An epidemiological overview of geohelminths and schistosomiasis in the Caribbean

The purpose of this publication is to provide a historical review of articles published on schistosomiasis and geohelminth infections in the Caribbean region. This is not an extensive overview of the entire region but rather one, which focuses on those nations and territories that have recent publications available. Efforts will be made in future revisions to examine countries and territories omitted from this review paper. The disease burden created by geohelminths as well as global prevalences will be discussed in this publication. In addition, various control and treatment methods will be explored. A summary of the data will be provided at the end of the publication (AU)

TRYPNET: new hemoparasite information network

Although Guyana, Suriname and French Guiana share borders and climatic and geographic similarities, the countries have maintained little contact, due to language, political, and administrative differences. In 1993, two international organizations involved in the improvement of animal health, the Inter-American Institute for Cooperation on Agriculture (IICA) and CIRAD-EMVT (Centre de Cooperation en Recherche Agronomique pour le Developement-Elevage et Medicine Veterinaire des Pays Tropicaux), jointly developed a collaborative project between the veterinary services of the three countries entitled Hemoparsite Network of the Guianas. This project seeks to pool livestock, laboratory, and technical resources between the three countries in order to generate and exchange information on hemoparasites of livestock. A Hemoparasite Reference Laboratory for the Guianas has been created at the CIRAD-EMVT laboratory in Cayenne, French Guiana. Besides processing ruminant serum samples for the three countries, specialists from this organization conduct training in hemoparasite diagnostic techniques for laboratory personnel from Guyana and Suriname. A large-scale epidemiologic study of cattle in the three countries is under way, to determine the prevalence, distribution, and clinical and economic significance of hemoparasites in the three countries, particularly Trypanosoma vivax and T. envansi. Preliminary results are presented and discussed. A hemoparasite information Network (TRYPNET) has been initiated, including a quarterly hemoparasite newsletter (TRYPNEWS), published in English and Spanish and disseminated to researchers in the Americas, Europe, and Africa. In 1995/96, it is proposed to expand the network's scope to include Venezuela and Brazil. (AU)

Parasitic infections associated with HIV/AIDS in the Caribbean

This review article seeks to highlight the significance for the Caribbean of major parasitic infections associated with AIDS, encourage awareness of these opportunistic parasites, and promote familiarity with appropriate diagnostic techniques and their clinical relevance. Specific agents considered include Pneumocystis carinii; Toxoplasma gondii; the enteric coccidians Crytosporidium spp., Isospora belli, and Cyclospora cayetanensis; the hemoflagellates Leishmania spp. and Trypanosoma cruzi; the fungi Histoplasma capsulatum and Cryptococcus neoformans; the nematode Strongyloides stercoralis; and the mite Sarcoptes scabiei. These disease agents can be divided into two groups, the immune-regulated "endogenous" parasites (the protozoans P. carinii and T. gondii, and possibly the roundworm S. stercoralis) and intracellular parasites (including the enteric coccidia, hemoflagellates, and fungi). Both in the Caribbean and elsewhere, the endogenous parasites (particularly P. carinii and T. gondii) are the most troublesome for AIDS patients, partly because they are likely to be transmitted and establish a benign immunoregulated presence early in the subjects's life. Indeed, health management programs for AIDS patients often routinely include P. carinii prophylaxis, since nearly all such patients who survive long enough are expected to experience an episode of acute P. carinii infection. In contrast, there is no known epidemiologic association between AIDS and strongyloidiasis in the Caribbean, and the prevalence there of potentially opportunisitc hemoflagellates such as Leishmania spp. and Trypanosoma cruzi is relatively low (AU)

Micronutrient deficiencies in the English-speaking Caribbean and methods for their control - abstract

Multiple micronutrient deficiencies is not a public health problem in the Caribbean. The most widespread micronutrient deficiency is iron. In some countries as many as 75 per cent of pregnant women had low haemoglobin levels. In one country 80 per cent of children 6 months to 2 years of age had no iron reserves as measured by ferritin levels. There is also a high prevalence of dental caries in some countries. Flouride has been added to salt in Jamaica. This paper reviews some of the data on micronutrient deficiencies and concentrates on the approaches for the control of iron deficiency in the region. These approaches are supplementation, nutrition education, parasitic control and fortification. The problems and successes of each approach are discussed and how they are helping to control anaemia in the English-speaking Caribbean (AU)

Moderate to heavy infections of Trichuris trichiura affect cognitive function in Jamaican school children

In Mandeville, Jamaica, researchers compared cognitive function test results of 62 male school children (9-12 years old) infected with 1 of 3 helminths (Trichuris trichiura [whipworm], Ascaris lumbricoides [roundworm], or Necator americanus [roundworm]) who received 3 doses of 400 mg of the broad spectrum anthelmintic, albendazole (Zental), each day with those of 41 male school children also infected with a helminth but who received instead a placebo and those of 22 uninfected male school children who also received the placebo to determine wether a causal relationship existed between moderate to heavy loads of Trichuris trichiura and cognitive function. Anthelmintic treatment infected children significantly improved auditory short-term memory (p<0.02;p<0.01) and especially scanning and retrieval of longterm memory (p<0.001). Most of this improvement was a result of removal of T. trichiura. These children had even improved significantly more than the uninfected children (controls) in the same cognitive functions (p<0.05; p<0.01 and p<0.003, respectively). Thus treatment eliminated the significant differences between the treatment children and uninfected control children. The treatment restored cognitive functions in a relatively short time span (9 weeks). Treatment reduced fecal egg density of 99 percent of all 3 parasites (p<0.0001) and prevalence of infection. This anthelmintic treatment greatly reduced whipworm infection which in turn significantly improved cognitive functions. (AU)

Parasitic infections in young Jamaicans in different ecological zones of the island

Data are presented for the first country wide prospective study on gastrointestinal tract parasitic infections done in Jamaca. Samples from 2,947 young Jamaicans drawn from all ecological zones and from all parochial divisions of the island were analyzed. Pica was practised by 8.6 percent. Generally, prevalence of organisms was as follows: Trichiuris trichiura (12.3 percent). Ascaris lumbricoides (9.5 percent), hookworm (2.2 percent), Strongyloides stercoralis (0.35), Giardia lamblia (6.3 percent) and Entamoeba coli (7.7 percent). Several other species of protozoans were recorded. Prevalence of A. lumbricoides, T. trichiura and Necator americanus was significantly greater in upland than in lowland (both rual and urban), while the situation was reversed for G. lamblia-infections. Greatest variations were age-related. A.lumbricoides and T. trichiura reached peak prevalence of 15-19 years of age. Suggestions are made for a national and even regional antihelminthic program for the mass treatment of pre- and primary school age children. (AU)

Comparative prevalence of parasites in five communities in Dominica - abstract

We analysed 640 randomly collected, fresh samples of faeces from children aged 2-10 years, living in five different communities in Dominica, by both the modified Kato and formol-ethyl acetate concentration techniques (FEA). There was excellent correlation (greater than 99.5 percent) for ova of Ascaris and Trichuris between the modified Kato techniuqe and the formol-ethyl acetate concentration technique. However, the FEA technique was able to provide information about a wider range of GI parasites. There was a high prevalence for ascariasis at Soufiers (77.8 percent) and Scott's Head (72.7 percent), an elevated prevalence at Grand Bay (28.1 percent), a significantly reduced prevalence at St. Joseph (10.4 percent) and a virtual absence of ascarisis from Mahaut (0.63 percent). Trichuriasis was also significantly higher in Soufriere (81.5 percent) and Scott's Head (85.2 percent), than in Grand Bay (33.7 percent), St. Joseph (34.9 percent), or Mahaut (27.2 percent). In the five communities surveyed, the infections with Ascaris lumbricoides and Trichuris trichiura were, generally, of low intensity (less than 5,000 epg). The higher prevalence of all parasites in the Soufriere and Scott's Head areas was probably due mainly to poorer sanitary conditions (AU)

A community study of parasites, nutritional status and housing in young Jamaican children - abstract

Parasitic infections may contribute to gastoenteritis and protein-energy malnutrition (PEM) both important problems among young Caribbean children. We conducted an epidemiological study of the prevalence of parasitic infestation and its association with the environment and nutritional status of preschool age children in a poor Kingston neighbourhood. The sample comprised all the 145 children (6 -36 months old) in a defined area. There were equal numbers of boys and girls and in each of 5 age groups (6 - 11, 12 - 17, 18 -23, 24 -29, 30 -36 months). Single stool specimens were examined for helminth ova and protozoan cysts using the formolether method, with iodine staining for light microscopy. The children's weights and heights were measured and their guardians were interviewed about their housing, sanitation and social background. Thirty-four per cent of the children were infested with 1 - 5 organisms: Trichuris, 21 percent, Ascaris, 18 percent, with generally low - moderate loads (< 5,000 ova/500 mg stool). Giardia occurred in 12.6 percent with very few other protozoans (E. coli, 4.2 percent, C.mesnili, 2.1 percent and E. nana, 0.7 percent). The peak prevalence (70 percent) was among 30-36 month-olds, age being significantly positively associated with the presence of parasites (p 0.001). The infested children had significantly poorer sanitation and water facilities (p<0.05) and their parents had a lower educational level (p<0.05) than the non-infested. Sixty-one (42.9 percent) children had some degree of undernutrition with 13(9.1 percent)moderately - severly malnourished. Single stool specimens probably underestimated the true point prevalence and load of parasitic infestations. There was a significant positive association between nutritional status and the presence of parasites in this study, However, undernutrition occurred most often among young toddlers (12 - 17 months) and parasitic infestation among 30 - 36 month-olds. This suggests that parasitic infestation did not play an important role in the aetiology of PEM in this community (AU)

A survey of parasites in primary school children in Dominica, West Indies

A study of Dominican school children aged four to twelve years showed that infection with gastrointestinal parasites was very common. Trichuris was found in the stools in 92 percent of the children. Ascaris in 38 percent, Nectar in 11 percent, Giardia in 18 percent and E. histolytica in 1 percent. In spite of the high prevalence of parasites, the general health of children studied was remarkably good, and only 18 of the 1000 children were found to have a haemoglobin level below 10g/dl (Summary)

An analysis of infections and infestations in Dominica, West Indies

An analysis of infections and infestations in Dominica indicates that these were major health problems. The common diseases were gastro-enteritis, typhoid fever, amoebiasis, and helminthiasis. Hospital bacteriological investigations showed a pattern similar to that seen elsewhere in the Commonwealth Caribbean. A striking feature was the obvious need for proper assessment of antibiotic sensitivity patterns. For example, staphylococci were sensitive to penicillin in 40 percent of cases, a situation which is far different from that which is at present observed in North America. This survey was carried out in collaboration with physicians practising in Dominica, and their years of experience of the local situation allowed the authors of this paper to introduce perspectives and priorities which are not usually possible in publications based entirely on figures reported by statistical departments. Recent improvements in clinical and laboratory services in Dominica have made accurate diagnosis possible in most cases except those in which virological studies were necessary (AU)

Gezondheidsleer voor Suriname dl.IIA: Infectie- en parasitaire ziekten / Health education for Suriname pt.IIA: Communicable and parasitic diseases

This book contains part of the study material needed for health education in Suriname. It discusses different aspects of various communicable and parasitic diseases in Suriname. It also contains a list of terminology

Gezondheidsleer voor Suriname dl.2: Speciele epidemiologie van infectie- en parasitaire ziekten / Health education for Suriname pt.2: Specialized epidemiology of communicable and parasitic diseases

Compendium on specialized epidemiology of communicable and parasitic diseases in Suriname. Its purpose is to make medical students, trainee-nurses and others familiar with this subject. It can also serve as a handbook for health experts. It discusses the sources and ways of infection, and therefore it succesively describes: man and his excretion products, animal and its excretion products, food, contact water, contact air, contact soil and contact objects. These are described for the various communicable and parasitic diseases which are discussed. It also contains a list of terminology

Clinical features of homozygous SS disease in Jamaican children

One hundred patients with homozygous SS disease who have at sometime attended, or who are currently attending Paediatric Clinic at University Hospital of the West Indies, are reviewed . The diagnosis of SS disease has been confirmed by family study in 60 cases. In the remaining 40 cases, the haematological picture is typical of SS disease and starch gel electrophoresis has been performed in all, with measurements of haemoglobine A2 levels. The majority of patients manifest their disease within the first 2 years of life (anaemia, limb swelling, pains, jaundice). Growth rates roughly parallel the 50th percentile for boys and girls in Jamaica. Splenomegaly is a common physical finding in the early years but the incidence of splenomegaly falls off with increasing age from 73 percent in the first two years to 33 percent at age 12 years. The most frequent complication of the disease is the painful crisis. Also frequent is avascular necrosis of bone (55 patients) and pneumonia (37 patients) chiefly involving the right lower lobe. The hand-food syndrome is a particular form of avascular necrosis commonly seen in the first 2 years of life. Other complications include leg ulceration (13), aplastic crisis (10), epistaxis (9), megaloblastic change (7), severe obstructive jaundice (6), neurological disorder (5) and osteomyelitis (2) and paripism (1). Megaloblastic change occurred exclusively in the first 2 years of life and leg ulcers were not seen before age 6 years. Death occurred in 2 patients at age 2 years respectively. In neither case did autopsy reveal any anatomical cause for death (AU)