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Carcinoembryonic antigen in schistosomiasis
708 TRANSAC~ONSOF THE ROYAI. Socwn
OF TROPIC~~LMEDICINE AND HYGIENE, VOL. 76, No. 5, 1982. CORRESPONDENCE
References Abonnenc, E. (1972). Les phl&otomes de la rkgion &hiopienne (Diptera: Psychodidae). M&wries O.R.S.T.O.M., No. 55, Paris, 289 pp. Chance, M. L., Schnur, L., Thomas, S. C. & Peters, W. (1978). The biochemical and serological taxonomy of L&&mania from the aethiopian zoogeographical region of Africa. Annals of Tropical Medicine and Hygiene and Parasitology, 72, 533-542. Larivikre, M., Quenum, C. & Abonnenc, E. (1961). A propos d’un cas de leishmanoise cutanee au S&gal. Discussion sur la transmission possible par Phlebotonzus duboscqi (P. roubaudi). Bulletin de la Soci@ Midicale Ajiique Noire langue fiancaise, 6, 431-435. Lewis, D. J. (1974). Some recent work on, old-world phlebotomine vectors of leishmaniasis. In: Ecologic des Le$manioses, Colloques Internaeonaux du .Centre z3y;;l de la Recherche Sclentiques, Pans, pp. Quate, L. \jcr. (1964). Leishmania in the Sudan Republic 19. Phlebotomussandflies of the Paloich Area in the Sudan (Diptera: Psychodidae). Journal of Medical Entomology, 1, 213-268.
Accepted
for publication 14th April, 1982.
Table-Serum CEA levels from single determinations in 32 patients with schistosomiasis Serum CEA (rig/ml) No. of cases Uncomplicated Liver cirrhosis Polyposis
16 6 10
<2.5 2.5-5.0 5.0-10 >lO 15 3 8
2 2 1
0 1 0
0 0 1
of CEA, usually less than 10 rig/ml (LOWENSTEIN & ZAMCHECK, 1978). We anticipated similarly elevated CEA levels in schistosomiasisbecauseof its extensive gastrointestinal involvement. Though no correlation with treatment status or diseaseactivity was attempted in this brief study, the results suggest that CEA levels are not elevated in uncomplicated S. mansoni infection. Further study with a larger number of patients will be needed to confirm these initial observations. Supported by Naval Medical Research and Development Command, NNMC, Bethesda, Md. Work Unit No. M0095-PN-002-5062.
Carcinoembryonic
antigen in schistosomiasis
Carcinoembryonic antigen (CEA), a glycoprotein of molecular weight 200,000, is an oncofoetal antigen present in small amounts in normal adult large intestine and serum. Considerable amounts are expressed postnatally by carcinomas, principally those of the large intestine. Elevated levels of serum CEA also are found in a variety of non-malignant conditions, including liver diseaseand inflammatory bowel disease (NIH Consensus Development Conference, 1981). We investigated patients with early and advanced Schistosoma mansoni infection for the presence of elevated levels of CEA. 32 adult Egyptian patients (30 males, two females) hospital in-patients with S. mansoni infection were divided into three groups according to their clinical status. Group A included patients with uncomplicated schistosomiasis, Group B with schistosomiasis and liver cirrhosis and Group C with schistosomal colonic polyposis. Clinical status was assessedby history, physical examination, laboratory and radiographic investigations, sigmoidoscopy, and liver biopsy. Serum CEA measurements were determined by radioimmunoassav using the PhadebasCEA PRIST in vitro test (Pharmacia, I?ppsala, Sweden). The upper limit of normal with this test is in’the range of 25 to 5-Onglrnl. We found levels less than 5 rig/ml in all but two uatients (Table). Of the two Datients with levels above 5.0 ng/mj, one’had evidence of chronic liver disease with increased liver enzymes and the presence of hepatitis B antibody. The other patient had metastatic nasopharyngeal carcinoma and was undergoing radiotherapy. Hepatitis and metastatic carcinoma are known to be associated with elevated serum CEA levels. At least 50% of patients with “severe benign hepatic disease” and a variable percentageof patients with inflammatory bowel disease have elevated levels
The opinions and assertions contained herein are the private ones of the authors and are not to be construed as official or as reflecting the views of the Department of the Navy. K. L. WATSKY S. BASSILY Z. FARID U.S. Naval Medical Research, Unit No. 3, Cairo, Egypt. References Loewenstein, M. S. & Zamcheck, N. (1978). Carcinoembryonic antigen (CEA) levels in benign gastrointestinal disease states. Cancer, 42, 1412-1418. National Institutes of Health ConsensusDevelopment Conference (1981). Carcinoembryonic antigen: its role as a marker in the management of cancer. Annals of Internal Medicine, 94, 407-409.
Accepted for publication- 29th May, 1982. Reprint requests to: Publication Editor, NAMRU-3, FPO New York 09527, USA.
Injection of Trypanosoma cruzi into the gut of triatomine bugs: number required to infect the vector
For a detailed study of the development of different flagellate forms of TrvPanosoma cruzi in the vector it is ir&ortant to know ddw many parasites were ingested bv the insect. It is Dossible to do this bv means of
artificial feeding, as’ proposed by NEAL & MILES (1977), but we have chosen a method of direct injection of the parasite into the stomach of triatomines. Fourth- and fifth-stage nymphs of Dipetalogaster maxima and fifth-stage Triatoma infestans were
OF TROPIC~~LMEDICINE AND HYGIENE, VOL. 76, No. 5, 1982. CORRESPONDENCE
References Abonnenc, E. (1972). Les phl&otomes de la rkgion &hiopienne (Diptera: Psychodidae). M&wries O.R.S.T.O.M., No. 55, Paris, 289 pp. Chance, M. L., Schnur, L., Thomas, S. C. & Peters, W. (1978). The biochemical and serological taxonomy of L&&mania from the aethiopian zoogeographical region of Africa. Annals of Tropical Medicine and Hygiene and Parasitology, 72, 533-542. Larivikre, M., Quenum, C. & Abonnenc, E. (1961). A propos d’un cas de leishmanoise cutanee au S&gal. Discussion sur la transmission possible par Phlebotonzus duboscqi (P. roubaudi). Bulletin de la Soci@ Midicale Ajiique Noire langue fiancaise, 6, 431-435. Lewis, D. J. (1974). Some recent work on, old-world phlebotomine vectors of leishmaniasis. In: Ecologic des Le$manioses, Colloques Internaeonaux du .Centre z3y;;l de la Recherche Sclentiques, Pans, pp. Quate, L. \jcr. (1964). Leishmania in the Sudan Republic 19. Phlebotomussandflies of the Paloich Area in the Sudan (Diptera: Psychodidae). Journal of Medical Entomology, 1, 213-268.
Accepted
for publication 14th April, 1982.
Table-Serum CEA levels from single determinations in 32 patients with schistosomiasis Serum CEA (rig/ml) No. of cases Uncomplicated Liver cirrhosis Polyposis
16 6 10
<2.5 2.5-5.0 5.0-10 >lO 15 3 8
2 2 1
0 1 0
0 0 1
of CEA, usually less than 10 rig/ml (LOWENSTEIN & ZAMCHECK, 1978). We anticipated similarly elevated CEA levels in schistosomiasisbecauseof its extensive gastrointestinal involvement. Though no correlation with treatment status or diseaseactivity was attempted in this brief study, the results suggest that CEA levels are not elevated in uncomplicated S. mansoni infection. Further study with a larger number of patients will be needed to confirm these initial observations. Supported by Naval Medical Research and Development Command, NNMC, Bethesda, Md. Work Unit No. M0095-PN-002-5062.
Carcinoembryonic
antigen in schistosomiasis
Carcinoembryonic antigen (CEA), a glycoprotein of molecular weight 200,000, is an oncofoetal antigen present in small amounts in normal adult large intestine and serum. Considerable amounts are expressed postnatally by carcinomas, principally those of the large intestine. Elevated levels of serum CEA also are found in a variety of non-malignant conditions, including liver diseaseand inflammatory bowel disease (NIH Consensus Development Conference, 1981). We investigated patients with early and advanced Schistosoma mansoni infection for the presence of elevated levels of CEA. 32 adult Egyptian patients (30 males, two females) hospital in-patients with S. mansoni infection were divided into three groups according to their clinical status. Group A included patients with uncomplicated schistosomiasis, Group B with schistosomiasis and liver cirrhosis and Group C with schistosomal colonic polyposis. Clinical status was assessedby history, physical examination, laboratory and radiographic investigations, sigmoidoscopy, and liver biopsy. Serum CEA measurements were determined by radioimmunoassav using the PhadebasCEA PRIST in vitro test (Pharmacia, I?ppsala, Sweden). The upper limit of normal with this test is in’the range of 25 to 5-Onglrnl. We found levels less than 5 rig/ml in all but two uatients (Table). Of the two Datients with levels above 5.0 ng/mj, one’had evidence of chronic liver disease with increased liver enzymes and the presence of hepatitis B antibody. The other patient had metastatic nasopharyngeal carcinoma and was undergoing radiotherapy. Hepatitis and metastatic carcinoma are known to be associated with elevated serum CEA levels. At least 50% of patients with “severe benign hepatic disease” and a variable percentageof patients with inflammatory bowel disease have elevated levels
The opinions and assertions contained herein are the private ones of the authors and are not to be construed as official or as reflecting the views of the Department of the Navy. K. L. WATSKY S. BASSILY Z. FARID U.S. Naval Medical Research, Unit No. 3, Cairo, Egypt. References Loewenstein, M. S. & Zamcheck, N. (1978). Carcinoembryonic antigen (CEA) levels in benign gastrointestinal disease states. Cancer, 42, 1412-1418. National Institutes of Health ConsensusDevelopment Conference (1981). Carcinoembryonic antigen: its role as a marker in the management of cancer. Annals of Internal Medicine, 94, 407-409.
Accepted for publication- 29th May, 1982. Reprint requests to: Publication Editor, NAMRU-3, FPO New York 09527, USA.
Injection of Trypanosoma cruzi into the gut of triatomine bugs: number required to infect the vector
For a detailed study of the development of different flagellate forms of TrvPanosoma cruzi in the vector it is ir&ortant to know ddw many parasites were ingested bv the insect. It is Dossible to do this bv means of
artificial feeding, as’ proposed by NEAL & MILES (1977), but we have chosen a method of direct injection of the parasite into the stomach of triatomines. Fourth- and fifth-stage nymphs of Dipetalogaster maxima and fifth-stage Triatoma infestans were