University of Nigeria on the Incidence and... · Enugu was one nf the areas she studied, but she...
83
University of Nigeria Research Publications IBEACHUM, Geoffrey .I. Author PG/M.Sc/76/110 Title Observation on the Incidence and Pathological Manifestations of Intestinal and Blood Parasite of Children in Enugu Nigeria Faculty Physical Sciences Department Zoology Date March, 1980 Signature
Transcript of University of Nigeria on the Incidence and... · Enugu was one nf the areas she studied, but she...
University of Nigeria Research Publications
IBEACHUM, Geoffrey .I.
Aut
hor
PG/M.Sc/76/110
Title
Observation on the Incidence and Pathological Manifestations of Intestinal and Blood Parasite of Children in Enugu
Nigeria
Facu
lty
Physical Sciences
Dep
artm
ent
Zoology
Dat
e
March, 1980
Sign
atur
e
Ohservntian on t h e Incidence and P a t h o l o g i c a l
m a n i f c s f a t i o n s o f I n t c s t i n n l and Blood P o r o s i t c s
o f C h i l d r e n i n Enugu, Nigeria.
*Y
Geoffrey I fennyichukwu Ibeachun
P~/MSc.76/110
A P r o j e c t Repor t Submitted t o the University o f
Nigeria i n p a r t i a l F u l f i l m e n t af t h e Requ i r emen t s
f o r t h e Degree of Master o f Science,
APRIL 1980
Acknowledgements
Summary
INTRODUCTION
P a r a s i t e I n f e c t i o n s and C h i l d Hen l t h i n
t h e T r o p i c s
Study Area - Enugu
MATERIALS AND METHODS
P o p u l a t i o n s t u d i e d and p e r i o d o f study
Haenintological methods
Faecal Examina t ion Methods
RESULTS
The General P a t t e r n of I n f ec t i uns in
C h i l d r e n
9 e x r e l a t e d I n f e c t i a n Rates
Faeca l Occult B l o o d
Age-group D i s t r i b u t i o n o f P a r a s i t e s
Monthly I n f e c t i o n Levcls
H a c m a t a l o g i c n l Changes i n H e l a t i o n tn
P a r a s i t i c I n f e c t i o n s
DISCUSSION
KEFERENCES
PAGE
1.
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3
4
7
14
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1t3
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21
2 4
34
ACKNOWLEDGEMENT
I an e x p r e s s i n g my s i n c e r e g r a t i t u d e a n d t h a n k s t o
my supervisor P r u f e s s u r 4.0. A y n f o r h i s tirnc d c v o t c d f u r
d i s c u s s i u n s a n d u s c f u l s u q g c s t i u n s t h r o u g h o u t t h i s p r o j e c t .
'The p r r o j c c t was c n r r i c d o u t w i k h t h e h c l p 2 n d e n c u u r n -
g c m e n t o f D r . 3.S.C. Nwusu a n d D r . U.V. Onubagu. I am
g r n t e f u l t u t hem f n r n s s i s t n n c c .
May 1 qlsu s c i z c t h i s o p p : ~ r t u n i t y -Lo t h n n k
Dr. T.C. O k c a h i n l n n l m r l D r . J.C. R z u b i k e p ~ s - t and p r e s e n t
l i c n d s , D e p a r t r n c n t u f P n c d i n t r i c s f o r n l l u w i n g no u s c O F
f a c i l i t i e s i n t h e De.pnr tmcnt . And n t h c r mcrnbcrs o f t h e
Dcportri1i~n-l; f o r 'ch.5.r con rn r l e sh ip w h i l c t h e m r k wns g o i n g
nn . I am i n d e b t e d LCJ t h e A c t i n g Hcgd, Dupar tmcnl ; r i f I ' l o rh id
/ \ n a t u m y , D r , S.E. I k c r i u n w u f u r immonse mural s u p p u r t .
F i n n l l y , I am t i i n n k i n g my w i f e , T h e r e s a , f u r h u r care
o f me t h r u u g h u u t t h e p e r i o d o f t hc e n t i r e s t u d y .
Blood a n d f a e c a l s a m p l e s u o r a c o l l z c t e d f r o m C51 nnd
839 c h i l d r e n r c s p c c t i v c l y , i n Enugu from A p r i l t o Ockuber
1 9 7 9 and e x a m i n e d f u r h e l m i n t h nnd p r m t u z o a l p a r a s i t e s . T h c i r
i n $ c c t i ; i n l e v e l s were a s f o l l u w s : Dipa-t;alonuma p c r c t n n s
( 4 , 6 % ) , Plasmodium - f n l c i p c l r u m -- (7.5%), - P.rnnlor iae (0.125i)
haokwcrm (11.6%), A s c o r i s l u r n b r i c o i d c s (9 ,3%), T r i c h u r i s - -__I_- --- t r i c h i u r n ( 4 , 6 % ) , S t r u n q ~ l o i d c s s t u r c o r n l i s (0,655) Entnmuchc ---- --. -- - -----
O f t h e 851 b l u u d s m p l ~ s , 505 wzrc m a l e s a n d 345 f c m n l c s .
nu-L oi' t h u s c 55 uf t h c molc s n m p l c s (11.8%) a n d 44 u f t h ~
f ~ r ~ i n l c snrnplos (12.8%) w e r e i n f c c t c u . The 839 f a e c a l s n n p l e s
c u n s i s t c d u f 4 9 9 f r u m m n l c s and 3 4 1 f r u m f e m a l e s , o u t o f
which 1 9 3 af t h e m a l e s (38.6%) and 152 (if t l i c f e r n a l e s (44,GO%)
wdra i n R a c t c ~ d , S i n g l e , m u l t i p l e a n d p u l y - i n f e c t i o n s w e r e
coinrnnn, a n d " o c c u l t h l o i ~ d tests;' wc?re s i g n i l " i c n n t 1 y p u s i t i v c
f u r Hookworm, up- T . t r i c h i u r r : a n d - E , h i s t d y t i c n -- i n f e c t i ~ ~ n s .
The l e v e l s i ~ f infection i n t h e v a r i u u s ngu g r i l u p s were
marc p r e v ~ 1 e n - i ; i n t h c 6 y m r age g r o u p ; Plasmodium, Huukworrn,
S . s t c r c ~ ~ r d i s E . c : ~ l i and 1 , b u t s c h l i . i i n tha 5 y e a r a g e q r u u p ; .-. -- d.,,f , .A,, - --a. C . m e s n i l i and L.@minis in the 4 y e a r a g e g r u u p ; A.lu!-nbri- ,
c o i d e s G.lnrnb1i.n 2nd E.nnna i n the 3 y e a r o g ~ g r u u p . The ,,.,*,I ., -- 'I a n d 2 ycnr ngc g r o u p s d i d n , ; t h a v c marked i n f e c t i o n s .
iii
The i n f e c t i o n r a t e s o f Plnsmodium showed p c o k s i n b u t h
t h e d r y a n d r n i n y s e a s o n s s a m p l c s w h i l c D - p e r s t a n s showcd
n penk u n l y i n t h c r n i n y s e a s o n . T h e s e s u g g e s t e d t h a t
t r a n s r n i o s i m n o f Plnsrnudiurn o c c u r r e d a h r a u g h o u t d r y a n d r a i n y
s e a s o n s w h i l e t h a t o f - D . p e r s t a n s - o c c u r r e d o n l y i n t h e r a i n y
s e a s o n , Hookworm a n d - A . l u m b r i c o i d e s had p e a k s d u r i n g t h e
d r y a n d r a i n y s e a s o n s , which r e f l e c t s h i g h i n c i d e n c e r a t h e r
t h a n t r a n s m i s s i o n t h r o u g h o u t t h e d r y a n d r a i n y s e a s o n s .
T. t r i c h i u r a , .S-.stercoralis,, E. h i s t o l y t i c a , g.cqli, S.;1amblia, - - - - E.nana, ~ . h o m i n i s , I - .butschl i i a n d C , m e s n i l i showed p e a k s -1 -.CI - o n l y d u r i n g t h e r a i n y s e a s o n i n d i c a t i n g t h a t t r a n s m i s s i o n
was s e a s o n a l a n d was p r e s u m a b l y r e l a t e d t o t h e w e t n e s s o f
t h e e n v i r o n m e n t ,
C e r t a i n h a e m a t o l o g i c a l p a r a m e t e r s w e r e m e a s u r e d i n a l l
cases o f t h e p a r a s i t i c i n f e c t i o n s and compared ~ & t h nun- 1
i n f e c t e d i n d i v i d u a l s . The i n f e c t b d p a t i e n t s were a l l
c h a r a c t e r i s e d by low h a e m o g l o b i n c o n c e n t r a t i o n , low p a c k e d
c e l l v o l u m e s a n d r a i s e d e r y t h r o c y t e s e d i m e n t a t i o n r a t s .
Hookworm, 5-.st-ercoralis1 L - J r i c h i u r a , - A . l u m b r i c o i d e s i n
p a r t i c u l a r were a s s o c i a t e d w i t h m o d e r a t e hypochromic anaemia .
I',lild t o m o d e r a t e e o s i n o p h i l i a was a s s o c i a t e d w i t h I-~ookworrn,
S , s t e r c o r e l i s T - t r i c h i u r a D p e r s t a n s E . h i s t a l y t i c a , ,d LA---._._.f , --,,I ,* --? - G.larnh1i.a a n d E . c o l i . T h e r e was a marked i n d i v i d u a l - . - --- v a r i a b i l i t y i n t h e e f f e c t s of these i n f e c t i o n s . Thus
P lasmodium showed s p h e r o c y t e s ; L . c o l i , D . p c r s t a n 5 :, L.&minis, . --.-
i v
T . t r i c h i u r a and g,lambliz atypica l lymphocytes ; I . & i a .-(C
and - S.stercor& t a r g e t cells;-Pifalciparurn, E.perstanp_,
T, t r i ch iu ra , Hookworm, 5. s tercorells toxic g r a n u l a t i o n of I u-- - - n e u t r o p h i l s ,
2
T r i c h u r i s and Entamoeba i n f e c t i o n s . I n Hookworm d i s e a s e -...-.LC- - - OLUUD LOSS OFTEN LEADS TU ANAEMIA WHILE ASCARIASIS k?AY
T71ESENT DIARX-IOEA, VDMITING AND INTESTINAL OElSTRUCTIUf4.
Entamoeba h i s t o l ~ t i c a may cause c h r o n i c t h o q c i c - -----I
manifes ta t ions w h i l e v i o l z n t r e a c t b o n s i n v o l v i n g t h e c e n t r a l
n e r v a u s system and t h e hear t have been obse rved i n t rypano-
somiasis (Elsden-Dew, 1973; FausE, Heaver and Jung , 1376; and
Tharnas e t al., 7978).
R e c e n t l y i n 'I978 Dnubagu c o n d u c t e d a p a r a s i t u l o g i c a l
s u r v e y a? t h e i n t e s t i n a l p a r a s i t e s of c h i l d r e n of Eastern
Nigeria. Enugu was one nf t h e a r eas s h e s t u d i e d , b u t she
d i d n o t i n c l u d e b lond pa ras i t e s s o t h a t t h c r c are no puh-
l i s h e d r e c o r d s o f h l o a d p a r a s i t e s a f c h i l d r e n i n Enugu
p r e s e n t l y . I n endemic areas o f t h e t r o p i c s these d i s e n s c s q
are l a r g e l y manifest i n c h i l d r e n because. n f t h e i r con tac t
w i t h t h e i n f e c t i v e a g e n t s i n t h e env i ronmen t as a r e s u l t of
paar p e r s a n a l and p u b l i c hygiene . I n Nigeria there have bean
s c v e r a l at tempts t o document the l eve l s of i n t e s t i n a l and
o c c a s i o n a l l y b lood i n f e c t i o n s o f c h i l d r e n , The va r ious
r e s u l t s have been c o l l a t e d by N n o c h l r i 1968, n z u h i k e , Izuara
and Obi (19771 m o n i t o r e d anaemia and h a e m a t o l o g i c a l parn-
meters i n c h i l d r e n b u t again t h i s was n u t i n r e l a t i o n t o
parasitism. The aim o f t h i s s t u d y wao t h e r e P o r e t u p r o v i d e
s u c h b a s e l i n e s t u d y on t h e primary p a r a s i t i c i n f e c t i o n s
c s p o c i a l l y o f i n t e s t i n a l and b load paras i tes i n c h i l d r e n i n
Enugu a n d t o r e l a t e t h e s e 1
t3y t a k i n g c o n t i n u o u s scrmplc
t o Uctubcr and t h e d r y
v e g e t a t i o n is m a i n l y
. n ., I
I.- - - -. .a y - "-'" '- y , --' "'- .-" "" -- " 3'" """"- Es ta te , k m j i l a y o u t , I\bakpa Nike, E k u l u lotrout;, Odoqwu
l a y o u t , and Iva V a l l e y C o l l i e r y .
Thc a n - t u a l c l imat ic c y c l e f a 1 l . s o r n a o l y xnzu zwu
s z a s a n ~ , t h e 17a iny season f rom Mey
season from October t o f l p r i l . The
s c r u b s a v a n n a h . The f i u n i c i p a l i t y 1s xravarauu o y many
r i v e r s . The L o r g e s t , E k u l u r i v e r , r u n s -3
ha17 from Iva \fnI . ley C o l l i e r y t h r o u g h t h e n l v e r s l u e e s d t ~ .
Tha A s a t ? r i v e r r u n s f rom i t s v a r i o u s s u u r c c s i n Ogbe-he a n d
Asa ta Canp t h r o q h t h e c c n t r c o f t h e town t o New Haven.
The b a n k s o f thcsc r i v e r s a n d t h e i r t r i b u t a r i e s a r e a l w a y s
overgrown w i t h g r o s s a n d o h r u b s a f f o r d i n g b reed ing grounds
f o r insect v e c t o r s whj
d e f e c a t i o n . Of t e r t h a ACLL11;3, aUIIIC: L J I LIIIZ I LUUU W C I L C ~ u ~ r a u l
i n t o these rivers, o the r s a r e t r a p p e d i n t h e i n a d e q u a t e l y
m a i n t a i n e d cuncrcte d r a i n a g e s u s u a l l y c loggcd by n i x t u r e s
of mud and d e b r i s f r s a i r r r g u l a r l y c l m r u d riYuse dumps
( p l u t e 78) . $73 a r e s u l t t h e r e arc p o a l s o f water which
s u p ~ o r t t h e g r o w t h of grasses a r a u n d horncs a11 over t h e
m u n i s i p n l i t y ( p l a t c Ih). Inodcqun te and ineff%cfenf muthods
of sewage d i s p o s a l e x i s t a l o n g s i d e the i l l - m a i n t a i n e d house-
h o l d water c l n s e t s , and c h i l d r e n o f t c n r c s o r t t u washing
t h e i r body a n d c lo -Lhcs i n d i r t y w a t e r ( p l a t e 2 o & b
gut 'ccrs and v a r i o u s d r a i n s i n t r ~ which o t h e r s d e f e c a t e L I I I U
) f rom
.- - - A
u r i n n tc ,
f l l t h o u g h Gavernrnmt in? a n t wcl Pare c l i n i c s e x i s t i n
var5-ous l a y o u t s i n thc m u n i c i p a l i t y f o r t h e d i s s e m i n a t i o n
of h e a l t h education t h e i r impact would appear minin
r i q u l n r s h o r t a g e s nf vaccines a n d ncdfcal p e r s o n n e l mndc t h e
f u n c t i o n i n g nf t h u s c c l i n i c s f a r Fran adequa te .
3 s MATEEII\LS AND METHODS ..II_-)_-- --- 3.1, ? o p u l n t i o n s t u d i e d -A-a-- anQcriod .- of s t u d ~ -
The s t u d y p o p u l a t i o n c n n s i s t c d uf a p p n r c n t l t
c h i l d r e n r c s i d i n g i n t h e d i f f c r c n t z o n o s n f Enugu. T h e i r
e n v i r o n r n c n t n l h a h i k t and some b c h a v i o u r n l aspects have
5
Tab lc I summnrisao t h e d i s t r i b u t i o n nnd p c r c c n t n g c
o f t h e d i f f c r c n t agc g r n u p s s t u d i e d which c u t acrnss v a r i o u s
s n c i ~ i l c l a s s e s . The s t u d y was conducted between H p r i l and
October 1979. R 1 1 investigations wcrc ca r r i ed o u t a t
P a c d i a t r i c s L a b o u r a t o r y , Depar t r n c n t of
- . .
P a u d i n t r i c s ,
U n i v c r n i t y o f N i g e r i a T e a c h i n g h n q j ital, Enugu.
Blood Ses C o l l e c t i o n : A 1 1 b l o o d s a m p l e s wcre --- ----
The t c c h n i q u c f o r u b t a i n f n g h l a o d was %he same
w h c t h c r c n n v c n t i u n a l nyringes o r t u b u systems werc used.
f i d r y s t e r i l r . s y r i n g e UP s u i t a b l e sizs u s u a l l y 5 crn 3
1.
c r 2.5 cm3 capaci ty and medium, s h a r p , s h o r t bevcLlcd
6
s y r i n g c n ~ z z l e while t h e s ter i le p l a s t i c cap rcrnaincd
a s p r o t e c t i n n ovur t h e n e ~ d l e shaft .
2. Thc c h i l d was t h e n p l a c e d i n a c o m f o r t a b l e pustubc
or h a l d sitting u s u a l l y , on t h e i r mnthers1 l a p .
3. Prcparc t h e s i t e by swabbing w i t h a p ledge t o f c o t t o n -
w o o l soaked i n 70 p e r c e n t e t h a n o l .
4. !Apply a s o f t p l a s t i c padded t o r n i q u e t a t n p u i n t
nbnul; 10 cm abuvc the s e l c c t c d p u n c t u r e s i t u , I t
was c :ons idered t i g h t enough when i t s deep asoec t
s i n k s about 1 nin be low t h e s u r r o u n d i n g s k i n and h e l d
firm by f t s s e l f - s a c u s i n g devise .
5. Remove t h e p r o t c c t i v e cap f rnrn t h e ncodla and h n l d
i t s s h a f t p a r a l l e l t o t h e course of t hc v e i n . Grnsp
t h c c h i l d ' s Drm ond draw t h e s k i n s l i g h t l y t a u t uvcr
t h e v e i n . Piercc t h e s k i n and advance i n t o t he
s u b c u t a n u o u s t i s sues a n d thcn p i c r c c t h e v e i n wall.
The b l o u d f l o w s on g e n t l e w i t h d r a w a l o f t he p i s t o n .
As s lmn as 4 cm3 o f b l n n d has b u ~ n collccter! t h ~
t o u r n i q u c t i s rclcased and the n e e d l e w i t h d r a w n . 4
b o l l o f s t e r i l e c o t t o n woll is o p p l i c d t o t h e punc-
ture s i t e and t h e child's m o t h e r i n s t r u c t e d t o press
on t h i s w i t h o n e o f her f i n g e r t i p s n r f l ~ x t h e
c h i l d ' s elbow. Tha b l n o d was g e n t l y e r n p t i c d i n k o
an a n t i c o a g u l a n t t u b e , s t o p p e r e d and Znvcrted
s e v e r a l t i nes .
7
An t i c o a q u l a n t -- Seques ' c rene : T h i s is t h e d i p o t n s s i u m s a i t o f e t n y l e - d
n c d l a n i n c - t e t r a a c e t i c a c id CEDTA).
A c t i o n : By chclotinn it p r e v e n t s calcium f r o i n i o n i -
z i n g a n d i s thus a v e r y s t r o n g a n t l c o n g u l n n t . L s e d i n t h e
p r u p o r t i n n of 0.1 cm3 of 10 pcr c rn t aqueous s o l u t i o n t o
4 cm3 of hload.
Advan tnqus : W h i t c and r e d c o u n t s and h a e r n a k o c r i t -I-.-
cnn b c d o n a even a f t e r t he bland has s tood fmr many hours.
Good smears w i t h well prcscrvcd l e u k o c y t e and erytt imcytc
mnrpholagy con be ubtainad a f t e r 4 hours s t a n d i n g . A n t i -
cr lagu la tcd onmplcs nay be s - t o r a d a v e r n i g h t a t 4 ' ~ w i t - h r ~ u t
d c t c r i u r a t i o n ,
EXQMINATION OF OLUBD SAMPLES (OACIE 8 LEWIS, 1970 -
7he Wastargren tube is n s t r a i g h t glass tuhe 30 cm
i n 1erigi;h and 2.5 cn diameter. I t is ca l ib ra ted i n mm f rurn
Ecaqant nnd @p&ment 7. .------ - 1. T r i s o d i u m c i t r a t e 33.3 grn/l i trc
2. Racks, spatially made w i t h ad jus t ab l e levelling
screws.
9
P r a c e d u r c 6-r.l-u-
1. Deliver 0.38 cm3 o r wba d i l u t i n g f l u i d i n t o the g l o s s
t ube .
3 2 , Add 0.02 cm c f w ~ l l rnixcd venous b loud !ntn t h e f l u i d ,
Th is g i v e s o 1/20 d i l u t i o n .
3 . Mix f o r I m i n u t e
4. F i l l the count in^ chambar by muanc o f CI post~ur p i p o t t c .
A l l o w thc cells t a s o t t l ~ f o r 2 m i n u t c s
5, Count the ca l l s i n 4 cnrncr sq. mrn. as P o l l u w s :
Ji.:h t h e x ;O o b j u c t i v c lucatr j the r u l e d a r ea s f t h e
cnunt ing p l a t f o r m . h u n t thus@ c e l l s t h a t tnuch t h e
l c f t and u p p e r boundary l i n e s a n d i y n u r ~ those t h n t
touch thc r i g h t and l u w u r b o u n d a r i e s .
Cnlculn t i o n - - N = Nu. of c e l l s counted i n 4 sq. mm,
Dcpt o f Chnmbcr = 1110 mm
D i l u t i o n o f b l o u d = 1/2Q
Nu. n f c e l l s i n 4 sq mm = T\J x 20
I1 I f ;I 4 cmm = f\] x 'lo x 2c
a! If I 7 I crnm - - N x m x 2 0 = , , * C J Q 4
Preparat ion o f t h i n b l a o d f i l m on s l i d e s .-A -------.-I-- - - )WL-C_)--.-.-
1. Gent l y touch n d r n p r ~ f b l o o d o n t o ann end n f n c l a n n ,
1 a
Using a bzva l led piece o f g l a s s s l i d c ( s p r c n d c r )
n i a r r w c r t h a n s t a n d a r d s l i d e , a l l o w t h e d r o p
t o sp read n lung it.
l-lol.ding t h e s l i d c a n d t h e sprcadcr a t n s u i t a b l e a n g l e
40 - GO dcgrecs, push t he s p r e a d e r n l n n g t h ~ s l i d c ?
D r a w t h e h l u o d b e h i n d u n t i l t h e w h n l e o f t h e d r o p h a s
Leave t o ] . i f ? f l a t on t - h ~ bcnch t o d r y i n a i r .
S t a i n by t h e L u i o h m a n l s Pk thod .
Leishrnnn s t a i n 0.15 gm
d i s s o l v e by t r i t u r a t i n g dye and n l c u h u l i n
a mortar f u r 15 r n i n ~ t e s , The s u l u t i o n i rnprnvcs
on s t o r a g e .
2. 3uf fe rcd d i s t i l l e d w n t c r pH 6.8.
P r m e d u r c --C- - --- 7 . Flrlijd t h e randy b l o o d f i l m w i t h 1 volume r i f n t n i n a n d
2. Add t n t h c u n d i l u t e d s t a i n un t h ~ s l i d c 2 v o l . u m ~ s n f
h u f f e r c d distilled water pH 6.8
3 , Piix by g c n t l c r o c k i n g .
4 , Allciu t h e ~ j i l u ' c n d s t a i n t o ac-t f u r 10 m i n u t e s .
5. Wash w i t h b u f f e r e d d i s t i l l e d watar u n t i l -the f i l m i n
s a l m o n p i n k .
r a. Irlipr! c l a n , t h c hock o f the s l i d e a n d s t a n d u p r i g h t to
d r y i n a i r .
E x a m i n a t i o n o f s t a i n e d f i l m --- -------a
P a r a s i t e s a n d C e l l u l a r E l ~ m e n t s : --& ---------- The p r e s e n c e {if m a l a r i a
p n r a s i k c s a n d c e l l u l z r e l e m e n t s - E r y t h r o c y t e s a n d l c u c c ~ c y t c s
w u r u d e t c r m i n c c l under t h e r n i c r u s c n p ~ u s i n g oil im-ticrsTon.
The f i l m s wero c o v e r e d u i t h i m r w r s i o n n i l a n d exarnincd
w i t h I G mrn o b j a s t i v c t a g e t an i d e n of t h e q u a l i t y o f t h e
p r c p n r n t i u n , nuinhcr, d i s t r i b u t i o n clnd s t a i n i n g of p a r a s i t e s
a n d 1 a u c u c y t : ~ s . Alsn t a select nn nrca of e v e n l y d i s t r i b u -
t e d a n d u n d i s t o ~ ? t c d c e l l o .
Having s e l a c t e d o s u i t a b l e oren n swi tch was made t o t hc
o i l i n r n c r s i o n l c m s f n r a d e t a i l e d cxamina t i .nn n f t h e cells.
U i f f e r e n t i a l l e u c o c y - t c c o u n t -.- -- - --A- -+-.
U s i n g t h o r i l i m m e r s i n n l c n s a13 t y p e s u f l e u = n c y t e s
~ n c r i u n t a r ~ d uerc n o t e d u n t i l a -imtal o f 200 h o s l ~ e m exnmined.
t he r e s u l t was t h e n e x p r e s s e d as a p e r c e n t a g e .
Procedure -_- --AI1
3 1. Tokc 2 cm of rnixsd v e n o u s b loud I n t o G crl? uf' 2 pe.r
c en t r"urnm1:i.n.
2. S t a n d fn:? 2 m i n u t e s
3 , T r a n s f e r b l n u d mix tu ra t o n c e n t r i f u g e tub^
4. S p i n a-t; ;!000 rprn f n r 3 m i n u t e s
5. Decnn t s u p e r n a t a n t
G. f l i x ncdir r -cnt a n d p i p e t t e a n t o g l a s s s l i d e and c o v e r
w i t h c o v e r s l i p .
7. E x n n i n c n i i c r o s c o p i c n l l y .
Identification of M i c r o f i l n r i ~ z ---- - p- *A-
Prnccdu rc : M o d i f i-ed Hagm~atoxy l in nnd E o s i n .(l-iGE)- Method ---A- --
P r q n r e t l i ic lc f i l m s oT-' t h e supr ! rno t :mt of p e s i t i v c
samplcs, ~ ~ r c v i u u s l y a s c e r t z i n a d f ram wet method.
D r y t h e f i lms a t roum t c r n p e r a t u r c
S t a i n w i t h Ehrlich's H n c m n t a x y l i n f u r 2 h u u r s a t rmm
t ~ , : ~ i p e r o t u ~ * a .
R i n s c i n w t e r
D i f f ~ r ~ n t i n t c b r i e f l y with 0.5 pcr c c n t a c i d n lcnhu l
Ellur: w i t h F j c o t t f s Tap w a t c r s u b s t i t u t c f o r 31 minu tes
Idash w c l l i n w a t e r .
C u u n t e r s t n i n w i t h 0.5 p e r ccn t Eoain f u r 1 m5nutc
Wash i n water
U a h y d r a t e Ln a s c e n d i n g g r a d e s a f n l c n h o l
E l c a r 3-n x l / l o l
Flourt in pcpox ( I b c a c h u n 1973?.
- t s t i m n t i o n u f Hncmpqlnbin (Hh) --.-.----
I. f 3ho toe l cc t r i c n h a u r p t i o r n c t c r w i t h a green f i l t e r
S t u c k s o : l u t i o n --.-- -- D i s s o l v r t hc P u l l o w i n g i n n v o l u r n c t ~ i c f l a s k
P u t n s s i u r n f ~ r r i c y q n i d e 200 mg
Patr~ssiurn c 'yanidc 50 mg
Patnss iu r i d i l l y d r u g e n p h ~ s p h o t c 140 mg
D i s t i l l e d waCur t o 1 l i t r e
ldurk inq s u l u t i o n --A-
Dilute I crg3 r i f s t o c k t n 1 0 0 cm3 w i t h d i s t i l l e d watcr i n a
5. 3 t n n d a r d s o l u t i o n u f Cyanrncthacmoglnbin.
TJr o c e d u r L! .- --. 1. Add 0.02 cm3 oP wcll m i x ~ d blnnd t o 5 crn3 u f w o r k i n g
Drahkin's s u l u t i o n (I i n 250 d i l u t i o n ) ,
CI L I4ir: w e l l 2nd; l e a v e t o s t a n d for 10 m i n u t e s
3. D u r i n g t h i s time s w i t c h on t h c a b s n r p t i o m e t e r .
4 . [:cad i n t h u absurptfnrnetr-lr u s i n g n tub^ of D r n h k i n l s
g o l u t i n n ns h l n n k .
5. Rend t h e s t a n d a r d cyanrne thacmuglub in .
6. Read t h e t e s t b l o o d .
7. C a l c u l a t e t h e c o n c e n t r a t i o n o f Hb a s f a l l o w s
G s a d i n q o f Test Cor~c o f S t d x D i l u t i - o n ( 1 / 2 5 0 ) %%diG o f 5 t d Y I
3 T h e r e s u l t s w e r e e x p r e s s e d a s gm/100 cm . D e t e r m i n a t i o n o f Packed C e l l Volume (PCV) - -- -- -. -.--
P r o c e d u r e --.-.----
I. Fill t h e c a p i l l a r y t u b e w i t h well m i x e d v e n o u s b l o o d
2. Sea l t h e o p p o s i t e e n d a? t h e c a p i l l a r y t u b e by d i p p i n g
s e v e r a l t i m e s i n t o t h e s p e c i a l s e a l i n g p l a s t e r t o g i v e
a t i n y p l u g o f 3 rnm i n l e n g t h ,
3 . P l a c e t h e c a p i l l a r y t u b e i n t h e c e n t r i f u g e a n d screw
h a c k t o c o v e r .
4. C l o s e l i d a n d s p i n a t 10,000 rpm f o r 5 m i n u t e s .
5. P l a c e t h e s p u n c a p i l l a r y t u b e o n t u t h e s p e c i a l l y
d c s i g n e d s c a l e - r e a d e r and r e a d o f f t h e PCV a s per-
c e n t a g e .
C a l c u l a t i o n o f Mean C e l l I-laerrtoolobin C o n c e n t r a t - i o n ( ICHC) . - ..- L I . A - . . - - -. - - - 2 Y -.. - -- T h i s was e x p r e s s e d a s a p e r c e n t a g e , t h e c o n c e n t r a t i o n
o f h a e m o g l o b i n p e r u n i t vo lume o f ncd c e l l . And c a n b e c a l -
c u l a t e d w i t h t h e hae rnog lob in c o n c e n t r a t i o n p e r 100 cm3 of
b l a o d and packEd c e l l volume e s t i m a t i o n s .
C s l c u l a t i o n .-
3.3 Faecal E~aminaEibh Methods ----- - Faecal Sa-rnple Collec. t ; ion -- - On r e c e i p t o f t h e f r e s h s t o o l , p o r t i o n s were processed
by t h ~ f o l - l o w i n g methods:
F o r m a l i n e the r method ( R i t c h i e 1548)
D i r e c t saline smear m e t h o d ( C a b l ~ 1970)
C e l c s t i n e 131uc 8 s t a i n f o r Intestinal P r o t o z o a (Yang &
Forrnbl-Ether Concentra t - i -on Method ( R i t c h i c 1948) -. - -- ---------.
P r o c e d u r e . --- - - --- I. Take 1 gn o f faeces anri emulsiFy in 10 cm3 oP 10 per
c c n t fn r rno l saline.
rl , s i e v e i n t o a c e n t r i f u g e t u b e
3 3. ndd 2 cm o f ether.
4. S t o l ~ ~ ~ e r and shake v igoroas l i , l f c r 1 r i l i n ~ ~ t c
5, C c n t r i P u g e f o r 2000 rpin f o r 5 m i n u t e s
6 . D i s c a r d t h e d e h r i p l u g a n d s u p e r n a t a n t
7. Tap d e p o s i t €a mix, d r o v on s l i d ? c o v e r 1lrit;h c o v e r s l i p
5. cxa~iiine P a r o v a , c y s t a n d 1;:rvre.
Direci s a l i n o smear method (Cab le 1970) ------------- T h e d i r e c t smear is u s e f u l in p a r t i c u l a r far t r o p n o z i t ~ s
o f p r o t o z o a n p a r a s i t c s ,
1. Place 3 r l rops o f s a l i n e in two s l i d e s
2. T r a n s f e r n small amnunt o f s p e c i m e n t o t t i c s a l i n e
3, ILlix t o o b t a i n f a i r l y d e n s e , u n i f o r m s l i s p e n s i o n f r c c o f
4. Add 2 d r o p s o f i o d i n e on o n e s l i d e
5, Cover w i t h c o v e r s l i p
6 , Examined u n d e r t he m i c r o s c o p e .
C c l e s t i n e Glue 8. S t a i n f o r I n t e s t i n a l P r a t o r o a ( Y a n ~ a n d .A_&-- -- -- -- -- .UI -------__14- --4--- -A-
Stnck S o l u t i o n s
A. C e l c s t i n e b l u e R 0.6 qn
G l a c i a l Acetic Acid 20 cm 3
D i s t i l l e d w a t e r 80 cm 3
n. Fer r i c ammonium s u l f a t e 40 gm
D i s t i l c d w a t z r 100 cm 5
S o l u t i o n A when s t o r e d i n brow17 g l a s s b o t t l e :?emains s t a b l e
i n d a f i n i t c l y . ' j o l u t i o n D i s s t a b l e f o r a t l e o s i ; G months ,
Workinq S o l u t i o n ---_..---I--
Prepare by ~ i x i n g cquo l p a r t s o f s o l u t i o n s A a n d 0.
The work in^ s o l u t i o n s l o w l y r l e t c r i - o r a t e s a f t e l : a b o u t 2 ~ d ~ [ ? l < : i .
S t a i n i n g P r o c e d u r e -- . - - I. Prepare s t o o l smear, d r y a t room tcrnpera:ure
7 ,. F i x i n S c h a n d i n n ' s S o l u t i o n I D m i n u t e s
Sa l u r a t e d , squ , ~ n e c u r i c c h l o r i d e 2 p a r t s
~ ~ h s o l u t e a l c o h o l - 1 p a r t *
17
Hornov~ HgC12 i n 70 per c , m t e thy l a l c u h o l w i t h i o d i n e
Hydra te t h rough z l c o h o l s e r i e s .
R i n s e b r i e f l y i n t a p watcr
S t a i n i n working s o l u t i o n f o r 10 minutes
Rinse in t a p w a t e r
Dehydrate i n a l c o h o l and c a r b o x y l o l
C l e a r i n x y l o l
i-iaunt in iJepox ( IbeacSum 1973).
Test f o r Blood ( o c c u l t b l o o d ) i n faeces ma--- -- ---- Raaqcnts: Hcmates t t a b l e t s ---*----UIUWI- -
HEMATEST r e a g e n t t a b l e t s :me qu ick s i m p l e s tandard ized
c u l o u r tests f o r b lood I n f a e c r ? ~ . They arc ;mn a d a p t a t i o n o f
t h e 11- to l id fne t e s t i n t a b l e t form.
C o ~ a s i t i o n : The t a b l e t c o n t a i . n s 0 - t o l i d i n e , s t r o n t i u m .-- ---- p e r o x i d e t a r t a r i c a c i d and ca l c ium acetate .
Chemistry: .--Mu !I p o s i - t i v e r e s u l t ~ ~ i t h HEFIATEST t a b l e t s is based
an a peroxidnse- l . i_kc reaction, Tar tar ic ac id , ca l c iu rn acctn; ;~
and s t r o n t i u m p e r v x i d e r e a c t i n s o l u t i o n t o pr2duce hydragen
p e r a x l d c , which i n t h e presence nf hocmagLobin and c e r t a i n
o f i ts i r o n - c o n t a i n i n g d e g r a d a t i o n p r n d u c t s o x i d i s c s 0 - t o l t d i n c
t o a b lue compound.
P r o c e d u r e .-.--4 ---
Hands, d r o p p e r and work ing arm n u s t be clean and f r c a
from t r a c e s of blood.
7 . k1dir! t h i n srncor n f faeces L'in filter p a p m SCpI9TC p ruv ided .
Do nut u s e emuls ion .
2. Placn IiEMfiTEST t a b l e t a c r o s s cdge of smzar.
3. Flow 1 d r o p o f w a t e r on t o p o f t a h l c t , wait for
10 s e c o n d s and f l o w secmd d r o p on t a b l e t so t h a t it
run: down s i d e s on t o f i l t e r papqr.
4 , O b s e r v e c o l o u r o f f i l t e r paper around t a b l e t exactly
2 m i n s l a t e r .
4 , RESULTS --- n oP I n f e c t i o n s i n c h i l d r e n ------
From 851 c h i l d r e n s c r e c n c d , 306 (35.9 p e r cent) wcra
i n f e c t e d w i 6 h v a r i o u s bloacl and i n t e s t i n a l parasi tes . S i n g l e
i n fec t ions a c c o u n t e d For 200 (65.3 p e r c e n t ) and mul t ip1 .u
i n f e c t i o n s a c c o u n t e d f o r 106 (34.7 p e r cent), In these
c h i l d r e n it was obscrved t h a t each child may h a r b o u r f r zm one
to f i v c different parasites.
O f t h e 051 ch i ld ren cxnrnined f o r blood p a r a s i t e s T I 4
(12.2 per c e n t ) werc infec ted (Table 2). Plasmo,d& accounted
for 7.G per c z n t w h i l e D.p,erstanns accounted f o r 4.6 per cent.
Thure was a s i n g l e case showing l a r v a o f - S t r o n g y l o i d e s --- 5p i n
blnod.
I n 347 (41.4 p e r cent) o f B39 s t o a l spcc imcns exarnincd,
v a r i o u s h e l m i n t h i c a n d p r o t a z a a l pn ras i t e s were d e t e c t e d
(Table 2) . O f the h e l n i n t h i n fec t ions hnoltworm (11.6 per
ccnt ) hod t l i e h i g h e s t r e c u r d e d inc ldcncc, w h i l e t hc p r o t o z o a l
p n r n s i t e - E.coli -- (5.7 pcr cent) was the most prevalent .
- No. No. No. Neg. No. Pos. % E x a m i n e d I n f e c t e d - -- -
Haokworm 839 9 7 47 50 5 ;!d
A, lumbricoides 839 70 51 27 3 5% - T.trichiura 839 26 1 7 9 35%
S . s t e r co ra lis 839 5 5 0 0%
E . nana 839 1 0 1 100 . -- -
T a b l e 4 s h e w i n g i n c i d e n c e of positive occult blood test i n t h e p n r a s i t i s e d faecal samples.
19
4.2 S E X - r e l a t e d I n f e c t i o n Rates --- -----.--
(Jut oP 50G moles examined (11.9 p e r c e n t ) were i n f e c t e d
and o f 346 f c m n l e s 44 (12.8 p e r c e n t ) were n l s n i n f e c t e d .
The feinolcs c a r r i e d more infections o f b l o o d parasites. No
s i g n i f i c a n t d i f f e r e n c e was o b s e r v e d i n t h e i n c i d e n c a o f
f i l a r i a l i n f e c t i o n betucen males and females; b u t Plasmodium -..-
Spp. was h i g h e r (8.7%) i n f e m a l e s ( T a b l e 3 ) .
D f t h e t o t a l nurnbar of 499 m a l e s , 205 (41.3 p e r c e n t )
w r e p a r a s i t i s c d by v a r i o u s h c l r n i n t h s a n d 70 (15.6 p u r c e n t )
by v a r i o u s p r o t o z o a . I n 340 f e m a l e s 91 (26.8 p e r c e n t ) were
p n r n s i t i s c d by v a r i o u s h e l r n i n t h s a n d a l s o 61 (17.9 per can t )
by p r o t o z o a . T h e rnnles c a r r i e d rilore i n f e c t i o n s of i n t e s t i n a l
p a r a s i t e s .
I n c a s e s o f s i n g l e i n f a c t i o n t h c f e m a l e s h a r b o u r e d
more k i l a r~ t h e 1na1es. I n t h e h e l m i n t h i n f e c t i o n , f e r n a l e s h a d
t h e h i g h c s t i n c i d e n c e of hoakworm 13.2 p e r c c v t ; &.wr_i-
c o i d c s t h e n e x t h i g h e s t 10.3 per cent. I n f e c t i o n w i t h %.ca'i --- - 7.1 p e r c e n t i n c i d e n c e was o b s e r v e d a n d G . l a n h l i a - --_a t h e n e x t
h i g h ~ s t w i t h 5.3 p a r c c n t i n f u r n a l c s ( T a h l c 3 ) .
4 , 3 F a e c a l U c c u l t Dlood Tes$ W ---_I- ---.-I_
T a b l e 4 s u m m a r i s e s t h e r e s u l t s o f t h e f a e c a l o c c u l t
b l a o d tes ts , A c c o r d i n g l y E , h i s t o l \ ~ t i c a .- . -- a n d hookworm were
a s s o c i n t ~ d w i t h 57 per c e n t and 52 p e r c a n t r c s p e c t i v e l \ l .
4.4 ; 7 l e _ - 3 r o u ~ D i s t r i b u t i o n Y.UI---W--... o f p n r a s i YL tes
Thc per c c n t a g e i n f e c t i o n s o f t h e v a r i o u s p a r a o i t c s
I b l D. pers tans --
( c ) H o o k w o r m
G R A P H 4 . D I S T R I S U T ~ Q N 9 P E 9 C E N T
OF P A R A S I T E INFECTIONS
I N THE A G E - G R O U P S .
! 2 3 4 Z 6
A G E- GROUP ( Y r . 1
( d l C . mesn i l i
according to age groups
to 4. Tfic highlights a:
Plasnodiun . a n d O.persta -.I _.-- - . ...,--
t h e f o r m e r h c i n g highcs-
and t h e I n t t c r i n t he 6
would a p p c n r from t h e g~
bousteci every three yea1
of c h i l d r e n .
Graphs I and 2 s u g g : : s t
and Ascar is . I n hookwu: ----..
r m u r d c d h i g h u s t (10.1 1
g r n u p s b u t uas r r x n r d o d t
age group . - S . s t c r co ra l i :
b u t c d En o n l y 3 , 4 and 5 x.,!ear nqu qroupa wxtn cnz n lcnes t sn
thc 5 y u a r ogc g r o u p (
r c w e m c n c n nt-1 cum d m s u e q s ~ a d ~ a 0 . o o a a d o a
0 N d' U? d' m a rc
d P d cr) 0 d 4 d m a m b a 0 r c m
a unTpouseTd o a a
0 Lr!
Jan F e b Mar A p r M a y Jun J u l Aug Sep t O c t
mm Total 0.5 75.1 64-3 29.4 199.0 237.1 365,2 305.4 208.4 130
days w i t h 0,3 mm or more 1
days w i t h 1 mrn or more -
Table7: Mean v a l u e s of monthly r a i n f u l Jan - O c t 1979 (Meterological Dept . A i r - P o r t , E h u g u ) .
I b ) X - - - -X R a m t o l l a 6 -
t.3 Hookworm I \
I ' A, lumbr~co ides , \
I \
A--A T t r i c h i u r a I \ \
s . s ~ e r c o r a ~ i s I
I %
I \
I \
\ ' I
\ I
I \
!
I \
-
f I
- -
7
+.. I
I \ I -
I \ \ I I
I - I
I
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G . l a m b l i o a n d T.hornin is i n G r a p h 4 , wcru d i s t r i h u t c d i h r a u g h - - -- .-- - u u t a l l ogc g r w u b s cxccp t C. rnusn i l i w h i c h w n s n o t o h s c r v c d - --- i n t h c 5 y e n r n g c g r o u p . T h e h i g h e s t i n c i d n n c c r c c o r d e d
(3.2 p e r c m t ) was i n thc 3 y z a r n g c
w h i l e f o r T . h u m i n i s - (8.6 pc r c e n t ) a n d f o r C . m c s n i l i (3.5 pcr .-a -.- --
c e n t ) w u r c in t h c 4 y e a r ogc g r o u p ,
4.5 M o n t h l y i n f e c t i o n 1 . c v c l s --~-. -
The ~ i i n n t h s i n w h i c h t h e c h i l d r c n rdcrc c x a i l i n c d : s t u n -
d c d f r o m l A p r i l t o O c t a h i ~ r . T h i s r e p r i s c n t s t h c b q i n n i n ~
o f t h d rainy scnson i n A p r i l x n d Lhc t e r m i n a t i o n nP t h ~
r n i n s i n Octohl : r . T a h l i , 7 sh i iwn 'chc mi!nn r a l n i 2 0 1 1 rn::nsuri:-
m m t r ; From J n n u n r y t o U c - t o h e r 1979, I n A p r i l , whcn t h i s
s t u d y s t a r t e d , t h e mcm r a i n P n l l was 29,4 rnm u i t h a p m k i n
J u l y u f 3G5,2 nm.
Tob l r ! G s u m n ~ o r i z r ~ s k h ~ : rnon th ly o b s c r v a t i l j r i s o-F -Lhc
f o l l u w i n g p a r a s i t e s , Plasmndiuim --- f n l c i p n r u r n a n d -P-,FJ.i,"$,
D , p u r s t n n s hookworm A . l u r ~ i b r i c o i . , T. t r i c h i u r 2 , 5-.-L::rcorn- -....---l - - ..
-- - -
P a r a m e t e r s
3 Haemoglobin ( g m / 1 0 0 cm )
P a c k e d C e l l Volume ( P C V , % )
Mean C e l l h a e m o g l o b i n c o n c e n t r a t i o n (MCHC,%)
E r y t h r o c y t e S e d i m e n t a t i o n R a t e ( E ~ R , m m / h r )
T o t a l C o u n t W h i t e B l o o g C e l l (WBC, p e r mm
D i f f e r e n t i a l C r u n t WBC
N e u t r 6 p h i l
E o s i n o p h i l s
B a s n p h i l s
L y m p h o c y t e s
Monocytes
Normal Range of v a l u e s
less t h a n
T a b l e 8: S;me blood ~ a r a m e t .el c h i l d h o o d . ' ( F r o m S e G r u c h y , G , C . , 1973)
c h i l d r ~ n c a n b o c u r r e l a t a d w i t h rnun th ly r z i n P a 1 1 c h o n g z s . Thc
p c r i o d a f i n c r e a s e d r a i n s coincided w i t h t h e p e r i o d oF i n c s ~ n s d
i n c i d ~ ! n c r ! o P i n f c c t i n n , T h u s , i n c r c n s c i n i n c i c l : m c c o f bu'zh
39 t h r r n i n f o l l i n c r e a s e d ,
4.G t i a n m a t o l o q i c a l c h n n n ~ 2 s i n r e l o t i u n i;u u n r n s i t i c i n f e c t - i c m s . ----&d--t.------A--.. - . -- - - T a h l ~ 8 , s h o w s t h c r a n g e U P n u r m l v n l u u s LIP s o n c hncma-
t i l l u g i c a l porarncters i n c h i l d h 3 o d , based on dc G r u c h y ( l 9 7 3 ) ,
The h n c r n o g l u b i n (Hb) p a c k e d c c l l vn lumz ( p c v ) and mcan
c a l l h a u m n g l a b i n c o n c e n t r n t i o n (MCHC) wzrd l u w i n a11 c a s e s oT
h e l n i n t h i c i n f c c k i o n s , Thc r a d u c u d v a l u e s t h u s u b s z r v c d fdr
~ h u s c b l o o d p a r n m c t o r s n r u b n b l y a r c i n d i c q t i v e i ~ f t h o Lncl!n-
Lion ilr d c v e l o p m c n t ' i ~ f a n n c m i c . Thus , h y p o c h r n m i c n n n ~ m i : ~ maif
b e n s o o c i n t c d w i t h p n r n s i t i c infections, T h o s e d i s t u r h n n c i ? s
1% h a s b e g n n b s c r v e d t h ~ : t t h ~ : r e d h l r l c ~ d c c l l f r o m hou!:worm,
The ~ ( i d b l o o d c c l l show t a r g ~ t c e l l f o r m s i n a l l i n P c c t i o n s
Thc w i ~ i t c h louc i c c l l (wbc) d i f f ~ r ~ i 1 t i . d c o u n - t s w r c n 3 r m l .
-- Ii-12 t u t q k wbc show n c ~ r m n l l c u c o c y t t i s i t i c v a l u c c f o r c l i i l d r z n .
Mi ld 'GO m a r k z d c o s i n o p h i l i E was o b s e r v e d i n t h e s e i n f ~ c t i u n s .
e (II cf t-' 0
dl s rn r- 3 0 - 0 3- s
r e
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m r- a f3 Wl cf ID t-J 0 0 rr 0 r. a 0 3 a in !2J 0 'l
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IJ CX, I 4 0
& 4
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P
Parame te r s I Range Mean deviation ( RanQe-: .:-,.Mean.. d e v i a t i o n I
I
F a c k e d cell V o l u m e ( % I PCV I 15-43 3 OW 2 - +1.9 / 27-32 29.4 +4.4
I S t a n d a r d Stabtland
Erythrocyte Sedmentatia? R a t e ( E S R )
Tctal C a ~ n t white blood Cell 1 (wbc) ceu mm) 4000-16600 8273 - e 3 5 6 9 - 6 000-12700 8800 1-3313.6
1 -
Mean Cell Haernog l~b in Concen- 1 t r a k i o n 1 5-132
3 6 - 8 - +31,7
Differential Count w b c (%) I
25-39 3 2 - 5 - + 2 18''
7-135 41.1 - + 5 2 , 7
Neutrophil 1 10-62 37-2 - +15.5 1 3 2 - 5 6 41-2 29.0
24-36 29.8 - +1.9
T a b l e 10 s k w i n g o b s e r v e d blaad parameters associated w i t h parev-sitic i n f e c t i o n s .
Monocyte 0-6 2 - 5 - +1,6 0 - 4 1,2 +5
Number of samples I 26 5
P a r a m e t e r s
Haemoglobin (grn%) Hb
P a c k e d Cell Volume ('%)Pcv
E r y t h r o c y t e S e d i m e n t a t i o n Rate ( E s R )
M e a n C e l l H a e r n o g l o b i n C o n c e n t r a t i o n (\ ;L) (PICHC)
Total Count white b l o o d Cell ( w b c ) ( C u mm)
D i f f e r e n t i a l Count w b c ( % )
Neutrophil
E o s i n o p h i l
B a s o p h i l
Lymphocyte
E , h i s t o l y t i c a
S t a n d a r d R a n q e Mean d e v i a t i o n
- E-coli
S t a n d a r d Ranqe Mean devia t i o r
304-13.4 9.3 - + 2 - 4
11-40 28.9 + 7 , 2 -
Number of samples
T a b l e 1 2 shnwing o b s e r v e d b l o o d p a r a m e t e r s a s s o c i a t e d with p a r a s i t i c i n f e c t i o n s ,
7
W 0 I a3 I-\
Ln W 0
Ln
I + I-, P O
cn
N IJ 0 lu I0 W 0 I I I I t-' b b (J 4 rP 0 0 @ VI IP
0 0
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0 0 0 6 r u r-\ VI u3 @ 4 0
23
S t r o n q ~ l o i d c ! ~ ~ and D.P~~~~~,J~;E;' i n P ~ c t i o n o . Thz pulynurphonucl~nr -.-
11:ucocytos s h o u t o x i c g r n n u l n t i o n s i n all in7act i i jns . Theru
DISCUSSION --- i\ p ~ r a s i t ~ 1 a g i c ; l l s u r v e y ar" c h i l d r e n i n Enugu has rcvsn11.ii
n p r u v ~ l c n c e l e v c l r;f 24.6 p 2 r c c n t c f b l o n d p n r n s i t e i n f c c -
L ~ l o n s and 133.29 pi?r c2n-t aT i n t ~ s t f n n l h c l r n i n t h and p r o t : l z n a l
i n Yec t i n n s , (Tnb lcs 3 nnd 4 ) . C[ lns ide i l ing e n v i r u n m u n - t a 1
f a c t o r s 2nd h b i t s u f t h e c h i l d r c n snmplod, t h c b l o c ~ d a n d
i n t m t t n n l p n r a s i t l c i n f ~ ? c t i o n s i d t m t i f i c d from t h i s i n v c s t i -
q a k i u n ccn bo n d n i t t c d 3s r ~ ~ r m e n t i n g thz cnrnmoncst p a r n o i t !s
[ ~ r e d u m i n n n t i n t h e s u r v c y c d arco, The pr i rosLtos f ~ i l n d i n t h 9 s
s u r v ~ y f u l l w ~ d closely t h a t o f Cinubogu (197,7) wtiusr! s t u d y
z r o n of i n t u s t i h n l p x r n s i t e o of s c h o o l c h i l d r c n 1nc lud~ :d kkuqu.
T h i s sugge..sJcs t h a t t h u s c p o r n s l t i c specir.!s ari: p r w n l a n i; noJi
o n l y i n c h i l d r e n i n Enugu b u t a l s o i n c h i l d r c n i n a t h e r
PJiq~!r ion urban c i t i e s , i n t h s o a u t h e r n r n i n f u r c s t z n n u s of
N i g u r i n . The s u r v e y shawcd huokworrn (41.6%3 ns h n v i n n Qhs
h i q h c s t i n c i d e n c e u f t hc hi2lrninth i n fuc t i nns , j u s t as Unubuc~u
(1973) h z d o b s e r v c d ( U V ~ T 5O'%), m d Okpnln (1955) i n Lngns
h z d shown .---- Zsc3ri.s (73.4%) as h n v i n q 'chi: h i g h c n t r3tc, w h i l e
hookwurm (l4.975) rclnkcd second.
h t i n g t h z prc- t ;uzozl i n f u c t i o n s , L.coli (5.7%) a n d 5.
l m b l i - : (3.576) wzrv t hs p r ~ v n l r i n t , , Onubogu (1978) hnd a l s o - -4-
r ~ c u r c l ~ d - G.lamblin (41.7%) in Enugu u r h n n Liut O k p n l * i (1955)
grouped the f lnge l la t ; fx , Ginrdi;, Chi1ornm-i;iz and ~ r ~ ~ ~ l , ~ , " ~ ~
a n d f r ~ u n d t h z t the52 c a n s t i t u t 2 d 4.5% no h i s s?,m~Lc.
Tht.2 w r i o u s h e r l t h p r ; ? b l ~ ? n s p a s c d by f l n g c l l z t e s , I n
p 3 r t i c u l n r - G,Larnhlin, + c z n n o t h u u v c r s t r c ~ s s u d . Nnochiri nnd
Lnnhn ( . T 9 G O ) ~ L ! ~ ~ L ? v L ! t h n t it i s n p ; l r ~ s i t i c i n f c c t i u l - I ~ i i f c h
cnusos r u c u r r u n t m t c r i t i s .
Thu r m u l t s u f t h e b l r ~ u d p n r r i s i t c s showcd P . f 3 l c i p n r u m -- -.- ----- C7.5%) and - P. rnn ln r i ac --- (fl,15%) i n Enugu, T h i s i s i n c o n P o r m i t y
w i t h t h o rcsul:ts o f Okpnla ( l97' ln) i n n s t u d y a ? s c h o o l c h i l r i -
rm i n Epe ~ r h k r e he r c c o r d c d P . f ~ l c j - p a r u r n (54.2%) cs t he mos t - ----- p r o v n l u n t .
Thc ~ x i s t ~ m c e o f D i p c t n l u n ~ m n p e r s t n n s i n P c c t i c ~ n I n P -- ...--,a
c h i l d r e n has n o t b c c n r c p n r - t z d i2y r c c z n . t 1nvi~s- t ; ig ; l - t i l r s o.? hl.ur!d
p z r c l s i t e s i n Enugu cnd Nsukkn n l t h o u g h 1JilcacC:o nrld I ' in~sori -8ohr
T i i i s s t u d y r e p r c e c n t c ; i h c f i r s t r c c o r d c d czsu n f - I>, p m s i : : n . ~
i n Enunu and i t s a n v i r u n a .
I n c o r n y ~ m i n g t h e dntn nn t h z i n c l d m c c : ! ? t i r ~ l r n i n ~ t h s p r l .
p r o t o z o n ob ta incd b y t h u v , r i o u s i n v c s t i g g t o r s on N i g a r i n
I n o d c q u a t c d i s p u s n l n f hunnn c x c r z t z a n d c r m n z q u c n t
c o n t n m i n n t i u n n f s o i l , b r c u d i n g u f v c c t s r s i n nwnnps n v a r -
c r a m w i t h hushcs a n d i n f c c - L e d c o r r i c r s d o p c r p ~ t r n t c in fec-
t i o n m d r ~ i n f e c t i o n i n c h i l d r e n . T h i s i s 1 o r g d . y d u c t u t h ~ !
h; :b i . t s cif c l - i i l c l r ~ : n w h i c h b r i n g thciil i n cuntnc t w i t h i n f cc t i o r i
s u u r c z s a n d n g c n t s t h u s i n c r c n s i n g t h i d p r u b ~ h i l i t y uf i nPcc -
t i m . T h u s , t h c p r ~ t i l c r n o f i n f c c t i u r i and r c i n f c c t f c ~ n US
c h i l d r c n s h n u l d b e r e q n r d c d ns 2 s s o r i u u s cnrnmunl ty hrmlth
problcrn ( O k c n h i n l m , 1979).
1:n -thz p r u s e n i ; s t u d y f c m l u c h i l d r e n showor-l thc! h : i q h z s t
i n f c c t i r i n incidence u f m o s t b l u u d h d m i n t h a n d pratuzunl
p m q s i t c s , w h i l c t h o m n l e s c m r i r 2 d o o r c i n t ~ s t i n n l p n r n s i t c s ,
Okpal r : i n 195G o b s ~ r v c d a l s o . t h a t m z l a schriol c i i i l c l r c n h o v c
t h c h i . ~ l i u s t i n c i d m c c [IF i n t c s t i n n l p n r a s i tcs. 3u'i; Okpn13
i n u i n l c s w h i l c t h i s s t u d y f o u n d m a r c i-n fcrnnlcs,
Tile f m c d ~ ~ c c u l t blclud t z s t p o s i t i v c i n I iookwnrr;~,
E , h i s t o l ! / t i c a nnd T . t r i c h i u r ; l was i n k c e p i n n 1 d - L t i l ~ s u c l l - - -- ....-- 1 z b r ) r n t a r y d i n g n o s t i c f a n t u r c s p r a s c n t z d (JclbfP:: n n d
J i ? l i f f c , 1378). Thasc p n r n s i t ~ s c m s c b1r1-:d l n s s whilc a t t n c h -
UP hrir~kworrn z n d --- S t r o n q y l o i d c s i n f e c t i o n is .'Chri3~1ljh br::as"i
m i l k a s has bcun suggcstcd by D n n g ~ s a n d M n d ~ x k i , 19GZ;
%?own 2nd Gl rn rdcau 1977; Nwosu 1970) . Thc a l d e r rigs-grr:up
i n F c c t i o r i s h ~ t h i n t i l e blor_.d znd i n -thc in-tcr-;tin:! m y i iavc
d i s t i n c t s a : ~ s u n ? l i t y u f o c c u r r c n c c , Any p n r r ~ m c t w wh;.ch rnn:lc
p o s s f b l c an adequntc dcqrcc u f %he wztncss o-? soil, frnn
c l i n o t i c P n c t o r s i n t h c trnnsmjssiun o f p m z n i t c s hzs h c c ~
demonstrntcr l by mnny i n v ~ s t i g z t o r s . ( O l l c r c n s h ~ w m d Smith
7459; Thumzs, 1974; G i l l c t t , 1974 ; Obinmiwu 1377; riwrjsu 2 n d
,7nyo, 1980 nmong c t h o r s ) . I n t hc t r c p i c s i t i s d u r i n g ti12
r n i n y scznun t h a t p n r n s i t c s t ransmiss inn is most r n m k ~ d
( H i n z 17GR ; O b i m i w ~ 1977; Nwosu zncl Anyn 1900; Udnnr;TW2-
? o r n i ~ s q u i t o ~ ! ; , i 4 l ~ : j , swnnps r l long t h r i r n m g i n s u f r3.w~.
b:;nks s h a d c ~ l by z m c r g u n t v c g c t n t i o n ;;;ny Torn pcrfocYk b r o u d l n ~
arcns. Tili: tnL1. nnd l u x u r i n n t e1l-lphnn.L grzss prvnc:n-t c m
23
a d ~ q u z t z l y pruv5-de t h e c o n g e n i ? l h igh mean z r n b i m t t ~ m p c r n t u ~ c
r c q u i r c d f u r h a t c h i n g o f v a c t o r eggs.
A n o t h ~ r f a c t o r which mhnnczs infections i s l a c k o f
t ; l : l squ i t nc p r o o f n e t t i n g o v c r t h c d u n r s nnd b~indr! ld~ t o keep of'?
n o s q u i t o m f r c m homes. i-lus t c h l l t l r u n 3r2 1cf.l; b x x - h o r l i c t l wL ti:
inn ids o r t h a i r h r o t h u r s nnrl s i s t .rs, t o p l n y uu-Lsir:lc haraps
ovorgrclwn w i t h g r m s t h u s c c l n s t i t u t i n g c o n v c l n i c n t h r c z r l l n g
g r o u n d s . Okpaln (1971a) a b s c r v c d similar f n c t u r s ns c n n t r i h l l t -
l n q to t h c h i g h i.ncfdcncc c f m g l n r i n i n h i s s t u d i e c u f s c h i ~ i j l
c h i l d r m i n Epc.
--
J Ihc L n c f d n n c ~ a f p r u t o z o z l i n f L : c t i o n w i t h d i s p e r s a l n f
c y s t s c o i n c i d e d w i t h hcnvy r a i n s ; suggesting c o n t m i n a t i o n nP
d r i n k i n g w ~ t c r . O b i m i w e (197?) n5t; o n l y rccr~rdcd p u n k s c l u r i r q
t h e hznvy r a i n s b u t n l s u sirnilm f o c t a r s . L1kpnl.a C195i;) r~cordzd
s i m i l a r p r n t o z o a l i n f ~ c t i o n s nnd c n n t r i b u t i n g f n c t r r s i n f l u a n - .
ci .ng h i g h p e r c m t a g c i n c i d m c c in s c h u o l children.
D . p z r s t n n s i n f e c t i c n shnw h i g h i n c i d c n c u d u r i r g t h e - ------ r a i n y s z n s o n . R z c c n t i n v ~ s t i g n t o ~ s ( O k p n l n 1971n) d i d n u t
r i !card t h i s p a r a s i t e w h i l e s t u d y i n g b l n o d p n r a s i t c s i n s c i i c n l
c h i l d r a n . Thz h i g h i n c i d c n c z tins b c m u b s c r v c d o s 5c i r i g l i n k s ? i
w3.t-1, v c g u t n , t i u n 2nd rnj.nf all. T h c r c f u r e , .th,- hush!; s u r r w i l d i r q s
u f t h e r i v ~ r s t r z v c r s i n g t h ~ Enugu r n u n i c i p ~ l i t y nne t 5 c d ~ z l l ! - n r
c o n s i d u r c d p ? t h o g c n i c as i t i s nut 3 s harmless as nnny r z p m t c d ;
t h i s v i z w h z s bnl:n s u p p ~ r t d r l h y S n n d e r g n n r d 1971, Dukrzi (197;)
a n d R n e g r o i t h (137G:. Usunl1y - C . p e r s t n n s - i s s n i r l t o show n d
c l i n i c z l r n n n i f ~ s k ~ t i n n s b u t o c c z s i u n o l l y c u s i n o p h i l i z , f u v m ,
i t c h i n g , lyrnphndzn;~pnthy; a n d j o i n t 2 n d b o n e p z i - n s hnvc hecn
r i : p r~ r t c r j , Evun n r ! u r o l o g i c n l . 2nd p s y c h o l ! q i c o l d i s t u r h n n c c z
I i ~ i v u hccn n c c r ~ d i t e d t a - D. PA- p z r s t n n s i n f cc -L i rms ((+i lgrzi th, 1776 ;
- ,~ nunt, EI~avi?;- nnd Jung, 137G; 5-Lett, 1352). T h i s i n r " z c t i 1 1 n
n i i ~ k t bi!comc 72 mnjor h c n l t h problem i n c h i l d r z n . T h u s , t h ~
i n c i d r ! n c u r n c m r d c d suggcs t a t h a t thu i n tcmncdizl;:: bus% 2 n d
t r n n s m i t t c r , ---Ad- C u l i c o i d c s i s p r c s m ' i i n Enugu. T h x c i n an
ullgxnt n a c d t h i ? r u f u r c -to i n v e s t i g n t r ! t t ~ ~ v ~ c t c r wi-hi : :: v i c u 'GO
i d e n t i f y i n g t h z spdc ius of C u l i c o i d t x .
i.;n?,~.!rnin hcrs b ~ c n u h s r ? r v c d i n all 'ihc hcl ,-r in-Lh i n f w t - ions .
Main f m t u r a o f c s t n b l i s h c d i n f ~ c t i n n w i t h huokworn hos h w n
t h z p r c d u c t i o n u f n n z c m i n ( G i l l z s 1976; r d i n ; ] t r ~ r i and G i l l e s
l a s t n l o n g t i n e bcforc r c s a l u t i o n 2nd c a n s a q u u n t l y p r o d u c e
nnncmi:!. k .pcrs t= lns was u c u a l l y rdgrrdcd as h a r m l c s s h u t nbi;
m y more ns p a i n t cd o u t by S t a t t ('1962) whu dcrmnstra-kcd
a n a m i n i n t h i s S n f c c t i u n , Cuun hypnchromin i n Houkworm nnd
T r i c h u r i s i n b c c t i o n i n c h i l d r e n Ims bccn c u n f i r m c d ( J c l i P f c C -...-.--- J c l i f f c 1970).
irrnunq p r u t a z o n l i n f c c k i u n s d c t c c t u d i n t h i s st-urly wcri!
G , l z m b l i n (Okenhinlnrn ct n l , 1972, M m s d e n , 1978; Urucc- .Chwntt , - -.-
and - G.lclmblio con c n u s c rnc l l absurp t iun and s t i ln to r rhnc i t l . Thcsc
infections t h e r e f ore , j u s t as PI-asmudium i n f i x t i o n , m y resu1.t
i n anaemia i n c h i l d r e n . Thc o t h e r prakozaa, t h a i ~ g h r e g a r d e d
a s n o n - p a t h o g e n s , may now be c o n s i d e r z d p a t l i o g c n i c as a
r e s u l t o f anaemin nhserved a s s o c i a t e d w i t h t h e i r p r e s e n c e .
T.ho:ninis h a s been r e g a r d e d a s a p a t h o g e n (Mnrsden 1970). - -- There a r e gasps o f n o n - p a t h n g e n i c p r o t o z o a a s s u m i n ? p3-Lhoqznic
d inwns io r i r ; , a s a n example i n a f a t a l c a s e o f i n f e c k i o n uTLh
1.butschlii a n d a n o t h e r o f C . n e s n i 1 i i n f e c t i o n c a u s i n g - .---&A - ..-. haerns$urFa ( E d i n g t o n a n d G i l l e s 1976). There is t l u o t h c
~ m s i b i l i t y t h a t m i c r o e n v i r o n m e n t a n d m i c r a a s s u c i a t i o n s i n
c h i l d r e n r m y i n d u c e p a t h o r j e n i c i t y i n t h e s e p rn tozo3 . Such
cnv i rnn rnen ta l a s s o c i a t i o n i n f l u ~ n c c was obse-ved w i t h
E . i i l ~ c i c a b c c n n i n g h a r m l e s s i n a b a c t $ : r i o - f r e c e n v i r o : d. - -- ( P h i l l i p s , iiolfe a n d B a r t i g i s , l 95D) . The same p r o t n z o a , wi I L L ~
i n a s s o c i a t f o n with viruses produced disease (Diarnord,
iJla t t c r n a n d Darqiqis, 1972).
The Cry th rocy t e SeddmenGatian Rate (Er~ilR) hos brzen
o h s e r v e d raised t n a l l t h e i n f e c t i o n s , bnth h c l r n i n t h a n d
p r a t a z o a n . Mast hclmin t h and p r n t n z u m i n r e c t j n n s do ~ n o r l i Pcs t
chron : c i n f l a n m a t i a n especially i n t r o p i c a l c i ~ u n t r i r ? ~ where
j.nf cct-5.m ;.nd r e i n f e c t i o n occur a s mixed i n f e c t i o n s (LdLngt-on
E Gilles q976; f aus t , Benver a n d J u n q , 1376; J e l I f F e a n d
tlel.if f c , 1978). C h r o n i c inPlammatnry conditions have h e e n
r e c o g n i s e d as prat jucing r a i n e d KSl?. I n a n anaemic pa t i cn ' ; ,
. - i f ; E so:netimes g i v e s a l e ad -to u n d e r l y i n g c a u s ; 1 2 i i v ~ r l t s o r d m
(de G r u c h y , 7973) a n d s u c h u n d e r l y i n g r-lisarcler has been r e c o q -
n i s z d a s p a r a s i t i c L n F e c t i o n .
Z n s h a p h i l i a the n a s t f r e q u e n t l y known v a r i a t i o n o f -1;he
w h i t e b l a r ~ d c e l l i n p a r a s i t i c i n f c c t i u n s was cibserved i n h1';h
h c l r n i n t h and p r o t n z o a l i n f e c t t a n s of t h i s s t u d y . H ~ o ! < ~ ~ r i n ,
: i t r r o n q ~ l o i d c s --a. a n d -- T r i c i - ~ u r i s a r e known h e l n i i n t h s t h a t e l i c i t
e o s i n o p h i l i a , ( J e l i f f E and J e l i f Pe , 1370; Faun 'c, L3eaver a n d
J u n g , 1376; E d i n g t o n and Gilles, 1976). c.pcrstan- h a s l o n g
s i n c e been r e c a g n i s e d a s a p a t h o g e n and S t a t t i n 13L2 r 1 b o e r v e 9
~ i 7 c i n f c c t i d n j u s k as i n t h i s s-i;udy, In e n s i n o p h i l i a i n '-'
1 ; 1 1 i r ; t o l ~ I n f e c t i o n s e o s i n o p h i l i n were obse rved and t ? ~ c .&* .-- same mas a l s u r e p o r t c d h y P'larsden (1978). &.=l.. may wzll I~nv::
a s s u m e d p a t h o q e n i c i t y due t o new e n v i r o n m n t a n d assoclatiijn::.
G . l a n b l i a a p a t h o g e n , i s a s s u m i n g cvcn grea ter pa thor jcn ic , ..,-,.I
r a l e a n d t h a t may h e as a r e s u l t n f a v i r u l e n t s t r a i n oP
- G.lainblia b e i n g p r e s e n t i n % . n u g u m Chang i n 1978 has r e p o r t e d .d .
k h e e x i s t e n c e o f a v i r u l c n t s t r a i n ~ 7 f ' G . l a m b l i a , - I ' i au l eaux f u r i n a t i n n may br? r eea rned a s an i m m u n u l n g i c n l
r c ac t i un . N o r m a l l y r o u l z n u x P u r r n a t i o n i s p r o m o t e d by cullni-
d a l changes in t h e p l a s m a ( L y n c h c t a l . , 19G9), D.parsGans - , I u ?
haul:wurm and A s c a r i s s l ic2weid t h i s p h ~ n u r n e n o n , --- -- llie fnvo1vemer : t u f D,perstans, l ' . t r i oh j . u r a , T . h o n i n i s ..- - - - - I ----.
2nd G , l a n b l i a i n o b s e r v a t i o n o f a t y p i c a l l y m p h o c y t e s is o f - - p a r t i c u l a r i n t c r c s t , D . p a r s t a n s i s f o u n d dircc-Lly i n t hc b l n o d
i ~ i d u c u s i ~ c i l p r c m a t u r i ~ t y i n l y m p h o c y t e s . Thus, - D. -- pc170tans . -. ~ ~ ~ k n s c
pnt l iogcnj . .c roli! w a s r c d i s c ! l v e r e d ( S t c i t t , 19G2) c o u l d p n s s i h l y
a c t un l y m p h a c y t u s t n c n t r c n c h i t s e l f . L . J , i c h i u r n , L . 1 - i n m i n i -
and - G.larnbl ia a r z a l l l o c n t c d i n t h c i n t e s t i n e a n d nay u c l l h e
p r o d u c i n g substnnces w h i c h un r e a c h i n g t h e p e r i p h e r a l b l u n d
i l c X d kr-lc~wn t 3 h z v c two s p e c i e s t h e n n n - - v i r u l e n t and v ' . ru lcn- i ;
str2ins (Chnng 1 9 7 8 ) , -- T.horninis 2 n d - T. t r i c h i u r a hzvc h c c n
i n c r i m i n n t e d ns p a t h o g e n s ( L d i n g t o n and C i l l e s , 13?:-1).
T . t r i c h i u r a by i t s p r e s e n c e c o u l d causr! oedcriin, a c a r i d i k i o l ~ - in h y p e r s e n s i t i v e r c n c t i a n which d u r i n g r e n h s o r p t i o n 8-~f
r::?dcmn B l u i r l may i n t - c n d u c e c h a n g e d s u b s Lances i n t o th.2 blunt!
3 3
J a r g ~ t cells werc noted i n Yilms DP a l l h e l m i n t h InTec-
t i on r ; cspcc i a l ly huokwarm T r i c h u r i s and - S . s t e r c u r n l i s . T n r g e I
czlls nrc c h n r n o t e r i s t i c hypuchrornic c e l l s f;,und i n l r a n
d e f i c i e n c y onnenin. The h e l n i n t h s in which t h e y wcse n n t a d
t ? spcc i a l l y havc been knnwn t u praduce 8naerni.n ( F a u s i ; , Gcnver
and J u n g , 1967; J z l L i PPc and J e l l i P f e , l 968) .
Ti7u t ~ x i c granulatinns of n c u t r r ~ p f i i l s i n d i c a t e s i n f e c t i o n .
Hlthuur~h b n c t c r i a c a u s e t h i s c a n d i t i o n , p a r n s i t c s alscj i n d u c e
this g r n n u l n t i o n i n thc n c u t r y h i l s .
Azubiku, J .C, , I z u u r a , G.I. and O b i , G.O. (1977) l inncnin i n
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G ~ u p r n p h i c a l Flcd ic lnc 23: 3 6 5 3 6 8 .
.-
Orown, R.C. a n d Girmdenu i.4.H. F. ( 7977). l ransrnarrrnilry passogc
ilP ~ t r u n q y J u i d e 3 - -. . Sp l a r v n c in -Lhc human h a s t . R ~ - , i c r i c n n
Jou rna l o f T r u p i c n l Medbc in r~ and I - l y g i m ~ 26:.215-215
Rrucc-Chwott, L.3. (1952) I!uutr:d hy Okpdn I (137') Annals u ?
T r o p i c a l M c d i c i n c and P a r 3 s i t o l o g y 46 : 173,
Z r ~ c c - C h w a t t , L.J. (1 978) r4alarin. I n D i s ~ o s e o u.F C h i l r h c n
i n t h e S u b t r o p i c s and T r o p i c s , c d i t u d by 5,iI. J c l l i f f c ?
nnrl J.?. 5i;anPleld 3 r d ccl., English Longungc I-luulc.
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i a b l c , H.M. (7970) An l l l u s t r n t u d L a b o r a t o r y Vnn~lnl o f
P n r n s i t u l o g y 4 t h cd. E l u r g ~ s s Publ ishing Crmpnny,
P l i i - ~ n c a p n l i s ,
T e c h n i q u e s B u t t c r w o r ths, Londgn,
P a t h a l o g y 3 - t h c d i t i u n . E n g l i s h L-anguagc Book Sncici;y
S o c i e t y and L e w i s , L8indmn.
5h
Foust-, E.C., Oeover, P.C. a n d J u n g , H.C. (197G) . i ~ n i n n l
f?genc ico nnd Vccturs r ~ f Hur,itln Diseasr! 4 t h ed. ~ ' h i l n c l z l p h i a
Lea and F u h i g ~ r .
1 2 i l l c s , H.N. (79761 1i:~okworm infection a n d ;Inaernin i n C l i n i c o l
T r o p i c n l Diseases 6 t h e d i t i o n p. 161-17 1. Enr j l - i sh
Lnngunqc Onok S n c i ~ t y 2nd Olockw211 , London.
C i l l c t t , J. 0. (197h) D i r e c t a n d Indirect i n f l u e n c e s uf Tonp-
e r n - t u x on the t r a n s m i s s i o n [if P n r o s L t c s Prnv i n s c c k s t n
mnn i n i h u E .F fec tn o f ~ l a t c o r o l o g i c c l l F n c t o r s upon parzei . tcs
p, 79-95 ud, i1.R. Tau lo r , a5yrnpasiz of the 8 r i t i s h ! i o c L c t y
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H i n r , L. (7960) R c g i o n a l c Gcterschicde i r n Vurkummi!n von Wclmin-
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5-n Disu2scs o f c h i l d r ~ n i n t h c 5 u b t r o p i c s and T r n p i c e
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3 r d ed. Cng l i sh Lnnqungr! Buuk ,;ncTcty and A-nolrl , L o n d i ~ n .
l i n ~ t t , J. I. ( 1933) 2 rn? t h q d f u r mz!:ing m i c r n f i l n r i . 3 1 s u r v e y s
on Day b l i l ~ ~ d . T r z n s n c t i u n s o f I j o y n l !.3ccii!ty o? T r a p i c a l
P ied ic inu X H y q i e n c 33: ?? I -195 ,
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L y n c h , N.J . , R a p l i x e l , S.S,, Mellor , L.D,, Spare , P.D. nnd Tnwonrl
1 1 . J. ( l 7 6 3 ) . Plcd icn l L n b o n a t n r y Techno?-ogy clnd CLj.nilr:nl..
P a t h o l o g y 2nd e d i t i o n . S n u r i d c r s , P h i l n d c l p l i i a .
t locgrni . i ;h , 13. (1976) !"lrlas a n d f l a c g r a i t h : C l i n i c a l T r o p i c 5 1
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C h i l d r e n i n Lhn S u b t r o p i c s and T r a p i c s p. 500 - 505 c d i t c d
by D.5. J e l l i f f e and J.P. S t n n f i e l d , 3 r d c d T t i r i n , E n g l f s h
Lnnqunge Bnuk S n c i c t y and A r n u l d , London.
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G i n r d i n s i s , 2s n m u s e n.7 r k c ~ ~ r r c n t r e r ~ t c r i t i - 5 in P l i g c r i o n
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i n a n endemic a rea - !I p o s s i b l c t ransrnnmmnry rou-Lc. Ir
f u u r t h I n t e r n n t i ~ n n l Cung re s s o f F ~ r q s i t o l o q ; ~ p. 10;
19th - 2 5 t h :iuguut,, 1970, ldorsznwn,
Mwosu, 1l.Fl.C. a n d i \ n y - ~ , A. U. ( l!ICE) S e n s u n a l i t y CIS' Iiulnan hod:-
wurn i n f e c t i o n i n an Endemic a m n uf N i g e r i a 2nd j-ts
i ' , c l r ~ t i n n s h i p t u I 7 n i n f n l l . T ru~enrned , P n r a s i i ; . 31
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h u ~ l n n gu- t a t t h e s p c c i z l i s t i i o s p i - k ~ l , A c n i n I : i ty, ?'i;cr:.:-ta
iAnnnls of T r u ~ i c a l Flcdic5-n;~ and P m a s i - k u l u g y 71: 35-43
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O k ~ _ . n h i z l n m , T.C., Ki lnma, W.L. x n d Xnr::ji, E.D. (1972) Thc!
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and I n t e s t i n n l p a r n s i t ~ s m o n g s t u d m t s a n d 'che k i t c h u r l
p e r s o n n e l o f t h e U n i v e r s i t y o f N i g e ~ i n l'~!oul;l:a. The l:lcs-t
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Fnr;.-i;orn and F o r e c a s - k s LIP [ l c l m i n - t h i c Disenoc i n I d v n n c a s
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p . 33-52, e d , fi. F:. T a y l o r . Syrnprlsin if 6hc :liri!;:!s!i C;flci;?t!:
fr-jr P a r q s k t n l o g y . VoL. 1 2 O l n c k w c l i , Lnndon.
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12i-tchic, L.S. ( 1 3 4 8 ) An e thcr sudimcn-tn-Lion k e c h n i q u e Par
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J u u r n d o P U p h t l ~ n l r n o l o g y 25: 4 3 - 4 5 ,
Thur , ins , R.T. ( 7 9 7 4 ) The r n l ~ r f t h e c l i m n - L e i n %he a p i d c r n i a l o ~ ! ~
; I ~ i x o r o l o g i c n l F a c t s r s upon P ~ C ~ S ~ ~ L S p. 13-32 cd,
A,R, Taylor . 5 y m p u s i n nf the B r i t i s h S o c i c t , { F t i ~
P a r ~ s i t r i l a g y Vul - 7 % O L n c k w e l l , L~ndun,
' P l a t e la. Access road to t h i s residential house is blocked by heap of refuse (r).
P l a t e Ib, Residential building (b) beseiged by stagnant water (w) a n d bushes (bu),
P l a t e 5 . Shawing Stxonqvloides spc in wet f i l m soon after concentration in blood La) Whole larva.
and (c) Poster ior a s p e c t s and an eos
ouorq35juy aTqnop ur '(s) aenJel s~le~ou~aqs-~ - pue 569 (3) eirn~y~r~q*~ f3ur~oqs aqeld
uor73aju~ alqnop u~ '(s) aeAJeT s~~e~oxaqs-s pue s6ba (q) w~o~yooy 6u~inoqs "EL qeld
P l a t e 15, Showing c y s t of E.coli ( c )
