Dear All,
If I am using this quip as a title, its just a reaction after reading the
two (both well presented and scientifically argued) papers from the same
issue (June 1999, Vol. 60(6)) of the American Journal of Tropical Medicine
and Hygiene..
On page 954 of this issue, Ruediger Kardorff (Pediatrics Dept., Hannover
Medical School, Germany) et al. provide a startling evaluation of
hepatosplenic morbidity in schistosomiasis japonica. Two lessons for the
'schisto club' can be found, in our opinion, from this fascinating paper..
The first one is the distinction between echogenic periportal thickening
(clearly a prognostic marker at least for upper gastroinstestinal bleeding
and probably also for survival of patients with portal hypertension) and
network fibrosis within the liver parenchyma (perhaps and independent, as
it is not correlated with portal hypertension, prognostic marker).
The second one is obviously the use of Doppler sonography under field
conditions (the study was recently performed in the Philippines), in
addition to 'classic' (B-mode) ultrasonography.
This new work will certainly stimulate much research along these lines,
both in S. japonicum and S. mansoni endemic foci. The next step will
probably the official presentation of the so-called 'Niamey classification'
(following recommendations from a meeting in Niger, 1996) of
ultrasonographic data in human schistosomiasis, to be published by WHO..
On page 960 of the same issue, Al-Sherbiny et al. presented a so-called
'multidiagnostic approach' of human schistosomiasis (here on a S.
haematobium- infected population, in Egypt). The two labs of Andre Deelder
(Leiden University, The Netherlands; specialized in the development of
assays quantifying schistosome circulating antigens) and Victor C.W. Tsang
(Center for Disease Control and Prevention, Atlanta; which has developed a
'gold standard' assay for many parasitic dieases including
(neuro-)cysticercosis) have joined forces in order to apply this
multistrategy investigation. Clinical data were combined with circulating
antigen (serum CAA and urine CCA) and antibodies against adult worm
microsomal antigens (by FAST-ELISA and confirmatory EITB) detection. I was
surprised to notice that, in population co-infected by W. bancrofti (Haiti
in this study) or O.volvulus (African sera), the specificity of CAA/CCA
assays was decreasing to abour 80 p.cent..
As expected, this combination of 'high tech' techniques and more 'classic'
approach leads to an accurate estimation of the worm prevalence and, more
importantly, to a better management of patients. But we don't think that
this sophisticated approach could be applied elsewhere than in the
(undoubtedly well sustained and sponsorized..) Schisto Control Programme in
Egypt.
Definitively not in the African and Malagasy schisto foci thant we have
visited in the recent years..
I would greatly appreciate any comments on these papers, and of course on
my (personal) presentation of the facts. Hard work for healthcare
professionals in the underdeveloped world...
Best regards to all - PHILIPPE (International Network of Pasteur Institutes)
Philippe ESTERRE (DVM, PhD, MSc)
International Network of Pasteur Institutes.
See our Filariasis Research program on our
Web site: http://www.malarde.pf
---- present adress ----
Head of Immunology Unit - Institut de Recherches
Médicales L. Malardé - BP 30
98713 Papeete Tahiti (French Polynesia)
Fax: 689 431590 / E-mail: esterre at malarde.pf
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