الفهرس 
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Abstract
Human schistosomiasis is one of the most important parasitic diseases. It is reported to be endemic in 77 countries in tropical and subtropical regions, leading to the infection of about 250 million individuals worldwide. The regions of the Middle East and North Africa represent high endemic spots for schistosomiasis, especially Egypt, which has about 7.2 million infected individuals. Intestinal schistosomiasis is an inflammatory disease in which the observable pathology derives from the local inflammatory host response to the egg entrapment inside the intestinal mucosa and submucosa. It can be manifested with a wide range of symptoms depending on the extent of the inflammation and friability of the mucosa, ranging from intermittent abdominal pain to overt acute dysentery. The microscopic examination of stools remains the gold standard for the diagnosis of schistosomiasis. Kato-Katz technique is a quantitative method assessing the number of eggs excreted in faeces. Praziquantel is the cornerstone treatment of schistosomiasis control programs focusing on mass drug administration. Lactoferrin is an iron-binding and multifunctional glycoprotein which functions to protect against pathogens during nonspecific immune responses.
The aim of the study was to detect the prevalence of S. mansoni in a rural area of Kafr El-Sheikh governorate and evaluate the intestinal inflammatory marker; lactoferrin in S. mansoni infected cases before and after praziquantel treatment.
The present work was a cross-sectional study carried out on 250 individuals aged from 5 to 30 years living in El Zowarat and El Salahba villages in Motobus in Kafr El-Sheikh governorate. Participants agreed to participate in the present study by submitting stool samples. All samples were examined for the presence of parasitic infection using Kato-Katz and formalin ethyl acetate techniques. All S. mansoni positive cases were treated with praziquantel and stool samples were recollected 21 days later.
Among the studied participants, parasitological examination revealed the overall percentage of parasitic infections was 83.2%. Schistosoma mansoni represented 14.4% (36/250). While B. hominis, G. intestinalis, and E. coli represented higher percentages than S. mansoni (62%, 17.2% and 16% respectively). Whereas D. fragilis, E. vermicularis, H. nana, Fasciola spp. and A. lumbricoides showed lower percentages of parasitic infections (3.6%, 2%, 1.6%, 1.2% and 0.8% respectively). The thirty-six cases with S. mansoni positive stool samples were selected for the present study. Before treatment in S. mansoni cases 80.6% had low intensity, 16.7% showed moderate intensity while only one case had a high intensity of infection. The results showed a statistically significant association between gender and Schistosoma infection (p= 0.026). Males had 2.3 times increased risk of being infected than females. As regard age, no statistically significant association with Schistosoma infection was reported. There were significant associations between Schistosoma infection and canal water contact, skin itching, abdominal pain, and the presence of blood in the stool (p values were <0.001, 0.001, 0.037 and <0.001 respectively). Among 36 infected cases with S. mansoni, the cure rate was 91.7%, while only three cases were not cured (8.3%).
The mean lactoferrin level was 1649.0±656.5 pg/ml before treatment compared to 1162.8±356.8 pg/ml after treatment with a statistically significant difference. The correlation between lactoferrin and the number of eggs per gram stool was not significant either before (r=0.286, p=0.090) or after treatment (r=0.004, p=0.983). Comparing the level of lactoferrin in each age group before and after treatment revealed a statistically significant difference in the mean lactoferrin level before and after treatment in the middle (p0= 0.004) and higher age group (p0= 0.017). As regard gender, a statistically significant difference in the mean lactoferrin level before and after treatment was detected in males (p0<0.001) but not in females (p0= 0.355). The difference in lactoferrin level before and after treatment was statistically significant in cases with single Schistosoma infection (p0<0.001) but not in cases with other parasitic co-infections (p0=0.492).
Assessing the relation between lactoferrin level before treatment and the manifestations reported by the infected cases revealed a nonsignificant association with either itching, abdominal pain, or the presence of blood in the stool (p=0.888, 0.913 and 0.969 respectively). There was no statistically significant association between lactoferrin level before treatment and the intensity of infection (p=0.981). Also, there was no statistically significant difference in the mean lactoferrin levels between participants who reported low (1630.8 ± 644.0 pg/ml) or moderate intensity of infection (1623.5 ± 774.1 pg/ml).