Mini-FLOTAC, an innovative direct diagnostic technique for intestinal parasitic infections: experience from the field

BACKGROUND

Soil-transmitted helminths and intestinal protozoa infection are widespread in developing countries, yet an accurate diagnosis is rarely performed. The aim of this study was to evaluate the recently developed mini-FLOTAC method and to compare with currently more widely used techniques for the diagnosis of intestinal parasitic infections in different settings.

METHODOLOGY/PRINCIPAL FINDINGS

The study was carried out in Dharamsala, Himachal Pradesh, India, and in Bukumbi, Tanzania. A total of 180 pupils from two primary schools had their stool analyzed (n = 80 in Dharamsala and n = 100 in Bukumbi) for intestinal parasitic infections with three diagnostic methods: direct fecal smear, formol-ether concentration method (FECM) and mini-FLOTAC. Overall, 72% of the pupils were positive for any intestinal parasitic infection, 24% carried dual infections and 11% three infections or more. The most frequently encountered intestinal parasites were Entamoeba coli, Entamoeba histolytica/dispar, Giardia intestinalis, hookworm, (and Schistosoma mansoni, in Tanzania). Statistically significant differences were found in the detection of parasitic infections among the three methods: mini-FLOTAC was the most sensitive method for helminth infections (90% mini-FLOTAC, 60% FECM, and 30% direct fecal smear), whereas FECM was most sensitive for intestinal protozoa infections (88% FECM, 70% direct fecal smear, and 68% mini-FLOTAC).

CONCLUSION/SIGNIFICANCE

We present the first experiences with the mini-FLOTAC for the diagnosis of intestinal helminths and protozoa. Our results suggest that it is a valid, sensitive and potentially low-cost alternative technique that could be used in resource-limited settings--particularly for helminth diagnosis.

[Effects of training of human intestinal parasitic diseases for basic health staff in Jiangsu Province]

OBJECTIVE

To evaluate the effect of the training of human intestinal parasitic diseases for basic health staff.

METHODS

A workshop including theory courses and practical operations was carried out. At the end of the workshop, the effects were evaluated through the examinations of theory and film-reading. The total score of film-reading was one hundred including reading ten modified thick Kato-Katz slides in five minutes per slide. The results were analyzed statistically with SAS 9.0.

RESULTS

There were 162 trainees from 13 cities. All of them took part in the final examination. The highest score of theory test was 99 and the lowest was 60 with the average of 86.3. The average score of the female was higher than that of the male, and the average score of 30-40 years' age group was higher than that of the other groups. The average score of the staff in Northern Jiangsu Province was higher than that of the staff in southern area and middle area of Jiangsu Province (P < 0.05). The highest score of film-reading was 100 and the lowest score was 20 with the average of 73.4. Among the total 9 species, the egg detection rates of five species were more than 60.00%. The detection rate of Trichuris trichiura was highest (88.17%) and the rate of Taenia was only 14.7%. The total average score of the staff in Nanjing City was highest (181.3) and the score of the staff in Changzhou City was lowest (138.3). There were significant differences among different regions (P < 0.05).

CONCLUSION

The technical capability of examining the human intestinal parasitic diseases of basic health staff is different among the different regions of Jiangsu Province. We still need to strengthen the capability of pathogen detection for basic health staff.

Rectal bleeding in Egyptian children

AIM

In a prospective study to outline the aetiology of bleeding per rectum (BPR) in Egyptian infants and children, a subsidiary aim was to define some of the clinical characteristics of the different aetiologies.

SUBJECTS AND METHODS

194 children with BPR are described. The diagnostic work-up included laboratory investigations, radiological and endoscopic assessment, radio-isotope scanning, angiography and histopathological examination of mucosal biopsies, as appropriate.

RESULTS

Ages ranged from 3 to 192 months with a mean (SD) of 49.8 (43.5). Infectious enterocolitis was the most common cause (37.1%). Others included colorectal polyps (21.1%), chronic colitis (16%) including inflammatory bowel diseases (5.2%), allergic colitis (2.6%), solitary rectal ulcer syndrome (1.5%) and non-specific colitis (6.7%). Intussusception and Meckel's diverticulae were the cause in 7.3% and 2.6%, respectively, while other aetiologies included vascular (6.2%), systemic (3.6%), local anal (3.1%) and upper gastro-intestinal causes (1.5%). In 1.5% of cases, the cause remained 'obscure'.

CONCLUSION

In Egyptian children, infectious enterocolitis followed by colorectal polyps and chronic colitis are major causes of BPR.

Investigation of intestinal parasites in dialysis patients

OBJECTIVE

To search for the opportunistic and other pathogenic intestinal parasites in dialysis patients, and to compare the methods used for diagnosis.

METHODS

This is a randomized study, which recruited participants from the dialysis patients. The study was carried out in the Department of Microbiology, Research Hospital, School of Medicine in Kocaeli University, Kocaeli, Turkey between June 2012 and March 2013. One hundred and forty-two patients were diagnosed with an end-stage renal failure, which underwent dialysis, and 150 healthy volunteers were enrolled in the study. Native-lugol, formol ethyl acetate sedimentation method, trichrome, modified trichrome, acid fast, and Calcofluor staining methods were applied to the stool samples. For the diagnosis of Cryptosporidium spp., Giardia intestinalis (G. intestinalis), and Entamoeba histolytica (E. histolytica), commercially available ELISA kits were used, which detect antigen in the stool.

RESULTS

Parasites were found in 62 of the dialysis patients (43.7%) and 19 of the control group (12.7%). The most encountered parasitic agents in the dialysis patients were Blastocystis spp. (23.9%), G. intestinalis (8.5%), E. histolytica (2.1%), Microsporidia spp. (2.1%), and Cryptosporidium spp. (2.1%). The parasite detection rate of the formol ethyl acetate sedimentation method was found to be higher than native-lugol (p<0.05).

CONCLUSION

To protect the dialysis patients with diarrhea from parasitic infections, it is important to carry out interval stool examinations with trichrome, modified trichrome, acid fast, and Calcofluor staining methods, and the ELISA method, which detects antigen in the stool.

Baboons as potential reservoirs of zoonotic gastrointestinal parasite infections at Yankari National Park, Nigeria

BACKGROUND

Zoonoses pose a risk to public health.

OBJECTIVE

To carry out the investigation of the prevalence of gastrointestinal parasites of baboons, Papio anubis, frequenting the Wikki base Camp in Yankari National Park, Nigeria.

METHOD

Formol-ether concentration technique was used to isolate parasite eggs and cysts from faecal samples.

RESULTS

Parasites recovered were Ascaris lumbricoides, Ancylostoma duodenale, Strongyloides stercoralis, Fasciola sp, Schistosoma mansoni, Hymenolepis nana, and Trichostrongylus sp, and cysts of protozoan parasites Entomoeba histolytica, E. coli, and Iodamoeba butschii.

CONCLUSION

Most of the parasites identified are known to have high pathologic involvement in humans, implicating the baboons as potential source and reservoirs for human zoonotic parasitic infections although further molecular work would be necessary to ascertain if these gastrointestinal parasites are the same strains that infect humans.

Impact of gastrointestinal parasitic nematodes of sheep, and the role of advanced molecular tools for exploring epidemiology and drug resistance - an Australian perspective

Parasitic nematodes (roundworms) of small ruminants and other livestock have major economic impacts worldwide. Despite the impact of the diseases caused by these nematodes and the discovery of new therapeutic agents (anthelmintics), there has been relatively limited progress in the development of practical molecular tools to study the epidemiology of these nematodes. Specific diagnosis underpins parasite control, and the detection and monitoring of anthelmintic resistance in livestock parasites, presently a major concern around the world. The purpose of the present article is to provide a concise account of the biology and knowledge of the epidemiology of the gastrointestinal nematodes (order Strongylida), from an Australian perspective, and to emphasize the importance of utilizing advanced molecular tools for the specific diagnosis of nematode infections for refined investigations of parasite epidemiology and drug resistance detection in combination with conventional methods. It also gives a perspective on the possibility of harnessing genetic, genomic and bioinformatic technologies to better understand parasites and control parasitic diseases.

Detection of Giardia lamblia, Cryptosporidium spp. and Entamoeba histolytica in clinical stool samples by using multiplex real-time PCR after automated DNA isolation

Diagnosis of intestinal parasites in stool samples is generally still carried out by microscopy; however, this technique is known to suffer from a low sensitivity and is unable to discriminate between certain protozoa. In order to overcome these limitations, a real-time multiplex PCR was evaluated as an alternative approach for diagnosing Giardia lamblia, Cryptosporidium spp. and Entamoeba histolytica in stool samples.Therefore, a total of 631 faecal samples were analysed both by microscopy as well as by real-time PCR following automated DNA extraction. Results showed that real-time PCR exhibited sensitivity and specificity of both 100%, whereas traditional microscopy exhibited sensitivity and specificity of 37.5% and 99.8% respectively. As real-time PCR provides simple, sensitive and specific detection of these three important pathogenic protozoan parasites, this technique, rather than microscopy, has become our diagnostic method of choice for the detection of enteric protozoan parasites for the majority of patients.

REASSESSMENT OF HELMINTH INFECTIONS IN GULU MUNICIPALITY NOTHERN UGANDA AFTER THE TWENTY YEARS OF INSURGENCY: USING THREE DIAGONOSTIC METHODS TO COMPARE THEIR SENSITIVITY

BACKGROUND

During the period of insurgency there were several internally displace people camps all over the Northern Uganda. People who lived within ten kilometers from Gulu Municipality were forced to evacuate their villages and re-locate and build huts for themselves in areas identified for them by the government. There were several of such camps within the municipality creating influx of people from the villages to the municipality for security. Now with the situation restored to normal, there is need to re-assess and update information on the prevalence of helminth infections in Gulu municipality where many of the internally displaced people (IDP) settled.

OBJECTIVE

To find out if S. mansoni and soil transmitted nematode infections are so prevalent and very common in children aged betweenfive to 20 years. In Gulu municipality and that additional preventive and curative measure need to be considered. Further is there a strong need to reconsider more sensitive diagnostic methods at the hospitals or does the standard approach of direct smear examination recognise at least most heavy infected children with any of the parasites. Setting. The study was carried out in Gulu municipality.

DESIGN

Purposive and random sampling methods were used. Study Population: Mainly Primary school children aged between five to 20 years randomly selected from four primary schools purposively selected around Gulu municipality were recruited for the study. For control 20 staff of each school randomly selected were also studied.

RESULTS

Of the 582 samples tested, 117(20.1%) were found positive for Schistosoma mansoni. Fifteen (2.6%) other samples were found positive for other helminths like Ascaris lumbricoides, Trichuris trichiura H.nana Hookworm. The comparison between the methods showed that the results obtained by the three methods were similar for field research. There is a low intensity of infection with soil transmitted helminths found in the primary schools around Gulu municipality.

CONCLUSION

We concluded that the prevalence and intensity of infection with soil transmitted helminths was low among the children aged between 5 to 20 years in the four primary school studied (2.6%) but there was medium infection with S.mansoi (20.1%). The sensitivity in detecting the helminthes eggs in the stool specimen were similar. Though the original Kato/Katz method recorded lowest egg count than the Polderman and Odongo-Aginya methods. This could be due to the fact that the slides were read immediately.

Intestinal parasitosis: data analysis 2006-2011 in a teaching hospital of Ancona, Italy

Intestinal parasites are a serious problem in developing countries, but should not be underestimated in industrialised countries either. Between January 2006 and December 2011, stool specimens and the scotch tests of 5323 Italian and non Italian patients (adults and children) attending the laboratory of our Infectious Diseases Clinic in a teaching Hospital at Ancona were analyzed specifically for intestinal parasites. The present study shows that, over a six-year period, of a total of 5323 patients 305 harboured at least one species of parasite (5.7%). Among the pathogenic protozoa Giardia lamblia was the most common, the overall prevalence of giardiasis being 1.8 % (99/5323). Helminths were found in 0.9% of the patients (48/5323). In particular, Hymenolepis nana, Strongyloides stercoralis and Trichuris trichiura were most commonly recovered in non-Italian children, suggesting that certain intestinal parasites are restricted to endemic areas in the tropics. Eighteen of the 305 infected patients had more than one parasite in their stools. Our study demonstrates that intestinal parasites must be considered even in industrialised areas and stool examination should be supported by epidemiological data and clinical features.

[Etiology of chronic diarrhea in the elderly in Hospital Edgardo Rebagliati, Lima-Peru]

INTRODUCTION

The impact of chronic diarrhea in the elderly is disproportionate by several factors causing increased morbidity and mortality.

OBJECTIVE

To describe the main features about the chronic diarrhea in elderly patients from Edgardo Rebagliati Hospital (Lima-Peru) during the period January 2005 to December 2011,

METHOD

A descriptive and retrospective study in which we reviewed the medical records of elderly patients with the diagnosis of chronic diarrhea, pouring in a data collection sheet.

RESULTS

We reviewed the medical records of 202 patients. The mean age was 73.5 ± 6.7 years, with most women (57.43%). Major comorbidities were cardiovascular (60.4%) and endocrine (27.2%). The half time of illness was 21.6 ± 13.6 weeks. The most requested tests were CBC, biochemistry, albumin, coprofuncional, parasitological and colonoscopy. The most common type of diarrhea was the organic (84.16%). Among the main causes were found microscopic colitis (35.15%), parasites (15.84%), irritable bowel syndrome (14.85%) and bacterial overgrowth (8.42%).

CONCLUSIONS

The most common causes of chronic diarrhea in the elderly are microscopic colitis, parasites, irritable bowel syndrome and bacterial overgrowth.

Soil-transmitted helminth infections and correlated risk factors in preschool and school-aged children in rural Southwest China

We conducted a survey of 1707 children in 141 impoverished rural areas of Guizhou and Sichuan Provinces in Southwest China. Kato-Katz smear testing of stool samples elucidated the prevalence of ascariasis, trichuriasis and hookworm infections in pre-school and school aged children. Demographic, hygiene, household and anthropometric data were collected to better understand risks for infection in this population. 21.2 percent of pre-school children and 22.9 percent of school aged children were infected with at least one of the three types of STH. In Guizhou, 33.9 percent of pre-school children were infected, as were 40.1 percent of school aged children. In Sichuan, these numbers were 9.7 percent and 6.6 percent, respectively. Number of siblings, maternal education, consumption of uncooked meat, consumption of unboiled water, and livestock ownership all correlated significantly with STH infection. Through decomposition analysis, we determined that these correlates made up 26.7 percent of the difference in STH infection between the two provinces. Multivariate analysis showed that STH infection is associated with significantly lower weight-for-age and height-for-age z-scores; moreover, older children infected with STHs lag further behind on the international growth scales than younger children.

Intestinal protozoan parasitic infection among school children

BACKGROUND

Intestinal protozoan parasitosis is highly prevalent among general population, majority of them are children. The objective of the study is to find out the prevalence of intestinal protozoan infection in school children of Sindhuli.

METHODS

Stool samples were collected from school children of Sindhuli in June 2011 and investigated in National Institute of Tropical Medicine and Public Health Research, Laboratory by using formal-ether concentration method. Statistical significance was analyzed by using Chi-Square test.

RESULTS

A total of 342 stool samples were collected and 68 (19.8%) protozoan parasites were identified. The prevalence rate of protozoa in boys and girls were 16.9% and 22.0% respectively. Altogether 5 species of protozoan parasites were detected. Of them Entamoeba coli was most common followed by Giardia lamblia, Entamoeba histolytica, Blastocystis hominis and Endolimax nana. Positive rate was highest in Dalit (20.3%), and least in Indo-Aryan (19.6%).

CONCLUSIONS

There is a low prevalence of intestinal protozoan parasitosis among children even though this study emphasizes the need for improved environmental hygiene i.e. clean water supplies and enhanced sanitation.

The incidence of feco-oral parasites in street-food vendors in Buea, south-west region Cameroon

BACKGROUND

The street-food industry lacks legal recognition, it operates in unstable and precarious conditions, involving women and men with minimal or no knowledge of hygienic food handling practices. Infective eggs, bacteria, toxins and cysts of faecal orally transmissible parasites are common agents responsible for food contamination in developing countries.

OBJECTIVE

To determine the incidence of digestive faecal-oral parasites among street-food vendors in Buea, South-west region of Cameroon,

METHODS

From March to May 2009, physical and laboratory analysis of stool samples of 150 randomly selected street-food vendors, residing in four different zones in the municipality were carried out. Information on environmental and personal hygiene was also collected.

RESULTS

Results revealed that 56.7% of the sampled population was infected with faecal-oral parasites. The major faecal-oral parasites detected in stool samples were: Entamoeba coli (14.0%), Entamoeba histolytica (12.67%), Ascaris lumbricoides (11.33%), Ankylostoma duodenalis (10.67%). Childcare activities, lack of deworming, poor personal hygiene, poor sanitary and toilet facilities, were factors promoting the spread of faecal-oral infections.

CONCLUSION

Food vendors should be educated on personal hygiene and safe food handling measures. Regulatory procedures on environmental hygiene and regular medical and paramedical follow up of food vendors should be enforced.

Intestinal parasitic infection and nutritional status among school children in Angolela, Ethiopia

INTRODUCTION

Gastrointestinal parasitic infections are most prevalent in populations with low household income, poor handling of personal and environmental sanitation, overcrowding, and limited access to clean water. We conducted this study to estimate the prevalence of parasitic infection and nutritional status, and to evaluate the extent to which the two are associated among schoolchildren in rural Ethiopia.

METHODS

This is a cross sectional study of 664 students aged from 6 to 19 years old from Angolela, Ethiopia. Socio-demographic information was collected using a structured questionnaire. Anthropometric measurements were taken at the time of interview. Examinations of fecal samples for helminthic and protozoan parasitic infections were performed. Logistic regression procedures were employed to evaluate the association between stunting, underweightedness, and wasting with parasitic infections. RESULTS. One-third of the participants were found to have a protozoan infection, while 7.1% were found to have a helminthic infection. Approximately 11% of the students were stunted, 19.6% were wasted, and 20.8% were underweight. Severely underweight boys were 3.88-times as likely as boys of adequate weight (odds ratio OR = 3.88, 95% confidence interval CI: 1.12-13.52) to be diagnosed with protozoan infections. Among girls, those who were severely stunted were approximately 12 times (OR = 11.84, 95%CI: 1.72-81.62) as likely to be infected with a helminthic parasite, than those who were not. Overall, there was a deficit in normal growth patterns as indicated by lower than average anthropometric measures. DISCUSSION AND CONCLUSIONS. There is a high prevalence of intestinal parasitic infections. Stunting, wasting, and underweightedness were also prevalent, and showed patterns of associations with intestinal parasitic infections. Efforts should be made to strengthen and expand school and community-based programs that promote inexpensive, though effective, practices to prevent the spread of parasitic diseases. Initiatives aimed at improving the nutritional status of school children are also needed.

Assessment of a school-based mass treatment for soil-transmitted helminth infections in Capiz, the Philippines

We evaluated the War on Worms in the Western Visayas (WOW-V) school-based mass treatment strategy in Capiz, the Philippines by assessing potential determinants of program acceptance among parents, teachers, and local health and education officials involved. Written surveys were distributed to parents and teachers assessing knowledge, attitudes and practices regarding soil-transmitted helminth (STH) infections. Associations between data were examined using the Fisher's exact test (alpha = 0.05). Descriptive statistics and t-tests were employed to analyze teacher survey results. Local health and education officials participated in key-informant interviews (KIs) to evaluate their attitudes and practices regarding WOW-V; data was qualitatively analyzed and grouped. A strong association was observed between parental consent during the first two rounds of treatment and willingness to do so again. Most parents gave consent for their child to receive treatment at least once and demonstrated a high level of knowledge regarding STH infections. The majority of teachers had positive attitudes toward their role in the program. Many identified lack of training and a fear of side effects as barriers to higher coverage. Lack of funding, program monitoring difficulties and insufficient parental education were identified by local officials as barriers. Proper planning and design is important to achieve high initial consent for program acceptance. The results correlate with studies showing relationships between health education and treatment acceptance. The implementation of health education and monitoring measures has the potential to greatly improve both treatment coverage and program infrastructure.

Albendazole therapy and enteric parasites in United States-bound refugees

BACKGROUND

Beginning on May 1, 1999, the Centers for Disease Control and Prevention (CDC) recommended presumptive treatment of refugees for intestinal parasites with a single dose of albendazole (600 mg), administered overseas before departure for the United States.

METHODS

We conducted a retrospective cohort study involving 26,956 African and Southeast Asian refugees who were screened by means of microscopical examination of stool specimens for intestinal parasites on resettlement in Minnesota between 1993 and 2007. Adjusted prevalence ratios for intestinal nematodes, schistosoma species, giardia, and entamoeba were calculated among refugees who migrated before versus those who migrated after the CDC recommendation of presumptive predeparture albendazole treatment.

RESULTS

Among 4370 untreated refugees, 20.8% had at least one stool nematode, most commonly hookworm (in 9.2%). Among 22,586 albendazole-treated refugees, only 4.7% had one or more nematodes, most commonly trichuris (in 3.9%). After adjustment for sex, age, and region, albendazole-treated refugees were less likely than untreated refugees to have any nematodes (prevalence ratio, 0.19), ascaris (prevalence ratio, 0.06), hookworm (prevalence ratio, 0.07), or trichuris (prevalence ratio, 0.27) but were not less likely to have giardia or entamoeba. Schistosoma ova were identified exclusively among African refugees and were less prevalent among those treated with albendazole (prevalence ratio, 0.60). After implementation of the albendazole protocol, the most common pathogens among 17,011 African refugees were giardia (in 5.7%), trichuris (in 5.0%), and schistosoma (in 1.8%); among 5575 Southeast Asian refugees, only giardia remained highly prevalent (present in 17.2%). No serious adverse events associated with albendazole use were reported.

CONCLUSIONS

Presumptive albendazole therapy administered overseas before departure for the United States was associated with a decrease in the prevalence of intestinal nematodes among newly arrived African and Southeast Asian refugees.

[Algorithm for the coproscopic diagnosis of human intestinal parasites]

The purpose of the study was to elaborate a detection algorithm for human intestinal helminth eggs. There is a broad spectrum ofcoproscopic methods recommended for the detection of Opisthorchis eggs in man and animals; these include Fulleborn's method, formalin-ether method, Goryachev's, Katoh's, Kalantaryan's, Shcherbovich's, and Kotelnikov-Varenichev methods. Combined coproscopic methods are significantly more effective in detecting the causative agents of enteric parasitoses than is Katoh's method. Among the considered coproscopic techniques for the diagnosis of human ascariasis, it is most rational to use a combined method for fecal examination, the basis for which is a multicomponent flotation system (such as the author's one). The Kotelnikov-Varenichev method is optimal for diagnosing opisthorchiasis. It is optimal to use 2-3 methods of different groups simultaneously for the screening diagnosis of intestinal parasitoses.

Molecular basis for identification of species/isolates of gastrointestinal nematode parasites

Gastrointestinal (GI) parasitism is the most serious constraint throughout the world in small ruminants which causes significant production loss in animals. GI parasites are major contributor to reduce productivity in terms of meat, milk and wool in animals. Control of GI parasite is done primarily by anthelmintic treatment where choice and schedule of treatment is done after identification and quantitation of individual parasite. Identification of GI parasites is done through microscopic method by identifying specific morphological characteristics of egg and larva (L(3)). Since most of parasite eggs are having similar morphological characteristics, identification up to species level through microscopy is not possible in most of cases. To address this issue, molecular techniques are the viable alternative for identification of species as well as molecular level differences within a species (isolates) of parasites. Different DNA based molecular techniques viz. PCR, AFLP, RAPD, RFLP, PCR-SSCP, real time PCR, DNA microarray etc. have been used for identification and to assess the genetic diversity among parasite population. For identification of species, the characteristic sequence of genomic DNA of different species should differ to allow the delineation of species, but at the same time, no/minor variation within the species should exist. In contrast, for purpose of identifying population variants (strains/isolates), a considerable degree of variation in the sequence should exist within a species. Various target regions, including nuclear ribosomal DNA (rDNA), mitochondrial DNA (mtDNA) or repetitive DNA elements (microsatellite loci), which show considerable variation in the number of repeats within individuals have been employed to achieve the identification of parasites species or strain.

[Ileocecal ameboma: a case diagnosed by pathology and molecular biology]

Colonic ameboma is a rare benign inflammatory tumor due to the infection by Entamoeba histolytica and poses frequently the problem of colon cancer. We report a case of a 52 year-old patient who presented a cecal amoeboma revealed by a painful mass in the right iliac fossa. Radiologic and endoscopic examinations depicted a parietal thickening of the right colon and the cecum. A presumptive diagnosis of colon cancer was firstly discussed. Confirmation of ameboma was made on pathological examination, PCR and serology.

Intestinal parasitic infection among school children

BACKGROUND

Intestinal parasitosis is a major public health problem of developing countries, children being major victims. Higher prevalence has been reported among school children, mostly in hilly regions of Nepal. This study aims at assessing prevalence of intestinal parasitosis among school children of a school in a border town of Nepal and the associated factors.

METHODS

Fecal samples from the students were examined by direct smear technique and result was correlated with their socioeconomic status and hygienic behavior. The chi-square test was used for analytical assessment.

RESULTS

The prevalence rate was 13.9%, girls being highly infected (19.1%) than boys (10.3%) (P>0.05). Entamoeba histolytica (36.0%) was the commonest parasite followed by A. lumbricoides (28.0%). The highest positive rate was found among children of 5 years and less age (29.2%) and least among those above 12 years (5.3%) (P>0.05). Those from family size 5 and less than 5 were least infected (10.5%). Children of illiterate parents (16.7%) and farmers (17.1%) were more infected than literate ones and non-farmers (P>0.05). 8.7% of positive children had multi-parasitic infection. Children drinking untreated water (15.0%) were more infected than those drinking treated water (5.5%) (P>0.05).

CONCLUSIONS

Intestinal parasitic infection was found among 17% school children. Awareness on infectious diseases, improving hygiene, and application of supportive programs for parents to elevate socioeconomic conditions may reduce the burden of infection.

Prevalence and epidemiology of intestinal parasitism, as revealed by three distinct techniques in an endemic area in the Brazilian Amazon

This survey aims to estimate the prevalence of intestinal parasitic infections in Santa Isabel do Rio Negro, Amazonian Brazil, through three distinct techniques, correlating the prevalence rates with family income and age groups as well as assessing the household clustering of infections. Prevalence rates were assessed through Graham (n=113), Baermann-Moraes (n=232) and Ritchie (n=463) methods. The Graham method was adopted only for children under 5 years old, 15% of whom were positive for Enterobius vermicularis. By the Baermann-Moraes technique, 5·6% of the samples were positive for Strongyloides stercoralis larvae. The Ritchie technique disclosed the following results: Ascaris lumbricoides (26%), Trichuris trichiura (22·5%), hookworms (9·5%), Entamoeba histolytica/Entamoeba dispar (25·3%), Giardia lamblia (12·5%) and E. vermicularis (0·6%). Children aged 5-14 years presented the highest prevalence for pathogenic parasites. Giardiasis and hookworm infection rates were inversely related to family income. The presence of positive contacts in the same household substantially increased the risk of infection by enteric parasites: odds ratio (OR)=2·70, 95% confidence interval (CI)=1·69-4·29 for ascariasis; OR=2·17, 95% CI=1·34-3·51 for trichuriasis; OR=2·13, 95% CI=1·08-4·17 for hookworm disease; OR=3·42, 95% CI=1·86-6·30 for giardiasis; and OR=2·16, 95% CI=1·35-3·47 for amoebiasis, supporting infection clustering in the home. Intestinal parasitoses are extremely frequent in the studied area, and routine methods for diagnosis may underestimate the prevalence of enterobiasis and strongyloidiasis.

[Aetiology of intestinal parasites in a sample of students from Mozambique]

The purpose of this survey is to assess the prevalence of intestinal parasites in a population of Mozambican students. Ninety five faecal samples were collected at the three schools in Marrere, Mozambique, for a period of about one week. Observations of fresh and Giemsa-stained samples were performed at the laboratory of the Geral de Marrere Hospital; observation after concentration (FEA) was performed later at the Microbiology Laboratory of the S. Maria Nuova Hospital (Reggio Emilia, Italy). The results show a high rate of intestinal parasites among the subjects examined, supported mainly by helminths (Strongyloides stercoralis and Ancylostoma/Necator americanus), and protozoa (Dientamoeba fragilis and Giardia intestinalis). Analysis of data shows that the search for pathogenic parasites with the formalin-ethyl acetate (FEA) stool concentration technique shows higher sensitivity than the observation of fresh samples (60% vs 30%) and in some cases allows the presence of a second or third parasite to be detected. The high rate of parasitosis in endemic areas underlines the importance of lending greater attention to immigrant patients in Italy, due also to the fact that parasitosis is often found in asymptomatic forms.

Hymenolepis nana in a renal transplant recipient: to treat or not to treat?

A case of hymenolepiasis in a renal transplant recipient. Issues discussed include the benefit of anti-parasitic agents as well as the preventive measures.

Persistent scrotal pain and suspected orchido-epididymitis of a young boy during pinworm (Enterobius vermicularis) infection in the bowel

AIM

Pinworm (Enterobius vermicularis) is the most common parasite among mankind. Ectopic pinworm infections in number of organs are broadly reported. The aim of this report is to review the pinworm infection in the scrotum on the basis of our case.

METHODS AND RESULTS

Our patient is a young boy with persistent pain in the scrotums together with abdominal symptoms. He underwent several urgent operations. Pinworm was finally found in appendix vermiformis. We hypothesize that concurrent unresponsive orchido-epididymitis was caused by pinworm as well. Eradication happened finally with pyvrinembonate.

CONCLUSION

Pinworm is a parasite that lives usually in the bowel. Many ectopic locations, like scrotum, are known. Orchido-epididymitis by pinworm has to be kept in mind when treating boys with persistent scrotal pain.

Prevalence of hookworm infection and its association with anemia among patients visiting Fenan Medical Center, East Wollega Zone, Ethiopia

BACKGROUND

Data was obtained from all study subjects and blood and fecal specimen were collected from all subjects who apparently volunteer to take part in the study.

OBJECTIVE

To determine prevalence of hookworm infection and its association with anemia. METHODS.: A cross-sectional study was conducted from February to April 2007 in Diga District, East Wollega Zone. Hematocrit test was done on all blood samples. All stool specimens were processed with a Kato-thick method and examined for parasites and the density of parasites was determined as eggs per gram of stool (epg). Frequencies and proportions were used for the descriptive analysis of the data and Pearson Chi-square test was used to assess the associations between the demographic characteristics of the study subjects and the findings of the test samples.

RESULTS

The overall prevalence of intestinal parasites was 64.9% Hookworm was the predominant (49.7%) intestinal parasite identified among the study participants. The density of hookworm egg ranged from 48 epg to 11,520 epg with mean and median values of 685 and 288 epg respectively. The observed result for hematocrit ranged from 12% to 50% with mean (SD) and median values of 34.6% (4.7) and 36% respectively. The prevalence of anemia is 65.5% among study participants. Among those subjects with hookworm, 83.9% were anemic. On the contrary only 41 (22.5%) study subjects who appeared negative for hookworm on stool examination were anemic.

CONCLUSION

The prevalence of hookworm is higher and it is associated with anemia in East Wollega zone. Therefore intervention strategies should consider the concomitance of hookworm and anemia in the implementations of appropriate prevention and control strategies.

[Longitudinal investigation on intestinal parasite infections among rural people in West Dongting Lake region]

The nylon pocket concentration method and modified Kato-Katz technique were used to detect the eggs of intestinal parasites and the iodine smear method was used for the detection of protozoa among the rural population in West Dongting Lake region. The infection rate of parasites in 2006 was 11.84%, and it declined by 86.63%, 81.34%, and 47.28%, respectively, compared to the rates in 1983, 1993, and 2003. Six major parasites were detected including Ascaris lumbricoides, Trichuris trichiura, Fasciolopsis buski, hookworm, Entamoeba histolytica and Giardia lamblia, and their infection rates were 8.60%, 6.41%, 1.75%, 0.14%, 2.50%, and 1.22%, respectively. The rate of multiple infections was 22.98%. The infection rates in the 5-9 years age group and 10-14 years age group were higher than those in other age groups.

[Laboratory diagnosis of pseudoparasites, artifacts and parasitic delusions]

Common practice in a diagnostic parasitology laboratory involves distinguishing parasitic organisms from various artifacts. Artifacts mean pseudoparasites, supposed parasites and parasitic delusions. Pseudoparasites include undigested leftovers or coincidentally or purposely ingested nonparasitic organisms or their parts. Supposed parasites are wild organisms which were incorrectly identified as the components of faeces. In parasitic delusions, it is impossible to find any kind of parasites while patients describe imaginary parasites in detail. All the above categories of nonparasitic findings including case reports are described and discussed in the article.

Intestinal parasitic infection among school age children

BACKGROUND

World Health Organization estimates one-fourth of world's population harbors one or more intestinal parasites. Intestinal parasites are among the most common infections of school age children causing-nutritional deficiency, chronic dysentery, rectal prolapse, poor weight gains, retarded growth and mental retardation.

METHODS

The stool samples were collected from school going children and examined for intestinal parasite by normal saline wet mount, formalin ether sedimentation technique was performed for the concentration.

RESULTS

Among 360 school age students, the prevalence of intestinal parasite was found 40%. Among the positive cases of which 60% were female. It was observed that the rate of parasitic infection among positive cases, Newar was 35(36.84%), Chettri 31(32.97%) and Brahmin and others 29(33.72%) respectively. The study detects an association between intestinal parasitic infection and drinking tape water.

CONCLUSIONS

The findings of this study showed that intestinal parasitic infections remain prevalent in the study area. The high prevalence of parasitic infections seems directly related to the unhygienic living conditions. This strongly indicates a need for intervention measures likely-to take up sustained health education, provision of safe drinking water and improvement in environmental sanitation and to provide the school student with health education.

[Intestinal parasitosis prevalence in outpatients and inpatients of Cã Granda IRCCS Foundation - Ospedale Maggiore Policlinico of Milan: data comparison between 1984-1985 and 2007-2009]

This paper evaluates the prevalence of intestinal parasitosis in a specific population over three years (2007-2009). The results were compared with published data collected from the same population in 1984-1985. During a survey from January 1st 2007 to December 31(st) 2009 a total of 2962 inpatients and outpatients were evaluated in our facility (IRCCS Foundation - Ospedale Maggiore Policlinico) for ova and protozoa stool examination (OPE) over three specimens collected alternatively for three days. 614 inpatients and outpatients were evaluated for the Graham Test (GT) over three slides collected for three days (day by day). Sixty inpatients and outpatients were also sampled for agar culture for detecting Strongyloides larvae in faeces. OPE revealed 13.26% of the patients positive for parasites; TG revealed 8.14% were positive. Overall, 16.66% of the patients were positive for Strongyloides larvae agar culture. Of the OPE trial group, only 4.2% were positive for real pathogen parasites. 1.78% of the total was affected by several parasites. Apart from the prevalence of Entamoeba histolytica/dispar and Taenia spp, which was unchanged, all other levels fell compared with the 1984 - 1985 results. New pathogens, namely Hymenolepis nana and Schistosoma mansoni, were detected during 2007-2009 period. Strongyloides stercoralis was the most frequently diagnosed helminth in 2007-2009 as in the previous time period.

Health screening for a translocation of captive-reared tuatara (Sphenodon punctatus) to an island refuge

AIMS

To screen tuatara undergoing translocation from a captive crèche to an island refuge for evidence of health and known diseases, and apply basic epidemiological techniques to assess the significance of disease test results.

METHODS

Tuatara (n=353) were physically examined and samples were taken from a random selection (n=30) for estimated white cell counts, screening for haemoparasites, and culture for Salmonella, Yersinia, Aeromonas and Campylobacter spp. Direct faecal smears were carried out on-site, and faecal floats were later performed to assess levels of endoparasitism with helminths and protozoa (n=69). Modified Ziehl-Neelsen staining was used to screen faecal smears, and positive specimens were further screened using an immunofluorescence antibody (IFA) test for Cryptosporidium oocysts.

RESULTS

There was no evidence of external parasites on any of the animals examined and only one animal had a gross abnormality. All estimated white cell counts were in the range 2.8- 17.5 x 10(9)/L. No haemoparasites were observed. There were no enteric pathogens cultured, indicating the intestinal carriage of these bacteria in the tuatara was <9.4%. Of the 69 individual faecal samples examined, 12 (17%) had unidentified coccidial oocysts, 21 (30%) had nematode ova of various kinds, and 12 (17%) had intestinal carriage of motile protozoa consistent with Trichomonas spp and another unidentified organism. Nineteen (28%) tuatara had acid-fast oocysts present; however, IFA staining failed to detect any Cryptosporidium oocysts.

CONCLUSIONS

Our understanding of the diversity of gastrointestinal endoparasites affecting tuatara is inadequate as many of the parasite ova seen could not be identified. This is the first record of tuatara as a host for Trichomonas spp of protozoa in the gastrointestinal tract.

Long fish tapeworm in the intestine: an in situ observation by capsule endoscopy

We present the case of a patient who was referred to our hospital after she reported having passed a long, whitish object per rectum. Accordingly, capsule endoscopy was performed using the PillCam(®) SB video capsule. A tapeworm of the species Diphyllobothrium nihonkaiense was detected; it appeared to be freely floating and unfolded in the jejunum and sometimes tangled or irregularly folded in the ileum. The stretching of the strobila by strong peristalsis in the ileum may have resulted in the separation of the caudal portion of the strobila, which descended into the colon and was eventually passed per rectum.

Examinations regarding the prevalence of intestinal parasitic diseases in Polish soldiers contingents assigned to missions abroad

The aim of this paper is to present the program of diagnostic examinations regarding the detection and following treatment of intestinal parasitic diseases in the population of Polish soldiers serving in different climatic and sanitary conditions. Intestinal parasitoses remain one of the health problems of soldiers participating in contemporary military operations. This fact mainly results from unsatisfactory sanitary and hygienic standards in the regions where troops are deployed, contamination of water and soil, inappropriate processes of purifying drinking water, and the terrible condition of sewage systems, water purification plants, or sewage treatment facilities. The occurrence of such diseases is further facilitated by disregard of some basic principles of food and feeding hygiene. Mass examinations of Polish troops to find the prevalence of intestinal parasitoses will cause a decrease in the morbidity rate of parasitic diseases among Polish soldiers deployed in military operations. They can also lead to a decrease in expenditure on medical treatment of disease-related complications and on damages awarded to soldiers who have developed a serious disease while being engaged in a mission abroad.

Parasitological stool examination from children without the typical symptoms of parasitic disease

Most parasitic intestinal infestations in humans are sub-clinical and, therefore, they are rarely diagnosed. A number of general, non-specific symptoms of parasitic invasions are often attributed to other diseases. A parasitological examination of feces performed as part of this study confirmed the presence of intestinal parasites in 21.6% of samples. Among the patients who reported 6 different symptoms, the percentage of parasite-positive samples reached 80%. The obtained results suggest that coproscopic tests may establish the diagnosis in unclear cases, particularly in children. Many parasitic invasions are zoonoses and pets owe a reservoir. In view of the above, the results for pet owners and non-pet owners were compared in the study. There was no direct correlation between pet ownership and the incidence of parasitic infections.

[Atopic diseases and intestinal helminth infections]

The purpose of the current study was to examine the relationship between past and current intestinal helminth infections, and asthma, allergic rhino-conjunctivitis, and atopic dermatitis.

MATERIAL AND METHOD

The study was performed on 84 patients aged 2-18 years with a mean of 9.31 +/- 3.75 years. Helminth infection was determined by stool examinations and questionnaire. Asthma was diagnosed by spirometry, atopic dermatitis and allergic rhino-conjunctivitis by skin prick testing.

RESULTS

Stool examinations revealed infection with A. lumbricoides in 5.95% of cases and E. vermicularis in 4.76% of cases. 8 patients had positive tests for at least a helminth. The most frequent respiratory symptoms were caught, wheezing and dispneea. Spirometry showed anormal results in 4.76% of patients and skin tests were positive in 20.24% of cases. 11 patients were diagnosed with allergic rhinoconjunctivitis and 5 with atopic dermatitis. A history of infection with E. vermicularis was associated with increased risk of atopic dermatitis (OR 1.86), asthma (OR 2.11), and allergic rhinoconjunctivitis (OR 1.34), and a positive stool examination for A. lumbricoides was negatively associated with asthma (OR 2.60).

CONCLUSIONS

Current A. lumbricoides infection protects against asthma while past infection with E. vermicularis are risk factors for allergic rhinoconjunctivitis, asthma and atopic dermatitis. Interactions depend on the type of helminth and time of infestation.