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Epidemiology and Transmission of Lymphatic Filariasis in Southern Sudan

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Epidemiology and Transmission of Lymphatic Filariasis in Southern Sudan Epidemiology and Transmission of Lymphatic Filariasis in Southern Sudan BY: ELTAYA HASSAN AWAD ELKARAM B. Sc. (General) Zoology Faculty of Science Omdurman Islamic University Qualifying M.Sc Zoology University of Khartoum A thesis Submitted in Fulfillment of the Requirements of the Master Degree in A Thesis Submitted in Fulfillment of the Requirements of the Zoology Master Degree in Zoology Department of Zoology Faculty of Science Department of Zoology Faculty of Science University of Khartoum ******************************************************* May 2007 ABSTRACT This study on Lymphatic Filariasis and its vectors has been carried out at Bahr El Jebal State (Juba and Terkaka towns) between the periods August 2004 – September 2004 and April 2005 – June 2005 . Mosquitoes , the vectors of this disease , were collected using Pyrethrum spray (Knock down ). This insect survey showed that Anopheles gambiae s.s. is the common species in Juba area but in Terkaka Culex quinquefasciatus is the common species . All insect components namely head , thorax and abdomen were dissected in search of the parasites. The result revealed that the parasite , causing Elephantiasis (chronic filariasis ) is Wuchereria bancrofti. From the total number of mosquitoes collected (2729) only 81 individuals were found infected : 60 Anopheles and 21 Culex The overall rate of the mosquitoes which carried the first , second and third stages of the parasite was 2.9 %, but the rate of mosquitoes which carried the infective stage (L3) reached its maximum at Rajaf west (4.2 %) . The observations showed that the disease is prevalent in Juba and Terkaka . Males were more affected by the disease than females specially in the villages. A similar visit was also made to Blue Nile State being a second area where this disease prevailed . الخﻻصة تمت هذه الدراسة لمرض الفﻻريا الليمفية و العائل الناقل له بوﻻية بحر الجبل )مدينتي جوب ـا وتركاكا( في الفترة من أغسطس 2004 – سبتمبر 2004 و ابريل 2005 – يونيو 2005 . تم جمع البعوض ) العائل الناقل ( لهذا المرض بواسطة الرش ال ـرذاذي لمبي ـد الب ـايريثرم . اوضح المسح الحشري لهذه الد ارسة ان انوفيليس قامبيا س .س. اكثر اﻻنواع شيوعا في منطقة جوب ـا اما في تركاكا فبعوض كيولكس كوينكيفاسكياتس هو اكثر اﻻنواع شيوعا . للبحث عن الطفيل تم التشريح ﻻجزاء جسم البعوضة الثﻻث ـة ، الـرأس ، ال ـصدر وال ـبطن واظهرت النتائج بأن الطفيل المسبب لمرض داء الفيل هو يوشيريريا بانكروفتي . من العدد الكلي للبعوض )2729( الذي تم جمعه وجد ان 81 بعوض ـة فقـط مـصابة : 60 انوفيليس و 21 كيوليكس . المعدل للبعوض المصاب الذي يحمل اﻻطوار اﻻول , الثاني والثال ـث للطفي ـل 9.2% لك ـن المعدل للبعوض الذي يحمل الطور الثالث المعدي )ل3( وصل اقصاه ف ـي منطقـة الرج ـاف غـرب . )%2.4( اوضحت المشاهدة بأن المرض يتفشى في جوبا وتركاكا . الرجال اكثر اصابة بالمرض م ـن النساء و خاصة في القرى . تضمنت هذه الد ارسة زيارة مشابهة لوﻻية النيل اﻻزرق كمنطقة ثانيه يتفشى بها هذا المرض. Chapter One INTRODUCTION AND LITERATURE REVIEW 1.1 INTRODUCTION Lymphatic Filariasis (LF) is a major cause of clinical morbidity and an impediment to socioeconomic development affecting some 80 countries in the tropics and subtropics (Farid et. al., 2003). And it puts at risk more than a billion people. Over 120 million people have already been affected by it, over 40 million of them are seriously incapacitated with the disease. One third of this number is in Africa and most of the remainder are in South Asia (particularly India), the Pacific and America. In tropical and subtropical areas where Lymphatic Filariasis is wellestablished, the prevalence of infection is continuing to increase. A primary cause of this increase is the rapid and unplanned growth of cities, which creates numerous breeding sites for the mosquitoes that transmit the disease (WHO, 2000). The causative agent of Lymphatic Filariasis in a nematode which belong to the following systematic status : Kingdom: Animalia. Phylum: Nematoda. Class: Secerneutea. Subclass: Spiruria. Order: Spirurida. Suborder: Spirurina. Family: Filariidae. Subfamily : Filarioidea Genus: Wuchereria Species:bancrofti.( www.keepbair alive, com/ para. Html).2006 1 Lymphatic Filariasis is evidently endemic in Sudan; this is based on previous published (Satti and Abd El-Nur,1974) and unpublished data of scattered spot surveys and hospital records (lymphoedema or/hydrocele). Of the 26 Sudanese States, 12 states are considered LF endemic areas (Farid et. al., 2003). These include the 10 Southern States in addition to South Dar-Fur and Blue Nile States. The total population of these states is around 8 millions and depending on Rajaf and Radom studies, 3 millions are at risk of having the disease, two thirds of them are in Southern State. A report of Ministry of Health stated that between 1948 to 1968 some 7957 cases were recorded although details and parasitological verification of these cases were not presented. Lymphatic Filariasis is a parasitic disease that is spread by mosquitoes (Anopheles, Culex, Aedes and Mansonia), caused by three nematode worms of the Family Filariidae. These are Wuchereria bancrofti, Brugia malayi and Brugia timori. There are fifteen species of filarial worms recorded from mammals and which can develop in mosquitoes. They include four species and Wuchereria bancrofti is one of them (Nelson, 1959). The latter is responsible for 90% of worldwide infections with 9% caused by Brugia malayi in southeast and eastern Asia and only 1% is reserved for Brugia timori in the Pacific Region (Michael and Bundy, 1997). Lymphatic Filariasis or Bancroftian disease depends on two hosts: humans and several species of mosquitoes which ingest microfilaria when they bite a person. These microfilariae undergo a process of transformation in mosquitoes to become infective larvae. The microfilariae mature into adult worms which can live for several years in man lymphatic system and produce millions of microfilariae. The latter circulate in the peripheral blood stream, usually at night .The worms lodge in the lymphtic system – net work of nodes and vessels that 2 regulate the delicate fluid balance between the tissue and blood and are essential for fighting infection - causing stagnation of the lymph and swelling (Evans, 2003). In endemic areas a proportion of infected persons develops no clinical symptoms although microfilariae can be found in their blood (microfilaraemia). Such persons can remain asymptomatic for several years or progress to acute and chronic filariasis (Monica , 1999). When the diagnosis of the disease becomes difficult by the use of classic ways (because the parasite is nocturnal in periodicity) the immunochromatogra - phic diagnostic test (ICT) is the suitable way at any time (WHO, 2000). Two primary biological characteristics of bancroftian parasites render transmission of infection insufficient: the lack of any animal reservoir host and no amplification of the parasite within the mosquito vector (Elsetouhy and Ramzy, 2003). It is impossible for a bite by a mosquito carrying a single infective larva to cause microfilariae (Hairston and DeMeillon, 1968), perhaps paradoxically, the efficiency of Lymphatic Filariasis transmission is actually quite low. Generally, a person needs to be exposed to many mosquito bites for a period of months or years before becoming infected. In contrast malaria can be caused by just one bite from a malaria-carrying mosquito. The microfilaria are not injected when the mosquito bites, they must migrate through the puncture site (Evans, 2003). WHO decided that Lymphatic Filariasis should be eliminated as a public health problem. Elimination of lymphatic filariasis means a reduction of the disease incidence close to zero as a result of deliberate efforts requiring continued and coordinated activities (WHO, 2002). 1.2 Objectives: Apparently Lymphatic Filariasis is transmitted by several genera or species of mosquitoes. And all these genera do exist in the Sudan. But 3 work or surveys about transmission vector have never been practiced in this country. All the efforts of combating this disease were directed towards treatment of ailing individuals but no control strategies were directed towards the vectors. Therefore, the objectives of this study are to: 1. Confirm existence of the disease and determine the genera and species of the transmission vector. 2. Identify the species of filarial worms responsible for this diseas. 1.3 Mosquitoes: Mosquitoes are insects belonging to the Order Diptera; they have a worldwide distribution being found in the tropics, in the temperate zones and in the Arctic Circle. They have been found breeding not only in underground tunnels but also in deep mines (Gordon and Lavoipierre, 1962). The term “Mosquitoes” or “Musketa” is a Spanish or Portuguese word meaning “little fly” while British people call mosquitoes “Gants”, for any two winged insect which bites and sucks the blood of man (Floore, 1999). Modern writers used the name Culex to refer to mosquitoes but this tern is now retained as a mosquito genus. Among the other important genera are Aedes and Anopheles. These three genera belong to the Phylum: Arthropoda, Class: Insecta, Subclass: Pterygota, Order: Diptera, Suborder: Nematocera, Family: Culicidae, Subfamily: Culicinae. The latter is divided into three tribes: the Anophelini (the Anophelines), Culicini (the Culicines) and the Toxorhychitini or elephant mosquitoes (Gordon and Lavoipierre, 1962). 1.3.1 What are mosquitoes: Culicine mosquitoes are small long legged organisms. They may be distinguished from all other Nematocerous flies by: 4 1. Proboscis with palps which are held straight and rigid, and which are not pendulous. 2. Scales are present on the body , the legs and the wings. The colouration of the mosquito is dependent on the colour of the scales. 3. Wing venation in which the third vein is straight and lies between two forked veins (Gordon and Lavoipierre, 1962). Mosquitoes are the most important single group of insects with regard to public health. They are remarkable and fully cosmopolitan group with 3.000 species distributed throughout the world (WHO, 1972). Since mosquitoes live in close association with man, travelling with and feeding on him, but existing for the most part as free-living insects, they are in particular well adapted to harbour and transmit agents of disease.
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