Prevalence of Intestinal Parasitic Infections, Genotypes, and Drug Susceptibility of Giardia lamblia among Preschool and School-Aged Children: A Cross-Sectional Study in Thailand.

This study aimed to estimate the prevalence of intestinal parasitic infections in children and assess the drug susceptibility and genotypes/assemblages of Giardia lamblia in Thailand. This cross-sectional study was conducted among children aged 3-12 years in Sangkhlaburi District, Kanchanaburi Province, Thailand, between 25 September 2017 and 12 January 2018. Parasites were identified by stool microscopic examination, cultivation of intestinal parasitic protozoa, and enzyme-linked immunosorbent assay (ELISA). Drug susceptibility and genotype of G. lamblia were performed, respectively, by a resazurin assay and Triosephosphate Isomerase A and B genes using modified primers and probes. Among the 661 participants, 445 had an intestinal parasitic infection, resulting in a prevalence of 67.32% (95% CI: 63.60-70.89%). Blastocystis hominis was the most prevalent protozoa infection (49.32%; 95% CI: 45.44-53.22%), while Ascaris lumbricoides was the most prevalent helminth infection (0.91%; 95% CI: 0.33-1.97%). The prevalence of G. lamblia was 17.40%, with genotype B being the most common. According to our study, intestinal parasitic infections were commonly found in Thai children. G. lamblia was the most common pathogenic protozoa infection identified and exhibited less susceptibility to metronidazole compared to furazolidone and mebendazole.

Traveler's diarrhea in Nepal-changes in etiology and antimicrobial resistance.

BACKGROUND: We conducted a comprehensive investigation to update our knowledge of traveler's diarrhea (TD) etiology and antimicrobial resistance (AMR) in Nepal. METHODS: A case-control study of TD etiology was conducted at the CIWEC Clinic Travel Medicine Center in Kathmandu from 2012 to 2014. Stool samples were tested by microscopy, culture and molecular techniques for identification of bacterial, viral and parasitic enteric pathogens, and AMR. We analysed patient demographic data, pre-treatment information and clinical outcomes. RESULTS: We enrolled 433 TD cases and 209 non-diarrhea controls. At least one of enteric pathogens was identified among 82% of cases and 44% of controls (P < 0.001). Multiple pathogens were observed among 35% of cases and 10% of controls. The most common pathogens significantly identified among cases in comparison with controls were Campylobacter (20%), norovirus (17%), enterotoxigenic E. coli (ETEC) (12%), rotavirus (9%) and Shigella (8%) (P < 0.001). We noted Campylobacter, Shigella and ETEC resistance to azithromycin at 8, 39 and 22% and to ciprofloxacin at 97, 78 and 23%, respectively. CONCLUSION: Among travellers to Nepal with TD, viral pathogens were commonly found and norovirus was the second most common pathogen after campylobacter. We noted increased AMR to fluoroquinolones (FQs) and azithromycin (AZM). There is heightened concern for AZM treatment failures, though this continues to remain the drug of choice for TD treatment in our setting where FQs should not be used.

Evaluation of an intragastric challenge model for Shigella dysenteriae 1 in rhesus monkeys (Macaca mulatta) for the pre-clinical assessment of Shigella vaccine formulations.

Shigellosis is a worldwide disease, characterized by abdominal pain, fever, vomiting, and the passage of blood- and mucus-streaked stools. Rhesus monkeys and other primates are the only animals that are naturally susceptible to shigellosis. A suitable animal model is required for the pre-clinical evaluation of vaccines candidates. In this study, the minimal dose of Shigella dysenteriae1 1617 strain required to produce dysentery in four of five (80% attack rate) monkeys using an escalating dose range for three groups [2 × 10(8) , 2 × 10(9) and 2 × 10(10) colony forming unit (CFU)] was determined. In addition, the monkeys were re-infected. The identified optimal challenge dose was 2 × 10(9) CFU; this dose elicited 60% protection in monkeys when they were re-challenged with a one log higher dose (2 × 10(10) CFU). The challenge dose, 2 × 10(10) CFU, produced severe dysentery in all monkeys, with one monkey dying within 24 h, elicited 100% protection when re-challenged with the same dose. All monkeys exhibited immune responses. This study concludes that the rhesus monkey model closely mimics the disease and immune response seen in humans and is a suitable animal model for the pre-clinical evaluation of Shigella vaccine candidates. Prior infection with the 1617 strain can protect monkeys against subsequent re-challenges with homologous strains.

Prevalence and antimicrobial susceptibilities of Vibrio, salmonella, and Aeromonas isolates from various uncooked seafoods in Thailand.

Uncooked seafood samples were collected from open markets and supermarkets in Bangkok, Thailand, and were examined for the presence of Vibrio, Salmonella, and Aeromonas species from January to February 2008. From 120 samples, 272 bacterial isolates were identified through biochemical testing. Of all sea bass, shrimp, oyster, and blood cockle samples (30 of each) that were processed for culture, 114 (95%) samples had at least one detectable isolate of Vibrio, Salmonella, or Aeromonas, leaving only 6 (5%) samples free of them. All oyster sample (100%) had at least one pathogen, followed by sea bass (97%), blood cockles (97%), and shrimp (90%). Overall, 111 (92%) of all samples had detectable Vibrio spp., 32 (27%) had detectable Aeromonas spp., and 25 (21%) had detectable Salmonella enterica. There was no overall difference between positive samples collected from fresh markets versus supermarkets (relative risk, 0.97; 95% CI, 0.89 to 1.05). Resistance to ampicillin among isolated pathogens was relatively high (56%), while resistance to 12 other antibiotics, including azithromycin, ciprofloxacin, and trimethoprim-sulfamethoxazole, was relatively low (0, 0, and 3%, respectively). Study results indicate that uncooked seafood in Bangkok, Thailand, commonly harbors enteric pathogens and that consumption of uncooked seafood should be avoided to reduce foodborne illnesses.

Enteric pathogen sampling of tourist restaurants in Bangkok, Thailand.

BACKGROUND: Travelers' diarrhea (TD) is the most prevalent disorder affecting travelers to developing countries. Thailand is considered "moderately risky" for TD acquisition, but the risk by city visited or behavior of the visitor has yet to be definitely defined. Restaurant eating is consistently associated with the acquisition of diarrhea while traveling, and pathogen-free meals serve as a marker of public health success. This study seeks to ascertain a traveler's risk of exposure to certain bacterial gastric pathogens while eating at Bangkok restaurants recommended in popular tourist guide books. METHODS: A cross-sectional tourist restaurant survey was conducted. Thirty-five restaurants recommended in the two top selling Bangkok guidebooks on Amazon.com were sampled for bacterial pathogens known to cause diarrhea in Thailand, namely Salmonella, Campylobacter, and Arcobacter (a Campylobacter-like organism). A total of 70 samples from two meals at each restaurant were obtained. Suspected bacterial pathogens were isolated by differential culture and tested for antibiotic resistance. RESULTS: Salmonella group E was isolated from one meal (2%), and Arcobacter butzleri from nine meals (13%). Campylobacter spp. were not found. The large majority of A butzleri isolates were resistant to azithromycin but susceptible to ciprofloxacin and an aminoglycoside. CONCLUSIONS: A traveler's risk of exposure to established bacterial pathogens, Salmonella and Campylobacter, by eating in recommended restaurants is small. Arcobacter butzleri exposure risk is 13% per meal eaten, and rises to 75% when 10 meals are eaten. All restaurants, regardless of price, appear to be equally "risky." Current evidence points to Arcobacter being pathogenic in humans; however, further research is needed to conclusively define pathogenicity. Routine prophylaxis for diarrhea is not recommended; however, travelers should be aware of the risk and come prepared with adequate and appropriate self-treatment medications.

Emergence and properties of fluoroquinolone resistant Salmonella enterica serovar Typhi strains isolated from Nepal in 2002 and 2003.

A total of 171 Salmonella enterica serovar Typhi strains isolated from Nepal, mostly from patients with typhoid fever in 2002-2003, were tested for antimicrobial susceptibility by disk diffusion assay. Selected S. enterica serovar Typhi isolates were tested for MICs by E-test for ceftriaxone, ciprofloxacin and ofloxacin. Mutations of DNA gyrase gyrA and gyrB and topoisomerase IV parC and parE were identified by sequencing of PCR amplicons. By disk diffusion assay, 75/171 S. enterica serovar Typhi isolates were resistant to nalidixic acid, ampicillin, choramphenicol, streptomycin, tetracycline, sulfisoxazole, and trimethroprim/sulfamethoxazoles. Multiple drug resistance to the 7 antimicrobials was most predominant among S. enterica serovar Typhi isolates in this study. Resistance to nalidixic acid was detected in 76/111 and 56/60 of total isolates collected in 2002 and 2003, respectively. Nalidixic acid-resistant isolates in 2002 and 2003 showed MIC range for ciprofloxacin of 0.125-0.250 mg/l. Nalidixic acid-resistant isolates contained point mutations in gyrA and parC but not gyrB and parE. The gyrA mutation of nalidixic acid-resistant isolates obtained in 2002 and 2003 had amino acid substitution at position 83 of Serine-->Tyrosine and Serine-->Phenylalanine, respectively. Two different mutations of gyrA were detected among nalidixic acid-resistant isolates. Thus it is necessary to monitor mutation in DNA topoisomerase associated with increases in quinolones resistance.

Prevalence of foodborne microorganisms in retail foods in Thailand.

Worldwide, foodborne illness is often associated with consumption of meats and poultry products sold at retail markets. A cross-sectional retail food study was conducted in Bangkok, Thailand to assess the prevalence of bacterial pathogens on retail food samples. Raw chicken, beef, pork, and chicken eggs were purchased from fresh markets and supermarkets and tested for Salmonella spp., Campylobacter spp., Arcobacter spp., and Enterococcus spp. Suspect bacterial pathogens were isolated by differential culture and Salmonella species were serotyped. A total of 200 samples were collected from 50 markets between May and August 2003. Of the 200 samples tested, 121 (61%) were positive for at least one Salmonella spp. serogroup. A total of 175 Salmonella spp. were isolated. The most common serotype was Salmonella Anatum, followed by S. Corvallis and S. Derby. Campylobacter spp. were found in 31 (15.5%) of 200 samples. C. jejuni was isolated from 15% of fresh market chicken samples and 35% of supermarket chicken samples. Arcobacter spp. were isolated from 42 (21%) samples; fresh market chicken had significantly higher A. butzleri contamination than supermarket chicken. The presence of Enterococcus spp., an indication of fecal contamination, was detected in 188 (94%) samples, including 100% of the beef and pork sources. Few studies have examined retail food contamination in Thailand. In particular, the high prevalence of samples with Arcobacter spp. warrants further study to determine pathogenicity.

Intestinal parasitic infections among pre-school children in Sangkhlaburi, Thailand.

This study was conducted to investigate the presence of intestinal parasites among pre-school children (aged 3 months to 5 years) in Sangkhlaburi, a rural district in the west of Thailand along the Thai-Myanmar border. Stool specimens were collected from October 2001 through October 2002. A total of 472 pre-school children, 233 males and 239 females, 236 children with diarrhea and 236 asymptomatic children were recruited for the study. Each specimen was processed and examined by direct wet smear, modified acid fast stain, formalin-ethylacetate sedimentation concentration technique, and trichrome stain. In detecting Giardia lamblia and Cryptosporidium species ProSpecT Microplate assays (Alexon-Trend, Lenexa, KS) were performed. There were 107 individuals (22.7%), 41 diarrheal and 66 asymptomatic children, infected with intestinal parasites. The most frequent parasites identified in cases and controls were G. lamblia and Cryptosporidium spp. Eighteen specimens (3.8%) showed mixed parasite infections. Highest proportion of intestinal parasites occurred during the rainy season (June-October).

Significantly increased recovery of intestinal parasites on routine stool specimen evaluation.

Three hundred thirty-six stool samples from October 2001 through October 2002 were analyzed for the presence of intestinal parasites. Fifty-six of these (16.7%) were positive for a total of 66 parasites; 65/66 (98.5%) were detected by iodine and dimethyl sulfoxide-modified acid-fast (DMSO-mAFB) stained smears of fresh and formalin-ethylacetate sedimentation concentrated samples. Saline, iodine, and DMSO-mAFB stained smears of fresh stool samples alone detected significantly fewer parasites, finding only 50/66 (75.8%) (p < 0.05). Stool samples analyzed by trichrome stained specimens preserved in Zinc sulfate polyvinyl alcohol (Zinc PVA) detected only 41/ 66 (62.2%) of the parasites. In our study population, it was necessary to perform the National Committee for Clinical Laboratory Standard (NCCLS) recommended to accurately detect intestinal parasites. The concentration technique is simple and significantly increased the detection of intestinal parasites.

Re-evaluation of commercially available enzyme-linked immunosorbent assay for the detection of Giardia lamblia and Cryptosporidium spp from stool specimens.

This study aimed to detect Giardia lamblia and Cryptosporidium spp infection from stool specimens. A total of 345 stool specimens were examined by microscopy (both direct smear and formalin concentration) and EIA techniques (ProSpecT Microplate Assay) for G. lamblia and Cryptosporidium spp. Of 73 tests positive for G. lamblia, 41(56.2%) were positive by microscopy, and 71(97.3%) were positive by EIA. Of 16 tests positive for Cryptosporidium spp, 5 (31.3%) were positive by microscopy, and 16(100%) were positive by EIA technique. The results demonstrate that this EIA method is quick, simple, and more sensitive than the microscopy method and should be used for the detection of G. lamblia and Cryptosporidium spp where the prevalence of these protozoan parasites is a public health problem.