Epidemiology of soil-transmitted helminthiases-related mortality in Brazil.

Soil-transmitted helminth (STH) infections are widely distributed in tropical and subtropical areas, including Brazil. We performed a nationwide population-based study including all deaths in Brazil from 2000 to 2011, in which STHs (ascariasis, trichuriasis and/or hookworm infection) were mentioned on death certificates, either as underlying or as associated causes of death. Epidemiological characteristics, time trends and spatial analysis of STH-related mortality were analysed. STHs was identified on 853/12 491 280 death certificates: 827 (97·0%) deaths related to ascariasis, 25 (2·9%) to hookworm infections, and 1 (0·1%) to trichuriasis. The average annual age-adjusted mortality rate was 0·34/1 000 000 inhabitants (95% confidence interval: 0·27-0·44). Females, children <10 years of age, indigenous ethnic groups and residents in the Northeast region had highest STH-related mortality rates. Nationwide mortality decreased significantly over time (annual percent change: -5·7%; 95% CI: -6·9 to -4·4), with regional differences. We identified spatial high-risk clusters for STH-related mortality mainly in the North, Northeast and South regions. Diseases of the digestive system and infectious/parasitic diseases were the most commonly associated causes of death mentioned in the STH-related deaths. Despite decreasing mortality in Brazil, a considerable number of deaths is caused by STHs, with ascariasis responsible for the vast majority. There were marked regional differences, affecting mainly children and vulnerable populations.

[Ascaris lumbricoides-caused risk factors for intestinal occlusion and subocclusion]. / Factores de riesgo para oclusión y suboclusión intestinal por Ascaris lumbricoides.

OBJECTIVES: Our objective was to determine risk factors and mortality for partial and complete bowel obstruction caused by Ascaris lumbricoides as well as diagnostic validity of eosinophilia in peripheral blood. MATERIAL AND METHODS: We studied 50 patients with partial or complete bowel obstruction and expulsion of Ascaris lumbricoides by mouth or anus, as well as 50 patients as controls; no patient had a negative coproparasitoscopic study. The period of study was from January 1995-December 2001 at the General Hospital of Ciudad Valles, San Luis Potosí State, Mexico. RESULTS: Cases with partial bowel obstruction had average age of 3.1 years against 10.13 years for those with complete obstruction (p = 0.029). Females accounted for 55% and males 43%, respectively. We do not find a relationship among nutritional status, gestational order in the family, and place of excreta deposition in this study group. In the case of eosinophilia, best point of section found was three or more eosinophils with sensitivity of 34% but specificity of 100%; mortality was 2%. CONCLUSIONS: We do not find a statistical difference between partial and complete bowel obstruction for different variables studied with the exception of age. To find 3% or more of eosinophils in peripheral blood strongly suggests the etiology of the obstruction as Ascaris lumbricoides at prevalence sites of this parasite.

Morbidity and mortality due to ascariasis: re-estimation and sensitivity analysis of global numbers at risk.

This paper presents estimates of the global numbers of people at risk from morbidity related to infection with Ascaris lumbricoides and the numbers of deaths from this infection. Morbidity is classified into 4 types: deficits in growth and fitness which are contemporaneous with infection, or permanent, overt acute illness of mild to moderate severity, and complications involving hospitalization. The estimation of morbidity is based on theoretical models of parasite distributions developed in previous papers. A sensitivity analysis is carried out in which parameters of the model are varied using a Latin hypercube sampling technique. The results estimate approximately 1300 million infections globally with 59 million at risk of some morbidity. The estimate for acute illness is 12 million cases per year with approximately 10,000 deaths. Most morbidity is in children. Sensitivity analysis suggests that infection estimates will not vary greatly with changes in parameter values but that morbidity estimates may be highly variable.

Morbidity and mortality due to Ascaris-induced intestinal obstruction.

We examined epidemiological aspects of Ascaris-induced intestinal obstruction (AI-IO) through analysis of published reports on the subject. In 9 studies of > or = 100 patients admitted to hospital due to ascariasis, intestinal obstruction was the single most common complication and accounted for 38-87.5% of all complications (weighted mean 72%). The proportion of intestinal obstruction caused by ascariasis was identified in 14 studies from 7 countries with varying degrees of endemic ascariasis. Using relevant data on the duration of the study, the number of beds in the reporting hospital, and the number of hospital beds/1000 population in the area, the number of cases of AI-IO/year/1000 population was estimated from 11 studies. Both the proportion of AI-IO (range 0-0.71) and the number of cases of AI-IO/year/1000 population (range 0-0.25) were significantly related, in a non-linear manner, to the local prevalence of ascariasis (range 0.01-0.92). In 12 studies of > or = 30 patients with AI-IO, the case fatality rates ranged from 0 to 8.6% (weighted mean 5.7%). The mean age of patients with AI-IO was < or = 5 years in 6 of 7 studies in which age was specified.

Role of ascariasis in surgical abdominal emergencies in the Rangoon Children's Hospital, Burma.

Patients aged 1 month to 12 years admitted with an acute abdominal surgical condition comprising 226 cases with and 206 cases without ascariasis, recorded in the operation theatre registers and in-patients clinical sheets, were studied in relation to morbidity, duration of operation and hospital stay and mortality. Annually, 7.5% of laparotomies were due to complications of ascariasis. Operations for ascariasis accounted for 10.6% of all hospital admissions for an acute abdominal emergency. Also, ascariasis accounted for 26.3% of emergency operations. All operated biliary obstruction cases were due to ascariasis. Moreover, 20.4% of all cases of ascariasis with abdominal complications required operation. The mean ages at operation were higher in Ascaris-induced than in non-Ascaris-induced intestinal obstruction (5.1 vs 3 yr), intussusception (3.5 vs 1.2 yr) and volvulus (4.8 vs 1.7 yr). The durations of operation and hospital stay were longer and case fatality rates higher in Ascaris-induced than in non-Ascaris-induced cases. The importance of this study in relation to the socio-economic benefits of controlling ascariasis is discussed.

Ascariasis intraperitoneal / Intraperitoneal ascariasis

Se revisaron los casos de Ascariasis intraperitoneal intervenidos quirúrgicamente en el Hospital Dr. Robert Reid Cabral de Santo Domingo desde 1980 hasta 1987. un total de 8 casos son reportados. La edad osciló entre 6 meses y 4 años. Murieron 5 pacientes para una mortalidad de 62.5%

Epidemiología y prevención de la ascariasis en México: investigación preliminar / Epidemiology and prevention of ascariasis in Mexico: preliminary research

Ascaris lumbricoides es el parásito intestinal más común en el hombre. La temperatura y la humedad son críticos en determinar la maduración de los huevos hasta su estado infectante y su sobrevivencia, aunque la transmisión de la infección al hombre es dependiente también de los factores socioeconómicos. En México, la ascariasis representa un problema de salud pública, cuyos principales factores de riesgo son el hacinamiento, producción agrícola con uso amplio de la materia fecal como fertilizante, pobreza, analfabetismo, insalubridad ambiental y los patrones culturales. La frecuencia registrada fue más alta en los niños, de los cuales 20 a 80% estaban infectados. La ascariasis fue más prevalente en las áreas rurales principalmente del sureste y de los estados costeros tropicales. No hubo diferencia en la tasa de infección por sexos. La endemicidad depende no sólo de las presiones selectivas ambientales, sino que están reguladas también por la inmunidad de la población

Intestinal perforation in ascariasis--case reports.

Two cases of intestinal perforation in association with ascariasis are described. In both cases adult ascarids were found either in the gut or lying free in the peritoneal cavity. Neither patient had typhoid fever, one had Hodgkin's lymphoma. The authors believe that the perforation were directly caused by the ascarids. Both patients died.

Intestinal perforation in ascariasis: case report

Two cases of intestinal perforation in association with ascariasis are described. In both cases adult ascarids were found either in the gut or lying free in the peritoneal cavity. Neither patient had typhoid fever, one had Hodgkin's lymphoma. The authors believe that the perforations were directly caused by the ascarids. Both patients died (Summary)

Dual infections of mice: visceral larva migrans and sublethal infection with Japanese encephalitis virus.

Experiments in 3 weeks old albino mice with Toxocara canis and sublethal infection with JE virus established a marked synergestic effect in dually infected mice. The results are discussed to indicate the possible role of visceral larva migrans in creating exploxive outbreaks of "acute encephalopathy syndrome" in individuals having simultaneous infection with a virus (es) which, alone, might produce only mild illness. The nature of the possible mechanisms involved yet remains to be understood.

Ascaris suum infection in calves. I. Clinical signs.

Clinical signs consistent with those of atypical interstitial pneumonia (AIP) were induced in calves sensitized with infective Ascaris suum eggs at seven to 20 weeks of age and challenged at three-week intervals one or more times. These signs usually appeared on the sixth or seventh day postinfection and reached maximum severity between the tenth and 13th days following infection. Prominent signs were: dyspnea, often with expiratory grunt, coughing, mouth breathing and emphysema as well as increased respiration and heart rates. In general, the intensity of signs was dependent upon dose size, although a single small dose resulted in acute signs and death in one calf. Intermittent coughing and vesicular sounds were induced in calves given A. suum eggs continually over prolonged periods. No respiratory abnormalities resulted from challenge with Toxocara canis after sensitization with A. suum. Antihistamine therapy did not alter the clinical signs in A. suum infected calves.