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Kala-azar in Libya
TRANSACTIONS
OP THE ROYAL
SOCIETY
OF TROPICAL
MELW.XNE
Rollinson, D. (1979). The use of enzymes in tazonomy of Bulinus. Transactions of the Royal Society of Tropical Medicine and Hygiene, 73, 601-602. Wright, C. A. & Rollinson, D. (1979). Analysis of enzymes in the Bulinus africanus group (Mollusca : Planorbidae) by isoelectric focusing. Journal of Natural History, 13, 263-273.
Accepted for publication
6th February, 1980.
Discovery of a site of transmission and hosts of a Schistosoma japonicum-like schistosome in Peninsular Malaysia SIR-There have been several recent reports of schistosomiasis among aborigines (Orang Ash) of Peninsular Malaysia (MURUGASU & DISSANAIKE, 1973; LEONG et al., 1975; MURUGASU et al., 1978). Before these reports, endemic schistosomiasis was thought not to occur in Peninsular Malaysia. In March 1978 we formed a team from the Institute for Medical Research, Kuala Lumpur and the Orang Asli Hospital, Gombak, to search for the natural hosts and foci of transmission of this parasite. In July 1978 we collected a previously undescribed freshwater hydrobioid snail from a small stream, the Sungai Kapor (4” 15’ 50’ N x 101’ 51’ 50” E), of the Jelai River system in Bahang State. The snail was tentatively placed in the genus Tricula (see GREER et al., 1980) of the &mily Pomatioosidae. subfamilv Triculinae (see DAVIS. 1979). In June 1979 S: japonicum-li& cercariae were recovered from a snail of the same species taken from this locality. TO date, 12 infected snails have been isolated from 22,182 snails of this species collected from the Sungai Kapor. We have also recently recovered S. japonicum-like eggs from a Rattus muelleri, one of nine trapped near the Sungai Kapor. These eggs possess a small lateral hook typical of S. japonicum and S. mekongi. 30 eggs containing live miracidia averaged 70 pm iong by 57 pm wide-smaller than unfixed eggs of the S. japonicum strains collected from dogs, cats mice and hamsters (HSU & HSU, 1958) but larger, than S. mekongi eggs from man (IITIMA et al.. 1971). Although eggsizemay vary considerably with host, duration of infection, and handling, eggs from the “Malavsian” schistosome are similar in size and-. shape to those of S. japonicum and S. mekongi. Nine pairs of adult worms have been recovered from a mouse and a hamster killed 51 and 65 days respectively after exposure to cercariae from naturally infected snails. The size and morphology of the adult worms are similar to those given by VOGE et al. (1978) for S. japonicum and S. mekongi. Studies are under way to provide a definitive description of this schistosome from Malaysia. Since the Sungai Kapor flows near a small village where two infected aborigines had lived, we believe that this parasite is responsible for the cases of human schistosomiasis detected in Peninsular Malaysia.
AND HYGIENE,
VOL.
74, No.
3, 1980.
CORRESPONDENCE
425
This study is supported in part by research grant AI-10051 from the National Institute of Allergy and Infectious Diseases, National Institute of Health, United States Public Health Service. We are, etc., G. J. GREER* C. K. OW-YANG0 K. INDER SINGHO H. K. LIM* * University of California International Center for Medical Research, Institute for Medical Research, Kuala Lumpur, Malaysia o Institute for Medical Research. Kuala Lumpur, Malaysia . References Davis, G. M. (1979). The origin and evolution of the gastropod family Pomatiopsidae, with emphasis on the Mekong River Triculinae. Academy of Natural Science of Philadelphia, Monograph, 20, l-120. Greer, G. J., Lim, H. K. & Ow-Yang, C. K. (1980). Report on a freshwater hydrobiid snail from Pahang, Malaysia: A possible host for schistosomes infecting man. Southeast Asian JournaZ of Tropical Medicine and Public Health, (in press). Hsu, H. F. & Hsu, S. Y. L. (1958). On the size and shape of eggs of the geographic strains of Schistosoma japonicum. American Journal of Tropical Medicine and Hygiene, 7, 125-134. Iijima, I’., Lo, C. T. & Ito, Y. (1971). Studies on schistosomiasis in the Mekong basin. I. Morphological observation of the schistosomes and detection of their reservoir hosts.JapaneserournaZ of Parasitology, 20, 24-33. Leong, S. H., Murugasu, R. & Chong, K. C. (1975). Schistosomiasis in O;;iAsli (A report of 9 cases) Malaysian-Singapore Proceedings of Congress of Medicine, No. 10, 184-186. Murugasu, R. & Dissanaike, A. S. (1973). First case of schistosomiasis in Malaysia. Transactions of the Royal Society of Tropical Medicine and Hygiene, 67, 880. Murugasu, R., Wang, F. & Dissanaike, A. S. (1978). Schistosoma japonicum-type infection in Malaysia -report at the first living case. Transacrions of the Royal Society of Tropical Medicine and Hygiene, 72,389-391. Voge, M., Bruckner, D. & Bruce, J. I. (1978). Schistosoma mekongi sp. n. from man and animals, compared with four geographic strains of Schistosoma japonicum. Journal of Parasitology, 64, 577-584.
AccePted for publication
26th March,
1980.
Kala-azar in Libya SIR-Subsequent to my report (1978) of a case of infantile kala-azar in eastern Libya, Dedet (1979) has pointed out earlier references to visceral leishmaniasis in the country. I am grateful for this
426
TRANSACTIONS OF THE
ROYAL
SOCIHTV
OP TROPICAL
MEDICINE
information and agree with him on the need of further search for the disease. The paucity of cases in this area is of considerable epidemiological interest, for all the conditions are right for transmission. Following the death of our reported case, we visited the focus in question on two occasions and examined 38 children, between the ages of 6 months and 15 years, and 20 adults. Considering the state of deprivation of the ‘tent-colony’ (a shifting population moving from area to area within the district), the children were in generally good health. Only two showed general lymphadenopathy with signs of rheumatic heart disease; two had lymph node enlargement and two showed slight enlargement of the liver. Blood and serum samples (on filter paper) were taken from all 58 subjects for laboratory examination. All blood films were negative for parasites; all six cases of lymph node and liver enlargement were negative for leishmaniasis in N.N.N. culture media, and all 58 eluted serum samples were negative for leishmania antibodies by the indirect fluorescent antibody test. As we had no suitable antigen we could not do skin tests. Cultures of our own isolate petered out at the fifth passage. The nuzzle remains: Whv was there onlv one single case of kala-azar in t-his focus when *many dogs and the sandflies are present in the area? I am, etc., F. K. DAR Faculty of Medicine, University of Garyounis, Benghazi, Libya References Dar, F. K. (1978). An autochthonous case of kalaazar in Libya. Transactions of the Royal Society of Tropical Medicine and Hyg;ene, 72,~555-556. Dedet. 1. P. (1979). About visceral leishmaniasis in Libya. Transactions of the Royal Society of Tropical Medicine and Hygiene, 73,350-35 1.
Accepted for publication
AND HYGIENE,
VOL. 74, No. 3, 1980.
CORRESPONDENCE
disagreement over this (LANCET, 1976). I would like to confuse further this already complex field by reporting briefly experiences in treating patients with Strongyloides stercoralis infections who also have asthma. In recent years, 88 patients with strongyloidiasis of 602 British have been identified from a erou~ personnel formerly prisoners-of-war in the Far East (GILL & BELL; 1979). Of the group with stronevloidiasis. four also had asthma (4.5%). whilst 11 of those free of the infection were asthmatic (2.1%). The difference between these prevalence rates was not significant (O*l
.
I”.,-
9th December, 1979. * Present address: Department of Clinical Biochemistry, Royal Victoria Infirmary, Newcastleupon-Tyne, UK.
Strongyloides and asthma SIR-The relationship between parasitic infection and bronchial asthma is complex. The asthmatic symptoms of tropical eosinophilia appear to be due to an allergic response to microfilariae in the lungs. Pulmonary involvement by certain other worms can also give rise to “asthma” (NWOKOLO & IMOHIOSEN, 1973), but in many of these cases the pathology is probably a result of trauma caused by larvae penetrating the alveoli, combined with an irritant or allergic effect. It has, however, recently been suggested that parasitic infections may actually protect against asthma, though there is some
References Gill, G. V. & Bell, D. R. (1979). Strongyloides stercoralis infection in former Far East prisoners of war. British Medical Journal, ii, 572-574. Lancet (1976). Leading article-IgE, parasites and allergy. Lancet, i, 894. Nwokolo, C. & Imohiosen, E. A. E. (1973). Strongyloidiasis of respiratory tract presenting with asthma. British Medical Journal, ii, 153- 154.
Accepted for publication
3rd January,
1980.
OP THE ROYAL
SOCIETY
OF TROPICAL
MELW.XNE
Rollinson, D. (1979). The use of enzymes in tazonomy of Bulinus. Transactions of the Royal Society of Tropical Medicine and Hygiene, 73, 601-602. Wright, C. A. & Rollinson, D. (1979). Analysis of enzymes in the Bulinus africanus group (Mollusca : Planorbidae) by isoelectric focusing. Journal of Natural History, 13, 263-273.
Accepted for publication
6th February, 1980.
Discovery of a site of transmission and hosts of a Schistosoma japonicum-like schistosome in Peninsular Malaysia SIR-There have been several recent reports of schistosomiasis among aborigines (Orang Ash) of Peninsular Malaysia (MURUGASU & DISSANAIKE, 1973; LEONG et al., 1975; MURUGASU et al., 1978). Before these reports, endemic schistosomiasis was thought not to occur in Peninsular Malaysia. In March 1978 we formed a team from the Institute for Medical Research, Kuala Lumpur and the Orang Asli Hospital, Gombak, to search for the natural hosts and foci of transmission of this parasite. In July 1978 we collected a previously undescribed freshwater hydrobioid snail from a small stream, the Sungai Kapor (4” 15’ 50’ N x 101’ 51’ 50” E), of the Jelai River system in Bahang State. The snail was tentatively placed in the genus Tricula (see GREER et al., 1980) of the &mily Pomatioosidae. subfamilv Triculinae (see DAVIS. 1979). In June 1979 S: japonicum-li& cercariae were recovered from a snail of the same species taken from this locality. TO date, 12 infected snails have been isolated from 22,182 snails of this species collected from the Sungai Kapor. We have also recently recovered S. japonicum-like eggs from a Rattus muelleri, one of nine trapped near the Sungai Kapor. These eggs possess a small lateral hook typical of S. japonicum and S. mekongi. 30 eggs containing live miracidia averaged 70 pm iong by 57 pm wide-smaller than unfixed eggs of the S. japonicum strains collected from dogs, cats mice and hamsters (HSU & HSU, 1958) but larger, than S. mekongi eggs from man (IITIMA et al.. 1971). Although eggsizemay vary considerably with host, duration of infection, and handling, eggs from the “Malavsian” schistosome are similar in size and-. shape to those of S. japonicum and S. mekongi. Nine pairs of adult worms have been recovered from a mouse and a hamster killed 51 and 65 days respectively after exposure to cercariae from naturally infected snails. The size and morphology of the adult worms are similar to those given by VOGE et al. (1978) for S. japonicum and S. mekongi. Studies are under way to provide a definitive description of this schistosome from Malaysia. Since the Sungai Kapor flows near a small village where two infected aborigines had lived, we believe that this parasite is responsible for the cases of human schistosomiasis detected in Peninsular Malaysia.
AND HYGIENE,
VOL.
74, No.
3, 1980.
CORRESPONDENCE
425
This study is supported in part by research grant AI-10051 from the National Institute of Allergy and Infectious Diseases, National Institute of Health, United States Public Health Service. We are, etc., G. J. GREER* C. K. OW-YANG0 K. INDER SINGHO H. K. LIM* * University of California International Center for Medical Research, Institute for Medical Research, Kuala Lumpur, Malaysia o Institute for Medical Research. Kuala Lumpur, Malaysia . References Davis, G. M. (1979). The origin and evolution of the gastropod family Pomatiopsidae, with emphasis on the Mekong River Triculinae. Academy of Natural Science of Philadelphia, Monograph, 20, l-120. Greer, G. J., Lim, H. K. & Ow-Yang, C. K. (1980). Report on a freshwater hydrobiid snail from Pahang, Malaysia: A possible host for schistosomes infecting man. Southeast Asian JournaZ of Tropical Medicine and Public Health, (in press). Hsu, H. F. & Hsu, S. Y. L. (1958). On the size and shape of eggs of the geographic strains of Schistosoma japonicum. American Journal of Tropical Medicine and Hygiene, 7, 125-134. Iijima, I’., Lo, C. T. & Ito, Y. (1971). Studies on schistosomiasis in the Mekong basin. I. Morphological observation of the schistosomes and detection of their reservoir hosts.JapaneserournaZ of Parasitology, 20, 24-33. Leong, S. H., Murugasu, R. & Chong, K. C. (1975). Schistosomiasis in O;;iAsli (A report of 9 cases) Malaysian-Singapore Proceedings of Congress of Medicine, No. 10, 184-186. Murugasu, R. & Dissanaike, A. S. (1973). First case of schistosomiasis in Malaysia. Transactions of the Royal Society of Tropical Medicine and Hygiene, 67, 880. Murugasu, R., Wang, F. & Dissanaike, A. S. (1978). Schistosoma japonicum-type infection in Malaysia -report at the first living case. Transacrions of the Royal Society of Tropical Medicine and Hygiene, 72,389-391. Voge, M., Bruckner, D. & Bruce, J. I. (1978). Schistosoma mekongi sp. n. from man and animals, compared with four geographic strains of Schistosoma japonicum. Journal of Parasitology, 64, 577-584.
AccePted for publication
26th March,
1980.
Kala-azar in Libya SIR-Subsequent to my report (1978) of a case of infantile kala-azar in eastern Libya, Dedet (1979) has pointed out earlier references to visceral leishmaniasis in the country. I am grateful for this
426
TRANSACTIONS OF THE
ROYAL
SOCIHTV
OP TROPICAL
MEDICINE
information and agree with him on the need of further search for the disease. The paucity of cases in this area is of considerable epidemiological interest, for all the conditions are right for transmission. Following the death of our reported case, we visited the focus in question on two occasions and examined 38 children, between the ages of 6 months and 15 years, and 20 adults. Considering the state of deprivation of the ‘tent-colony’ (a shifting population moving from area to area within the district), the children were in generally good health. Only two showed general lymphadenopathy with signs of rheumatic heart disease; two had lymph node enlargement and two showed slight enlargement of the liver. Blood and serum samples (on filter paper) were taken from all 58 subjects for laboratory examination. All blood films were negative for parasites; all six cases of lymph node and liver enlargement were negative for leishmaniasis in N.N.N. culture media, and all 58 eluted serum samples were negative for leishmania antibodies by the indirect fluorescent antibody test. As we had no suitable antigen we could not do skin tests. Cultures of our own isolate petered out at the fifth passage. The nuzzle remains: Whv was there onlv one single case of kala-azar in t-his focus when *many dogs and the sandflies are present in the area? I am, etc., F. K. DAR Faculty of Medicine, University of Garyounis, Benghazi, Libya References Dar, F. K. (1978). An autochthonous case of kalaazar in Libya. Transactions of the Royal Society of Tropical Medicine and Hyg;ene, 72,~555-556. Dedet. 1. P. (1979). About visceral leishmaniasis in Libya. Transactions of the Royal Society of Tropical Medicine and Hygiene, 73,350-35 1.
Accepted for publication
AND HYGIENE,
VOL. 74, No. 3, 1980.
CORRESPONDENCE
disagreement over this (LANCET, 1976). I would like to confuse further this already complex field by reporting briefly experiences in treating patients with Strongyloides stercoralis infections who also have asthma. In recent years, 88 patients with strongyloidiasis of 602 British have been identified from a erou~ personnel formerly prisoners-of-war in the Far East (GILL & BELL; 1979). Of the group with stronevloidiasis. four also had asthma (4.5%). whilst 11 of those free of the infection were asthmatic (2.1%). The difference between these prevalence rates was not significant (O*l
.
I”.,-
9th December, 1979. * Present address: Department of Clinical Biochemistry, Royal Victoria Infirmary, Newcastleupon-Tyne, UK.
Strongyloides and asthma SIR-The relationship between parasitic infection and bronchial asthma is complex. The asthmatic symptoms of tropical eosinophilia appear to be due to an allergic response to microfilariae in the lungs. Pulmonary involvement by certain other worms can also give rise to “asthma” (NWOKOLO & IMOHIOSEN, 1973), but in many of these cases the pathology is probably a result of trauma caused by larvae penetrating the alveoli, combined with an irritant or allergic effect. It has, however, recently been suggested that parasitic infections may actually protect against asthma, though there is some
References Gill, G. V. & Bell, D. R. (1979). Strongyloides stercoralis infection in former Far East prisoners of war. British Medical Journal, ii, 572-574. Lancet (1976). Leading article-IgE, parasites and allergy. Lancet, i, 894. Nwokolo, C. & Imohiosen, E. A. E. (1973). Strongyloidiasis of respiratory tract presenting with asthma. British Medical Journal, ii, 153- 154.
Accepted for publication
3rd January,
1980.