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Mohamed Emara
Middle name: Hussien, Dr
Middle name: Asem, Dr


Schistosomiasis; Colonic; Rural Inhabitants; Egyptian Nile Delta; Prevalence.


Background and Aims: Human schistosomiasisis one of the most important and unfortunately neglected tropical diseases. The aim of the current study was to investigate the prevalence and characterize colonic schistosomiasis, among symptomatizing rural inhabitants of the Middle Northern region of the Egyptian Nile delta.

Patients and Methods:  This study recruited 193 inhabitants of the rural community in the Egyptian Nile Delta referred for colonoscopy because of variable symptoms. After giving a written informed consent, they were exposed to thorough history; clinical examination; stool analysis; abdominal ultrasonography, and pan-colonoscopy with biopsies.

Results:Twenty-four cases out of the 193 patients had confirmed active schistosomiasis with prevalence rate of 12.4%.  Bleeding with stool was the predominant manifestation of active schistosomainfection among the cases either alone or in combination with abdominal pain. On clinical examination, the majority of the patients (n=17; 70.8%)did not have organomegaly and 25% of them had clinically palpable splenomegaly. As far as, 75% of them had sonographically detected hepatic peri-portal fibrosis. Also 66.6% of patients havesignificant endoscopic lesions (polyps, ulcers, mass-like lesions), and 16.6% of them had colonic affection beyond the recto-sigmoid region.

Conclusion:Colonic schistosomiasis still running among symptomatizing rural inhabitants of the Egyptian Nile Delta at a rate of 12.4%. Of them66.6% had significant endoscopic colorectal lesions. This persistent transmission of schistosomiasis in the rural community of the Egyptian Nile Delta sounds the alarm for continuing governmental efforts and plans to screen the high-risk groups.


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1.Hotez PJ, Savioli L, Fenwick A. Neglected tropical diseases of the Middle East and North Africa: review of their prevalence, distribution and opportunities of control. PLoS Negl Trop Dis 2012; 6:e1475–e1482.

2. Hotez PJ, Alvarado M, Basanez M-G, et al. The Global Burden of Disease Study 2010: interpretation and implications for the neglected tropical diseases. PLoS Negl Trop Dis 2014; 8:e2865–e2873.

3. El Sharazly BM, Abou Rayia DM, Antonios SN, et al. Current status of Schistosoma mansoni infection and its snail host in three rural areas in Gharbia governorate, Egypt. Tanta Med J 2016; 44:141-50.

4. El-Khoby T, Galal N, Fenwick A, et al. The epidemiology of schistosomiasis in Egypt: summary findings in nine governorates. Am J Trop Med Hyg 2000; 62:88–99.

5. Barakat MR, El-Morshedy H, Farghaly A. Human schistosomiasis in the Middle East and North Africa region. In: McDowell MA, Rafati S, editors. Neglected tropical diseases ? Middle East and North Africa. Wien: Springer-Verlag; 2014. 23–57.

6. Olveda DU, Li Y, Olveda RM, et al.. Bilharzia: Pathology, Diagnosis, Management and Control. Trop Med Surg. 2013 20;1(4):135.

7. Barakat RM. Epidemiology of Schistosomiasis in Egypt: Travel through Time: Review. J Adv Res. 2013;4(5):425-32.

8. Mohamed AM, el-Sharkawi FM, el-Fiki SA. Prevalence of schistosomiasis among fishermen of Lake Maryut. Egypt J Bilharz. 1978;5(1-2):85-90.

9. Taman A, El-Tantawy N, Besheer T, et al. Schistosoma mansoni infection in a fishermen community, the Lake Manzala region-Egypt, As Pac J Trop Dis,2014; 4(6): 463-468.

10. Haggag AA, Rabiee A, Abd Elaziz KM, et al. Mapping of Schistosoma mansoni in the Nile Delta, Egypt: Assessment of the prevalence by the circulating cathodic antigen urine assay. Acta Trop. 2017;167:9-17.

11. Doenhoff MJ, Chiodini PL, Hamilton JV. Specific and sensitive diagnosis of schistosome infection: can it be done with antibodies? Trends Parasitol 2004; 20:35–39.

12. Katz N, Chaves A, Pellegrino J. A simple device for quantitative stool thick smear technique in Schistosomiasis mansoni. Rev Inst Med Trop Sao Paulo 1972; 14:397–400.

13- Abdel-Wahab MF, Esmat G, Farrag A, et al. Grading of hepatic schistosomiasis by the use of ultrasonography. Am J Trop Med Hyg. 1992;46(4):403-8.

14. Harries AD, Speare R. Rectal snips in the diagnosis of hepatosplenic schistosomiasis, Transactions of The Royal Society of Tropical Medicine and Hygiene, 1988; 82(5): 720.

15. Shipkey FH. Squash technique for rapid identification of schistosoma ova. Ann Saudi Med. 1986;6:71–2.

16. Gray DJ, Ross AG, Li YS, et al. Diagnosis and management of schistosomiasis. BMJ. 2011 17;342:d2651.

17.Li Y, Sleigh AC, Williams GM, et al. Measuring exposure to Schistosoma japonicum in China. III. Activity diaries, snail and human infection, transmission ecology and options for control. Acta Trop 2000;75:279-89.
18. Othman AA, Soliman RH. Schistosomiasis in Egypt: A never-ending story? Acta Trop. 2015; 148:179-90.

19. El-Hawey AM, Amer MM, Abdel Rahman AH, et al. The epidemiology of schistosomiasis in Egypt: Gharbia Governorate. Am J Trop Med Hyg 2000; 62:42–48.

20. Melo, Andrea Gomes Santana de, Irmão, José Jenivaldo de Melo, Jeraldo, Verónica de Lourdes Sierpe, et al. Schistosomiasis mansoni in families of fishing workers of endemic area of Alagoas. Escola Anna Nery, 2019; 23(1), e20180150.


22. Conceição MJ, Carlôto AE, de Melo EV, et al. Prevalence and Morbidity Data on Schistosoma mansoni Infection in Two Rural Areas of Jequitinhonha and Rio Doce Valleys in Minas Gerais, Brazil. ISRN Parasitol. 2013 19;2013:715195.

23. El Malatatwy A., El Habashy A., Lechine N.,et al. Selective population chemotherapy among school children in Beheira Governate: the UNICEF/Arab Republic of Egypt/WHO Schistosomiasis Contrl Project. Bull World Health Organization. 1992;70:47–56.

24. Elbaz T, Esmat G. Hepatic and intestinal schistosomiasis: review. J Adv Res. 2013;4(5):445-52.

25.Da Silva LC, Chieffi PP, Carrilho FJ. Schistosomiasis mansoni -- clinical features.Gastroenterol Hepatol. 2005;28(1):30-9.

26.Mazigo HD, Dunne DW, Morona D, et al. Periportal fibrosis, liver and spleen sizes among S. mansoni mono or co-infected individuals with human immunodeficiency virus-1 in fishing villages along Lake Victoria shores, North-Western, Tanzania. Parasit Vectors. 2015 7;8:260.

27.Nooman ZM, Hasan AH, Waheeb Y, et al. The epidemiology of schistosomiasis in Egypt: Ismailia governorate. Am J Trop Med Hyg. 2000;62(2 Suppl):35-41.

28.Abdel-Kader S, Amin M, Hamdy H, et al. Causes of minimal hepatic periportal fibrosis present in Egypt. J Egypt Soc Parasitol. 1997;27(3):919?924.

29. Zaher T, Abdul-Fattah M, Ibrahim A, et al.Current Status of Schistosomiasis in Egypt: Parasitologic and Endoscopic Study in Sharqia Governorate.Afro-Egypt J Infect Endem Dis 2011; 1(1):9-11.

30. Gad YZ, Ahmad NA, El-Desoky I, et al. Colorectal schistosomiasis: Is it still endemic in delta Egypt, early in the third millennium?. Trop Parasitol 2011;1:108-10.

31. Ross AGP, Bartley PB, Sleigh AC, et al. Schistosomiasis. N Eng J Med 2002;346:1212-9.

32. Gryseels B, Polman K, Clerinx J, et al. Human schistosomiasis. Lancet 2006; 368:1106-18.
33. Elbatee HE, Emara MH, Zaghloul MS, et al. Huge bilharzial polyp mimicking colon cancer. JGH Open. 2019 12;4(2):280-283.
34. Barsoum H. Cancer in Egypt: its incidence and clinical forms. Acta Uni Intern ConCan. 1953;9:241–250.

35. Salim HO, Hamid HK, Mekki SO, et al. Colorectal carcinoma associated with schistosomiasis: a possible causal relationship. World J Surg Oncol. 2010;8:68.

36.Mohamed AR, al Karawi M, Yasawy MI. Schistosomal colonic disease. Gut. 1990;31(4):439-42.

37. Emara MH, Ahmed MH, Mahros AM, et al. No part of the colon is immune from large Bilharzial polyps. Eur J Gastroenterol Hepatol. 2020;32(7):896?897.
38. Bessa SM, Helmy I, El-Kharadly Y. Colorectal schistosomiasis. Endoscopic polypectomy. Dis Colon Rectum. 1983;26(12):772-4.)