university of nigeria on the incidence and... · enugu was one nf the areas she studied, but she...
TRANSCRIPT
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
18
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1t3
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21
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
I J F M A M J J A S 0 N D
month
I \ -
1 0 J X - - -X R o ~ n f a l l 1 , I \
C W Wsmodlur r ( I - D perstons 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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it (D P- 'l 0 <
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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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
kJ t-' Cil w 0 w N N
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 ,
37
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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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 )
