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1.
BMC Infect Dis ; 20(1): 350, 2020 May 15.
Artículo en Inglés | MEDLINE | ID: mdl-32414337

RESUMEN

BACKGROUND: Pediatric diarrhea caused by a range of pathogens, including intestinal parasites, is one of main causes of death among children under 5 years of age. The distribution of these parasitic infections overlaps in many environmental, socioeconomic and epidemiological settings. Their distribution and prevalence varies from region to region. In the current study, we assess the prevalence of intestinal parasites among pediatric patients with syndromic diarrheal disease living in Franceville, Gabon. METHODS: A cross-sectional study conducted in the Amissa Bongo Regional Hospital and Chinese-Gabonese Friendship Hospital in Franceville, between November 2016 and August 2017, enrolled a total of 100 diarrheic children between 0 and 180 months of age. Parasite detection in stool samples was performed using molecular diagnostic by PCR. Difference in means were tested by Student's t test and ANOVA while principal component analysis was used to determine the correlation between parasite distributions and age groups. RESULTS: The overall prevalence of intestinal parasite infection was 61% (61/100). Hymenolepis sp and Cryptosporidium hominis/parvum were the most common parasites (31 and 19%, respectively), followed by Encephalitozoon intestinalis (15%), Trichuris trichiura (4%), Dientamoeba fragilis (4%), and Enterocytozoon bieneusi (2%). The polyparasitism rate was 19.7%, with 83.3% double and 16.7% triple infections. Protozoan infections (66.7%) were more prevalent than helminths infections (33.3%). Seasonal association of the circulation of intestinal parasite was statistically significant (p = 0.03). Correlations between different parasites was also observed. CONCLUSION: The prevalence of intestinal parasitic infections is highest in diarrheic pediatric children. The prevalence of parasitic infections indicates that protozoa and helminths are the most common parasites in the Franceville environment. This study reinforces the importance of routine examination of diarrheic stool samples for the diagnostic of intestinal parasites. Further analyses are required to better understand the local epidemiology and risk factors associated with the transmission of intestinal parasites in Franceville, Gabon. KEYSWORDS: diarrhea, children, intestinal parasitic infections, molecular diagnostic, Franceville, Gabon.


Asunto(s)
Diarrea/parasitología , Helmintiasis/epidemiología , Parasitosis Intestinales/epidemiología , Infecciones por Protozoos/epidemiología , Animales , Preescolar , Estudios Transversales , Criptosporidiosis/epidemiología , Criptosporidiosis/parasitología , Cryptosporidium/genética , Diarrea/epidemiología , Heces/parasitología , Femenino , Gabón/epidemiología , Humanos , Lactante , Masculino , Reacción en Cadena de la Polimerasa , Prevalencia , Infecciones por Protozoos/parasitología , Factores de Riesgo
3.
PLoS Negl Trop Dis ; 14(4): e0008195, 2020 04.
Artículo en Inglés | MEDLINE | ID: mdl-32320399

RESUMEN

BACKGROUND: Intestinal parasites such as Cryptosporidium spp., Giardia lamblia and Entamoeba histolytica can cause severe diarrhea, especially among children in developing countries. This study aims to determine the frequency of Cryptosporidium spp., Giardia lamblia and Entamoeba histolytica in children with diarrhea and identify risk factors for infection. METHODOLOGY: We conducted a cross-sectional study in children aged 0-168 months hospitalized with diarrhea in three regions of Mozambique, from June 2014 to January 2018. Following consent, caretakers were interviewed and a single stool specimen was collected from each child to diagnose Cryptosporidium spp., G. lamblia and E. histolytica using commercial immune-enzymatic assay (TechLab, Inc, Blacksburg, VA, USA). Anthropometric data were collected from the clinical reports. Multivariable logistic regression models were built to identify risk factors for Cryptosporidium spp. and G. lamblia infection. RESULTS: Twenty-one percent of all specimens (212/1008) presented at least one parasitic infection. Cryptosporidium spp. infection was the most common 12.0% (118/985), followed by G. lamblia 9.7% (95/983) and E. histolytica 2.0% (20/1004). Risk factors for infection by Cryptosporidium spp. were: provenience (children from Nampula province showed the highest risk, OR: 8.176; CI: 1.916-34.894; p-value < 0.01); animal contact (children with animal contact had a protective effect OR: 0.627; CI: 0.398-0.986; p-value < 0.05); underweight (children severely underweight showed a risk of 2.309; CI: 1.310-4.069; p-value < 0.05). Risk factors for infection by G. lamblia were: age (group with highest risk, 60-168 months (OR: 2.322; CI: 1.000-5.393, p-value > 0.05)); and living in a household with five or more members (OR: 2.141; CI: 1.286-3.565, p-value < 0.01). CONCLUSIONS: Parasitic infection is common among children with diarrhea. Routine testing, standard treatment, and assessment for risk exposure of children with diarrhea should be implemented at health facilities in Mozambique.


Asunto(s)
Criptosporidiosis/epidemiología , Diarrea/parasitología , Entamebiasis/epidemiología , Giardiasis/epidemiología , Adolescente , Animales , Niño , Preescolar , Estudios Transversales , Cryptosporidium/aislamiento & purificación , ADN Protozoario/análisis , Diarrea/epidemiología , Entamoeba histolytica/aislamiento & purificación , Heces/parasitología , Femenino , Giardia lamblia/aislamiento & purificación , Humanos , Lactante , Recién Nacido , Modelos Logísticos , Masculino , Mozambique/epidemiología , Análisis Multivariante , Reacción en Cadena en Tiempo Real de la Polimerasa , Factores de Riesgo
4.
BMC Infect Dis ; 20(1): 257, 2020 Mar 30.
Artículo en Inglés | MEDLINE | ID: mdl-32228484

RESUMEN

BACKGROUND: Cryptosporidium sp. are common intracellular parasites responsible of severe diarrhea in T-cell-immunocompromised patients. We report the first case of a woman who contracted cryptosporidiosis after treatment with fingolimod, a drug labeled for multiple sclerosis and responsible for marked lymphopenia. CASE PRESENTATION: A 60-year-old woman was admitted for abdominal pain diarrhea and fever. The patient suffered from multiple sclerosis and had been treated with fingolimod from august 2017 to september 2018 time of occurrence of the first digestive symptoms. Stool culture was negative but parasitological examination was positive for Cryptosporidium sp. Blood biological examination profound lymphopenia of 240/mm3 [17 CD4/mm3 (7%) and 32 CD8/mm3 (14%)]. Fingolimod was stopped, and the patient was put on nitazoxanide 500 mg bid for 7 days. The diarrhea resolved and no relapse was observed. Six other cases were found in the Pharmacovigilance database. CONCLUSION: Physicians should be aware of this association and screen for Cryptosporidium in cases of diarrhea in patients treated with fingolimod. Patients should be aware of this risk and advise to take appropriate measures to avoid such contamination.


Asunto(s)
Criptosporidiosis/tratamiento farmacológico , Diarrea/parasitología , Clorhidrato de Fingolimod/efectos adversos , Dolor Abdominal/parasitología , Animales , Antiparasitarios/uso terapéutico , Criptosporidiosis/parasitología , Diarrea/etiología , Heces/parasitología , Femenino , Fiebre/parasitología , Clorhidrato de Fingolimod/uso terapéutico , Humanos , Huésped Inmunocomprometido , Persona de Mediana Edad , Esclerosis Múltiple/tratamiento farmacológico , Farmacovigilancia , Tiazoles/uso terapéutico
5.
Epidemiol Infect ; 148: e64, 2020 03 02.
Artículo en Inglés | MEDLINE | ID: mdl-32115003

RESUMEN

Gastroenteritis remains a serious health condition among children under 5 years especially in Africa. We conducted a systematic review and meta-analysis to investigate the aetiologic pathogens of gastroenteritis in the region. We did a systematic search for articles with original data on the aetiology of gastroenteritis and acute diarrhoea among children younger than 5 years. Pooled results were extracted and analysed in STATA version 12.0 using random-effects for statistical test for homogeneity following the guidelines provided in the Cochrane Collaboration and Preferred reporting items for systematic reviews and meta-analyses. Overall, viruses accounted for 50.2% of the cases followed by bacteria with 31.6% of the cases. Parasites accounted for 12.1% of the case. Rotavirus was the most common cause of acute diarrhoea in all regions resulting in 29.2% of the cases followed by E. coli (15.6%) of diarrhoeal cases and Adenovirus (10.8%). The most prevalent parasite detected was Giardia lamblia (7.3%). Acute diarrhoea remains rampant with Rotavirus still being the major pathogen responsible for the disease in children less than 5 years old despite the introduction of vaccine. It is recommended that the vaccine should be promoted much more widely in the region.


Asunto(s)
Diarrea , Gastroenteritis , Adenoviridae , Infecciones por Adenovirus Humanos/epidemiología , Infecciones por Adenovirus Humanos/virología , África del Sur del Sahara/epidemiología , Preescolar , Diarrea/epidemiología , Diarrea/microbiología , Diarrea/parasitología , Escherichia coli , Infecciones por Escherichia coli/epidemiología , Infecciones por Escherichia coli/microbiología , Gastroenteritis/epidemiología , Gastroenteritis/microbiología , Gastroenteritis/parasitología , Giardia lamblia , Giardiasis/epidemiología , Giardiasis/parasitología , Humanos , Lactante , Recién Nacido , Rotavirus , Infecciones por Rotavirus/epidemiología , Infecciones por Rotavirus/virología
6.
BMC Infect Dis ; 20(1): 16, 2020 Jan 07.
Artículo en Inglés | MEDLINE | ID: mdl-31910816

RESUMEN

BACKGROUND: Cryptosporidium is a genus of common intestinal protozoa, members of which cause diarrhea in a wide variety of hosts. Previous studies on Cryptosporidium in China have mainly focused on diarrhea sufferers, children, and immunodeficient individuals such as HIV/AIDS patients. However, the epidemiological characteristics of Cryptosporidium in the population in rural areas remain unclear. Herein, we investigated the prevalence of, and risk factors for, Cryptosporidium in rural areas of Binyang County, Guangxi Zhuang Autonomous Region, China, and genetically characterized the Cryptosporidium isolates we obtained. METHODS: From August to December 2016, two villages in Binyang County, Guangxi, were sampled using a random cluster sampling method. Fresh fecal samples were collected from all eligible residents (residence time > 6 months). Molecular characterization of Cryptosporidium was carried out based on its SSU rRNA, gp60, actin and hsp70 gene sequences. Fisher's exact test were conducted to assess the risk factors for Cryptosporidium infection. RESULTS: A total of 400 fecal samples were collected from 195 males (48.8%) and 205 females (51.2%). Two samples (0.5%) were positive for Cryptosporidium and were identified as C. viatorum and C. occultus respectively. Moreover, a new C. viatorum subtype XVaA3h was identified based on the sequence of the gp 60 gene. CONCLUSIONS: To our knowledge, this is the first report of C. viatorum and C. occultus infections in humans in China and of C. viatorum subtype XVaA3h. The findings provide important information on the prevalence of Cryptosporidium in the Chinese population, and expand the range of Cryptosporidium species known to infect people in China.


Asunto(s)
Secuencia de Bases/genética , Criptosporidiosis/epidemiología , Cryptosporidium/clasificación , Cryptosporidium/genética , ADN Protozoario/genética , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Animales , Niño , Preescolar , China/epidemiología , Estudios Transversales , Criptosporidiosis/parasitología , Cryptosporidium/aislamiento & purificación , Diarrea/parasitología , Heces/parasitología , Femenino , Genotipo , Humanos , Lactante , Masculino , Persona de Mediana Edad , Filogenia , Prevalencia , Factores de Riesgo , Encuestas y Cuestionarios , Adulto Joven
7.
Trop Doct ; 50(1): 19-22, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31600122

RESUMEN

Entamoeba histolytica is a rare but feared pathogen owing to its related morbidity and mortality. Physicians in an ambulatory clinic in Cusco noted frequent reports of E. histolytica diagnosed by microscopy. Other non-pathogenic species of Entamoeba have an identical microscopic appearance. To determine whether the organisms were actually E. histolytica, faecal specimens from children aged six months to three years with diarrhoea were tested by a species-specific ELISA for E. histolytica antigen. Although 19/73 patients (26.0%) were presumptively diagnosed with amoebiasis based on microscopy, none were confirmed by ELISA. Most cases diagnosed as E. histolytic by microscopy in Peru are not infected by the pathogenic species and are probably colonised by non-pathogenic amoeba such as Entamoeba dispar.


Asunto(s)
Diarrea/diagnóstico , Entamoeba histolytica/aislamiento & purificación , Entamebiasis/diagnóstico , Instituciones de Atención Ambulatoria , Animales , Preescolar , Errores Diagnósticos , Diarrea/parasitología , Entamoeba/citología , Entamoeba/inmunología , Entamoeba/aislamiento & purificación , Entamoeba histolytica/citología , Entamoeba histolytica/inmunología , Entamebiasis/parasitología , Ensayo de Inmunoadsorción Enzimática , Heces/parasitología , Humanos , Lactante , Microscopía , Perú/epidemiología
8.
Parasitol Res ; 119(1): 243-248, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31754858

RESUMEN

Cryptosporidiosis has been reported as an important cause of neonatal diarrhea and mortality in cattle, sheep, and other ruminants, but its impact on alpaca health has not been studied thoroughly. In this study, we have determined the prevalence and evaluated the role of cryptosporidiosis as a risk factor for diarrhea occurrence in newborn alpacas. During the calving season (January-March) of 2006, stool specimens (N = 1312) were collected from 24 herds of newborn alpacas in Puno and Cuzco, departments that account for the largest populations of alpacas in Peru. All the specimens were microscopically screened for Cryptosporidium spp. using the acid-fast technique. The association between Cryptosporidium detection and diarrhea was analyzed using χ2 test and generalized lineal model. Cryptosporidium species were determined by PCR-RFLP analysis of the small subunit rRNA gene. Cryptosporidium oocysts were detected in 159 of 1312 (12.4%) newborn alpacas. Results of the analyses demonstrated that crypstosporidiosis was significantly associated with diarrhea (PR = 3.84; CI95% 2.54-5.81; p < 0.0001). Only Cryptosporidium parvum was detected in the 153 Cryptosporidium-infected animals. Thus, there is an association of C. parvum infection with diarrhea in neonatal alpacas.


Asunto(s)
Camélidos del Nuevo Mundo/parasitología , Criptosporidiosis/epidemiología , Criptosporidiosis/parasitología , Cryptosporidium parvum/aislamiento & purificación , Diarrea/veterinaria , Animales , Animales Recién Nacidos , Cryptosporidium parvum/clasificación , Cryptosporidium parvum/citología , Cryptosporidium parvum/genética , Diarrea/epidemiología , Diarrea/parasitología , Heces/parasitología , Oocistos/citología , Perú/epidemiología , Prevalencia , Subunidades Ribosómicas Pequeñas/genética , Factores de Riesgo
9.
Korean J Parasitol ; 57(5): 531-536, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31715696

RESUMEN

Cryptosporidium parvum and Giardia duodenalis are the main diarrhea-causing parasitic pathogens; however, their prevalence in Korea is unknown. Here, we conducted a survey to determine the prevalence and genotype distribution of these 2 pathogens causing acute diarrhea in 8,571 patients hospitalized in 17 Regional Institute of Health Environment sites in Korea, during 2013-2016. C. parvum and G. duodenalis were detected and genotyped by nested PCR, and the isolate were molecularly characterized by sequencing the glycoprotein 60 (Gp60) and ß-giardin genes, respectively. The overall prevalence of C. parvum and G. duodenalis was 0.37% (n=32) and 0.55% (n=47), respectively, and both pathogens were more prevalent in children under 9 years old. Molecular epidemiological analysis showed that the C. parvum isolates belonged to the IIa family and were subtyped as IIaA13G2R1, IIaA14G2R1, IIaA15G2R1, and IIaA18G3R1. Analysis of the ß-giardin gene fragment from G. duodenalis showed that all positive strains belong to assemblage A. This is the first report on the molecular epidemiology and subtyping of C. parvum and G. duodenalis in such a large number of diarrheal patients in Korea. These results highlight the need for continuous monitoring of these zoonotic pathogens and provide a basis for implementing control and prevention strategies. Further, the results might be useful for epidemiological investigation of the source of outbreak.


Asunto(s)
Criptosporidiosis/parasitología , Cryptosporidium parvum/aislamiento & purificación , Diarrea/parasitología , Giardia lamblia/aislamiento & purificación , Giardiasis/parasitología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Animales , Niño , Preescolar , Criptosporidiosis/diagnóstico , Criptosporidiosis/epidemiología , Cryptosporidium parvum/clasificación , Cryptosporidium parvum/genética , Diarrea/diagnóstico , Diarrea/epidemiología , Heces/parasitología , Femenino , Genotipo , Giardia lamblia/clasificación , Giardia lamblia/genética , Giardiasis/diagnóstico , Giardiasis/epidemiología , Humanos , Lactante , Masculino , Persona de Mediana Edad , Filogenia , República de Corea/epidemiología , Adulto Joven
10.
Parasit Vectors ; 12(1): 515, 2019 Nov 04.
Artículo en Inglés | MEDLINE | ID: mdl-31685003

RESUMEN

BACKGROUND: Strongyloidiasis is a health problem in Vietnam, but appropriate information is still limited. The aim of this study was to determine the prevalence, geographical distribution, epidemiological aspects, symptoms and other health indicators of Strongyloides stercoralis infections in patients from 27 provinces of northern Vietnam attending the Hanoi Medical University Hospital during 2016 and 2017. METHODS: Blood samples of 2000 patients were analyzed for S. stercoralis infection with an IgG ELISA test. Seroprevalence was analyzed by gender, age group, locality of origin (rural or urban areas) and symptoms. Stools from the seropositive patients were examined for the detection of worms which were subsequently used for species identification by morphology and rDNA ITS1 sequencing. RESULTS: A seroprevalence of 20% was detected, showing an increasing prevalence from young to older age groups but without significant gender difference. Seroprevalence was higher in rural areas than in urban areas, both in general and individually in all provinces without exception, and lower in the mountainous areas than in the large valley lowlands. The follow-up of the 400 patients showed eosinophilia in 100% of cases, diarrhoea in 64.5%, digestion difficulties in 58.0%, stomachache in 45.5%, stomach and duodenal ulcers in 44.5%, itching in 28.0% and fever in 9.5%. The prevalence of symptoms and signs were also higher in older age groups than in younger age groups. Worms were detected in stools of 10.5% of the patients. Sequencing of a 501-bp nuclear ribosomal DNA ITS1 fragment allowed for the verification of infection by Strongyloides stercoralis. CONCLUSIONS: To our knowledge, this study is the largest survey of human strongyloidiasis in Vietnam so far and the first molecular identification of this nematode species in this country. Long-term chronicity may probably be usual in infected subjects, mainly in the older age groups.


Asunto(s)
Strongyloides stercoralis/genética , Estrongiloidiasis/epidemiología , Adolescente , Adulto , Distribución por Edad , Anciano , Animales , Anticuerpos Antihelmínticos/sangre , ADN de Helmintos/análisis , ADN de Helmintos/química , ADN Ribosómico/análisis , ADN Ribosómico/química , Diarrea/epidemiología , Diarrea/parasitología , Eosinofilia/epidemiología , Eosinofilia/parasitología , Femenino , Geografía , Humanos , Inmunoglobulina G/sangre , Parasitosis Intestinales/epidemiología , Parasitosis Intestinales/parasitología , Masculino , Persona de Mediana Edad , Prevalencia , Población Rural , Estudios Seroepidemiológicos , Strongyloides stercoralis/inmunología , Strongyloides stercoralis/aislamiento & purificación , Estrongiloidiasis/parasitología , Vietnam/epidemiología , Adulto Joven
11.
J Vet Sci ; 20(6): e64, 2019 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-31775191

RESUMEN

Calf diarrhea caused by infectious agents is associated with economic losses in the cattle industry. The purpose of this study was to identify the causative agents and epidemiological characteristics of diarrhea in Korean native calves (KNC). In total, 207 diarrheal KNC aged less than 7 months were investigated. Fecal samples collected from the rectum were examined for causative agents using polymerase chain reaction (PCR) or real-time PCR and the number of oocysts were counted. Fourteen causative agents were detected from 164 of the 207 diarrheal KNC. Rotavirus was the most common agent (34.8%), followed by Eimeria spp. (31.7%), Escherichia coli (22.0%), Giardia spp. (14.0%), Clostridium difficile (9.8%), bovine viral diarrhea virus (8.5%), coronavirus (7.9%), Cryptosporidium spp. (7.3%), torovirus (6.7%), parvovirus (5.5%), norovirus (4.9%), kobuvirus (1.8%), adenovirus (1.2%), and Salmonella spp. (0.6%). About 95 (57.9%) of 164 calves were infected with a single causative agent and 42.1% were infected by multiple agents. No significant difference was observed in mortality between calves infected with a single agent and multiple agents. The occurrence of diarrhea caused by rotavirus, Eimeria spp., kobuvirus, and Giardia spp. was significantly different based on onset age, and the prevalence of diarrhea caused by rotavirus or C. difficile was significantly different between seasons. This study help the understanding of KNC diarrhea for the development of an effective strategy for disease prevention and control, especially in Eastern provinces of South Korea.


Asunto(s)
Enfermedades de los Bovinos/epidemiología , Diarrea/veterinaria , Animales , Bovinos , Enfermedades de los Bovinos/microbiología , Enfermedades de los Bovinos/parasitología , Enfermedades de los Bovinos/virología , Diarrea/epidemiología , Diarrea/microbiología , Diarrea/parasitología , Heces/microbiología , Heces/parasitología , Heces/virología , República de Corea/epidemiología
12.
Exp Parasitol ; 207: 107772, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31610183

RESUMEN

Cyclosporiasis is an emerging worldwide infection caused by an obligate intracellular protozoan parasite, Cyclospora cayetanensis. In immunocompetent patients, it is mainly manifested by self-limited diarrhea, which is persistent and may be fatal in immunocompromised patients. The standard treatment for cyclosporiasis is a combination of two antibiotics, trimethoprim and sulfamethoxazole. Gastrointestinal, haematologic and renal side effects were reported with this combination. Moreover, sulfa allergy, foetal anomalies and recurrence were recorded with no alternative drug treatment option. In this study, silver nanoparticles were chemically synthesized to be evaluated for the first time for their anti-cyclospora effects in both immunocompetent and immunosuppressed experimental mice in comparison to the standard treatment. The effect of silver nanoparticles was assessed through studying stool oocyst load, oocyst viability, ultrastructural changes in oocysts, and estimation of serum gamma interferon. Toxic effect of the therapeutic agents was evaluated by measuring liver enzymes, urea and creatinine in mouse sera. Results showed that silver nanoparticles had promising anti-cyclospora potentials. The animals that received these nanoparticles showed a statistically significant decrease in the oocyst burden and number of viable oocysts in stool and a statistically significant increase in serum gamma interferon in comparison to the corresponding group receiving the standard treatment and to the infected non-treated control group. Scanning electron microscopic examination revealed mutilated oocysts with irregularities, poring and perforations. Biochemical results showed no evidence of toxicity of silver nanoparticles, as the sera of the mice showed a statistically non-significant decrease in liver enzymes in immunocompetent subgroups, and a statistically significant decrease in immunosuppressed subgroups. Furthermore, a statistically non-significant decrease in urea and creatinine was recorded in all subgroups. Thus, silver nanoparticles proved their effectiveness against Cyclospora infection, and this will draw the attention to its use as an alternative to the standard therapy.


Asunto(s)
Coccidiostáticos/uso terapéutico , Cyclospora/efectos de los fármacos , Ciclosporiasis/tratamiento farmacológico , Nanopartículas del Metal/uso terapéutico , Alanina Transaminasa/análisis , Animales , Aspartato Aminotransferasas/análisis , Coccidiostáticos/farmacología , Coccidiostáticos/toxicidad , Creatinina/sangre , Ciclofosfamida/inmunología , Cyclospora/aislamiento & purificación , Cyclospora/ultraestructura , Diarrea/tratamiento farmacológico , Diarrea/parasitología , Heces/parasitología , Humanos , Inmunocompetencia , Huésped Inmunocomprometido , Inmunosupresores/inmunología , Interferón gamma/sangre , Hígado/efectos de los fármacos , Hígado/enzimología , Masculino , Nanopartículas del Metal/toxicidad , Ratones , Microscopía Electrónica de Rastreo , Microscopía Electrónica de Transmisión , Oocistos/aislamiento & purificación , Oocistos/ultraestructura , Plata , Combinación Trimetoprim y Sulfametoxazol/uso terapéutico , Urea/sangre
13.
Parasitol Res ; 118(11): 3139-3147, 2019 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-31606836

RESUMEN

Currently, chronic diarrhoea syndrome in children is a very common pathology whose aetiology is sometimes difficult to identify. Methodologies for the diagnosis of infections have diversified, and gas chromatography/mass spectrometry (GC/MS) is a very useful tool. The aim of this study was to identify volatile biomarkers of the presence of Giardia duodenalis in the faeces of patients with chronic diarrhoea (with and without giardiasis) using static headspace extraction followed by GC/MS. The analysis of the volatiles extracted from the headspace had enough sensitivity to detect differences in the volatile profiles in the faeces of the patients with and without Giardia duodenalis infection and discriminate between them. Dimethyl disulphide and trisulphide were found in the faeces of patients without giardiasis but not in the faeces of patients with G. duodenalis. Finally, three possible biomarkers, acetic acid, 1,4-dimethoxy-2,3-butanediol and 1,3-dimethoxy-2-propanol, were proposed to identify patients with giardiasis; these compounds were not present in the patients without the parasite. Multivariate analysis revealed that principal component 1 separated the stool samples according to the presence of infection by G. duodenalis despite the inter-individual variability in biological specimens such as faeces.


Asunto(s)
Diarrea/parasitología , Giardia lamblia , Giardiasis/diagnóstico , Animales , Biomarcadores/análisis , Niño , Preescolar , Heces/parasitología , Femenino , Cromatografía de Gases y Espectrometría de Masas , Giardiasis/parasitología , Humanos , Masculino , Análisis Multivariante
14.
Cochrane Database Syst Rev ; 9: CD011055, 2019 09 24.
Artículo en Inglés | MEDLINE | ID: mdl-31549742

RESUMEN

BACKGROUND: Diarrhoea and soil-transmitted helminth (STH) infections represent a large disease burden worldwide, particularly in low-income countries. As the aetiological agents associated with diarrhoea and STHs are transmitted through faeces, the safe containment and management of human excreta has the potential to reduce exposure and disease. Child faeces may be an important source of exposure even among households with improved sanitation. OBJECTIVES: To assess the effectiveness of interventions to improve the disposal of child faeces for preventing diarrhoea and STH infections. SEARCH METHODS: We searched the Cochrane Infectious Diseases Group Specialized Register, CENTRAL, MEDLINE, Embase, and 10 other databases. We also searched relevant conference proceedings, contacted researchers, searched websites for organizations, and checked references from identified studies. The date of last search was 27 September 2018. SELECTION CRITERIA: We included randomized controlled trials (RCTs) and non-randomized controlled studies (NRS) that compared interventions aiming to improve the disposal of faeces of children aged below five years in order to decrease direct or indirect human contact with such faeces with no intervention or a different intervention in children and adults. DATA COLLECTION AND ANALYSIS: Two review authors selected eligible studies, extracted data, and assessed the risk of bias. We used meta-analyses to estimate pooled measures of effect where appropriate, or described the study results narratively. We assessed the certainty of the evidence using the GRADE approach. MAIN RESULTS: Sixty-three studies covering more than 222,800 participants met the inclusion criteria. Twenty-two studies were cluster RCTs, four were controlled before-and-after studies (CBA), and 37 were NRS (27 case-control studies (one that included seven study sites), three controlled cohort studies, and seven controlled cross-sectional studies). Most study sites (56/69) were in low- or lower middle-income settings. Among studies using experimental study designs, most interventions included child faeces disposal messages along with other health education messages or other water, sanitation, and hygiene (WASH) hardware and software components. Among observational studies, the main risk factors relevant to this review were safe disposal of faeces in the latrine or defecation of children under five years of age in a latrine.Education and hygiene promotion interventions, including child faeces disposal messages (no hardware provision)Four RCTs found that diarrhoea incidence was lower, reducing the risk by an estimated 30% in children under six years old (rate ratio 0.71, 95% confidence interval (CI) 0.59 to 0.86; 2 trials, low-certainty evidence). Diarrhoea prevalence measured in two other RCTs in children under five years of age was lower, but evidence was low-certainty (risk ratio (RR) 0.93, 95% CI 0.84 to 1.04; low-certainty evidence).Two controlled cohort studies that evaluated such an intervention in Bangladesh did not detect a difference on diarrhoea prevalence (RR 0.91, 95% CI 0.64 to 1.28; very low-certainty evidence). Two controlled cross-sectional studies that evaluated the Health Extension Package in Ethiopia were associated with a lower two-week diarrhoea prevalence in 'model' households than in 'non-model households' (odds ratio (OR) 0.26, 95% CI 0.16 to 0.42; very low-certainty evidence).Programmes to end open defecation by all (termed community-led total sanitation (CLTS) interventions plus adaptations)Four RCTs measured diarrhoea prevalence and did not detect an effect in children under five years of age (RR 0.92, 95% CI 0.79 to 1.07; moderate-certainty evidence). The analysis of two trials did not demonstrate an effect of the interventions on STH infection prevalence in children (pooled RR 1.03, 95% CI 0.64 to 1.65; low-certainty evidence).One controlled cross-sectional study compared the prevalence of STH infection in open defecation-free (ODF) villages that had received a CLTS intervention with control villages and reported a higher level of STH infection in the intervention villages (RR 2.51, 95% CI 1.74 to 3.62; very low-certainty evidence).Sanitation hardware and behaviour change interventions, that included child faeces disposal hardware and messagingTwo RCTs had mixed results, with no overall effect on diarrhoea prevalence demonstrated in the pooled analysis (RR 0.79, 95% CI 0.49 to 1.26; very low-certainty evidence).WASH hardware and education/behaviour change interventionsOne RCT did not demonstrate an effect on diarrhoea prevalence (RR 1.15, 95% CI 0.93 to 1.41; very low-certainty evidence).Two CBAs reported that the intervention reduced diarrhoea incidence by about a quarter in children under five years of age, but evidence was very low-certainty (rate ratio 0.77, 95% CI 0.71 to 0.84). Another CBA reported that the intervention reduced the prevalence of STH in an intervention village compared to a control village, again with GRADE assessed at very low-certainty (OR 0.17, 95% CI 0.02 to 0.73).Case-control studiesPooled results from case-control studies that presented data for child faeces disposal indicated that disposal of faeces in the latrine was associated with lower odds of diarrhoea among all ages (OR 0.73, 95% CI: 0.62 to 0.85; 23 comparisons; very low-certainty evidence). Pooled results from case-control studies that presented data for children defecating in the latrine indicated that children using the latrine was associated with lower odds of diarrhoea in all ages (OR 0.54, 95% CI 0.33 to 0.90; 7 studies; very low-certainty evidence). AUTHORS' CONCLUSIONS: Evidence suggests that the safe disposal of child faeces may be effective in preventing diarrhoea. However, the evidence is limited and of low certainty. The limited research on STH infections provides only low and very-low certainty evidence around effects, which means there is currently no reliable evidence that interventions to improve safe disposal of child faeces are effective in preventing such STH infections.While child faeces may represent a source of exposure to young children, interventions generally only address it as part of a broader sanitation initiative. There is a need for RCTs and other rigorous studies to assess the effectiveness and sustainability of different hardware and software interventions to improve the safe disposal of faeces of children of different age groups.


Asunto(s)
Diarrea/parasitología , Helmintiasis/prevención & control , Helmintiasis/transmisión , Saneamiento , Suelo/parasitología , Animales , Niño , Preescolar , Estudios Controlados Antes y Después , Heces , Helmintos , Humanos , Lactante , Ensayos Clínicos Controlados Aleatorios como Asunto
15.
BMC Public Health ; 19(1): 1144, 2019 Aug 20.
Artículo en Inglés | MEDLINE | ID: mdl-31429732

RESUMEN

BACKGROUND: Cryptosporidiosis is a pathological condition caused by infection with coccidian protozoan parasites Cryptosporidium. Cryptosporidium is one of the most common causes of childhood diarrhea in developing countries. So far, no data has been published on its prevalence among children with diarrhea in Cameroon. This study was therefore, designed to assess the prevalence and risk factors associated with Cryptosporidiosis among children within the ages 0-5 years suffering from diarrhea and being attended to at the Limbe Regional Hospital. METHODS: The study was a hospital based analytical cross-sectional study involving children within the ages 0-5 years (n = 112) hospitalized or consulted in the pediatric departments of the hospital between April 2018 and May 2018. Stool specimens were processed using the modified acid-fast staining method, and microscopically examined for Cryptosporidium infection. RESULTS: A total of 112 participants were recruited out of which 67 presented with diarrhea. A high prevalence 9/67 (13.40%) of Cryptosporidium was noticed in children with diarrhea than children without diarrhea 1/45 (2.2%). There was a significant relationship (p = 0.041) between prevalence of Cryptosporidium and the presence of diarrhea in children within the ages 0-5 years in the Limbe Regional Hospital. It was realized that children from parents with primary level of education, children whose parents did not respect exclusive breastfeeding and those whose parents were giving them pipe borne water for drinking recorded a higher prevalence. CONCLUSIONS: This study revealed an overall prevalence of 8.9% for Cryptosporidium among children of ages 0-5 years that attended the Limbe Regional Hospital. The prevalence among children that presented with diarrhea was 13.4%. The study clearly demonstrated that Cryptosporidium is an important protozoal etiologic agent for children with diarrhea in Limbe.


Asunto(s)
Criptosporidiosis/epidemiología , Cryptosporidium , Diarrea/parasitología , Animales , Lactancia Materna/estadística & datos numéricos , Camerún/epidemiología , Preescolar , Estudios Transversales , Criptosporidiosis/parasitología , Países en Desarrollo , Escolaridad , Femenino , Hospitales/estadística & datos numéricos , Humanos , Lactante , Recién Nacido , Masculino , Padres , Prevalencia , Factores de Riesgo
16.
PLoS Negl Trop Dis ; 13(8): e0007211, 2019 08.
Artículo en Inglés | MEDLINE | ID: mdl-31415558

RESUMEN

BACKGROUND: Pediatric diarrhea can be caused by a wide variety of pathogens, from bacteria to viruses to protozoa. Pathogen prevalence is often described as seasonal, peaking annually and associated with specific weather conditions. Although many studies have described the seasonality of diarrheal disease, these studies have occurred predominantly in temperate regions. In tropical and resource-constrained settings, where nearly all diarrhea-associated mortality occurs, the seasonality of many diarrheal pathogens has not been well characterized. As a retrospective study, we analyze the seasonal prevalence of diarrheal pathogens among children with moderate-to-severe diarrhea (MSD) over three years from the seven sites of the Global Enteric Multicenter Study (GEMS), a case-control study. Using data from this expansive study on diarrheal disease, we characterize the seasonality of different pathogens, their association with site-specific weather patterns, and consistency across study sites. METHODOLOGY/PRINCIPAL FINDINGS: Using traditional methodologies from signal processing, we found that certain pathogens peaked at the same time every year, but not at all sites. We also found associations between pathogen prevalence and weather or "seasons," which are defined by applying modern machine-learning methodologies to site-specific weather data. In general, rotavirus was most prevalent during the drier "winter" months and out of phase with bacterial pathogens, which peaked during hotter and rainier times of year corresponding to "monsoon," "rainy," or "summer" seasons. CONCLUSIONS/SIGNIFICANCE: Identifying the seasonally-dependent prevalence for diarrheal pathogens helps characterize the local epidemiology and inform the clinical diagnosis of symptomatic children. Our multi-site, multi-continent study indicates a complex epidemiology of pathogens that does not reveal an easy generalization that is consistent across all sites. Instead, our study indicates the necessity of local data to characterizing the epidemiology of diarrheal disease. Recognition of the local associations between weather conditions and pathogen prevalence suggests transmission pathways and could inform control strategies in these settings.


Asunto(s)
Diarrea Infantil/epidemiología , Diarrea/epidemiología , Salud Global , Estudios Multicéntricos como Asunto/métodos , África/epidemiología , Asia/epidemiología , Estudios de Casos y Controles , Preescolar , Países en Desarrollo , Diarrea/microbiología , Diarrea/parasitología , Diarrea/virología , Diarrea Infantil/microbiología , Diarrea Infantil/parasitología , Diarrea Infantil/virología , Diseño de Investigaciones Epidemiológicas , Femenino , Humanos , Incidencia , Lactante , Recién Nacido , Masculino , Prevalencia , Estudios Retrospectivos , Estaciones del Año , Clima Tropical
17.
BMC Infect Dis ; 19(1): 728, 2019 Aug 19.
Artículo en Inglés | MEDLINE | ID: mdl-31426759

RESUMEN

BACKGROUND: Cryptosporidium is among the most common causes of severe diarrhea in African children 0-23 months old. It is associated with excess mortality, stunting and malnutrition. The most common manifestation of cryptosporidium is intestinal diarrheal disease. However, respiratory cryptosporidiosis has been documented in up to a third of children presenting with diarrhea. It is unclear whether respiratory involvement is a transient phenomenon or a reservoir for gastrointestinal (GI) disease. This study aims to evaluate the role of respiratory cryptosporidiosis in pediatric diarrheal disease. METHODS: This is a prospective, observational study conducted at Queen Elizabeth Central Hospital (QECH) in Blantyre, Malawi. Young children aged 2-24 months hospitalized with diarrhea will be enrolled. Enrolled children will have induced sputum, nasopharyngeal (NP) swab and stool samples collected. All participants positive for cryptosporidium on sputum/NP/stool PCR testing will be followed up fortnightly after discharge from the hospital up to 8 weeks post-discharge. Sputum/NP/stool sample collection will be done at each visit. The primary outcomes will be presence of Cryptosporidium spp. in sputum/NP/stool. The secondary outcome will be presence of respiratory and GI symptoms, mortality and stunting. Ethical approval was obtained from the University of Malawi College of Medicine Research Ethics Committee (COMREC) and the Liverpool School of Tropical Medicine (LSTM) research ethics committee. DISCUSSION: The study began recruitment activities at QECH in February 2019. The protocol allows for expansion of recruitment to secondary sites within Blantyre and Chikwawa districts in the event that targets are not met at QECH. Study recruitment is expected to continue until early 2020.


Asunto(s)
Criptosporidiosis/complicaciones , Diarrea/parasitología , Estudios Observacionales como Asunto , Infecciones del Sistema Respiratorio/parasitología , Preescolar , Cryptosporidium/aislamiento & purificación , Heces/parasitología , Humanos , Lactante , Malaui , Estudios Prospectivos , Esputo/parasitología
18.
Clin Microbiol Infect ; 25(12): 1519-1524, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31374260

RESUMEN

OBJECTIVES: Studies of acute gastroenteritis (AGE) are hampered by the lack of routine diagnostic methods with good sensitivity and specificity. Molecular methods are increasingly used for clinical purposes, but the clinical significance of a positive result remains a challenge. In this study we aimed to compare results of routine diagnostic methods and molecular methods in symptomatic children and asymptomatic controls. METHODS: Patients presenting to the pediatric emergency departments of two university hospitals in Brussels with AGE were recruited prospectively from May 2015 to October 2016; asymptomatic controls were recruited from the same hospitals. Stool analyses were performed for all participants for common pathogenic bacteria (culture), virus (immunochromatography) and parasites (microscopy). Stools were also analysed with the Luminex Gastrointestinal Pathogen Panel, a multiplex-PCR for common enteropathogens. RESULTS: Stools from 178 patients and 165 controls were analysed. An enteropathogen was detected in 62.4% (111/178) of cases when combining the two methods (56.2% (100/178) by Luminex, 42.7% (76/178) with routine methods) and 29.1% (48/165) of controls (24.2% (40/165) by Luminex and 10.3% (17/165) by routine methods). Some pathogens were detected more often with Luminex than with routine methods, such as Salmonella (16.3% (29/178) with Luminex and 3.9% (7/178) with routine method, p < 0.05), whereas others identified by culture methods, such as Campylobacter, Shigella, Yersinia, were missed by Luminex. CONCLUSIONS: Molecular tools seem attractive methods, providing high positivity and a rapid turn-around time for the diagnosis of AGE. However, high rates of positivity in both cases and controls highlight the difficulty in interpreting results. Pathogens missed by Luminex but detected by culture methods raise more questions about the true clinical interest of the technique for our patients.


Asunto(s)
Pruebas Diagnósticas de Rutina/métodos , Gastroenteritis/diagnóstico , Técnicas de Diagnóstico Molecular/métodos , Preescolar , Diarrea/diagnóstico , Diarrea/microbiología , Diarrea/parasitología , Diarrea/virología , Heces/microbiología , Heces/parasitología , Heces/virología , Femenino , Gastroenteritis/microbiología , Gastroenteritis/parasitología , Gastroenteritis/virología , Humanos , Masculino , Técnicas Microbiológicas , Reacción en Cadena de la Polimerasa Multiplex , Sensibilidad y Especificidad
19.
Comp Immunol Microbiol Infect Dis ; 66: 101333, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31437689

RESUMEN

To obtain information about the occurrence and genotype distribution of G. intestinalis and C. parvum in Austrian cattle, faecal samples from diarrhoeic calves younger than 180 days of age originating from 70 farms were examined. Of the 177 faecal samples, 27.1% were positive for Giardia cysts (immunofluorescence microscopy) and 55.4% for Cryptosporidium oocysts (phase-contrast microscopy). Positive samples were characterized by nested PCR for Giardia, 83.3% (triosephosphate isomerase; tpi) and 89.6% (ß-giardin; bg) were positive, while the Cryptosporidium nested PCR returned 92.5% (60-kDa glycoprotein) positive results. Sequence analysis revealed one assemblage A-positive sample and 30 (bg) respectively 29 (tpi) assemblage E-positive samples for G. intestinalis. For C. parvum four subtypes within the IIa family (IIaA15G2R1, n = 29; IIaA19G2R2, n = 3; IIaA21G2R1, n = 2; IIaA14G1R1, n = 1) could be differentiated. Validation of two immunochromatographic point-of-care tests resulted in a sensitivity of 29.2% and 77.6%; a specificity of 98.4% and 91.1% for the detection of Giardia intestinalis and Cryptosporidium parvum, respectively. Results confirm the widespread occurrence of both protozoa in diarrhoeic calves in Austria.


Asunto(s)
Enfermedades de los Bovinos/parasitología , Cryptosporidium parvum/genética , Diarrea/veterinaria , Giardia lamblia/genética , Sistemas de Atención de Punto/normas , Factores de Edad , Animales , Austria , Bovinos , Criptosporidiosis/diagnóstico , Cryptosporidium parvum/aislamiento & purificación , Diarrea/parasitología , Heces/parasitología , Genotipo , Giardia lamblia/aislamiento & purificación , Giardiasis/diagnóstico , Giardiasis/veterinaria , Inmunoensayo/normas
20.
Am J Trop Med Hyg ; 101(3): 534-540, 2019 09.
Artículo en Inglés | MEDLINE | ID: mdl-31392942

RESUMEN

Multiplex polymerase chain reaction (PCR) platforms have enhanced understanding of intestinal pathogens in low- and middle-income countries (LMICs). However, few such studies have been performed in Latin America, where poverty, poor sanitation, and undernutrition persist. Multiplex PCR (BioFire, Salt Lake City, UT) was used to identify viral, bacterial, and parasitic pathogens in stool collected on day 1 and 31 from children aged 6 to 35 months with acute, non-bloody diarrhea in two locations (rural and urban) in Guatemala. We analyzed correlation between pathogens and clinical, demographic, and socioeconomic variables; described patterns of pathogen acquisition, persistence, and clearance over the 30-day period; and calculated population attributable fractions (PAFs) for diarrheal causation for individual pathogens. We analyzed 316 subjects (144 urban; 172 rural) enrolled between March 2015 and January 2016. Rural subjects had significantly more malnutrition, animal exposure, and unimproved water/sanitation infrastructure. The majority of subjects had multiple pathogens/sample (4.8 rural and 2.7 urban). Few meaningful correlates were identified between individual pathogens and clinical, demographic, or environmental variables. Escherichia coli pathotypes, Shigella, Campylobacter, and Giardia had high rates of persistence between initial and 30-day follow-up. Statistically significant adjusted PAFs were identified for Campylobacter (14.9%, 95% CI: 3.2-23.1), norovirus (10.2%, 95% CI: 0.4-17.1), sapovirus (7.6%, 95% CI: 2.3-10.9), and adenovirus 40/41 (5.6%, 95% CI: 0.3-8.7). These observations further characterize the diversity and complexity of enteric pathogens in children in LMICs. Patterns of chronic symptomatic and asymptomatic infection among Latin American children are similar to those observed in other LMIC regions. Findings have direct implications for practitioners treating individuals with acute infectious diarrhea and should inform regional public health strategies.


Asunto(s)
Diarrea/diagnóstico , Reacción en Cadena de la Polimerasa Multiplex , Población Rural , Población Urbana , Enfermedad Aguda , Animales , Bacterias/genética , Bacterias/patogenicidad , Preescolar , Coinfección/diagnóstico , Coinfección/microbiología , Coinfección/parasitología , Coinfección/virología , Diarrea/microbiología , Diarrea/parasitología , Diarrea/virología , Femenino , Tracto Gastrointestinal/microbiología , Tracto Gastrointestinal/parasitología , Tracto Gastrointestinal/virología , Humanos , Lactante , Masculino , Parásitos/genética , Parásitos/patogenicidad , Virus/genética , Virus/patogenicidad
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