Clustering of cases of mycobacterium fortuitum infection investigated by molecular typing

Organisms of the mycobacterium fortuitum complex are recognised but uncommon causes of pulmonary disease, primary cutaneous disease and a wide spectrum of nosocomial infections. M fortuitum was isolated from 20 patients over a 15 month period, with a apparent clustering of isolates occurring from January to March 1994. The molecular epidemiology of this clustering eas investigated using an arbitrary primer polymerase chain reaction method (AP-PCR). 21 isolates were studied, which yielded 13 distinct profiles. Multiple isolates from a single patient yielded identical profiles. All of seven isolates recovered during the six week period from January to March 1994 shared a common profile which was distinct from all other isolates, suggesting that a single strain was isolated from specimens from all seven patients. The source of this cluster in uncertain. We can find no epidemilogical basis for an episode of cross-infection within the hospital environment, and it is assumed that contamination of the specimens during collection, transport or processing was responsible for the "pseudo-outbreak" of M fortuitum

Absence of Escherichia coli 0157 in a survey of wildlife from Trinidad and Tobago

Fecal, cloacal, or rectal swabs of free-ranging and captive mammalian and avian wildlife in Trinidad and Tobago were cultured for non-sorbitol fermenting Escherichia coli and tested for 0157: H7 strains. Ability of E. coli strains to produce hemolysin and mucoid colonies also was investigated. Of 271 free-ranging mammals tested, 158 (58 percent) yielded E. coli; only one (< 1 percent) bacterial isolate was a non-sorbitol fermenter which was not agglutinated by 0157 antiserum. All isolates were negative for hemolysin production and mucoid colonial growth. Two hundred and sixty-three (90 percent) of 293 free-flying birds were positive for E. coli and all isolates were sorbitol fermenters and negative for production of hemolysin and mucoid growth. Of 175 captive wild animals from individual backyard farms and a government demonstration farm, 145 (83 percent) yielded E. coli with four (2 percent) non-sorbitol fermenters; all were negative for 0157 strains, hemolysin production, and mucoid colonial growth. Of 373 animals in a zoo, 250 (67 percent) were positive for E. coli with only two (0.5 percent) non-sorbitol fermenters. All strains were non-hemolytic and non-mucoid farms. It appears that free-ranging and captive avian and mammalian wildlife are not important reservoirs of 0157: H7 stains of E. coli in Trinidad and Tobago.(AU)

Epidemiology of giardiasis and cryptosporidiosis in Jamaica

We report the findings of a cross-sectional epidemiologic of Giardia lamblia and Cryptosporidum infections in Jamaica. Three hundred twenty eight stool samples from patients less than one to 81 years of age were examined using formalin-ether concentration for G. lamblia, Zeihl-Neelsen staining for Cryptosporidum, and the Prospect rapid enzyme immunoassay (EIA; Alexon, Sunnyvale, CA) for parasite diagnosis. The Prospect Giardia rapid assay detected 17 cases of G. lamblia infections compared with six by formalin-ether concentration. However, the Prospect Cryptosporidum EIA did not increase the rate of detection of Cryptosporidum when compared with Zeihl-Neelsen staining. Cryptosporidum infections were most frequently diagnosed in children less than five years old and prevalence decreased with age. In contrast, the prevalence of giardiasis increased as children became older. There were no associations between the infections and stool consistency, clinical manifestations, or sex of the individuals. The contribution of the parasites to childhood morbidity will depend on accurate laboratory diagnosis (Au)

Some bacterial enteropathogens in wildlife and racing pigeons from Trinidad

Fecal and cloacal swabs or feces of wild mammalian, avian and reptilian species, either farmed or free-ranging, and of racing pigeons (Columba livia) kept in lofts were cultured for Salmonella spp., Campylobacter spp., and Yersinia spp. Of 291 free-ranging mammals tested 6 (2 percent) and 1 (< 1 percent) and 1 (< 1 percent) yielded positive culture of Salmonella spp. and Campylobacter spp., respectively. Salmonella newport was the predominant serotype isolated and the opossum (Didelphis marsupialis insularis) had the significantly highest prevalence (29 percent) of Salmonella spp. infection compared to other species such as deer (Mazama americana trinitatis), lappe (Agouti paca), tattoo (Dasypus novemcinctus), agouti (Dasyprocta leporina), and wild hog (Tayassu tajacu). Among 14 species of farmed wildlife studied, 13 (7 percent) and 10 (5 percent) of 184 fecal or cloacal samples tested were positive for Salmonella spp. and Campylobacter spp., respectively. Salmonella javians accounted for 50 percent of the Salmonella spp. isolates and C. jejuni represented 90 percent of the Campylobacter spp. cultured. Only 1 (1 percent) of 124 cloacal swabs of free-flying avian species yielded Salmonella spp. compared to 21 (17 percent) samples positive for Campylobacter spp. Of 171 racing pigeons which originated from 8 fanciers, 8 (5 percent) yielded Salmonella spp. all of which were serotype typhimurium while only 1 (1 percent) were positive for Campylobacter spp. Seven (88 percent) of 8 Salmonella spp. isolates were recovered from one fancier. Yersina spp. was not cultured from any of the above samples. Although the prevalences of Salmonella spp. and Campylobacter spp. in wildlife in Trinidad are low, the practice of wildlife farming and the increased consumption of meat from wildlife may increase the health risk to human consumers(AU)

Trichuris trichiura infection and cognitive function in Jamaican school children

Trichuris trichiura is extremely prevalent worldwide and there is concern that this geohelminth may affect the cognitive function of children in developing countries. A random-controlled, double-blind, treatment trial was conducted in Jamaican children with light to moderate infections. This was part of a research programme involving several studies in Jamaica. Ninety-seven subjects, each with a minimum of 1200 T. trichiura eggs/g faeces, were randomly assigned to placebo (N = 48) or treatment (N = 49) groups. Each pair of infected children was matched with an uninfected classmate (N = 48). All children were given seven cognitive functions tests: French-learning; digit spans (forward and backwards), Corsi block span; fluency; picture search; and silly sentences. Albendazole was given to the treatment group and the other groups received a placebo. Three months later, these treatments were repeated, and the cognitive function battery was given again. On pre-test, the infected groups performed significantly poorer only in the silly-sentence test (analysis of variance F-value=8.17; two degrees of freedom; p<0.001). There was no significant improvement with treatment in any of the tests. Taking into account these findings and those of the other Jamaican studies, it is therefore probable that light to moderate Trichuris infections have little effect on cognitive functioning in school children who have adequate nutritional status.(AU)

Intestinal worm infestation of children under 9 years of age in Annotto Bay, St. Mary

A study of gastrointestinal parasitic infection was conducted in Annotto Bay community in the Parish of St. Mary, Jamaica. 64 percent of stool specimen (n=85) contained ova/cyst of one or more 3 helminth species. The prevalence was markedly age-dependent, with infection occurring most commonly in pre-school children. It is concluded that gastriontestinal parasitic infection is also related to low socioeconomic status, lack of education in personal hygiene and environmental sanitation, prevalence level of intestinal infestation likely to have a significant impact on community health until and unless treatment and control programmes are combined with other public health measures such as health education, environmental sanitation, proper personal hygiene and most of all community participation(AU)

Treatment of trichuris trichiura infections improves growth, spelling scores and school attendance in some children

The effects of treating Trichuris trichiura infections were investigated in 407 Jamaican children age 6 to 12 years. The children were randomly assigned to receive treatment (albendazole) or a placebo. The outcome variables included growth, tests of reading, spelling and arithmetic, and school attendance. After 6 months of treatment, there was no significant main effect on any of the outcomes. However, there were significant treatment-by-infection intensity interactions with spelling (P < 0.05) and body mass index (P < 0.01), and a significant treatment-by-stunting interaction with school attendance (P < 0.01). In spelling, the children with heavy infections showed improvements with treatment that approached significance d(P = 0.06), whereas those with lower intensities did not. However, the children with lower infection intensities had increased body mass index with treatment (P = 0.02), although there was no difference in children with heavy infections. In school attendance, the stunted children improved with treatment (P < 0.04), whereas there was no difference in the nonstunted children. These findings suggest that in the sample of Jamaican children examined, the treatment of T. trichiura was more likely to benefit school performance in children of poor nutritional status and those with heavy infections, and to improve weight gain in children with lighter infection intensities (AU)

Trichuris trichiura infection and cognition in children: results of a randomized clinical trial

The effects of mild to moderate infections of Trichuris trichiura on cognitive functions were investigated in Jamaican children aged 7 to 10 years. In all, 189 infected children and 100 uninfected classmates were studied. The infected children were randomly assigned to receive treatment (albendazole) or a placebo. All children were given cognitive tests on enrolment and 14 weeks later. These included verbal fluency (generation of ideas), digit span (working memory), number choice (speed of processing of visual stimuli), visual search (sustained attention) and a French Vocabulary test (paired-associate learning). At baseline, the infected children had lower scores than the uninfected ones in fluency (P=0.01), search (P=0.02) and French (P=0.01). Treatment effects were examined among infected children and there was no significant treatment effect for any of the tests. However, there was a significant treatment by weight-for-age interaction in fluency (P<0.05). The children with low weight-for-age (Z-score < -1) improved with treatment while there was no improvement with treatment among the other children. We concluded that treatment of children with mild to moderate T. trichiura infections using albendazole produces little benefit in cognition if they are adequately nourished; however, undernourished children are more likely to benefit (AU)

Prospective evaluation of enzyme-linked immunosorbent assay and immunoblot methods for the diagnosis of endemic Strongyloides stercoralis infection

Recently described enzyme-linked immunosorbent assay (ELISA) and immunoblot methods for the detection of serum IgG against Strongyloides stercoralis larval antigens were prospectively evaluated for the diagnosis of endemic strongyloidiasis. A modification of the ELISA involved preincubation of sera with Onchocerca gutturosa phosphate-buffered saline-soluble extract to remove cross-reactivity with other helminths. The sensitivity of the ELISA increased from 80 percent and 85 percent following preincubation. Similarly, there was an increase in specifity from 94 percent to 97 percent. The IgG recognition of 41-, 31-, and 28-kD filariform larval components showed sensitivities of 100 percent, 85 percent and 65 percent, respectively. Both the ELISA following incubation of sera with O. gutturosa extract and serum IgG reactivity to a 41-kD larval component using immunoblotting are sensitive and specific techniques for diagnosing endemic strongyloidiasis.(AU)

Prevalence of trichuris trichiura and ascaris lumbricoides in Jamaican schoolchildren - abstract

There is increasing concern that geohelminth infections may adversely affect the growth and development of children. The relevance of this in the Caribbean is unclear since in many territories the prevalence of these parasites is unknown. We report the results of three surveys conducted in Jamaican schools located in areas thought to be at high risk of geohelminthiasis. The first was conducted in 12 primary schools in Kingston and comprised children in grades 2 to 5 (age 7 to 10 years). The second and third surveys were conducted in rural areas with children in grades 2 to 5 and 4 and 5 respectively. Overall, 9 244 children provided stool samples for analysis. The prevalence of Trichuris trichiura ranged from 42 per cent to 47 per cent among the surveys while that for Ascaris lumbricoides ranged from 15 per cent to 37 per cent. When differences by grade were examined, the children in grades 2 and 3 had lower prevalences of T. trichiura than those in grades 4 and 5 in the first and second surveys (p<0.05 and p<0.005, respectively). The only significant grade difference in A. lumbricoides was in the second survey with children in grades 4 and 5 having higher prevalences than those in grades 2 and 3 (p<0.005). Most of the infections were light with approximately 1 per cent of the sample having heavy egg densities of greater than 7000 T. trichiura eggs per gram or 35 000 A. lumbricoides eggs per gram. Because of the sampling methodology, the observed prevalences are likely to be overestimates of national infection levels. However, it appears that Trichuriasis and Ascariasis are still common infections in Jamaican school-children (AU)

Geohelminth infections in school-aged children in Jamaica

There is concern that geohelminthiasis may adversely affect the growth and development of children. The relevance of this in the Caribbean in unclear since in many territories the prevalence of geohelminths is unknown. We report the results of three surveys conducted in Jamaican primary schools located in areas at high risk for geohelminthiasis. The first was conducted in 12 Kingston schools and comprised children in grades 2 to 5 (age 7 to 10 years). The second and third surveys were conducted in rural areas with children in grades 2 to 5 and grades 4 and 5, respectively. Overall, 9244 children provided stool sample for analysis. The prevalence of Trichuris trichiura ranged from 42 percent to 47 percent among the surveys while that for Ascaris lumbricoides ranged from 15 percent to 37 percent. Children in grades 2 and 3 had lower T. trichiura prevalences than those in grades 4 and 5 in the first and second surveys (p<0.05 and p<0.005, respectively). In the second survey only, children in grades 2 and 3 had a lower prevalence of A. lumbricoides than those in grades 4 and 5(p<0.005). Most infections were light with approximately 1 percent of the sample having heavy egg densities (AU)

Compliance and absenteeism in school children implications for helminth control

The validity of epidemiological surveys and the success of helminth control programmes based on the diagnosis of infection depend upon an accurate screening procedure. The success of all school-based control programmes, whether they involve prior diagnosis or not, depends on the level of school attendance and school enrollment. The degree to which compliance and school absenteeism may affect estimates of helminth infection and the coverage of treatment was investigated using empirical data from a survey conducted in 3 rural schools in Jamaica. Two sequential stool samples were requested from each child aged 9 to 12 years and screened for the presence and intensity of helminth infection using the Kato thicksmear technique. Of the 696 children recruited into the study, 94 percent agreed to participate but only 90 percent of these children actually provided a stool sample for diagnosis and only 74 percent returned the second stool. Children infected with moderate to heavy loads of Trichuris trichiura were less likely to comply fully with the protocol than the uninfected children. They also took longer to comply and were absent from school more often than their uninfected counterparts. Increasing the sample effort increased the compliance of all infected, and heavily infected, children. By giving them the option to comply, heavily infected children were under-represented by the sampling procedure. This has important implications for the design of control programmes and epidemiological surveys (AU)

Blastocystis hominis in immunocompetent children in Trinidad - abstract

Blastocystis hominis, formerly described as an enteric yeast, was reclassified as a protozoan parasite. The organism has elicited tremendous interest as reports have been controversial regarding its status as a pathogen or non-pathogen. Between March and August, 1990, we examined the formed stools of 894 asymptomatic children (age range 1-14 years) by the modified Ritchie-formalin-ethylacetate method for ova and cysts of parasites. Fourteen of the 73 under-five (19.2 percent) had B. hominis with 8/10 having B.hominis only. Seventy-one of 96 (74 percent) orphans had parasites, 64 (66.7 percent) of whom had B.hominis with 22/64 (34.4 percent) having B.hominis only. In the survey sample of 705 school children 158 (22.4 percent) had parasites with 98 having B.hominis and 74/98 (75.55 percent) had B.hominis only. It was noted that 13 children who had heavy B.hominis burdens did not present with diarrhoea. Children 8-12 years old appeared to be most frequently colonised. From our experience, we conclude that B.hominis in immunocompetent children is not a pathogen (AU)

Inactivation of strongyloides stercoralis filariform larvae in vitro by six Jamaican plant extracts and three commercial antihelminthics

In vitro bioassay of (a) aqueous methanol extracts (AME) of the green leaves of mimosa (Mimosa pudica), love weed (Cuscuta americana), vervine (Stachytarpheta jamaicensis), chicken weed (Salvia serotina) and breadfruit (Artocarpus altilis); (b) methanol-water fraction (MWF) of breadfruit leaves, and (c) commercially available drugs albendazole, thiabendazole and levamisole were assayed for nematode inactivating potential, using filariform larvae of Strongyloides stercoralis. Test larvae were obtained from a 10-day-old charcoal coproculture. Bioassays were conducted in Locke's solution, using 100 larvae in each of three replicates. Inactivation was recorded microscopically at 1, 2, 6 and 12 hours, then every 24 hours up to 5 days' incubation. It(50) (time for inactivation of 50 percent of larvae) values read: levamisole and mimosa extract < 1 hour; love weed extract, approximately 2 hours; breadfruit (MWF), 9.5 hours; chicken weed, 20 hours; albendazole, 35 hours; breadfruit (AME), 49 hours; thiabendazole, 74 hours and vervine extract, 81.5 hours. It(95) values followed a similar trend, and were approximately double the It(50) measures. A potential role for locally available natural products in the treatment of strongyloidiasis is highlighted (AU)

Detection of ruminal bacteria that degrade toxic dihydroxypyridine compounds produced from mimosine

Leucaena leucocephala, a tropical leguminous shrub, contains a toxic amino acid, mimosine. Successful utilization of leucaena as a ruminant forage depends on colonization of the rumen by bacteria that degrade dihydroxypyridines (DHP), which are toxic intermediates in the metabolism of mimosine. Populations in the rumina of animals in some parts of the world, however, do not include bacteria that are able to carry out this degradation. We thus describe tests for the presence of DHP degraders in ruminal populations that are based on degradation (loss) of DHP compounds from culture media. Results obtained with the tests indicate that DHP degraders were not part of microbial populations in the rumina of cattle, sheep, and goats in Iowa, while most rumen samples examined from animals from the Virgin Islands and Haiti contained DHP degraders. These results confirm and extend the findings of others about geographic limits to the distribution of these important ruminal bacteria. (AU)

Control of geohelminths by delivery of targeted chemotherapy through schools

This study describes the age-targeted chemotherapeutic control of geohelminthiasis in the total population (n=11 500) of the island of Montserrat, West Indies. The intervention programme involved the treatment with single dose albendazole of all children aged 2-15 years (approximately 2500) in 4 sequential cycles at intervals of 4 months. Infection status was monitored by an inital coprological survey of an age-stratified sample (11.5 percent) of the population, and by the surveys of smaller samples (4-5 percent) after 2 and 4 cycles of treatment (7 and 15 months respectively). The programme delivered treatment to >90 percent of the target population in each cycle, and reduced the prevalence and intensity of Ascaris lumbricoides and Trichuris trichiuria infection in the target age-class. A decline in infection was observed in the 16-25 year age class, even though 4 percent of adults received treatment. The study demonstrates that chemotherapy targeted only at children can be implemented within an existing health infrastructure, and can achieve an overall reduction in the prevalence and intensity of geohelminth infection. (AU)

Food preparation and sale on the Mona campus, University of the West Indies, Jamaica

In this study, an attempt was made to assess food preparation and sale on the Mona campus of the University of the West Indies, Jamaica, with special emphasis on contaminant levels and the operators' knowledge of food hygiene. The five larger food establishments were inspected and food handlers questioned. Consecutive food samples were taken and analysed. Fresh stool samples were obtained from 78 percent of the food handlers questioned. Inspections revealed dry storage in disarray, absence of use of polythene gloves for preparing salads, lack of thorough fly-proofing and rat-proofing, and very insanitary out-fall of kitchen sinks in all establishments in sample. Food sample results showed that 92 percent of the meat (chicken) samples were food to have a very high coliform count - in excess of 300 cfu/ml. In addition there were two samples which facilitated the growth of Staphylococcus. Faecal E. coli was not found. The 25 vegetable salad samples were found to be heavily contaminated with coliform. Most of the time in excess of 300 cfu/ml. Most of the food samples exceeded the international specification for coliform count in cooked food 10 and raw vegetables 10. Of the five water samples taken, two supported the growth of anaerobic sporebearing bacilli with coliform count greater than 300 cfu/ml. However, no faecal coliforms were isolated. A major recommendation is that in-service training be incorporated in the terms of the operators' contract (AU)