Schistomiasis mekongi endemic rediscovered in northern Cambodian: 1. Cultural perception of disease; description and monitoring of 20 severe clinicalcases
S. Biays et al., Schistomiasis mekongi endemic rediscovered in northern Cambodian: 1. Cultural perception of disease; description and monitoring of 20 severe clinicalcases, TR MED I H, 4(10), 1999, pp. 662-673
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.