高度流行区仅由肝片吸虫引起的片形吸虫病进行比较。检测到的片形吸虫病患病率（范围 = 5.2 - 19.0%，平均 = 12.8%）是埃及有记录以来最高的。与先前结果的比较表明，在尼罗河三角洲，片形吸虫病正从动物疾病著名流行区偶发人类病例的初始情况，蔓延至人类中的地方病分布，这可能被描述为一个中流行区，其中包括几个人类疾病高度流行区。与安第斯国家一样，发现了与性别的关系，不过在埃及，女性的患病率虽高，但感染强度并无显著差异。所有年龄段似乎都易感染肝吸虫，患病率和感染强度在学龄前后较低，这种情况与在安第斯国家检测到的情况一致，尽管埃及9 - 11岁年龄组的峰值似乎不那么明显。与动物疾病流行区偶发感染的人群相比，感染强度非常高，但对于高度流行情况而言相对较低，不过由于尼罗河三角洲片形吸虫病的传播具有季节性，感染强度可能不具决定性。原生动物和蠕虫的定性和定量谱、多重寄生虫感染以及肝吸虫与其他寄生虫种类之间的关联存在显著相似性，这表明在所有人类片形吸虫病高度流行区具有相似的自然地理 - 水文和行为 - 社会特征，这些特征独立于气候、海拔以及文化或宗教特征等其他因素。在一个地区检测到的肝吸虫感染与曼氏血吸虫病之间的显著正相关在其他地方从未有过描述，从临床、病理诊断和治疗角度来看都必须予以重视。有趣的是，血吸虫病的患病率和感染强度与性别和年龄的关系遵循与片形吸虫病相似的模式。
