Prevalence and risk factors of intestinal protozoan and helminth infections among pulmonary tuberculosis patients without HIV infection in a rural county in P. R. China.

Although co-infection of tuberculosis (TB) and intestinal parasites, including protozoa and helminths, in humans has been widely studied globally, very little of this phenomenon is known in China. Therefore, a cross-sectional study was conducted in a rural county of China to investigate such co-infections. Patients with pulmonary TB (PTB) undergoing anti-Mycobacterium tuberculosis (anti-MTB) treatment were surveyed by questionnaires, and their feces and blood specimens were collected for detection of intestinal protozoa and helminths, routine blood examination and HIV detection. The χ(2) test and multivariate logistic regression model were used to identify risk factors. A total of 369 patients with PTB were included and all of them were HIV negative. Overall, only 7.3% of participants were infected with intestinal protozoa, among which prevalence of Blastocystis hominis, Entamoeba spp. and Trichomonas hominis were 6.0%, 1.1% and 0.3%, respectively; 7.0% were infected with intestinal helminths, among which prevalence of hookworm, Trichuris trichiura, Ascaris lumbricoides and Clonorchis sinensis were 4.3%, 1.9%, 0.5% and 0.3%, respectively; and 0.5% were simultaneously infected with intestinal protozoa and helminths. Among patients with PTB, body mass index (BMI)≤18 (OR=3.30, 95% CI=1.44-7.54) and raised poultry or livestock (e.g., chicken, duck, pig) (OR=3.96, 95% CI=1.32-11.89) were significantly associated with harboring intestinal protozoan infection, while BMI≤18 (OR=3.32, 95% CI=1.39-7.91), anemia (OR=3.40, 95% CI=1.44-8.02) and laboring barefoot in farmlands (OR=4.54, 95% CI=1.88-10.92) were significantly associated with having intestinal helminth infection. Additionally, there was no significant relationship between duration of anti-MTB treatment and infection rates of intestinal parasites including protozoa and helminths. Therefore, preventing malnutrition, avoiding unprotected contact with reservoirs of protozoa, and improving health education for good hygiene habits, particularly wearing shoes while outdoors, are beneficial in the prevention of intestinal protozoan and helminth infection among patients with PTB.

[Assessment of malaria knowledge and capability on Plasmodium detection among professionals from class III malaria-endemic counties of Henan Province in 2012].

OBJECTIVE: To evaluate the capability of malaria parasite detection among professionals from Class III malaria endemic counties of Henan Province in 2012. METHEDS: The capacity assessment of professionals from the Centres for Disease Control and the medical institutions was done in September to December 2012. The content of the assessment included malaria knowledge (including malaria etiology, clinical manifestation, diagnosis, treatment and epidemiology and so on, 100 scores as full marks and 60 as passing score), making blood slides of Plasmodium (4 slides in 1 hour, including Giemsa staining, 40 scores as full marks and 24 as passing score) and identification of species with microscopy (6 slides, 8 min per slide 60 scores as full marks and 36 as passing score). All the participanats were grouped by gender, age, professional title, level and type of institution. Their scores were statistically analyzed by SSPS 17.0 software. RESULTS: The average total score in 891 participants was 162.1, the highest was 200 (full markers), and the lowest was 96, and 871 (97.8%) participants passed the test (> or = 120 scores). There were no significant differences for the scores of blood slide making among gender, age, professional title and level of institution (P > 0.05). No significant differences in the scores of malaria knowledge and blood slide reading among gender female participants (162.97 +/- 17.64) was higher than that of males (159.01 +/- 20.33) (P < 0.05). The film-reading and total scores of 50-plus age group (34.62 +/- 14.82, 144.62 +/- 20.33) was significantly lower than the other three groups (under age 30 group: 45.75 +/- 13.58 and 162.50 +/- 18.90, age 31-40 group: 46.53 +/- 12.72 and 163.51 +/- 17.77, age 41-50 group: 46.22 +/- 13.38 and 159.80 +/- 17.32) (P < 0.05). The scores of malaria knowledge in 50-plus age group (84.38 +/- 9.41) was lower than that of under age 30 group (89.91 +/- 7.81), age 31-40 group (89.96 +/- 7.74) (P < 0.05). The scores of malaria knowledge (88.33 +/- 8.23, 90.00 +/- 7.76, 92.37 +/- 7.29), film-reading (44.88 +/- 13.62, 46.59 +/- 12.88, 49.57 +/- 11.98) and total scores (159.61 +/- 18.37, 163.81 +/- 18.03, 169.15 +/- 16.38) of primary, intermediate and senior groups was proportional to the level of the titles, and the difference between the groups was statistically significant (P< 0.05). The theory (88.28 +/- 8.30, 90.84 +/- 7.32, 93.54 +/- 6.10), film-reading (44.54 +/- 13.14, 47.69 +/- 13.40, 52.62 +/- 11.04) and total scores (159.48 +/- 18.33, 165.92 +/- 17.31, 171.97 +/- 15.53) of the three institution level groups (township, county and province) were proportional to their level, and the difference between the groups was statistically significant (P < 0.05). There was no significant differences for the scores between the CDCs and hospitals (P < 0.05). CONCLUSION: The capabilities of malaria parasite detection in Class III malaria endemic counties of Henan Province is balanced. It needs to strengthen the skills training for the professionals of the junior, intermediate and primary care units.

Intestinal parasite co-infection among pulmonary tuberculosis cases without human immunodeficiency virus infection in a rural county in China.

Epidemiologic studies of co-infection with tuberculosis (TB) and intestinal parasites in humans have not been extensively investigated in China. A cross-section study was conducted in a rural county of Henan Province, China. Pulmonary TB (PTB) case-patients receiving treatment for infection with Mycobacterium tuberculosis and healthy controls matched for geographic area, age, and sex were surveyed by using questionnaires. Fecal and blood specimens were collected for detection of intestinal parasites, routine blood examination, and infection with human immunodeficiency virus. The chi-square test was used for univariate analysis and multivariate logistic regression models were used to adjust for potential confounding factors. A total of 369 persons with PTB and 366 healthy controls were included; all participants were negative for human immunodeficiency virus. The overall prevalence of intestinal parasites in persons with PTB was 14.9%, including intestinal protozoa (7.9%) and helminthes (7.6%). The infection spectrum of intestinal parasites was Entamoeba spp. (1.4%), Blastocystis hominis (6.2%), Trichomonas hominis (0.3%), Clonorchis sinensis (0.3%), Ascaris lumbricoides (0.5%), Trichuris trichiura (2.2%), and hookworm (4.6%). The prevalence of intestinal parasites showed no significant difference between persons with PTB and healthy controls after adjusting for potential confounding factors. There was no factor that affected infection rates for intestinal parasites between the two groups. Infection with intestinal parasites of persons with PTB was associated with female sex (adjusted odds ratio [AOR] = 2.05, 95% confidence interval [CI] = 1.01-4.17), body mass index ≤ 19 (AOR = 3.02, 95% CI = 1.47-6.20), and anemia (AOR = 2.43, 95% CI = 1.17-5.03). Infection of healthy controls was only associated with an annual labor time in farmlands > 2 months (AOR = 4.50, 95% CI = 2.03-10.00). In addition, there was no significant trend between rates of infection with intestinal parasites and duration of receiving treatment for infection with M. tuberculosis in persons with PTB. The prevalence of intestinal parasites was not higher in persons with PTB, and there was no evidence that PTB increased susceptibility to intestinal parasites in this study. However, for patients with PTB, women and patients with comorbidities were more likely to be infected with intestinal parasites.

[Laboratory detection on two cases with imported Plasmodium ovale infection].

OBJECTIVE: To compare the laboratory tests of the imported Plasmodium ovale infection and analyse the genetic character. METHODS: After Giemsa staining and microscopy, CareStart rapid detection and nested PCR were used to detect two cases with P. ovale infection returning from Congo (Brazzaville) in Henan Province. Sequencing was performed after PCR amplification using the 18S rRNA genus-specific primers. Their genetic characteristics were analyzed and the sequence homology analysis was performed in the NCBI. RESULTS: The two cases were confirmed as P. ovale infection by morphological examination microscopically. Amplified bands were produced by 18S rRNA nested PCR, which was the same with P. ovale in size, whereas the results of CareStart rapid detection test were all negative. A sequence of 906 bp in length was obtained by sequencing their 18S rRNA genes in which GC accounted for 35.4%, and the sequence showed 99% homology to the corresponding part of the known P. ovale 18S rRNA gene (GenBank accession No. AB182492). CONCLUSION: Both the nested PCR and microscopy confirm the infection of P. ovale. A negative result of CareStart rapid detection can not ruled out the Plasmodium infection.

[Epidemiological investigation on sparganosis mansoni and animal experiments].

The investigation was made in Luohe City of Henan Province from April to November, 2008. Cyclops were collected and plerocercoids of Spirometra mansoni were examined by microscope. Skin, muscle and internal organs of frogs and tadpoles were checked to detect spargana by naked eye and/or anatomical microscope. Feces of cats and dogs were collected to examine eggs after washing and precipitation. Spargana from tadpoles were collected to infect cats by oral inoculation. Results showed that the infection rate of plerocercoids in cyclops was 3.5% (3/85) and that of spagarna in tadpoles and frogs was 35.9% (120/334) and 16.8% (75/446), respectively. Among 3 cats and 31 dogs investigated, 1 and 6 (19.4%) were found infected respectively. Eggs of Spirometra mansoni were found in feces of cats 12 days after infection. 17 adult worms were found in the intestine of the cat on the 25th day. The habit of eating live tadpoles was found in local residents. The investigation reveals a high prevalence of Spirometra mansoni in the intermediate and final hosts. Eating live tadpoles seems a main reason of getting sparganosis mansoni.

[Imported falciparum malaria situation in Henan Province during 2005-2009].

Imported falciparum malaria data of Henan Province in 2005-2009 were collected and statistically analyzed by using Microsoft Office Excel 2003. A total of 84 imported falciparum malaria cases with one death were reported during 2005-2009. The ratio of males to females was 20 : 1(80/4). The average age was (34 +/- 11) years old. Seventy-five patients returned from Africa, occupying 89.3%. The number of annual cases reported in 2008 (24 cases) and 2009 (32 cases) was higher than that in 2005-2007(9-10 cases). The top three high-risk populations were farmers (34 cases), workers (17 cases) and the cadre (13 cases), accounted for 76.2% of all cases. The cases were reported every month, of which 37 cases (44.0%) were reported in June and July. All cases had a history of prior residence in falciparum malaria endemic area, and the initial symptom was fever. The average interval from symptom appearing to diagnosis was (5.9 +/- 8.6) d, only 21.4% (18/84) of the patients was diagnosed within 24h. There were 72 laboratory-confirmed cases (85.7%). Seventeen cases (22.1%) were reported by county level medical treatment units. A total of 83 cases recovered with the treatment of artemisinin-based combination drugs. One case died with serious cerebral malaria. Effective measures should be carried to control the increasing trend of imported falciparum malaria.

[Impact of blastocystis hominis infection on ultrastructure of intestinal mucosa in mice].

OBJECTIVE: To observe the ultrastructural change ot intestinal mucosa in mice infected with Blastocystis hominis, and to study the pathogenic mechanism of B. hominis infection. METHODS: 20 Kunming mice were randomly divided into 4 groups: group A treated with immunosuppressant (dexamethasone), group B without immunosuppressant, group C as normal control and group D as immunosuppressant control. Groups A and B were then orally infected with 20(4) cysts of B. hominis. Groups C and D were treated as control by infusing same volume of Locke's solution. Six days after inoculation, mice in each group were killed and mucosa of ileocecum was observed by transmission electron microscope (TEM) and scanning electron microscope (SEM). RESULTS: Under SEM, B. hominis located in enteric cavity and on the surface of ileocecum mucosa. Individual parasites also invaded into mucosa and its fold. Partial destruction of microvilli on the mucosa was observed. TEM observation indicated a reduction of microvilli on the surface of absorptive cells. Mitochondrial edema, rough endoplasmic reticulum dilatation and degranulation were found on absorptive cells and goblet cells. Lymphocyte infiltration and eosinophilia were found in intercellular stroma. Pathological changes in group A were more serious than that of group B. No abnormal change on the mucosal ultrastructure was found in groups C and D. CONCLUSIONS: B. hominis infection causes significant ultrastructural lesion on the ileocecal mucosa in mice. Immune status of the mice can affect the degree of the lesion due to infection.

[Study on number and mature rate of eggs in gravid proglottids of Taenia solium].

OBJECTIVE: To investigate the number and mature rate of eggs in gravid proglottids of Taenia solium. METHODS: Ten worms of Taenia solium, expelled from patients, were detected. Eggs were collected from the last 10 gravid proglottids of each worm. RESULTS & CONCLUSION: The egg number in each mature proglottids varied from 3,900 to 126,520, and the mean number was 28,332. The mature rate of eggs was from 7.00% to 36.00% with an average of 29.12%, which was lower than that in proglottids naturally excreted with feces. With suitable temperature and humidity, the proglottids developed continually after excreted out of host body. Two to three days later, the mature rate of their eggs increased to 85%-90%.