Schistomiasis mekongi endemic rediscovered in northern Cambodian: 1. Cultural perception of disease; description and monitoring of 20 severe clinicalcases

In 1992 a foci of Schistosomiasis mekongi was rediscovered in the province of Kracheh in Northeast Cambodia. Severe clinical signs due to portal hyper tension, which were frequently observed in this population, allowed the dis covery of this 'forgotten' focus. Elements of the perception of the populat ion and clinical observations of 20 severe cases due to S. mekongi infectio ns are presented. Interviews with patients and villagers of the area of Kra cheh showed severe psychosocial impact including fear from death, infirmity and invalidity. The symptoms of schistosomiasis were well known by the pop ulation and were reported to have increased in frequency in the last two de cades. They have received traditional names and specific traditional treatm ent. The description of the clinical cases illustrates the severe pathology , which was observed in the hospital of Sambour, in the north of the provin ce of Kracheh. It shows the pathogenic potential of S. mekongi in all age g roups (from 7 to 58 years old): cachexia, hepatosplenomegaly stunting and r etardation of puberty decompensation of portal hypertension with ascites an d rupture of oesophagual varicies. The efficacy of the treatment in the sev ere stages varies. A follow-up after 30 months showed that 5 patients died, 5 initially improved but then relapsed, 3 remained unchanged and only 5 pa tients clearly improved. Two patients could not be followed-up. The clinica l observations and interviews show severe pathology with impact at both ind ividual and community level. The infection with S. mekongi is the main fact or but additional concomitant factors are responsible for this fact. At a c ertain stage of the disease the prognosis for successful treatment is very low. These observations show the importance of the foci in the Province of Kracheh, Cambodia and underline the need for a long-term global interventio n.