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Studies on the sero-epidemiology of endemic diseases in Libya. I. Echinococcosis in Libya.

In Libya traditional animal husbandry and the practice of domestic slaughter of food animals contribute to the maintenance of the Echinococcus cycle. The cost of echinococcosis is high and may significantly affect the national economy. This study, employing the ELISA test, has indicated an approximately 10% infection rate in children and young adults from the environs of Benghazi, no difference being apparent between rural and urban dwellers. The prevalence of the infection should be determined in both animals and man and possible disease inter-relationships investigated. Surveys are required in all alleged endemic areas and in sheep and camel breeding areas. It is also necessary to determine the importance of foxes, hyaenas and jackals in transmission among other animals. A clinical trial is recommended to assess the value of mebendazole against Echinococcus cysts.

Adolescent

First record of Planorbis planorbis (Linnaeus) naturally infected with Xiphidiocercariae from Derna, Libya.

A review of the literature shows that the fresh water snail Planorbis planorbis (Mollusca: Gastropoda) infected with Xiphidiocercariae has never been recorded in Derna, Libya. In the present paper the first record is made from Wadi Derna (= Darnah), East coast of Libya. The snail harbour Xiphidiocercariae, the percentage of infection during May, 1989, was found to be 7.3%. Morphological description of the snail Planorbis planorbis, Xiphidiocercariae is given in the present investigation. The snail possibly acts as an intermediate host of trematode species in Libya. Further studies are needed to investigate and to observe the exact type of trematode in which the fresh water snail P. planorbis acts as an intermediate host in the life-cycle and to determine the definitive host in Libya.

Animals

Prevalence of human hydatid disease in northwestern Libya: a cross-sectional ultrasound study.

A total of 4103 people were screened in an ultrasound survey of the prevalence of hydatid disease (Echinococcus granulosus) in five areas of northwestern Libya; hydatid cysts were seen in 57 (1.4%), an overall prevalence of approximately 2.0% when adjusted for the likelihood of the occurrence of cysts in other sites in the body. All ultrasound-positive cases were confirmed by dot-blot ELISA. The prevalence of hydatid cysts increased with age, and differed between the sexes except in the five to 14 age group. All diagnosed cases, even those with large cysts, were asymptomatic. This study demonstrates the value of ultrasonography for screening field populations for hydatid disease. The technique was well received locally, facilitating the rapid collection of prevalence data from all ages and both sexes. Libyan people keep guard dogs, but there is little direct human:dog contact. Many people own a single dog, invariably kept outside and often chained up. Stray dogs are common, roaming the countryside to scavenge sheep carcases etc., and such dogs could be the main reservoir of E. granulosus in Libya. Because of the minimal direct human:dog contact, transmission of hydatid disease in Libya is probably indirect by ingestion of eggs from contaminated vegetables or drinking water.

Adolescent

Experience of a family clinic at Benghazi, Libya, and sociomedical aspects of its catchment population.

The article highlights the pioneering efforts towards establishment of a family clinic as a model for provision of primary health care to the community at family level in Libya. Home visits were undertaken by health teams to introduce the clinic and record demographic and sociomedical data. Families were invited to attend the clinic for a complete health examination. It was largely a young population with an average family size of 7.1. The houses were generally overcrowded. The majority of the heads of families had no formal education or skilled occupation but 98.1% had gainful employment. The vital statistics of the population, though comparable to the national figures, reflect a better health status. The infant mortality rate of the reference population was 25.9 per 1000 live births compared with 32.8 for the whole of Libya. Most reproductive age women (81.5%) breast fed their children for six months or more and 4% used contraceptives. The overall morbidity rate was 255 per 1000 population and the morbidity pattern, with a predominance of infections, was typical of a developing country. Each case diagnosed during the survey was appropriately treated and those with chronic diseases are being followed up. It is felt that such family based comprehensive health care units will go a long way in providing primary health care throughout Libya.

Adolescent

Kala azar in an adult Libyan and review of visceral leishmaniasis in Libya.

Less than 30 confirmed cases of kala azar have been reported from Libya in this century. Many of the reported patients had stayed outside Libya and the majority were young children. After a span of fifty years we diagnosed an autochthonous case in an adult Libyan. The parasite was difficult to grow in N.N.N. culture media. During a small population survey in the area, no other case could be detected. Very little is known about the reservoir, vector, and sub-species of the parasite in Libya. The atypical symptoms, the rarity of cases detected and the difficulty of growing the parasite in vitro could be due to a different strain of the parasite causing visceral leishmaniasis in this area.

Adult

Major causes of intestinal obstruction in Libya.

The object of this study is to focus attention on the causes of intestinal obstruction in Libya. In this study, spread over 30 months and involving 114 patients, the most common cause was the entrapment of bowel in an external hernia. Postoperative adhesions accounted for obstruction in a third of our patients, and 59 per cent of them followed appendicectomy. Biliary lithiasis is the most common surgical disease in Libya, yet there was only one instance of gallstone ileus in this series. Sigmoid volvulus and intestinal lymphoma were also rare, and tubercular stricture and Crohn's disease were remarkable by their absence. There were no cases of idiopathic intussusception during or immediately following Ramadan.

Adolescent

On the distribution of some genetic markers in libya.

On a sample of N equals 169 nonrelated blood donors from Libya several blood group, serum protein group and enzyme frequencies are within the range of those of other Caucasoid populations. However, the frequencies of cDe, Jk-a, Fy-c, Hp-1, Gc-1, aP-b and AK-1 show some greater differences and seem to indicate certain Negroid influence on the genetic composition of our Libyan sample. This assumption is conceivable considering the racial history of Libya.

Acid Phosphatase

Cytogenetic analysis of Down syndrome in Libya.

The frequency of Down syndrome in Libya was 1 in 516 live births. The mean age of Down mother was 35.62 years. Eighty two percent of the Down mothers were over 30 years of age as compared to 36% of the control Libyan mothers. As there was a greater percentage of late conceptions, the maternal age appears to be influential in the birth of Down syndrome in Libya. Cytogenetically 96% of the cases were that of trisomy 21. There was one case each of mosaic and 21/21 translocation, and four cases of 14/21 translocation as evidenced by Giemsa banding. Twenty two percent of the cases of Down syndrome also had other associated congenital abnormalities. The unique features involved in genetic counselling in this population are discussed. This study reflects the enormous problem of Down syndrome in the Arab world.

Adult

Observations on the New World screwworm fly in Libya and the risk of its entrance into Egypt.

Data on traumatic myiasis caused by Cochliomyia hominivorax in Libya were reported from August 1988 until February 1989. A total of 468 cases of screwworm myiasis were recorded in seven species of livestock and 229 humans, mainly children, were also found to be infested. Cattle and sheep were the most common hosts in livestock. In cattle, the principal infestation site was the umbilicus of neonates; in sheep, it was mainly the fatty tail. Animal myiasis reached its peak in October and November, but disappeared abruptly in winter on the onset of cold weather. Screwworm distribution was confined to the northwest of Libya. The potential dispersion of the fly from this area and the possibility of infestation of other countries, particularly Egypt, are discussed. Food and Agriculture Organization (FAO) efforts to confront the New World screwworm problem in Africa are mentioned.

Animals

A survey of ticks on farm animals in Libya.

Thirteen species of ixodid ticks and two species of argasid ticks were collected during a three-year survey of 58 farms in Libya. These included Boophilus annulatus, B. microplus, B. decoloratus, seven species of Hyalomma, Rhipicephalus sanguineus, Rh. evertsi, Rh. bursa, Argas persicus and Ornithodoros foleyi. This is the first recording of B. microplus, B. decoloratus and Rh. bursa in Libya. Of 20,391 animals examined by random sampling, 2020 (9.6%) had ticks; particularly common were Hy. dromedarii on camels, Hy. impeltatum on sheep and Hy. excavatum on cattle. The tick found most frequently overall was Hy. dromedarii.

Animals

The New World screwworm fly in Libya: a review of its introduction and eradication.

The New World screwworm fly, Cochliomyia hominivorax (Coquerel) (Diptera: Calliphoridae), became established in the Old World for the first time during 1988, in the Socialist People's Libyan Arab Jamahiriya. An obligate parasite of mammals in its larval stages, causing wound myiasis, it is one of the most serious insect pests of livestock in the Americas. To avert a major disaster for the livestock industry and wildlife of Africa and southern Europe, the Libyan Government and the Food and Agriculture Organization of the United Nations launched a massive screwworm eradication programme, based on the sterile insect technique, SIT. An initial containment operation involved veterinary teams working in the infested area (25,000 km2 around Tripoli), regularly inspecting livestock and, if necessary, treating them with insecticide. Quarantine stations were also set up, to prevent the movement of infested livestock out of the area. Sterile flies from the Mexican-American Commission for Eradication of Screwworms were first released in December 1990 at the rate of 3.5 million per week. This built up to 40 million per week by May 1991. The release of sterile flies was terminated on 17 October 1991, 6 months after the last detected case of screwworm myiasis in Libya. Intensive surveillance and quarantine activities will, however, continue through 1992. During 1992 the Libyan Government should be able to officially declare the New World screwworm eradicated from Libya, making it one of the most important success stories of pest control.

Animals

Prevalence and pattern of renal disease in eastern Libya.

A prospective study was conducted to identify the pattern and aetiology of kidney disease in children living in eastern Libya. A total of 343 patients was studied, representing 3% of annual admissions to the children's hospital. The major renal diseases were post-streptococcal glomerulonephritis (in 116), acute renal failure (in 93), and idiopathic nephrotic syndrome (in 65). Less common diseases were tubular transport defect (in 3) and end-stage renal disease (in 3). The mortality rate (excluding neonates) was below 1%. The pattern of kidney disease referred to this hospital in Libya was different from that reported in other parts of Africa.

Acute Kidney Injury

Pseudotumour cerebri: incidence and pattern in North-Eastern Libya.

The present documentation of 23 female patients with pseudotumour cerebri seen in Benghazi, North-Eastern Libya, over a period of 2 years constituted 21 cases with idiopathic pseudotumour and 2 patients with associated endocrine diseases. The clinical, laboratory and CT scan findings indicated idiopathic hypoparathyroidism in 1 case. The association of pseudotumour and hypothyroidism in a 40-year-old woman is suggested to be more than coincidental. The patient group was significantly more obese. Moderate to severe visual loss occurred in 9 patients. The incidence and extent of visual impairment did not correlate with the duration of symptoms, degree of obesity, use of contraceptive pills, steroid treatment, the presence of systemic hypertension, menstrual irregularity or empty sella. The incidence of 1.7 per 100,000 for the total and 3.6 per 100,000 for the female population in Benghazi observed in the present study is believed to be more than the frequency (as assessed by the hospital incidence) reported from other regions. A high prevalence of obesity may partly explain the increased occurrence of pseudotumour cerebri in North-Eastern Libya.

Adult

Haemoglobinopathies in Libya.

Electrophoretic study of haemolysates from five hundred and forty-five subjects from the University of Garyounis, Benghazi, was carried out to find out the incidence of abnormal haemoglobins in Libya. Abnormal haemoglobins were encountered in 23 subjects of unrelated families, giving an overall incidence of 4.2 per cent. Sixteen of these subjects had Hb-AS trait (3.0%), Five subjects had Hb-AC trait (0.9%) and two subjects had Hb-AD trait (0.36%). Present study indicates that the incidence of abnormal haemoglobins in the indigenous population of Libya is low.

Anemia, Sickle Cell

The incidence of red-green colourblindness in the populations of Tripolitania, Cyrenaica and Fezzan in Libya, and of the Kikuyu, Kamba, Taita, Taveta and Luo tribes of Kenya.

The results of surveys of colourblindness carried out using the Ishihara test cards in Libya and Kenya, involving 384 and 504 individuals respectively, are reported. The Libyan samples, drawn from three geographically distinct regions of the country, are relatively homogeneous. The Kenyan samples, on the other hand, are heterogeneous, but in toto they display a markedly lower colourblindness percentage than do the Libyans. The Kenyan data are in broad accord with the other data available for sub-Saharan African populations. There are very few sets of comparative data available for North African populations, but the Libyan material displays a lower incidence of colourblindness than the values reported in European populations.

Color Vision Defects

A clinical, epidemiological and genetic study of hereditary motor neuropathies in Benghazi, Libya.

A 4-year-search for spinal muscular atrophies (hereditary motor neuropathies, HMN) in Benghazi, Libya, yielded a total of 24 patients, among whom 18 were index cases. This group comprised 6 acute infantile, 12 chronic childhood, and 3 each with adult-onset proximal, and distal forms of the disorder. Distal HMN constituted 12.5% of the total cases. The crude average annual incidence of acute infantile HMN was 0.3/100,000 total population and 1/12,500 births in Benghazi. The crude prevalence rates of chronic childhood, adult-onset proximal, and distal types of HMN were 2.3, 0.6, and 0.6/100,000 respectively. The segregation ratios, 0.26 for acute infantile HMN and 0.24 for chronic childhood HMN, suggested autosomal recessive inheritance. The consanguinity rates among parents of cases and the population did not differ significantly.

Acute Disease

Studies on the screwworm fly Cochliomyia hominivorax in Libya: effect of temperature on pupation and eclosion.

The American screwworm fly Cochliomyia hominivorax has recently been reported in Libya (El-Azazy 1989). Fly larvae were cultured on blood agar at different temperatures (-5 degrees, 5 degrees, 18 degrees, 20 degrees, 30 degrees, 37 degrees, or 40 degrees C). Larvae pupated at 18 degrees, 20 degrees, 30 degrees, or 37 degrees C, and the highest pupation (100%) occurred at 20 degrees C. Adult flies emerged from pupae that were maintained at 18 degrees, 20 degrees, 30 degrees, or 37 degrees C; the maximal eclosion (94%) occurred at 20 degrees C. Correlation of these findings with meteorological temperature data from local areas in which C. hominivorax myiasis occurs suggests a crucial role for temperature in the determination of the effective environment for this fly species.

Animals

Serological and clinical investigations of human hydatid case in Libya.

Fifty surgically confirmed cases of hydatid disease in Eastern Libya were investigated. Of these, 30 had cysts of the liver, five had extra-hepatic abdominal cysts and 15 had cysts in the chest, including the lungs. Ten cases of malignancy of the liver and five cases of malignancy of the lung were used as controls. Differential diagnosis of cancer was made by measuring the ESR and glycoprotein levels (elevated x 4 and x 3 respectively, in cancer cases). Serum bilirubin, SGOT, SGPT and serum alkaline phosphatase levels were also significantly raised in malignancy, while the total protein levels and eosinophilia were the same in both diseases. The intradermal test was positive in 88%, the haemagglutination test in 86% and the complement fixation test in 70% of cases. In the post-operative follow-up, complement-fixing antibodies disappeared somewhat faster than did the haemagglutinins. The positive skin test cases, however, remained positive throughout the 12-month follow-up period.

Blood Sedimentation