EVALUATION OF ENHANCED CHEMILUMINESCENCE TECHNIQUE IN SCHISTOSOMA INFECTED PATIENTS BEFORE AND AFTER TREATMENT WITH COMMIPHORA MOLMOL

SUMMARYSchistosomiasis is considered as one of the most important parasitic helminthic diseases in many developing countries including Egypt and constitutes a major health problem affecting man’s health and productivity.Since resistance of schistosomiasis to different chemotherapeutic agents has been a growing problem in recent times with reported low efficacy of Praziquantel which was the corner stone in treatment of schistosomiasis.It is wise to resort to an alternative drug with a better effectiveness and also safety. Myrrh (Commiphora molmol) is one of the oldest known remedies used since ancient Egyption for medical purposes and recently proved to have schistosomicidal activities beside many other therapeutic effects with high safety.This study was designed to evaluate the ECL technique as a diagnostic noninvasive modality in detecting circulating schistosomal antigens before and after treatment with Commiphora molmol and assessment of cure rate after treatment.This study comprised 120 subjects divided into three groups.The first group (infected group) :Included 100 patients with manifestations suggestive of schistosomiasis attending the outpatient clinic of Tropical Medicine Department of Zagazig University Hospitals and proved by Kato method and rectal snips to have active bilharzial infection, they were 71 males and 29 females. Their ages ranged from 15-45 years.The second group (normal control group) :Included 10 persons proved to be healthy by routine clinical examination and routine investigations. They were 8 males and 2 females. Their ages ranged from 18-40 years.The third group (infected control group) :Included 10 patients proved to be free from bilharzial infection by routine stool analysis and Kato method, but had other parasites like Ascaris, Fasciola and Entrobius Vermicularis. They were 10 males and their age ranged from 16-26 years. ECL was done for all subjects CBC, liver and serum creatinine were done before and after treatment In the present study abdominal pain was the commonest symptom found in 28% of cases followed by tenesmus 20% of patients. The least frequent symptom was bleeding per rectum found only in 9% of cases. According to clinical data, hepatomegaly was found in 32% of cases while shrunken liver was noticed in 8% of cases and splenomegaly was detected in 26% of cases. Ultrosongraphy revealed hepatomegaly in 35% of cases and splenomegaly in 37% of cases while periportal fibrosis was detected in 45% of cases. All the studied cases were having light and moderate infections with no cases with heavy infection. There is a highly significant statistical decrease in egg output before and after treatment. There is a great improvement in the sigmoidoscopic picture after treatment as regard hyperaemia and hyperaemia with ulcer. There is no significant change niether liver functions nor kidney functions after treatment . A highly significant statistical decrease was noticed in mean ECL values after treatment with Commiphora molmol monitored by egg count and rectal snips. The overall cure rate in this study was 66% after treatment with Commiphora molmol. ECL test became negative in 95.5% of cured patients after treatment with Commiphora molmol. So, ECL test could be used for assessment of cure. The diagnostic sensitivity, specificity and accuracy of ECL test were 93%, 85% and 91.7% receptively.CONCLUSION1- ECL technique is a sensitive new method for detection of circulating schistosomal antigens.2- Commiphora molmol is an effective antischistosomal drug with high safety.3- There is no determining factor for responsiveness to treatment with Commiphora molmol as regard age, sex and hepatosplenic affection.4- ECL test could be used for assessment of cure after treatment (ECL became negative in 95.5% cured cases).RECOMMENDATIONS1- More studies based on a wide scale of population must be performed on the ECL technique to evaluate its sensitivity and specificity for circulating schistosomal antigens detection.2- As Commiphora molmol has been found to be highly effective and safe in comparison with other conventional drugs (e.g. praziquantel) so it is possible to recommend its use in prophylactic and mass treatment community programs.3- Some patients who are resistant to treatment with Commiphora molmol may benefit from extending the duration of treatment with or without the same standard daily dose.