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HYPERENDEMIC FASCIOLIASIS ASSOCIATED WITH SCHISTOSOMIASIS IN VILLAGES IN THE NILE DELTA OF EGYPT

Coprologic surveys were carried out in villages of the Behera Governorate in the Nile Delta region of Egypt to characterize the epidemiologic features of human fascioliasis caused by Fasciola hepatica and F. gigantica in this lowland endemic area by comparison with fascioliasis caused by only F. hepatica in areas hyperendemic for human disease in the Andean highlands of South America. The fascioliasis prevalences detected (range = 5.2–19.0%, mean = 12.8%) are the highest obtained in Egypt. The comparison with previous results suggests that in the Nile Delta, fascioliasis is spreading from an original situation of sporadic human cases in well-known endemic foci for animal disease to an endemic distribution in humans, which may be characterized as a mesoendemic region that includes several hyperendemic areas for human disease. As in Andean countries, a relationship with sex was found, although in Egypt prevalences, but not intensities, appeared to be significantly higher in females. All ages appear to be susceptible to liver fluke infection, with prevalences and intensities being lower before and after school age, a situation that is consistent with that detected in Andean countries, although the peak in the 9–11-year-old age group appears less pronounced in Egypt. The intensities were very high when compared with those found in subjects sporadically infected in areas endemic for animal disease, but relatively low for a hyperendemic situation, although the intensities may not be conclusive because of the transmission seasonality of fascioliasis in the Nile Delta. The marked similarities in the qualitative and quantitative spectrums of protozoans and helminths, multiparasitisms, and associations between liver flukes and other parasitic species suggest physiographic-hydrographic and behavioral-social characteristics similar in all areas hyperendemic for human fascioliasis, which are independent of other factors such as climate, altitude, and cultural or religious features. The significant positive association between liver fluke infection and schistosomiasis mansoni detected in one locality has never been described elsewhere, and must be considered relevant from clinical, pathologic, diagnostic, and therapeutic points of view. Interestingly, the relationships of schistosomiasis prevalences and intensities with sex and age follow patterns similar to those found in fascioliasis.

Received February 4, 2003. Accepted for publication May 29, 2003.

Acknowledgments: Special thanks are given to all the staff of the Behera Survey Team for their help in both field surveys and laboratory analyses.

Financial support: The field and laboratory work of the investigators from the Parasitology Department in Valencia was supported by the Patronat Sud-Nord of the Universidad de Valencia, Project No. BOS2002-01978 of the Spanish Ministry of Science and Technology, Madrid, and the Red de Investigación de Centros de Enfermedades Tropicales – RICET (Project No. C03/04 of the Programme of Redes Temáticas de Investigación Cooperativa) of the Fondo de Investigación Sanitaria, Spanish Ministry of Health (Madrid, Spain). Carolina González was partially supported by the Instituto de Cooperación Iberoamericana (I.C.I.-A.E.C.I.) (Madrid, Spain) and by the Universidad de los Andes-CONICIT, Venezuela; this author is on leave from the Departamento de Microbiología y Parasitología of the Escuela de Bioanálisis, Facultad Farmacia, Universidad de los Andes, Mérida, Venezuela. The data and results presented in this paper were collected in the framework of the bilateral cooperation project "Strengthening Rural Health Services (SRHS)" in Behera, Dakhalia, and Qena Governorates (AID No. 3703) between the Primary Health Care Department, Ministry of Health and Population (Egypt), and the Directorate General for Cooperation and Development, Ministry of Foreign Affairs (Rome, Italy).

Authors’ addresses: José-Guillermo Esteban, Carolina González, Carla Muñoz-Antolí, María Adela Valero, María Dolores Bargues, and Santiago Mas Coma, Departamento de Parasitología, Facultad de Farmacia, Universidad de Valencia, Av. Vicente Andrés Estellés s/n, 46100 Burjassot, Valencia, Spain, Telephone: 34-96-354-42-98, Fax: 34-96-354-47-69, E-mail: Jguillermo.Esteban{at}uv.es. Filippo Curtale, Istituto Superiore di Sanità, Ministry of Health, Viale Regina Elena 266, 00161 Rome, Italy, Telephone: 39-6-4990-3430, Fax: 39-6-4938-7073. Mabrouk El Sayed and Aly Abd el Wahed El Wakeel, Strengthening Rural Health Services Project, Ministry of Health and Population, Behera Regional Health Office, Damanhour, Egypt, Telephone/Fax: 20-45-346-234. Yehia Abdel-Wahab, National Schistosomiasis Control Program, Ministry of Health and Population, Magles El-Shaab Street 3, PO Box 1048689, Cairo, Egypt, Telephone/Fax: +20-2-794-8187. Antonio Montresor, Dirk Engels, and Lorenzo Savioli, Parasitic Diseases and Vector Control, Communicable Diseases Control, Prevention and Eradication, World Health Organization (WHO/OMS), Avenue Appia 20, 1211 Geneva 27, Switzerland, Telephone: 41-22-7912621, Fax: 41-22 –7914869.

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