Zoonotic transmission of intestinal helminths in southeast Asia: Implications for control and elimination

The burden and trend of intestinal parasitosis among women at Berekum, Ghana: a 9-year retrospective study

BACKGROUND

Intestinal parasitic infections (IPIs) are serious global public health issues, especially in low and middle-income countries. These parasites can cause high morbidity and mortality, especially in immunocompromised individuals, and can easily be transmitted by consumption of contaminated food or water or by penetration of skin and mucous membranes.

METHODS

We retrospectively analyzed all archived data from stool examination reports at the Parasitology Unit of Precise Health Diagnostic Services, Berekum for the prevalence and trends of parasitic infections spanning a period of 9 years (2013-2021). The data was retrieved and exported to IBM SPSS v.26 for statistical analysis. Descriptive data was summarized as proportions and presented in tables and charts. Pearson Chi-Square test (χ2) or Fisher's exact test was used to test for a statistical association between demographic factors and intestinal parasitic infections. P value was significant at < 0.05.

RESULTS

A total of 9,217 records of stool examinations were retrieved. Almost half (48.45%) of the data were from patients aged between 20 and 29 years. An overall prevalence of intestinal parasitic infections of 21.20% was observed in this study. Patients aged 70 to 79 had the highest prevalence of the IPIs (44.44%). The parasites recovered in this study were intestinal flagellates, Entamoeba coli, Hookworm, Entamoeba histolytica/dispar, Ascaris lumbricoides, Enterobius vermicularis, Strongyloides stercoralis and Hymenolepis nana. The intestinal flagellates had the highest prevalence (98.31%) compared to the other intestinal parasites recovered. Intestinal parasitic infections had the highest prevalence in the year 2020 (28.56%) and lowest in 2018 (11.78%).

CONCLUSION

An overall prevalence of 21.20% of intestinal parasitic infection was found. The majority of the parasites reported were intestinal flagellates (98.31%). The trend analysis revealed that the overall prevalence fluctuated across the entire period from 2013 to 2021.

Socio-economic risk factors for intestinal helminthiases in selected endemic communities in Mindanao, the Philippines: a cross-sectional study

BACKGROUND

Parasitic neglected tropical diseases (NTDs) or 'infectious diseases of poverty' continue to affect the poorest communities in the world, including in the Philippines. Socio-economic conditions contribute to persisting endemicity of these infectious diseases. As such, examining these underlying factors may help identify gaps in implementation of control programs. This study aimed to determine the prevalence of schistosomiasis and soil-transmitted helminthiasis (STH) and investigate the role of socio-economic and risk factors in the persistence of these diseases in endemic communities in the Philippines.

METHODS

This cross-sectional study involving a total of 1,152 individuals from 386 randomly-selected households was conducted in eight municipalities in Mindanao, the Philippines. Participants were asked to submit fecal samples which were processed using the Kato-Katz technique to check for intestinal helminthiases. Moreover, each household head participated in a questionnaire survey investigating household conditions and knowledge, attitude, and practices related to intestinal helminthiases. Associations between questionnaire responses and intestinal helminth infection were assessed.

RESULTS

Results demonstrated an overall schistosomiasis prevalence of 5.7% and soil-transmitted helminthiasis prevalence of 18.8% in the study population. Further, the household questionnaire revealed high awareness of intestinal helminthiases, but lower understanding of routes of transmission. Potentially risky behaviors such as walking outside barefoot and bathing in rivers were common. There was a strong association between municipality and prevalence of helminth infection. Educational attainment and higher "practice" scores (relating to practices which are effective in controlling intestinal helminths) were inversely associated with soil-transmitted helminth infection.

CONCLUSION

Results of the study showed remaining high endemicity of intestinal helminthiases in the area despite ongoing control programs. Poor socio-economic conditions and low awareness about how intestinal helminthiases are transmitted may be among the factors hindering success of intestinal helminth control programs in the provinces of Agusan del Sur and Surigao del Norte. Addressing these sustainability gaps could contribute to the success of alleviating the burden of intestinal helminthiases in endemic areas.

Endoscopic Diagnosis of Hookworm Disease in a Patient with Severe Iron Deficiency Anemia: A Case Report

Hookworm infection is an important cause of iron deficiency anemia, especially in heavily infected high-risk populations residing in underdeveloped tropical countries. Stool examination is the main method used for hookworm diagnosis; however, its sensitivity is relatively low. Hookworm infections have been incidentally diagnosed during routine upper gastrointestinal endoscopies. We present the case of a 60-year-old Ethiopian farmer who had severe iron deficiency anemia and positive occult blood in the stool. Repeated stool examinations revealed no ova or parasites. Esophagogastroduodenoscopy revealed the presence of hookworms in the duodenum. The patient was treated with albendazole and ferrous sulfate. Careful endoscopic examination of the duodenum is crucial for identifying unsuspected hookworm infection responsible for chronic gastrointestinal bleeding and iron deficiency anemia.

Zoonotic helminths - why the challenge remains

Helminth zoonoses remain a global problem to public health and the economy of many countries. Polymerase chain reaction-based techniques and sequencing have resolved many taxonomic issues and are now essential to understanding the epidemiology of helminth zoonotic infections and the ecology of the causative agents. This is clearly demonstrated from research on Echinococcus (echinococcosis) and Trichinella (trichinosis). Unfortunately, a variety of anthropogenic factors are worsening the problems caused by helminth zoonoses. These include cultural factors, urbanization and climate change. Wildlife plays an increasingly important role in the maintenance of many helminth zoonoses making surveillance and control increasingly difficult. The emergence or re-emergence of helminth zoonoses such as Ancylostoma ceylanicum, Toxocara, Dracunculus and Thelazia exacerbate an already discouraging scenario compounding the control of a group of long neglected diseases.

Prevalence of Parasitic Infections with Zoonotic Potential in Tilapia: A Systematic Review and Meta-Analysis

Tilapia has a high socioeconomic value in many countries worldwide. However, it has been identified as a zoonotic parasite reservoir. A systematic literature search and meta-analysis were carried out in order to estimate the global prevalence of zoonotic parasites that affect tilapia. The search was performed by three field experts to avoid reviewer bias. Polled prevalence was estimated using a logistic-normal random-effect regression model in the R software. We dealt with the heterogeneity among studies through subgroup analysis, taking into account the continent, country, genus of the host, parasite taxonomic group, sample origin, and type of diagnostic test as moderator variables. Fifty-two eligible articles were identified covering five tilapia genera with a pooled prevalence of 0.14 (95% CI: 0.10−0.20) showed significant heterogeneity (I2 = 98.4; p < 0.001). The subgroup analysis revealed that the most affected host was Sarotherodon, with a prevalence of 0.42 (95% CI: 0.22−0.65). Cestode was the taxonomic group with the largest prevalence (0.40; 95% CI:0.32−0.48), followed by amoeba (0.24; 95% CI: 0.16−0.35) and nematode (0.22; 95% CI: 0.11−0.38), among which, Schyzocotyle spp., Opistorchis spp., Gnathostoma spp. and Vermamoeba spp. have an impact on public health. Significant differences (p < 0.004) were found among continents and countries, with the highest value of prevalence detected in the African continent (0.28; 95% CI: 0.20−0.37), specifically in Tanzania (0.56; 95% CI: 0.22−0.87) and Egypt (0.43; 95% CI: 0.20−0.55). The origin of samples had a significant effect (p < 0.0001) on the detected prevalence, especially from those that showed the highest prevalence (0.24; 95% CI: 0.17−0.33). Finally, there were no differences in prevalence according to the diagnostic test (p = 0.97). Our results provide useful information on the development of epidemiological programs for the control of zoonoses associated with parasites in tilapia and in the design, planning, and implementation of future research.

Insights to helminth infections in food and companion animals in Bangladesh: Occurrence and risk profiling

Introduction

A better understanding of the epidemiology of helminths in animal hosts is important in order to ensure animal welfare, public health and food safety. The aim of this study was to explore parasitism in common animals in Bangladesh. Perception and understanding of animal owners regarding parasitic diseases management were also assessed.

Materials and methods

A total of 550 fecal samples were examined from common animals (cattle, goat, pig, chicken, dog, and cat) across three different areas of Bangladesh (Dhaka, Sylhet, and Chattogram) from January 2020 to March 2021. Associated risk factors were assessed through questionnaire surveys among 50 animal owners. Parasitological assessment was done using the combined sedimentation-flotation method, and factors associated with infection were modeled using mixed-effects logistic regression.

Results

Helminths including Toxocara sp., Spirometra sp., Capillaria sp., Trichuris sp., opisthorchiid, Ascaris suum, Fasciola sp., Paramphistomum sp., strongyles, hookworms, roundworms, taeniid, and acanthocephalans were detected in the examined animals, and overall prevalence was 59.3% (95% CI = 54.1–62.8). Parasites were found in 61.3% (245/400) of food animals and 54.0% (81/150) of companion animals. Animal owners have a good understanding of parasite infections; however, that knowledge was not being translated into practice. Logistic regression analysis showed that frequency of deworming, animal husbandry practice, contact with untreated animals, and treatment-seeking behaviors were significantly associated with parasitic infection.

Conclusion

Several types of zoonotic parasites are widely prevalent in animals of Bangladesh and pose a potential risk to human health. This study highlights the need to diagnose animal parasitic infection and intensified case management to avoid spillovers to animals and humans.

Environmental contamination with parasites in selected rural farms in the Philippines: impacts of farming practices on leafy greens food safety

Fresh vegetables are an important part of a healthy diet, however, they can also be agents of transmission of intestinal parasites. This study aimed to evaluate the presence of parasite contamination in vegetable farms as a source of transmission in selected rural communities in Laguna, Philippines. A total of 168 vegetable, 55 soil and 15 water samples collected from four selected farms and a reference farm were processed through various standard parasitological techniques. Of these, 17.3% of vegetables, 47.3% soil and 73.3% water samples were found contaminated with parasites’ eggs or cysts. Interestingly, leafy vegetables, such as lettuce, were found to be more contaminated. Results showed that strongylids/hookworms (egg/larva) showed the highest prevalence in farm soil (38.2%) and vegetable (13.1%); other helminth parasite eggs were also recovered such as Toxocara sp., Ascaris sp., Trichiuris, Trichostrongylus sp. and protozoan cysts of Balantidium coli. Cryptosporidium sp. oocysts of and Giardia sp. cysts were observed in all water samples in the farms. Furthermore, results revealed that some farming practices such as the use of improperly treated animals manure as fertilizers, unhygienic practice of farmers and sanitation issues were factors that contribute to parasite contamination in the farms. These findings have implications on food safety in poor-resource communities posing public health risks. Recommendations were discussed in the study for the control and prevention of parasite contamination at the farm level.

The status of schistosomiasis japonica control in the Philippines: The need for an integrated approach to address a multidimensional problem

Schistosomiasis japonica remains a public health concern in many areas of the Philippines. Adequate and updated information is essential to enhance policy and service delivery toward control and elimination. Despite the efforts on schistosomiasis control in the Philippines, some challenges remain in these dimensions. An integrated surveillance system is recommended to determine the prevalence of infection in humans, animal reservoirs, and snail intermediate hosts, allowing the identification of high-priority areas for targeted interventions. This will entail the enhancement of laboratory diagnosis capacity through the use of more sensitive techniques, complemented by capacity building of concerned human and animal health professionals. Given the zoonotic nature of schistosomiasis japonica, adopting the One Health approach is essential to influence policies and interventions that may accelerate control and elimination. This can be achieved through the attainment of mass drug administration coverage targets and intensified case finding and management, robust implementation and integration of veterinary public health activities, the conduct of snail control measures, provision of safe water, sanitation, and hygiene services, and health promotion and education into the national schistosomiasis control and elimination program. This review aimed to describe the status of schistosomiasis japonica control in the Philippines in the context of human health, animal health, vector ecology and management, environmental health, and sociocultural dimensions.

Insights into geohelminth contamination in Bangladesh: feasibility of a modified diagnostic method and prevalence study

INTRODUCTION

The objectives of this study were to evaluate a modified method for isolating geohelminth eggs and to assess the geohelminth contamination in Bangladesh.

METHODS

The efficacy of the modified method was evaluated using naturally contaminated and experimentally seeded soil samples. In total, 240 samples were assessed from four different sites in three geographic contexts. A questionnaire survey with 50 professionals was conducted.

RESULTS

The modified method showed considerable efficacy in isolating parasitic eggs from naturally contaminated soil (54.0%) and experimentally seeded soils (63.0% for Toxocara eggs and 52.0% for Ascaris eggs). The modified method was described as convenient by the majority of participants. Overall prevalence was 52.5%, with several species of helminth observed, including Toxocara sp., Ascaridia galli/Heterakis gallinarum, Ascaris sp., hookworms/strongyles, Capillaria sp., Trichuris sp., and taeniids). The contamination rate was found to be higher around livestock farms (76.7%), followed by latrines (63.3%), households (41.6%), and schools (28.3%).

CONCLUSIONS

The modified method was shown to be feasible in terms of field applicability and egg recovery rate, and could be adopted in low-resource settings. A substantial prevalence of geohelminths was observed, with some of the species associated with zoonoses. These findings highlight the urgent need for widespread mapping of geohelminths to avoid spillovers to animals and humans.

Molecular identification of Trichuris trichiura and Hymenolepis diminuta in long-tailed macaques (Macaca fascicularis) in Lopburi, Thailand

Background and Aim:

Trichuris trichiura and Hymenolepis diminuta are helminthic intestinal parasites that infect humans and other animals, including non-human primates. However, molecular detection of these parasites remains scarce in long-tailed macaques (Macaca fascicularis), which coexist with human communities in Thailand. Thus, this study aimed to molecularly confirm the occurrence of Trichuris spp. and Hymenolepis spp. infection and determine the species of both parasites that were found in long-tailed macaques.

Materials and Methods:

A total of 200 fecal samples were randomly collected from long-tailed macaques living in Lopburi, Thailand, and tested based on polymerase chain reaction (PCR) assays for Trichuris spp. and Hymenolepis spp. infections. The PCR products were submitted for DNA purification and sequencing. Phylogenetic analysis was performed using the maximum likelihood method.

Results:

Of 200 tested samples, three (1.5%) were positive for Trichuris spp. Sequence analysis of all positive samples revealed the presence of T. trichiura, while eight samples (8/200, 4%) positive for Hymenolepis spp. were classified as H. diminuta. No significant associations were found between parasite infection and sex of macaques.

Conclusion:

This study revealed that long-tailed macaques harbor T. trichiura and H. diminuta. These results suggested that local residents and tourists must pay attention to limiting contact with long-tailed macaques and take hygienic precautions to reduce the risk of zoonotic and anthroponotic transmission of these parasites between humans and long-tailed macaques.

High prevalence of Clonorchis sinensis infection in Guangxi, Southern China

BACKGROUND

Soil-transmitted helminths (STHs), such as hookworm, roundworm and whipworm, and food-borne trematodiases, including Clonorchis sinensis, remain a public health problem worldwide, especially in tropical and subtropical regions.

OBJECTIVE

We aimed to determine the current prevalence of these parasites in Guangxi, China, which is located in a subtropical region.

METHODS

A cross-sectional study and a 4-year longitudinal surveillance study were carried out. Stool samples were collected and examined microscopically for parasite eggs using the modified Kato-Katz thick smear method.

RESULTS

The study subjects selected using stratified random cluster sampling for the cross-sectional study and longitudinal surveillance study numbered 15,683 and 24,429, respectively. In the cross-sectional study, hookworm, roundworm, whipworm, pinworm, C. sinensis, and tapeworm were found. The total prevalence of soil-transmitted helminths (STHs) was 6.4% (95% CI, 6.0-6.8). The prevalences of C. sinensis, hookworm, roundworm, whipworm, and pinworm were 10.6%, 4.2%, 0.3%, 0.3%, and 1.8%, respectively. The prevalence of C. sinensis in males (14.0%, 95% CI, 13.3-14.8) was significantly higher than in females (7.2%, 95% CI, 6.7-7.8) (P = 0.0001). The prevalence also was significantly higher in the medical worker group (20.8%, 95% CI, 12.9-28.7) than in all other occupational groups (10.5%, 95% CI, 10.0-11.0) (P = 0.0001). The prevalence of hookworm in females (5.3%, 95% CI, 4.8-5.8) was significantly higher than in males (3.0%, 95% CI, 2.6-3.3) (P = 0.0001). In the longitudinal surveillance study, the prevalence of C. sinensis and STHs in 2016, 2017, 2018, and 2019 were 12.0%, 6.0%, 11.0%, and 10.0% and 2.6%, 2.8%, 1.5%, and 1.5%, respectively.

CONCLUSIONS

Adult male and occupation of and medical workers are risk factors for infection with C. sinensis and hookworm. The prevalence rate of C. sinensis remains high while those of the other STHs are decreasing, suggesting that enhanced health education should be focused on C. sinensis in Guangxi.