Медицинская паразитология
Биология ва тиббиёт муаммолари, 2014, №3 (79)
81
билан зарарланиши аниқланди. Бир ёшдан икки
ёшгача ва катта ёшдаги қўйларда ёзда
трихоцефаллар билан инвазияланиш пасаяди.
Айнан шундай эпизоотологик ҳолатни тоғолди-
тоғ биоценозларида ҳам кузатиш мумкин.
Хулоса: Самарқанд вилояти шароитида
қўйлар орасида трихоцефалёзни бир мунча кенг
тарқалганлиги ва уни икки турга оид
трихоцефаллар
Trichocephalus ovis ва T. skrjabini
лар қўзғатилиши аниқланди.
SCREENING FOR TOXOCARIASIS OF PATIENTS WITH ALLERGIC DISEASES
M.D. Akhmedova, M.B. Ibragimov, J.A. Anvarov
Tashkent medical academy
Toxocariasis is a disease of humans caused
by larvae (immature worms) of either the dog
roundworm (Toxocara canis) or the cat roundworm
(Toxocara cati). Toxocariasis is often called visceral
larva migrans. This zoonotic, helminthic infection is
a major cause of blindness and may provoke
rheumatic, neurologic or asthmatic symptoms.
Humans normally become infected by ingestion of
embryonated eggs from contaminated sources (soil,
fresh or unwashed vegetables).
Diagnosis of toxocariasis is difficult in view
of polymorphism and uncertainty of clinical
manifestations.
Clinical
manifestations
of
toxocariasis do not have their own specific features,
complicating the diagnosis of the disease. Patients
often focus doctor’s attention on previously
established diagnosis: bronchial asthma, atopic
dermatitis and other. Eosinophilia is often severe
and sometimes represents the only sign of infection,
except in ocular and neurological forms. Therefore,
a key role in diagnosis belongs to laboratory
methods of diagnostics.
The object. Optimization of diagnosis of
toxocariasis among high risk groups.
Materials and methods. 30 patients aged 21
to 55 years (men - 17, women – 13) were under our
supervision. 19 of them were in the in-patient
Department of the specialized allergological center,
11 patients were treated in outpatient clinics
allergological center and Republic infectious
diseases clinic. We have examined for toxocariasis
30 patients with chronic allergic diseases (bronchial
asthma, urticaria, atopic dermatitis), and patients
with high level of eosinophils of unknown etiology.
During the study all the patients were carefully
analyzed for the history of the illness, accent has
been
made
on
epidemiological
anamnesis.
Collecting epidemiological history we asked about
the presence of an animal in the house, especially
the dogs and the presence of pietism (geophagia).
Clinical and laboratory examination were carried
out. Serological testing for toxocariasis was
performed at the laboratory of immunology of
parasites, by using ELISA test system "Toxocara-
strip".
Results. Positive results were received in 14
patients from 30 examined patients. The frequency
of major clinical manifestations of toxocariasis was
presented as follows: manifestations of allergic skin
rash - 7 (50,0%), astheno-vegetative syndrome - in
11 (78,5%), intoxication syndrome - in 10 (71.4%),
pulmonary syndrome in 5 (35.7%), enlargement of
lymph nodes - 4 (28,5%), alopecia in 1 (7,1%). In
peripheral blood eosinophilia were found in 13
(92,8%) patients.
Conclusion. Based on epidemiological
analysis it was established that the key risk factors
for infection with T. canis are existence of
geophagia and/or contact with a dog (79%). The
range of clinical variants of toxocariasis course
varies to a great extent. These data coincide with the
literature data. The most frequently toxocariasis was
diagnosed in patients with allergic skin rash
(50,0%), astheno-vegetative syndrome (78,5%),
intoxication syndrome (71,4%) and high titers of
antibodies to T. canis.
LEISHMANIASIS PREVENTION BY LEISHMANIZATION
OR VACCINES: A BRIEF OVERVIEW
A. Khamesipour
Center for Research and Training in Skin Diseases and Leprosy (Iran).
Leishmaniasis is among the neglected
diseases which are reported from 98 countries.
According to World Health Organization (WHO)
estimation a tenth of the world population is at risk
of contracting the disease, and 12 million are
affected, the annual incidence rate being 1.5-2
million.
Leishmaniasis
clinical
manifestations
depend upon the
Leishmania
species which causes
the disease and the host immune response, the
clinical forms ranging from a self-healing cutaneous
leishmaniasis (CL) to a lethal visceral form. Vector
and reservoir control are not always possible and
Современные вопросы медицинской паразитологии и инфекционных заболеваний
82
Проблемы биологии и медицины, 2014, №3 (79)
require infrastructure beyond the means of endemic
areas. The standard treatment is toxic, costly and
needs a prolonged series of daily injections, the
efficacy is variable and resistance is rapidly
developing in many countries. Individuals upon cure
of CL lesion induced by natural infection or
leishmanization (LZ) are protected against further
lesion development, induction of protection in
experimental model of leishmaniasis is achieved,
most of the
Leishmania
parasites are easily cultured.
For all these reasons, in 1980s, global mobilization
to
develop
an
effective
vaccine
against
leishmaniasis under GMP/GCP guidelines with
support of WHO/TDR was initiated in new world
and old world. Several candidate antigens were
introduced and a few of the first generation (killed
parasite) vaccines were reached to phase 3 trials.
The results of efficacy trials in Brazil, Colombia,
Ecuador, Iran and Sudan using single and multiple
doses of first generation vaccines with or without
BCG are safe but not enough immunogenic to
protect against
Leishmania
infection. So far no
vaccine is available against any form of the disease.
Leishmanization is an inoculation of live
virulent
Leishmania major
to a predetermined part
of the div to induce a lesion similar to natural
infection. Leishmanized individuals are protected
against further natural infection which might be
multiple lesions in exposed parts of the div such as
on the face. LZ was practiced in Asian countries for
centuries and originally exudates of an active lesion
was used to scratch on buttocks of susceptible
individuals. When culture media was developed,
Leishmania
promastigotes from culture media were
used for inoculation in the early 1930s. LZ was
practiced in Uzbekistan, Israel and Iran. In the
1980s, as a preventive measure, massive LZ was
performed in Iran in which more than 2 million
soldiers and children were leishmanized. The
results of LZ in different endemic regions showed
the LZ is the most effective control measure against
CL, but accompanies limitations. Endemic countries
need to resume LZ and research on LZ issues should
be prioritized to standardize
Leishmania
stabilates,
develop well defined serum free media and possibly
lyophilize
Leishmania
. To facilitate vaccine
development, LZ should be used as live challenge to
evaluate candidate vaccines. The objective of the
current presentation is to overview history of
Leishmania
vaccines and LZ.
CUTANEOUS LEISHMANIASIS TREATMENT: A BRIEF OVERVIEW
A. Khamesipour
Center for Research and Training in Skin Diseases and Leprosy (Iran).
Human infection with
Leishmania
parasites
presents several different clinical forms of diseases;
Cutaneous Leishmaniasis (CL), the most common
form of the disease and Visceral Leishmaniasis
(VL) which is the fetal form of the disease. Due to
the diversity of epidemiological characteristics,
specific to each species and its environment, vector
and reservoir control are impractical, costly and
usually
requires
political
commitment
and
infrastructures beyond the means of the countries
suffering most from this disease and as such the
disease is expanding to new foci and the incidence
rate is increasing in some of the endemic areas. CL
is usually a self healing lesion but leaves a
disfiguring scar which leads to stigma, isolation and
barrier to marriage, especially for girls. In case of
severe forms of CL such as recidivans and non
healing forms no efficacious treatment is available.
Pentavalent antimonials (Sb
+5
) have been introduced
since 1930s and still is the first-line WHO
recommended treatment for all types of CL.
Antimonials require multiple injections which is
uncomfortable and painful, so full recommended
course is not tolerated by most of the patients and
resulted in low compliance. The efficacy of
antimonials depends upon the
Leishmania
species
and usually is low and resistant is reported.
Moreover, Antimonials are contraindicated in
pregnancy, heart/renal failure, hepatic disease and
diabetes and accompanies serious side effects which
in the worst scenario, it might cause death if not
carefully monitored. CL patients do not need
hospitalization so the cost of treatment is not high,
but still is not affordable for most the endemic areas.
Development of safe and efficacious drugs is
urgently needed. There is no global interest in drug
development against CL, so endemic countries,
NGOs and international agencies need to invest.
Clinical trials to assess the efficacy of various
modalities on leishmaniasis have been carried out in
different parts of the world, but mostly suffer from
inadequacies related different issues such as design,
sample size, endpoints and etc. Currently, in
addition to antimonials several lines of drugs like
Ambisome (liposomal form of Amphotericin B),
Miltefosine and Paromomycine are available for the
treatment of VL but not CL. Clinical trials on CL
using chemotherapy, physical therapy, traditional
medicine and immunotherapy have been published.
In this presentation, various clinical trials of
