Intestinal parasites among young children in the interior of Guyana

Intestinal parasites contribute greately to morbidity in developing countries. While there have been several studies of the problem in the Caribbean, including the implementation of control programmes, this has not been done for Guyana. The aim of this study was to determine the prevalence of intestinal parasites among young children in a town located in the interior of Guyana. Eighty-five children under the age of 12 years were studied prospectively for intestinal parasites in Mahdia, Guyana. Stool samples were transported in formalin to the Department of microbiology, the University of the West Indies, Jamaica, for analysis using the formalin-ether concentration and Ziehl-Neelsen techniques. Data on age and gender of the children were recorded on field sheets. At least one intestinal parasite was detacted in 43.5 percent (37/85) of the children studied and multiple parasitic infections were recorded in 21.2 percent (18/85). The most common intestinal helminth parasite was hookworm (28.2 percent; 24/85), followed by Ascaris lumbricoides (18.8 percent; 16/85) and then Trichuris trichuria (14.1 percent; 12/85). Among the protozoan infections Giardia lamblia was detected in 10.5 percent (9/85) of the study population while Entamoeba histolytica appeared rarely. All stool samples were negative for Cryptosporidium and other intestinal Coccidia. There was no predilection for gender with any of the parasites. The pattern of distribution of worms in this area of Guyana was unlike that seen in other studies. Hookworm infection was the most common among the children and a large proportion had multiple infections. The study established the occurrence and prevalence of a number of intestinal parasites in the population of Guyana. This sets the stage for the design and implementation of more detailed epidemiological studies. (AU)

The changing picture of intestinal parasitoses in the Caribbean

The economic and public health importance of gastro-intestinal parasitoses varies enormously from country to country due to a complex interplay of organisms, the environment, the hosts involved, socio-economic conditions, and human behaviour. The major parasitoses include three roundworm species (nematodes) and three microscopic, unicellular (protozan) species. Infection with two or more species (polyparasitism) is not uncommon, and this aggregation of parasites leads to an increased morbidity and mortality. Aggregation may result from human behaviour, socio-economic conditions (level of education, water and sanitary conditions, ability to diagnose and treat infections etc.) and numerous still relatively arcane reasons, such as immunological and nutritional status and genetics (AU)

The prevalence of intestinal nematodes at the Adelphi all-age school in Saint James

A cross-sectional study of these rural school children was done to determine the level of infection in the school, and the types of geohelminths present. Data was collected through the use of one hundred and sixty-six (166) close-ended questionnaires, and the analysis of one hundred and nineteen (119) stool samples, and eighty (80) blood samples. A high prevalence of 22.3 percent was demonstrated in the school's population, with prevalence in the 10-12 age group reaching a high of 44 percent. Trichuris (13.4 percent), Ascaris (8.9 percent) and eosinophilia (6.4 percent), all showed significant prevalence. However, the prevalence of Hookworm (3.6 percent) and anaemia (2.6 percent), were not significant among the group. Infection strongly correlated with the eating of chalk and marl (a type of soil, composed chiefly of clay and limestone). The source of infection was identified as two marl pits located near the school, which are obviously used for indiscriminate defaecation. The construction of more latrines at the school, school health education, and public health education were recommended, to help eradicate worms from the school (AU)

The prevalence of intestinal nematodes at the Adelphi All-age school in Saint James

A cross-sectional study of these rural school children was done to determine the level of infection in the school, and the types of geohelminths present. Data was collected through the use of one hundred and sixty-six (166) close-ended questionnaires, and the analysis of one hundred and nineteen (119) stool samples, and eighty (80) blood samples. A high prevalence of 22.3 percent was demonstrated in the school's population, with prevalence in the 10-12 age group reaching a high of 44 percent. Trichuris (13.4 percent), Ascaris (8.9 percent), and eosinophilia (6.4 percent), all showed significant prevalence. However, the prevalence of Hookworm (3.6 percent), and anaemia (2.6 percent), were not significant among the group. Infection strongly correlated with the eating of chalk and marl (a type of soil, composed chiefly of clay and limestone). The source of infection was identified as two marl pits located near the school, which are obviously used for indiscriminate defaecation. The construction of more latrines at the school, school health education, and public health education were recommended, to help eradicate worms from the school.(Au)

A longitudinal study of the persence of gastrointestinal tract parasitic infections in children of St. Kitts over the 15-year period, 1982-1997

When 188 (1962), 266 (1991) and 222 (1997) five and nine year old children in St. Kitts were assessed for the presence of parasitic infections, there were significant reductions in the prevalence of trichurias from 83 percent through 58 percent to 27 percent, of ascariasis from 24 percent through 8.6 percent to 0.9 percent and of giardiasis from 15 percent through 9.4 percent to 5 percent, respectively; over the 15 year period. Anthelminthic use, which appeared to be the most important responsible intervention tool, remained roughly at the same level at 59-51 percent. However, the types of anthelminthics used changed over the period. Piperazine citrate, which was used by 66 percent in 1982, had only 35 percent usage in 1991 and 11.3 percent in 1197. Albendazole, which was not used at all in 1982, was taken by 32 percent of the children in 1991 and 45.9 percent in 1997, and at the same time use of laevo-tetramisole increase by 20 percent in 1991 from 14 percent in 1982, to 42.9 percent in 1997. Details are given of a proposed island-wide parasitic infection with the assistance of identified private and public sector partners.(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. 64.7 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 gastrointestinal parasitic infection is also related to low socioeconomic status, lack of education in personal hygiene and environmental sanitation, prevalence level of intestinal infection 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)

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)

Significant reductions in the rates of gastrointestinal tract parasitic infections in children of St. Vincent over a thirteen-year period (1979-1992) - abstract

When 314 (1979) and 207 (1992) five- to nine-year old school children in St. Vincent were investigated for the presence of parasitic infections, there were significant reductions in the prevalence of trichuriasis (75 per cent to 21.7 per cent), ascariasis (37 per cent to 8.6 per cent), amoebiasis (9 per cent to 2.8 per cent) and giardiasis (10 per cent to 5.3 per cent) over the 13-year interval. Anthelminthic use remained at 63 - 65 per cent, but the brands of worm medicines taken changed over the period. Thus, whilst piperazine citrate was used by 41 per cent of the children in 1979, only 4.8 per cent of them used it in 1992. Albendazole which was used by a great majority (42.5 per cent) in 1992 was never used in 1979. Commensals were observed in 211 (67 per cent) children in 1979, and in 83 (40 per cent) children in 1992 (AU)

Changes in gastrointestinal tract parasitic infections in St. Kitts children - abstract

When 239 (1982) and 361 (1991) 5- and 9-year-old children in St.Kitts were assessed for the presence of parasitic infections there were significant reductions in the prevalence of trichuriasis from 83 percent to 58 percent, of ascariasis from 24 percent to 8.6 percent and of giardiasis from 15 percent to 9.4 percent. Health education appeared to be the most important responsible intervention tool. Anthelmintic use remained roughly at the same level. However, the types of anthelmintics used changed over the period. Piperazine citrate, which was used by 66 percent in 1982, only had 35 percent usage in 1991. Albendazole which was not used at all in 1982 was taken by 32 percent of the children in 1991, and, at the same time, use of laevotetramisole increased by 20 percent from 14 percent (AU)

Gastrointestinal parasitic infection in healthy Jamaican carriers of HTLV-I

A subsample (1.6 percent; n = 13,260) of a healthy Jamaican population of food-handlers, studied by Murphy et al. (1991), who were serologically positive (n = 99) or negative (n = 113) for HTLV-I was investigated for intestinal parasitic infection using coprological methods. Helminth infection included Ascaris lumbricoides (2.8 percent), Trichuris trichiura (7.1 percent) and hookworms (6.1 percent). Entamoeba coli was found in 21.8 percent of samples, while E. hartmanni, Giardia lamblia, Endolimax nana, Iodamoeba butschlii and Chilomastrix mesnili each occurred in less than 10 percent of responders. T. trichiura displayed a higher prevalence (10.6 vs 3 percent (chi 2 = 4.623;p = 0.03) in the HTLV-I negative group. G. lamblia was detected more frequently among HTLV-I carriers compared to controls (9.1 and 3.5 percent respectively), but the association was not statistically significant (chi 2 = 2.825;p = 0.09). Infection with intestinal parasites is likely to occur independent of HTLV-I status: however, possible HTLV-I-induced immunosuppression may lead to higher intensity infections of certain organisms thus facilitating easier detection using parasitological methods. The immunomodulatory potential of HTLV-I infection in the aetiology of non-malignant diseases requires further investigation. (AU)

Immediate hypersensitivity in colon of children with chronic Trichuris trichiura dysentery

There are few data on mucosal immune responses to intestinal helminths in human beings, especially those involving the IgE system, which is thought to be important in parasite expulsion. We sought evidence of an immediate hypersensitivity reaction in the colon of children with chronic dysentery due to Trichuris trichiura. 28 children with Trichuris dysentery syndrome (TDS) were compared with 16 control children (with no TDS or worms visible on colonoscopy). All children were aged 1-11 years. Rectal biopsy samples were taken before and after expulsion of the worms by means of mebendazole treatment. Children wtih TDS had significantly greater numbers than controls of mast cells (mean [SD] 10.9 [1.3] vs 3.9 [0.6] percent of all cells; p<0.0003) and of cells with surface IgE (median [range] 11.1 [7.5-11.6] vs 1.0 [0-1.5] percent; p<0.001) in the subepithelial region of the mucosa. On electronmicroscopy, degranulating mast cells were prominent in parasitised children. In culture, rectal biopsy samples from parasitised children showed high rates of spontaneous histamine release, but only low rates of antigen-specific release. After treatment, spontaneous histamine release was significantly reduced and antigen-specific histamine release could be provoked. Thus, an IgE-mediated immune mucosal response to a helminth infection does occur in human beings but is not sufficient to cause appreciable parasite expulsion. (Summary)

Helminthiasis in Montserrat after the parasite control programme and hurricane Hugo - abstract

The Parasite Control Programme of Montserrat, West Indies, was a child-targeted chemotherapeutic control programme which ran from August 1986 to July 1989. The Programme involved the delivery of a broad spectrum antihelminthic to children (2-15 years old) once every school term. Two months after the end of the Programme, Hurricane Hugo devastated Montserrat on September 17, 1989. The Health Department (Montserrat) felt that the reductions in prevalence and intensity of Trichuris trichiura and Ascaris lumbricoides gained as a result of the Programme would be compromised by the disruption to sanitation and water supply caused by Hugo. In December 1989, a cycle of treatment was therefore administered to the child target group using the same infrastructure and procedure as that used in the Control Programme. The treatment compliance was 97.0 percent of the student population (n=2,125). Six months later, an age-stratified survey was done to assess the level of infection in the population and the age-standardised prevalence of T. trichiura for the overall population. Changes in the age-standardised intensity of both helminths before and after Hugo were recorded for the overall population: for T. trichiura the intensity went from 0.8 to 1.5 epg-faeces, while for A. lumbricoides the intensity rose from 1.2 to 1.7 epg.faeces. The observed rise in the infection levels of the overall population not statistically significant. The changes seen in the prevalence and intensity of both parasites taken from the surveys before and after Hugo were all found to be non-significant. There appeared to have been a non-significant increase in parasitic infection levels 9 months after Hugo to levels seen in the latter part of the Control Programme (AU)

Infective arthritis due to Blastocystis hominis

A patient with rheumatoid arthritis taking prednisone developed Blastocystis hominis acute diarrhoea, which was associated with increased inflammation and effusion of the left knee. B. hominis organisms were found in synovial fluid from the left knee. The patient responded dramatically to metronidazole treatment. B. hominis may become disseminated in immunosuppressed patients with diarrhoea and may cause infective arthritis. (AU)

William Hillary and sprue in the Caribbean: 230 years later

Parasitic infestation as a cause of diarrhoea and malabsorption is well recognised. It may occur in heavy infestations with hookworm as reported by Sheehy in Puerto Rico and Giardia Lamblia as reported by Professor O'Donovan of Dublin. In hookworm and giardial infestations tissue invasion of the small intestine as been observed occasionally by Stronglyoides stercoralis has much greater potential in this respect. A spru-like syndrome caused by this parasite is not uncommon in the Caribbean islands, particularly in Jamaica, Trinidad and Tobago and Puerto Rico (AU)

Parasitic infections in young Jamaicans in different ecological Zones in the Island - abstract

A gastrointestinal tract parasitological study was done on 2,947 young Jamaicans drawn from all ecological zones and from all parochial divisions of the island where pica was practised by 6.9 percent. Generally, the prevalence was Trichuris 12.3 percent, Ascaris 9.5 percent, Hookworm 2.2 percent, Strongyloides 0.3 percent, Giardia 6.3 percent and E. coli 7.7 percent. Several other spp. of protozoans were recorded. Prevalence of Ascaris, Trichuris and Necator was significantly greater in upland than in lowland areas, both urban and rural, while the situation was reversed for Giardia infections. Greatest variations in prevalence were age-related. Ascaris and Trichuris reached peak prevalences of 15.3 percent and 20.5 percent, respectively, in 5-9 year olds, while Hookworm peaked later at 15-19 years of age. Suggestions are made for a national, even a regional, antihelminthic programme for the mass treatment of pre- and primary school age children. This would aim at the eventual eradication of helminthiasis in the region (AU)

A survey of intestinal helminths of well-cared-for dogs in Jamaica, and their potential public health significance

This study investigates the level of helminthic infestation in better-cared-for dogs in a middle-class community in suburban Kingston. A canine zoographic study was conducted, and fresh faecal deposits were collected and analysed for helminth life-cycle stages. The survey indicated that 73 percent (n=93) of households in the study area owned one dog or more (mean=1.4). Resident's attitudes towards canine management suggested that the dog population was, in general, restricted to the residential estate, and most owners claimed to have dewormed their dogs at least as young animals. Of 141 faecal specimens, 58 percent contained eggs or larvae of one or more of eight helminths: Uncinaria stenocephala (26 percent), Ancylostoma sp. (23 percent), Trichuris vulpis (9 percent), Toxocara canis (8 percent), Spirocerca lupi (6 percent), Strongyloides sp. (6 percent), Apophallus sp. (4 percent) and taeniids (1 percent). There was a high level of multiple infection in the host animals, with approximately one fifth of the infected samples containing three or more helminth types. Infection intensity was apparently low, but some dogs harboured heavy worm loads. (AU)