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Enriquez GF, Macchiaverna NP, Garbossa G, Quebrada Palacio LP, Ojeda BL, Bua J, Gaspe MS, Cimino R, Gürtler RE, Postan M, Cardinal MV. Humans seropositive for Trypanosoma cruzi co-infected with intestinal helminths have higher infectiousness, parasitaemia and Th2-type response in the Argentine Chaco. Parasit Vectors 2024; 17:340. [PMID: 39135121 PMCID: PMC11320973 DOI: 10.1186/s13071-024-06401-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 07/09/2024] [Indexed: 08/15/2024] Open
Abstract
BACKGROUND The Gran Chaco ecoregion is a well-known hotspot of several neglected tropical diseases (NTDs) including Chagas disease, soil-transmitted helminthiasis and multiparasitic infections. Interspecific interactions between parasite species can modify host susceptibility, pathogenesis and transmissibility through immunomodulation. Our objective was to test the association between human co-infection with intestinal parasites and host parasitaemia, infectiousness to the vector and immunological profiles in Trypanosoma cruzi-seropositive individuals residing in an endemic region of the Argentine Chaco. METHODS We conducted a cross-sectional serological survey for T. cruzi infection along with an intestinal parasite survey in two adjacent rural villages. Each participant was tested for T. cruzi and Strongyloides stercoralis infection by serodiagnosis, and by coprological tests for intestinal parasite detection. Trypanosoma cruzi bloodstream parasite load was determined by quantitative PCR (qPCR), host infectiousness by artificial xenodiagnosis and serum human cytokine levels by flow cytometry. RESULTS The seroprevalence for T. cruzi was 16.1% and for S. stercoralis 11.5% (n = 87). We found 25.3% of patients with Enterobius vermicularis. The most frequent protozoan parasites were Blastocystis spp. (39.1%), Giardia lamblia (6.9%) and Cryptosporidium spp. (3.4%). Multiparasitism occurred in 36.8% of the examined patients. Co-infection ranged from 6.9% to 8.1% for T. cruzi-seropositive humans simultaneously infected with at least one protozoan or helminth species, respectively. The relative odds of being positive by qPCR or xenodiagnosis (i.e. infectious) of 28 T. cruzi-seropositive patients was eight times higher in people co-infected with at least one helminth species than in patients with no such co-infection. Trypanosoma cruzi parasite load and host infectiousness were positively associated with helminth co-infection in a multiple regression analysis. Interferon-gamma (IFN-γ) response, measured in relation to interleukin (IL)-4 among humans infected with T. cruzi only, was 1.5-fold higher than for T. cruzi-seropositive patients co-infected with helminths. The median concentration of IL-4 was significantly higher in T. cruzi-seropositive patients with a positive qPCR test than in qPCR-negative patients. CONCLUSIONS Our results show a high level of multiparasitism and suggest that co-infection with intestinal helminths increased T. cruzi parasitaemia and upregulated the Th2-type response in the study patients.
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Affiliation(s)
- Gustavo Fabián Enriquez
- Universidad de Buenos Aires., Facultad de Ciencias Exactas y Naturales. Departamento de Ecología, Genética y Evolución. Laboratorio de Eco-Epidemiología., Buenos Aires, Argentina.
- Instituto de Ecología, Genética y Evolución (IEGEBA), CONICET-Universidad de Buenos Aires, Buenos Aires, Argentina.
| | - Natalia Paula Macchiaverna
- Universidad de Buenos Aires., Facultad de Ciencias Exactas y Naturales. Departamento de Ecología, Genética y Evolución. Laboratorio de Eco-Epidemiología., Buenos Aires, Argentina
- Instituto de Ecología, Genética y Evolución (IEGEBA), CONICET-Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Graciela Garbossa
- Laboratorio de Parasitología Clínica y Ambiental, Facultad de Ciencias Exactas y Naturales, Universidad de Buenos Aires, IQUIBICEN-CONICET-UBA), Instituto de Investigaciones en Salud Pública, Buenos Aires, Argentina
| | - Luz Piedad Quebrada Palacio
- Universidad de Buenos Aires., Facultad de Ciencias Exactas y Naturales. Departamento de Ecología, Genética y Evolución. Laboratorio de Eco-Epidemiología., Buenos Aires, Argentina
- Instituto de Ecología, Genética y Evolución (IEGEBA), CONICET-Universidad de Buenos Aires, Buenos Aires, Argentina
- Institute of Virology, Helmholtz Centre Munich, German Research Centre for Environmental Health, Neuherberg, Germany
| | - Bárbara Leonor Ojeda
- Universidad de Buenos Aires., Facultad de Ciencias Exactas y Naturales. Departamento de Ecología, Genética y Evolución. Laboratorio de Eco-Epidemiología., Buenos Aires, Argentina
| | - Jacqueline Bua
- Instituto Nacional de Parasitología Dr. M. Fatala Chabén, Administración Nacional de Laboratorios e Institutos de Salud Dr. C.G. Malbrán, Buenos Aires, Argentina
| | - María Sol Gaspe
- Universidad de Buenos Aires., Facultad de Ciencias Exactas y Naturales. Departamento de Ecología, Genética y Evolución. Laboratorio de Eco-Epidemiología., Buenos Aires, Argentina
- Instituto de Ecología, Genética y Evolución (IEGEBA), CONICET-Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Rubén Cimino
- Instituto de Investigaciones de Enfermedades Tropicales (IIET). Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET)-CCT Salta, Universidad Nacional de Salta, Sede Regional Orán, Salta, Argentina
- Facultad de Ciencias Naturales, Cátedra de Química Biológica, Universidad Nacional de Salta, Salta, Argentina
| | - Ricardo Esteban Gürtler
- Universidad de Buenos Aires., Facultad de Ciencias Exactas y Naturales. Departamento de Ecología, Genética y Evolución. Laboratorio de Eco-Epidemiología., Buenos Aires, Argentina
- Instituto de Ecología, Genética y Evolución (IEGEBA), CONICET-Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Miriam Postan
- Consejo Nacional de Investigaciones Científicas y Tecnológicas (CONICET), Buenos Aires, Argentina
| | - Marta Victoria Cardinal
- Universidad de Buenos Aires., Facultad de Ciencias Exactas y Naturales. Departamento de Ecología, Genética y Evolución. Laboratorio de Eco-Epidemiología., Buenos Aires, Argentina
- Instituto de Ecología, Genética y Evolución (IEGEBA), CONICET-Universidad de Buenos Aires, Buenos Aires, Argentina
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Hoekstra PT, Madinga J, Lutumba P, van Grootveld R, Brienen EAT, Corstjens PLAM, van Dam GJ, Polman K, van Lieshout L. Diagnosis of Schistosomiasis without a Microscope: Evaluating Circulating Antigen (CCA, CAA) and DNA Detection Methods on Banked Samples of a Community-Based Survey from DR Congo. Trop Med Infect Dis 2022; 7:315. [PMID: 36288056 PMCID: PMC9608707 DOI: 10.3390/tropicalmed7100315] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 10/13/2022] [Accepted: 10/17/2022] [Indexed: 11/16/2022] Open
Abstract
Detection of Schistosoma eggs in stool or urine is known for its low sensitivity in diagnosing light infections. Alternative diagnostics with better sensitivity while remaining highly specific, such as real-time PCR and circulating antigen detection, are progressively used as complementary diagnostic procedures but have not yet replaced microscopy. This study evaluates these alternative methods for the detection of Schistosoma infections in the absence of microscopy. Schistosomiasis presence was determined retrospectively in 314 banked stool and urine samples, available from a previous survey on the prevalence of taeniasis in a community in the Democratic Republic of the Congo, using real-time PCR, the point-of-care circulating cathodic antigen (POC-CCA) test, as well as the up-converting particle lateral flow circulating anodic antigen (UCP-LF CAA) test. Schistosoma DNA was present in urine (3%) and stool (28%) samples, while CCA (28%) and CAA (69%) were detected in urine. Further analysis of the generated data indicated stool-based PCR and the POC-CCA test to be suitable diagnostics for screening of S. mansoni infections, even in the absence of microscopy. A substantial proportion (60%) of the 215 CAA-positive cases showed low antigen concentrations, suggesting that even PCR and POC-CCA underestimated the "true" number of schistosome positives.
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Affiliation(s)
- Pytsje T. Hoekstra
- Department of Parasitology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Joule Madinga
- Institute of Health and Society, Université Catholique de Louvain, 1348 Brussels, Belgium
- Department of Biomedical Sciences, Institute of Tropical Medicine, 2000 Antwerp, Belgium
| | - Pascal Lutumba
- Institut National de Recherche Biomédicale, Kinshasa 1197, Democratic Republic of the Congo
- Department of Tropical Medicine, University of Kinshasa, Kinshasa 7948, Democratic Republic of the Congo
| | - Rebecca van Grootveld
- Department of Clinical Microbiology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Eric A. T. Brienen
- Department of Parasitology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Paul L. A. M. Corstjens
- Department of Cell and Chemical Biology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Govert J. van Dam
- Department of Parasitology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Katja Polman
- Department of Biomedical Sciences, Institute of Tropical Medicine, 2000 Antwerp, Belgium
- Department of Health Sciences, VU University Amsterdam, 1081 HV Amsterdam, The Netherlands
| | - Lisette van Lieshout
- Department of Parasitology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
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Nigo MM, Odermatt P, Salieb–Beugelaar GB, Morozov O, Battegay M, Hunziker PR. Epidemiology of Schistosoma mansoni infection in Ituri Province, north-eastern Democratic Republic of the Congo. PLoS Negl Trop Dis 2021; 15:e0009486. [PMID: 34855748 PMCID: PMC8638996 DOI: 10.1371/journal.pntd.0009486] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 05/14/2021] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Schistosomiasis, caused by Schistosoma mansoni, is of great significance to public health in sub-Saharan Africa. In the Democratic Republic of Congo (DRC), information on the burden of S. mansoni infection is scarce, which hinders the implementation of adequate control measures. We assessed the geographical distribution of S. mansoni infection across Ituri province in north-eastern DRC and determined the prevailing risk factors. METHODS/PRINCIPAL FINDINGS Two province-wide, community-based studies were conducted. In 2016, a geographical distribution study was carried out in 46 randomly selected villages across Ituri. In 2017, an in-depth study was conducted in 12 purposively-selected villages, across the province. Households were randomly selected, and members were enrolled. In 2016, one stool sample was collected per participant, while in 2017, several samples were collected per participant. S. mansoni eggs were detected using the Kato-Katz technique. In 2017, a point-of-care circulating cathodic S. mansoni antigen (POC-CCA) urine test was the second used diagnostic approach. Household and individual questionnaires were used to collect data on demographic, socioeconomic, environmental, behavioural and knowledge risk factors. Of the 2,131 participants in 2016, 40.0% were positive of S. mansoni infection. Infection prevalence in the villages ranged from 0 to 90.2%. Of the 707 participants in 2017, 73.1% were tested positive for S. mansoni. Prevalence ranged from 52.8 to 95.0% across the health districts visited. Infection prevalence increased from north to south and from west to east. Exposure to the waters of Lake Albert and the villages' altitude above sea level were associated with the distribution. Infection prevalence and intensity peaked in the age groups between 10 and 29 years. Preschool children were highly infected (62.3%). Key risk factors were poor housing structure (odds ratio [OR] 2.1, 95% 95% confidence interval [CI] 1.02-4.35), close proximity to water bodies (OR 1.72, 95% CI 1.1-2.49), long-term residence in a community (OR 1.41, 95% CI 1.11-1.79), lack of latrine in the household (OR 2.00, 95% CI 1.11-3.60), and swimming (OR 2.53, 95% CI 1.20-5.32) and washing (OR 1.75, 95% CI 1.10-2.78) in local water bodies. CONCLUSIONS/SIGNIFICANCE Our results show that S. mansoni is highly endemic and a major health concern in Ituri province, DRC. Infection prevalence and intensity, and the prevailing socioeconomic, environmental, and behavioural risk factors in Ituri reflect intense exposure and alarming transmission rates. A robust plan of action is urgently needed in the province.
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Affiliation(s)
- Maurice M. Nigo
- Nanomedicine Translation Group, Intensive Care Unit, University Hospital Basel, University of Basel, Basel, Switzerland
- CLINAM–European Foundation for Clinical Nanomedicine, Basel, Switzerland
- University of Basel, Basel, Switzerland
- Institut Supérieur des Techniques Médicales (ISTM) Nyankunde, Bunia, Democratic Republic of Congo
| | - Peter Odermatt
- University of Basel, Basel, Switzerland
- Swiss Tropical and Public Health Institute, Basel, Switzerland
| | - Georgette B. Salieb–Beugelaar
- Nanomedicine Translation Group, Intensive Care Unit, University Hospital Basel, University of Basel, Basel, Switzerland
- CLINAM–European Foundation for Clinical Nanomedicine, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Oleksii Morozov
- Nanomedicine Translation Group, Intensive Care Unit, University Hospital Basel, University of Basel, Basel, Switzerland
- CLINAM–European Foundation for Clinical Nanomedicine, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Manuel Battegay
- University of Basel, Basel, Switzerland
- Department of Infectiology & Hospital Hygiene, University Hospital Basel, Basel, Switzerland
| | - Patrick R. Hunziker
- Nanomedicine Translation Group, Intensive Care Unit, University Hospital Basel, University of Basel, Basel, Switzerland
- CLINAM–European Foundation for Clinical Nanomedicine, Basel, Switzerland
- University of Basel, Basel, Switzerland
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Balbino LF, Alves Filho A, Farias BES, Costa GV, Sinhorin GH, Silva LLS, Marques RCR, Jucá FL, Brilhante AF, Melchior LAK. Intestinal protozoan infections and environment conditions among rural schoolchildren in Western Brazilian Amazon. BRAZ J BIOL 2021; 83:e247530. [PMID: 34190765 DOI: 10.1590/1519-6984.247530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 03/17/2021] [Indexed: 11/22/2022] Open
Affiliation(s)
- L F Balbino
- Universidade Federal do Acre - UFAC, Cento de Ciências da Saúde e do Desporto, Rio Branco, Rio Branco, AC, Brasil
| | - A Alves Filho
- Universidade Federal do Acre - UFAC, Cento de Ciências da Saúde e do Desporto, Rio Branco, Rio Branco, AC, Brasil
| | - B E S Farias
- Universidade Federal do Acre - UFAC, Cento de Ciências da Saúde e do Desporto, Rio Branco, Rio Branco, AC, Brasil
| | - G V Costa
- Universidade Federal do Acre - UFAC, Cento de Ciências da Saúde e do Desporto, Rio Branco, Rio Branco, AC, Brasil
| | - G H Sinhorin
- Universidade Federal do Acre - UFAC, Cento de Ciências da Saúde e do Desporto, Rio Branco, Rio Branco, AC, Brasil
| | - L L S Silva
- Universidade Federal do Acre - UFAC, Cento de Ciências da Saúde e do Desporto, Rio Branco, Rio Branco, AC, Brasil
| | - R C R Marques
- Universidade Federal do Acre - UFAC, Cento de Ciências da Saúde e do Desporto, Rio Branco, Rio Branco, AC, Brasil
| | - F L Jucá
- Centro Universitário Uninorte, Rio Branco, AC, Brasil
| | - A F Brilhante
- Universidade Federal do Acre - UFAC, Cento de Ciências da Saúde e do Desporto, Rio Branco, Rio Branco, AC, Brasil
| | - L A K Melchior
- Universidade Federal do Acre - UFAC, Centro de Ciências Biológicas e da Natureza, Rio Branco, AC, Brasil
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Mukuku O, Sánchez SS, Bugeme M, Garcia HH. Case Report: Three Cases of Neurocysticercosis in Central Africa. Am J Trop Med Hyg 2020; 103:1955-1957. [PMID: 32901607 DOI: 10.4269/ajtmh.19-0759] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Neurocysticercosis (NCC) is an infection prevalent in developing countries; however, it is neglected in the Democratic Republic of the Congo (DRC) and in sub-Saharan Africa. Here, we present three different cases seen in a consulting room in Lubumbashi. These cases are evidence that NCC is more common than it was previously thought in sub-Saharan Africa. Neurocysticercosis is a pathology-neglected and ignored infection, not only by the population but also by health professionals and health authorities in the DRC, and because of that, it is important to increase the research about NCC in the DRC to assess the prevalence and risk factors for NCC to assess the severity of the phenomenon and to help designing appropriate prevention and control measures.
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Affiliation(s)
- Olivier Mukuku
- Institut Supérieur des Techniques Médicales de Lubumbashi, Lubumbashi, Democratic Republic of the Congo
| | - Sofía S Sánchez
- Cysticercosis Unit, Instituto Nacional de Ciencias Neurológicas, Lima, Peru
| | - Marcellin Bugeme
- University of Lubumbashi, Lubumbashi, Democratic Republic of the Congo
| | - Hector H Garcia
- Center for Global Health, Universidad Peruana Cayetano Heredia, Lima, Peru.,Cysticercosis Unit, Instituto Nacional de Ciencias Neurológicas, Lima, Peru
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Inocencio da Luz R, Linsuke S, Roucher C, Mpanya A, Nyandele J, Mubwa Mungwele N, Mboma BN, Polman K, Hasker E, Boelaert M. Community-based survey on helminth infections in Kwilu province, the Democratic Republic of the Congo, and implications for local control strategies. PLoS Negl Trop Dis 2020; 14:e0008745. [PMID: 33112859 PMCID: PMC7592847 DOI: 10.1371/journal.pntd.0008745] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 08/25/2020] [Indexed: 11/19/2022] Open
Abstract
To adequately plan mass drug administration campaigns, the Democratic Republic of the Congo (DRC) needs further support for the mapping and monitoring of schistosomiasis (SCH) and soil-transmitted helminths (STH). We conducted a community-based survey in the health districts of Mosango and Yasa Bonga of the Kwilu province, DRC. A stratified two-stage cluster random sampling method was used to include participants into three different strata: Preschool-aged children (PSAC), school-aged children (SAC), and adults who were further subdivided into women of reproductive age (WRA) and other adults. In total, surveyors visited 30 villages, and 1 206 individuals participated in the study. Stool samples were collected to perform duplicate Kato-Katz smears for the detection of SCH and STH infection. Hookworm was the most prevalent infection in both districts, 34.1% (95%CI: 32.0–38.4), followed by A. lumbricoides (2.7%; 95%CI: 1.3–2.9) and T. trichiura (1.9%; 95%CI: 1.1–2.7). We did not find any SCH infection. The prevalence of each STH infection was similar across all risk groups, and the majority of the infected individuals was carrying light intensity infection. Compared to SAC, other adults were equally infected with hookworm. The prevalence of STH infection in SAC guides the MDA implementation because schoolchildren are most at risk and easily accessible program targets if school attendance is high. The current treatment strategy targets PSAC, SAC and WRA. However, this study shows that adults in general could also benefit from deworming. Therefore, community-wide preventive chemotherapy would be the most appropriate choice to control the hookworm burden rapidly. Helminths are a group of intestinal worms that cause abdominal discomfort, diarrhea, and anemia due to blood loss in the stool. Regular mass drug administration (MDA) is one strategy to fight these worm infections. The appropriate MDA treatment scheme is chosen based on a population survey estimating the burden of infection. This survey is usually done in schoolchildren because they suffer the most from these infections and they are easy to reach through school infrastructures. However, one particular worm, the hookworm, is also highly present and clinically relevant in adults. We conducted a community-based survey in two districts of the Kwilu Province of the DRC. We found that hookworm was the predominant infection in the area and that adults were as often infected as the schoolchildren. Therefore, to effectively reduce hookworm infection, we advise extending treatment schemes to the entire community.
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Affiliation(s)
| | - Sylvie Linsuke
- Epidemiology Unit, Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo
| | - Clémentine Roucher
- Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Alain Mpanya
- Ministry of Health, PNLTHA, Kinshasa, Democratic Republic of the Congo
| | - Jane Nyandele
- Hubert Kairuki Memorial University, Dar es Salaam, Tanzania
| | | | | | - Katja Polman
- Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Epco Hasker
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Marleen Boelaert
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
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Amoebic toxic megacolon with poly-helminthic coinfection: Case presentation and review of intestinal polyparasitic infections. Int J Surg Case Rep 2020; 71:151-154. [PMID: 32450374 PMCID: PMC7251492 DOI: 10.1016/j.ijscr.2020.04.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 03/25/2020] [Accepted: 04/09/2020] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Intestinal parasitic infections are a health burden to developing countries, but can also become more prevalent worldwide, even in developed countries, with the advent of globalization. While most of these infections are benign, some may be associated with acute infections with high morbidity and mortality rates. CASE PRESENTATION A 36 years old patient presented with toxic megacolon with poly-helminthic infections, likely a result of raw food ingestion. She subsequently required multiple surgeries with a total colectectomy and small bowel resection, and ended up with an end-ileostomy. DISCUSSION Intestinal polyparasitism has been reported in undeveloped countries, but it appears that such a trend can be found in developed countries as well. Clinicians, especially those practicing in countries with large expatriate or immigrant worker populations, should be aware of this trend and adjust treatment protocols accordingly. CONCLUSION Even in countries whereby intestinal parasitic infections are not common, clinicians should have a heightened awareness of the possibility for such infections to be present, especially in returning travellers, expatriate or immigrant populations.
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Donohue RE, Cross ZK, Michael E. The extent, nature, and pathogenic consequences of helminth polyparasitism in humans: A meta-analysis. PLoS Negl Trop Dis 2019; 13:e0007455. [PMID: 31211774 PMCID: PMC6599140 DOI: 10.1371/journal.pntd.0007455] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 06/28/2019] [Accepted: 05/09/2019] [Indexed: 02/07/2023] Open
Abstract
Background Individual helminth infections are ubiquitous in the tropics; geographical overlaps in endemicity and epidemiological reports suggest areas endemic for multiple helminthiases are also burdened with high prevalences of intestinal protozoan infections, malaria, tuberculosis (TB), and human immunodeficiency virus (HIV). Despite this, pathogens tend to be studied in isolation, and there remains a need for a better understanding of the community ecology and health consequences of helminth polyparasitism to inform the design of effective parasite control programs. Methodology We performed meta-analyses to (i) evaluate the commonality of polyparasitism for helminth-helminth, helminth-intestinal protozoa, helminth-malaria, helminth-TB, and helminth-HIV co-infections, (ii) assess the potential for interspecies interactions among helminth-helminth and helminth-intestinal protozoan infections, and (iii) determine the presence and magnitude of association between specific parasite pairs. Additionally, we conducted a review of reported health consequences of multiply-infected individuals compared to singly- or not multiply-infected individuals. Principal findings We found that helminth-helminth and helminth-intestinal protozoan multiple infections were significantly more common than single infections, while individuals with malaria, TB, and HIV were more likely to be singly-infected with these infections than co-infected with at least one helminth. Most observed species density distributions significantly differed from the expected distributions, suggesting the potential presence of interspecies interactions. All significant associations between parasite pairs were positive in direction, irrespective of the combination of pathogens. Polyparasitized individuals largely exhibited lower hemoglobin levels and higher anemia prevalence, while the differences in growth-related variables were mostly statistically insignificant. Conclusions Our findings confirm that helminth polyparasitism and co-infection with major diseases is common in the tropics. A multitude of factors acting at various hierarchical levels, such as interspecies interactions at the within-host infra-parasite community level and environmental variables at the higher host community level, could explain the observed positive associations between pathogens; there remains a need to develop new frameworks which can consider these multilevel factors to better understand the processes structuring parasite communities to accomplish their control. Helminth infections are a highly prevalent global health problem. These parasitic worm infections occur in areas also burdened with intestinal protozoan infections, malaria, tuberculosis, and human immunodeficiency virus. While these pathogens tend to be studied in isolation, there remains a need to better understand the nature, extent, and health consequences of helminth polyparasitism and co-infection with major diseases. Here, we reviewed the literature and performed meta-analyses to evaluate the commonality of helminth polyparasitism and co-infection, the potential for interspecies interactions between parasites, the association between parasite pairs, and the health consequences among multiply-infected individuals. We confirmed that polyparasitism and co-infection with major diseases are common in the global South and found that multiply-infected individuals experienced worse health consequences when compared to singly or not-multiply infected individuals. Our analysis suggested the potential presence of interspecies interactions and we identified the existence of positive associations between parasite pairs. These findings support the call for integrating deworming into malaria, TB, and HIV treatment protocols and suggest there remains a need to improve our understanding of the factors influencing co-transmission to achieve sustainable parasite control.
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Affiliation(s)
- Rose E. Donohue
- Department of Biological Sciences, University of Notre Dame, Notre Dame, Indiana, United States of America
| | - Zoë K. Cross
- University of Utah, Salt Lake City, Utah, United States of America
| | - Edwin Michael
- Department of Biological Sciences, University of Notre Dame, Notre Dame, Indiana, United States of America
- * E-mail:
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Cavalcanti MG, Cunha AFA, Peralta JM. The Advances in Molecular and New Point-of-Care (POC) Diagnosis of Schistosomiasis Pre- and Post-praziquantel Use: In the Pursuit of More Reliable Approaches for Low Endemic and Non-endemic Areas. Front Immunol 2019; 10:858. [PMID: 31191512 PMCID: PMC6546849 DOI: 10.3389/fimmu.2019.00858] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Accepted: 04/03/2019] [Indexed: 12/22/2022] Open
Abstract
Like soil-transmitted helminth infections, schistosomiasis is an important neglected tropical disease (NTD) related to poverty with a major impact on public health in developing countries. Diagnosis of active infection is crucial for surveillance of controlled or post-elimination schistosomiasis areas. In addition, the use of conventional diagnostic tools in non-exposed populations (such as travelers) results in misdiagnoses in the prepatent period of infection. Also, the accuracy of standard tests applied in low-endemicity areas (LEAs) decreases after several rounds of treatment. We aimed to determine whether it would be necessary to replace schistosomiasis conventional diagnostic tests such as parasitological methods in LEAs. Also, we evaluate the use of new tools in non-endemic areas. Reliable, cheap and easy-to-use diagnostic tools are needed to respond to the demands of a new era of elimination and eradication of schistosomiasis. To this end, molecular diagnosis-including nucleic acid-based assays (loop-mediated isothermal amplification, polymerase chain reaction) and circulating cathodic and anodic antigen detection tests have become promising strategies. In this review, we attempt to address the use of alternative diagnostic tests for active infection detection and drug-monitoring after specific schistosomiasis treatment.
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Affiliation(s)
- Marta G Cavalcanti
- Serviço de Doenças Infecciosas e Parasitárias, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.,Departmento de Imunologia, Instituto de Microbiologia Paulo de Góes, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Aline Fernandes Araujo Cunha
- Departmento de Imunologia, Instituto de Microbiologia Paulo de Góes, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - José Mauro Peralta
- Departmento de Imunologia, Instituto de Microbiologia Paulo de Góes, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
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Enriquez GF, Macchiaverna NP, Argibay HD, López Arias L, Farber M, Gürtler RE, Cardinal MV, Garbossa G. Polyparasitism and zoonotic parasites in dogs from a rural area of the Argentine Chaco. VETERINARY PARASITOLOGY- REGIONAL STUDIES AND REPORTS 2019; 16:100287. [PMID: 31027600 DOI: 10.1016/j.vprsr.2019.100287] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 03/13/2019] [Accepted: 04/07/2019] [Indexed: 12/30/2022]
Abstract
Dogs play an important role as reservoirs and hosts of multiple pathogens shared with humans and wildlife, which contribute significantly to the global burden of disease. Here, we assessed the occurrence of a broad range of zoonotic and non-zoonotic parasites in dogs from a rural area in the humid Chaco; determined the occurrence of polyparasitism; and explored its association with selected risk factors. In total, 212 dogs were examined serologically to determine Trypanosoma cruzi infection and 152 of them also were examined for Ehrlichia canis, Borrelia bugderfori, Anaplasma phagocitophylum, Dirofilaria immitis and Toxoplasma gondii. Fecal samples from 85 dogs were examined for intestinal parasites. Seventeen parasite species were seen, 77% of which are zoonotic. The most prevalent parasites were Ancylostoma caninum (68.2%), T. gondii (55.3%, first report for dogs in Argentina), Giardia sp. (25.9%), Cryptosporidium sp. (20.0%), T. cruzi (16.5%), trematodes (15.3%) and Toxocara canis (14.1%). Polyparasitism was found in 96% of the dogs, with up to six parasite species in a single dog, and was significantly associated with age of dog but not with host body condition or sex. The most frequent pair of parasites found together were T. gondii-A. caninum (46%), A. caninum-T. cruzi (34%) and T. gondii-T. cruzi (27%). The prevalence of anemia and leukocytosis was significantly higher in dogs showing the worst body condition. Our findings likely reflect structural poverty, poor sanitation and lack of a safe water supply. Importantly, many of the prevalent parasites seen are threats to human health. 243 words.
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Affiliation(s)
- G F Enriquez
- Laboratory of Eco-Epidemiology, Faculty of Exact and Natural Sciences, University of Buenos Aires, Intendente Güiraldes 2160, Piso 2, Ciudad Universitaria, Buenos Aires, Argentina; Institute of Ecology, Genetics and Evolution of Buenos Aires (UBA-CONICET), Argentina.
| | - N P Macchiaverna
- Laboratory of Eco-Epidemiology, Faculty of Exact and Natural Sciences, University of Buenos Aires, Intendente Güiraldes 2160, Piso 2, Ciudad Universitaria, Buenos Aires, Argentina; Institute of Ecology, Genetics and Evolution of Buenos Aires (UBA-CONICET), Argentina
| | - H D Argibay
- Laboratory of Eco-Epidemiology, Faculty of Exact and Natural Sciences, University of Buenos Aires, Intendente Güiraldes 2160, Piso 2, Ciudad Universitaria, Buenos Aires, Argentina; Institute of Ecology, Genetics and Evolution of Buenos Aires (UBA-CONICET), Argentina
| | - L López Arias
- Laboratory of Molecular Parasitology, Institute of Biotechnology, Center for Research in Veterinary and Agronomic Sciences, INTA, Los Reseros S/N, Castelar, Province of Buenos Aires, Argentina
| | - M Farber
- Laboratory of Molecular Parasitology, Institute of Biotechnology, Center for Research in Veterinary and Agronomic Sciences, INTA, Los Reseros S/N, Castelar, Province of Buenos Aires, Argentina
| | - R E Gürtler
- Laboratory of Eco-Epidemiology, Faculty of Exact and Natural Sciences, University of Buenos Aires, Intendente Güiraldes 2160, Piso 2, Ciudad Universitaria, Buenos Aires, Argentina; Institute of Ecology, Genetics and Evolution of Buenos Aires (UBA-CONICET), Argentina
| | - M V Cardinal
- Laboratory of Eco-Epidemiology, Faculty of Exact and Natural Sciences, University of Buenos Aires, Intendente Güiraldes 2160, Piso 2, Ciudad Universitaria, Buenos Aires, Argentina; Institute of Ecology, Genetics and Evolution of Buenos Aires (UBA-CONICET), Argentina
| | - G Garbossa
- Laboratory of Clinical and Environmental Parasitology, Faculty of Exact and Natural Sciences, University of Buenos Aires, Intendente Güiraldes 2160, Piso 4, Ciudad Universitaria, Buenos Aires, Argentina; Public Health Research Institute, University of Buenos Aires, Presidente José Evaristo Uriburu 950, Piso 1, Buenos Aires, Argentina
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11
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A comparative analysis of preservation techniques for the optimal molecular detection of hookworm DNA in a human fecal specimen. PLoS Negl Trop Dis 2018; 12:e0006130. [PMID: 29346412 PMCID: PMC5773002 DOI: 10.1371/journal.pntd.0006130] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Accepted: 11/22/2017] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Proper collection and storage of fecal samples is necessary to guarantee the subsequent reliability of DNA-based soil-transmitted helminth diagnostic procedures. Previous research has examined various methods to preserve fecal samples for subsequent microscopic analysis or for subsequent determination of overall DNA yields obtained following DNA extraction. However, only limited research has focused on the preservation of soil-transmitted helminth DNA in stool samples stored at ambient temperature or maintained in a cold chain for extended periods of time. METHODOLOGY Quantitative real-time PCR was used in this study as a measure of the effectiveness of seven commercially available products to preserve hookworm DNA over time and at different temperatures. Results were compared against "no preservative" controls and the "gold standard" of rapidly freezing samples at -20°C. The preservation methods were compared at both 4°C and at simulated tropical ambient temperature (32°C) over a period of 60 days. Evaluation of the effectiveness of each preservative was based on quantitative real-time PCR detection of target hookworm DNA. CONCLUSIONS At 4°C there were no significant differences in DNA amplification efficiency (as measured by Cq values) regardless of the preservation method utilized over the 60-day period. At 32°C, preservation with FTA cards, potassium dichromate, and a silica bead two-step desiccation process proved most advantageous for minimizing Cq value increases, while RNA later, 95% ethanol and Paxgene also demonstrate some protective effect. These results suggest that fecal samples spiked with known concentrations of hookworm-derived egg material can remain at 4°C for 60 days in the absence of preservative, without significant degradation of the DNA target. Likewise, a variety of preservation methods can provide a measure of protection in the absence of a cold chain. As a result, other factors, such as preservative toxicity, inhibitor resistance, preservative cost, shipping requirements, sample infectivity, and labor costs should be considered when deciding upon an appropriate method for the storage of fecal specimens for subsequent PCR analysis. Balancing logistical factors and the need to preserve the target DNA, we believe that under most circumstances 95% ethanol provides the most pragmatic choice for preserving stool samples in the field.
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Abstract
PURPOSE OF REVIEW Cestodes infections in humans are among the most prevalent parasitosis worldwide. Although tapeworm infection is often asymptomatic, they can be associated with a range of symptoms. The landscape of cestode infections is changing with rapid diagnosis techniques and advanced molecular diagnosis aiding in identification of species specific epidemiology. RECENT FINDINGS Traditional descriptions of species by location have been challenged with molecular diagnostic techniques, which show variation in distribution of species, thought to be because of globalization and importation of disease. MAIN THEMES IN LITERATURE Epidemiology, molecular diagnostic techniques. SUMMARY Infection by tapeworms is often asymptomatic or accompanied by mild symptoms though can occasionally cause severe disease and contribute to anemia and malnutrition. Tapeworm infection is most prevalent in resource-poor countries but the distribution is worldwide. Epidemiology of infection is changing because of molecular diagnostics, which allow more accurate tracking of species.
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Affiliation(s)
- Camille Webb
- Division of Infectious Disease Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas, USA
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Inocencio da Luz R, Linsuke S, Lutumba P, Hasker E, Boelaert M. Assessment of schistosomiasis and soil-transmitted helminths prevalence in school-aged children and opportunities for integration of control in local health services in Kwilu Province, the Democratic Republic of the Congo. Trop Med Int Health 2017; 22:1442-1450. [PMID: 28853206 DOI: 10.1111/tmi.12965] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To determine the prevalence of schistosomiasis (SCH) and soil-transmitted helminths (STH) in the Democratic Republic of Congo, and to assess the capacity of the local health centres for diagnosis and treatment. METHODS Cross-sectional school-based survey in two health districts in the Province of Kwilu. We collected a stool and a urine sample for parasitological examination. Urine filtration and duplicate Kato-Katz thick smears were used for the diagnosis of SCH. Health centres were evaluated using a structured questionnaire. RESULTS In total, 526 children participated in the study and the overall prevalence of Schistosoma mansoni infection was 8.9% (95% CI: 3.5-13.2) in both districts. The prevalence was higher in Mosango (11.7%; 95% CI: 8.9-14.8) than Yasa Bonga district (6.2%; 95% CI: 1.1-11.4). Urine filtration showed that Schistosoma haematobium infection was not present. The combined STH infection prevalence was 58.1% in both districts; hookworm infection was the most common STH found in 52.9% (95% CI: 29.3-62.4) of subjects, followed by Ascaris lumbricoides 9.3% (95% CI: 5.8-15.5) and Trichuris trichiura 2.1% (95% CI: 0.9-4.9). Mixed STH infections were observed as well as SCH-STH coinfection. CONCLUSION Further mapping of both SCH and STH burden is needed, and coverage of preventive chemotherapy in school-aged children should be increased.
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Affiliation(s)
- R Inocencio da Luz
- Department of Public Health, Institute of Tropical Medicine Antwerp, Antwerp, Belgium
| | - S Linsuke
- Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo
| | - P Lutumba
- Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo
| | - E Hasker
- Department of Public Health, Institute of Tropical Medicine Antwerp, Antwerp, Belgium
| | - M Boelaert
- Department of Public Health, Institute of Tropical Medicine Antwerp, Antwerp, Belgium
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Davaasuren A, Davaajav A, Ukhnaa B, Purvee A, Unurkhaan S, Luvsan A, Logan JE, Ito A. Neurocysticercosis: A case study of a Mongolian traveler who visited China and India with an updated review in Asia. Travel Med Infect Dis 2017; 20:31-36. [PMID: 28478337 DOI: 10.1016/j.tmaid.2017.04.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 04/20/2017] [Accepted: 04/23/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Neurocysticercosis (NCC) of Taenia solium has never been reported in Mongolia. A Mongolian traveler who visited China and India presented with epileptic seizures after his return to Mongolia. Magnetic resonance imaging showed multiple ring enhancing lesions with edema surrounding several lesions in his brain that were initially diagnosed to be viral encephalitis or NCC. METHODS Serology for cysticercosis using diagnostic antigens partially purified by cation-exchange chromatography and chimeric recombinant antigens and DNA analysis of a proglottid found in the patient's stool were applied for differential diagnosis. RESULTS Serology showed strong positivity for NCC, and mitochondrial cox1 gene analysis revealed Indian but not Chinese haplotype of T. solium. CONCLUSION This NCC case was considered to be caused by eggs released from adult tapeworm(s) established after eating uncooked or undercooked pork contaminated with cysticerci during his stay in India. This is a case report of taeniasis and secondary NCC associated with travel to India with an updated review of NCC in Asia. Molecular tracking of the specimen is highly informative as a way to identify where the infection was acquired.
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Affiliation(s)
- Anu Davaasuren
- Laboratory of Parasitology, National Center for Communicable Diseases, Ulaanbaatar, Mongolia.
| | - Abmed Davaajav
- Laboratory of Parasitology, National Center for Communicable Diseases, Ulaanbaatar, Mongolia.
| | - Baigalmaa Ukhnaa
- Department of Radiology, Luxmed Hospital, Ulaanbaatar, Mongolia.
| | | | - Saraa Unurkhaan
- Neurology Center, The State Third Central Hospital, Ulaanbaatar, Mongolia.
| | - Amartuvshin Luvsan
- Department of Radiology, The State Third Central Hospital, Ulaanbaatar, Mongolia.
| | - Jenae E Logan
- Division of Infectious Disease, School of Medicine and Global Health Institute, Duke University, North Carolina, USA.
| | - Akira Ito
- Department of Parasitology, Asahikawa Medical University, Asahikawa, Japan.
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