Prevalence of intestinal parasitic infections versus knowledge, attitudes and practices of male residents in Brazilian urban slums: a cross-sectional study.

Intestinal parasitic infections (IPIs) are neglected diseases caused by helminths and protozoa, with the relationships between parasite, host and environment having the potential to produce high morbidity and incapacity to work and mortality in vulnerable areas. This study assessed the prevalence of IPIs concerning socio-environmental conditions and analyzed the knowledge, attitudes and practices related to these diseases among men living in the slums of Rio de Janeiro city, Rio de Janeiro State, Brazil. A cross-sectional study was conducted in an agglomeration of urban slums between 2018 and 2019, with men aged between 20 and 59 years. A socioeconomic status questionnaire and an IPIs knowledge, attitudes and practices questionnaire (KAPQ) were applied. Coproparasitological diagnoses (n=454) were performed using four methods and samples of water for household consumption (n=392) were subjected to microbiological and physicochemical analysis. A total of 624 participants were enrolled. About 40% of the households had "water unsuitable for consumption". Only one Major Area, MA 3 was not statistically significant for IPIs (AOR=0.75; 95% CI: 0.30-1.88; p=0.55). The overall prevalence of IPIs was 23.8%. Endolimax nana (n=65, 14.3%) and hookworm (n=8, 1.7%) were the most frequently identified parasites. The analysis of the frequency of responses to the KAPQ has shown that men reported to seeking medical care if they were suspicious of IPIs, and around 35% would self-medicate. The results have shown the need to adopt integrated health education practices targeting male residents in urban slums to qualify the care with water for human consumption and promote self-care about IPIs. The household can be considered strategic for Primary Health Care activities for men.

Multi-parallel qPCR provides increased sensitivity and diagnostic breadth for gastrointestinal parasites of humans: field-based inferences on the impact of mass deworming.

BACKGROUND: Although chronic morbidity in humans from soil transmitted helminth (STH) infections can be reduced by anthelmintic treatment, inconsistent diagnostic tools make it difficult to reliably measure the impact of deworming programs and often miss light helminth infections. METHODS: Cryopreserved stool samples from 796 people (aged 2-81 years) in four villages in Bungoma County, western Kenya, were assessed using multi-parallel qPCR for 8 parasites and compared to point-of-contact assessments of the same stools by the 2-stool 2-slide Kato-Katz (KK) method. All subjects were treated with albendazole and all Ascaris lumbricoides expelled post-treatment were collected. Three months later, samples from 633 of these people were re-assessed by both qPCR and KK, re-treated with albendazole and the expelled worms collected. RESULTS: Baseline prevalence by qPCR (n = 796) was 17 % for A. lumbricoides, 18 % for Necator americanus, 41 % for Giardia lamblia and 15% for Entamoeba histolytica. The prevalence was <1% for Trichuris trichiura, Ancylostoma duodenale, Strongyloides stercoralis and Cryptosporidium parvum. The sensitivity of qPCR was 98% for A. lumbricoides and N. americanus, whereas KK sensitivity was 70% and 32%, respectively. Furthermore, qPCR detected infections with T. trichiura and S. stercoralis that were missed by KK, and infections with G. lamblia and E. histolytica that cannot be detected by KK. Infection intensities measured by qPCR and by KK were correlated for A. lumbricoides (r = 0.83, p < 0.0001) and N. americanus (r = 0.55, p < 0.0001). The number of A. lumbricoides worms expelled was correlated (p < 0.0001) with both the KK (r = 0.63) and qPCR intensity measurements (r = 0.60). CONCLUSIONS: KK may be an inadequate tool for stool-based surveillance in areas where hookworm or Strongyloides are common or where intensity of helminth infection is low after repeated rounds of chemotherapy. Because deworming programs need to distinguish between populations where parasitic infection is controlled and those where further treatment is required, multi-parallel qPCR (or similar high throughput molecular diagnostics) may provide new and important diagnostic information.

Prevalencia de parasitismo y control de la calidad en el diagnóstico de las parasitosis intestinales en 15 policlínicos de La Habana / Prevalence of parasitism and quality control in the diagnosis of intestinal parasitoses at 15 Havana polyclinics

Introducción: el control de la calidad del diagnóstico de las parasitosis intestinales es un proceder de gran importancia en la práctica de la salud pública; sin embargo, no está tan difundido como en otras ramas del diagnóstico del laboratorio clínico y solo ha sido incorporado en los últimos años. Objetivos: evaluar la calidad del diagnóstico parasitológico en cuatro municipios de La Habana. Métodos: el estudio se efectuó en 15 policlínicos de los municipios La Lisa, Arroyo Naranjo, La Habana del Este y Cerro, de la provincia de La Habana, en el período comprendido entre marzo de 2011 a mayo de 2012. El universo de trabajo estuvo constituido por 747 muestras de heces analizadas en los laboratorios de dichos policlínicos. Para determinar la concordancia entre observadores se calculó el coeficiente Kappa para dos observadores y dos categorías. Resultados: solo en un policlínico hubo grado de acuerdo casi perfecto en el diagnóstico parasitario (coeficiente de concordancia kappa de 0.90, p < 0,05). En una cuarta parte de los policlínicos evaluados fue posible establecer la concordancia en el diagnóstico parasitario y de ellos solo en uno hubo calidad satisfactoria. Conclusiones: los principales errores en el diagnóstico son para Ascaris lumbricoides y Blastocystis spp. Estos resultados sugieren perfeccionar constantemente la capacitación del personal que realiza este tipo de exámenes(AU)

Introduction: quality control in the diagnosis of intestinal parasitoses is a very important public health procedure. However, it is not as well known as it is in other branches of clinical laboratory diagnosis, and has only been incorporated in recent years. Objectives: Evaluate the quality of parasitological diagnosis in four Havana municipalities. Methods: the study was conducted at 15 polyclinics from the municipalities of La Lisa, Arroyo Naranjo, Habana del Este and Cerro, in the province of Havana, from March 2011 to May 2012. The study universe was composed of 747 stool samples analyzed in laboratories of the aforementioned polyclinics. The kappa coefficient was estimated for two observers and two categories, in order to determine the degree of agreement between observers. Results: only in one polyclinic was there an almost perfect degree of agreement in parasitological diagnosis (a kappa concordance coefficient of 0.90, p < 0,05). Conclusions: it was possible to establish the concordance in parasitological diagnosis. Only in one case was quality satisfactory. The main diagnostic errors corresponded to Ascaris lumbricoides and Blastocystis spp. Based on these results, permanent improvement is recommended in the training of the personnel performing these tests(AU)

Prevalencia de parasitismo y control de la calidad en el diagnóstico de las parasitosis intestinales en 15 policlínicos de La Habana / Prevalence of parasitism and quality control in the diagnosis of intestinal parasitoses at 15 Havana polyclinics

Introducción: el control de la calidad del diagnóstico de las parasitosis intestinales es un proceder de gran importancia en la práctica de la salud pública; sin embargo, no está tan difundido como en otras ramas del diagnóstico del laboratorio clínico y solo ha sido incorporado en los últimos años. Objetivos: evaluar la calidad del diagnóstico parasitológico en cuatro municipios de La Habana. Métodos: el estudio se efectuó en 15 policlínicos de los municipios La Lisa, Arroyo Naranjo, La Habana del Este y Cerro, de la provincia de La Habana, en el período comprendido entre marzo de 2011 a mayo de 2012. El universo de trabajo estuvo constituido por 747 muestras de heces analizadas en los laboratorios de dichos policlínicos. Para determinar la concordancia entre observadores se calculó el coeficiente Kappa para dos observadores y dos categorías. Resultados: solo en un policlínico hubo grado de acuerdo casi perfecto en el diagnóstico parasitario (coeficiente de concordancia kappa de 0.90, p < 0,05). En una cuarta parte de los policlínicos evaluados fue posible establecer la concordancia en el diagnóstico parasitario y de ellos solo en uno hubo calidad satisfactoria. Conclusiones: los principales errores en el diagnóstico son para Ascaris lumbricoides y Blastocystis spp. Estos resultados sugieren perfeccionar constantemente la capacitación del personal que realiza este tipo de exámenes

Introduction: quality control in the diagnosis of intestinal parasitoses is a very important public health procedure. However, it is not as well known as it is in other branches of clinical laboratory diagnosis, and has only been incorporated in recent years. Objectives: Evaluate the quality of parasitological diagnosis in four Havana municipalities. Methods: the study was conducted at 15 polyclinics from the municipalities of La Lisa, Arroyo Naranjo, Habana del Este and Cerro, in the province of Havana, from March 2011 to May 2012. The study universe was composed of 747 stool samples analyzed in laboratories of the aforementioned polyclinics. The kappa coefficient was estimated for two observers and two categories, in order to determine the degree of agreement between observers. Results: only in one polyclinic was there an almost perfect degree of agreement in parasitological diagnosis (a kappa concordance coefficient of 0.90, p < 0,05). Conclusions: it was possible to establish the concordance in parasitological diagnosis. Only in one case was quality satisfactory. The main diagnostic errors corresponded to Ascaris lumbricoides and Blastocystis spp. Based on these results, permanent improvement is recommended in the training of the personnel performing these tests

Comparison of three copromicroscopic methods to assess albendazole efficacy against soil-transmitted helminth infections in school-aged children on Pemba Island.

BACKGROUND: The diagnostic accuracy of three faecal egg count techniques (Kato-Katz, McMaster and FLOTAC) to assess albendazole efficacy against soil-transmitted helminth (STH) infections was compared. METHODS: The study is registered with Current Controlled Trials [identifier: ISRCTN90088840]. During September-November 2009, 304 school-aged children on Pemba Island, Tanzania, were screened and those infected with Ascaris lumbricoides, hookworm or Trichuris trichiura were treated with a single dose of albendazole (400 mg). Twenty-one days post-treatment, children provided a single stool sample which was examined using the same diagnostic methods. All stool samples were divided into two aliquots and one was fixed in 5% formalin and examined using FLOTAC and McMaster approximately 6 months after collection. RESULTS: Using fresh stool samples, comparable prevalences were demonstrated for the three methods at baseline (90-92.2% for T. trichiura, 41.1-52.8% for hookworm, 32.9-37.2% for A. lumbricoides); FLOTAC was the most sensitive method at baseline and follow-up. Albendazole showed high cure rate (CR) against A. lumbricoides (90-97%), moderate CR against hookworm (63-72%) and very low CR against T. trichiura (6-9%), regardless of the technique used. Egg counts (eggs per gram) at baseline were similar for A. lumbricoides and for hookworm among the three methods, and higher using McMaster and Kato-Katz compared with FLOTAC for T. trichiura. All methods were similar for hookworm and A. lumbricoides egg reduction rate (ERR) estimation, but Kato-Katz indicated a significantly higher ERR than McMaster and FLOTAC for T. trichiura. Preserved stool samples revealed consistently lower FECs at baseline and follow-up for all STHs. CONCLUSION: Further development and validation of standard protocols for anthelminthic drug efficacy evaluation must be pursued.

Wintergreen oil: a novel method in Wheatley's trichrome staining technique.

Permanent staining of faecal smears by Wheatley's trichrome technique has been used by many scientists for the detection of parasites in the past and it was found to be highly sensitive. This study was conducted to evaluate the use of Wintergreen oil in comparison with xylene in Wheatley's trichrome staining technique, as the reference technique. In a blind comparison study, 500 collected faecal samples from aboriginal communities were examined. Wintergreen oil was found to be more superior than xylene as a clearing agent in the Wheatley's trichrome staining of polyvinyl alcohol-fixed faecal smears for the identification of intestinal protozoa. Elimination of toxic, carcinogenic, and fire hazards makes Wintergreen oil the preferred choice in routine parasitology examinations.

Diagnostics are central for a truly holistic approach against intestinal parasitic diseases.

This is a perspectives piece on the central role of diagnostics for a truly holistic approach against gastrointestinal (GI) parasitic diseases. This article was motivated by a recent review in the International Journal of Infectious Diseases, where Absar Alum and colleagues (September 2010) reviewed the global burden, key transmission pathways, current tools and strategies, and provided their vision of a holistic approach to control GI protozoan and helminthic infections in humans. We argue that, as the success of multiple rounds of national deworming campaigns are actualized in various parts of the world, diagnostics become vital to achieve successful elimination and to aid pharmacovigilance against emerging pathogen resistance to the limited deworming pharmacopoeia.

An unusual case of Toxocara canis of the ascending colon.

A 52-year-old Cypriot woman was admitted to the surgical department of Larnaca General Hospital complaining of diarrhea and pain in the right upper and lower quadrants, which was reproduced by clinical examination. A palpable mass was also felt in the region. The white blood cell count was 8420/mul: 73.9% neutrophils, 13.3% lymphocytes and 6.9% eosinophils. Erythrocyte sedimentation rate was 80 mm/h. Parasitic examination of the stools was negative. A colonoscopy located a small mass near the ileoceacal valvule, which was sent for a biopsy. A barium enema and computed tomography scan revealed the same lesion to have expanded into the ascending colon. Despite negative biopsy reports, other findings suggestive of colon cancer prompted us to perform a right hemicolectomy and ileotransverse end to side anastomosis. The mass was found to be expanding into the surrounding fat tissue and into the regional lymph notes. Surprisingly, histological examination of the mass revealed visceral larva migrans, owing to ascaris Toxocara canis or Toxocara cati.

Common intestinal parasites.

Intestinal parasites cause significant morbidity and mortality. Diseases caused by Enterobius vermicularis, Giardia lamblia, Ancylostoma duodenale, Necator americanus, and Entamoeba histolytica occur in the United States. E. vermicularis, or pinworm, causes irritation and sleep disturbances. Diagnosis can be made using the "cellophane tape test." Treatment includes mebendazole and household sanitation. Giardia causes nausea, vomiting, malabsorption, diarrhea, and weight loss. Stool ova and parasite studies are diagnostic. Treatment includes metronidazole. Sewage treatment, proper handwashing, and consumption of bottled water can be preventive. A. duodenale and N. americanus are hookworms that cause blood loss, anemia, pica, and wasting. Finding eggs in the feces is diagnostic. Treatments include albendazole, mebendazole, pyrantel pamoate, iron supplementation, and blood transfusion. Preventive measures include wearing shoes and treating sewage. E. histolytica can cause intestinal ulcerations, bloody diarrhea, weight loss, fever, gastrointestinal obstruction, and peritonitis. Amebas can cause abscesses in the liver that may rupture into the pleural space, peritoneum, or pericardium. Stool and serologic assays, biopsy, barium studies, and liver imaging have diagnostic merit. Therapy includes luminal and tissue amebicides to attack both life-cycle stages. Metronidazole, chloroquine, and aspiration are treatments for liver abscess. Careful sanitation and use of peeled foods and bottled water are preventive.

Case of megaloblastic anemia caused by intestinal taeniasis.

A 61-year-old eutrophic male was diagnosed with vitamin B12 deficiency and megaloblastic anemia. A modified Schilling test suggested intestinal malabsorption unrelated to intrinsic factor deficiency. Subsequent colonoscopy revealed the presence of a Taenia tapeworm. The anemia resolved within days under therapy with niclosamide and temporary vitamin B12 supplements. The present case suggests that, in addition to other well-known parasitic agents, e.g., Diphyllobothrium latum and Giardia lamblia, Taenia infestation can also be a cause of intestinal vitamin B12 malabsorption.

[Value of screening for intestinal and urinary parasites in non-resident permanent students in Tunisia]. / Intérêt du dépistage des parasitoses digestives et urinaires chez les étudiants non résidents permanents en Tunisie.

In order to fight digestive and urinary parasitoses, a national program of surveillance has been founded. The screening of these parasitoses among the non permanent resident students in Tunisia (ENRPTS) is one of the main actions of this program. Among 2560 ENRPTS tested in the laboratory of Parasitologie of Institut Pasteur of Tunis, between 1998 and 2002, 674 were infected by parasites, which represents a global prévalence of 26.3%. The intestinal protozoa constitute the majority of parasites identified (87.4%). Entamoeba histolytica has been isolated in 89 cases, essentially from students from tropical African countries. Urinary bilharziosis has been diagnosed in 25 cases. These results confirm the utility of the control of the ENRPTS. The precocious tracking permits to avoid the introduction and the dissemination of parasites already absent or rare in our country.

Fumagillin treatment of intestinal microsporidiosis.

BACKGROUND: Intestinal microsporidiosis due to Enterocytozoon bieneusi is a cause of chronic diarrhea, malabsorption, and wasting in immunocompromised patients. Currently, there is no effective treatment. METHODS: We conducted a randomized, double-blind, placebo-controlled trial of fumagillin (60 mg per day orally for two weeks) in patients with chronic E. bieneusi infection. Efficacy was assessed primarily by the clearance of microsporidia, as evidenced by analysis of stool specimens. Patients in whom microsporidia were not cleared received treatment for two weeks with open-label fumagillin. After clearance of the parasite, follow-up stool examinations were performed monthly to detect relapses. RESULTS: Twelve patients were enrolled in this study, 10 with the acquired immunodeficiency syndrome and 2 who had received organ transplants. Clearance of microsporidia occurred in all six of the patients in the fumagillin group, as compared with none of the six in the placebo group (P=0.002). Treatment with fumagillin was also associated with increases in absorption of D-xylose (P=0.003) and in Karnofsky performance scores (P<0.001) and with decreases in loperamide use (P=0.01) and total stool weight (P=0.04). There were serious adverse events (neutropenia and thrombocytopenia) in three patients in the fumagillin group; one patient in the placebo group had severe diarrhea. All six controls subsequently had clearance of microsporidia after open-label treatment with fumagillin. Relapses of the infection were identified in two patients during follow-up (median follow-up, 10 months). CONCLUSIONS: Fumagillin is an effective treatment for chronic E. bieneusi infection in immunocompromised patients.

Hypertonic saline enema in gastrointestinal ascariasis.

Many dangerous surgical complications like intestinal obstruction, acute appendicitis with perforation, ileal perforation in a typhoid patient, Meckel's diverticulitis, disruption of post operative intestinal anastomosis, volvulus, and intussusception are known to occur due to ascariasis, with considerable morbidity and mortality. In this retrospective study of 250 cases of gastrointestinal ascariasis admitted in paediatric surgical wards of Govt. Medical College, Jabalpur (MP), the authors analysed the results of conservative (especially the use of hypertonic saline enema-given just like an ordinary soap water enema but substituting freshly made hypertonic saline in place of soap water) and surgical treatment. The success rate of conservative treatment was 95.6%. Hypertonic saline passes through the incompetent ileo-caecal valve (present in 80% of children) and irritates the worm bolus commonly situated in the terminal ileum, causing it to disintegrate. It also helps to increase the intestinal motility and passage of worms into the colon. The use of hypertonic saline enema is safe and effective in the conservative treatment of gastrointestinal ascariasis. Authors feel that it is the most grossly under utilized part of conservative treatment and deserves to be known and used on wider scale.

Radiologic investigation of acute inflammatory and infectious bowel disease.

Definitive diagnosis of infectious or idiopathic inflammatory bowel disease ultimately rests on histologic and bacteriologic documentation. Nevertheless, radiologic studies play an important role in the evaluation and management of patients with acute enterocolitis. Plain abdominal films can give a gross estimate of disease extent in the colon and detect complications, such as perforation or toxic megacolon. Double-contrast barium enema allows visualization of the mucosal pattern and the overall configuration of the bowel, which are important for determining the extent and severity of disease and its most likely cause. Cross-sectional imaging depicts the mural and mesenteric involvement as well as intraperitoneal complications of inflammatory bowel disease, thus providing a critically important perspective that complements the information afforded by endoscopic and conventional radiographic techniques.

Anisakiasis of the colon: radiologic and endoscopic features in six patients.

The radiologic and endoscopic findings in six patients with anisakiasis of the colon were analyzed. The diagnosis was based on the demonstration of Anisakis larvae at radiography or on elevated serum levels of antibodies to this parasite. All patients reported abdominal symptoms 12-23 hours after the ingestion of raw fish. Double-contrast barium enema examination, performed 2-4 days after the onset of syptoms in all the patients, revealed that the right side of the colon was frequently affected by edema, which was radiographically demonstrated as luminal narrowing and thumbprinting. In addition, the worm was shown at radiography in four patients. Colonoscopy, performed 1-7 days after the onset of symptoms, revealed edematous mucosa, characterized by narrowing and multiple smooth and round protrusions, in all four of the patients studied, but it failed to demonstrate the worm in any patient. The authors believe that the demonstration of these features, together with a history of raw fish ingestion, is essential for the diagnosis of this disorder.

Intestinal parasitic infestation in rural communities: a focus for primary health care in Nigeria.

A study carried out in four villages in two local government areas of Oyo State in the southwestern part of Nigeria, revealed that intestinal helminthiasis is still very prevalent in Nigeria. Ascaris is the most common helminth encountered and multiple infestation is also quite common. Schoolchildren and pre-school children are the greatest sufferers of Ascaris, while students and farmers are the greatest target for hookworm. The usefulness of a community-based distribution programme of health services using trained traditional birth attendants and voluntary health workers for data collection and distribution of antihelminth drugs is discussed.

PIP: The prevalence of the 3 most common types of helminth infections was surveyed in 4 villages in Oyo State, Nigeria, and antihelminth medications were distributed by community-based-workers (CBWs). The villages were Ijaye and Ikereku 30 km north of Ibadan, and Faforiji and Ifewara 120 km southeast of Ibadan. A total of 827 stool samples were collected at random by the CBWs, and examined under light microscope. 68.7% of the samples were positive, 39% of which had 2 or more species, and 12% had 3 or more. The most common infestations were Ascaris in 58.2% of the total population, Trichuris in 14.9%, hookworm in 13.8% and Strongyloides in 1.0%. Ascaris and Trichuris was the most common double infection, followed by hookworm and Ascaris. Ascaris was most prevalent in young children; hookworm in farmers and in adults 45 years. Since CBWs enjoy respect among these people and were able to collect stool samples and distribute oral medication, it is suggested that periodic de-worming of pre-schoolers, school children and farmers would improve nutritional status and food production in the area.