- Email: [email protected]
Possible relationship of Schistosoma infection and liver carcinoma
552
CORRESPONDENCE
written “Culex larvae (II-IVinstars)* but no pupae were collected from underground pools from Lodna on three occasions”. This was out of the 14 visits made over a period of eight months searching for various arthropods in coal mines of varying depths. The larvae collected were identified as Culex futiguns after emergence of imagines. McCay & Senior White (1941) also observed such a short-lived “mosquito nuisance” a thousand feet (300 m approx.) below ground in the Saltore colliery (m the vicinity of the Bejdih colliery in question) and categorically recorded “culicine mosquitoes were discovered breeding prolifically in shallow pools” in mine workings. This observation is also mentioned in my article. Hence the Bejdih episode is, in my opinion, one in a series and nothing unusual. In my eight months’.survey C. fatiguns collected from inside mines had an infection rate of 5.4 y0 but nil infectivity; on-the surface the infection rate was 15 y0 and the infectivity rate 1.5 %. I am, etc., S. A. AZEEZ Entomologist, Coalfield Malaria Unit, Dhanbad-3 (Bihar), India
recovered. (The values were determined by comparing the percentages of infected erythrocytes on thin blood films before and after concentration.) Mornhological preservation was better than that obtainid in thick blood films. Four days after starting treatment, 0.84 y0 of gametocytes were detected by this method in the blood of one patient, when thin blood films failed to reveal any (LE BRASet al., in press). The method may be useful in attempting confirmation of a doubtful diagnosis when normal parasitological methods have failed. We are, etc., T. LE BRAS ti.
PAYET
Laboratoire de l’lnstitut de Medecine et d’Epidemiologie Africaines, HGpital Claude Bernard, 10 avenue Porte d’dubervilliers, 75019 Paris, France. References
Eling, W. M. C. (1977). Separation of parasitized erythrocytes from Plasmodium berghei infected mouse blood. Transactions of the Royal Society of Tropical Medicine and Hygiene, 71, 267-268.
References
Azeez, S. A. (1965). Arthropod and rodent infestation of coal mines in Dhanbad and Parulia districts. Bulletin of the indian Society for Malaria and Other Communicable Diseases, 2, 327-332.
Dutta, S. N. (1977). Evidence of Culex fatigans mosquito breeding in underground pits of a coahnine in India. Transactions of the Royal Society of Tropical Medicine and Hygiene, 71, 180. McCay, F. & Senior White, R. (1941). Biological control of culicine mosquitoes by prawns in a Bengal coalmine. Indian Medical Gazette, 76.37.
Le Bras, J., Ricour, A., Savel, J. & Payet, M. (1978). Diagnostic parasitologique du paludisme par - : concentration des hemanes parasitees: technique et resultats nrcliminaires. Bulletin de la So&t de Pathologie Exotique (in press). Miller, L. K. & Chien, S. (1971). Density distribution of red cells infected by Plasmodium knowlesi and Plasmodium coatnevi. ExPerimental Parasitology, 29,451-456.
-
-
Rowley, P. T., Siddiqui, W. A. 8c Geiman, Q. M. (1967). Separation of malarial parasites according to age by density gradient centrifugation. Journal of Laboratory and Clinical Medicine, 70,933-937.
*Parentheses in original text. Accepted for publication 26th April, Accepted for publication
Concentration
15th March,
1978.
1978.
of parasitized erythrocytes malaria diagnosis
in
SIR-We have used the technique of concentrating parasitized erythrocytes by centrifugation on a Ficoll R solution, as described by ELING (1977) for Plasmodium berghei, in diagnosing 20 human cases of malaria (LE BRASet al., in press). The effectiveness of the technique increases with increasing size of the parasites (ROWLEYet al., 1967; MILLER & CHIEN, 1971) and is therefore less in P. falciparum infections where most parasites are young ring forms. Concentrations of 40X or more (maximum 13600x) were obtained with six cases of P. vivax infection and three of P. ovale, but with only three of 11 cases due to P. falciparum; less concentration (10x to 30X) was achieved with six cases and none with the remainder-in two no parasites being
Possible
relationship and liver
of Schistosoma infection carcinoma
SIR-The
recent symposium on liver carcinoma in
the Transactions (71 16). 459-473) omitted recent
relevant observations regarding thepossible relationship of Schistosoma infection and liver carcinoma. Many case reports of liver carcinoma in schistosomiasis due to S. juponicum have been published (WARREN& NEWELL, 1967). One hospital-based retrospective study in Japan supports the hypothesis of an aetiological relationship between skin reactivity to S. j%ponicum antigen and liver carcinoma (KITANI et al., 1972). HBs antigen and S. japonicum infection have been associated with liver carcinoma in Japan (NAKASHIMAet al., 1975). This association may be confounded by the recent demonstration of persistent HBs antigenaemia in schistosomiasis due to S. mansoni with hepatic and splenic enlargement (COULARD& CONSTANT-DESPORTES, 1976; LYRA et
CORRESPONDENCE aE., 1976). Although their aetiological relationship has been infrequently studied, it is interesting that the geographical prevalence of liver carcinoma corresponds to that of schistosomiasis due to S. mansoni and S. japonicum. I am, etc., K.-E. h&OTT Schistosomiasis and other Hebninthic Infections, Division of Malaria and other Parasitic Diseases, Special Programme for Research and Training in Tropical Diseases, World Health Organization, Geneva, Switzerland. References Coulard, J. I?. & Constant-Desportes, M. (1976). Reoartition des sous-tvues d’anticctne HBs aux An%lles. Nouvette Pres;; Medicale;5, 2548-2549. Kitani, E. et al. (1972). Hepatoma in patients with schistosomiasis japonica. Proceedings of the Joint Conference on Parasitic Diseases, Japan- United States Cooperative Medical Science Program, Hiroshima, 18-20 July, 1972, Abstract No. 20, pp. 62-64. Lyra, G., Reboucas, G. & Andrade, Z. A. (1976). Hepatitis B surface antigen carrier state in hepatoschistosomiasis. Gastroenterology, 71, splenic 641-645. Nakashima, T., Okuda, K., Kojira, M., Sakamoto, K.. Kubo. Y. & Shimokawa. Y. (1975). Primary liver cancer coincident with ‘schistosomiasis japonica. Cancer, 36, 1483-1489. Warren, K. S. & Newell, V. A. (1967). Schistosomiasis: A bibliography of the world’s literature from 1852 to 1962. USA: Press of Western Reserve University, Vol. 1, pp. 286-287.
Accepted for publication
Circumoval and acute
30th March,
1978.
precipitin test in the prepatent phases of human schistosomiasis mansoni infection* SIR-It is widely known that the circumoval precipitin test (COPT), first described by OLIVERGONZALEZ (1954), is a reaction of antibody to schistosome egg antigens. In experimentally infected laboratory animals the reaction becomes positive 45 to 66 days after infection (COKER & OLIVERGONZALEZ, 1957). Althouah the test is timeconsuming and requires thi laborious preparation of fresh or lyophilized eggs of the parasite, it offers good specificity and is the fastest reaction to become negative following cure of the disease. There is, however, a lack of data of COPT titres from spontaneous human schistosomiasis mansoni infection in the prepatent period and acute phase. Four male patients, two children and two adults, without previous history of schistosomal infection, presented a typical picture of cercarial dermatitis
553
after bathing in a contaminated swimming-pool (Lagoa Santa city, Minas Gerais State, Brazil). It was then possible to determine exactly the day of infection. A follow-up study was then done and quantitative stool examinations, by Kato’s method, as modified by KATZ et al. (1972), were performed 35,40,47,54 and 60 days after cercarial exposure. Blood samples were obtained on the same day as the stool collection. The COPT reaction was performed according to the technique of PELLEGRINO & ANDRADE (1962) with some modifications, as follows: 0.1 ml of serum (inactivated at 56°C for 30 min) and an equal volume of a suspension of Schistosoma mansoni eggs (recovered from the liver and intestine of infected hamsters) in 2 * 0 oh saline were mixed on a slide, covered with a coverslip and incubated at 37°C for 24 hours. For the interpretation, the circumoval reactions were scored (“points”) according to the area of precipitation. The larger the area, the higher the serum reactivity (r). For each sample 100 S. mansoni live, mature eggs were counted. When the r value was equal to or higher than 5, the reaction was considered positive. Until day 47 all sera were negative. At day 54, one patient showed a positive reaction with an r value of 28. At dav 60 this natient had the same r value and the other three showed r values of 12, 16 and 36. Faecal examinations were first positive for all patients on day 47. Summarizing, since the COPT becomes positive only after viable S. mansoni eggs have been found in stool examinations, we conclude that this test is not useful for the early diagnosis of schistosomal infection. On the other hand, these findings from human cases parallel findings in experimental laboratory animals. We are, etc., R. T. MELLO L. H. PEREIRA N.KATZ J. PELLEGRINO** Grupo Interdepartmental de Estudos sobre Esquistossomose (GZDE), Universidade Federal de Minas Gerais, C.P. 2486, and Centro de Pesquisad “Rene’ Rachou”-FIOCR UZ, Belo Horizonte, Brasil * This work was supported, in part, by grants from Conselho National de Desenvolvimento Cientifico e Tecnologico (CNPq), Brazil, and WHO, Switzerland. Contribution No. 99 from the Schistosomiasis Research Unit. ** Died February, 1977. References Coker, C. M. & Oliver-Gonzalez, J. (1957). Experiments on anti-schistosome circumoval precipitating antibody in mice. AmericanJournal if Tropical Medicine and Hvgiene. 6. 390. Katz, N., Chave<-A. 8r eellegrino, J. (1972). A simple device for quantitative stook thick smear technique in schistosomiasis mansoni. Revista do Znstituto de Medicina Tropicale de Scio Paula, 14, 397400.
CORRESPONDENCE
written “Culex larvae (II-IVinstars)* but no pupae were collected from underground pools from Lodna on three occasions”. This was out of the 14 visits made over a period of eight months searching for various arthropods in coal mines of varying depths. The larvae collected were identified as Culex futiguns after emergence of imagines. McCay & Senior White (1941) also observed such a short-lived “mosquito nuisance” a thousand feet (300 m approx.) below ground in the Saltore colliery (m the vicinity of the Bejdih colliery in question) and categorically recorded “culicine mosquitoes were discovered breeding prolifically in shallow pools” in mine workings. This observation is also mentioned in my article. Hence the Bejdih episode is, in my opinion, one in a series and nothing unusual. In my eight months’.survey C. fatiguns collected from inside mines had an infection rate of 5.4 y0 but nil infectivity; on-the surface the infection rate was 15 y0 and the infectivity rate 1.5 %. I am, etc., S. A. AZEEZ Entomologist, Coalfield Malaria Unit, Dhanbad-3 (Bihar), India
recovered. (The values were determined by comparing the percentages of infected erythrocytes on thin blood films before and after concentration.) Mornhological preservation was better than that obtainid in thick blood films. Four days after starting treatment, 0.84 y0 of gametocytes were detected by this method in the blood of one patient, when thin blood films failed to reveal any (LE BRASet al., in press). The method may be useful in attempting confirmation of a doubtful diagnosis when normal parasitological methods have failed. We are, etc., T. LE BRAS ti.
PAYET
Laboratoire de l’lnstitut de Medecine et d’Epidemiologie Africaines, HGpital Claude Bernard, 10 avenue Porte d’dubervilliers, 75019 Paris, France. References
Eling, W. M. C. (1977). Separation of parasitized erythrocytes from Plasmodium berghei infected mouse blood. Transactions of the Royal Society of Tropical Medicine and Hygiene, 71, 267-268.
References
Azeez, S. A. (1965). Arthropod and rodent infestation of coal mines in Dhanbad and Parulia districts. Bulletin of the indian Society for Malaria and Other Communicable Diseases, 2, 327-332.
Dutta, S. N. (1977). Evidence of Culex fatigans mosquito breeding in underground pits of a coahnine in India. Transactions of the Royal Society of Tropical Medicine and Hygiene, 71, 180. McCay, F. & Senior White, R. (1941). Biological control of culicine mosquitoes by prawns in a Bengal coalmine. Indian Medical Gazette, 76.37.
Le Bras, J., Ricour, A., Savel, J. & Payet, M. (1978). Diagnostic parasitologique du paludisme par - : concentration des hemanes parasitees: technique et resultats nrcliminaires. Bulletin de la So&t de Pathologie Exotique (in press). Miller, L. K. & Chien, S. (1971). Density distribution of red cells infected by Plasmodium knowlesi and Plasmodium coatnevi. ExPerimental Parasitology, 29,451-456.
-
-
Rowley, P. T., Siddiqui, W. A. 8c Geiman, Q. M. (1967). Separation of malarial parasites according to age by density gradient centrifugation. Journal of Laboratory and Clinical Medicine, 70,933-937.
*Parentheses in original text. Accepted for publication 26th April, Accepted for publication
Concentration
15th March,
1978.
1978.
of parasitized erythrocytes malaria diagnosis
in
SIR-We have used the technique of concentrating parasitized erythrocytes by centrifugation on a Ficoll R solution, as described by ELING (1977) for Plasmodium berghei, in diagnosing 20 human cases of malaria (LE BRASet al., in press). The effectiveness of the technique increases with increasing size of the parasites (ROWLEYet al., 1967; MILLER & CHIEN, 1971) and is therefore less in P. falciparum infections where most parasites are young ring forms. Concentrations of 40X or more (maximum 13600x) were obtained with six cases of P. vivax infection and three of P. ovale, but with only three of 11 cases due to P. falciparum; less concentration (10x to 30X) was achieved with six cases and none with the remainder-in two no parasites being
Possible
relationship and liver
of Schistosoma infection carcinoma
SIR-The
recent symposium on liver carcinoma in
the Transactions (71 16). 459-473) omitted recent
relevant observations regarding thepossible relationship of Schistosoma infection and liver carcinoma. Many case reports of liver carcinoma in schistosomiasis due to S. juponicum have been published (WARREN& NEWELL, 1967). One hospital-based retrospective study in Japan supports the hypothesis of an aetiological relationship between skin reactivity to S. j%ponicum antigen and liver carcinoma (KITANI et al., 1972). HBs antigen and S. japonicum infection have been associated with liver carcinoma in Japan (NAKASHIMAet al., 1975). This association may be confounded by the recent demonstration of persistent HBs antigenaemia in schistosomiasis due to S. mansoni with hepatic and splenic enlargement (COULARD& CONSTANT-DESPORTES, 1976; LYRA et
CORRESPONDENCE aE., 1976). Although their aetiological relationship has been infrequently studied, it is interesting that the geographical prevalence of liver carcinoma corresponds to that of schistosomiasis due to S. mansoni and S. japonicum. I am, etc., K.-E. h&OTT Schistosomiasis and other Hebninthic Infections, Division of Malaria and other Parasitic Diseases, Special Programme for Research and Training in Tropical Diseases, World Health Organization, Geneva, Switzerland. References Coulard, J. I?. & Constant-Desportes, M. (1976). Reoartition des sous-tvues d’anticctne HBs aux An%lles. Nouvette Pres;; Medicale;5, 2548-2549. Kitani, E. et al. (1972). Hepatoma in patients with schistosomiasis japonica. Proceedings of the Joint Conference on Parasitic Diseases, Japan- United States Cooperative Medical Science Program, Hiroshima, 18-20 July, 1972, Abstract No. 20, pp. 62-64. Lyra, G., Reboucas, G. & Andrade, Z. A. (1976). Hepatitis B surface antigen carrier state in hepatoschistosomiasis. Gastroenterology, 71, splenic 641-645. Nakashima, T., Okuda, K., Kojira, M., Sakamoto, K.. Kubo. Y. & Shimokawa. Y. (1975). Primary liver cancer coincident with ‘schistosomiasis japonica. Cancer, 36, 1483-1489. Warren, K. S. & Newell, V. A. (1967). Schistosomiasis: A bibliography of the world’s literature from 1852 to 1962. USA: Press of Western Reserve University, Vol. 1, pp. 286-287.
Accepted for publication
Circumoval and acute
30th March,
1978.
precipitin test in the prepatent phases of human schistosomiasis mansoni infection* SIR-It is widely known that the circumoval precipitin test (COPT), first described by OLIVERGONZALEZ (1954), is a reaction of antibody to schistosome egg antigens. In experimentally infected laboratory animals the reaction becomes positive 45 to 66 days after infection (COKER & OLIVERGONZALEZ, 1957). Althouah the test is timeconsuming and requires thi laborious preparation of fresh or lyophilized eggs of the parasite, it offers good specificity and is the fastest reaction to become negative following cure of the disease. There is, however, a lack of data of COPT titres from spontaneous human schistosomiasis mansoni infection in the prepatent period and acute phase. Four male patients, two children and two adults, without previous history of schistosomal infection, presented a typical picture of cercarial dermatitis
553
after bathing in a contaminated swimming-pool (Lagoa Santa city, Minas Gerais State, Brazil). It was then possible to determine exactly the day of infection. A follow-up study was then done and quantitative stool examinations, by Kato’s method, as modified by KATZ et al. (1972), were performed 35,40,47,54 and 60 days after cercarial exposure. Blood samples were obtained on the same day as the stool collection. The COPT reaction was performed according to the technique of PELLEGRINO & ANDRADE (1962) with some modifications, as follows: 0.1 ml of serum (inactivated at 56°C for 30 min) and an equal volume of a suspension of Schistosoma mansoni eggs (recovered from the liver and intestine of infected hamsters) in 2 * 0 oh saline were mixed on a slide, covered with a coverslip and incubated at 37°C for 24 hours. For the interpretation, the circumoval reactions were scored (“points”) according to the area of precipitation. The larger the area, the higher the serum reactivity (r). For each sample 100 S. mansoni live, mature eggs were counted. When the r value was equal to or higher than 5, the reaction was considered positive. Until day 47 all sera were negative. At day 54, one patient showed a positive reaction with an r value of 28. At dav 60 this natient had the same r value and the other three showed r values of 12, 16 and 36. Faecal examinations were first positive for all patients on day 47. Summarizing, since the COPT becomes positive only after viable S. mansoni eggs have been found in stool examinations, we conclude that this test is not useful for the early diagnosis of schistosomal infection. On the other hand, these findings from human cases parallel findings in experimental laboratory animals. We are, etc., R. T. MELLO L. H. PEREIRA N.KATZ J. PELLEGRINO** Grupo Interdepartmental de Estudos sobre Esquistossomose (GZDE), Universidade Federal de Minas Gerais, C.P. 2486, and Centro de Pesquisad “Rene’ Rachou”-FIOCR UZ, Belo Horizonte, Brasil * This work was supported, in part, by grants from Conselho National de Desenvolvimento Cientifico e Tecnologico (CNPq), Brazil, and WHO, Switzerland. Contribution No. 99 from the Schistosomiasis Research Unit. ** Died February, 1977. References Coker, C. M. & Oliver-Gonzalez, J. (1957). Experiments on anti-schistosome circumoval precipitating antibody in mice. AmericanJournal if Tropical Medicine and Hvgiene. 6. 390. Katz, N., Chave<-A. 8r eellegrino, J. (1972). A simple device for quantitative stook thick smear technique in schistosomiasis mansoni. Revista do Znstituto de Medicina Tropicale de Scio Paula, 14, 397400.