• [A foci of Schistosomiasis mekongi rediscovered in Northeast Cambodia: cultural perception of the illness; description and clinical observation of 20 severe cases]

      Biays, S; Stich, A H; Odermatt, P; Long, C; Yersin, C; Men, C; Saem, C; Lormand, J D; Médecins sans Frontières, Suisse. Odermatt_Biays@hotmail.com (Wiley-Blackwell, 1999-10)
      RésuméLa découverte en 1992 d'une population présentant des signes cliniques d'hypertension portale très évoluée a permis la redécouverte d'un foyer de bilharziose 'oublié' pendant plus de vingt ans dans la province de Kracheh au nord-est du Cambodge. Des éléments de la perception culturelle de la maladie par la population et des observations cliniques sur la morbidité grave provoquée par Schistosoma mekongi sont présentés. Les entretiens avec les patients et la population des villages alentours révèlent que la bilharziose a de lourdes conséquences psychosociales: angoisse de la mort, infirmité, invalidité. Les symptômes sont bien identifiés et auraient augmenté ces vingt dernières années. Ils font l'objet de dénominations et de traitements traditionnels spécifiques. Les descriptions cliniques de 20 patients illustrent la pathologie grave observée dans l'hôpital de Sambour, au nord de la province de Kracheh. Elles montrent le pouvoir pathogène de S. mekongi aux différents âges de la vie (de 7 à 58 ans): cachexie, hépatosplénomégalie, retard de croissance et pubertaire, décompensation d'hypertension portale avec ascite et rupture de varices oesophagiennes. L'efficacité du traitement à ces stades avancés de la maladie est inconstant: le suivi des patients sur 30 mois montre que 5 d'entre eux sont décédés, 5 se sont améliorés puis ont récidivés, 3 étaient dans des états stationnaires et 5 se sont nettement améliorés, 2 ont été perdus de vus. Les observations cliniques et les entretiens montrent qu'une pathologie très sévère, aux graves conséquences individuelles et communautaires, est présente dans la province de Kracheh. Cette maladie est liée à une infection par S. mekongi mais l'aggravation des symptômes par d'éventuelles infections associées est à préciser. A un stade avancé de la maladie le pronostic vital est très réservé même après traitement. Ces observations démontrent l'importance d'une intervention globale à long-terme sur toute la population touchée, à des degrés divers, par cette maladie. SUMMARY: In 1992 a foci of Schistosomiasis mekongi was rediscovered in the province of Kracheh in Northeast Cambodia. Severe clinical signs due to portal hypertension, which were frequently observed in this population, allowed the discovery of this 'forgotten' focus. Elements of the perception of the population and clinical observations of 20 severe cases due to S. mekongi infections are presented. Interviews with patients and villagers of the area of Kracheh showed severe psychosocial impact including fear from death, infirmity and invalidity. The symptoms of schistosomiasis were well known by the population and were reported to have increased in frequency in the last two decades. They have received traditional names and specific traditional treatment. (ABSTRACT TRUNCATED)
    • Foci of Schistosomiasis mekongi, Northern Cambodia: II. Distribution of infection and morbidity.

      Stich, A H; Biays, S; Odermatt, P; Men, C; Saem, C; Sokha, K; Ly, C S; Legros, P; Philips, M; Lormand, J D; et al. (Wiley-Blackwell, 1999-10)
      In the province of Kracheh, in Northern Cambodia, a baseline epidemiological survey on Schistosoma mekongi was conducted along the Mekong River between December 1994 and April 1995. The results of household surveys of highly affected villages of the East and the West bank of the river and of school surveys in 20 primary schools are presented. In household surveys 1396 people were examined. An overall prevalence of infection of 49.3% was detected by a single stool examination with the Kato-Katz technique. The overall intensity of infection was 118.2 eggs per gram of stool (epg). There was no difference between the population of the east and west shore of the Mekong for prevalence (P = 0.3) or intensity (P = 0.9) of infection. Severe morbidity was very frequent. Hepatomegaly of the left lobe was detected in 48.7% of the population. Splenomegaly was seen in 26.8% of the study participants. Visible diverted circulation was found in 7.2% of the population, and ascites in 0.1%. Significantly more hepatomegaly (P = 0.001), splenomegaly (P = 0. 001) and patients with diverted circulation (P = 0.001) were present on the west bank of the Mekong. The age group of 10-14 years was most affected. The prevalence of infection in this group was 71.8% and 71.9% in the population of the West and East of the Mekong, respectively. The intensity of infection was 172.4 and 194.2 epg on the West and the East bank, respectively. In the peak age group hepatomegaly reached a prevalence of 88.1% on the west and 82.8% on the east bank. In the 20 schools 2391 children aged 6-16 years were examined. The overall prevalence of infection was 40.0%, ranging from 7.7% to 72.9% per school. The overalls mean intensity of infection was 110.1 epg (range by school: 26.7-187.5 epg). Both prevalence (P = 0.001) and intensity of infection (P = 0.001) were significantly higher in schools on the east side of the Mekong. Hepatomegaly (55.2%), splenomegaly (23.6%), diverted circulation (4. 1%), ascites (0.5%), reported blood (26.7%) and mucus (24.3%) were very frequent. Hepatomegaly (P = 0.001), splenomegaly (P = 0.001), diverted circulation (P = 0.001) and blood in stool (P = 0.001) were significantly more frequent in schools of the east side of the Mekong. Boys suffered more frequently from splenomegaly (P = 0.05), ascites (P = 0.05) and bloody stools (P = 0.004) than girls. No difference in sex was found for the prevalence and intensity of infection and prevalence of hepatomegaly. On the school level prevalence and intensity of infection were highly associated (r = 0. 93, P = 0.0001). The intensity of infection was significantly associated only with the prevalence of hepatomegaly (r = 0.44, P = 0. 05) and blood in stool (r = 0.40, P = 0.02). This comprehensive epidemiological study documents for the first time the public health importance of schistosomiasis mekongi in the Province of Kracheh, Northern Cambodia and points at key epidemiological features of this schistosome species, in particular the high level of morbidity associated with infection.