Simultaneous detection and quantification of Ancylostoma duodenale, Necator americanus, and Oesophagostomum bifurcum in fecal samples using multiplex real-time PCR.

A multiplex real-time PCR was developed and evaluated for the simultaneous detection of Ancylostoma duodenale, Necator americanus, and Oesophagostomum bifurcum in fecal samples. Using well-defined control samples (N = 150), known positive fecal samples (N = 50), and fecal samples from an area in Ghana where human infections with all 3 nematode species are endemic (N = 339), the method proved to be highly specific and sensitive. Cycle threshold (Ct) values, reflecting parasite-specific DNA load, showed significant correlation with the intensity of infection as measured by microscopy using Kato-Katz fecal smears or by species specific third-stage larval count after coproculture. The multiplex real-time PCR described combined with the simple fecal sample collection procedure and the potential for high throughput makes this approach a powerful diagnostic tool to study species-specific transmission patterns of human hookworm-like infections. Moreover, this procedure facilitates monitoring of intervention programs and allows species-specific detection of treatment failure following rounds of mass treatment.

Oesophagostomiasis, a common infection of man in northern Togo and Ghana.

Infection with Oesophagostomum sp. is normally considered a rare zoonosis and up to this time its diagnosis has been based on the demonstration of larvae and young adult worms in the typical nodules formed in the intestinal wall. Only in Dapaong, in North Togo, and Bawku, North Ghana, have larger series of clinical cases been described. In the rural areas around these towns, a survey was made in which stool samples were collected and cultured. Third-stage larvae of Oesophagostomum sp. could be found after 5-7 days of incubation at room temperature, and the prevalence of infection with this parasite was often high but varied from one village to another. It was over 30% in seven villages out of the 15 villages surveyed. Anthelmintic treatment resulted in the evacuation of adult males and females of O. bifurcum. It is concluded that O. bifurcum is a locally common parasite of humans, not requiring an animal reservoir for completion of its lifecycle.

Serological diagnosis of Oesophagostomum infections.

A sensitive and specific enzyme-linked immunosorbent assay (ELISA) is described to diagnose human infection with Oesophagostomum bifurcum. In an ELISA using crude soluble antigen, prepared from adult O. bifurcum, many cross reactions occurred when measuring IgG titres in patients with other helminth infections. An ELISA based on the detection of specific IgG4, however, had a specificity of over 95%. The sensitivity of the IgG4 ELISA was difficult to assess because a reliable parasitological diagnosis is not available. The IgG4-ELISA described seems to be a powerful new tool to study the distribution of this little known but locally very common nematode parasite.

Clinical epidemiology and classification of human oesophagostomiasis.

The intestinal helminth Oesophagostomum bifurcum is highly and focally endemic in northern Ghana and Togo, and its juveniles produce a nodular inflammatory response as they develop in the intestinal wall. This pathology can produce clinical symptoms. We report on 156 cases of oesophagostomiasis presenting in 1996-98 to Nalerigu hospital in northern Ghana. The disease accounted for 0.2% of the out-patient department new presentations (about 1 patient per week), and 1% (16) of the major acute surgical cases. Children aged 5-9 years were most commonly affected. Multinodular disease (13% of the cases) results from hundreds of pea-sized nodules within the colon wall and other intra-abdominal structures, and presents with general abdominal pain, persistent diarrhoea and weight loss. Dapaong tumour (87%) presents as an abdominal inflammatory mass often associated with fever. The 3-6-cm tumour is painful, well-delineated, smooth, spherical, 'wooden', periumbilical, and adhered to the abdominal wall. Cases most commonly presented during the late rains and early dry season. Diagnosis by ultrasound has reduced the need for exploratory surgery, and the ability to sonographically evaluate conservative treatment with albendazole has curtailed management by colectomy or incision and drainage.

Strongyle infections in sheep and goats under the traditional husbandry system in peninsular Malaysia.

Faecal egg counts were used to study patterns of trichostrongyle infections in sheep and goats according to season, age, pregnancy and lactation on traditional farms in west Malaysia. Haemonchus contortus and Trichostrongylus spp. were the most important strongyles in sheep and in goats, H. contortus, Trichostrongylus spp. and Oesophagostomum spp. were most prevalent. The faecal egg counts of sheep and goats were apparently not influenced by the small seasonal climatic variations. Strongyle infections were acquired at an earlier age in sheep than in goats. Mean faecal egg counts decreased from the age of 8 months onwards in sheep while in goats this occurred from 12-18 months onwards. A periparturient rise in strongyle egg counts was observed in both animal species. Haemonchus contortus was mainly responsible for this rise in faecal egg counts. The results are discussed with reference to control of gastrointestinal strongyle infections in sheep and goats.

Characterization of Oesophagostomum bifurcum and Necator americanus by PCR-RFLP of rDNA.

Esophagostomiasis in humans due to infection with Oesophagostomum bifurcum (nodular worm) is of major human health significance in northern Togo and Ghana, where Necator americanus (human hookworm) also exists at high prevalence. Yet, very little is known about the transmission patterns of O. bifurcum, which is in part due to the difficulties in diagnosis and in differentiating some life-cycle stages of O. bifurcum from N. americanus using morphological features. As a first step toward developing a molecular-diagnostic assay, it was evaluated whether ribosomal (r)DNA could provide genetic markers for the identification of O. bifurcum and N. americanus to species. Internal transcribed spacer rDNA (plus flanking and intervening sequences) was analyzed by polymerase chain reaction-linked restriction fragment length polymorphism (PCR-RFLP) using several restriction endonucleases. The analysis showed that there was no detectable intraspecific difference in the size of the PCR products among multiple samples, that there was a consistent size difference in the products (of 110 bp or 350 bp, depending on region amplified) between the species, and that there was no significant variation in restriction patterns within each species. These results indicate that the rDNA spanning the internal transcribed spacers provides useful genetic markers for the identification of O. bifurcum and N. americanus to species, which has important implications for developing PCR-based tools to study the epidemiology and population biology of O. bifurcum.

Serological assays for the identification of Oesophagostomum dentatum infections in pigs.

Oesophagostomum dentatum antigen preparations of third (L3) or fourth (L4) stage larvae were characterised by Western blotting. Panels of sera obtained from pigs infected with O dentatum and Ascaris suum, respectively, reacted with the same bands of L3 antigen. In contrast high specificity against a characteristic band, was observed when L4 extract was employed as antigen. To establish an enzyme-linked immunosorbent assay (ELISA), a panel of homologous and heterologous sera was tested against O dentatum L4 extract. The best combined specificity and sensitivity was obtained when horseradish peroxidase (HRP) goat anti swine IgG conjugate was used rather than HRP rabbit anti swine Ig conjugate. Testing series of sera from pigs infected with single doses of either 2000, 20,000 or 200,000 infective larvae by the ELISA, a significant dose dependency in the antibody response was observed between the low and high dosage groups. This assay may be useful in future studies of the immune-mechanisms against nodular worm infections in pigs.

Polyclonal antibody based coproantigen detection immunoassay for diagnosis of Oesophagostomum columbianum infection in goats.

A polyclonal antibody based coproantigen detection enzyme linked immunosorbent assay (cAg-ELISA) for diagnosis of experimental and natural Oesophagostomum columbianum infection in goats was developed and evaluated. Adult O. columbianum worms, collected from the caecum and colon of slaughtered goats, were triturated and cultured for obtaining infective third stage larvae (L(3)) and also used for preparation of excretory-secretory antigen (ESAg). Experimental goats were orally infected each with 600 L(3)/kg of the body weight. Filter sterilized faecal supernatant, i.e. the coproantigen (cAg) was harvested from the rectal faeces of all the infected goats, on alternate days from day-5 till day-31 after the infection. Hyperimmune serum (HIS) against ESAg of O. columbianum was raised in rabbits. Molecular and antigenic characterization of ES products of O. columbianum by HIS revealed that 50 and 39kDa polypeptides were immuno-dominant. Coproantigen detection ELISA was standardized by using the cAg as coating antigen and its subsequent binding with the HIS against ESAg of O. columbianum. The sensitivity, specificity and accuracy of the standardized assay were determined by evaluating the assay on the faecal supernatant of 96 slaughtered goats taking into consideration their recorded parasitological status in respect of the abomasal and the intestinal parasites. The cAg-ELISA detected the prepatent oesophagostomosis on 20-24-day-post-infection with a sensitivity, specificity and accuracy of 88, 89.13 and 88.54%, respectively. The assay is relatively easy to perform and would serve as a reliable tool for detection of caprine nodular oesophagostomosis.

A multiplex PCR tool for the specific identification of Oesophagostomum spp. from pigs.

Based on the sequences of the internal transcribed spacers (ITS-1 and ITS-2) of nuclear ribosomal deoxyribonucleic acid (DNA) of the porcine nodule worms Oesophagostomum dentatum and O. quadrispinulatum, a pair of specific primers (OdspF/OdspR2) for O. dentatum and a pair of specific primers (OqspF/OqspR) for O. quadrispinulatum were designed and used to develop a multiplex polymerase chain reaction (PCR) assay for the identification and differentiation of the two porcine nodule worms. This approach allowed the specific identification and differentiation of O. dentatum and O. quadrispinulatum, with no amplicons being amplified from heterogeneous DNA samples, and sequencing confirmed the identity of the sequences amplified. The minimum amount of DNA detectable using this multiplex PCR assay was 0.1 ng for both O. dentatum and O. quadrispinulatum. The identity of 53 porcine nodule worms collected from pigs from different geographical localities in mainland China was ascertained as O. dentatum or O. quadrispinulatum, respectively, by this multiplex PCR method. This multiplex PCR assay is useful for the simultaneous identification of eggs of O. dentatum and O. quadrispinulatum and should provide a useful tool for the diagnosis and molecular epidemiological investigation of Oesophagostomum spp. infection in pigs.

Insights into the epidemiology and genetic make-up of Oesophagostomum bifurcum from human and non-human primates using molecular tools.

The nodule worm Oesophagostomum bifurcum (Nematoda: Strongylida) is a parasite of major human health importance predominantly in northern Togo and Ghana. Currently, it is estimated that 0.25 million people are infected with this nematode, and at least 1 million people are at risk of infection. Infection with this parasite causes significant disease as a consequence of encysted larvae in the wall of the large intestine. In spite of the health problems caused by O. bifurcum, there have been significant gaps in the knowledge of the biology, transmission and population genetics of the parasite. This review provides an account of some recent insights into the epidemiology and genetics of the parasite from human and non-human primate hosts in specific regions of Africa using molecular tools. Recent research findings are discussed mainly in relation to non-human primates being reservoirs of infection, and the consequences for the prevention and control of oesophagostomiasis in humans are briefly discussed.

Definition of genetic markers in nuclear ribosomal DNA for a neglected parasite of primates, Ternidens deminutus (Nematoda: Strongylida)--diagnostic and epidemiological implications.

Ternidens deminutus (Strongylida) is a parasitic nematode infecting non-human and human primates in parts of Africa, Asia and the Pacific islands. The present study genetically characterized T. deminutus and defined genetic markers in nuclear ribosomal DNA (rDNA) as a basis for developing molecular-diagnostic tools. The sequences of the second internal transcribed spacer (ITS-2) of rDNA were determined for adult specimens of T. deminutus (Nematoda: Strongylida: Oesophagostominae) from the Olive baboon and the Mona monkey. The length and G+C content of the ITS-2 sequences was 216 bp and approximately 43%, respectively. While there was no sequence variation among individual T. deminutus specimens from the baboon, 6 (2.8%) nucleotide differences were detected in the ITS-2 between the parasite from baboon and that of the Mona monkey, which is similar to the difference (3.2%) between 2 other species of Oesophagostominae (Oesophagostomum bifurcum and O. stephanostomum) from non-human primates, suggesting significant population variation or the existence of cryptic (i.e. hidden) species within T. deminutus . Pairwise comparisons of the ITS-2 sequences of the 2 operational taxonomic units of T. deminutus with previously published ITS-2 sequences for selected members of the subfamilies Oesophagostominae and Chabertiinae indicated that species from primates (including those representing the subgenera Conoweberia and Ihleia) are closely related, in accordance with previous morphological studies. The sequence differences (27-48.3%) in the ITS-2 between the 2 taxonomic units of T. deminutus and hookworms (superfamily Ancylostomatoidea) enabled their identification and delineation by polymerase chain reaction (PCR)-based mutation scanning. The genetic markers in the ITS-2 provide a foundation for improved, PCR-based diagnosis of T. deminutus infections and for investigating the life-cycle, transmission patterns and ecology of this parasite.

Oesophagostomiasis in man.

A case of oesophagostomiasis in an 8-years-old Africa girl is reported. The patient presented with abdominal pain and weight loss. Examination revealed multiple abdominal masses most of which were resected. The difficulties in differential diagnosis are discussed especially with reference to the need for increased awareness of this disease. The extant world literature on this subject is tabulated.

Determining the prevalence of Oesophagostomum bifurcum and Necator americanus infections using specific PCR amplification of DNA from faecal samples.

Until recently infection of humans with Oesophagostomum bifurcum was regarded as a rare zoonosis. But in northern Togo and Ghana its prevalence is 50% or more in certain villages. Diagnosis is hampered by the fact that the eggs of O. bifurcum are morphologically identical to those of the hookworm Necator americanus. Stools have to be cultured for 7 days to allow eggs to hatch to the characteristic third-stage (L3) larvae. We evaluated the applicability of specific polymerase chain reactions (PCRs) to amplify DNA from faecal samples as an alternative method for the differential diagnosis of the two infections. Oesophagostomum bifurcum-PCR was positive in 57 of 61 faecal samples known to contain O. bifurcum L3 larvae in coproculture. Necator americanus PCR was positive in 137 of 146 faecal samples known to contain N. americanus L3 larvae in coproculture. PCR also detected 26 additional O. bifurcum cases in 72 samples from O. bifurcum endemic villages in which no O. bifurcum larvae were found and 45 N. americanus cases in 78 samples in which no N. americanus larvae were found in coproculture. No O. bifurcum DNA was detected in 91 stool samples from individuals from two non-endemic villages. These results prove the usefulness of specific PCR assays as epidemiological tools to estimate the prevalence of O. bifurcum and N. americanus infections in human populations.

Identification, isolation, and characterization of a species-specific 30-kDa antigen of Oesophagostomum dentatum.

In the search for a serology tool for the diagnosis of nonpatent as well as patent infections with Oesophagostomum dentatum in pigs a water-soluble, unglycosilated antigen of about 30 kDa specific for the third-stage larvae of the parasite was purified by ion-exchange chromatography. In Western blots, the antigen was first detected by antibodies at day 7 postinfection. Cross-reactivity with O. quadrispinulatum, Ascaris suum, or Trichuris suis was not detected. It is suggested that this protein is a suitable tool for the species-specific serodiagnosis of O. dentatum infection in pigs.

Diagnosis of Oesophagostomum bifurcum and hookworm infection in humans: day-to-day and within-specimen variation of larval counts.

Oesophagostomum bifurcum, as well as hookworm infections are hyperendemic among humans in northern Togo and Ghana. For parasite-specific diagnosis a coproculture is obligatory, because only the infective larvae, and not the eggs, can be distinguished morphologically. The sensitivity of duplicate coprocultures from a single stool sample was found to be above 90% in comparison to a gold standard of 10 coprocultures made from a single stool specimen. Prevalence of infection with O. bifurcum and hookworm further increased with the number of coprocultures made from each individual stool. Notwithstanding the high sensitivity, intensity of infection per individual varied considerably from day-to-day and the number of larvae found in different samples out of 1 stool also varied highly, both showing a heterogeneous distribution. Surprisingly, daily fluctuation and within-specimen variation could not be differentiated from each other, probably because of the variation created by the coproculture technique. To estimate the intensity of infection, it is sufficient to make repeated coprocultures from only 1 individual stool sample. Laborious collection of stool samples on subsequent days does not give better estimates of the individual infection status.

Helminthic pseudotumours of the bowel: thirty-four cases of helminthoma.

Human infestation with nematode worms of the superfamily Strongyloidea has been recorded from time to time to give rise to serious surgical complications. Worms of the genus Oesophagostomum are most frequently responsible. These are common parasites of ruminants, monkeys, and apes in which their histotropic phase is confined to the bowel wall and sometimes results in multiple inflammatory nodules. Man is an accidental host and it seems an abnormal one. The worm fails to return to the bowel lumen, migrates further and persists in the tissues. The commonest manifestation is a solitary tumour-like inflammatory mass or abscess (;helminthoma') in the ileocaecal region. The ileum, transverse and sigmoid colons are affected less commonly and the lesions are occasionally multiple. Patients may also present with abscesses of the abdominal wall. The clinical diagnosis is difficult, even at laparotomy. Carcinoma, appendicitis, ileocaecal tuberculosis are frequently simulated and unnecessary radical surgery is often the result, particularly in expatriate Europeans. In this communication 34 cases from Uganda are reviewed with emphasis on histopathology as responsibility for the correct diagnosis is likely to fall on pathologists. Three characteristic appearances are described and related to phases in the natural history of the disease. Current knowledge on parasitology is reviewed. The disease affects Africans as well as Europeans and it is anticipated that cases will be seen in those returning from the tropics.

Natural Ascaris suum infections in swine diagnosed by coprological and serological (ELISA) methods.

Paired samples of faeces and blood were collected from weaners (W), fatteners (F), lactating sows (S) and piglets (P) in 20 Danish sow herds. The samples were examined by a McMaster technique for Ascaris suum eggs and an indirect ELISA for anti-A. suum IgG. The coprological and serological results were significantly correlated for W and F (P < 0.0001) but not for S (P = 0.35). The coproprevalences were much lower (W 4.0%, F 15.5%, S 7.4%) than the seroprevalences (W 20.3%, F 50.5%, S 65.4%). Thus, egg counts greatly underestimate the proportion and number of A. suum-exposed pigs even in the young susceptible age groups. The ELISA ODs of the piglets were closely correlated with those of their mothers (P < 0.0001), although the mean OD decreased gradually from 111% of the mean sow OD in the 1st week of life to 48% at 5-6 weeks of age. It is concluded that the ELISA technique gives a more realistic impression of A. suum exposure levels in swine herds than do faecal egg counts.