A Comprehensive Retrospective Study: Intestinal Parasites in Human in Van Province

Global prevalence of 4 neglected foodborne trematodes targeted for control by WHO: A scoping review to highlight the gaps

BACKGROUND

Foodborne trematodiases (FBTs) are a group of trematodes targeted for control as part of the World Health Organization (WHO) road map for neglected tropical diseases from 2021 to 2030. Disease mapping; surveillance; and capacity, awareness, and advocacy building are critical to reach the 2030 targets. This review aims to synthesise available data on FBT prevalence, risk factors, prevention, testing, and treatment.

METHODS

We searched the scientific literature and extracted prevalence data as well as qualitative data on the geographical and sociocultural risk factors associated with infection, preventive/protective factors, and methods and challenges of diagnostics and treatment. We also extracted WHO Global Health Observatory data representing the countries that reported FBTs during 2010 to 2019.

RESULTS

One hundred and fifteen studies reporting data on any of the 4 FBTs of focus (Fasciola spp., Paragonimus spp., Clonorchis sp., and Opisthorchis spp.) were included in the final selection. Opisthorchiasis was the most commonly reported and researched FBT, with recorded study prevalence ranging from 0.66% to 88.7% in Asia, and this was the highest FBT prevalence overall. The highest recorded study prevalence for clonorchiasis was 59.6%, reported in Asia. Fascioliasis was reported in all regions, with the highest prevalence of 24.77% reported in the Americas. The least data was available on paragonimiasis, with the highest reported study prevalence of 14.9% in Africa. WHO Global Health Observatory data indicated 93/224 (42%) countries reported at least 1 FBT and 26 countries are likely co-endemic to 2 or more FBTs. However, only 3 countries had conducted prevalence estimates for multiple FBTs in the published literature between 2010 to 2020. Despite differing epidemiology, there were overlapping risk factors for all FBTs in all geographical areas, including proximity to rural and agricultural environments; consumption of raw contaminated food; and limited water, hygiene, and sanitation. Mass drug administration and increased awareness and health education were commonly reported preventive factors for all FBTs. FBTs were primarily diagnosed using faecal parasitological testing. Triclabendazole was the most reported treatment for fascioliasis, while praziquantel was the primary treatment for paragonimiasis, clonorchiasis, and opisthorchiasis. Low sensitivity of diagnostic tests as well as reinfection due to continued high-risk food consumption habits were common factors.

CONCLUSION

This review presents an up-to-date synthesis on the quantitative and qualitative evidence available for the 4 FBTs. The data show a large gap between what is being estimated and what is being reported. Although progress has been made with control programmes in several endemic areas, sustained effort is needed to improve surveillance data on FBTs and identify endemic and high-risk areas for environmental exposures, through a One Health approach, to achieve the 2030 goals of FBT prevention.

Monitoring the Trends in Intestinal Parasite Frequencies; 2018 and 2022 Data

Objective

Monitoring intestinal parasite frequencies is effective on diagnosis, treatment, and prevention strategies to be developed against these parasites. In this study, it was aimed to reveal the parasite species and frequency data of stool samples in parasitology direct diagnosis laboratory.

Methods

Stool parasitological examination results were obtained retrospectively from our laboratory internal quality control data tables. Data belonging to the year 2018 and 2022 were compared retrospectively.

Results

Annual parasites detected in stool samples were 388 of 4.518, and 710 of 3.537, in 2018 and 2022, respectively. Frequency of parasite detection in stool samples was found to be significantly higher in 2022 (p<0.0001). Number of stools with more than one parasite was 12 and 30 in 2018 and 2022, respectively. Incidence of infection with more than one parasite was significantly higher in 2022 (p=0.0003). Five most common parasite species were Blastocystis spp., Enterobius vermicularis, Cryptosporidium spp., Giardia intestinalis and Entamoeba histolytica in 2018, respectively; and Cryptosporidium spp., Blastocystis spp., Cyclospora spp., Entamoeba dispar and Giardia intestinalis, in 2022, respectively. Cryptosporidium spp., Cyclospora spp. and Entamoeba dispar increased significantly, while Blastocystis spp. and Enterobius vermicularis decreased significantly, in 2022.

Conclusion

According to the data obtained, causative agents for intestinal parasitic infections were protozoans, especially Cryptosporidium spp. It has been concluded that tightening the measures for protection of water with one health approach and improving the education and habits of society on personal hygiene and food safety can be effective in reducing the frequency of intestinal parasite infections in our region.

Distribution and Phylogenetic Analysis of Subtypes and Alleles of Blastocystis sp. in the Stool Samples Collected from Patients with Gastrointestinal Complaints in İzmir, Turkey

PURPOSE

Blastocystis sp. is one of the most prevalent intestinal protozoa found in humans and many other animals. The present study aimed to examine the distribution and genetic diversity of Blastocystis sp. in stool samples from patients with gastrointestinal complaints in İzmir, Turkey.

METHODS

All stool samples of 439 patients with gastrointestinal complaints were examined by native-Lugol and trichrome staining. To investigate the presence of Blastocystis sp. in stool samples, DNA was isolated, and PCR was performed with the barcode region in the SSU rRNA gene. PCR positive samples were sequenced to identify subtypes and alleles of Blastocystis sp.

RESULTS

The prevalence of Blastocystis sp. was found to be 16.6% (73/439) in patients with gastrointestinal complaints in İzmir, Turkey. Three different Blastocystis sp. subtypes were identified. ST3 (28/55; 51.0%) was the most common subtype followed by ST2 (19/55; 34.5%) and ST1 (8/55; 14.5%). Itching and diarrhea were the most prominent clinical symptoms in Blastocystis sp. positive patients. When clinical symptoms and subtypes were compared, diarrhea was found in 62.5%, 47.4%, and 46.4% of patients with ST1, ST2, and ST3 subtypes, respectively. In addition, itching was found in 37.5%, 32.1%, and 21.1% of patients with ST1, ST3, and ST2, respectively. Six distinct alleles were identified by allele analysis of Blastocystis 18S rRNA gene: allele 4 for ST1, alleles 9, 11, and 12 for ST2, and alleles 34 and 36 for ST3. In this study, Blastocystis sp. was detected in 16 of 21 districts, including the central and rural districts of İzmir. Although ST1 was detected in central districts, it was not found in rural districts.

CONCLUSION

This study provides comprehensive data on the prevalence and molecular epidemiology of the genetic diversity at the level of subtypes and alleles of Blastocystis sp. in different districts of İzmir province in Turkey. To the best of our knowledge, this is the first study which evaluates the distribution of subtypes and alleles of Blastocystis sp. according to PCR and SSU rRNA gene sequencing in patients with gastrointestinal complaints in different districts of İzmir province in Turkey.

The global prevalence of human fascioliasis: a systematic review and meta-analysis

Background

Fascioliasis is a parasitic zoonosis that can infect humans and be a source of significant morbidity. The World Health Organization lists human fascioliasis as a neglected tropical disease, but the worldwide prevalence of fascioliasis data is unknown.

Objective

We aimed to estimate the global prevalence of human fascioliasis.

Data sources and methods

We performed a systematic review and prevalence meta-analysis. We used the following inclusion criteria: articles published in the English, Portuguese, or Spanish languages from December 1985 to October 2022 and studies assessing the prevalence of Fasciola in the general population with an appropriate diagnostic methodology, including longitudinal studies, prospective and retrospective cohorts, case series, and randomized clinical trials (RCTs). We excluded animal studies. Two reviewers independently reviewed the selected studies for methodological quality, performing critical standard measures from JBI SUMARI. A random-effects model was conducted of the summary extracted data on the prevalence proportions. We reported the estimates according to the GATHER statement.

Results

In all, 5617 studies were screened for eligibility. Fifty-five studies from 15 countries were selected, including 154,697 patients and 3987 cases. The meta-analysis revealed a pooled prevalence of 4.5% [95% confidence interval (CI): 3.1-6.1; I² = 99.4%; T² = 0.07]. The prevalence in South America, Africa, and Asia was 9.0%, 4.8%, and 2.0%, respectively. The highest prevalence was found in Bolivia (21%), Peru (11%), and Egypt (6%). Subgroup analysis showed higher prevalence estimates in children, in studies from South America, and when Fas2-enzyme-linked immunosorbent assay (ELISA) was used as a diagnostic method. A larger study sample size (p = 0.027) and an increase in female percentage (p = 0.043) correlated with a decrease in prevalence. Multiple meta-regression showed a higher prevalence for hyperendemic than hypoendemic (p = 0.002) or mesoendemic (p = 0.013) regions.

Conclusion

The estimated prevalence and projected disease burden of human fascioliasis are high. Study findings support that fascioliasis continues to be a globally neglected tropical disease. Strengthening epidemiological surveillance and implementing measures to control and treat fascioliasis is imperative in the most affected areas.

Bağışıklık Sistemi Baskılanmış Hastalarda Cryptosporidium spp. ve Giardia intestinalis Sıklığının Araştırılması

Amaç: Giardia intestinalis ve Cryptosporidium spp. türleri gelişmiş ve gelişmekte olan ülkelerde ishale neden olan bağırsak parazitleridir. Özelikle bağışıklık sistemi baskılanmış hastalarda ve çocuklarda tedavi edilemediğinde ölümcül olabilmektedir. Bu çalışmada Harran Üniversitesi Araştırma ve Uygulama Hastanesine başvuran bağışıklık sistemi baskılanmış hastaların dışkı örneklerinde Cryptosporidium spp. ve G.intestinalis sıklığının araştırılması amaçlanmıştır. Yöntem: Bu çalışma Ocak 2017 ve Ocak 2019 yılları arasında hastanemize başvuran bağışıklık sistemi baskılanmış ve ishal şikâyeti olan toplam 100 hasta ile gerçekleştirildi. Hastaların dışkı örneklerinde immünokromatografik (İK) metot ile Cryptosporidium spp. ve G. intestinalis antijenleri arandı ve nativ-lugol ve kinyoun asit fast boyama ile ookist, kist-trofozoit açısından incelendi. Bulgular: Toplam sekiz (%8) hastada G. intestinalis saptandı. Bunlardan yedisi (%14) çocuk hasta (n=50) ve biri (%2) yetişkin (n=50) bir kadın hasta olduğu tespit edildi. Hastaların 3 (%3)’ünde ise Cryptosporidium spp. görüldü. Bunlardan ikisi (%4) çocuk ve biri (%2) yetişkin kadın hastalar idi. Sonuçlarımız hem Cryptosporidium hem de G. intestinalis’in bağışıklık sistemi baskılanmış çocuk hastalarda (sırasıyla %4 ve %14) daha fazla saptandığını göstermiştir. Sonuç: Dışkı örneklerinde antijen saptayan İK metodun maliyeti yüksek olmasına rağmen çalışması kolay, erken sonuç vermesi ve etkensel tanı yöntemlerindeki zorluklara yardımcı olduğu görülmektedir. Sınırlı sayıda araştırılmış örnek bulunmasına rağmen bulgularımız bu iki parazitten kaynaklı enfeksiyonların Türkiye'de veya Avrupa ülkelerinde yapılan diğer çalışmalardaki görülme sıklığından daha yüksek olduğunu gösterdi.

Comparison of Intestinal Parasites in Native and Refugee Patients Admitted to a Territory Hospital in Turkey

OBJECTIVE

This study aimed to evaluate the distribution of intestinal parasites in refugee and native patients who applied to a territory hospital in Turkey.

METHODS

A total of 17911 patients who were admitted to our hospital between January 2018 and January 2019 were evaluated retrospectively in terms of intestinal parasites. The patients' stool samples were investigated for the existence of intestinal parasites by direct wet mount preparation, formalin ether concentration technique and cellophane tape method. The data obtained were compared between patient groups according to the examination method.

RESULTS

The overall prevalence of E. vermicularis in refugee children was found twice higher than that in native patients and the most common symptom was abdominal pain in these patients. Intestinal parasite detection rates were significantly higher in the stool concentration method than in the direct wet mount examination. Cutaneous complaints and protein energy malnutrition/growth retardation were the most common clinical conditions besides gastrointestinal symptoms in patients with intestinal parasitosis.

CONCLUSION

In our study, the prevalence of Blastocystis sp. in refugees was found to be higher than in the normal population. Intestinal parasitic infections should be investigated with proper diagnostic methods especially in children with PEM/GR and cutaneous symptoms in addition to gastrointestinal problems.

Retrospective Results of Hacettepe University Faculty of Medicine Parasitology Laboratory Between 2014-2019

OBJECTIVE

Parasitic infections emerge as a significant health problem, especially in underdeveloped and developing countries. Epidemiological data play an important role in taking effective measures against parasitic diseases.

METHODS

Clinical samples (stool, blood, bone marrow and tissue samples, etc.) that were sent to Hacettepe University Hospitals Parasitology Laboratory between 2014 and 2019 were analyzed retrospectively.

RESULTS

The positivity rates of the parasites detected in this study are as follows; Blastocystis sp. (71.6%), Dientamoeba fragilis (13.3%), Giardia lamblia (4.7%), Echinococcus spp. (1.9%), Enterobius vermicularis (1.8%) and Taenia spp. (0.3%). In this study, four of the patients were found to be positive for Leishmania spp. and two patients for Plasmodium falciparum and four patients for Plasmodium spp. E. histolytica/E. dispar cysts and/or trophozoites examined by Trichrome staining in our study were not detected within six years.

CONCLUSION

According to this data and in the light of the results obtained from different regions of our country, it will be possible to properly direct the necessary strategies for the diagnosis, treatment of parasitic infections and the implementation of preventive measures.

Evaluation of Intestinal Parasites and Some Clinical Symptoms in Children with Diarrhea

OBJECTIVE

This study aimed to determine the frequency of intestinal parasites in children who were presented to health centers with a complaint of diarrhea and to reveal the importance of these parasites.

METHODS

The study was conducted on children within the age range of 1-16 who were presented to Iğdır State Hospital and Private Bulut Hospital between 2020 February-April 2020 with a complaint of diarrhea. A total of 300 children comprising 141 girls and 159 boys were enrolled in the study. The control group was composed of 100 children (girls=50, boys=50) without any chronic disease and diarrhea. Stool samples were evaluated by the native-Lugol method and the modified acid-fast staining method.

RESULTS

Intestinal parasite positivity was found in 105 (35%) out of the 300 children in the patient group and in 17 (17%) out of the 100 children in the control group. In terms of parasitic positivity, a statistically significant difference was found between children with diarrhea and the healthy control group (p=0.001). Blastocystis hominis (13%), Cryptosporidium spp. (3%), and Giardia intestinalis (2%) were found in the patient group. Intestinal parasitic positivity was found in 30.2% and 40.4% of the boys and girls in the patient group, respectively, whereas it was found in 14% and 20% of the boys and girls in the control group, respectively. When evaluated statistically according to gender, a significant difference (comparison for boys: p=0.008; comparison for girls: p=0.004) was noted between the patient group and control group for each gender. In terms of the relationship between the frequency of parasites and some living conditions of the patients, a statistically significant relationship was found in the comparison of "whether or not livestock" (p=0.004) and "whether there is a sewerage network" (p=0.002). Additionally, a significant difference was found between parasitic positivity and abdominal pain (p=0.008) and nausea (p=0.003).

CONCLUSION

The present study concludes that children with clinical symptoms, such as diarrhea, abdominal pain, and nausea, should be evaluated for intestinal parasites. Furthermore, it has been understood that intestinal parasites remain an important health problem among the pediatric cohort.

The Coexistence of Blastocystis spp. in Humans, Animals and Environmental Sources from 2010-2021 in Asia

Blastocystis spp. are controversial unicellular protists that inhabit the gastrointestinal tract of humans and a wide range of animals worldwide. This review provides an overview of the prevalence and distribution of Blastocystis spp. and their subtypes throughout Asia. Research articles reporting on the presence of Blastocystis spp. in locations within Asia, between 1 January 2010, and 10 May 2021, were obtained from Scopus, PubMed, and Google Scholar. In 427 articles, the prevalence of Blastocystis spp. in 31 countries within the last decade was revealed. Isolates were found in humans, various mammals, birds, reptiles, insects, water sources, vegetables, and ambient air. Prevalence of Blastocystis spp. varied widely across host categories. Subtypes identified throughout Asia were STs 1-14, and ST18-22 (novel subtypes). ST1, ST2, ST3, ST4 were the most frequently isolated in humans; ST5 in pigs; ST10 and ST14 in goats, sheep, and cattle; and ST6 and ST7 in chickens. ST1 and ST3 were most common in water samples. ST1, ST2, ST3, ST4, ST5 and ST6 were shared by humans, animals, and water sources. There is a growing interest in the study of Blastocystis spp. and their subtypes in Asia. Due to the isolation of Blastocystis spp. from biotic and abiotic sources in Asia, the application of the One Health (OH) approach to the study of Blastocystis spp. is proposed for improved perception of this organism.

Comparative analysis of routine parasitological methods for recovery of cysts, molecular detection, and genotyping of Giardia duodenalis

In order to improve the diagnosis of giardiasis, fecal samples (high/medium/low concentration of cysts) were processed by the parasitological methods used in the routine: Faust, Lutz e Ritchie modified (replacement of formaldehyde by distilled water). The cysts were quantified; the DNA was extracted and amplified by semi-nested PCR (GDH gene). Fifteen clinical samples were analyzed to validate the study by PCR-RFLP. The results showed that the parasite was only detected and genotyped correctly when samples from children with high, medium, and low parasitic load, belonging to genotype AII, were processed by the modified Ritchie method, different from what was observed for the other methods used in laboratory routine (Faust and Lutz). The modified Ritchie method proved to be more suitable, recovering a greater number of cysts from samples, regardless of parasitic load, which reduces the chance of false negative results and has epidemiological repercussions since individuals with low parasite load are usually asymptomatic and the main disseminators of this infection.