The Terrible Effect of Tissue Nematodes to Human Health

Filariasis, onchocerciasis, loiasis, dracunculiasis are tropical diseases. Wuchereria affects about 200-300 million people. Onchocerca affects millions of people in Africa and Central America. What is the medical concern about these strange ailments?

Wuchereria bancrofti

This causes filariasis. It occurs in the tropics and its mode of transmission through biting by the females mosquito (especially Anopheles and Culex species) on the skin of Humans, depositing the infective larvae. The larva penetrates the skin, enter a lymph node, and after a year, mature to adults that produce mecrofilariae. These circulate in the blood, chiefly at night, and are ingested by biting mosquitoes. Within the mosquitoe, the micro filariae produce infective larvae that are transferred with the next bite. Humans are the only definitive hosts.

Adult worms in the lymph nodes cause obstruction of lymphatic vessels, causing edema of the legs and genitalia (elephantiasis). Laboratory diagnosis is based on blood smears taken from the patient at night to reveal the microfilariae. A yearly dose of drug therapy would kill the microscopic worms circulating in the blood. Drugs such as Diethylcarbamazine (DEC) and ivermectin are most trusted drugs for the effective treatment therapy of filariasis. Even if these drugs do not totally kill all the adult worms, they prevent the affected person from spreading it to someone else. But even after the death of all Adult worms, there could still be swellings of the genitals, breast, arms, legs etc. Management therapy can then be applied by

1. Daily cleaning up of swollen regions with careful administration of soap and water.

2. Application of anti-bacterial cream/ointment on any wounds.

3. Elevation and constant exercise of swollen limb to spread the fluid and improve lymph flow.

Prevention involves mosquito control with insecticides and the use of protective clothing, mosquito netting and repellents.

Onchocerca volvulus

This causes onchocerciasis. Vectors of Onchocerca volvulus (black flies) develop in rivers and people who live along those rivers are affected. Infection rates are often over 80% in endemic areas. Humans are infected when the female black fly simulium deposits infective larvae on the skin while biting. The larvae enter the wound and migrate into the subcutaneous tissue, where they differentiate into adults, usually within dermal nodules. The female produces microfilariae that are ingested when another black fly bites. The microfilariae develop into infective larvae in the fly to complete the cycle. Humans are the only definitive hosts.

Infalmmation occurs in subcutaneous tissue, and pruritic papules and nodules form. Microfilariae migrate through subcutaneous tissue, ultimately concentrating in the eyes. They cause lesions that can lead to blindness (“river blindness”). Laboratory diagnosis is based on Biopsy of the affected skin which would reveal microfilariae. Treatment is based on drug therapy. Drugs which can be used are as follows

1. Diethylcarbamazine (DEC)

2. Suramin (Antrypol)

3. Amocarzine (CGP-6140)

4. Ivermectin

5. Surgical (Nodulectomy) in severe cases.

Prevention involves control of the black fly with insecticides.

Building Decision Support for Developing Nations

Ontology Programming Makes the Difference

Developing countries are increasing their reliance on technology to modernize their industries, and the health care industry is no exception. Their governments, health care ministries, and public health officials are utilizing IT solutions to improve health outcomes. International Health and Human Services (HHS) organizations such as the World Health Organization, the International Red Cross, and U.S. agencies such as USAID are assisting them by:

  • Providing resources that help them improve care by strengthening their health care-related infrastructures.
  • Providing them with expertise in the fields of medicine and disease management.
  • Utilizing technologies to drive important health care-related decisions for improving health care outcomes.

Some of the HHS organizations are utilizing technology to improve program effectiveness and to audit their own work in the field. One such organization is utilizing a cutting-edge ontological engineering software Decision Support System (a vector control software) to determine potential health care issues in a developing country and to also measure and monitor the impact of their disease control initiatives.

This paper describes the challenges and opportunities in building a health care DSS for developing nations. It also outlines how such nations are fusing their health care needs and ontology programming with their infrastructures (or lack thereof in various places) to accomplish desired outcomes.

Ontologically Engineered Software

A vector control software that’s an ontology-based platform with an integrated Geographic Information System (GIS) has been successfully designed to be used for disease management-related decision making in developing nations. Its initial release was developed for a prevalent disease (malaria) in an African country. However, it is currently being expanded to address numerous diseases in multiple countries.

The system is used to determine the disease footprint in a region so that remedial initiatives can be undertaken by the local public health officials. The HHS also utilizes the product as an audit tool to determine an initiative’s effectiveness and to refine the subsequent iterations of the program based on prior results. The disease control initiatives include a wide range of measures such as the use of various types of insecticide sprays.

The DSS uses ontological programming principles (or “semantic” technologies) to model geographic, entomological, and insecticidal nomenclature. Standardization of insect-related terminology allows data from multiple organizations to be effectively combined and queried. Additionally, since terms have hierarchical relationships, the technology allows for automatic categorization and grouping of related data.

As new terms are added, ontology programming allows dynamic queries to automatically include them. This provides the health care DSS with a high degree of flexibility, as terms and relationships between terms can change and adapt dynamically in the field to accommodate new requirements.

Furthermore, the geographic ontology standardizes terms for geographic features. This ensures data interoperability and allows for the GIS system to work, even in cases where the exact longitude and latitude of a data point is not known.

The DSS uses GIS to capture, store, and analyze data associated with geographic locations in order to generate maps as a visual tool. A map consists of one or more layers, with each layer defined by a query created in the DSS. The layers can be overlaid and color-coded into meaningful representations of relationships and correlations between the data and geographic locations. These custom-generated maps of vector control software greatly assist public health officials in making informed decisions regarding disease control.

This ontologically engineered product is capable of providing reports and query results using local data alone or data aggregated across geographic and governmental hierarchies. For example, an end user can query the system and utilize data from health care facilities at a village, city, district, state, or regional level-as well as a countrywide level.

The HHS expects geo-tagged data collection to occur throughout the African country and intends to use it for reports at all levels. This will be accomplished by deploying self-contained, fully functional copies of the DSS at all the locations and levels of interest. Data collected at each level will be forwarded to the next higher aggregation point in order to achieve a wider coverage report at subsequent levels, until eventually the entire country is covered.

Life And Health In The Year 1000

Compared with the way things used to be, we have it so very soft today. It’s easy to take our modern conveniences for granted. We can fill our days with leisure, bustle around in comfy autos, work only 40 of the 168 hours in a week, chat with therapists, read philosophy, shop for unnecessary stuff to clog our closets and garages, climate control our dwellings and complain about the softness of our mattresses.

In the year 1000, even when agriculture had been around for some 10,000 years, life was entirely different. In Anglo-Saxon society, a precursor to the modern West, the possibility of famine was ever-present and memories of the last one made dread and fear a part of everyday life. Looming natural disasters were constant specters.

Domiciles were not the neat and clean hygienic environs we experience today. They did not smell of disinfectant or exhaust from engines wafting in the windows, but the exhaust from every manner of farm creature and humans always hung in the air. Manure was everywhere with each one having its characteristic bouquet of fragrance. The human nose in the year 1000 could certainly not be so prissy as ours today.

Latrines were located at or near the back door and moss was toilet paper. Flies filled the dank and earthen floor homes where there were few if any hard surfaced utensils and there was no understanding of disease vectors or antiseptic. If you dropped food on the filthy floor, you picked it up and ate it with relish. Five baths a year for monks was thought to be fanaticism by Saxon standards of personal hygiene.

In time of famine, their law code permitted fathers to sell their sons aged seven or above into slavery. Infanticide was not a crime. Communities of 40 or 50 starving emaciated people would join hands at the edge of a cliff and jump. Some chronicles report that “men ate each other.” They would comb the forests for beechnuts overlooked by the wild pigs and would grind acorns, beans, peas and tree bark into a flour to bake as bread. Hedgerows were scoured for paltry herbs, roots, nettles and grasses. “What makes bitter things sweet?” asked a Yorkshire schoolmaster. “Hunger.”

A “crazy bread” of ground poppies, hemp and darnel gave our poor starving ancestors some relief with visions of paradise. Molds that laced the rye that was aging contained a variety of mycotoxins (and lysergic acid [LSD], the psychedelic drug of the “60s) that could not only make people appear mad but would severely weaken the immune system, permitting disease to run rampant. (Note that the cause of the great plagues and epidemics was not the disease agent, but the fragile or non-existent immune system of the starving and poisoned host.)

The church would help allay the pain by harnessing hunger to spiritual purposes. Lent made virtue of necessity, coming as it did in the final months of winter when barns and larders were growing empty. Feast and famine were linked to spiritual purification and gave meaning to hardship as well as hope for better times.

July was particularly tough since the spring crops had not matured and the barns were empty from the previous year’s harvest. Starving was common in the balmiest month of the year when so much toil in the fields was necessary.

Every single hour of the August harvest month was filled with urgency, since everyone knew from the pains of July what was in store for them next year if they did not fill their larders now. Work was not a right, a place to lobby for benefits and ease. It was a life and death struggle.

The contrast between then and now is astonishing. They were on the verge of starvation; we are fighting an epidemic of obesity. They might have to subsist for months on potatoes or stale bread; we have a glut of food options at our instant disposal. They had shortened life spans and were highly vulnerable to injury and disease. We live longer but suffer cruel lingering degenerative conditions.

It is clear from a realistic view of times gone by that it was not the advent of modern medicine that brought relief, it was, as I mentioned in a previous article on SARS [], it was the plumber bringing public utilities and with that the possibility of hygiene and the trucker distributing food supplies that brought us our present long lives.

For them it was a daily struggle for survival. Necessity and muscle ruled the day. It was the physical stress of enduring cold, harnessing 8 oxen to a plow to break new soil, hand harvesting and making their own way every moment of the day. It was the true helplessness and victimization (unlike modern day contrived social “victims” clamoring for rights and handouts) from floods, droughts, winds and rain that could wipe out their only hope to avoid starvation in the coming year. For us it is a surfeit of choices requiring intellectual decisions – decisions that make the difference between whether we experience full health or its slow insidious ruination by mindlessly partaking of every offering that promises yet more ease and flavor just because it is there.