Unusual presentations of a severe type 2 leprosy reaction mimicking sepsis induced by helminth infection.

We describe an unusual case of type 2 leprosy reaction (T2R) with septic shock-like features induced by helminth infection in a 31-year-old Moluccan male patient with a history of completed treatment of WHO multidrug therapy (MDT)-multibacillary (MB) regimen 2 years before admission. During the course of illness, the patient had numerous complications, including septic shock, anemia, and disseminated intravascular coagulation (DIC). Nevertheless, antibiotic therapies failed to give significant results, and the source of infection could not be identified. Helminth infection was subsequently revealed by endoscopic examination followed by parasitological culture. Resolution of symptoms and normal level of organ function-specific markers were resolved within 3 days following anthelmintic treatment. This report demonstrated the challenge in the diagnosis and treatment of severe T2R. Given that helminth infections may trigger severe T2R that mimics septic shock, health professionals need to be aware of this clinical presentation, especially in endemic regions of both diseases.

Immunity to Soil-Transmitted Helminths: Evidence From the Field and Laboratory Models.

Infection with soil-transmitted helminths (STH) remains a major burden on global health and agriculture. Our understanding of the immunological mechanisms that govern whether an individual is resistant or susceptible to infection is derived primarily from model infections in rodents. Typically, experimental infections employ an artificially high, single bolus of parasites that leads to rapid expulsion of the primary infection and robust immunity to subsequent challenges. However, immunity in natura is generated slowly, and is only partially effective, with individuals in endemic areas retaining low-level infections throughout their lives. Therefore, there is a gap between traditional model STH systems and observations in the field. Here, we review the immune response to traditional model STH infections in the laboratory. We compare these data to studies of natural infection in humans and rodents in endemic areas, highlighting crucial differences between experimental and natural infection. We then detail the literature to date on the use of "trickle" infections to experimentally model the kinetics of natural infection.

Prevalence and Associated Factors of Soil-Transmitted Helminth Infections among Children Living with and without Open Defecation Practices in Northwest Ethiopia: A Comparative Cross-Sectional Study.

Soil-transmitted helminth (STH) infections cause devastating effect in human health. School-age children (SAC) account for the highest prevalence of STH infections in sub-Sahara. Open defecation practicing might be the major contributing factor, and creating an open defecation-free (ODF) declared community is also a big challenge. This study aimed to assess the prevalence of STH infections and associated factors among SAC in ODF declared and open defecation-practicing kebeles. A comparative cross-sectional study was conducted among 806 SAC from January 2019 to April 2019. Questionnaire-based data were collected using a structured questionnaire. Stool samples were collected and processed via the Kato-Katz technique. Prevalence and associated factors were computed with descriptive statistics and regression, respectively. Variables with a P-value < 0.05 were considered as significantly associated. This study revealed that the prevalence of STH infections in open defecation-practicing and ODF declared kebeles were 39.0% and 30.0%, respectively. Wearing open shoes, wearing shoes sometimes, and playing with soil were significantly associated (P < 0.01) with STH infections in ODF declared kebeles. Similarly, wearing shoes sometimes, not using latrine, and playing with soil were also significantly associated (P < 0.01) with STH infections in open defection-practicing kebeles. In conclusion, lower prevalence of STH infections was recorded in ODF declared than in open defection-practicing kebeles. Wearing shoes sometimes, playing with soil, and not using latrine were associated with STH infections. Therefore, creating an ODF environment and community awareness should be strengthened.

Soil Contamination Rate, Prevalence, Intensity of Infection of Geohelminths and Associated Risk Factors among Residents in Bazou (West Cameroon).

BACKGROUND: Soil-transmitted helminths (STH) infections remain an important public health problem in the tropics. This study aimed to evaluate the soil contamination rate and prevalence of infestations of geohelminth among residents in Bazou. METHODS: Four hundred (400) soil samples and 182 stool specimens were collected respectively from four sites and from inhabitants aged 1 to 40 years and above in 12 households. A questionnaire was administered to evaluate risk factors of STH-infections. Soil samples were screened using sucrose centrifugal flotation method while stool specimens were analyzed using two techniques. RESULTS: Out of the 400 soil and 182 stool samples examined, 13(3.3%) and 9(4.95%) were positive respectively after analyses. Soil contamination rates were 2%, 1% and 0.3% for Ascaris, Trichuris and hookworm eggs respectively while 4.95% of stool samples were positive to one species nematode (Ascaris lumbricoides). The soil contamination rate observed (5%) in the rainy season was significantly different (p>0.05) from the one observed (1.5%) in the dry season. Irrespectively of the season, the most frequent parasite identified was Ascaris spp. Soils around houses were more contaminated 6(12%) as compared to those collected from markets 5(10%) and roads 2(4%) while those around classrooms were not contaminated. Participants in the age group of 1-10 were more infected. Factors such as no hand washing habit and untrimmed finger nails were found to be important risk factors for STH. CONCLUSION: These results suggest the necessity to promote measures that could help to reduce STH infections.

Household sanitation is associated with lower risk of bacterial and protozoal enteric infections, but not viral infections and diarrhoea, in a cohort study in a low-income urban neighbourhood in Vellore, India.

OBJECTIVE: This study examined associations between household sanitation and enteric infection - including diarrhoeal-specific outcomes - in children 0-2 years of age in a low-income, dense urban neighbourhood. METHODS: As part of the MAL-ED study, 230 children in a low-income, urban, Indian neighbourhood provided stool specimens at 14-17 scheduled time points and during diarrhoeal episodes in the first 2 years of life that were analysed for bacterial, parasitic (protozoa and helminths) and viral pathogens. From interviews with caregivers in 100 households, the relationship between the presence (and discharge) of household sanitation facilities and any, pathogen-specific, and diarrhoea-specific enteric infection was tested through mixed-effects Poisson regression models. RESULTS: Few study households (33%) reported having toilets, most of which (82%) discharged into open drains. Controlling for season and household socio-economic status, the presence of a household toilet was associated with lower risks of enteric infection (RR: 0.91, 95% CI: 0.79-1.06), bacterial infection (RR: 0.87, 95% CI: 0.75-1.02) and protozoal infection (RR: 0.64, 95% CI: 0.39-1.04), although not statistically significant, but had no association with diarrhoea (RR: 1.00, 95% CI: 0.68-1.45) or viral infections (RR: 1.12, 95% CI: 0.79-1.60). Models also suggested that the relationship between household toilets discharging to drains and enteric infection risk may vary by season. CONCLUSIONS: The presence of a household toilet was associated with lower risk of bacterial and protozoal enteric infections, but not diarrhoea or viral infections, suggesting the health effects of sanitation may be more accurately estimated using outcome measures that account for aetiologic agents.

Effect of polymorphisms on TGFB1 on allergic asthma and helminth infection in an African admixed population.

BACKGROUND: Allergic asthma is a complex disorder that results from a combination of genetic and environmental factors. Studies suggest that helminth infections can activate a regulatory network characterized by the production of regulatory cytokines, such as interleukin 10 and transforming growth factor ß1 (TGF-ß1) and subsequently protect against immune-mediated diseases, such as asthma. On the other hand, TGF-ß1 is increased in the lungs of individuals with asthma and may modulate airway inflammation. The role of TGF- ß 1 single-nucleotide polymorphisms (SNPs) in allergic disease remains inconclusive. OBJECTIVE: To evaluate the effects of genetic variations in the TGF-ß1 on allergy and helminths infections in children. METHODS: We tested for association among 4 TGF-ß1 SNPs and allergic asthma, specific IgE, skin prick test result, and IL-10 production in 1,335 Brazilians. In addition, we analyzed the association with markers of helminth infection (parasite burden, anti-Ascaris IgE, and worm specific IgG4). The polymorphisms were genotyped using Taq Man probes. RESULTS: We found an association between rs1800470 (C allele) and atopic wheezing (odds ratio [OR], 0.60; 95% confidence interval [CI], 0.37-0.95) and markers of allergy (OR, 0.41; 95% CI, 0.22-0.79). In contrast, a positive association was observed between the haplotype ACCA and Trichuris trichiura infection (OR, 1.85; P = .003) and Ascaris lumbricoides infection (OR, 2.01; P < .001). This haplotype was also associated with increased IL-10 production (ß = 50.7; P < .001). CONCLUSION: Individuals with TGF-ß1 polymorphisms have an increased susceptibility to helminth infections and a lower risk of developing allergy. These studies suggest that immune modulation of allergic disease results not only from environmental factors but also from genetic susceptibility and IL-10 production.

Soil transmitted helminthiasis in indigenous groups. A community cross sectional study in the Amazonian southern border region of Ecuador.

BACKGROUND: Rural communities in the Amazonian southern border of Ecuador have benefited from governmental social programmes over the past 9 years, which have addressed, among other things, diseases associated with poverty, such as soil transmitted helminth infections. The aim of this study was to explore the prevalence of geohelminth infection and several factors associated with it in these communities. METHODS: This was a cross sectional study in two indigenous communities of the Amazonian southern border of Ecuador. The data were analysed at both the household and individual levels. RESULTS: At the individual level, the prevalence of geohelminth infection reached 46.9% (95% CI 39.5% to 54.2%), with no differences in terms of gender, age, temporary migration movements or previous chemoprophylaxis. In 72.9% of households, one or more members were infected. Receiving subsidies and overcrowding were associated with the presence of helminths. CONCLUSIONS: The prevalence of geohelminth infection was high. Our study suggests that it is necessary to conduct studies focusing on communities, and not simply on captive groups, such as schoolchildren, with the object of proposing more suitable and effective strategies to control this problem.

Population Density, Poor Sanitation, and Enteric Infections in Nueva Santa Rosa, Guatemala.

Poor sanitation could pose greater risk for enteric pathogen transmission at higher human population densities because of greater potential for pathogens to infect new hosts through environmentally mediated and person-to-person transmission. We hypothesized that incidence and prevalence of diarrhea, enteric protozoans, and soil-transmitted helminth infections would be higher in high-population-density areas compared with low-population-density areas, and that poor sanitation would pose greater risk for these enteric infections at high density compared with low density. We tested our hypotheses using 6 years of clinic-based diarrhea surveillance (2007-2013) including 4,360 geolocated diarrhea cases tested for 13 pathogens and a 2010 cross-sectional survey that measured environmental exposures from 204 households (920 people) and tested 701 stool specimens for enteric parasites. We found that population density was not a key determinant of enteric infection nor a strong effect modifier of risk posed by poor household sanitation in this setting.

The epidemiology of soil-transmitted helminths in Bihar State, India.

BACKGROUND: Soil-transmitted helminths (STHs) infect over a billion individuals worldwide. In India, 241 million children are estimated to need deworming to avert the negative consequences STH infections can have on child health and development. In February-April 2011, 17 million children in Bihar State were dewormed during a government-led school-based deworming campaign. Prior to programme implementation, a study was conducted to assess STH prevalence in the school-age population to direct the programme. The study also investigated risk factors for STH infections, including caste, literacy, and defecation and hygiene practices, in order to inform the development of complementary interventions. METHODS: A cross-sectional survey was conducted among children in 20 schools in Bihar. In addition to providing stool samples for identification of STH infections, children completed a short questionnaire detailing their usual defecation and hand-hygiene practices. Risk factors for STH infections were explored. RESULTS: In January-February 2011, 1279 school children aged four to seventeen provided stool samples and 1157 children also completed the questionnaire. Overall, 68% of children (10-86% across schools) were infected with one or more soil-transmitted helminth species. The prevalence of ascariasis, hookworm and trichuriasis was 52%, 42% and 5% respectively. The majority of children (95%) practiced open defecation and reported most frequently cleansing hands with soil (61%). Increasing age, lack of maternal literacy and certain castes were independently associated with hookworm infection. Absence of a hand-washing station at the schools was also independently associated with A. lumbricoides infection. CONCLUSIONS: STH prevalence in Bihar is high, and justifies mass deworming in school-aged children. Open defecation is common-place and hands are often cleansed using soil. The findings reported here can be used to help direct messaging appropriate to mothers with low levels of literacy and emphasise the importance of water and sanitation in the control of helminths and other diseases.

Intervención educativa al personal médico y paramédico sobre Inermicapsifer madagascariensis / Educational intervention to medical and paramedical personnel on Inermicapsifer madagascariensis

Se realiza una intervención educativa en el personal de salud de la provincia Guantánamo durante el mes de septiembre de 2013, con el objetivo de capacitar sobre aspectos esenciales del diagnóstico, tratamiento y prevención de la helmintiasis por Inermicapsifer madagascariensis. El universo de estudio estuvo formado por 10 tecnólogos de laboratorio, seis técnicos, ocho MGI y un decidor a los que se les aplicó una encuesta para determinar el nivel de conocimiento sobre Inermicapsifer madagascariensis. Se obtuvo que existía desconocimiento sobre el diagnóstico clínico-epidemiológico y de laboratorio. Se diseña e imparte un curso de posgrado y un plegable para elevar el nivel de conocimiento de esta parasitosis(AU)

An educational intervention is done in health personnel of this province during the month of September 2013, with the objective of training on key aspects of diagnosis, treatment and prevention of helminth Inermicapsifer madagascariensis. The study group consisted of 10 laboratory technologists, 6 technicians, 8 MGI and decidor those who were given a survey to determine the level of knowledge about Inermicapsifer madagascariensis. It was found that there was lack of knowledge about the clinical-epidemiological and laboratory diagnosis. It is designed and is received a graduate course and a folding to raise awareness of this parasitosis(AU)

Knowledge, attitudes and practices among parents and teachers about soil-transmitted helminthiasis control programs for school children in Guimaras, Philippines.

We determined the attitudes toward and practices regarding soil-transmitted helminthes (STH) control among parents and school teachers to identify reasons behind attitudes and practices that do not promote STH control. Written knowledge, attitudes and practices surveys were distributed to parents (N = 531) and teachers (N = 105) of students at 11 elementary schools in Guimaras Province, the Philippines. The survey addressed attitudes about mass drug administration (MDA), knowledge about STH control, hygienic practices, and acceptability of distributing deworming tablets among teachers. More than 90% of parents and teachers held favorable attitudes towards MDA. Sixty-nine percent of parents and 75.5% of teachers believed stool exams were necessary before MDA. Thirty-seven percent of parents stated they would not allow teachers to administer deworming tablets and 91.5% of parents feared teachers would not detect side effects of the medication. Forty-eight percent of teachers felt they could safely give deworming tablets and 81.4% of teachers were afraid of managing the side effects of deworming tablets. Forty-seven point eight percent of parents and 42.2% of teachers stated defecation in the open occured in their community. Although attitudes toward STH control were largely favorable, misconceptions about the MDA strategy, lack of support for teachers giving deworming tablets, and the practice of open defecation still exist as barriers to STH control efforts. The next step to achieve effective STH control will be to clarify misconceptions in education campaigns, to train teachers about medication administration, campaign to improve sanitation and hygiene and begin targeted mass treatment in Guimaras, the Philippines.

Assessment of a school-based mass treatment for soil-transmitted helminth infections in Capiz, the Philippines.

We evaluated the War on Worms in the Western Visayas (WOW-V) school-based mass treatment strategy in Capiz, the Philippines by assessing potential determinants of program acceptance among parents, teachers, and local health and education officials involved. Written surveys were distributed to parents and teachers assessing knowledge, attitudes and practices regarding soil-transmitted helminth (STH) infections. Associations between data were examined using the Fisher's exact test (alpha = 0.05). Descriptive statistics and t-tests were employed to analyze teacher survey results. Local health and education officials participated in key-informant interviews (KIs) to evaluate their attitudes and practices regarding WOW-V; data was qualitatively analyzed and grouped. A strong association was observed between parental consent during the first two rounds of treatment and willingness to do so again. Most parents gave consent for their child to receive treatment at least once and demonstrated a high level of knowledge regarding STH infections. The majority of teachers had positive attitudes toward their role in the program. Many identified lack of training and a fear of side effects as barriers to higher coverage. Lack of funding, program monitoring difficulties and insufficient parental education were identified by local officials as barriers. Proper planning and design is important to achieve high initial consent for program acceptance. The results correlate with studies showing relationships between health education and treatment acceptance. The implementation of health education and monitoring measures has the potential to greatly improve both treatment coverage and program infrastructure.

Omalizumab for pediatric asthma.

IMPORTANCE TO THE FIELD: Omalizumab is of proven efficacy in the treatment of severe allergic bronchial asthma and works through inhibiting the activity of IgE and the allergic immune mechanism IgE mediates. It has been demonstrated to be efficacious in children with asthma but is not approved by the FDA for use in children below 12 years of age. AREAS COVERED IN THIS REVIEW: Omalizumab is a 95% humanized monoclonal antibody that binds to circulating IgE at the same site on the Fc domain as the high-affinity IgE receptor, FcϵRI. This blocks the interaction between IgE and mast cells and basophils, thereby preventing the release of inflammatory mediators that cause allergic signs and symptoms. WHAT THE READER WILL GAIN: From the review of the literatures and statements from the FDA, Genentec and Novartis, the reader will gain a better appreciation of the value of omalizumab in treatment of severe asthma and the current status of its reported side effects. TAKE HOME MESSAGE: Omalizumab is of proven efficacy in adults and children with severe asthma and allows a markedly reduced dependence on oral and inhaled corticosteroids and decreased hospitalizations. A potential mechanism of omalizumab's effect on thrombus formation and cardiovascular effect is postulated.

Eosinophilia during intestinal infection.

Eosinophilia is a common finding in tropical developing countries, and is mainly caused by chronic helminth infections, predominantly of the gut. Although only a minority of infections is symptomatic, development during childhood can be impaired, and in some patients serious complications and sequelae may occur. Eosinophilia in helminth infection is typically associated with a strong Th2 immune response, and eosinophils can effectively kill or damage larvae and adult worms in vitro. However, in vivo, eosinophils are only partly effective in the control of helminth infection, and recent research has shown that eosinophils are involved in a range of immunomodulatory effects, such as increased production of the down-modulatory cytokines interleukin 10 and tumour growth factor beta, as well as stimulation of regulatory T cells and alternatively activated macrophages. Increasing evidence suggests that immunomodulation favours parasite survival and reduces immune pathology. On the other hand, immunomodulation induced by helminth infections may contribute to protection from allergic and autoimmune responses, as proposed by the 'hygiene hypothesis' to explain the increase in allergic diseases in the industrialised world. The predictive value of eosinophilia for the presence of helminth infections is limited and depends on the epidemiological background and the extent of the eosinophilia. It increases considerably in populations with a high prevalence of parasitic infections, as in developing tropical countries or in travellers to those areas.

School-based deworming programme in Sanliurfa, Turkey: changing from externally funding phase to self-sufficient phase.

In Sanliurfa, Turkey, externally funded temporary deworming activities have led to an internally funded self-sufficient programme in 2004-05 academic year. A total of 200,000 doses of mebendazole were distributed to schoolchildren, absentee children and small children and women through both schools and health centres. We interviewed 64 representative teachers, 82 administrative teachers, 112 schoolchildren and 108 parents using questionnaires, department interviews and focus groups discussions. We also collected 162 stool samples from third- and fourth-grade schoolchildren and examined them using the Kato-Katz technique. The evaluation of second year's of deworming program indicated that the programme's methodology of training representative teachers to play a major role in organizing the activities within schools and liaising with health staff was found to be successful by most of the teachers. The results showed that 85.2% of the women had benefited from the extended anthelmintic coverage. A total of 67.4% of them received the drugs from schools and 10.9% obtained them from health centres. The prevalence of helmintic infection had declined from 77 to 35% in shantytown schoolchildren and from 53 to 6.4% in apartment schoolchildren. The prevalence of Ascaris lumbricoides and Trichuris trichiura decreased from 63.2 to 17% and from 16.8 to 1.1%, respectively, in schoolchildren. The results also indicated that 53.5% of the schoolchildren changed over to clean habits and began to use soap after using the toilet. The evaluation of the second year's deworming programme showed that the programme was sustainable and there was no risk of the programme being discontinued. Political commitment was obtained from the local business community, academic sector, the local governmental administrations and the city municipality. These organizations realized the programme's rapid and clear benefits and collaborated in a multipartners' programme. The cost of treatment per child was $0.05 and in total $11 000 was sufficient to implement a broad-range programme including education of children about cleanliness and treatment of infection to improve their health.

Prevalence and risk factors associated with worm infestation in pre-school children (6-23 months) in selected blocks of Uttar Pradesh and Jharkhand, India.

BACKGROUND: Intestinal worm infestation is widely prevalent in developing countries and can result in impaired nutrition and development. AIMS: To estimate prevalence of and risk factors for intestinal geohelminths and other intestinal parasites in children aged 6 to 23 months. SETTINGS AND DESIGN: Cross sectional study in rural India. MATERIALS AND METHODS: Proportionate population size sampling method was used to randomly select 15 villages per block. Thereafter, house-to-house survey was done to recruit eligible children and obtain fecal sample for microbiological examination. STATISTICAL ANALYSIS: Univariate distribution of variables was assessed and comparison between categorical variables and continuous variables was done using a Chi-square test and student's t-test, respectively. Odds ratio was calculated to assess associations. RESULTS: Overall 926 children were recruited and 909 fecal samples examined. Combined prevalence of infestation with intestinal geohelminths treatable by albendazole and other intestinal parasites non-treatable by albendazole was 50.3% (457/909) and 51.6% (469/909), respectively. Exclusive use of hand pump water (OR = 1.79, CI = 1.36-2.35, P CONCLUSION: Since almost half the children are infected with intestinal geohelminths treatable by albendazole, targeted deworming of population in this age group should be considered.

Intestinal parasitic infections in Srimum suburban area of Nakhon Ratchasima Province, Thailand.

A survey on intestinal parasitic infections and some risk factors of infection (social, economic and behavioral) was conducted in suburban area at Simum subdistrict, Mueang district, Nakhon Ratchasima Province during the period of April 3rd to April 11th, 2007. A total of 214 stool samples, from 85 males and 129 females were examined using simple direct smear, Kato's thick smear and modified Harada-Mori Filter Paper Strip culture technique. The results showed that the prevalence rate of protozoa infections by simple direct smear method was 17.3% (37 infected samples) in 11 males and 26 females and were from all age groups. Mixed infections (56.8%), showed higher results than single infection. The highest number of intestinal protozoan infections was Entamoeba histolytica (11.7%), followed by Blastocystis hominis (5.6%). Fifty four percent of protozoan infection was at a moderate to high level. Ninety five percent of infected cases consumed unboiled water. The prevalence rate of helminthic infections was 7% total by Kato's thick smear and Modified Harada-Mori Filter Paper Strip culture technique. Kato's Thick smear Technique showed the highest rate of Strongyloides stercolaris (2.8%), followed by hookworm infection (1.4%) Taenia spp. (0.9%), and Enterobius vermicularis (0.5%), respectively. All infections showed a light intensity, (< 200 epg), using Kato-Katz thick smear. Although Modified Harada-Mori's culture Technique showed higher S. stercolaris (3.3%) and hookworm infection (2.3%) than Kato's thick smear in the area where there is low Soil transmitted helminthes, we recommend using Simple or Kato's thick smear to determine the prevalence of parasitic infection due to these techniques being able to detect various groups of parasites, and being inexpensive and less time consuming.

[Examination of helminth contaminated wastewaters used for agricultural purposes in Afyonkarahisar]. / Afyonkarahisar'da tarimsal amaçli kullanilan atik sularin helmint kontaminasyonu yönünden incelenmesi.

This research was performed in order to examine helminth contaminated wastewaters used in agriculture in Afyonkarahisar. Ten rural areas were selected that used water for agricultural purposes from a creek contaminated with human and animal wastes. Between September 2004 and August 2005, these areas were visited once every two weeks, and a total of 240 water samples were collected. Out of untreated water samples, 32 samples (26.70%) had helminth eggs, whereas there were neither helminths nor developmental stages of helminths (p < 0.001) in treated water samples. Cestode eggs were seen in 10.00% of untreated water samples and nematode eggs were seen in 16.70%. Out of the helminth eggs, 13 (40.60%) were hookworm eggs; 6 (18.75%), Taenia spp.; 5 (5.60%), Ascaris lumbricoides; 3 (9.40%), Hymenolepis diminuta; 3 (9.40%), H. nana; and 2 (6.25%), Toxocara spp. In conclusion; the creek was found to be contaminated by helminths originating from human and animal wastes in Afyonkarahisar. This type of water presents a risk for human and animal health and contaminated waters, therefore, should be avoided in irrigation of vegetables and fruit consumed raw.