N
e w s it e s o fB
u l in u s t r u n c a t u sAND INDIGENOUS CASES OF URINARY SCHISTOSOMIASIS
in
J
o r d a nARBAJI A.*, AMR Z.S.**, ABBAS A.A.***, AL-ORAN R.****, AL-KHARABSHEH S.***** & AL-MELHIM W.N.**
Summary :
Thirty-two autochthonous cases of Schistosoma haematobium are reported from Ghore As-Safi, Karak lowlands, Jordan. All infected persons were males (9-46 years-old). New unusual breeding sites for Bulinus truncatus are discovered. The past and current distribution of the snail intermediate host is given.
KEY WORDS : Bulinus truncatus,schistosomiasis, Jordan.
R ésu m é : Nou vea uxsitesde Bulinustruncatusetcasa utoch ton es d esch istosom ia se urinaireen Jordanie
Trente-deux observations d'infections autochtones à Schistosoma haematobium sont rapportés de Ghore As-Safi, dans la région de Karak en Jordanie. Les personnes infectées sont toutes des hommes, âgés de 9 à 4 6 ans; Bulinus truncatus est découvert dans de nouveaux sites, inhabituels. La distribution ancienne et actuelle de cet hôte intermédiaire est précisée.
MOTS CLÉS :Bulinus truncatus, schistosomiase, Jordanie.
J
ordan w as co n sid ered a schistosom iasis-free country (Abdel Azim & Gismann, 1956). There has been a continuous influx o f foreign labor originating from schistosomiasis endem ic countries, especially from Egypt, into Jordan. Many o f these w or
kers are em ployed in agriculture in the most schisto
somiasis receptive areas in the country.
The first incligenous case o f S ch istoso m a h a e m a t o b iu m infection was reported in 1975 in the Jordan Valley (Saliba et a l ., 1976). During the period 1984- 1995, a total o f 60 cases o f urinary schistosomosis were reported among Jordanians from Tafila Governorate and the Jordan Valley (Saliba et al., 1986; Ministry o f Health records).
In 1980-1983, a national survey was organized to study the freshw ater snails o f Jordan, w hich resulted in reporting more than 15 breeding sites o f B u lin u s tru n ca tu s (Burch et al, 1985). Subsequently, the surveillance team o f the Ministry o f Health reported additional 45 sites in the Jordan Valley and along the Yarmouk River (Malaria, schistosom iasis and Zoonotic Diseases Division, Unpublished report).
* Malaria, Schistosomes and Zoonotic Diseases Division, Ministry o f Health. Amman, Jordan.
** Department o f Biology, Jordan University o f Science & Techno
logy. P.O. Box 3030. Irbid, Jordan.
*** Faculty of Medicine, The University o f Jordan.
**** Department o f Biology, Mutah University. Mutah, Jordan.
***** Disease Control Directorate, Ministry o f Health. Amman, Jordan.
Correspondence: Zuhair S. Amr. e-mail: amrz@just.edu.jo
Within the past forty years, Jordan has witnessed rapid changes in its environment, including habitat modifi
cation due to agricultural expansion along the Rift V alley and the Eastern D esert. W ater extraction, changes in watercourses, and construction o f dams and irrigation canals has drastically affected the distribution o f freshwater snails.
The present study reports on discovery o f new sites o f B. tru n ca tu s that lead to detection o f 32 autoch
thonous cases o f S. h a e m a t o b iu m in G hore As-Safi, Karak low lands.
MATERIALS AND METHODS
SAMPLING FRESHWATER BO D IES FOR THE PRESENCE o f Bu lin u s t r u n c a t u s
F
reshwater bodies (streams, ponds, pools, etc.) in diffe rent localities in Jordan w ere inspected for the presence o f B. tru n catu s. Snails w ere collected either manually from underneath rocks, floating ve ge tation, subm erged o b jects (plastic sheets and containers) or around the edges.
Ur i n e c o l l e c t i n g a n d e x a m i n i n g f o r t h e PRESENCE OF SCHISTOSOMA HAEMATOBIUM OVA Collected urine specim ens w ere kept in plastic tubes.
Specim ens w ere then centrifuged at 2,000 rpm for ten minutes. The sediment was aspirated by a Pasteur
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Article available athttp://www.parasite-journal.orgorhttp://dx.doi.org/10.1051/parasite/1998054379
ARBAJI A., AMR Z.S., ABBAS A.A., AL-ORAN R., AL-KHARABSHEH S. & AL-MELHIM W.N.
pipette onto glass slides and exam ined under the m icroscope.
DETERMINATION OF NATURAL INFECTION IN Bulinus TRUNCATUS
A total o f 195 B. tru n ca tu s snails w ere checked for infection. Snails w ere collected from irrigation pools in G hore As-Safi w here infected persons had previous contact with water. Shedding was performed as des
cribed in Amr et al. (1988).
RESULTS
D i s t r i b u t i o n o f Bulinus tr u n c a tu s in J o r d a n
S
ince 1975 and until the present, a total o f 60 sites w ere identified in four G ovem orates (Ministry o f Health Records). Most o f the know n populations were concentrated along the Jordan Valley and the Yar-m ouk River (Balqa and Irbid G ovem orates), other major sites includes Zarqa River, King Talal Dam and Jarash Roman Pools (Zarqa and Jarash G ovem orates).
Additional site in the southeastern desert was found to harbor the snail (Aqaba G ovem orates). Figure 1 shows the past and current distribution o f B . tru n ca tu s in Jordan.
N ew s ite s f o r Bulinus :tru ncatu s
During the summer and winter o f 1996, several field trips w ere made covering many perm anent and tem- porary water bodies in Jordan. Breeding populations o f B. tru n catu s were found in four additional new sites.
Ad-Disah
This new site is located to the south-east o f Jordan (29° 3 7 ’ N 35° 3 3 ’ E). The site is a permanent pool fed from an artesian well with thick vege tation o f Typha and T am arix .
Fig. 1. — The past and current dis
tribution of Bulinus truncatus in the m ajo r w ater b o d ies. Solid c ir c le s • in d ic a te p re v io u sly rep orted site. Stars * indicated newly discovered sites.
1. Ghadir Abu-Zeid 2. Zur Al-Khbeinah 3. Zur Al-Nasaireh
4. Tallat Khalid ben Al-Walid 5. Mahatat Iklid
6. Zur Al-Klea 7. Ar Ramtha
8. Jarash - The Roman pools 9- Jarash
10. Ghawr Kabid 11. El-Karamah 12. Ash Shunah
13- Wadi Batus & Al-Kufren Dam 14. Al-Kufren
15. Rama Wadi 16. Zur Shasha'a 17. Ghore As-Safi 18. Burbaytah Hammamat 19. Wadi Abu Dubana 20. Ad-Disah
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B ULINUS TRUNCATUS AND SCHISTOSOMIASIS IN JORDAN
Ar Ramtha
This new location (32° 3 4 ’ N 360 0 0 ’ E) is a small mud dam constructed at the Jord an University o f Science and Technology cam pus to hold rain w ater for irriga
tion. Aquatic vegetation such as Typha is restricted to the dams’ wall.
Ghore As-Safi
G hore As-Safi is an agricultural area situated along the Southern end o f the Dead Sea (31° 0 2 ’ N 35° 28’ E). Irri
gation ponds are very com m on and fed from Wadi Al- Hasa. O f 172 ponds exam ined, 59 (34.7% ) w ere found infested with B. tru n ca tu s at diffe rent stages o f deve
lopment. The population o f G hore As-Safi is about 15,000 inhabitants, mostly engaged in agriculture.
Wadi Abu Dubana
This site is a permanent water body that stretches from the east to the northwest o f Wadi Araba (3 0 ° 4 2 ’ N 35° 17’ E). Lush vege tation o f T ypha and other reeds are common.
All new sites w ere sprayed using niclosamide (1 ppm).
Urin e e x a m in a tio n resu lts
After the discovery o f the above-m entioned breeding sites for B. tru n catu s, an extensive urine exam ination cam paign am ong the Egyptian w orkers em ployed in these areas w as undertaken. O ne Jordanian living in G hore As-Safi indicated that he discharged bloody urine. Subsequently, mass urine co llectio n and ex a m ination w ere undertaken in this area. At G hore As- Safi, a total o f 5,637 urine sam ples w ere exam ined for the p resen ce o f S. h a e m a t o b iu m ova (T able I).
Thirteen m a le school students (0.3 4 %), 19 m a le far- m ers (a ll Jord an ians) and 17 foreign w orkers (a ll Egyptian m a le s) w ere found to be infected. m a le school students under 16 and m ales aged 16-27 years- old constituted 37.5 % and 46.9 % o f infected persons respectively. Fem ale school students w ere not found to be infected.
A total o f 349 and 65 samples w ere collected from Egyptian w orkers at Al-Disah and Ar-Ramtha with infection rates o f 7.5 and 7 .7 % respectively.
Table I. - Infection rates among diffe rent population categories in Ghore As-Safi.
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All infected persons w ere treated immediately using praziquantel (40 mg/kg as a single dose).
N a t u r a l i n f e c t i o n in Bulinus truncatus
All snails exam ined for the presence o f cercaria were negative.
DISCUSSION
R
em arkable changes o f water utilization patterns are continuing to occur in Jordan, this is exem - plified by w ater extraction from the underground aquifers in rem ote and arid environments in the Eastern Desert and Wadi Rum area to m eet the demand for the expanding m odem agriculture and drinking water. Several major changes have occurred within the past two decades including construction o f dams in diffe rent parts o f the kingdom (Karamah and King Talal Dam), and changes in w atercourses o f natural waterbodies, will allow the dispersai and range expansion o f several freshwater snails into newly sui- table habitats. Indeed, one o f these dams, King Talal Dam, was the most heavily infested site for B. truyi- catus. Similar findings w ere reported by Tiemersma et a l (1997) in M orocco due to construction o f m odem surface irrigation schem es.
Most o f the agricultural irrigation systems in the Jordan Valley and many parts o f Jordan depend on the drip- ping system, w here water ponds (Plastic, cem ented or mud) are constructed to pump water. Such ponds hold water all-year-round and offers a suitable breeding sites for the intermediate host snail.
Continuous surveillance o f perm anent water bodies should be continued to reveal new breeding sites for the snail vector. T he num ber o f discovered sites increased enorm ously after the initial discovery o f the snail in the Jordan Valley in 1975, reaching 60 in 1997. Also, a data-base covering all w ater bodies should be established. Monitoring newly constructed dams and other irrigation schem es must be imple- mented in collaboration with the involved authorities (Jordan Valley authority, Ministry o f Planning, etc.).
It is noteworthy to indicate that tap water reaches up to 95 % o f villages and houses are served with modest latrines. Due to the presence o f these services, beha- vioral and social patterns o f water contact in areas w here the intermediate host snail is abundant are not practiced on a large scale such as washing clothes, utensils, and animals, bathing and swimming, urina
tion and de fe cation and taking water for domestic use.
In Egypt and Iraq, such activities are practiced in many villages due to the absence o f municipal services (Abdel-W ahab, 1982). Social customs and tradition
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ARBAJI A., AMR Z.S., ABBAS A.A., AL-ORAN R., AL-KHARABSHEH S. & AL-MELHIM W.N.
forbid fem ales from pathing or swimming in open w ater. This may explain the ab sen ce o f infection among females.
A m obile unit for active case detection is stationed in the Jordan Valley. Tasks o f this unit include laboratory diagnosis for urine samples and treatment o f infected persons using praziquantel (40 mg/kg as a single dose).
However, urine sample collecting at ports o f entry should be enforced.
In addition, health e d ucation through the m edia should b e addressed and promoted. Further investi
gation into man-water contact patterns is needed if the disease is to be controlled effectively. In the Jordan Valley, sanitary practices remain poor w ithout ade quate disposai o f human excreta and developm ent o f sew age systems, to avoid contact o f urine with the fre
shw ater habitats.
Chemical control seem s not to affect the populations o f the snail interm ediate host. Since 1981, the King Talal Dam is undergoing chem ical control on irregular basis, and the snails re-appeared several times. Addi- tionally, the high cost o f m olluscicides and the ill- effects they inflect on fish farms may hinder the efforts. In an area like G hore As-Safi, with extensive ponds and ditches, it is advisable to resort to biolo
gical control. Our initial laboratory studies show ed that B a c illu s th u rin g ien sis isolated from different soil sam ples in Jord an has an effect on the viability o f B.
t r u n c a tu s egg m asses. O th er co n tro l alternatives should be investigated in especially large water bodies (fishes as G a m b u s ia a ffin is, other predatory snails as M a risa c o m u a r ie t is and other bacterial agents).
ACKNOWLEDGEMENTS
W
e would like to extend our thanks to the staff o f Malaria, Schistosom es and Z oonotic Diseases Division, Ministry o f Health, Amman, Jordan. This work was supported in part by the Higher Council o f Science & Technology/Badia D evelopm ent and Research Project (Animal Biodiver- sity). W e are grateful for the continuous support o f Eng. Mohamed Shahbaz, D irector o f the Badia D eve
lopm ent and Research Project.
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Reçu le 23 septembre 1997 Accepté le 25 juin 1998
Parasite, 1998, 5, 379-382
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