Contribution of Wastewater Irrigation to Soil Transmitted Helminths Infection among Vegetable Farmers in Kumasi, Ghana.

Wastewater irrigation is associated with several benefits but can also lead to significant health risks. The health risk for contracting infections from Soil Transmitted Helminths (STHs) among farmers has mainly been assessed indirectly through measured quantities in the wastewater or on the crops alone and only on a limited scale through epidemiological assessments. In this study we broadened the concept of infection risks in the exposure assessments by measurements of the concentration of STHs both in wastewater used for irrigation and the soil, as well as the actual load of STHs ova in the stool of farmers and their family members (165 and 127 in the wet and dry seasons respectively) and a control group of non-farmers (100 and 52 in the wet and dry seasons, respectively). Odds ratios were calculated for exposure and non-exposure to wastewater irrigation. The results obtained indicate positive correlation between STH concentrations in irrigation water/soil and STHs ova as measured in the stool of the exposed farmer population. The correlations are based on reinfection during a 3 months period after prior confirmed deworming. Farmers and family members exposed to irrigation water were three times more likely as compared to the control group of non-farmers to be infected with Ascaris (OR = 3.9, 95% CI, 1.15-13.86) and hookworm (OR = 3.07, 95% CI, 0.87-10.82). This study therefore contributes to the evidence-based conclusion that wastewater irrigation contributes to a higher incidence of STHs infection for farmers exposed annually, with higher odds of infection in the wet season.

[Investigation on prevalence and risk factors of HIV/AIDS and Schistosoma japonicum, Ascaris lumbricoides and Trichuris trichiura infections in a rural community of southwestern China].

OBJECTIVE: To investigate the prevalence and risk factors of helminthic infections including Schistosoma japonicum, Ascaris lumbricoides and Trichuris trichiura and human immunodeficiency virus (HIV), and find out the association among them in a rural community of southwestern China. METHODS: A community-based cross sectional study was conducted. One town was selected randomly; the infections of S.japonicum, A.lumbricoides and T.trichiura were detected with the modified Kato-Katz thick smear method and HIV infection with the diagnostic Test Kit among all residents. A questionnaire survey was conducted to investigate the related risk factors. RESULTS: Among the participants, the infection rates of HIV, S.japonicum, A.lumbricoides and T.trichiura were 2.33%, 2.05%, 13.47% and 30.59% respectively; 7.08% (31/438) were infected with both A.lumbricoides and T.trichiura; 0.23% (1/438) were co-infected with HIV and A.lumbricoides, and the same with HIV and T.trichiura. The multivariate logistic regression analysis showed that sex (male, OR=3.26, 95% CI：0.97, 10.95) and drug abuse (OR=72.86, 95% CI：18.51, 286.76) were significantly associated with HIV infection. Home toilet was negatively related to A.lumbricoides infection (OR=0.52, 95% CI：0.27, 0.98) and T.trichiura infection (OR=0.48, 95% CI：0.28, 0.80). Compared with the people in Villages Four, the people living in Village One were at a higher risk for A.lumbricoides infection (OR=3.14, 95% CI：1.35, 7.27), and compared with the people living in Village Four, the people living in Village Two and Village Three were more likely to be infected with T.trichiura (OR=3.73, 95% CI：1.92, 7.26; OR=4.53, 95% CI：2.12, 9.68). The people aged between 11 and 20 years had a higher T.trichiura infection risk than the people aged more than 50 years (OR = 3.72, 95% CI：1.59, 8.67). There was a significant association between A.lumbricoides and T.trichiura infections (OR = 3.11, 95% CI：1.63, 5.93). There was no association between S.japonicum infection and related factors above mentioned. CONCLUSIONS: The infection rates of HIV, S.japonicum, A.lumbricoides and especially T.trichiura were rather high in this area, and therefore, the prevention and treatment of these diseases should be strengthened. Further studies on the relationship between HIV and the infections of helminths, especially S.japonicum are needed.

Ascaris lumbricoides: complicaciones graves en niños hospitalizados en el Centro Hospitalario Pereira Rossell / Ascaris lumbricoides: serious complications in children hospitalized in the Centro Hospitalario Pereira Rossell

La infección por Ascaris lumbricoides (AL) es una geohelmintiasis que constituye un problema de salud pública, especialmente en niños con vulnerabilidad socio económica y ambiental. La carencia de saneamiento y agua potable, el hacinamiento, la precariedad de la vivienda y las malas condiciones de higiene constituyen los principales factores de riesgo. El impacto de esta enfermedad en Uruguay no está claramente definido. La existencia de casos graves de infección por AL sugiere la presencia de zonas de alta prevalencia. El objetivo de esta comunicación es alertar sobre la presencia de complicaciones y formas graves de esta enteroparasitosis. Se revisaron los aspectos patogénicos y modalidades de evaluación y tratamiento. Se incluyeron siete niños hospitalizados entre el 1 de enero de 2007 y el 31 de mayo de 2012, edad mínima 18 meses y máxima 59 meses. Todos habitaban viviendas precarias, de las cuales cinco carecían de saneamiento y cuatro de baño interno. Las complicaciones asociadas fueron: abscesos múltiples pulmonares y hepáticos, síndrome suboclusivo, oclusión intestinal, síndrome de Loffler, peritonitis biliar por perforación del conducto hepático común y colangitis. Los síntomas abdominales fueron los más frecuentes. La media de la estadía hospitalaria fue 11 días. Ingresaron a Unidad de cuidado intensivo cuatro niños, dos requirieron alimentación parenteral y dos apoyo ventilatorio. En todos los casos se realizaron estudios imagenológicos. Requirieron tratamiento quirúrgico tres niños. Todos sobrevivieron. Esta enfermedad es un “marcador de pobreza” y se relaciona directamente con las condiciones de vida de la población. Fortalecer las medidas de promoción y prevención contribuye al control de esta enfermedad. Erradicar el problema exige políticas dirigidas a superar las condiciones de exclusión social, identificando zonas de riesgo con intervenciones intersectoriales.

Ascaris lumbricoides infection and parasite load are associated with asthma in children.

INTRODUCTION: Association between Ascaris lumbricoides infection and asthma is a controversial subject that has been studied by several authors based on the hygiene theory. This work contributes to better understanding this issue. METHODOLOGY: This was a cross-sectional study involving 1,004 children from a neighborhood of low socioeconomic status in Campina Grande, Paraíba, northeastern Brazil. Asthma was diagnosed using the International Study of Asthma and Allergy in Childhood (ISAAC) questionnaire. Intestinal parasitosis was diagnosed by parasitological examination (the Ritchie technique), and parasite load determined by the Kato-Katz technique. The statistical analysis was descriptive, and hypotheses were tested according to odds ratios. RESULTS: A total of 260 children were infected with A. lumbricoides, and 233 had asthma. Light parasite loads were significantly associated with asthma (wheezing more than three times per year); p = 0.003, OR = 0.41(IC 0.22 - 0.75), while the heavy parasite loads were not; p = 0.002, OR = 2.37(IC 1.35 - 4.18). Similar results were observed in almost all the symptoms of asthma. No association was found with maternal educational level. CONCLUSION: In children living in urban areas of low socioeconomic status, a light parasite load of A. lumbricoides is a protective factor against asthma and its symptoms. Meanwhile, heavy parasite load is a risk factor and contributes to the high prevalence of asthma and its symptoms among these children.

Prevalence and risk factors of soil-transmitted helminth infection in Nepal.

BACKGROUND: The purpose of this study is to evaluate the prevalence and intensity and examine the risk factors of soil transmitted helminth (STH; i.e., roundworm [Ascaris lumbricoides], hookworms [Ancylostoma duodenale and Necator americanus], and whipworm [Trichuris trichiura]) infections in Nepal. METHODS: Five hundred and ninety-four adults (256 men and 338 women) were selected via convenience sampling from five communities in Nepal. The Kato-Katz method was used to assess the prevalence and intensity of STH infection in this population. RESULTS: Prevalence of STH infection ranged from 3.3% in Birendranagar in Chitwan, 3.5% in Kuleshor in Kathmandu, 11.7% in Kanyam in Ilam, 17.0% in Dhikurpokhari in Kaski and 51.4% in Khokana in Lalitpur District [corrected]. Multivariable regression analysis revealed that not using soap for hand-washing was significantly associated with the prevalence and infection intensity of roundworm, hookworms and whipworm. Similarly, not wearing sandals or shoes outside was significantly associated with the prevalence and infection intensity of roundworm and hookworms, but not with infection intensity of whipworm. Literacy, being underweight or overweight, anemia and occupation were not associated with prevalence and intensity of roundworm and hookworms infection, but there was an association between occupation and the prevalence of whipworm infection. CONCLUSION: STH infection was associated with individual hygiene behavior, but not with nutritional status or socio-demographic characteristics. Health policy focusing on changing individual hygiene behaviors might be useful in addressing STH infection in Nepal.

Hepatolithiasis after Hepaticojejunostomy: Ascaris lumbricoides in the biliary tract.

BACKGROUND: Biliary ascariasis is a common problem in Third World countries and other underdeveloped areas of the world. Ascaris lumbricoides migrates into the biliary tree, where it is apparent commonly on diagnostic imaging. We present a unique case of a patient with chronic right upper quadrant abdominal pain, massive hepatolithiasis, and stricture of a previous hepaticojejunostomy in whom ascariasis was found. METHODS: A 28-year-old female presented to the emergency department with right upper quadrant abdominal pain, syncope, and seizure-like activity. She was found by magnetic resonance cholangiopancreatography to have cholangitis, choledocholithiasis, and bile duct stricture. After multiple radiographic studies, she was taken to the operating room for revision of a hepaticojejunostomy performed 10 years previously. RESULTS: Ascaris lumbricoides was found in the right intrahepatic bile duct, that had not been identified by multiple radiologic modalities. The worm was sent to the pathology department for identification. A Fogarty catheter was passed into the hepatic ducts for successful stone extraction. The hepaticojejunostomy was revised, with catheter placement in the Roux limb to accommodate radiologic stone extraction as necessary. Post-operatively, she was given a single dose of albendazole and discharged on hospital day 19. CONCLUSION: The worm was likely the nidus for the stricture and stone formation. Surgical exploration of the biliary tree was required to diagnose and treat her condition accurately. This case is unique in that typical means of diagnosis failed to identify the causative agent of hepatolithiasis because of the prior Roux-en-Y hepaticojejunostomy.

Geophagy and potential health implications: geohelminths, microbes and heavy metals.

The practice of geophagy (soil-eating) is widespread among pregnant and breast-feeding women in sub-Saharan Africa. To assess some of the potential risks accompanying the consumption of geophagic material, we analysed contamination with bacteria, fungi, and geohelminths as well as heavy metals (lead, mercury and cadmium) in 88 African geophagic soil samples, which were purchased in Central, West and East Africa, Europe and the United States. Median microbial viable counts of positive samples were 440 cfu/g (maximum 120,000 cfu/g). The median metal concentrations were 40 mg/kg lead (up to 148 mg/kg), 0.05 mg/kg mercury (up to 0.64 mg/kg), and 0.055 mg/kg cadmium (maximum 0.57 mg/kg). No geohelminth eggs were found in these samples. Our results suggest that geophagic soil samples can be highly contaminated with microbes and may contain high levels of lead. Geophagy, however, is not a cause of adult helminth infection. The periodic consumption of geophagic materials at high dosages might be problematic particularly during pregnancy.

Biliary ascariasis: a review.

Ascariasis, a helminthic infection of humans, is the most common parasitic infestation of the gastrointestinal tract. It infects about 25% of the world's population; around 20 thousand deaths occur per year from an adverse clinical course of the disease. This review is focused on biliary ascariasis, examining in some detail the pathogenesis of the disease with special reference to postcholecystectomy ascariasis and related issues. Although an endemic disease of tropical and subtropical countries, increasing population migration facilitated by fast improving communication facilities demands that clinicians everywhere be familiar with the clinical profile and management of biliary ascariasis.

The health effects of wastewater on the prevalence of ascariasis among the children of the discharge zone of El Jadida, Morocco.

Proximity to wastewater constitutes an infection hazard by ascariasis. This is supported by the results of an epidemiologic study of a group of children living near an area of wastewater effluents. The subjects of this study were schoolchildren from Sidi Daoui, a neighborhood located in the area of the main effluent of the city of El Jadida, Morocco. For a comparative approach, a control group was selected from Sidi Moussa, a neighborhood far from the discharge area. The incidence of ascariasis was 18.1% in the study group (Sidi Daoui) and 1% in the control group (Sidi Moussa). It was found that 71% of the exposed children were suffering from acute parasitic infections. The risk attributable to wastewater in transmitting ascariasis to examined children in Sidi Daoui was about 17%. Boys, particularly those aged 7 - 10, appeared to be the most vulnerable to contracting ascariasis. This study demonstrates the relationship between ascariasis in children and their proximity to wastewater effluents.

Earth-eating and reinfection with intestinal helminths among pregnant and lactating women in western Kenya.

We conducted a longitudinal study among 827 pregnant women in Nyanza Province, western Kenya, to determine the effect of earth-eating on geohelminth reinfection after treatment. The women were recruited at a gestational age of 14-24 weeks (median: 17) and followed up to 6 months postpartum. The median age was 23 (range: 14-47) years, the median parity 2 (range: 0-11). After deworming with mebendazole (500 mg, single dose) of those found infected at 32 weeks gestation, 700 women were uninfected with Ascaris lumbricoides, 670 with Trichuris trichiura and 479 with hookworm. At delivery, 11.2%, 4.6% and 3.8% of these women were reinfected with hookworm, T. trichiura and A. lumbricoides respectively. The reinfection rate for hookworm was 14.8%, for T. trichiura 6.65, and for A. lumbricoides 5.2% at 3 months postpartum, and 16.0, 5.9 and 9.4% at 6 months postpartum. There was a significant difference in hookworm intensity at delivery between geophagous and non-geophagous women (P=0.03). Women who ate termite mound earth were more often and more intensely infected with hookworm at delivery than those eating other types of earth (P=0.07 and P=0.02 respectively). There were significant differences in the prevalence of A. lumbricoides between geophagous and non-geophagous women at 3 (P=0.001) and at 6 months postpartum (P=0.001). Women who ate termite mound earth had a higher prevalence of A. lumbricoides, compared with those eating other kinds of earth, at delivery (P=0.02), 3 months postpartum (P=0.001) and at 6 months postpartum (P=0.001). The intensity of infections with T. trichiura at 6 months postpartum was significantly different between geophagous and non-geophagous women (P=0.005). Our study shows that geophagy is associated with A. lumbricoides reinfection among pregnant and lactating women and that intensities built up more rapidly among geophagous women. Geophagy might be associated with reinfection with hookworm and T. trichiura, although these results were less unequivocal. These findings call for increased emphasis, in antenatal care, on the potential risks of earth-eating, and for deworming of women after delivery.

Endoscopic management of early postoperative biliary ascariasis in patients with biliary tract surgery.

Bile leak and residual stones are well known complications of biliary tract surgery. In endemic areas of ascariasis, invasion of the biliary tract by roundworms during the early postoperative period is an infrequent but serious complication. The present study describes the endoscopic management of postoperative biliary ascariasis in 19 consecutive patients. There were 5 men and 14 women with a mean age of 33.3 +/- 6.3 years. All patients had undergone cholecystectomy, with choledocholithotomy and placement of a T-tube in 13 (68.4%) patients. Eight (42.1%) patients including two with T-tubes were acutely sick at referral. Altogether, 16 (84.2%) patients had widened papillae due to previous endoscopic sphincterotomy (3 patients) or recent dilatation of the sphincter of Oddi by Bake's dilators (13 patients). All patients with a T-tube in situ had undergone unsuccessful attempts to remove the worms by flushing saline through the T-tube. Endoscopic retrograde cholangiopancreatography was performed 4 to 16 days after biliary tract surgery and revealed roundworms in the common bile duct in 10 patients, in the hepatic ducts in 2, or in both ducts in 7. Three patients had coexisting biliary leakage: from the cystic duct stump in two and from a T-tube track in one. Endoscopic treatment consisted of extracting the worms from the biliary tree and placing stents in those with coexisting leakage. Endoscopic success was defined as complete worm extraction and resolution of biliary leakage and was achieved in all patients. Complications occurred in one (5.3%) patient. We concluded that endoscopic management is an effective, safe approach for extracting ascarids from the biliary tree during the early postoperative period. It reduces the hospital stay, avoids T-tube-related complications, and permits a postoperative complication to be treated using a nonsurgical method.

The risk of Ascaris lumbricoides infection in children as an environmental health indicator to guide preventive activities in Caparaó and Alto Caparaó, Brazil.

OBJECTIVE: To develop an environmental health indicator for use as a basis for developing preventive measures against Ascaris lumbricoides infection in children from the rural municipalities of Caparaó and Alto Caparaó, in Minas Gerais, Brazil. METHODS: A cross-sectional survey was conducted between May and September 1998 among 1171 children under 14 years of age living in 588 dwellings selected from 11 communities. Trained interviewers used a questionnaire to identify risk factors for infection (socioeconomic, sanitation and hygiene variables) and collected stool samples from each child for parasitological tests. RESULTS: The overall prevalence of A. lumbricoides infection was 12.2%. The results showed the protective effects of availability of water in the washbasin and better hygiene, sanitation and socioeconomic status; the interactive effect of crowding was five times larger in households without water in the washbasin than in those having water. There was a statistically significant association between infection and children's age. CONCLUSION: The environmental health indicator, which incorporated the most significant biological, environmental and social factors associated with the risk of A. lumbricoides infection in children from these communities, should contribute to the development of surveillance tools and health protection measures in this population.

The risk of enteric infections associated with wastewater reuse: the effect of season and degree of storage of wastewater.

The effect of season and wastewater storage on the risk of Ascaris lumbricoides infection and diarrhoeal disease associated with wastewater reuse was studied in Mexico in 1991. Data were collected from 10,489 individuals during a dry-season survey. Exposure was to untreated wastewater, or effluent from 1 reservoir (< or = 1 nematode egg/L), or no wastewater irrigation (control group). The results were compared with a previous rainy-season survey which included effluent from 2 reservoirs in series. Direct exposure to untreated wastewater was associated with an excess risk of A. lumbricoides infection in children aged < 5 years (OR = 18.0) and persons aged > 5 years (OR = 13.5) and an increased risk of diarrhoea, particularly to children aged < 5 years (OR = 1.75); effects were stronger in the dry than in the rainy season. There was also an excess risk associated with the 1-reservoir group for A. lumbricoides infection (OR = 21.2 and 9.4) and for diarrhoeal disease (OR = 1.1 and 1.5) but little excess associated with the 2-reservoirs group. Therefore, wastewater retention in 1 reservoir (quality 10(5) faecal coliforms/100 mL, < or = 1 egg/L) does not significantly reduce risks of Ascaris infection and diarrhoeal disease whereas retention in 2 reservoirs in series (quality 10(3) faecal coliforms/100 mL, no detectable eggs/L) does.

Antihelmínticos como factor de riesgo en la obstrucción intestinal por ascaris lumbricoides en niños / Anthelmintics as a risk factor of intestinal obstruction by ascaris lumbricoides in children

In a retrospective study the authors analyzed the clinical records of 199 children ages one month to 16 years hospitalized, with the diagnosis of intestinal ascariasis, in the Instituto Nacional de Pediatría of México from 1984 to 1999. The purpose of the study was to evaluate the use of anthelmintics drugs as a risk factor of intestinal obstruction by A. lumbricoides. Two groups were made for the study: group A (n=66) of children who presented intestinal obstruction, group B (n=133) children with no complications. A comparative analysis of clinical data of both groups was made by means of chi square with Yates correction and a stratified analysis by means of chi square. Possible confusing elements were overcrowding, age and the use of antiparasitic drugs. The calculus of risk factors for intestinal obstruction by A. lumbricoides was done by means of contingency tables of 2 x 2 and odds ratio with an IC of 95 percent. The significant risk factors were included in a model of logistic regression with an impact variable consting in the presence or absence of intestinal obstruction in order to establish a multivariate model of predictive risk at level of significance of p<0,05

Epidemiology of human geohelminth infections (ascariasis, trichuriasis and necatoriasis) in Lushui and Puer Counties, Yunnan Province, China.

Between April and June of 1998, the prevalence and intensity of geohelminth infections caused by hookworm, Ascaris and Trichuris were investigated in two rural Yunnan villages. In Liuku, a village of Lisu indigenous people in Lushui County, there was an overall geohelminth prevalence of 72% (48%, 43% and 16% for hookworm infection, ascariasis, and trichuriasis, respectively). The prevalence of ascariasis was greatest among preschool and school aged children, whereas the prevalence of trichuriasis was greatest among teenagers and the prevalence of hookworm increased until the age of 10-15 and then remained high throughout adulthood. In Linger, a village of Han Chinese, located in Puer County, there was an overall geohelminth prevalence of 77% (30%, 60% and 36% for hookworm infection, ascariasis, and trichuriasis, respectively). The differences in prevalence for hookworm and ascariasis were statistically significant. The prevalence of hookworm in Linger increased steadily with age and did not plateau, but there were no discernible patterns of prevalence versus age for either ascariasis or trichuriasis. Heavy trichuriasis infections were noted to occur in Linger. In both villages, more than 98% of the hookworm infections were of light and moderate intensity. Both by morphologic identification of third-stage infective larvae (L3) from eggs as well as identification of adult hookworms recovered from adult residents after treatment with quantrel, Necator americanus was identified as the exclusive hookworm in each village. Geohelminth infections caused by Ascaris, Trichuris and hookworm remain highly endemic to the rural areas of Yunnan Province in southwestern China.

Concurrent infections and neutrophil phagocytic function in Nigerians with urinary schistosomiasis.

Bacteria infections, parasitic infections and neutrophil phagocytic function were assessed in 60 urinary schistosomiasis (USS) subjects and 36 healthy controls. Only Salmonella was isolated from the blood samples of few USS subjects (3%) and controls (1%). The species of bacteria detected in the urine of USS and control subjects are Escherichia coli, Salmonella, Staphylococcus aureus, Streptococcus faecalis and Klebsiella. There was no significant difference in the proportion of the USS subjects with bacteriuria compared with the controls (X2 = 0.20, P > 0.20). Higher proportions of USS subjects compared with the controls were concurrently infected with Ascaris lumbricoides, hookworms, Giardia lambila and Taenia solium. In contrast, significantly higher proportion of the control subjects were concurrently infected with Plasmodium falciparum and Schistosoma mansoni. There was no significant reduction in neutrophil phagocytic function of USS subjects compared with the controls (P > 0.49). This study suggests that S. haematobium protects its host from certain blood dwelling parasites and that Nigeria USS subjects expressed adequate neutrophil phagocytic function. These may explain the absence of clinical manifestations of bacterial and viral infections in these subjects.

Biliary ascariasis complicating endoscopic sphincterotomy for choledocholithiasis in India.

Endoscopic sphincterotomy is the treatment of choice for patients with choledocholithiasis. Biliary ascariasis has been reported from many parts of the world but is common in Kashmir, India. We report five cases of biliary ascariasis of which four were the result of post-endoscopic sphincterotomy for choledocholithiasis. Therefore, biliary ascariasis is not an uncommon complication of endoscopic sphincterotomy.

Lagochilascaríase humana. Registro de um novo caso procedente do sul do Pará / Human Lagochilascariasis: a report of a new case from south of Pará State

Relata-se um novo caso de infcção por Lagochilascaris minor em ma criança de 7 anos de idade, sexo feminino, procedente do município de Xinguara-Pa. Segundo a mãe, a doença iniciou-se há três anos com tumoração na região retroauricular esquerda seguida de fistulização com eliminação de secreção purulenta contendo pequenos vermes. À época de sua admissão no Hospital de Doenças Tropicais apresentava comprometimento da audição e lesões nas regiões: retroauricular esquerda, pré -auricular esquerda e cervical bilateral. Nos exames laboratoriais foram encontrados os seguintes resultados: PPD NR, Candidina 0,4 cm; Reação de Montenegro NR; Paracoccidiodina NR; PT 5,9g pôr cento, Albumina 3,6g pôr cento, fezes: larvas de Strongyloides stercoralis, ovos de ancilostomideos. Ao exame microscópico do mateerial colhido das lesões foi encontrado um grande número de ovos do parasito. Iniciado o tratamento com albendazol 400 mg/dia, houve eliminação de uma centena de larvas e vermes adultos, identificados como L. minor. A ingestão de carne de animais silvestres como paca, anta, capivara, veado constitui hábito alimentar da paciente - o que poderia justificar a transmmissão da doença