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1.
PLoS Negl Trop Dis ; 13(10): e0007776, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31618208

RESUMO

We investigated the impact of helminths and malaria infection on Kaposi's sarcoma associated herpesvirus (KSHV) seropositivity, using samples and data collected from a cluster-randomised trial of intensive versus standard anthelminthic treatment. The trial was carried out in 2012 to 2016 among fishing communities on Lake Victoria islands in Uganda. Plasma samples from 2881 participants from two household surveys, the baseline (1310 participants) and the final (1571 participants) surveys were tested for KSHV IgG antibody responses to K8.1 and ORF73 recombinant proteins using ELISA. The baseline survey was carried out before the trial intervention while the final survey was carried out after three years of the trial intervention. Additionally, a subset sample of 372 participants from the final survey was tested for IgE, IgG and IgG4 antibody concentrations to S. mansoni adults worm antigen (SWA) and S. mansoni egg antigen (SEA) using ELISA. Infection by helminths (S. mansoni, N. americanus, T. trichiura and S. stercoralis) was diagnosed using real-time PCR, urine circulating cathodic antigen (CCA) and stool microscopy (Kato-Katz method) while malaria infection was diagnosed using microscopy. We analysed the relationship between helminth and malaria infections and KSHV seropositivity using regression modelling, allowing for survey design. At baseline, 56% of the participants were male while 48% of the participants were male in the final survey. The most prevalent helminth infection was S. mansoni (at baseline 52% and 34% in the final survey by microscopy, 86% by CCA and 50% by PCR in the final survey). KSHV seropositivity was 66% (baseline) and 56% (final survey) among those 1-12 years and >80% in those 13+ years in both surveys; malaria parasitaemia prevalence was 7% (baseline) and 4% (final survey). At baseline, individuals infected with S. mansoni (detected by microscopy) were more likely to be KSHV seropositive (aOR = 1.86 (1.16, 2.99) p = 0.012) and had higher anti-K8.1 antibody levels (acoefficient = 0.03 (0.01, 0.06) p = 0.02). In the final survey, S. mansoni (by microscopy, adjusted Odds Ratio (aOR = 1.43 (1.04-1.95), p = 0.028) and malaria parasitaemia (aOR = 3.49 (1.08-11.28), p = 0.038) were positively associated with KSHV seropositivity. Additionally, KSHV seropositive participants had higher S. mansoni-specific IgE and IgG antibody concentrations in plasma. Furthermore, HIV infected individuals on cART were less likely to be KSHV seropositive compared to HIV negative individuals (aOR = 0.46 (0.30, 0.71) p = 0.002). Schistosoma species skew the immune response towards Th2 and regulatory responses, which could impact on KSHV reactivation if co-infected with both organisms.


Assuntos
Antígenos de Helmintos/imunologia , Herpesvirus Humano 8/imunologia , Doenças Parasitárias/epidemiologia , Doenças Parasitárias/imunologia , Adolescente , Adulto , Idoso , Albendazol/uso terapêutico , Animais , Anticorpos Anti-Helmínticos/sangue , Criança , Pré-Escolar , Estudos Transversais , Infecções por HIV/imunologia , Helmintíase/tratamento farmacológico , Helmintíase/epidemiologia , Helmintíase/imunologia , Helmintíase/parasitologia , Humanos , Imunoglobulina E/sangue , Imunoglobulina G/sangue , Lactente , Ilhas , Lagos , Malária/imunologia , Pessoa de Meia-Idade , Razão de Chances , Doenças Parasitárias/tratamento farmacológico , Doenças Parasitárias/fisiopatologia , Praziquantel/uso terapêutico , Prevalência , Schistosoma mansoni/imunologia , Esquistossomose mansoni/epidemiologia , Uganda/epidemiologia , Adulto Jovem
2.
Cochrane Database Syst Rev ; 9: CD000371, 2019 09 11.
Artigo em Inglês | MEDLINE | ID: mdl-31508807

RESUMO

BACKGROUND: The World Health Organization (WHO) recommends treating all school children at regular intervals with deworming drugs in areas where helminth infection is common. Global advocacy organizations claim routine deworming has substantive health and societal effects beyond the removal of worms. In this update of the 2015 edition we included six new trials, additional data from included trials, and addressed comments and criticisms. OBJECTIVES: To summarize the effects of public health programmes to regularly treat all children with deworming drugs on child growth, haemoglobin, cognition, school attendance, school performance, physical fitness, and mortality. SEARCH METHODS: We searched the Cochrane Infectious Diseases Group Specialized Register; Cochrane Central Register of Controlled Trials (CENTRAL); MEDLINE; Embase; LILACS; the metaRegister of Controlled Trials (mRCT); reference lists; and registers of ongoing and completed trials up to 19 September 2018. SELECTION CRITERIA: We included randomized controlled trials (RCTs) and quasi-RCTs that compared deworming drugs for soil-transmitted helminths (STHs) with placebo or no treatment in children aged 16 years or less, reporting on weight, height, haemoglobin, and formal tests of cognition. We also sought data on other measures of growth, school attendance, school performance, physical fitness, and mortality. DATA COLLECTION AND ANALYSIS: At least two review authors independently assessed the trials for inclusion, risk of bias, and extracted data. We analysed continuous data using the mean difference (MD) with 95% confidence intervals (CIs). Where data were missing, we contacted trial authors. We stratified the analysis based on the background burden of STH infection. We used outcomes at time of longest follow-up. We assessed the certainty of the evidence using the GRADE approach. MAIN RESULTS: We identified 51 trials, including 10 cluster-RCTs, that met the inclusion criteria. One trial evaluating mortality included over one million children, and the remaining 50 trials included a total of 84,336 participants. Twenty-four trials were in populations categorized as high burden, including nine trials in children selected because they were helminth-stool positive; 18 with intermediate burden; and nine as low burden.First or single dose of deworming drugsFourteen trials reported on weight after a single dose of deworming drugs (4970 participants, 14 RCTs). The effects were variable. There was little or no effect in studies conducted in low and intermediate worm burden groups. In the high-burden group, there was little or no effect in most studies, except for a large effect detected from one study area in Kenya reported in two trials carried out over 30 years ago. These trials result in qualitative heterogeneity and uncertainty in the meta-analysis across all studies (I2 statistic = 90%), with GRADE assessment assessed as very low-certainty, which means we do not know if a first dose or single dose of deworming impacts on weight.For height, most studies showed little or no effect after a single dose, with one of the two trials in Kenya from 30 years ago showing a large average difference (2621 participants, 10 trials, low-certainty evidence). Single dose probably had no effect on average haemoglobin (MD 0.10 g/dL, 95% CI 0.03 lower to 0.22 higher; 1252 participants, five trials, moderate-certainty evidence), or on average cognition (1596 participants, five trials, low-certainty evidence). The data are insufficient to know if there is an effect on school attendance and performance (304 participants, one trial, low-certainty evidence), or on physical fitness (280 participants, three trials, very low-certainty evidence). No trials reported on mortality.Multiple doses of deworming drugsThe effect of regularly treating children with deworming drugs given every three to six months on weight was reported in 18 trials, with follow-up times of between six months and three years; there was little or no effect on average weight in all but two trials, irrespective of worm prevalence-intensity. The two trials with large average weight gain included one in the high burden area in Kenya carried out over 30 years ago, and one study from India in a low prevalence area where subsequent studies in the same area did not show an effect. This heterogeneity causes uncertainty in any meta-analysis (I2 = 78%). Post-hoc analysis excluding trials published prior to 2000 gave an estimate of average difference in weight gain of 0.02 kg (95%CI from 0.04 kg loss to 0.08 gain, I2 = 0%). Thus we conclude that we do not know if repeated doses of deworming drugs impact on average weight, with a fewer older studies showing large gains, and studies since 2000 showing little or no average gain.Regular treatment probably had little or no effect on the following parameters: average height (MD 0.02 cm higher, 95% CI 0.09 lower to 0.13 cm higher; 13,700 participants, 13 trials, moderate-certainty evidence); average haemoglobin (MD 0.01 g/dL lower; 95% CI 0.05 g/dL lower to 0.07 g/dL higher; 5498 participants, nine trials, moderate-certainty evidence); formal tests of cognition (35,394 participants, 8 trials, moderate-certainty evidence); school performance (34,967 participants, four trials, moderate-certainty evidence). The evidence assessing an effect on school attendance is inconsistent, and at risk of bias (mean attendance 2% higher, 95% CI 5% lower to 8% higher; 20,650 participants, three trials, very low-certainty evidence). No trials reported on physical fitness. No effect was shown on mortality (1,005,135 participants, three trials, low-certainty evidence). AUTHORS' CONCLUSIONS: Public health programmes to regularly treat all children with deworming drugs do not appear to improve height, haemoglobin, cognition, school performance, or mortality. We do not know if there is an effect on school attendance, since the evidence is inconsistent and at risk of bias, and there is insufficient data on physical fitness. Studies conducted in two settings over 20 years ago showed large effects on weight gain, but this is not a finding in more recent, larger studies. We would caution against selecting only the evidence from these older studies as a rationale for contemporary mass treatment programmes as this ignores the recent studies that have not shown benefit.The conclusions of the 2015 edition have not changed in this update.


Assuntos
Anti-Helmínticos/uso terapêutico , Helmintíase/tratamento farmacológico , Enteropatias Parasitárias , Estado Nutricional , Solo/parasitologia , Ganho de Peso , Peso Corporal , Criança , Desenvolvimento Infantil/efeitos dos fármacos , Cognição , Doenças Endêmicas , Humanos , Enteropatias Parasitárias/complicações , Enteropatias Parasitárias/tratamento farmacológico , Saúde Pública , Ensaios Clínicos Controlados Aleatórios como Assunto
4.
BMC Infect Dis ; 19(1): 822, 2019 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-31533666

RESUMO

BACKGROUND: Current guidelines and targets for soil-transmitted helminth (STH) control focus on school-based deworming for school-age children, given the high risk of associated morbidity in this age group. However, expanding deworming to all age groups may achieve improved STH control among both the community in general and school-age children, by reducing their risk of reinfection. This trial aims to compare school-based targeted deworming with community-wide mass deworming in terms of impact on STH infections among school-age children. METHODS: The CoDe-STH (Community Deworming against STH) trial is a cluster-randomised controlled trial (RCT) in 64 primary schools in Dak Lak province, Vietnam. The control arm will receive one round of school-based targeted deworming with albendazole, while in the intervention arm, community-wide mass deworming with albendazole will be implemented alongside school-based deworming. Prevalence of STH infections will be measured in school-age children at baseline and 12 months following deworming. The primary outcome is hookworm prevalence in school-age children at 12 months, by quantitative PCR. Analysis will be intention-to-treat, with outcomes compared between study arms using generalised linear and non-linear mixed models. Additionally, cost-effectiveness of mass and targeted deworming will be calculated and compared, and focus group discussions and interviews will be used to assess acceptability and feasibility of deworming approaches. Individual based stochastic models will be used to predict the impact of mass and targeted deworming strategies beyond the RCT timeframe to assess the likelihood of parasite population 'bounce-back' if deworming is ceased due to low STH prevalence. DISCUSSION: The first large-scale trial comparing mass and targeted deworming for STH control in South East Asia will provide key information for policy makers regarding the optimal design of STH control programs. TRIAL REGISTRATION: ACTRN12619000309189 .


Assuntos
Antiprotozoários/uso terapêutico , Helmintíase/tratamento farmacológico , Helmintos/isolamento & purificação , Solo/parasitologia , Albendazol/uso terapêutico , Ancylostomatoidea/isolamento & purificação , Animais , Criança , Análise Custo-Benefício , Feminino , Helmintíase/economia , Helmintíase/epidemiologia , Humanos , Masculino , Prevalência , Vietnã/epidemiologia
5.
Acta Trop ; 200: 105181, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31542370

RESUMO

China was once a country plagued by parasitic diseases. At the beginning of the founding of the People's Republic of China, nearly 80% of the population suffered from parasitic diseases because of poverty and poor sanitary conditions. After nearly 70 years of development, China has made remarkable achievements in the prevention and control of parasitic diseases, and the prevalence of parasitic diseases has been greatly reduced. In addition to organizational leadership from the government and various preventive measures, drug treatment and drug research & development are important and irreplaceable links in prevention and control work. Since the 1950s, China has begun to introduce, produce and imitate antiparasitic drugs from abroad, such as santonin, benzimidazole, and praziquantel. Chinese scientists have also contributed to the optimization of production techniques, improvements in drug formulation, the application in the clinic and the mechanisms of actions of generic drugs. At the same time, China has independently developed tribendimidine (TrBD, a broad spectrum anthelminthic), and its anthelminthic spectrum has been comprehensively studied. It is active against almost 20 parasites, is especially superior to benzimidazoles against Necator americanus, and surpasses the effectiveness of praziquantel against Clonorchis sinensis. In the treatment of tapeworm disease, the traditional Chinese medicines pumpkin seeds and betel nuts have good curative effects for taeniasis. Chinese scientists have explored the action modes and clinical administration methods of pumpkin seeds and betel nuts, which is still the main clinical regimen for the disease. This paper reviews the history and progress of the study of anthelmintics in intestinal helminth infections since the founding of the People's Republic of China and aiming to support clinicians and drug researchers in China and other countries.


Assuntos
Anti-Helmínticos/história , Anti-Helmínticos/uso terapêutico , Infecções por Cestoides/tratamento farmacológico , Helmintíase/tratamento farmacológico , Enteropatias Parasitárias/tratamento farmacológico , Doenças Parasitárias/tratamento farmacológico , Doenças Parasitárias/história , Animais , Infecções por Cestoides/epidemiologia , Infecções por Cestoides/história , China/epidemiologia , Clonorchis sinensis/efeitos dos fármacos , Helmintíase/história , História do Século XX , História do Século XXI , Humanos , Enteropatias Parasitárias/história , Doenças Parasitárias/epidemiologia , Fenilenodiaminas/uso terapêutico , Praziquantel/história , Praziquantel/uso terapêutico , Teníase/tratamento farmacológico , Teníase/história
6.
Pan Afr Med J ; 33: 94, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31489072

RESUMO

Introduction: Soil-transmitted helminth infections (STHs) and schistosomiasis have serious consequences for the health, education and nutrition of children in developing countries. As Loum is known as a highly endemic commune for these infections, several deworming campaigns have been carried out in the past. The purpose of this study was to determine any changes that have occurred since then in the characteristics of these infections among schoolchildren in this site. Methods: A cross-sectional study was conducted in October 2016 on 289 schoolchildren. Stool and urine samples were collected and examined to determine the prevalence and intensity of helminth infections. Results: The highest prevalence was noted for Schistosoma haematobium (34.2%), followed by Ascaris lumbricoides (8.6%), S. mansoni (4.9%) and Trichuris trichiura (4.9%) in decreasing order. A prevalence of less than 2% was noted for each of the other two helminths. The highest mean intensity was found for S. haematobium (39.6 eggs/10 ml of urine), followed by A. lumbricoides (24.2 eggs per gram of faeces: epg), Strongyloides stercoralis (16.6 epg) and Schistosoma mansoni (12.3 epg). The prevalence of T. trichiura was significantly higher in boys and that of S. haematobium in children aged 10 years or older, while the differences between other values of prevalence or between egg burdens were not significant. Conclusion: Compared with values reported in 2003, the prevalence and intensity of schistosomiases and STH infections in Loum has sharply decreased in 2016. Confirmation of this decrease in the years to come allowed to space deworming campaigns among schoolchildren.


Assuntos
Anti-Helmínticos/administração & dosagem , Helmintíase/epidemiologia , Esquistossomose/epidemiologia , Solo/parasitologia , Adolescente , Camarões/epidemiologia , Criança , Pré-Escolar , Estudos Transversais , Fezes/parasitologia , Feminino , Helmintíase/tratamento farmacológico , Helmintíase/parasitologia , Humanos , Masculino , Prevalência , Esquistossomose/tratamento farmacológico , Esquistossomose/parasitologia , Fatores Sexuais
7.
PLoS Negl Trop Dis ; 13(8): e0007471, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31369562

RESUMO

BACKGROUND: Preventive chemotherapy (PC) with benzimidazole drugs is the backbone of soil-transmitted helminth (STH) control programs. Over the past decade, drug coverage has increased and with it, the possibility of developing anthelmintic resistance. It is therefore of utmost importance to monitor drug efficacy. Currently, a variety of novel diagnostic methods are available, but it remains unclear whether they can be used to monitor drug efficacy. In this study, we compared the efficacy of albendazole (ALB) measured by different diagnostic methods in a head-to-head comparison to the recommended single Kato-Katz. METHODS: An ALB efficacy trial was performed in 3 different STH-endemic countries (Ethiopia, Lao PDR and Tanzania), each with a different PC-history. During these trials, stool samples were evaluated with Kato-Katz (single and duplicate), Mini-FLOTAC, FECPAKG2, and qPCR. The reduction rate in mean eggs per gram of stool (ERR) and mean genome equivalents / ml of DNA extract (GERR) were calculated to estimate drug efficacy. PRINCIPAL FINDINGS AND CONCLUSIONS: The results of the efficacy trials showed that none of the evaluated diagnostic methods could provide reduction rates that were equivalent to a single Kato-Katz for all STH. However, despite differences in clinical sensitivity and egg counts, they agreed in classifying efficacy according to World Health Organization (WHO) guidelines. This demonstrates that diagnostic methods for assessing drug efficacy should be validated with their intended-use in mind and that other factors like user-friendliness and costs will likely be important factors in driving the choice of diagnostics. In addition, ALB efficacy against STH infections was lower in sites with a longer history of PC. Yet, further research is needed to identify factors that contribute to this finding and to verify whether reduced efficacy can be associated with mutations in the ß-tubulin gene that have previously been linked to anthelmintic resistance. TRIAL REGISTRATION: ClinicalTrials.gov NCT03465488.


Assuntos
Albendazol/uso terapêutico , Anti-Helmínticos/uso terapêutico , Helmintíase/diagnóstico , Helmintíase/tratamento farmacológico , Solo/parasitologia , Administração Oral , Albendazol/administração & dosagem , Animais , Brasil , Criança , Testes Diagnósticos de Rotina/métodos , Etiópia , Fezes/parasitologia , Feminino , Helmintos/genética , Humanos , Laos , Masculino , Contagem de Ovos de Parasitas/métodos , Sensibilidade e Especificidade , Tanzânia , Tubulina (Proteína)/genética , Organização Mundial da Saúde
9.
Immunol Allergy Clin North Am ; 39(3): 417-427, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31284930

RESUMO

Helminth infections may inhibit the development of allergic diseases, including asthma. On the other hand, some helminth species may induce or worsen symptoms of asthma. This article discusses the impact of helminth infections on asthma as well as the potencial of helminth-derived molecules with regulatory characteristics in the prevention or treatment of this disease. The ability to induce regulation has been observed in animal models of asthma or cells of asthmatic individuals in vitro. Potential future clinical applications of helminth antigens or infection for prevention of asthma merit further translational research.


Assuntos
Asma/etiologia , Suscetibilidade a Doenças , Helmintíase/complicações , Helmintíase/imunologia , Helmintos/imunologia , Interações Hospedeiro-Parasita , Animais , Anti-Helmínticos/farmacologia , Anti-Helmínticos/uso terapêutico , Suscetibilidade a Doenças/imunologia , Helmintíase/tratamento farmacológico , Helmintíase/parasitologia , Interações Hospedeiro-Parasita/imunologia , Humanos , Imunomodulação/efeitos dos fármacos
10.
Pan Afr Med J ; 32: 96, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31231453

RESUMO

Introduction: Controlling vitamin A deficiency and soil-transmitted helminth infections are public health imperatives. We aimed at revealing some caregiver and child-related determinants of uptake of vitamin A supplementation and deworming, and examine their programmatic implications in Kenyan context. Methods: A cross-sectional study of randomly selected 1,177 households with infants and young children aged 6-59 months in three of the 47 counties of Kenya. The number of times a child was given vitamin A supplements and dewormed 6 months and one year preceding the study was extracted from mother-child health books. Results: Coverage for age-specific deworming was considerably depressed compared to corresponding vitamin A supplementation and for both services, twice-yearly provisions were disproportionately lower than half-yearly. Univariate and multivariate analyses showed relatively younger children, of Islam-affiliated caregivers (vis a vis Christians) and those who took less time to nearest health facilities as more likely to be supplemented with vitamin A. Similar observations were made for deworming where additionally, maternal and child ages were also determinants in favour of older groups. Other studied factors were not significant determinants. Programmatic allusions of the determining factors were discussed. Conclusion: Key to improving uptake of vitamin A supplementation and deworming among Kenyan 6-59 months olds are: increasing access to functional health facilities, expanding outreaches and campaigns, dispelling faith-related misconceptions and probably modulating caregiver and child age effects by complementing nutrition literacy with robust and innovative caregiver reminders. Given analogous service points and scheduling, relative lower uptake of deworming warrants further investigations.


Assuntos
Anti-Helmínticos/administração & dosagem , Helmintíase/tratamento farmacológico , Deficiência de Vitamina A/tratamento farmacológico , Vitamina A/administração & dosagem , Cuidadores , Pré-Escolar , Estudos Transversais , Suplementos Nutricionais , Feminino , Acesso aos Serviços de Saúde , Helmintíase/transmissão , Humanos , Lactente , Quênia , Masculino , Estado Nutricional , Religião , População Rural , Solo/parasitologia
11.
Vet Parasitol ; 270 Suppl 1: S38-S44, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31104940

RESUMO

The efficacy and safety of a new topical formulation containing selamectin plus sarolaner (Revolution® Plus / Stronghold® Plus, Zoetis) was evaluated for the prevention of heartworm (Dirofilaria immitis) disease and the treatment of roundworm infection in cats enrolled as veterinary patients in two field studies conducted in Japan. In the heartworm field study, 91 cats negative for D. immitis antigen and anti-D. immitis antibody were enrolled and received 9 monthly topical treatments with selamectin plus sarolaner during the period of April to December 2015. Efficacy was assessed by testing post-treatment blood samples collected 8, 12, and 15 months after initiation of treatment for the presence of D. immitis antigen and anti-D. immitis antibody. Eighty-seven cats completed the entire study and were included in the determination of efficacy. No D. immitis antigen or anti-D. immitis antibody were detected in any of the post-treatment samples. In the roundworm field study, completed in the period from April to November 2015, 64 cats with ≥100 roundworm eggs per gram (EPG) of feces were enrolled and allocated randomly in a 1:1 ratio, to receive either selamectin plus sarolaner or emodepside plus praziquantel (Profender®, Bayer). Treatments were administered topically on Days 0 and 30, and efficacy was assessed by fecal EPG counts conducted on Days 14, 30, and 60. All cats completed the entire study. At enrollment, all cats were infected with Toxocara cati. Compared to pre-treatment, geometric mean T. cati EPG counts on Days 14, 30, and 60 were reduced by >99.9% in both treatment groups. There were no treatment-related adverse events in either study. Monthly topical administration of Revolution® Plus / Stronghold® Plus providing a minimum of 6 mg/kg selamectin and 1 mg/kg sarolaner was safe and effective in the prevention of heartworm disease and the treatment of roundworm infection in cats enrolled as veterinary patients in Japan.


Assuntos
Antiparasitários/administração & dosagem , Azetidinas/administração & dosagem , Doenças do Gato/prevenção & controle , Dirofilariose/prevenção & controle , Enteropatias Parasitárias/veterinária , Ivermectina/análogos & derivados , Infecções por Nematoides/veterinária , Compostos de Espiro/administração & dosagem , Administração Tópica , Animais , Doenças do Gato/tratamento farmacológico , Doenças do Gato/parasitologia , Gatos , Dirofilaria immitis/efeitos dos fármacos , Dirofilaria immitis/imunologia , Dirofilariose/tratamento farmacológico , Dirofilariose/parasitologia , Composição de Medicamentos/veterinária , Feminino , Helmintíase/tratamento farmacológico , Helmintíase/parasitologia , Helmintíase/prevenção & controle , Enteropatias Parasitárias/tratamento farmacológico , Enteropatias Parasitárias/parasitologia , Enteropatias Parasitárias/prevenção & controle , Ivermectina/administração & dosagem , Masculino , Infecções por Nematoides/tratamento farmacológico , Infecções por Nematoides/parasitologia , Infecções por Nematoides/prevenção & controle , Contagem de Ovos de Parasitas/veterinária , Distribuição Aleatória , Toxocara/efeitos dos fármacos , Resultado do Tratamento
12.
Georgian Med News ; (288): 125-131, 2019 Mar.
Artigo em Russo | MEDLINE | ID: mdl-31101791

RESUMO

Helminth infestations, including trematodoses, are a group of the most common diseases in the world. Trematodoses cause significant damage to human health, lead to various complications, which also causes significant economic damage. To develop effective anthelmintic drugs, it is necessary to study the structure and physiology of parasites and interaction with the host body. To create specific anthelmintic drugs, it is necessary to study the features of biochemistry and molecular biology of the structural components of the covers of trematodes. The is important role of the tegument in the evasion of the immune response. The trematode tegument antigens are good candidates for the development of anthelmintic vaccines. It is important to study the trematode genome and identify specific enzyme systems. Proteases of tegument of trematodes are digestive enzymes that can destroy the immunoglobulins of the host to modulate the immune response. Identification of specific differences in protein and enzyme systems will create more effective drugs for the treatment of helminthiasis.


Assuntos
Anti-Helmínticos , Helmintíase , Trematódeos , Animais , Anti-Helmínticos/farmacologia , Helmintíase/tratamento farmacológico , Humanos , Trematódeos/efeitos dos fármacos , Vacinas
13.
PLoS Negl Trop Dis ; 13(5): e0007406, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-31083673

RESUMO

BACKGROUND: The World Health Organization has recently reemphasized the importance of providing preventive chemotherapy to women of reproductive age in countries endemic for soil-transmitted helminthiasis as they are at heightened risk of associated morbidity. The Demographic and Health Surveys (DHS) Program is responsible for collecting and disseminating accurate, nationally representative data on health and population in developing countries. Our study aims to estimate the number of pregnant women at risk of soil-transmitted helminthiasis that self-reported deworming by antenatal services in endemic countries that conducted Demographic and Health Surveys. METHODOLOGY/PRINCIPAL FINDINGS: The number of pregnant women living in endemic countries was extrapolated from the United Nations World Population Prospects 2015. National deworming coverage among pregnant women were extracted from Demographic and Health Surveys and applied to total numbers of pregnant women in the country. Sub-national DHS with data on self-reported deworming were available from 49 of the 102 endemic countries. In some regions more than 73% of STH endemic countries had a DHS. The DHS report an average deworming coverage of 23% (CI 19-28), ranging from 2% (CI 1-3) to 35% (CI 29-40) in the different regions, meaning more than 16 million pregnant women were dewormed in countries surveyed by DHS. The deworming rates amongst the 43 million pregnant women in STH endemic countries not surveyed by DHS remains unknown. CONCLUSIONS/SIGNIFICANCE: These estimates will serve to establish baseline numbers of deworming coverage among pregnant women, monitor progress, and urge endemic countries to continue working toward reducing the burden of soil-transmitted helminthiasis. The DHS program should be extended to STH-endemic countries currently not covering the topic of deworming during pregnancy.


Assuntos
Anti-Helmínticos/uso terapêutico , Helmintíase/tratamento farmacológico , Helmintos/isolamento & purificação , Complicações Parasitárias na Gravidez/tratamento farmacológico , Solo/parasitologia , Adulto , África/epidemiologia , Animais , Ásia/epidemiologia , Doenças Endêmicas/prevenção & controle , Feminino , Helmintíase/epidemiologia , Helmintos/classificação , Helmintos/genética , Humanos , Gravidez , Complicações Parasitárias na Gravidez/epidemiologia , Autorrelato , América do Sul/epidemiologia , Organização Mundial da Saúde , Adulto Jovem
14.
Adv Parasitol ; 104: 247-326, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31030770

RESUMO

Soil-transmitted helminth (STH) infections represent a major public health problem globally, particularly among socio-economically disadvantaged populations. Detection of STH infections is often challenging, requiring a combination of diagnostic techniques to achieve acceptable sensitivity and specificity, particularly in low infection-intensity situations. The microscopy-based Kato-Katz remains the most widely used method but has low sensitivity in the detection of, for instance, Strongyloides spp. infections, among others. Antigen/antibody assays can be more sensitive but are parasite species-specific. Highly sensitive PCR methods have been developed to be multiplexed to allow multi-species detection. Novel diagnostic tests for all STH species are needed for effective monitoring, evaluation of chemotherapy programmes, and to assess the potential emergence of parasite resistance. This review discusses available diagnostic methods for the different stages of STH control programmes, which vary in sensitivity and spectrum of detection requirements, and tools to evaluate drug efficacy and resistance.


Assuntos
Resistência a Medicamentos , Helmintíase/parasitologia , Saúde Pública , Animais , Anti-Helmínticos/farmacologia , Helmintíase/diagnóstico , Helmintíase/tratamento farmacológico , Helmintíase/prevenção & controle , Helmintos/efeitos dos fármacos , Humanos , Reação em Cadeia da Polimerase , Solo/parasitologia
15.
Adv Parasitol ; 103: 11-30, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30878055

RESUMO

Parasitic helminth infections remain a significant challenge to global health. These are highly prevalent diseases, affecting over 1 billion persons worldwide. Their prevalence is closely linked to the presence of severe poverty and its associated sub-standard housing and sanitation. The last decade has seen a remarkable increase in our understanding of the true disease burden of helminth infections, and there has been increasing momentum on the part of national and non-governmental developmental organizations for prevention and control of these diseases. The expansion in mass treatment programmes for their control has yielded some significant successes. However, challenges remain in terms of ecological heterogeneity in transmission, incomplete drug uptake, and the likelihood of emerging drug resistance. The development of new, more-sensitive diagnostics is now broadening our knowledge of infection prevalence and of the risk of reinfection and has enhanced our knowledge of the prevalence of concurrent helminth infections. Adoption of these new diagnostic techniques for large-scale screening and surveillance will require adaptation of current mass treatment guidelines for control as programmes move from initial morbidity control objectives toward coordinated interventions aimed at local elimination.


Assuntos
Helmintíase/epidemiologia , Helmintíase/prevenção & controle , Animais , Anti-Helmínticos/uso terapêutico , Helmintíase/diagnóstico , Helmintíase/tratamento farmacológico , Humanos , Vigilância da População , Prevalência
16.
Adv Parasitol ; 103: 91-115, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30878060

RESUMO

The soil-transmitted helminths (STHs), Ascaris lumbricoides, hookworm and Trichuris trichiura are common in areas with warm and moist climates with little access to adequate water, sanitation, and hygiene affecting the poorest populations. The current control strategy of the World Health Organization is preventive chemotherapy (PC), i.e., the administration of the two benzimidazoles (albendazole and mebendazole) using single, oral doses to at risk populations without prior diagnosis. The recent success of PC is threatened by anthelmintic drug resistance and the low efficacy of the drugs against hookworm (mebendazole) and T. trichiura (albendazole and mebendazole). Only a handful of alternative drugs with anthelmintic properties are available, however, none of the drugs show high efficacy against all three STHs. The combination of two drugs with different activity profiles presents an attractive alternative, which could prevent the development of drug resistance and increase the efficacy compared to monotherapy. In this review, we summarize the efficacy of current and alternative anthelmintics, coadministrations and triple drug therapies assessed by means of network meta-analysis including only randomized controlled trials. Our results highlight that coadministrations have improved efficacy over monotherapy and the necessity of adapting current STH control strategies for the successful continuation of PC programs.


Assuntos
Anti-Helmínticos/administração & dosagem , Quimioterapia Combinada , Helmintíase/tratamento farmacológico , Animais , Anti-Helmínticos/farmacologia , Helmintíase/prevenção & controle , Helmintos/efeitos dos fármacos , Humanos , Solo/parasitologia
17.
BMC Med ; 17(1): 69, 2019 03 28.
Artigo em Inglês | MEDLINE | ID: mdl-30917824

RESUMO

BACKGROUND: The most prevalent neglected tropical diseases are treated through blanket drug distribution that is reliant on lay community medicine distributors (CMDs). Yet, treatment rates achieved by CMDs vary widely and it is not known which CMDs treat the most people. METHODS: In Mayuge District, Uganda, we tracked 6779 individuals (aged 1+ years) in 1238 households across 31 villages. Routine, community-based mass drug administration (MDA) was implemented for schistosomiasis, lymphatic filariasis, and soil-transmitted helminths. For each CMD, the percentage of eligible individuals treated (offered and ingested medicines) with at least one drug of praziquantel, albendazole, or ivermectin was examined. CMD attributes (more than 25) were measured, ranging from altruistic tendencies to socioeconomic characteristics to MDA-specific variables. The predictors of treatment rates achieved by CMDs were selected with least absolute shrinkage and selection operators and then analyzed in ordinary least squares regression with standard errors clustered by village. The influences of participant compliance and the ordering of drugs offered also were examined for the treatment rates achieved by CMDs. RESULTS: Overall, only 44.89% (3043/6779) of eligible individuals were treated with at least one drug. Treatment rates varied amongst CMDs from 0% to 84.25%. Treatment rate increases were associated (p value< 0.05) with CMDs who displayed altruistic biases towards their friends (13.88%), had friends who helped with MDA (8.43%), were male (11.96%), worked as fishermen/fishmongers (14.93%), and used protected drinking water sources (13.43%). Only 0.24% (16/6779) of all eligible individuals were noncompliant by refusing to ingest all offered drugs. Distributing praziquantel first was strongly, positively correlated (p value < 0.0001) with treatment rates for albendazole and ivermectin. CONCLUSIONS: These findings profile CMDs who treat the most people during routine MDA. Criteria currently used to select CMDs-community-wide meetings, educational attainment, age, years as a CMD, etc.-were uninformative. Participant noncompliance and the provision of praziquantel before albendazole and ivermectin did not negatively impact treatment rates achieved by CMDs. Engaging CMD friend groups with MDA, selecting CMDs who practise good preventative health behaviours, and including CMDs with high-risk occupations for endemic infections may improve MDA treatment rates. Evidence-based guidelines are needed to improve the monitoring, selection, and replacement of CMDs during MDA.


Assuntos
Antiparasitários/uso terapêutico , Medicina Comunitária/organização & administração , Assistência à Saúde/organização & administração , Filariose Linfática/tratamento farmacológico , Helmintíase/tratamento farmacológico , Administração Massiva de Medicamentos , Esquistossomose/tratamento farmacológico , Solo/parasitologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Animais , Criança , Pré-Escolar , Medicina Comunitária/normas , Medicina Comunitária/estatística & dados numéricos , Assistência à Saúde/normas , Assistência à Saúde/estatística & dados numéricos , Eficiência Organizacional , Filariose Linfática/epidemiologia , Filariose Linfática/transmissão , Feminino , Helmintíase/epidemiologia , Helmintíase/transmissão , Humanos , Lactente , Masculino , Administração Massiva de Medicamentos/métodos , Administração Massiva de Medicamentos/normas , Administração Massiva de Medicamentos/estatística & dados numéricos , Pessoa de Meia-Idade , Prevalência , Esquistossomose/epidemiologia , Esquistossomose/transmissão , Uganda/epidemiologia , Desempenho Profissional , Adulto Jovem
20.
Parasit Vectors ; 12(1): 76, 2019 Feb 07.
Artigo em Inglês | MEDLINE | ID: mdl-30732642

RESUMO

BACKGROUND: Soil-transmitted helminth (STH) and schistosome infections are among the most prevalent neglected tropical diseases (NTDs) in the world. School-aged children are particularly vulnerable to these chronic infections that can impair growth, nutritional status and cognitive ability. Mass drug administration (MDA) delivered either once or twice annually is a safe and effective approach recommended by the World Health Organization (WHO) to reduce worm burden. In 2012, Kenya began a national school-based deworming programme (NSBDP) aimed at reducing infection and associated morbidity. The change in prevalence and intensity of these infections was monitored over five years (2012-2017). Here, we present the changes in STH and schistosome infections between baseline and endline assessments, as well as explore the yearly patterns of infection reductions. METHODS: We used series of pre- and post-MDA intervention, repeat cross-sectional surveys in a representative, stratified, two-stage sample of schools in 16 counties of Kenya. The programme consisted of two tiers of monitoring; a national baseline, midterm and endline surveys consisting of 200 schools, and pre- and post-MDA surveys conducted yearly consisting of 60 schools. Stool and urine samples were collected from randomly selected school children and examined for STH and schistosome infections using Kato-Katz and urine filtration techniques respectively. RESULTS: Overall, 32.3%, 16.4% and 13.5% of the children were infected with any STH species during baseline, midterm and endline assessment, respectively, with a relative reduction of 58.2% over the five-year period. The overall prevalence of S. mansoni was 2.1%, 1.5% and 1.7% and of S. haematobium was 14.8%, 6.8% and 2.4%, respectively, for baseline, midterm and endline surveys. We observed inter-region and inter-county heterogeneity variation in the infection levels. CONCLUSIONS: The analysis provided robust assessment of the programme and outlined the current prevalence, mean intensity and re-infection pattern of these infections. Our findings will allow the Government of Kenya to make informed decisions on the strategy to control and eliminate these NTDs. Our results suggest that complimentary interventions may have to be introduced to sustain the chemotherapeutic gains of MDA and accelerate attainment of elimination of these NTDs as a public health problem in Kenya.


Assuntos
Anti-Helmínticos/uso terapêutico , Helmintíase/epidemiologia , Esquistossomose/tratamento farmacológico , Esquistossomose/epidemiologia , Adolescente , Animais , Criança , Pré-Escolar , Estudos Transversais , Fezes/parasitologia , Feminino , Helmintíase/tratamento farmacológico , Helmintos , Humanos , Quênia/epidemiologia , Masculino , Administração Massiva de Medicamentos , Prevalência , Schistosoma , Instituições Acadêmicas , Solo/parasitologia , Inquéritos e Questionários , Adulto Jovem
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