Impact of health education on knowledge and prevention behavior for congenital toxoplasmosis: the experience in Poznań, Poland

In 1991-1997 educational activities were undertaken in the Poznań region of Poland to promote health education for the prevention of toxoplasmosis. The effect of education was measured in 2710 pregnant women by a questionnaire survey. Knowledge of toxoplasmosis and its prevention was almost doubled within 4 years. Similarly, the proportion of women having antenatal serological tests for toxoplasmosis significantly increased. In the examined population the knowledge of how Toxoplasma gondii is transmitted/acquired was better than the knowledge of individual risk factors for congenital toxoplasmosis. Correct hygienic behaviors in pregnancy were often practised by women who lacked good knowledge of toxoplasmosis. The experience from this study suggests the possible effectiveness of including prevention of toxoplasmosis into the whole package of preventing infectious diseases in pregnancy and into healthy lifestyle promotion. Health educational activities need to be realized by modern promotional technologies in addition to making available traditional written educational texts. There is a considerable role of medical services in promotion of a hygienic behavior in pregnant women preventing congenital toxoplasmosis in their offspring. Health education should be especially tailored to the population of pregnant women below the age of 21.

Neonatal screening for congenital toxoplasmosis in the Poznań region of Poland by analysis of Toxoplasma gondii-specific IgM antibodies eluted from filter paper blood spots

OBJECTIVES

The aims of the study were to determine the prevalence of congenital toxoplasmosis at birth in the Poznań region of Poland, the value of the serologic examination of filter paper blood specimens collected from newborns for the diagnosis of congenital Toxoplasma infection and the duration of anti-Toxoplasma-specific IgM antibodies in infants' sera.

MATERIALS AND METHODS

All neonates born in the maternity wards of the University Hospital of Gynaecology and Obstetrics in Poznań and in 10 selected obstetrics wards in the district hospitals were included. Blood samples were collected on filter paper cards, between the first and sixth day of life, screened for anti-Toxoplasma-specific IgM antibodies by an immunocapture enzyme-linked immunosorbent assay and if positive further analyzed for specific IgG and IgA antibodies.

RESULTS

Between June, 1996, and October, 1998, filter paper samples from 27,516 liveborn infants were tested, which constituted approximately 75% of all births and 83% of liveborn neonates from the Poznań region. Anti-T. gondii-specific IgM antibodies were found in 13 newborns, equivalent to a prevalence of Toxoplasma-specific IgM in newborns of 1 per 2,117 liveborn children (0.47 per 1,000) or 1 per 870 children (1.15 per 1,000) born to seronegative women at risk of primary T. gondii infection during pregnancy. We identified two congenitally infected infants who were IgM-negative at birth, had a classic triad of clinical symptoms during the first year of life and had high levels of specific IgG. The birth prevalence of congenital toxoplasmosis in the Poznań region was at least 1 per 1,834 live births (0.55 per 1,000) or 1 per 754 live neonates born to seronegative women (1.33 per 1,000). The sensitivity of the IgM assay on eluate from filter paper was not more than 86.7%, and the mean duration of IgM detectable by enzyme-linked immunosorbent assay in serum samples was the first 4.8 weeks of life.

CONCLUSION

In Poland the screening for congenital toxoplasmosis detecting one case per each 2,000 live births could be considered for inclusion in existing national neonatal screening programs for phenylketonuria and congenital hypothyroidism.

Differential serodiagnosis for cystic and alveolar echinococcosis using fractions of Echinococcus granulosus cyst fluid (antigen B) and E. multilocularis protoscolex (EM18)

Echinococcus granulosus cyst fluid and E. multilocularis protoscolex extract were fractionated by a single step of preparative isoelectric focusing, resulting in an antigen B-rich fraction (8-kD) and an Em18-rich fraction, respectively. The usefulness of both fractions for differential serodiagnosis of cystic (CE) and alveolar (AE) echinococcosis was evaluated by a large-scale immunoblot analysis on a battery of 354 serum samples. These included 66 from AE patients originating from four different endemic areas, 173 from CE patients originating from seven different endemic areas, 71 from patients with other parasitic diseases, 15 from patients with hepatomas, and 29 from healthy individuals. In an immunoblot with the antigen B-rich fraction, 92% (158 of 173) of the CE sera as well as 79% (52 of 66) of the AE sera reacted with the 8-kD subunit. No cross-reactivity occurred with any sera from patients with cysticercosis, other parasitic diseases, or with hepatomas, or from healthy controls. In an immunoblot with the Em18-rich fraction, all but two sera from AE patients (64 of 66, 97%) recognized Em18, and only nine of 34 CE sera from China reacted with it. All other (139) CE sera from six other countries were negative as were all (115) other non-echinococcosis sera. These findings indicate that antigen B (8-kD) is not species-specific for E. granulosus but is genus-specific for Echinococcus, and that the Em18 antigen is a reliable serologic marker for species-specific differentiation of AE from CE.

Molecular genetic analysis of human cystic hydatid cases from Poland: identification of a new genotypic group (G9) of Echinococcus granulosus

We have used nuclear (ribosomal ITS1) and mitochondrial (ND1) sequences to characterize human and pig isolates of Echinococcus granulosus collected by fine needle aspiration biopsy (FNAB) in Poland. The data indicate clearly that the Polish patients were not infected with the common sheep strain (G1 genotype) of E. granulosus, normally associated with human cystic hydatid infection. Instead, the hydatid parasite infecting the Polish patients shares very similar ND1 sequence with the previously characterized pig (G7) genotype but it also exhibits some clear differences. In particular, E. granulosus DNA from the Polish patients amplified a single ITS1 fragment in PCR and distinct ITS1-RFLP patterns were obtained after restriction digestion. The form of hydatid isolated from the Polish patients appears, therefore, to represent a distinct, previously undescribed genotype (designated G9) of E. granulosus.

Further evidence for the occurrence of a distinct strain of Echinococcus granulosus in European pigs

The morphology, adult development and genetic characteristics of Echinococcus granulosus isolated from pigs in Poland were examined and compared with those of other recognised strains of E. granulosus. The isolates were characterised by their distinct morphology, rapid maturation and unique DNA hybridisation profiles. The form of E. granulosus that occurs in European pigs may therefore be a distinct strain that can be separated morphologically and genetically from other strains and that exhibits features of epidemiological significance, including a rapid rate of development in dogs and an apparent low infectivity to humans and domestic ungulates.

Experimental infection with Taenia saginata (Poland strain) in Taiwanese pigs

Two 22-day-old Landrace-Small Ear Miniature (L-SEM) pigs, five 45 to 66-day-old Small Ear Miniature (SEM) pigs, and one 16-day-old Holstein calf were each fed 1000, 3000 or 10,000 Taenia saginata (Poland strain) eggs respectively and killed 34-77 days after inoculation. Four of the five SEM pigs and the Holstein calf were susceptible to this parasite. However, two L-SEM pigs and one SEM pig remained negative. The cysticerci recovery rates for the SEM pig and Holstein calf were 36% and 3%, respectively. All cysticerci from the SEM pigs were found in the livers, more in the parenchyma (89%) than on the surface (11%). Only eleven cysticerci in two SEM pigs were mature and the remainder were either immature, degenerated or calcified. The cysticerci in the calf were distributed throughout the body: leg muscles (248), heart (27), tongue (17), intercostal muscles (14), diaphragm (5), kidney (1) and liver (1). Most (299) of the cysticerci were mature, one was immature and 13 were degenerated or calcified. The length, width, diameter of the protoscolex and sucker of the cysticerci from the calf were larger than those from the SEM pigs. However, the diameter of the rostellum of the latter was slightly larger than the former. Hooklets were not found on any mature cysticercus recovered. The results of the present study provide evidence that the SEM pig can be used as an experimental intermediate host for T. saginata.

Control of Taenia solium taeniasis and cysticercosis by focus-oriented chemotherapy of taeniasis

The mortality, mortality, and disability due to Taenia solium neurocysticercosis are common and serious health problems in some regions, including several Asian countries. Neurocysticercosis in man and cysticercosis in pigs can be controlled by treatment, in man with a single, low (2 1/2 or 5 mg/kg) and safe dose of praziquantel. The problem which remains is the identification of a Taenia solium taeniasis foci. The definition of a focus is: T. solium-infected or suspected case; household with recent case of epilepsy in family or cysticercosis in pigs; group of houses or a village with high rate of cysticercosis in pigs. In a rural area a focus can be easily identified by tracing infected pigs to their place of origin, or in vivo tongue examination. All people with suspected T. solium taeniasis in a focus should be treated.

An enzyme-linked immunosorbent assay for diagnostic detection of Taenia saginata copro-antigens in humans

An immunodiagnostic sandwich enzyme-linked immunosorbent assay (ELISA) was developed for the detection of soluble Taenia saginata antigens in stool samples (copro-antigens) of infected humans, using affinity-purified polyclonal antibodies obtained from rabbits hyperimmunized with excretory/secretory antigens derived from T. saginata maintained in vitro. Investigation of operating characteristics showed very low cross-reactivity with crude antigens from helminths other than Taenia, including Dipylidium caninum and Diphyllobothrium latum. The specificity of the assay was 95% when testing stool samples from 100 persons who were either infected with Ascaris lumbricoides, Trichuris trichiura, hookworms, Enterobius vermicularis or Hymenolepis nana, or who had no intestinal helminthosis detected. Analysis of diagnostic sensitivity demonstrated that in 85% of 34 samples from 23 untreated persons with intestinal T. saginata infection (selected by previous proglottid and/or egg detection) copro-antigens were detected by the T. saginata ELISA. In the same samples, Taenia eggs were detected in 62%. Only 41% of the samples reacted positively in a heterologous T. hydatigena ELISA. Post-treatment control revealed a high concentration of T. saginata copro-antigens for 1-4 d after administration of niclosamide or praziquantel, and negative values 9-17 d after treatment. The Taenia copro-antigens remained detectable by ELISA even after storage of untreated faeces at 25 degrees C for at least 5 d.

Operational studies on the control of Taenia solium taeniasis/cysticercosis in Ecuador

A large-scale study in Loja and El Oro Provinces, Ecuador, demonstrated that population-based treatment of human taeniasis with a low dose of praziquantel is feasible and effective for the short-term control of transmission of Taenia solium in hyperendemic areas. Chemotherapeutic intervention also effectively promoted local preventive measures and contributed greatly to the elaboration of a long-term control programme.

Multicentre clinical trials of benzimidazole-carbamates in human cystic echinococcosis (phase 2)

A multicentre study which constituted the second phase of trials of the efficacy of albendazole and mebendazole in human cystic echinococcosis was coordinated by WHO. A total of 112 patients from four clinical centres in Beirut, Paris, Rome and Sofia completed standardized dosage of regimens of each drug and 68 patients were followed up for at least 12 months after treatment. Albendazole was more effective than mebendazole and adverse reactions were comparable with both treatment regimens. At least 12 months is needed after treatment for an objective evaluation of the efficacy of benzimidazoles. At present, treatment with albendazole or mebendazole should be reserved for inoperable cases of cystic echinococcosis (under strict medical supervision) and individualized according to the patient's response and the occurrence and severity of adverse reactions.

Multicentre clinical trials of benzimidazolecarbamates in human echinococcosis

Studies coordinated by the World Health Organization were conducted in seven clinical centres on the chemotherapy of human echinococcosis with mebendazole, albendazole, and flubendazole. The first phase of these ended with the following conclusions.Treatment of 85 patients with mebendazole for cystic (Echinococcus granulosus) echinococcosis was successful in 8 patients and partially successful in 4 others. Flubendazole was effective in only one case of lung echinococcosis. Albendazole was successful in 5 of 30 patients treated and partially successful in 4 others. Further studies on new drugs or new formulations of existing benzimidazoles and on better forms of their application are needed. In the mean time, chemotherapy of human cystic echinococcosis should be restricted to inoperable cases.In 54 patients with E. multilocularis echinococcosis, it was confirmed that mebendazole therapy may arrest the development of the lesions. This treatment is therefore indicated in most cases of alveolar echinococcosis with or without surgery. However, further studies are needed to clarify the optimal regimen for mebendazole treatment and to explore the effectiveness of albendazole therapy.

Amoebiasis and its control

On a global scale, 480 million people were recently estimated to be infected with Entamoeba histolytica and some 48 million people suffer from invasive amoebiasis. The latter, in the intestinal and extra-intestinal forms, accounts for 40 000 to 110 000 deaths annually. In view of this considerable mortality and morbidity, more research is urgently needed so that more effective control strategies may be introduced.This Update article reviews the magnitude of the problem, clinical and laboratory diagnosis, present treatment and prevention measures, possible control strategies, and research priorities.

Implications of parasite-nutrition interactions from a world perspective

Parasitic intestinal infections are among the most common in Africa, Asia, and Latin America. Although the mortality and morbidity caused by intestinal parasitic infections are relatively low, the absolute number of deaths and cases of disease is rather high in relation to other bacterial and viral infections. Scientific evidence for a causal relationship between intestinal parasitic infections and malnutrition is only fragmentary. The overdispersed frequency distribution of helminth parasites in the human population and the stability of giardiasis in some individuals may help only to define the potential target groups for immediate medical intervention, i.e., those patients heavily parasitized and/or severely malnourished. Long-term preventive intervention should include prenatal control of malnutrition, breast feeding and proper weaning food practices, oral rehydration for acute diarrhea, and immunization and possibly control of parasitic infections. Solid arguments in favor of the latter are expected to emerge from the field studies on intestinal parasitic infections and nutrition designed in 1981 by the World Health Organization and the United Nations Children's Emergency Fund. The results of these studies that will be carried out in several countries should serve as a guide for future parasite control projects and nutritional policies, including supplementary feeding programs.

Ascariasis: host-pathogen biology

Ascaris lumbricoides is one of the most common intestinal parasites in humans. Daily global contamination of the soil by A. lumbricoides eggs is enormous (approximately 9 x 10(14) eggs/day). Physical factors, particularly temperature and moisture, are critical in determining the maturation of eggs to the infective stage and their survival. Transmission of the infection to humans, on the other hand, depends more on various socioeconomic factors. In theory, ascariasis is preventable; it is indeed on the way to disappearing completely in developed societies where there is a high standard of sanitation. Ascariasis remains a problem in developing countries, however, where methods of disposal of human excreta are inadequate. The intensity of invasion is regulated by specific and nonspecific responses of the host to migrating A. lumbricoides larvae. Whether or not ascariasis becomes symptomatic depends on the intensity of the infection, the nutritional and immunologic status of the host, and the possible complications that may arise. Host responses to A. lumbricoides are brisk during the larval migratory stage in which hypersensitivity reactions may become clinically manifest, whereas people are rather tolerant of intestinal infections with adult worms. The role of ascariasis in the prevalence of allergic asthma still remains unclear. Complications due to migration of adult worms into the biliary duct system and to intestinal obstructions are the major causes of acute morbidity and mortality in ascariasis.