Determination of subtypes of Blastocystis sp. in Chilean patients with and without inflammatory bowel syndrome, A preliminary report.

BACKGROUND & METHODS: Blastocystis sp. is one of the most prevalent unicellular eukaryote of the human large intestine in Chile and worldwide. It is classified in subtypes (STs), where using the polymorphic sequences of its 18S rRNA genes currently recognizes 22. STs 1-9 and ST12 have been reported in humans. It has been hypothesized that different STs of Blastocystis sp. differentially affect the clinical severity of the digestive disease in Irritable Bowel Syndrome (IBS) patients, but more studies ar4e needed to establish this statement. To contribute in the elucidation of the potential relationship between Blastocystis sp. subtypes and IBS severity, 37 IBS patient fecal samples were collected at hospitals in Santiago (Chile) and were screened for the presence of vacuolated forms of Blastocystis sp. by using conventional microscopy. Positive samples were submitted to PCR and sequencing for determining STs. The same procedure was performed in fecal samples from five non-IBS Blastocystis sp. carriers for preliminary comparative purpose. RESULTS AND DISCUSSION: Four out of the 37 samples from the IBS patients were found positive for Blastocystis sp. (10.81%) by using microscopy. The presence of this microorganism in these four samples were confirmed by PCR and sequencing. Subtypes and their respective closest match alleles were searched and the ST1, ST2 and ST4 subtypes were found in these patients. ST4 subtype is scarcely detected in South America countries, being reported previously only in Colombia and Brazil. In this ST4 subtype we determined the allele 42 which is the most frequent allele observed in human Blastocystis isolates. In the non-IBS individuals' carriers, three subtypes were found: ST1, ST2 and ST3, even belonging to the same family group. Closest match alleles: 2, 12 and 34 here detected were also commonly reported globally. Instead of the small number of IBS patients studied here, the frequency of blastocystosis detected (10.81%) was lower than the prevalence of Blastocystis sp. infections described for the Chilean general population (30.4%). In Chile, clear correlation of Blastocystis sp. subtypes and IBS severity is still lacking with this study but it may lead and contribute to a better understanding of its pathogenicity and worldwide epidemiology.

[Delusional parasitosis intestinal and dermatological: clinical cases]. / Parasitosis ilusoria intestinal y dermatológica: casos clínicos.

Illusory parasitosis, better known as delusional parasitosis, is a neuropsychiatric syndrome in which patients have the belief of suffering a parasitic disease, that can not be demonstrated after an exhaustive medical study. These patients are characterized by being polyconsultants in different medical specialties and, many of them, have antecedents of psychiatric disorders, some of them undiagnosed. Knowing the existence of the clinical picture, diagnosing early and empathizing with the patient, could give to clinician some clues for a timely and assertive psychiatric referral, and improve patient adherence to the proposed treatment.

Parasitosis ilusoria intestinal y dermatológica: casos clínicos / Delusional parasitosis intestinal and dermatological: clinical cases

Illusory parasitosis, better known as delusional parasitosis, is a neuropsychiatric syndrome in which patients have the belief of suffering a parasitic disease, that can not be demonstrated after an exhaustive medical study. These patients are characterized by being polyconsultants in different medical specialties and, many of them, have antecedents of psychiatric disorders, some of them undiagnosed. Knowing the existence of the clinical picture, diagnosing early and empathizing with the patient, could give to clinician some clues for a timely and assertive psychiatric referral, and improve patient adherence to the proposed treatment.

La parasitosis ilusoria, más conocida como delusión parasitaria, es un síndrome neuropsiquiátrico donde los pacientes tienen el convencimiento de padecer una infestación parasitaria, que no puede ser demostrada tras un exhaustivo estudio médico. Estos pacientes se caracterizan por ser policonsultantes en distintas especialidades médicas y, muchos de ellos, poseen antecedentes de trastornos psiquiátricos, algunos de ellos no diagnosticados. Conocer la existencia del cuadro, diagnosticar precozmente y empatizar con el paciente, pueden dar al médico clínico algunas claves para una derivación psiquiátrica oportuna y asertiva, y mejorar la adherencia del paciente al tratamiento propuesto. Se presentan cuatro casos clínicos que consultaron por esta extraña condición.

Fascioliasis hepática humana: resistencia al tratamiento con triclabendazol / Resistant human fasciolasis: Report of four patients

Human fascioliasis is a parasitic zoonosis that affects the liver of human and herbivorous animals. In chronic cases, its diagnosis is confirmed by direct visualization of parasitic eggs in stool examination, by positive testing for Fasciola hepatica antigens in stools, or by direct observation of parasites by endoscopic retrograde cholangiography or surgery. In acute cases, serological reactions as immunoblothing or detection of parasite antigens in the blood are useful. The treatment of choice is triclabendazole. However, parasite resistance in animals, as well as in man, has been reported to this drug. We report four patients in whom the parasitic infection persisted despite a course of treatment with triclabendazole.

[Resistant human fasciolasis: report of four patients]. / Fascioliasis hepática humana: resistencia al tratamiento con triclabendazol.

Human fascioliasis is a parasitic zoonosis that affects the liver of human and herbivorous animals. In chronic cases, its diagnosis is confirmed by direct visualization of parasitic eggs in stool examination, by positive testing for Fasciola hepatica antigens in stools, or by direct observation of parasites by endoscopic retrograde cholangiography or surgery. In acute cases, serological reactions as immunoblothing or detection of parasite antigens in the blood are useful. The treatment of choice is triclabendazole. However, parasite resistance in animals, as well as in man, has been reported to this drug. We report four patients in whom the parasitic infection persisted despite a course of treatment with triclabendazole.

Molecular identification of the Diphyllobothrium species causing diphyllobothriasis in Chilean patients.

Diphyllobothriasis caused by the infection of adult Diphyllobothrium tapeworms sporadically occurs in Chile. The occurrence of the disease is closely linked to the consumption of raw or undercooked freshwater and marine fishes. Diagnosis of diphyllobothriasis has been based on laboratory examinations of the morphological characteristics of proglottids and eggs passed in the feces. Although determination of the parasite to the species level is possible through histologic examination of proglottid specimens, the parasites of patients who only discharge eggs cannot be diagnosed to the species level. Determining the species responsible for the infection of humans and other animals in affected areas is an important component of understanding the epidemiologic and enzootic characteristics of any infectious disease. We therefore compared the classification results obtained using a molecular approach with those obtained from morphological and histopathological examination of proglottids or eggs from five Chilean individuals with diphyllobothriasis. DNA analysis confirmed that the causative Diphyllobothrium species in Chile were first identified as Diphyllobothrium latum and Diphyllobothrium pacificum at least. Furthermore, mitochondrial cytochrome c oxidase subunit 1 gene analysis also supported the hypothesis that D. latum from Chile originated from Europe.

Enfermedad de Chagas crónica en Chile. Experiencia de intervención educativa / Chronic Chagas disease in Chile: educational intervention

Las diversas inquietudes planteadas por pacientes chagásicos crónicos en relación a su condición clínica, motivaron a un grupo de parasitólogos a diseñar un programa de intervención educativa. Participaron en forma voluntaria 72 pacientes, 32 hombres y 40 mujeres, procedentes de zona de alta y baja endemia chagásica de Chile. La metodología docente consistió fundamentalmente en: aplicación de test diagnóstico y de conocimientos adquiridos; sesiones teóricas que abordaron seis temáticas relacionadas; actividades prácticas tutoriales; utilización de material audiovisual e impreso; atención personalizada por médico parasitólogo (posterior a la intervención educativa y con los antecedentes serológicos, electrocardiográficos y parasitológicos previamente determinados) y evaluación de la actividad educativa por parte de los pacientes. Un mayor conocimiento previo y adquirido se observó en chagásicos crónicos procedentes de zonas endémicas. Todos demos-traron un alto grado de interés y participaron activamente de las actividades programadas. La metodología utilizada, el trabajo tutorial de pequeño grupo y la atención-orientación individual por parte del médico parasitólogo, facilitaron el proceso de enseñanza-aprendizaje. Se concluye que la intervención educativa responde a muchas de las interrogantes respecto de la afección, permite al paciente reconocer el rol que le cabe como protagonista de su propio bienestar y lo transforma en un eficaz agente en el control de la enfermedad de Chagas.

Exposure to larva migrans syndromes in squares and public parks of cities in Chile.

Between November 2001 and December 2002, 600 dog fecal samples were collected in main squares and public parks of 13 cities in Chile, from the extreme north to the extreme south of the country. The samples were processed in the laboratory by centrifugal sedimentation and the Harada-Mori methods. T. canis eggs were found in 12 cities. Detection rates ranged from 1.9 to 12.5% with an average of 5.2%. Seven percent of the samples had eggs and 9.5% had rhabditoid and/or filariform larvae of Ancylostomatidae. Strongyloides stercoralis were not found. Squares and public parks in Chile pose a potential risk of exposure to visceral, ocular, and/or cutaneous larva migrans syndromes.

Exposure to larva migrans syndromes in squares and public parks of cities in Chile

Entre novembro de 2001 e dezembro de 2002, 600 amostras de fezes de cão foram coletadas nas principais praças e parques públicos de 13 cidades do Chile, localizadas nas regiões norte ao estremo sul da nação. No laboratório, as amostras foram processadas mediante os métodos de sedimentação por centrifugação e de Harada-Mori. Ovos de Toxocara canis foram encontrados em 12 cidades em freqüências que variaram entre 1,9 a 12,5 por cento por cidade, com média de 5,2 por cento. Sete por cento das amostras apresentaram ovos e 9,5 por cento larvas rabditóides ou filarióides de Ancylostomatidae. Strongyloides stercoralis não foi encontrado nas amostras estudadas. Praças e parques públicos do Chile apresentam riscos potenciais para aquisição de larva migrans visceral, ocular ou cutânea.

Strongyloidosis no autóctona en Chile: descripción de un brote familiar / Non autochthonous strongyloidosis in Chile: report of a familiar outbrake

Se presenta un brote familiar de stron-gyloidosis que afectó a inmigrantes peruanos que habían llegado a Chile en noviembre del año 2001. En marzo del 2002, se confirmó en el Laboratorio de Parasitología Básico-Clínico de la Facultad de Medicina de la Universidad de Chile que el caso índice presentaba infección por Strongyloides stercoralis. Correspondía a una menor de 11 años que estaba siendo estudiada en el Hospital Roberto del Río por artritis reumatoide juvenil. Además de esta patología la niña refería leves molestias abdominales, siendo derivada a nuestra unidad, donde se le efectuó un examen parasitológico seriado de deposiciones (EPSD), observándose abundantes larvas rabditoides de S. stercoralis, por lo cual se procedió a estudiar al grupo familiar integrado por los padres y una hermana. A todos ellos se les efectuó EPSD e inmunodiagnóstico mediante ELISA para detectar anticuerpos anti S.stercoralis. Resultaron positivos para ambos exámenes la madre y las dos hijas. El padre fue negativo. Se decidió tratar con ivermectina y controlar los resultados del tratamiento anti-parasitario al grupo familiar al cabo de un año. Después de ese periodo permanecía positiva serológicamente, solamente la hermana del caso índice debido a que no ingirió los medicamentos de la manera indicada.

Infecciones por protozoos y helmintos intestinales en pre-escolares y escolares de la Comuna de Colina, Santiago, Chile, 2003 / Intestinal protozoa and infections in pre-school and elementary school-children from colina county, Santiago, Chile, 2003

En mayo de 2003 se efectuó una encuesta epidemio-parasitológica en pre-escolares y escolares de la Escuela San Vicente de Lo Arcaya de Colina, comuna semirural de la Provincia de Santiago ubicada en la Región Metropolitana de Chile. Hay que destacar que los niños estudiados eran asintomáticos. Los elementos parasitarios más frecuentemente encontrados fueron: Blastocystis hominis - en hombre y mujeres respectivamente - 38,8 por ciento y 44,4 por ciento, Giardia intestinalis con 9,5 por ciento y 16,2 por ciento y Enterobius vermicularis con 12,9 por ciento y 10,0 por ciento. Cryptosporidium parvum no fue encontrado y ELISA para Strongyloides stercoralis resultó positiva en un niño.

Uso de un método simple de sedimentación-centrifugación para detectar estadios evolutivos de enteroparásitos humanos en cursos de aguas de Chile / Detection of human enteroparasites transmissible stages in water streams by using a simple method of sedimentation-centrifugation in Chile

Mediante el uso de un método simple de sedimentación-centrifugación se detectaron estadios evolutivos de enteroparásitos de probable origen humano en 37 muestras de cursos de aguas de diversas localidades de Chile, entre los años 1994 y 1997. En 34 de las 37 muestras estudiadas (91,7 porciento) se observaron elementos parasitarios. La especie parasitaria mas frecuentemente hallada fue Giardia sp (97,0 porciento). Otros protozoos detectados fueron: Entamoeba coli(79,0 porciento), Endolimax nana(73,5 porciento) y Entamoeba histolytica(30,4 porciento). Con relación a los helmintos, se detectaron huevos de Hymenolepis nana en una muestra (3,0 porciento) y larvas de nematodes en el 79,4 porciento. El método de sedimentación-centrifugación descrito permitió pesquisar diversos estadios evolutivos de enteroparasitos de probable origen humano demostrándose contaminación de los cursos de aguas estudiados

Estudio comparativo de la sensibilidad y mortalidad de las ninfas III y IV de triatoma infestans usadas en el xenodiagnóstico de pacientes chagásicos crónicos / Comparative study on sensivity and mortality of triatoma infestans nymphs III and IV used in the xenodiagnosis of chronic chagasic patients

Triatoma infestans nymphs have shown a good sensitivity for detecting trypanosoma cruzi in the bood stream of infected hosts when are used in the xenodiagnosis (XD). This method, with its natural limitations, using seven nymphs III of T. infestans, has been routinely utilized with a satisfactory yield. With the aim of an eventual improving of the yield of XD (with 7 nymphs), two series of 54 XD boxes each, containing a total of 378 nymphs III and 378 nymphs IV respectively, were applied one of each during three consecutive days to nine chronic chagasic patients. Each of the nymphs was weighted before an after the application of the boxes, and the intestinal content of them was examined 30, 60 and 90 days later. The main comparative results obtained with nymphs III and IV of T. infestans were: blood ingestion 40 versus 107 mg (2,7 higher), positivity of insects 35,8 percent versus 50,6 percent (15,8 percent higher), positivity of XD boxes (7 nymphs each) 46,3 percent versus 55,6 percent (9,3 percent higher), and mortality rates 28,6 percent versus 12,2 percent (16,4 percent lower). All these results demonstrate that nymphs IV of T. infestans, because their higher capacity of ingesting blood and higher tolerance to examination manipulations, are more suitable for been used in XD

Contaminación ambiental por huevos de toxocara sp. en algunas plazas y parques públicos de Santiago de Chile, 1999 / Environmental contamination by toxocara sp. eggs in public squares and parks from Santiago, Chile, 1999

Most of cases of visceral larva migrans syndrome are caused by Toxocara canis larvae. Man acquires the infection by accidental ingestion of ripe eggs of the helminth. In order to find out the frequency of the presence of Toxocara sp. eggs in dog fecal specimens from public places of Santiago city in 1999 july-september a study was carried out in 84 squares and 12 parks from 32 couties. Three fecal samples were collected in each of these places, making a total of 288. Each sample was processed according to a modified Telemann method and three smears of each were microcopically examined. Toxocara sp. eggs were found in 39 (13.5 percent) fecal specimens. In 28/84 (33.3 percent) squares and in 8/12 (66.7 percent) parks these eggs were detected. These results make necessary the control of dogs and cats populations with the aim of reduce the presence of animals without responsible owners. It schould be advisable to prevent dogs and cats defecation in public areas grounds, trying to exclude these animals from recreation areas

Tendencia actual de la epidemiología de la triquinosis humana en Chile / Present trends of human trichinosis epidemilogy in Chile

Surveillance of the epidemiology of human triquinosis in Chile has been maintained during the last 30 years by the Department of Parasitology. Incidence and prevalence have been followed-up by analysing Ministry of Health annual reports and periodical phototrichinoscopic examination of diaphragm samples from individuals autopsied at the Santiago Medico Legal Service. A decrease has been observed on: incidence from 1.4 per 100.000 in the 1960s to 0.7 in the 1980s down to 0.3 in 1993 and 1994 and to 0.5 in 1995, and prevalence from 3.4 percent 2.8 percent, 2.0 percent and 0.8 percent in 1972, 1982, 1992 and 1997 respectively. A predominance of the prevalence in the groups of more age, with the observation of calcified Trichinella spiralis larvae should be indicating a decline of new infections in the general population. This decrease of frequence of human trichinosis in Chile is possible due to the interaction of two main factors, efficacy and higher implementation of control measures and significant advances in porcine technology with a resulting provision to consumers of pork from young animals practically trichinosis free