There appears to be no epidemiological association between Schistosoma mansoni infection, the intensity of S. mansoni infection or S. mansoni infection complicated by schistosome hepatic fibrosis and the presence of antibody to hepatitis B virus core antigen (anti-HBc), hepatitis B surface antigen (HBsAg), antibody to hepatitis C virus (anti-HCV) or antibody to both agents. This was the main conclusion of a population-based study of an entire village in the northern Egyptian Nile Delta. All 1850 villagers were invited to participate and serological, parasitological and ultrasound examinations were completed on a high proportion of the total population (68% provided sera and higher percentages provided stool specimens and were subjected to ultrasound examinations). Testing with dual Kato slides indicated a high prevalence of S. mansoni infection in the village (49.1%), typical of the area. Hepatitis B virus (HBV) markers (presence of either anti-HBc and/or HBsAg) and anti-HCV were also found to be prevalent, present in 24% and 15.9% of the villagers, respectively. The age-adjusted odds ratios (OR) for infection with S. mansoni and HBV [1.13; 95% confidence interval (CI) = 0.87-1.48], HBsAg (1.11; CI = 0.47-2.58), or anti-HCV (1.02; CI = 0.7-1.37) were not significantly greater than unity. Similarly low and non-significant OR estimates were observed with those positive for both HBV and anti-HCV. No other outcome measures of S. mansoni infection (i.e. intensity of infection or ultrasonographically-determined schistosomal hepatic fibrosis) were found to be associated with HBV, HBsAg or anti-HCV.(ABSTRACT TRUNCATED AT 250 WORDS)

One hundred forty-four of 166 adults with acute viral hepatitis (AVH) admitted to an Egyptian fever hospital were followed for 12 months. The hepatitis B surface antigen (HBsAg) carrier rate in 95 with hepatitis B virus (HBV) hepatitis decreased from 53% at three months to 13% at 12 months. At 12 months, 22% of the male patients had persistent HBsAg compared with only 7% of the female patients. The HBsAg carrier rate was 25% at 12 months in those with schistosomiasis compared with 9% in those with only acute HBV infection. Splenomegaly persisted in those with palpable spleens at the initial examination and others developed splenomegaly. The prevalence of splenomegaly increased from 11% on admission to 20% at 12 months in those with only AVH, and from 40% to 69% in those with concomitant schistosomiasis. Patients with concomitant schistosomiasis had higher mean values for liver function test results and a greater proportion had abnormal liver function test results during hospitalization and follow-up than those with AVH only. Concomitant schistosomiasis increased the prevalence and prolonged splenomegaly and morbidity due to AVH. Both male sex and concomitant schistosomiasis prolonged the HBsAg carrier state. We propose that AVH frequently converts uncomplicated intestinal schistosomiasis to hepatosplenic schistosomiasis.

Forty-one schoolchildren with positive stools for Schistosoma mansoni eggs and 39 age- and sex-matched children with negative stools were given 3 doses, 5 micrograms each, of a plasma derived hepatitis B vaccine. Their sera were examined 3 and 9 months after the third dose for hepatitis B surface antibody (anti-HBs). At 9 months after vaccination, both the number of responders and the mean of antibody titers were significantly higher in the control group than in the group infected with S. mansoni (97% vs. 56% and 334.8 +/- 192.9 vs. 67.7 +/- 74.4 mIU/ml). There was a negative correlation between anti-HBs titers and the long diameter of the spleen as well as between the titers and the long diameter of the spleen and the liver span in the mid-clavicular line (right lobe) taken together. There was also a positive correlation between anti-HBs titers and the diameters of the portal vein. There was no correlation between anti-HBs titers and any of the following 3 parameters: liver span in the mid-clavicular line (right lobe) alone, liver span in the middle line (left lobe) alone, and the degree of thickness of the periportal fibrosis. There was also no correlation between anti-HBs titers and egg counts in the stools. An interpretation of these findings was made in the light of the role of phagocytic activity of the liver and spleen as well as of porta-caval shunts in the immune mechanism.

A follow-up study for one year was made on 35 babies born to HBsAg positive mothers in a semirural population in Egypt. Five of 21 babies (24%) showed HBsAg in the umbilical cord blood and remained positive throughout the observation period. At 3 months, eight of 37 babies (23%) were HBsAg + ve. At 6 months, 13 of 35 babies (37%) were HBsAg + ve and they were also still found positive at 12 months. None of 30 babies born to HBsAg-ve mothers developed antigenaemia throughout the observation period. Factors which significantly contributed to transmission were maternal educational level, family socio-economic standard, family residence, maternal e/anti-e status, and maternal schistosomal infestation. Factors which did not significantly affect transmission were maternal age, maternal parasitic non-schistosomal infestations, maternal transaminases level, order of the child in the family, and type of child feeding. Of particular note, four of five babies (80%) born to HBsAg + ve mothers who as well had schistosomiasis were HBsAg + ve throughout the observation period.

SCHISTOSOMAL lesions affecting the urinary bladder in the majority of Egyptian farmers play a great role in the higher percentage of bladder cancer (the most common form of cancer in Egypt) at earlier ages than in any other country (El Sebai, 1962).Thus finding a simple test to aid in the diagnosis or exclusion of malignant diseases of the bladder in patients infected with schistosomiasis would be of great help.

SummaryAtabrine cured a case of acute amebic hepatitis which received the drug orally, and a case of advanced amebic abscess of the liver to which, besides oral therapy, intrahepatic instillations of the drug were given. It failed to cure two other cases of advanced amebic liver abscess which received the drug by the oral route only. Inadequate dosage in one of the two latter cases, and secondary infection in the other probably contributed to the failure. In vitro studies on Endamoeba histolytica showed that atabrine is about 10 times more effective than chloroquine and about 40 per cent as effective as emetine. A dosage schedule for atabrine in hepatic amebiasis has been set up on a purely tentative basis.