مطالعه اپيدميولوژي باليني فاسيوليازيس انساني در گيلان

CLINICOEPIDEMIOLOGICAL STUDY OF HUMAN FASCIOLIASIS IN GUILAN

بدنبال اپيدمي هيپرائوزينوفيلي در اواخر سال 1367 و اوائل سال 1368، مطالعه روي 2364 بيمار صورت گرفت. پس از معاينات باليني كامل و انجام آزمايشات هماتولوژيك متداول، نمونه مدفوع 884 نفر به روشهاي مختلف به خصوص Modified KATOمورد آزمايش قرارگرفت كه در 5/‌36٪ تخم .Fasciola sp مشاهده شد. البته در بررسي اختصاصي تر75٪ بيماراني كه در فرمول شمارش خون آنها تعداد ائوزينوفيلها از 30٪ تجاوز مي‌كرد و بيش از سه ماه از شروع علائم باليني آنها مي گذشت نمونه مدفوع براي تخم Fasciola مثبت بود. 79٪از بيماران مونث بودند. در گروه سني 30-10 سال، بيماري بيشترين فراواني را داشت و شايعترين علائم و نشانه‌هاي بيماري به ترتيب عبارت بودند از: كاهش وزن (‌88٪)، در دا‌پيكاستر (87%)، تعريق (83%)، دردهيپوكندرراست (79%)، دردهاي عضلاني (78٪)، تب (77٪)، بي اشتهايي (75٪)، سرفه و تنگي نفس (57٪)، هپاتو اسپلنومگالي (25٪)، و يزينگ (10٪) و ندولها و آبسه هاي زيرجلدي (%11) .

Following an outbreak of hypereosinophilia in 1988 in Guilan province of Iran (particularly in Bandar Anzali and Laheejhan) a clinicoepidemiological study on 2364 patients was carried out. All patients were clinically examined and routine hematological tests were performed. Samples of stool from 884 patients (convenient sampling) were parasitologically examined, using different methods speciallpy modified KATO (3 Samples for each patient during lodags). Ova of Fasciola sp. were found in %36.5 of the patients. In a more specified study the parasitological examinations for Fasciola sp. was positive in %75 of the selected patients, who had a clinical history of more than 3 months and eosinophilia greater than %30.Detailed studies have shown that %79 of the patients were females and the infection was more frequent in 10-30 years old age group. The peak of the clinical disease was in spring 1989, which could be related to the consumption of raw local vegetables ( Mentha piperata Mentha aquatica, Nasturtium officinale , and Eryngium coerulesce) earlier in the winter. Different non- specific signs and symptoms were observed among which weight-loss, epigastric pain and sweating were chief complaints of more than %80 of the patients. myalgia, artreralgia, fever, pain of the right hypochondrium and anorexia were also of cosiderable occurrence (more than %70), cough and dyspnea were not uncommon (%57). In %66 of the patients leucocytosis in association with hypereosinophilia was observed. More than %90 of the patients had eosinophilia greater than %30 and %3 of them had eosinophilia still greater than %80. ESR was normal in only %2 and CRP was positive in %55 of the patients. This is the first report of weight loss as a major clinical finding in human fascioliasis