A survey of intestinal helminths in domestic dogs in a human-animal-environmental interface: the Oloisukut Conservancy, Narok County, Kenya.

Dogs living in a domestic-wildlife interface can serve as reservoirs and sentinels of parasites shared among humans, domestic animals and wildlife. In Kenya, the epidemiology of intestinal parasites of dogs and their role as reservoirs of zoonoses is poorly understood, especially in domestic-wildlife interfaces. This study aimed to determine the occurrence of intestinal helminths in domestic dogs in the Oloisukut Conservancy. One hundred dog faecal samples were collected per rectum and examined microscopically following zinc chloride flotation and formal-ether concentration techniques. Genotyping of helminths was achieved by nested polymerase chain reaction of NADH dehydrogenase subunit 1, cytochrome oxidase 1 and partial sequencing. Nine genera were detected by microscopy in 65 (65%) dog faecal samples from 54/76 (71.05%) households. The most frequent helminths were hookworm (39%), Spirometra spp. (17%), taeniids (13%), Toxocara spp. (10%), Trichuris spp. (10%), Spirocerca lupi (5%), Physaloptera spp. (2%), Dipylidium caninum (1%) and Strongyloides spp. (1%). Ancylostoma caninum was the only hookworm species detected in dogs, while Taenia serialis and Taenia madoquae were detected in four and one faecal samples, respectively. This study reports for the first time the molecular detection of the cestodes Spirometra theileri, D. caninum and Mesocestoides sp. in dogs in Kenya. The presence of zoonotic helminths in dogs indicates that the residents of this conservancy are exposed to public health risks. The helminths reported here confirm the interaction of domestic dogs with wildlife. An integrated control programme involving the medical, veterinary and wildlife conservation professionals is needed to avert transmission of infectious diseases to humans, domestic animals and wildlife.

Molecular identification of zoonotic hookworms in dogs from four counties of Kenya.

All canine hookworms are known to be zoonotic, causing infections ranging from transient skin irritations to prolonged 'creeping eruptions', eosinophilic enteritis and even patent intestinal infections. There is little information on canine hookworm species and their public health significance in sub-Saharan Africa. This study determined the prevalence and species of hookworms in dogs from different climatic zones of Kenya. Dog faecal samples were collected from the environment, and hookworm eggs were isolated by zinc chloride flotation and subjected to DNA extraction. Polymerase chain reaction (PCR) assays targeting the internal transcribed spacer (ITS) 1 and 2, 5.8S and 28S ribosomal RNA of Ancylostoma spp. and Uncinaria stenocephala were performed, and hookworm species were identified by PCR-restriction fragment length polymorphism (RFLP) or DNA sequencing. Hookworm eggs were detected by microscopy in 490/1621 (30.23%, 95% CI 28.01-32.54) faecal samples. Estimates of faecal prevalence were high in counties receiving higher rainfall (Narok 46.80%, Meru 44.88%) and low in those with a more arid climate (Isiolo 19.73%, Turkana 11.83%). In a subset of 70 faecal samples, Ancylostoma caninum (n = 59) was the most common species, followed by A. braziliense (n = 10) and A. cf. duodenale (n = 1). This study reports for the first time the detection of A. cf. duodenale in dog faeces and zoonotic hookworm species in Kenyan dogs. These findings emphasize the need for control measures such as enforcing laws for restraining stray dogs, regular deworming of dogs, and public health awareness programmes aimed at informing communities on outdoor use of footwear.

Prevalence and genotyping of Echinococcus granulosus in sheep in Narok County, Kenya.

Cystic echinococcosis (CE) is a zoonotic disease caused by the larval stage of Echinococcus granulosus species (sensu lato, s.l.). In East Africa, several species/strains occur in livestock, wildlife, and humans, but there is limited information on frequencies of infection by different genotypes in the various mammalian hosts. We have obtained data on E. granulosus infection prevalence in sheep sampled from abattoirs in Narok County, southern Kenya. We inspected carcasses for the presence of hydatid cysts in 180 sheep randomly selected in five sub-locations. The overall prevalence was 16.0% (144/900 animals), with the majority of cysts (50.7%) found in the liver, followed by the lungs (36.8%), while infections involving the liver and lungs were detected in 12.5% of the sheep. PCR-RFLP genotyping of the mitochondrial nad-1 gene in all the 343 cysts identified E. granulosus G1-G3 (sensu stricto, s.s.) as the only genotype. The majority of the cysts (62.1%) were fertile, and 35.2% were sterile, while 2.7% were calcified. Considering cyst fertility, 73.02% of lung cysts were fertile compared to 53.4% in liver cysts. Our data extends previous CE studies in livestock and indicates a high level of CE infection of sheep in Narok, with a predominance of E. granulosus s.s., which is highly pathogenic and commonly infects humans. Given the high fertility rates observed in the cysts, there is an urgent need to determine whether there is a significant incidence of human infection in Narok, and initiate "One Health" control measures.

Global Distribution of Alveolar and Cystic Echinococcosis.

Alveolar echinococcosis (AE) and cystic echinococcosis (CE) are severe helminthic zoonoses. Echinococcus multilocularis (causative agent of AE) is widely distributed in the northern hemisphere where it is typically maintained in a wild animal cycle including canids as definitive hosts and rodents as intermediate hosts. The species Echinococcus granulosus, Echinococcus ortleppi, Echinococcus canadensis and Echinococcus intermedius are the causative agents of CE with a worldwide distribution and a highly variable human disease burden in the different endemic areas depending upon human behavioural risk factors, the diversity and ecology of animal host assemblages and the genetic diversity within Echinococcus species which differ in their zoonotic potential and pathogenicity. Both AE and CE are regarded as neglected zoonoses, with a higher overall burden of disease for CE due to its global distribution and high regional prevalence, but a higher pathogenicity and case fatality rate for AE, especially in Asia. Over the past two decades, numerous studies have addressed the epidemiology and distribution of these Echinococcus species worldwide, resulting in better-defined boundaries of the endemic areas. This chapter presents the global distribution of Echinococcus species and human AE and CE in maps and summarizes the global data on host assemblages, transmission, prevalence in animal definitive hosts, incidence in people and molecular epidemiology.

Echinococcus spp. in central Kenya: a different story.

Research on cystic echinococcosis (CE) has a long history in Kenya, but has mainly concentrated on two discrete areas, Turkana and Maasailand, which are known to be foci of human CE in Africa. Here, we report on a survey for CE in livestock from central to northeastern Kenya, from where no previous data are available. A total of 7,831 livestock carcasses were surveyed. CE prevalence was 1.92% in cattle (n = 4,595), 6.94% in camels (n = 216), 0.37% in goats (n = 2,955) and 4.62% in sheep (n = 65). Identification of the parasite was done using an RFLP-PCR of the mitochondrial nad1 gene, which had been validated before against the various Echinococcus taxa currently recognized as distinct species. From a total of 284 recovered cysts, 258 could be identified as Echinococcus granulosus sensu stricto (n = 160), E. ortleppi (n = 51) and E. canadensis (n = 47) by RFLP-PCR of nad1. In cattle, fertile cysts occurred mostly in the lungs and belonged to E. ortleppi (31 of 54), while the vast majority were sterile or calcified cysts of E. granulosus s.s.. Most fertile cysts in camels belonged to E. canadensis (33 of 37); sterile or calcified cysts were rare. Goats harboured fertile cysts of E. ortleppi (n = 3)--which is the first record in that host species--and E. canadensis (n = 1), while all cysts of E. granulosus were sterile. Only sterile cysts were found in the three examined sheep. Typically, all cysts in animals with multiple infections belonged to the same species, while mixed infections were rare. Our data indicate that the epidemiological situation in central to northeastern Kenya is clearly different from the well-studied pastoral regions of Turkana and Maasailand, and the apparently low number of human CE cases correlates with the infrequent occurrence of E. granulosus s.s.

A survey for Echinococcus spp. of carnivores in six wildlife conservation areas in Kenya.

To investigate the presence of Echinococcus spp. in wild mammals of Kenya, 832 faecal samples from wild carnivores (lions, leopards, spotted hyenas, wild dogs and silver-backed jackals) were collected in six different conservation areas of Kenya (Meru, Nairobi, Tsavo West and Tsavo East National Parks, Samburu and Maasai Mara National Reserves). Taeniid eggs were found in 120 samples (14.4%). In total, 1160 eggs were isolated and further analysed using RFLP-PCR of the nad1 gene and sequencing. 38 of these samples contained eggs of Echinococcus spp., which were identified as either Echinococcus felidis (n=27) or Echinococcus granulosus sensu stricto (n=12); one sample contained eggs from both taxa. E. felidis was found in faeces from lions (n=20) and hyenas (n=5) while E. granulosus in faeces from lions (n=8), leopards (n=1) and hyenas (n=3). The host species for two samples containing E. felidis could not be identified with certainty. As the majority of isolated eggs could not be analysed with the methods used (no amplification), we do not attempt to give estimates of faecal prevalences. Both taxa of Echinococcus were found in all conservation areas except Meru (only E. felidis) and Tsavo West (only E. granulosus). Host species identification for environmental faecal samples, based on field signs, was found to be unreliable. All samples with taeniid eggs were subjected to a confirmatory host species RLFP-PCR of the cytochrome B gene. 60% had been correctly identified in the field. Frequently, hyena faeces were mistaken for lion and vice versa, and none of the samples from jackals and wild dogs could be confirmed in the tested sub-sample. This is the first molecular study on the distribution of Echinococcus spp. in Kenyan wildlife. The presence of E. felidis is confirmed for lions and newly reported for spotted hyenas. Lions and hyenas are newly recognized hosts for E. granulosus s.s., while the role of leopards remains uncertain. These data provide the basis for further studies on the lifecycles and the possible link between wild and domestic cycles of cystic echinococcosis in eastern Africa.

MOLECULAR CHARACTERISATION OF ECHINOCOCCUS GRANULOSUS SPECIES/STRAINS IN HUMAN INFECTIONS FROM TURKANA, KENYA.

BACKGROUND: Cystic echinococcosis (CE) or hydatid disease is a neglected, economically important zoonotic disease endemic in pastoralist communities, in particular the Turkana community of Kenya. It is caused by the larval stage of the highly diverse species complex of Echinococcusgranulosus sensu lato (s.l). The situation on the genetic diversity in humans in Kenya is not well established. OBJECTIVE: To characterise Echinococcus granulosus (s.1) species/strains isolated from humans undergoing surgery in Turkana, Kenya. DESIGN: A Cross sectional study. SETTING: The Kakuma Mission Hospital and Centre for Microbiology Research, Kenya Medical Research Institute. SUBJECTS: Eighty (80) parasite samples from 26 subjects were analysed by Polymerase chain reaction--Restriction fragment length polymorphism (PCR-RFLP) targeting the nad 1 gene for molecular characterization. RESULTS: Two different genotypes of E. granulosus were identified from the samples analysed: E. granulosus sensu stricto (G1-G3) 85% of the samples analysed and E. canadensis G6/7 (15%). Most of the hydatid cysts (35%) were isolated from the liver. Other sites where cysts were isolated from include: kidney, abdomen, omentum, retroperitonium and the submandibular. Majority of cysts presented as CE1 (50%) and CE3B (42%) images according to WHO ultrasound classification. Both males and females were infected with E. granulosus s.s but only the females showed infection with E. canadensis G6/7. Chi-square test revealed significant difference between age of individuals and cysts classification by ultrasound. In addition, there was an association between cyst presentation (single or multiple) and genotype whereby all the E. canadensis G6/7 cases presented as single cysts in the infected persons. CONCLUSION: This study corroborates previous reports that E. canadensis G6/7 strain is present in Turkana, a place where initially only E. granulosus s.s (G1-G3) was known to be present and that E. granulosis (G1-G3) remains the most widespread genotype infecting humans in the Turkana community.

Health-care waste incineration and related dangers to public health: case study of the two teaching and referral hospitals in Kenya.

There are practically no low cost, environmentally friendly options in practice whether incineration, autoclaving, chemical treatment or microwaving (World Health Organisation in Health-care waste management training at national level, [2006] for treatment of health-care waste. In Kenya, incineration is the most popular treatment option for hazardous health-care waste from health-care facilities. It is the choice practiced at both Kenyatta National Hospital, Nairobi and Moi Teaching and Referral Hospital, Eldoret. A study was done on the possible public health risks posed by incineration of the segregated hazardous health-care waste in one of the incinerators in each of the two hospitals. Gaseous emissions were sampled and analyzed for specific gases the equipment was designed and the incinerators Combustion efficiency (CE) established. Combustion temperatures were also recorded. A flue gas analyzer (Model-Testos-350 XL) was used to sample flue gases in an incinerator under study at Kenyatta National Hospital--Nairobi and Moi Teaching and Referral Hospital--Eldoret to assess their incineration efficiency. Flue emissions were sampled when the incinerators were fully operational. However the flue gases sampled in the study, by use of the integrated pump were, oxygen, carbon monoxide, nitrogen dioxide, nitrous oxide, sulphur dioxide and No(x). The incinerator at KNH operated at a mean stack temperature of 746 °C and achieved a CE of 48.1 %. The incinerator at MTRH operated at a mean stack temperature of 811 °C and attained a CE of 60.8 %. The two health-care waste incinerators achieved CE below the specified minimum National limit of 99 %. At the detected stack temperatures, there was a possibility that other than the emissions identified, it was possible that the two incinerators tested released dioxins, furans and antineoplastic (cytotoxic drugs) fumes should the drugs be subjected to incineration in the two units.

Echinococcosis in sub-Saharan Africa: emerging complexity.

Cystic echinococcosis occurs in most regions of sub-Saharan Africa, but the frequency of this zoonosis differs considerably among and within countries. Especially human cases seem to be focally distributed. A number of environmental and behavioural factors partially explain this pattern, i.e. density of livestock, presence of dogs, uncontrolled slaughter, and hygiene. In addition, the various taxa of Echinococcus spp. are known to differ considerably in infectivity to different host species including humans. Genetic characterizations of isolates, which are necessary to evaluate the impact of this factor - so far done in only a few countries - indicate that the diversity of Echinococcus spp. in Sub-Saharan Africa is greater than on any other continent. The very incomplete data which are available show that sympatrical taxa may infect different hosts, others may be geographically restricted, some life cycles involve livestock, others wild animals. Possible implications of this complexity for public health, livestock economy and conservation are briefly discussed.

Genetic characterization of African swine fever viruses from a 2008 outbreak in Tanzania.

Outbreaks of African swine fever (ASF) have been reported in the past from several countries in sub-Saharan Africa. The aim of this study was to genotype ASF viruses (ASFVs) from the 2008 outbreak in Morogoro and Dar es Salaam regions of Tanzania. Tissue samples from domestic pigs that died as a result of severe haemorrhagic disease were collected and analysed with PCR and genome sequencing methods using ASFV-specific primer sets. Nucleotide sequence data were obtained for the B646L (p72), E183L (p54) and the variable region of the B602L gene sequences. Phylogenetic analyses based on DNA sequences showed that the 2008 Tanzanian isolates belonged to p72 genotype XV and clustered together with those derived from the 2001 outbreak in Tanzania. Analysis of the tetrameric amino acid repeat regions within the variable region of the B602L gene showed that the repeat signature of the 2008 Tanzanian ASFV was unique and contained three novel tetramers (U = NIDT/NTDT and X = NTDI). Epidemiological investigation suggested that transportation of live pigs continues to play an active role in the epidemiology of ASF in Tanzania. It is recommended that future control of ASF spread in Tanzania should focus on the early detection and confirmation of the disease, prompt institution of quarantine measures, culling and proper disposal of infected and in-contact animals and decontamination of affected premises.

Intestinal polyparasitism in a rural Kenyan community.

BACKGROUND: Polyparasitism seems to be a common feature in human populations in sub-Saharan Africa. However, very little is known about its epidemiological significance, its long term impact on human health or the types of interactions that occur between the different parasite species involved. OBJECTIVES: To determine the prevalence and co-occurrence of intestinal parasites in a rural community in the Kibwezi, Makueni district, Kenya. DESIGN: A cross sectional study. SETTING: Kiteng'ei village, Kibwezi, Makueni district, between May and September 2006. SUBJECTS: One thousand and forty five who comprised of 263 adult males, 271 adult females > 15 years of age and 232 boys, and 279 girls <15 years of age. INTERVENTIONS: All infected members of the community were offered Praziquantel (at dosages of 40 mg/kg body weight) for Schistosomiasis and Albendazole (600 mg) for soil transmitted helminths. RESULTS: A total of ten intestinal parasite species (five protozoan and five helminth parasite species) were present in this community and polyparasitsm was common in individuals 5-24 years of age with no gendar related differences. Most of the infections were mild. The protozoan parasites of public health significance present were Entamoeba histolytica and Giardia lamblia with prevalence of 12.6% and 4.2%, respectively. The helminth parasites of public health significance in the locality were Schistosoma mansoni with a prevalence of 28%, and hookworms prevalence of 10%. About 53% of the study population harboured intestinal parasite infections, with 31% of the infected population carrying single parasite species infections, and 22% harbouring two or more intestinal parasite species per individual. Significant positive associations (p values <0.05) were observed between S. mansoni and hookworms, hookworms and Hymenolepis. nana and Entamoeba histolytica and Entamoeba coli. CONCLUSION: Intestinal polyparasitism was common in the Kiteng'ei community, particularly in individuals aged of 5-24 years old. An integrated control programme of approach would be recommended for the control of S. mansoni, hookworms and Entamoeba histolytica for this community.

A study of cystic echinococcosis in slaughter animals in three selected areas of northern Turkana, Kenya.

In an attempt to establish the prevalence of cystic echinococcosis, a study was conducted in slaughter animals in three divisions of northern Turkana, Kenya. A total of 5752 goats, 588 sheep, 381 cattle and 70 camels were examined at slaughter. Echinococcus granulosus metacestodes were found in 19.4% of the cattle, 3.6% of sheep, 4.5% of goats and 61.4% of camels. The prevalence of cystic echinococcosis in cattle, sheep and goats was higher in Lokichogio than in either Kakuma or Central divisions. On the other hand, the prevalence of the disease in camels was higher in Central (84.6%) than either Lokichogio (70.6%) or Kakuma (50%). The differences in prevalence rates in different study areas are attributed to differences in environmental conditions, livestock stocking intensity and cross-border migration of livestock.

Application of ultrasonography in prevalence studies of hydatid cysts in goats in north-western Turkana, Kenya and Toposaland, southern Sudan.

A study was done to determine the prevalence of hydatid cysts in goats using ultrasonography. A total of 1,390 goats were examined, 43,6 % (606/1,390) of them from north-western Turkana, Kenya, and 56,4% (784/1,390) from Toposaland, southern Sudan. Hydatid cysts were visualized in 1,82 % (11/ 606) of the goats from north-western Turkana and 4,34% (34/784) of those from Toposaland. Unlike abattoir surveys, the prevalence data obtained in this study were unbiased because entire flocks were examined. The lower prevalence rate of the disease in goats from Turkana was attributed to the hydatid disease control programme in that area, which is absent in Toposaland.

Hepatic cyst in a Turkana woman - case report.

An unusual case of hepatic hydatid cyst in a 27-year old female is reported. The patient had abdominal distention of 10-year duration, pain, pallor of mucous membranes, and was grossly wasted. Ultrasonography revealed a large hydatid cyst that covered most of the abdomen. A successful surgical intervention was performed and 24 litres of hydatid fluid drained.

Prevalence of intestinal parasites among children in southern Sudan.

A study was conducted in southern Sudan to determine the prevalence of intestinal parasites among school children. A total of 275 stool samples which were examined using formol-ether concentration techniques yielded 15 different species of parasites. Hook worm with a prevalence of 13.1% was the predominant nematode followed by Strongyloides stercoralis (3.3%), Trichostrongylus (2.5%), Schistosoma mansoni (2.2%) and Trichuris trichiura (1.8%). Ascaris lumbricoides and cestodes were not detected in this population. Intestinal protozoans were common. Entamoeba coli (37.8%), Entamoeba histolytica (28.4%) and Giardia lamblia (9.8%). Children in the age group 6-10 years old were the most affected followed by the 11-15 year-old age group. The infection rate was slightly higher in males than females.

Oxfendazole treatment for cystic hydatid disease in naturally infected animals.

Few chemotherapeutic agents are available for the medical management of hydatid disease caused by the parasite Echinococcus granulosus. In order to test the potential of oxfendazole for the treatment of infection with this parasite, nine infected goats and four sheep were given oxfendazole twice weekly at a dose of 30 mg/kg of body weight for 4 weeks and monitored by ultrasound for an additional 4 weeks. Efficacy was finally evaluated by postmortem examination, including determination of protoscolex viability and cyst wall histology. In treated animals, protoscolices were dead or absent in 97% of cysts from oxfendazole-treated animals compared to 28% of cysts from untreated control animals. On postmortem examination, 53% of cysts from treated animals were found to be grossly degenerate. A sample of those cysts that appeared potentially viable all demonstrated evidence of severe damage to the cyst wall. By light microscopy, cysts showed severe disorganization of the adventitial layer with invasion of inflammatory cells and in some cases frank necrosis with no apparent adventitial layer. The follow-up period for assessment of the drug's ability to cause complete degeneration and resorption of cysts was relatively short. This study, however, indicates that oxfendazole is at least as effective as and is easier to administer than albendazole for the treatment of hydatid disease.

Ultrastructural changes in Ascaris suum after oxibendazole treatment.

The effect of oxibendazole treatment on adult Ascaris suum was assessed using scanning and transmission electron microscopy. The changes included collapse of the lip papillae, rupture of buccal cavity cuticle, prolapse of the pharynx, degeneration of epithelial cells and erosion of microvilli. Theses changes may lead to impaired digestion and absorption of nutrients and cause cellular autolysis, resulting in the death of the worm.

Hydatid disease in Toposaland, Southern Sudan.

A total of 1010 people in Toposa-land Southern Sudan were screened for hydatid disease using a portable ultrasound scanner. The prevalence of the disease was shown to be 3.5% with a majority of the cysts (60%) being located in the liver. Unlike the situation observed among the Turkana people, the level of hydatid infection within various age groups depict progressive linear increase. In addition, the level of the disease infection in both sexes show no significant difference whereas in Turkana the prevalence in women is twice that found in men. The occurrence of such differences within two culturally closely related communities is an enigma requiring further investigations. In the absence of guaranteed source of funding on a long term basis which is essential for a hydatid control programme, the control measures recommended include incorporation of hydatid education into the school and health curriculum.