Ahmed Ehab - Academia.edu (original) (raw)

Papers by Ahmed Ehab

Research paper thumbnail of Echopulmonography as a Surrogate Modality in Disclosure of Occult Pulmonary Consequences of Pulmonary Vascular Occlusion

Current Respiratory Medicine Reviews

Background: Diagnostic modalities of pulmonary embolism (PE) are still emerging day after day wit... more Background: Diagnostic modalities of pulmonary embolism (PE) are still emerging day after day with new tools and promising characteristic features. Objective: The aim of our work was to assess the diagnostic yield of echopulmonography in patients with PE regarding pleural, parenchymal and vascular features of acute events and consequences. Methods: This is a prospective quasi-experimental study in which transthoracic echopulmonography was adopted as a screening method for patients with clinical suspicion of PE in comparison to Multi-Detector Computed Tomography Angiography of the chest, which is the best standard. This study was conducted on 32 patients at the chest department in Mansoura University Hospital and a Specialized Internal Medicine Hospital. Results: Echopulmonography was positive for pulmonary embolism at 68.75% but was of negative value in 31.25%. On the other hand, CTPA was positive for pulmonary embolism in (71.78%) but was of negative value in 28.12%. EPG confirm PE...

Research paper thumbnail of Screening of latent TB infection in patients with recently diagnosed bronchogenic carcinoma

Asian Cardiovascular and Thoracic Annals

Background Cancer and pulmonary tuberculosis are major global health concerns and are associated ... more Background Cancer and pulmonary tuberculosis are major global health concerns and are associated with substantial morbidity and mortality. The association between active tuberculosis and subsequent cancer development has been investigated for many years. This study was planned to determine the prevalence of latent tuberculosis infection in patients with recently diagnosed bronchogenic carcinoma. Methods Sixty-four newly diagnosed primary lung cancer patients were enrolled. Diagnosis of latent tuberculosis infection was performed with QuantiFERON-TB Gold In-Tube tests, with exclusion of active tuberculosis. Results Latent tuberculosis infection was detected in 16 (25%) patients, and 8 (12.5%) had indeterminate results of the QuantiFERON-TB Gold In-Tube test. Being a current smoker was associated with a higher prevalence of latent tuberculosis ( p = 0.001). Comorbidities, tumor site, and histopathology were not associated with latent tuberculosis infection. Conclusions There is a cons...

Research paper thumbnail of Internal fixation of the proximal tracheal self-expandable metallic stent (SEMS): migration prevention in high risk patients

Journal of Thoracic Disease

Research paper thumbnail of Intralobar pulmonary sequestration: A rare presentation in adults

International Journal of Case Reports and Images

Research paper thumbnail of Cryobiopsy increases the EGFR detection rate in non-small cell lung cancer

Research paper thumbnail of Cryobiopsy to increase the detection rate of EGRF-mutations in non-small cell lung cancer

Journal of Clinical Oncology

Research paper thumbnail of Bleeding risk of transbronchial cryobiopsy compared to transbronchial forceps biopsy in interstitial lung disease – a prospective, randomized, multicentre cross-over trial

Research paper thumbnail of Cryobiopsy increases diagnostic yield in mucosal endobronchial lesions in comparison to forceps biopsy

Interventional Pulmonology

Research paper thumbnail of Efficacy and safety of transbronchial cryobiopsy in interstitial lung diseases

Interventional Pulmonology

Research paper thumbnail of The Clinical Significance of a ‘Crazy-Paving’ Pattern on Chest Radiology

European Journal of Case Reports in Internal Medicine

Research paper thumbnail of Cryobiopsy versus forceps biopsy in endobronchial lesions, diagnostic yield and safety

Advances in respiratory medicine, 2017

This study aimed to evaluate the safety and diagnostic yield of CB in comparison to forceps biops... more This study aimed to evaluate the safety and diagnostic yield of CB in comparison to forceps biopsy in endobronchial lesions. Patients with suspected endobronchial lesions were enrolled. Two forceps biopsies and one cryobiopsy were done in the same patient with randomized sequence. The largest diameter of the samples was measured in mm by electronic caliper. Diagnostic yield of each technique and postbronchoscopy bleeding were evaluated. Samples obtained by CB was significantly larger than that of the forceps biopsy (5.9 ± 2.3 vs 2.5 ± 0.8), (p = 0.001). Diagnostic yield of CB was significantly higher than forceps biopsy 74.5% versus 51.1% (p = 0.001). Mild and moderate bleeding grades were reported in both techniques with no significant difference (p = 0.063) (p = 0.5) respectively. Severe bleeding was not recorded in both techniques. CB represents a safe and effective tool to obtain a larger tissue samples of a good quality with higher diagnostic yield in comparison to standard for...

Research paper thumbnail of Transbronchial Cryobiopsy – Is the bleeding risk changed in comparison to transbronchial forceps biopsy?

1.4 Interventional Pulmonology

Research paper thumbnail of A new functional method to choose the target lobe for lung volume reduction in emphysema - comparison with the conventional densitometric method

International journal of chronic obstructive pulmonary disease, 2017

Lung volume reduction (LVR) improves breathing mechanics by reducing hyperinflation. Lobar select... more Lung volume reduction (LVR) improves breathing mechanics by reducing hyperinflation. Lobar selection usually focuses on choosing the most destroyed emphysematous lobes as seen on an inspiratory CT scan. However, it has never been shown to what extent these densitometric CT parameters predict the least deflation of an individual lobe during expiration. The addition of expiratory CT analysis allows measurement of the extent of lobar air trapping and could therefore provide additional functional information for choice of potential treatment targets. To determine lobar vital capacity/lobar total capacity (LVC/LTC) as a functional parameter for lobar air trapping using on an inspiratory and expiratory CT scan. To compare lobar selection by LVC/LTC with the established morphological CT density parameters. 36 patients referred for endoscopic LVR were studied. LVC/LTC, defined as delta volume over maximum volume of a lobe, was calculated using inspiratory and expiratory CT scans. The CT mor...

Research paper thumbnail of Feasability of flexible bronchoscopy under sedation without local anaesthesia of the pharynx

European Respiratory Journal, 2015

Research paper thumbnail of The impact of single-dose diethylcarbamazine treatment of bancroftian filariasis in a low-endemicity setting in Egypt

The American journal of tropical medicine and hygiene, 2002

This study was designed to evaluate the effect of a single dose of diethylcarbamazine (DEC, 6 mg/... more This study was designed to evaluate the effect of a single dose of diethylcarbamazine (DEC, 6 mg/kg) on Wuchereria bancrofti infections in a low-endemicity setting in Egypt (microfilaremia, or MF, 3.7%, median MF 34/mL). Subjects with MF or filarial antigenemia were treated and restudied 1 year later. Treatment with DEC dramatically reduced blood MF counts, with clearance in 69% of subjects. Treatment also reduced filarial antigen levels, but low clearance rates suggest that some adult worms survived treatment in most patients. Mass treatment was administered in one village; 27 months later, MF prevalence had decreased 84% (from 4.9% to 0.8%). These results show that single-dose DEC treatment can have a major effect on MF prevalence rates and levels in low-endemicity settings. Although the World Health Organization advocates repeated multidrug regimens for filariasis elimination, mass treatment with DEC alone may be sufficient to interrupt transmission in areas with low infection in...

Research paper thumbnail of A randomized clinical trial comparing single- and multi-dose combination therapy with diethylcarbamazine and albendazole for treatment of bancroftian filariasis

The American journal of tropical medicine and hygiene, 2004

The Global Program for Elimination of Lymphatic Filariasis calls for mass drug administration for... more The Global Program for Elimination of Lymphatic Filariasis calls for mass drug administration for endemic populations outside of sub-Saharan Africa with a single dose of diethylcarbamazine (DEC) and albendazole (Alb) annually for 4-6 years. Single-dose DEC/Alb dramatically reduces blood microfilaria (MF) counts, but most treated subjects fail to completely clear MF after a single dose. A more effective regimen might reduce the number of years required for elimination programs. We performed a randomized clinical trial in Egyptian adults with asymptomatic microfilaremia to compare treatment with seven daily doses of oral DEC (6 mg/kg) and Alb (400 mg) with a single dose of the same combination. We also studied the effect of re-treatment with single-dose DEC/Alb 12 months after the first treatment course. Multi-dose DEC/Alb was significantly more effective than single-dose therapy for reducing and clearing microfilaremia (mean reduction in MF/ml relative to pretreatment counts at 12 mo...

Research paper thumbnail of Duplex Doppler sonographic assessment of the effects of diethylcarbamazine and albendazole therapy on adult filarial worms and adjacent host tissues in Bancroftian filariasis

The American journal of tropical medicine and hygiene, 2004

We used duplex Doppler sonography to assess effects of diethylcarbamazine and albendazole therapy... more We used duplex Doppler sonography to assess effects of diethylcarbamazine and albendazole therapy (DEC/ALB) on adult Wuchereria bancrofti in vivo. The study was performed in clinically normal Egyptian adults with blood microfilaria counts > 80/mL. Motile adult worms were observed before treatment in dilated scrotal lymphatic vessels in 28 of 36 men (78%) and over the proximal extremities in 5 of 22 women (23%). Most worm nests were inactivated in the months following treatment (90% at 12 months). Circulating filarial antigen levels (a marker for living adult worms) also fell dramatically following treatment. Some men had intrascrotal calcifications and/or non-palpable hydroceles detectable by ultrasound before they were treated. New hydroceles and intrascrotal calcifications appeared after treatment in many cases. However, most of these were transient and of no clinical significance. Prevelance rates for hydrocele and intrascrotal calcifications 24 months after treatment were ess...

Research paper thumbnail of Ultrafast Phase Aberration Correction in Ultrasound Imaging Using a Simple Model for Fat Layer

Proceedings of the Twenty Third National Radio Science Conference (NRSC'2006), 2006

Research paper thumbnail of Bancroftian filariasis: effect of repeated treatment with diethylcarbamazine and albendazole on microfilaraemia, antigenaemia and antifilarial antibodies

Transactions of the Royal Society of Tropical Medicine and Hygiene, 2006

Diethylcarbamazine/albendazole (DEC/ALB) therapy is widely used in mass drug administration (MDA)... more Diethylcarbamazine/albendazole (DEC/ALB) therapy is widely used in mass drug administration (MDA) programmes aimed at eliminating lymphatic filariasis. We studied the effects of repeated annual treatments with DEC/ALB on Wuchereria bancrofti microfilaraemia, filarial antigenaemia and IgG4 antibodies to Bm14 antigen. Fifty-seven subjects with asymptomatic microfilaraemia were treated with one or seven daily doses of DEC/ALB at time zero. All subjects were re-treated with single-dose DEC/ALB 12, 24 and 36 months later. The two treatment groups had comparable pre-treatment microfilaria counts. Multidose treatment cleared microfilaraemia more effectively than single-dose treatment. Filarial antigen levels decreased equally in both treatment groups. Total antigen clearance was observed in 29.6%, 52.0%, 63.6% and 79.5% of subjects at 12, 24, 36 and 48 months. These clearance rates are much higher than those observed in prior treatment trials with DEC or ivermectin. Antibody levels increased 4 weeks after treatment and then slowly decreased in most subjects. Antibody tests turned negative in 20%, 35%, 39.4% and 52.5% of treated subjects at 12, 24, 36 and 48 months post treatment. These results show that the studied parameters decline at different rates and to differing degrees following DEC/ALB treatment. These findings have important implications regarding strategies for monitoring the effects of MDA in populations.

Research paper thumbnail of Effect of yearly mass drug administration with diethylcarbamazine and albendazole on bancroftian filariasis in Egypt: a comprehensive assessment

The Lancet, 2006

Egypt was one of the first countries to implement a national programme to eliminate lymphatic fil... more Egypt was one of the first countries to implement a national programme to eliminate lymphatic filariasis based on WHO's strategy of repeated rounds of mass drug administration (MDA) with diethylcarbamazine and albendazole (target population, 2.5 million in 181 localities). We assessed the effect of five yearly rounds of MDA on filariasis in four sentinel villages in Egypt. We studied two areas with different infection rates before MDA: the Qalubyia study area had a low infection rate because of previous treatment with diethylcarbamazine; this was typical of most filariasis-endemic villages in Egypt before MDA. The Giza study area had a high baseline infection rate. We undertook repeated surveys in villages for treatment compliance and tests for microfilaraemia and circulating filarial antigenaemia, antibodies to filarial antigen Bm14 in schoolchildren, and infections in indoor-resting mosquitoes (assessed by PCR). MDA compliance rates were excellent (>80%). In Giza after MDA, prevalence rates of microfilaraemia and circulating filarial antigenaemia fell from 11.5% to 1.2%, and from 19.0% to 4.8%, respectively (p<0.0001). Corresponding rates in Qalubyia fell from 3.1% to 0% and 13.6% to 3.1%, respectively (p<0.0001). Rates of antifilarial antibody and circulating filarial antigenaemia in schoolchildren (aged about 7-8 years), fell from 18.3% to 0.2% (p<0.0001) and from 10.0% to 0.4% (p<0.0001) in Giza, respectively, and from 1.7% to 0% and 1.7% to 0% (both p=0.13) in Qalubyia, respectively. Mosquito infection rates fell from 3.07% (95% CI 2.38-3.88) to 0.19% (0.08-0.38) in Giza and from 4.37% (3.07-5.99) to 0% (0-0.05) in Qalubyia. MDA greatly affects variables related to infection (microfilaraemia and circulating filarial antigenaemia prevalence rates) and transmission (antifilarial antibodies in young children and mosquito infection rates). Our results suggest that after five rounds of MDA filariasis is likely to have been eliminated in most endemic localities in Egypt.

Research paper thumbnail of Echopulmonography as a Surrogate Modality in Disclosure of Occult Pulmonary Consequences of Pulmonary Vascular Occlusion

Current Respiratory Medicine Reviews

Background: Diagnostic modalities of pulmonary embolism (PE) are still emerging day after day wit... more Background: Diagnostic modalities of pulmonary embolism (PE) are still emerging day after day with new tools and promising characteristic features. Objective: The aim of our work was to assess the diagnostic yield of echopulmonography in patients with PE regarding pleural, parenchymal and vascular features of acute events and consequences. Methods: This is a prospective quasi-experimental study in which transthoracic echopulmonography was adopted as a screening method for patients with clinical suspicion of PE in comparison to Multi-Detector Computed Tomography Angiography of the chest, which is the best standard. This study was conducted on 32 patients at the chest department in Mansoura University Hospital and a Specialized Internal Medicine Hospital. Results: Echopulmonography was positive for pulmonary embolism at 68.75% but was of negative value in 31.25%. On the other hand, CTPA was positive for pulmonary embolism in (71.78%) but was of negative value in 28.12%. EPG confirm PE...

Research paper thumbnail of Screening of latent TB infection in patients with recently diagnosed bronchogenic carcinoma

Asian Cardiovascular and Thoracic Annals

Background Cancer and pulmonary tuberculosis are major global health concerns and are associated ... more Background Cancer and pulmonary tuberculosis are major global health concerns and are associated with substantial morbidity and mortality. The association between active tuberculosis and subsequent cancer development has been investigated for many years. This study was planned to determine the prevalence of latent tuberculosis infection in patients with recently diagnosed bronchogenic carcinoma. Methods Sixty-four newly diagnosed primary lung cancer patients were enrolled. Diagnosis of latent tuberculosis infection was performed with QuantiFERON-TB Gold In-Tube tests, with exclusion of active tuberculosis. Results Latent tuberculosis infection was detected in 16 (25%) patients, and 8 (12.5%) had indeterminate results of the QuantiFERON-TB Gold In-Tube test. Being a current smoker was associated with a higher prevalence of latent tuberculosis ( p = 0.001). Comorbidities, tumor site, and histopathology were not associated with latent tuberculosis infection. Conclusions There is a cons...

Research paper thumbnail of Internal fixation of the proximal tracheal self-expandable metallic stent (SEMS): migration prevention in high risk patients

Journal of Thoracic Disease

Research paper thumbnail of Intralobar pulmonary sequestration: A rare presentation in adults

International Journal of Case Reports and Images

Research paper thumbnail of Cryobiopsy increases the EGFR detection rate in non-small cell lung cancer

Research paper thumbnail of Cryobiopsy to increase the detection rate of EGRF-mutations in non-small cell lung cancer

Journal of Clinical Oncology

Research paper thumbnail of Bleeding risk of transbronchial cryobiopsy compared to transbronchial forceps biopsy in interstitial lung disease – a prospective, randomized, multicentre cross-over trial

Research paper thumbnail of Cryobiopsy increases diagnostic yield in mucosal endobronchial lesions in comparison to forceps biopsy

Interventional Pulmonology

Research paper thumbnail of Efficacy and safety of transbronchial cryobiopsy in interstitial lung diseases

Interventional Pulmonology

Research paper thumbnail of The Clinical Significance of a ‘Crazy-Paving’ Pattern on Chest Radiology

European Journal of Case Reports in Internal Medicine

Research paper thumbnail of Cryobiopsy versus forceps biopsy in endobronchial lesions, diagnostic yield and safety

Advances in respiratory medicine, 2017

This study aimed to evaluate the safety and diagnostic yield of CB in comparison to forceps biops... more This study aimed to evaluate the safety and diagnostic yield of CB in comparison to forceps biopsy in endobronchial lesions. Patients with suspected endobronchial lesions were enrolled. Two forceps biopsies and one cryobiopsy were done in the same patient with randomized sequence. The largest diameter of the samples was measured in mm by electronic caliper. Diagnostic yield of each technique and postbronchoscopy bleeding were evaluated. Samples obtained by CB was significantly larger than that of the forceps biopsy (5.9 ± 2.3 vs 2.5 ± 0.8), (p = 0.001). Diagnostic yield of CB was significantly higher than forceps biopsy 74.5% versus 51.1% (p = 0.001). Mild and moderate bleeding grades were reported in both techniques with no significant difference (p = 0.063) (p = 0.5) respectively. Severe bleeding was not recorded in both techniques. CB represents a safe and effective tool to obtain a larger tissue samples of a good quality with higher diagnostic yield in comparison to standard for...

Research paper thumbnail of Transbronchial Cryobiopsy – Is the bleeding risk changed in comparison to transbronchial forceps biopsy?

1.4 Interventional Pulmonology

Research paper thumbnail of A new functional method to choose the target lobe for lung volume reduction in emphysema - comparison with the conventional densitometric method

International journal of chronic obstructive pulmonary disease, 2017

Lung volume reduction (LVR) improves breathing mechanics by reducing hyperinflation. Lobar select... more Lung volume reduction (LVR) improves breathing mechanics by reducing hyperinflation. Lobar selection usually focuses on choosing the most destroyed emphysematous lobes as seen on an inspiratory CT scan. However, it has never been shown to what extent these densitometric CT parameters predict the least deflation of an individual lobe during expiration. The addition of expiratory CT analysis allows measurement of the extent of lobar air trapping and could therefore provide additional functional information for choice of potential treatment targets. To determine lobar vital capacity/lobar total capacity (LVC/LTC) as a functional parameter for lobar air trapping using on an inspiratory and expiratory CT scan. To compare lobar selection by LVC/LTC with the established morphological CT density parameters. 36 patients referred for endoscopic LVR were studied. LVC/LTC, defined as delta volume over maximum volume of a lobe, was calculated using inspiratory and expiratory CT scans. The CT mor...

Research paper thumbnail of Feasability of flexible bronchoscopy under sedation without local anaesthesia of the pharynx

European Respiratory Journal, 2015

Research paper thumbnail of The impact of single-dose diethylcarbamazine treatment of bancroftian filariasis in a low-endemicity setting in Egypt

The American journal of tropical medicine and hygiene, 2002

This study was designed to evaluate the effect of a single dose of diethylcarbamazine (DEC, 6 mg/... more This study was designed to evaluate the effect of a single dose of diethylcarbamazine (DEC, 6 mg/kg) on Wuchereria bancrofti infections in a low-endemicity setting in Egypt (microfilaremia, or MF, 3.7%, median MF 34/mL). Subjects with MF or filarial antigenemia were treated and restudied 1 year later. Treatment with DEC dramatically reduced blood MF counts, with clearance in 69% of subjects. Treatment also reduced filarial antigen levels, but low clearance rates suggest that some adult worms survived treatment in most patients. Mass treatment was administered in one village; 27 months later, MF prevalence had decreased 84% (from 4.9% to 0.8%). These results show that single-dose DEC treatment can have a major effect on MF prevalence rates and levels in low-endemicity settings. Although the World Health Organization advocates repeated multidrug regimens for filariasis elimination, mass treatment with DEC alone may be sufficient to interrupt transmission in areas with low infection in...

Research paper thumbnail of A randomized clinical trial comparing single- and multi-dose combination therapy with diethylcarbamazine and albendazole for treatment of bancroftian filariasis

The American journal of tropical medicine and hygiene, 2004

The Global Program for Elimination of Lymphatic Filariasis calls for mass drug administration for... more The Global Program for Elimination of Lymphatic Filariasis calls for mass drug administration for endemic populations outside of sub-Saharan Africa with a single dose of diethylcarbamazine (DEC) and albendazole (Alb) annually for 4-6 years. Single-dose DEC/Alb dramatically reduces blood microfilaria (MF) counts, but most treated subjects fail to completely clear MF after a single dose. A more effective regimen might reduce the number of years required for elimination programs. We performed a randomized clinical trial in Egyptian adults with asymptomatic microfilaremia to compare treatment with seven daily doses of oral DEC (6 mg/kg) and Alb (400 mg) with a single dose of the same combination. We also studied the effect of re-treatment with single-dose DEC/Alb 12 months after the first treatment course. Multi-dose DEC/Alb was significantly more effective than single-dose therapy for reducing and clearing microfilaremia (mean reduction in MF/ml relative to pretreatment counts at 12 mo...

Research paper thumbnail of Duplex Doppler sonographic assessment of the effects of diethylcarbamazine and albendazole therapy on adult filarial worms and adjacent host tissues in Bancroftian filariasis

The American journal of tropical medicine and hygiene, 2004

We used duplex Doppler sonography to assess effects of diethylcarbamazine and albendazole therapy... more We used duplex Doppler sonography to assess effects of diethylcarbamazine and albendazole therapy (DEC/ALB) on adult Wuchereria bancrofti in vivo. The study was performed in clinically normal Egyptian adults with blood microfilaria counts > 80/mL. Motile adult worms were observed before treatment in dilated scrotal lymphatic vessels in 28 of 36 men (78%) and over the proximal extremities in 5 of 22 women (23%). Most worm nests were inactivated in the months following treatment (90% at 12 months). Circulating filarial antigen levels (a marker for living adult worms) also fell dramatically following treatment. Some men had intrascrotal calcifications and/or non-palpable hydroceles detectable by ultrasound before they were treated. New hydroceles and intrascrotal calcifications appeared after treatment in many cases. However, most of these were transient and of no clinical significance. Prevelance rates for hydrocele and intrascrotal calcifications 24 months after treatment were ess...

Research paper thumbnail of Ultrafast Phase Aberration Correction in Ultrasound Imaging Using a Simple Model for Fat Layer

Proceedings of the Twenty Third National Radio Science Conference (NRSC'2006), 2006

Research paper thumbnail of Bancroftian filariasis: effect of repeated treatment with diethylcarbamazine and albendazole on microfilaraemia, antigenaemia and antifilarial antibodies

Transactions of the Royal Society of Tropical Medicine and Hygiene, 2006

Diethylcarbamazine/albendazole (DEC/ALB) therapy is widely used in mass drug administration (MDA)... more Diethylcarbamazine/albendazole (DEC/ALB) therapy is widely used in mass drug administration (MDA) programmes aimed at eliminating lymphatic filariasis. We studied the effects of repeated annual treatments with DEC/ALB on Wuchereria bancrofti microfilaraemia, filarial antigenaemia and IgG4 antibodies to Bm14 antigen. Fifty-seven subjects with asymptomatic microfilaraemia were treated with one or seven daily doses of DEC/ALB at time zero. All subjects were re-treated with single-dose DEC/ALB 12, 24 and 36 months later. The two treatment groups had comparable pre-treatment microfilaria counts. Multidose treatment cleared microfilaraemia more effectively than single-dose treatment. Filarial antigen levels decreased equally in both treatment groups. Total antigen clearance was observed in 29.6%, 52.0%, 63.6% and 79.5% of subjects at 12, 24, 36 and 48 months. These clearance rates are much higher than those observed in prior treatment trials with DEC or ivermectin. Antibody levels increased 4 weeks after treatment and then slowly decreased in most subjects. Antibody tests turned negative in 20%, 35%, 39.4% and 52.5% of treated subjects at 12, 24, 36 and 48 months post treatment. These results show that the studied parameters decline at different rates and to differing degrees following DEC/ALB treatment. These findings have important implications regarding strategies for monitoring the effects of MDA in populations.

Research paper thumbnail of Effect of yearly mass drug administration with diethylcarbamazine and albendazole on bancroftian filariasis in Egypt: a comprehensive assessment

The Lancet, 2006

Egypt was one of the first countries to implement a national programme to eliminate lymphatic fil... more Egypt was one of the first countries to implement a national programme to eliminate lymphatic filariasis based on WHO's strategy of repeated rounds of mass drug administration (MDA) with diethylcarbamazine and albendazole (target population, 2.5 million in 181 localities). We assessed the effect of five yearly rounds of MDA on filariasis in four sentinel villages in Egypt. We studied two areas with different infection rates before MDA: the Qalubyia study area had a low infection rate because of previous treatment with diethylcarbamazine; this was typical of most filariasis-endemic villages in Egypt before MDA. The Giza study area had a high baseline infection rate. We undertook repeated surveys in villages for treatment compliance and tests for microfilaraemia and circulating filarial antigenaemia, antibodies to filarial antigen Bm14 in schoolchildren, and infections in indoor-resting mosquitoes (assessed by PCR). MDA compliance rates were excellent (>80%). In Giza after MDA, prevalence rates of microfilaraemia and circulating filarial antigenaemia fell from 11.5% to 1.2%, and from 19.0% to 4.8%, respectively (p<0.0001). Corresponding rates in Qalubyia fell from 3.1% to 0% and 13.6% to 3.1%, respectively (p<0.0001). Rates of antifilarial antibody and circulating filarial antigenaemia in schoolchildren (aged about 7-8 years), fell from 18.3% to 0.2% (p<0.0001) and from 10.0% to 0.4% (p<0.0001) in Giza, respectively, and from 1.7% to 0% and 1.7% to 0% (both p=0.13) in Qalubyia, respectively. Mosquito infection rates fell from 3.07% (95% CI 2.38-3.88) to 0.19% (0.08-0.38) in Giza and from 4.37% (3.07-5.99) to 0% (0-0.05) in Qalubyia. MDA greatly affects variables related to infection (microfilaraemia and circulating filarial antigenaemia prevalence rates) and transmission (antifilarial antibodies in young children and mosquito infection rates). Our results suggest that after five rounds of MDA filariasis is likely to have been eliminated in most endemic localities in Egypt.