Toxocara: Seroprevalence in Mexico.

In Mexico, toxocariasis, like some other parasitosis in humans, is not a disease of conventional surveillance or immediate notification. Seroprevalence studies are scarce, six dealing with paediatric populations and eight dealing with adults; the reports were only from four states in Mexico. There were 1596 children, and the seroprevalence was 13.8%. In the case of adults, there were 1827 subjects, and seroprevalence was 4.7%. There is a significant positive association between seroprevalence and the paediatric population P<0.0001 (OR, 3.285; 95% CI, 2.541-4.279). It is advisable to perform competitive ELISAs and add another diagnostic test, such as Western blot or the detection of circulating antigens to reduce diagnostic uncertainty. This neglected parasitosis can be confused with retinoblastoma. Therefore, there is a risk of ocular enucleation. It is necessary to sensitise the authorities of the Ministry of Health and decision-makers, to provide economic support for epidemiological surveillance of this zoonotic parasite.

Disulfiram as a novel inactivator of Giardia lamblia triosephosphate isomerase with antigiardial potential.

Giardiasis, the infestation of the intestinal tract by Giardia lamblia, is one of the most prevalent parasitosis worldwide. Even though effective therapies exist for it, the problems associated with its use indicate that new therapeutic options are needed. It has been shown that disulfiram eradicates trophozoites in vitro and is effective in vivo in a murine model of giardiasis; disulfiram inactivation of carbamate kinase by chemical modification of an active site cysteine has been proposed as the drug mechanism of action. The triosephosphate isomerase from G. lamblia (GlTIM) has been proposed as a plausible target for the development of novel antigiardial pharmacotherapies, and chemical modification of its cysteine 222 (C222) by thiol-reactive compounds is evidenced to inactivate the enzyme. Since disulfiram is a cysteine modifying agent and GlTIM can be inactivated by modification of C222, in this work we tested the effect of disulfiram over the recombinant and trophozoite-endogenous GlTIM. The results show that disulfiram inactivates GlTIM by modification of its C222. The inactivation is species-specific since disulfiram does not affect the human homologue enzyme. Disulfiram inactivation induces only minor conformational changes in the enzyme, but substantially decreases its stability. Recombinant and endogenous GlTIM inactivates similarly, indicating that the recombinant protein resembles the natural enzyme. Disulfiram induces loss of trophozoites viability and inactivation of intracellular GlTIM at similar rates, suggesting that both processes may be related. It is plausible that the giardicidal effect of disulfiram involves the inactivation of more than a single enzyme, thus increasing its potential for repurposing it as an antigiardial drug.

Toxocara canis: Analysis of the kinetics of antigen release and antibody production in an in vivo model for the detection of past or present infection.

Worldwide, Toxocara canis is an important zoonotic nematode of public health concern. This soil-transmitted helminth causes visceral larva and ocular larva migrans in paratenic hosts. The detection of T. canis larva migrans is complicated because current immunological tests detect only IgG antibodies, which can cross-react with antigens from other parasites and cannot distinguish between the past and present infection. Analysis of antigen release and antibody production could help improve the detection of larva migrans. Here, we report the kinetics of antigen release, IgM and IgG production in an in vivo model for the detection of past or present infection. We used four groups of seven mice: two groups infected orally with 50 or 100 embryonated eggs, and the other two infected intraperitoneally with 50 or 100 live larvae. We obtained blood samples at 0, 3, 7, and 14days and, then, every two weeks until day 140. Sandwich ELISA and indirect ELISA were performed for antigen capture and the detection of immunoglobulins, respectively. Mice inoculated with larvae developed an immune response faster than those inoculated with eggs. In all groups, antigen capture was positive starting at 3days until 140days post-inoculation (dpi). Detection of immunoglobulins was at 14 or 28dpi in mice inoculated with larvae or eggs, respectively. Negative IgM values were detected at days 98 and 112. The samples remained positive for IgG until the last day of the experiment. Data suggest that in mice inoculated with T canis eggs, some larvae did not hatch, others died or never reached the bloodstream. Based on our model, we propose that there is early infection when only antigens are present, and active larva migrans when antigen and immunoglobulins are detected, implying an immune response of the host against the antigen. Our study offers a view into the parasite-host relationship and enables us to infer if there are live larvae. Additionally, these findings provide a foundation for the diagnosis and differentiation of recent infection and active larva migrans.

Successful capture of Toxocara canis larva antigens from human serum samples.

BACKGROUND: Toxocara canis is a nematode that parasitizes dogs, while humans are paratenic hosts. When humans are infected the migrating larvae damage the liver, lungs and even the nervous system. Larva migrans diagnosis is based on immunological techniques; however, the commercial immunodiagnostic kits detect anti-T. canis antibodies which may cross-react with other parasites, mainly nematodes with extra-intestinal migration. Moreover, antibodies do not necessarily reflect an active infection; so detection and quantification of circulating antigens may provide appropriate and timely information for treatment, which prevents irreversible damage. Here we report the standardization of a monoclonal antibody based antigen capture ELISA to diagnose human toxocariasis without cross-reaction. METHODS: We developed anti-T. canis polyclonal antibodies in rabbits and a monoclonal antibody in mouse which did not cross-react with 15 antigens from several parasites. The sandwich ELISA standardization was performed using sera from mice experimentally infected. We tested the method using 29 positive and 58 negative human sera previously typified with a commercial kit, which detects antibodies. RESULTS: Only 5.0 µg/mL and 10 µg/mL polyclonal antibodies and monoclonal antibody, respectively, were needed in the sandwich ELISA standardization, detecting since 440 pg/mL larva antigens. Nine out of 29 antibody-positive sera were also positive for antigens and no false positive were found. Taking the antibody kit as the reference standard, the sensibility and specificity of the antigen test were 31% and 100%, respectively. CONCLUSIONS: With these tools we established a detection threshold as low as 440 pg/mL antigen. Monoclonal antibody is specific, and did not cross-react with antigens from other parasites. Detection of circulating antigens helps provide appropriate and timely treatment and prevents irreversible damage.

Intraepithelial giardia intestinalis: a case report and literature review.

The giardiasis is a neglected parasitic disease. The WHO has estimated more than 280 million of human infections each year; however, intraepithelial giardiasis is a rare entity, there are only 5 reports showing invasive giardiasis. A pediatric female patient with chronic abdominal pain, diarrhea, or pasty stools, without fever, was seen in the Gastroenterology and Nutrition Service. The stool studies were negative for pathogens and lactose hydrogen breath test was positive. The presumptive clinical diagnosis was giardiasis and the patient was empirically treated with nitazoxanide. But, the patient persisted with abdominal pain and pasty stools. Endoscopy was indicated to search for Helicobacter and Giardia. Guardian and patient gave written informed consent. Hematological profile was normal. The endoscopy was performed under general anesthesia and the biopsies and duodenal aspirate were obtained. The microscopic analyses of duodenal fluid showed Giardia trophozoites. Electron microscopic analysis was negative for Helicobacter pylori, but Giardia trophozoites with a typical crescent shape within the tissue were found. The patient was treated with tinidazole, subsequent tests showed that lactose absorption was normal, stool examinations were negative for Giardia and abdominal pain had stopped. This case suggest that intraepithelial giardiasis could be a common entity but unseen because the giardiasis diagnosis is usually made on fecal samples. Future studies are necessary to determine the role of intraepithelial trophozoites in giardiasis pathogenic mechanisms.

[Microsporidia in pediatric patients with leukemia or limphoma]. / Microsporidiosis en pacientes pediátricos con leucemia o linfoma.

INTRODUCTION: Microsporidia are intracellular micro-organisms, characterized by mature spores with chitin walls and by one extrusive polar tube through which they pour their sporoplasm to the host cells. In immunocompromised patients, Enterocytozoon bieneusi and Encephalitozoon intestinalis produce diarrhea and systemic dissemination. In Mexico there is not information about microsporidia in children with cancer. OBJECTIVE: The aim of this pilot study was to investigate the presence of microsporidia species in pediatric patients with leukemia or lymphoma. MATERIAL AND METHODS: We obtained fecal samples from thirteen patients. The samples were processed to detect microsporidia by both modified Ziehl-Neelsen and clacofluor white stains, DNA was isolated to amplify rRNA specific sequences, to identify E. bieneusi, E. intestinalis, E. cuniculi and E. hellem by DNA polymerase chain reaction (PCR). Other parasites and pathogenic bacteria were also tested. RESULTS: Based on morphologic traits 7/13 samples were found positives to microsporidia and 6/10 by PCR. Was identified E. bieneusi in three patients with leukemia and one with lymphoma, another two children with leukemia were infected with E. intestinalis. Almost all children were high-risk patients and in phase of re-induction, consolidation or with many chemotherapy treatments. All the patients with microspiridia did not present diarrhea at the moment of the sampling; however, in two children with diarrhea it was found Cyclospora cayetanensis. Also we obtained feces from five patients' mothers and microsporidia spores were identified by stain in all of them and by PCR it was diagnosed the species in three of them. CONCLUSION: It was demonstrated that the feces of patients with leukemia or lymphoma had microsporidia, therefore is necessary to know the prevalence of these microorganisms and to analyze their impact in evolution of cancer patients.

Trypanosoma cruzi: seroprevalence detected in the blood bank of the Instituto Nacional de Pediatría, Mexico City, in the period 2004 through 2009.

BACKGROUND: The second most common mode of Trypanosoma cruzi or Chagas disease transmission is via therapeutic blood transfusion. In Mexico, control of T. cruzi is still in its initial phase; in fact, there are only 14 studies published covering 10 states on T. cruzi seroprevalence in donated blood in Mexico. Here we present the results of 5 years of trypanosomiasis screening in the blood bank of the Instituto Nacional de Pediatría. STUDY DESIGN AND METHODS: Samples from all blood donated in the period from 2004 to 2009 were analyzed. We screened for T. cruzi using an enzyme-linked immunosorbent assay technique. Seropositive samples were then processed using the polymerase chain reaction (PCR) to detect a nuclear gene segment. RESULTS: A total of 37,333 samples were analyzed and a 0.17% (64 samples) T. cruzi seroprevalence was found. Donors were mostly from Mexico State and Mexico City, which is considered nonendemic for T. cruzi area. Of 64 seropositive samples, only two tested positive by PCR (3.12%), which amplified a 189-bp product from nuclear gene from the parasite. CONCLUSION: Although the seroprevalence of T. cruzi infection was low, this surveillance program prevented the infection of more than 100 children because each unit of blood provides 2.6 to 3.5 blood products. The majority of the donors were from Mexico State and Mexico City, which is a nonendemic area. The serodetection of T. cruzi in this region is evidence that is necessary to increase our understanding of its distribution in the Mexico City and surrounding places.

Prevalencia de Giardia intestinalis y predominio de genotipos zoonóticos en ovinos y bovinos de traspatio de cinco estados de la República Mexicana / Prevalence of Giardia intestinalis and zoonotic genotype predominance in small scale sheep and cattle farms in five states of the Mexican Republic

The aim of this paper was to discover the prevalence and assemblages of Giardia intestinalis, harbored in sheep and cows on familiar farms from five states of the Mexican Republic. Stool samples from 265 sheep and 174 cows were analyzed by centrifugation and flotation in zinc sulfate to search for cysts and ova. The samples with Giardia cysts were processed in a Sheather solution in order to isolate them. Afterwards, cultures were established in TYI-S-33, each one of which was the Giardia DNA source. The DNA was obtained and used as a template to amplify a fragment of the glutamate dehydrogenase (gdh) enzyme. The 430 bp amplicons were restricted with Nla IV and Rsa I in order to identify the restriction fragments length polymorphisms (RFLP's) patterns. From the cyst analysis, Giardia cysts in nine cows (5.1%) and 30 sheep (11.3%) were found. Then 10 axenic cultures (5 from sheep and 5 from cows) were set up. From the RFLP's pattern it was found that one cow had assemblage (AI), another two had a mixture of assemblages (AI + BIII) and the other two had (E + BIII). In sheep, it was found that two sheep had assemblage (AI) and the other three had a mixture of assemblages (AI + BIII). This is the first report in which zoonotic assemblages (A-I and BIII) predominance in ruminants from five states of Mexico have been demonstrated. Therefore, it is necessary to carry out further studies aimed at discovering other Giardia genotypes and transmission patterns between animals and humans in Mexico.

Con el fin de determinar la frecuencia y genotipos de Giardia intestinalis en ovinos y bovinos de traspatio de algunos estados de la República Mexicana, en este trabajo se colectaron heces de 265 ovinos y 174 bovinos, para la búsqueda de Giardia mediante coproparasitoscópicos (CPS) de concentración flotación. De las muestras fecales que resultaron positivas se obtuvieron los quistes por el método de Sheather. Los quistes se desenquistaron in vitro y los trofozoítos se mantuvieron en cultivo TYI-S-33 axénico. El ADN de los trofozoítos se obtuvo mediante extracciones fenólicas y se amplificó un segmento de ≈ 430 pb del gen de la enzima glutamato deshidrogenasa (gdh) por medio de la reacción en cadena de la ADN polimerasa (PCR), el producto se restringió con las enzimas Nla IV y Rsa I y se obtuvieron los polimorfismos de los fragmentos de restricción (RFLP). En los CPS se encontró a Giardia en nueve bovinos (5.1%) y 30 ovinos (11.3%). Se establecieron 10 cultivos axénicos (5 de bovinos y 5 de ovinos). En un bovino se encontró el genotipo (AI), dos tuvieron mezcla de los genotipos (AI + BIII) y los otros dos fueron (E + BIII). Un ovino fue genotipo (AI) y tres tuvieron mezcla de los genotipos (AI + BIII). Éste es el primer informe que presenta predominio de genotipos zoonóticos (AI y BIII) en ovinos y bovinos de México. Es necesario investigar los genotipos de Giardia y patrones de transmisión entre animales y humanos en México.

Oregano (Lippia spp.) kills Giardia intestinalis trophozoites in vitro: antigiardiasic activity and ultrastructural damage.

In the world, giardiosis is still a very important parasitic disease; only in Asia, Africa and America, there are more than 200 million of infected people in a year. The usual treatments are drugs that produce undesirable secondary effects, perhaps favouring the resistant strain selection. One alternative is to research compounds from plants used as antidiarrhoeic or antiparasitic in the traditional medicine. In a previous work, we found that Lippia beriandieri (Oregano) revealed to be more potent than tinidazole, a common antigiardiasic drug. In this current work, we tested the cell viability by re-culture and reduction of MTT-tetrazolium salts to MTT-formazan, and we showed the effect of oregano ethanolic extracts against Giardia intestinalis (synonyms: Giardia duodenalis, Giardia lamblia) trophozoites at concentrations ranging form 58 to 588 microg. We demonstrated the ultrastructural injury produced by oregano extracts in this parasite. Trophozoites lost their size and shape and showed damage in nucleus structure, perhaps by breaking the pattern of nucleoskeleton proteins.

Cyclospora en dos niños mexicanos / Two cases of cyclospora in children

Se informa el hallazgo de dos pacientes -uno sintomático y otro asintomático- infectados por Cyclospora, un enteropatógeno de reciente aparición. La sintomatología involucró: dolor abdominal, hiporexia, vómito, bruxismo y 3 ó 4 evacuaciones diarreicas que se autolimitaron después de 24 a 72 horas. En ambos casos se identificaron ooquistes no esporulados cuyo diámetro fue de 8.44 ñ 0.146 µm; el método coproparasitoscópico de flotación de Faust permitió detectar al parásito; la confirmación diagnóstica se logró con la tinción de Ziehl-Neelsen y por la esporulación (dos esporoblastos por ooquiste). En México Cyclospora probablemente pasa inadvertida en los laboratorios de parasitología o quizás se reporta como ooquiste de Cryptosporidium