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1.
Lancet ; 393(10185): 2039-2050, 2019 05 18.
Artigo em Inglês | MEDLINE | ID: mdl-31006575

RESUMO

BACKGROUND: School-based deworming programmes can reduce morbidity attributable to soil-transmitted helminths in children but do not interrupt transmission in the wider community. We assessed the effects of alternative mass treatment strategies on community soil-transmitted helminth infection. METHODS: In this cluster-randomised controlled trial, 120 community units (clusters) serving 150 000 households in Kenya were randomly assigned (1:1:1) to receive albendazole through annual school-based treatment targeting 2-14 year olds or annual or biannual community-wide treatment targeting all ages. The primary outcome was community hookworm prevalence, assessed at 12 and 24 months through repeat cross-sectional surveys. Secondary outcomes were Ascaris lumbricoides and Trichuris trichiura prevalence, infection intensity of each soil-transmitted helminth species, and treatment coverage and costs. Analysis was by intention to treat. This trial is registered with ClinicalTrials.gov, number NCT02397772. FINDINGS: After 24 months, prevalence of hookworm changed from 18·6% (95% CI 13·9-23·2) to 13·8% (10·5-17·0) in the annual school-based treatment group, 17·9% (13·7-22·1) to 8·0% (6·0-10·1) in the annual community-wide treatment group, and 20·6% (15·8-25·5) to 6·2% (4·9-7·5) in the biannual community-wide treatment group. Relative to annual school-based treatment, the risk ratio for annual community-wide treatment was 0·59 (95% CI 0·42-0·83; p<0·001) and for biannual community-wide treatment was 0·46 (0·33-0·63; p<0·001). More modest reductions in risk were observed after 12 months. Risk ratios were similar across demographic and socioeconomic subgroups after 24 months. No adverse events related to albendazole were reported. INTERPRETATION: Community-wide treatment was more effective in reducing hookworm prevalence and intensity than school-based treatment, with little additional benefit of treating every 6 months, and was shown to be remarkably equitable in coverage and effects. FUNDING: Bill & Melinda Gates Foundation, the Joint Global Health Trials Scheme of the Medical Research Council, the UK Department for International Development, the Wellcome Trust, and the Children's Investment Fund Foundation.


Assuntos
Albendazol/uso terapêutico , Anti-Helmínticos/uso terapêutico , Ascaríase/tratamento farmacológico , Infecções por Uncinaria/tratamento farmacológico , Solo/parasitologia , Tricuríase/tratamento farmacológico , Adolescente , Adulto , Animais , Ascaríase/diagnóstico , Ascaríase/epidemiologia , Ascaris lumbricoides , Criança , Pré-Escolar , Estudos Transversais , Feminino , Infecções por Uncinaria/diagnóstico , Infecções por Uncinaria/epidemiologia , Humanos , Análise de Intenção de Tratamento , Quênia/epidemiologia , Masculino , Pessoa de Meia-Idade , Prevalência , Saúde Pública/economia , Saúde Pública/estatística & dados numéricos , Serviços de Saúde Escolar/economia , Serviços de Saúde Escolar/estatística & dados numéricos , Tricuríase/diagnóstico , Tricuríase/epidemiologia , Trichuris , Adulto Jovem
2.
PLoS Negl Trop Dis ; 12(6): e0006562, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29864132

RESUMO

BACKGROUND: Over one billion people are infected with soil-transmitted helminths (STH), i.e. Ascaris lumbricoides, hookworm and Trichuris trichiura. For estimating drug efficacy and monitoring anthelminthic drug resistance, accurate diagnostic methods are critical. FECPAKG2 is a new remote-diagnostic tool used in veterinary medicine, which produces an image of the stool sample that can be stored on an internet cloud. We compared for the first time FECPAKG2 with the recommended Kato-Katz method. METHODOLOGY/PRINCIPAL FINDINGS: Two stool samples were collected from adolescent participants (age 15-18 years) at baseline and 14 to 21 days after treatment in the framework of a randomized clinical trial on Pemba Island, Tanzania. Stool samples were analyzed with different diagnostic efforts: i) one or ii) two Kato-Katz thick smears from the first sample, iii) two Kato-Katz thick smears from two samples and iv) FECPAKG2 from the first sample. Parameters were calculated based on a hierarchical Bayesian egg count model. Complete data for all diagnostic efforts were available from 615 participants at baseline and 231 hookworm-positive participants at follow-up. At baseline FECPAKG2 revealed a sensitivity of 75.6% (72.0-77.7) for detecting A. lumbricoides, 71.5% (67.4-95.3) for hookworm and 65.8% (64.9-66.2) for T. trichiura, which was significantly lower (all p<0.05) than any of the Kato-Katz methods and highly dependent on infection intensity. Despite that the egg counts based on FECPAKG2 were relatively lower compared to Kato-Katz by a ratio of 0.38 (0.32-0.43) for A. lumbricoides, 0.36 (0.33-0.40) for hookworm and 0.08 (0.07-0.09) for T. trichiura, the egg reduction rates (ERR) were correctly estimated with FECPAKG2. CONCLUSIONS/SIGNIFICANCE: The sensitivity to identify any STH infection was considerably lower for FECPAKG2 compared to Kato-Katz. Following rigorous development, FECPAKG2 might be an interesting tool with unique features for epidemiological and clinical studies.


Assuntos
Ascaríase/diagnóstico , Fezes/parasitologia , Contagem de Ovos de Parasitas/métodos , Solo/parasitologia , Tricuríase/diagnóstico , Adolescente , Animais , Ascaríase/epidemiologia , Ascaríase/parasitologia , Ascaríase/transmissão , Ascaris lumbricoides/isolamento & purificação , Teorema de Bayes , Feminino , Helmintíase/diagnóstico , Helmintíase/epidemiologia , Helmintíase/parasitologia , Helmintíase/transmissão , Helmintos/isolamento & purificação , Humanos , Enteropatias Parasitárias/diagnóstico , Enteropatias Parasitárias/epidemiologia , Enteropatias Parasitárias/parasitologia , Masculino , Kit de Reagentes para Diagnóstico , Sensibilidade e Especificidade , Manejo de Espécimes/métodos , Tanzânia/epidemiologia , Tricuríase/epidemiologia , Tricuríase/parasitologia , Tricuríase/transmissão , Trichuris/isolamento & purificação
3.
Vet Parasitol Reg Stud Reports ; 14: 181-186, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-31014727

RESUMO

Trichuris felis, the whipworm of cats, is a relatively rare parasite, although more common in tropical and sub-tropical regions such as the Caribbean and South America. In southern Florida, T. felis is known to occur, but estimating prevalence can be challenging using fecal egg counts due to low intensity and single sex infections. A microplate enzyme-linked immunosorbent assays (ELISAs) for parasite-specific antigen in feces could increase the ability to detect these infections. In this study, the IDEXX Fecal Dx™ antigen ELISA for whipworm (designed for detection of Trichuris vulpis) was evaluated for detection of T. felis using 35 feral cats from St. Kitts, euthanized for non-study related reasons. Twenty-nine of the cats were positive for T. felis with worm counts ranging from 1 to 66 per cat (mean 9.6) and egg counts ranging from 0 to >500 (mean 109.8). The ELISA detected 26 of 29 positive cats while flotation (centrifugation with Sheather's sugar solution) detected 24 of the 29 positive cats. To estimate prevalence in southern Florida, feces from 65 feral cats from the greater Miami area were tested using the ELISA and fecal flotation (centrifugation with zinc sulfate). Twenty-five cats (38%) were identified as positive with the ELISA compared to 17 using fecal flotation. This prevalence was surprising and further investigated by reviewing results of feline samples from Florida submitted to IDEXX Reference Laboratories between 2010 and 2017 and analyzed using fecal flotation. While prevalence was below 1%, there was an apparent trend in increasing prevalence. The results of this study confirm that the IDEXX Fecal Dx™ antigen test for whipworm ELISA, while developed for T. vulpis, can detect T. felis infections. It also suggests that prevalence might be higher than previously known in Florida and might be increasing. Further studies are required to determine the distribution of this higher prevalence and if the distribution and prevalence of T. felis are changing.


Assuntos
Animais Selvagens/parasitologia , Antígenos de Helmintos/imunologia , Doenças do Gato/diagnóstico , Doenças do Gato/epidemiologia , Tricuríase/veterinária , Animais , Gatos/parasitologia , Ensaio de Imunoadsorção Enzimática , Fezes/parasitologia , Feminino , Florida/epidemiologia , Masculino , Prevalência , Tricuríase/diagnóstico , Tricuríase/epidemiologia
4.
Rev Chilena Infectol ; 35(5): 501-508, 2018.
Artigo em Espanhol | MEDLINE | ID: mdl-30724997

RESUMO

INTRODUCTION: Currently, Paraguay has no data on the prevalence of soil-transmitted geohelminth infection in schoolchildren aged 6 to 12 years. AIM: To determine the prevalence and intensity of infection by Ascaris lumbricoides, Trichuris trichiura and hookworms and the socio-cultural-environmental characteristics of the affected population. METHODS: Descriptive, cross-sectional study, in three semi-tropical climatic zones: continental, semi steppe and humid. A total of 1,404 schoolchildren from 20 schools in eight departments were selected from the country's three climate zones. Copro-parasitological exams were analyzed in situ with the Kato-Katz method. RESULTS: The national prevalence for geohelminthiasis was 3.73% (95% CI = 2.8-4.8). The risk factors found were consumption of well water OR: 2.88 (95% CI = 1.64-2.07), ground floor in housing OR: 2.56 (95% CI = 1.45-4.50) and lack of flushing water baths in households OR: 2.29 (95% CI = 1.23-4.28). CONCLUSION: Although the national prevalence of geohelminthiasis was low, it is recommended to promote good hygienic practices, use of footwear, and safe water consumption, as well as designing interventions with all relevant sectors to improve access to safe water and improved basic sanitation facilities.


Assuntos
Ascaríase/epidemiologia , Ascaris lumbricoides/isolamento & purificação , Fezes/parasitologia , Tricuríase/epidemiologia , Trichuris/isolamento & purificação , Animais , Ascaríase/diagnóstico , Criança , Estudos Transversais , Características Culturais , Feminino , Humanos , Masculino , Paraguai/epidemiologia , Prevalência , Fatores de Risco , Fatores Socioeconômicos , Tricuríase/diagnóstico
5.
Vet Parasitol Reg Stud Reports ; 11: 22-26, 2018 01.
Artigo em Inglês | MEDLINE | ID: mdl-31014613

RESUMO

The population of African green monkeys (AGM, Chlorocebus aethiops sabaeus) on St. Kitts, West Indies is believed to be as large as or greater than the human population. Interactions with humans are frequent and the pathogens carried by AGM, such as Trichuris spp., may pose a risk to humans. The objectives of this study were to assess the use of molecular methods for diagnosing Trichuris spp. in AGM and compare its DNA sequences to those of Trichuris spp. found in other non-human primates and humans. Fecal samples were collected from trapped and individually housed AGM between January and December 2015 and analysed using fecal flotation with Sheather's sugar flotation solution and PCR amplification and DNA sequencing of 18S rRNA and ITS2 fragments. Phylogenetic analysis was performed. 91% (81/89) and 55.4% (31/56) were Trichuris spp. positive by fecal flotation and PCR, respectively. Both AGM-NADH1 gene and T. trichiura-18S rRNA gene showed no variations in sequence and were 100% identical to corresponding sequences deposited in GenBank. Nevertheless Trichuris ITS2 showed some diversities among 12 sequences, which was <5%. Phylogenetic analysis of ITS2 put Trichuris spp. in Kittitian AGM into the same clades of T. trichiura found in human and other non-human primates in many other geographical regions. These data confirm that AGM are reservoirs for T. trichiura in humans. We suggest a one health approach to curtail enteric parasitic infections in human populations in the insular country.


Assuntos
Cercopithecus aethiops/parasitologia , DNA de Helmintos/genética , Reservatórios de Doenças/veterinária , Tricuríase/veterinária , Trichuris/classificação , Animais , Reservatórios de Doenças/parasitologia , Fezes/parasitologia , Humanos , NADH NADPH Oxirredutases/genética , Filogenia , Reação em Cadeia da Polimerase , RNA Ribossômico 18S/genética , Análise de Sequência de DNA , Tricuríase/diagnóstico , Tricuríase/parasitologia , Índias Ocidentais
6.
PLoS Negl Trop Dis ; 11(11): e0006022, 2017 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-29108026

RESUMO

BACKGROUND: Soil-transmitted helminths (STH) are the most common parasitic infections in impoverished communities, particularly among children. Current STH control is through school-based mass drug administration (MDA), which in the Philippines is done twice annually. As expected, MDA has decreased the intensity and prevalence of STH over time. As a result, the common Kato Katz (KK) thick smear method of detecting STH is less effective because it lacks sensitivity in low intensity infections, making it difficult to measure the impact of deworming programs. METHODOLOGY/PRINCIPAL FINDINGS: A cross-sectional study was carried out over a four-week period from October 27, 2014 until November 20, 2014 in Laguna province, the Philippines. Stool samples were collected from 263 schoolchildren, to determine the prevalence of STH and compare diagnostic accuracy of multiplex quantitative polymerase chain reaction (qPCR) with the KK. A large discrepancy in the prevalence between the two techniques was noted for the detection of at least one type of STH infection (33.8% by KK vs. 78.3% by qPCR), Ascaris lumbricoides (20.5% by KK vs. 60.8% by qPCR) and Trichuris trichiura (23.6% by KK vs. 38.8% by qPCR). Considering the combined results of both methods, the prevalence of at least one type of helminth infection, A. lumbricoides, and T. trichiura were 83.3%, 67.7%, and 53.6%, respectively. Sensitivity of the qPCR for detecting at least one type of STH infection, A. lumbricoides, and T. trichiura were 94.1%, 89.9%, and 72.3% respectively; whereas KK sensitivity was 40.6%, 30.3%, and 44.0%, respectively. The qPCR method also detected infections with Ancylostoma spp. (4.6%), Necator americanus (2.3%), and Strongyloides stercoralis (0.8%) that were missed by KK. CONCLUSION/SIGNIFICANCE: qPCR may provide new and important diagnostic information to improve assessment of the effectiveness and impact of integrated control strategies particularly in areas where large-scale STH control has led to low prevalence and/or intensity of infection.


Assuntos
Ascaríase/diagnóstico , Ascaríase/epidemiologia , Ascaris lumbricoides/isolamento & purificação , Solo/parasitologia , Tricuríase/diagnóstico , Tricuríase/epidemiologia , Animais , Ascaríase/parasitologia , Criança , Estudos Transversais , Fezes/parasitologia , Feminino , Humanos , Masculino , Contagem de Ovos de Parasitas , Filipinas/epidemiologia , Prevalência , Instituições Acadêmicas , Sensibilidade e Especificidade , Tricuríase/parasitologia , Trichuris/isolamento & purificação
7.
Indian J Gastroenterol ; 36(5): 420-423, 2017 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-29058208

RESUMO

Diagnosis of Trichuris trichiura infestations is usually based on identification of barrel-shaped ova in stool, but is frequently missed on stool microscopy. We describe the clinical profile of patients in whom Trichuris infection was incidentally diagnosed at colonoscopy. In a cross-sectional study, patients with colonoscopic diagnosis of trichuriasis were enrolled from the endoscopy unit in a tertiary care center. Blood and stool samples were collected from all those who were willing to participate and provide samples. Sixty-two patients participated, with mean (SD) age of 50.5 (13.6) years and male to female ratio of 40:22. Abdominal pain (61.2%) and/or altered bowel habits (32.2%) were the most common indication for colonoscopy. Most (66.6%) of the Trichuris were located in the cecum and ascending colon. Majority of the patients had live worms, either motile or adhering to the colonic mucosa. The number of worms was single or a few (<15) in 74.2% of patients. Out of 62 patients, 16 (25.8%) had relatively heavy load of parasites. Most patients had normal colonoscopic findings (80.6%). Periappendicular and/or cecal ulcerations/erosions were the most common (16.1%) abnormalities noted. Stool examination showed parasite ova only in four (6.4%) patients. In conclusion, colonoscopy was better than stool microscopy for the diagnosis of trichuriasis in our study.


Assuntos
Colonoscopia , Tricuríase/diagnóstico , Tricuríase/parasitologia , Adulto , Animais , Ceco/parasitologia , Colo Ascendente/parasitologia , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Trichuris/isolamento & purificação
8.
Parasit Vectors ; 10(1): 496, 2017 Oct 18.
Artigo em Inglês | MEDLINE | ID: mdl-29047387

RESUMO

BACKGROUND: Diagnosis of soil-transmitted helminths (STHs) has traditionally relied on stool microscopy, which has a number of critical deficiencies. Molecular diagnostics are powerful tools to identify closely related species, but the requirement for costly equipment makes their implementation difficult in low-resource or field settings. Rapid, sensitive and cost-effective diagnostic tools are crucial for accurate estimation of STH infection intensity in MDA programmes in which the goal is to reduce morbidity following repeated rounds of chemotherapy. RESULTS: In this study, colourimetric isothermal assays were developed using SmartAmp2 primer sets and reagents in loop-mediated amplification (LAMP) assays. Species-specific primer sets, designed on a specific target sequence in the ß-tubulin gene, were used to identify Necator americanus, Trichuris trichiura and Ascaris lumbricoides. After initial optimization on control plasmids and genomic DNA from adult worms, assays were evaluated on field samples. Assays showed high sensitivity and demonstrated high tolerance to inhibitors in spiked faecal samples. Rapid and sensitive colourimetric assays were successfully developed to identify the STHs in field samples using hydroxy napthol blue (HNB) dye. CONCLUSIONS: Rapid and simple colourimetric diagnostic assays, using the SmartAmp2 method, were developed, with the potential to be applied in the field for detection of STH infections and the estimation of response to treatment. However, further validation on large numbers of field samples is needed.


Assuntos
Ascaríase/diagnóstico , Ascaris lumbricoides/isolamento & purificação , Necator americanus/isolamento & purificação , Necatoríase/diagnóstico , Tricuríase/diagnóstico , Trichuris/isolamento & purificação , Animais , Ascaríase/parasitologia , Ascaris lumbricoides/genética , Fezes/parasitologia , Feminino , Humanos , Larva , Necator americanus/genética , Técnicas de Amplificação de Ácido Nucleico , Óvulo , Solo/parasitologia , Especificidade da Espécie , Tricuríase/parasitologia , Trichuris/genética , Tubulina (Proteína)/genética
9.
PLoS One ; 12(4): e0175646, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28410387

RESUMO

Parasitic infections are generally diagnosed by professionals trained to recognize the morphological characteristics of the eggs in microscopic images of fecal smears. However, this laboratory diagnosis requires medical specialists which are lacking in many of the areas where these infections are most prevalent. In response to this public health issue, we developed a software based on pattern recognition analysis from microscopi digital images of fecal smears, capable of automatically recognizing and diagnosing common human intestinal parasites. To this end, we selected 229, 124, 217, and 229 objects from microscopic images of fecal smears positive for Taenia sp., Trichuris trichiura, Diphyllobothrium latum, and Fasciola hepatica, respectively. Representative photographs were selected by a parasitologist. We then implemented our algorithm in the open source program SCILAB. The algorithm processes the image by first converting to gray-scale, then applies a fourteen step filtering process, and produces a skeletonized and tri-colored image. The features extracted fall into two general categories: geometric characteristics and brightness descriptions. Individual characteristics were quantified and evaluated with a logistic regression to model their ability to correctly identify each parasite separately. Subsequently, all algorithms were evaluated for false positive cross reactivity with the other parasites studied, excepting Taenia sp. which shares very few morphological characteristics with the others. The principal result showed that our algorithm reached sensitivities between 99.10%-100% and specificities between 98.13%- 98.38% to detect each parasite separately. We did not find any cross-positivity in the algorithms for the three parasites evaluated. In conclusion, the results demonstrated the capacity of our computer algorithm to automatically recognize and diagnose Taenia sp., Trichuris trichiura, Diphyllobothrium latum, and Fasciola hepatica with a high sensitivity and specificity.


Assuntos
Algoritmos , Helmintíase/diagnóstico , Animais , Difilobotríase/diagnóstico , Diphyllobothrium/crescimento & desenvolvimento , Fasciola hepatica/crescimento & desenvolvimento , Fasciolíase/diagnóstico , Humanos , Processamento de Imagem Assistida por Computador , Microscopia , Óvulo/patologia , Reconhecimento Automatizado de Padrão , Sensibilidade e Especificidade , Taenia/crescimento & desenvolvimento , Teníase/diagnóstico , Tricuríase/diagnóstico , Trichuris/crescimento & desenvolvimento
10.
Korean J Gastroenterol ; 69(4): 243-247, 2017 Apr 25.
Artigo em Inglês | MEDLINE | ID: mdl-28449427

RESUMO

Trichuris trichiura infection is a common helminth infection, which is transmitted via soil, with worldwide distribution, especially in rural areas of developing countries. Occasionally, sporadic cases occur in non-endemic, developed areas due to the widespread of immigration. We experienced a case of Trichuris dysentery syndrome in a young North Korean defector, who had been suffering from chronic abdominal pain for 10 years. He is relatively short and thin compared with his older brother. Unexpectedly, the diagnosis, made by a colonoscopy, revealed numerous, small, white, and gently moving worms at the cecum and ascending colon. After 3 days of albendazole (400 mg once daily) administration, clinical symptoms subsided dramatically. On the follow-up colonoscopy, which was performed two months after the completion of his treatment, complete eradication was identified. Soil-transmitted helminths, including Trichuris trichiura, are disappearing becoming less prevalent in South Korea as a result of both national driving force and environmental improvement. However, these diseases should be considered when we meet foreign patients from developing countries, like North Korea, presenting chronic abdominal pain. Moreover, proper treatment of North Korean defectors and performing cohort studies of them would help to prepare for the possible unification era in the field of gastroenterology.


Assuntos
Dor Abdominal/etiologia , Tricuríase/diagnóstico , Adulto , Animais , Ceco/parasitologia , Ceco/patologia , Colo/parasitologia , Colo/patologia , Colonoscopia , República Democrática Popular da Coreia , Disenteria/diagnóstico , Emigrantes e Imigrantes , Humanos , Masculino , Óvulo/patologia , Tricuríase/complicações , Tricuríase/parasitologia , Trichuris/crescimento & desenvolvimento , Trichuris/isolamento & purificação
11.
Parasitology ; 144(7): 965-974, 2017 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-28290266

RESUMO

For the majority of intestinal parasites, real-time PCR-based diagnosis outperforms microscopy. However, the data for Trichuris trichiura have been less convincing and most comparative studies have been performed in populations with low prevalence. This study aims to improve detection of T. trichuria DNA in human stool by evaluating four sample preparation methods. Faecal samples (n = 60) were collected at Flores island, Indonesia and examined by microscopy. Aliquots were taken and a bead-beating procedure was used both on directly frozen stool and on material preserved with 96% ethanol. PCR on frozen samples showed 40% to be positive for T. trichiura, compared with 45% positive by microscopy. The percentage positive increased when using ethanol preservation (45·0%), bead-beating (51·7%) and a combination (55·0%) and all three methods showed significantly higher DNA loads. The various procedures had a less pronounced effect on the PCR results of nine other parasite targets tested. Most prevalent were Ascaris lumbricoides (≈60%), Necator americanus (≈60%), Dientamoeba fragilis (≈50%) and Giardia lamblia (≈12%). To validate the practicality of the procedure, bead-beating was applied in a population-based survey testing 910 stool samples. Findings confirmed bead-beating before DNA extraction to be a highly efficient procedure for the detection of T. trichiura DNA in stool.


Assuntos
Reação em Cadeia da Polimerase Multiplex , Reação em Cadeia da Polimerase em Tempo Real , Manejo de Espécimes , Tricuríase/diagnóstico , Trichuris/isolamento & purificação , Adulto , Animais , Pré-Escolar , Etanol/química , Fezes/parasitologia , Feminino , Humanos , Indonésia/epidemiologia , Lactente , Microscopia , Pessoa de Meia-Idade , Prevalência , Tricuríase/epidemiologia , Tricuríase/parasitologia , Adulto Jovem
13.
PLoS Negl Trop Dis ; 10(8): e0004910, 2016 08.
Artigo em Inglês | MEDLINE | ID: mdl-27509077

RESUMO

BACKGROUND: Many U.S.-bound refugees travel from countries where intestinal parasites (hookworm, Trichuris trichuria, Ascaris lumbricoides, and Strongyloides stercoralis) are endemic. These infections are rare in the United States and may be underdiagnosed or misdiagnosed, leading to potentially serious consequences. This evaluation examined the costs and benefits of combinations of overseas presumptive treatment of parasitic diseases vs. domestic screening/treating vs. no program. METHODS: An economic decision tree model terminating in Markov processes was developed to estimate the cost and health impacts of four interventions on an annual cohort of 27,700 U.S.-bound Asian refugees: 1) "No Program," 2) U.S. "Domestic Screening and Treatment," 3) "Overseas Albendazole and Ivermectin" presumptive treatment, and 4) "Overseas Albendazole and Domestic Screening for Strongyloides". Markov transition state models were used to estimate long-term effects of parasitic infections. Health outcome measures (four parasites) included outpatient cases, hospitalizations, deaths, life years, and quality-adjusted life years (QALYs). RESULTS: The "No Program" option is the least expensive ($165,923 per cohort) and least effective option (145 outpatient cases, 4.0 hospitalizations, and 0.67 deaths discounted over a 60-year period for a one-year cohort). The "Overseas Albendazole and Ivermectin" option ($418,824) is less expensive than "Domestic Screening and Treatment" ($3,832,572) or "Overseas Albendazole and Domestic Screening for Strongyloides" ($2,182,483). According to the model outcomes, the most effective treatment option is "Overseas Albendazole and Ivermectin," which reduces outpatient cases, deaths and hospitalization by around 80% at an estimated net cost of $458,718 per death averted, or $2,219/$24,036 per QALY/life year gained relative to "No Program". DISCUSSION: Overseas presumptive treatment for U.S.-bound refugees is a cost-effective intervention that is less expensive and at least as effective as domestic screening and treatment programs. The addition of ivermectin to albendazole reduces the prevalence of chronic strongyloidiasis and the probability of rare, but potentially fatal, disseminated strongyloidiasis.


Assuntos
Helmintíase/tratamento farmacológico , Helmintíase/economia , Enteropatias Parasitárias/tratamento farmacológico , Enteropatias Parasitárias/economia , Programas de Rastreamento/economia , Refugiados , Ancylostomatoidea/isolamento & purificação , Animais , Ascaríase/diagnóstico , Ascaríase/tratamento farmacológico , Ascaríase/economia , Ascaríase/epidemiologia , Ascaris lumbricoides/isolamento & purificação , Ásia/epidemiologia , Análise Custo-Benefício , Intervenção Médica Precoce/economia , Helmintíase/diagnóstico por imagem , Helmintíase/epidemiologia , Infecções por Uncinaria/diagnóstico , Infecções por Uncinaria/tratamento farmacológico , Infecções por Uncinaria/economia , Infecções por Uncinaria/epidemiologia , Hospitalização/economia , Hospitalização/estatística & dados numéricos , Humanos , Enteropatias Parasitárias/diagnóstico por imagem , Enteropatias Parasitárias/epidemiologia , Modelos Econômicos , Prevalência , Strongyloides stercoralis/isolamento & purificação , Estrongiloidíase/diagnóstico , Estrongiloidíase/tratamento farmacológico , Estrongiloidíase/economia , Estrongiloidíase/epidemiologia , Tricuríase/diagnóstico , Tricuríase/tratamento farmacológico , Tricuríase/economia , Tricuríase/epidemiologia , Trichuris/isolamento & purificação , Estados Unidos/epidemiologia
14.
Am J Trop Med Hyg ; 95(1): 77-82, 2016 07 06.
Artigo em Inglês | MEDLINE | ID: mdl-27246448

RESUMO

Soil-transmitted helminth (STH) infections and micronutrient deficiencies are closely related and often coexist among low-income populations. We studied the association between infections with specific STH species and micronutrient status in rural Vietnamese schoolchildren. Children (N = 510) aged 6-9 years were recruited from two primary schools. STH infections were determined in stool samples. Hemoglobin, ferritin, retinol, and zinc were measured in blood samples, as well as C-reactive protein to control for inflammation. Iodine excretion was measured in urine. Associations of single and multiple infections with Ascaris lumbricoides, Trichuris trichiura, and hookworm with micronutrient status (hemoglobin, plasma ferritin, retinol, zinc, and urinary iodine) were estimated by multiple regression analysis. Ascaris infections showed a specific and intensity-dependent negative association with vitamin A. Trichuris and hookworm infections were associated with lower hemoglobin concentration, but not with plasma ferritin. Trichuris-infected children had zinc deficiency less often than uninfected children. In conclusion, our study shows species-specific associations between STH infections and micronutrient status in children. The different life cycles of STH species might have specific effects on the absorption or loss of specific micronutrients. Tailor-made combinations of deworming and nutritional interventions may be needed to improve child health and nutrition.


Assuntos
Ascaríase/epidemiologia , Infecções por Uncinaria/epidemiologia , Desnutrição/epidemiologia , Micronutrientes/sangue , Solo/parasitologia , Tricuríase/epidemiologia , Ancylostomatoidea/isolamento & purificação , Animais , Ascaríase/sangue , Ascaríase/diagnóstico , Ascaris lumbricoides/isolamento & purificação , Proteína C-Reativa/metabolismo , Criança , Estudos Transversais , Fezes/parasitologia , Feminino , Ferritinas/sangue , Hemoglobinas/metabolismo , Infecções por Uncinaria/sangue , Infecções por Uncinaria/diagnóstico , Humanos , Iodo/urina , Masculino , Desnutrição/sangue , Micronutrientes/deficiência , Prevalência , População Rural , Especificidade da Espécie , Tricuríase/sangue , Tricuríase/diagnóstico , Trichuris/isolamento & purificação , Vietnã/epidemiologia , Vitamina A/sangue , Zinco/sangue
15.
Trop Doct ; 46(2): 100-2, 2016 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-26264463

RESUMO

Trichuris trichiura (T. Trichiura) is a known parasite infestation among tropical children. Humans acquire Trichuriasis infection after ingestion of embryonated eggs via contaminated food or water. Most of them are asymptomatic. A severe form of trichuris infestation is known as Trichuris dysentery syndrome (TDS). It manifests as mucous diarrhoea, bleeding, malnutrition and stunting, or even life-threatening anaemia. We are reporting an interesting case of a 7-year-old girl who presented with bloody diarrhoea for 2 years. Her growth was stunted as she was not gaining weight. Severe inflammatory bowel disease was suspected clinically. Physical examination revealed marked pallor, pedal oedema and koilonychia along with sparse and hypopigmented hair. On evaluationT. Trichiurahelminths were seen on stool examination and massive worm load was visualised directly on colonoscopy. A diagnosis of TDS was made. She was successfully treated with oral Albendazole (400 mg) and blood transfusion.


Assuntos
Transtornos da Nutrição Infantil/etiologia , Hemorragia Gastrointestinal/etiologia , Tricuríase/diagnóstico , Trichuris/isolamento & purificação , Albendazol/uso terapêutico , Anemia/etiologia , Animais , Antinematódeos/uso terapêutico , Criança , Colonoscopia , Diagnóstico Diferencial , Diarreia/etiologia , Diarreia/parasitologia , Feminino , Humanos , Síndrome , Tricuríase/complicações , Tricuríase/tratamento farmacológico , Tricuríase/parasitologia
16.
Trop Biomed ; 32(3): 545-50, 2015 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-26695216

RESUMO

Trichuris Dysentery Syndrome (TDS) is a severe persistent trichuriasis associated with heavy worm build-up in the colon that continues to be neglected and underestimated in endemic countries. Trichuriasis is most prevalent in children in tropical countries, and that increases the risk of TDS. We reported a series of four preschool children of both genders chronically having TDS over a period ranging from several months to years presenting with anaemia. The hemoglobin levels ranged from 4.6 to 9.1 g/dl on first admissions. Despite treatment, the cases were reported to have failure to thrive with persistent anaemia. It was concluded that TDS should be considered in endemic areas among children presenting with chronic bloody diarrhea and anaemia.


Assuntos
Colo/patologia , Colo/parasitologia , Disenteria/etiologia , Disenteria/patologia , Tricuríase/diagnóstico , Tricuríase/patologia , Trichuris/isolamento & purificação , Anemia/etiologia , Anemia/patologia , Animais , Criança , Pré-Escolar , Doença Crônica , Disenteria/complicações , Feminino , Humanos , Masculino , Falha de Tratamento , Tricuríase/complicações
17.
Przegl Epidemiol ; 69(3): 483-8, 601-4, 2015.
Artigo em Inglês, Polonês | MEDLINE | ID: mdl-26519844

RESUMO

OBJECTIVE: A comparison of the prevalence of intestinal parasites (IP) in preschoolers and orphans in the Warmia-Masuria province (Poland). MATERIAL AND METHODS: Between 2003-2006 fecal samples and perianal swabs from 1052 preschoolers and 859 orphans were tested on the basis of direct saline and iodine mount, decantation test and the adhesive cellophane tape method. RESULTS: 10.8% of preschoolers and 46,3% of orphans were infected with IP. Among the six detected IP species the E. vermicularis was the most common. Infections of E. vermicularis were diagnosed in 9.5% of preschoolers and 36,7% of orphans. There were statistically significant differences in the distribution of IP between males and females in preschools. IP infections were the most frequent among 7-year-old children, 19.1% in preschools and 65.7% in orphanages, respectively. In preschools, the prevalence of IP was higher among preschoolers from the rural area (17.3%) than from the urban area (10.3%). CONCLUSION: Orphans and children from rural areas, especially at the age of 7, should be covered by systematic screening with parasitic tests throughout all of Poland. In this group of children, enterobiasis is the main health problem. The promotion of the awareness of IP infections and their prevention among parents and educational staff is required.


Assuntos
Crianças Órfãs/estatística & dados numéricos , Fezes/parasitologia , Enteropatias Parasitárias/diagnóstico , Enteropatias Parasitárias/epidemiologia , Ascaríase/diagnóstico , Ascaríase/epidemiologia , Criança , Bem-Estar da Criança/estatística & dados numéricos , Pré-Escolar , Entamebíase/diagnóstico , Entamebíase/epidemiologia , Enterobíase/diagnóstico , Enterobíase/epidemiologia , Feminino , Giardíase/diagnóstico , Giardíase/epidemiologia , Humanos , Masculino , Polônia/epidemiologia , Prevalência , Fatores de Risco , População Rural/estatística & dados numéricos , Tricuríase/diagnóstico , Tricuríase/epidemiologia , População Urbana/estatística & dados numéricos
18.
Pediatr Rev ; 36(8): 341-52; quiz 353-4, 2015 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-26232464

RESUMO

• On the basis of research evidence, worm infections are important global child health conditions causing chronic disability that lasts from childhood into adulthood (Table 1). (2)(3) Evidence Quality: B • On the basis of research evidence, the major worm infections found in developing countries include ascariasis, trichuriasis, hookworm infection, and schistosomiasis; toxocariasis, enterobiasis, and cysticercosis are also found in poor regions of North America and Europe. (4)(9)(13) Evidence Quality: B • On the basis of expert consensus, children and adolescents are often vulnerable to acquiring large numbers of worms, ie, high-intensity infections (Fig 1)(21)(22)(23) Evidence Quality: D • On the basis of expert consensus and research evidence, moderate and heavy worm burdens cause increased morbidity because of growth and intellectual stunting in children and adolescents. Many of these effects may result from helminth-induced malnutrition. (21)(22)(23) Evidence Quality: C • On the basis of expert consensus and research evidence, worm infections are also commonly associated with eosinophilia. (48) (49) Evidence Quality: B • On the basis of research evidence as well as consensus, helminthes can cause inflammation in the lung (asthma), gastrointestinal tract (enteritis and colitis), liver (hepatitis and fibrosis), and urogenital tract. (7)(21)(22)(23)(27)(28)(40)(41)(43) Evidence Quality: B • On the basis of research evidence, microscopy techniques for diagnosis of worm infections in children often exhibit suboptimal sensitivities and specificities, necessitating new or improved diagnostic modalities such as polymerase chain reaction. (54)(55) Evidence Quality: A • On the basis of research evidence and expert consensus, mass drug administration ("preventive chemotherapy") has becomea standard practice for ministries of health in low- and middle-income countries to control intestinal helminth infections and schistosomiasis. (67)(68) Evidence Quality: B.


Assuntos
Ascaríase , Enterobíase , Infecções por Uncinaria , Tricuríase , Ascaríase/diagnóstico , Ascaríase/tratamento farmacológico , Ascaríase/epidemiologia , Ascaríase/prevenção & controle , Criança , Efeitos Psicossociais da Doença , Países em Desenvolvimento/estatística & dados numéricos , Doenças Endêmicas , Enterobíase/diagnóstico , Enterobíase/tratamento farmacológico , Enterobíase/epidemiologia , Enterobíase/prevenção & controle , Infecções por Uncinaria/diagnóstico , Infecções por Uncinaria/tratamento farmacológico , Infecções por Uncinaria/epidemiologia , Infecções por Uncinaria/prevenção & controle , Humanos , Tricuríase/diagnóstico , Tricuríase/tratamento farmacológico , Tricuríase/epidemiologia , Tricuríase/prevenção & controle , Estados Unidos
19.
Trials ; 16: 187, 2015 Apr 23.
Artigo em Inglês | MEDLINE | ID: mdl-25902705

RESUMO

BACKGROUND: The Hygiene Hypothesis proposes that infection exposure protects against inflammatory conditions. Helminths possess allergen-like molecules and may specifically modulate allergy-related immunological pathways to inhibit responses which protect against them. Mass drug administration is recommended for helminth-endemic communities to control helminth-induced pathology, but may also result in increased rates of inflammation-mediated diseases in resource-poor settings. Immunological studies integrated with implementation of helminth control measures may elucidate how helminth elimination contributes to ongoing epidemics of inflammatory diseases. We present the design of the Lake Victoria Island Intervention Study on Worms and Allergy-related diseases (LaVIISWA), a cluster-randomised trial evaluating the risks and benefits of intensive versus standard anthelminthic treatment for allergy-related diseases and other health outcomes. METHODS/DESIGN: The setting is comprised of island fishing communities in Mukono district, Uganda. Twenty-six communities have been randomised in a 1:1 ratio to receive standard or intensive anthelminthic intervention for a three-year period. Baseline characteristics were collected immediately prior to intervention rollout, commenced in February 2013. Primary outcomes are reported wheeze in the past 12 months and atopy (skin prick test response and allergen-specific immunoglobulin (asIg) E concentration). Secondary outcomes are visible flexural dermatitis, helminth infections, haemoglobin, growth parameters, hepatosplenomegaly, and responses to vaccine antigens. The trial provides a platform for in-depth analysis of clinical and immunological consequences of the contrasting interventions. DISCUSSION: The baseline survey has been completed successfully in a challenging environment. Baseline characteristics were balanced between trial arms. Prevalence of Schistosoma mansoni, hookworm, Strongyloides stercoralis and Trichuris trichiura was 52%, 23%, 13%, and 12%, respectively; 31% of Schistosoma mansoni infections were heavy (>400 eggs/gram). The prevalence of reported wheeze and positive skin prick test to any allergen was 5% and 20%, respectively. Respectively, 77% and 87% of participants had Dermatophagoides- and German cockroach-specific IgE above 0.35 kUA/L. These characteristics suggest that the LaVIISWA study will provide an excellent framework for investigating beneficial and detrimental effects of worms and their treatment, and the mechanisms of such effects. TRIAL REGISTRATION: This trial was registered with Current Controlled Trials (identifier: ISRCTN47196031) on 7 September 2012.


Assuntos
Albendazol/administração & dosagem , Anti-Helmínticos/administração & dosagem , Dermatite Atópica/tratamento farmacológico , Praziquantel/administração & dosagem , Hipersensibilidade Respiratória/tratamento farmacológico , Esquistossomose mansoni/tratamento farmacológico , Estrongiloidíase/tratamento farmacológico , Tricuríase/tratamento farmacológico , Albendazol/efeitos adversos , Animais , Anti-Helmínticos/efeitos adversos , Biomarcadores/sangue , Protocolos Clínicos , Dermatite Atópica/diagnóstico , Dermatite Atópica/imunologia , Dermatite Atópica/parasitologia , Esquema de Medicação , Hemoglobinas/metabolismo , Interações Hospedeiro-Parasita , Humanos , Imunoglobulina E/sangue , Testes Intradérmicos , Praziquantel/efeitos adversos , Projetos de Pesquisa , Hipersensibilidade Respiratória/diagnóstico , Hipersensibilidade Respiratória/imunologia , Hipersensibilidade Respiratória/parasitologia , Sons Respiratórios/efeitos dos fármacos , Sons Respiratórios/imunologia , Schistosoma mansoni/efeitos dos fármacos , Schistosoma mansoni/imunologia , Schistosoma mansoni/patogenicidade , Esquistossomose mansoni/diagnóstico , Esquistossomose mansoni/imunologia , Esquistossomose mansoni/parasitologia , Strongyloides stercoralis/efeitos dos fármacos , Strongyloides stercoralis/imunologia , Strongyloides stercoralis/patogenicidade , Estrongiloidíase/diagnóstico , Estrongiloidíase/imunologia , Estrongiloidíase/parasitologia , Fatores de Tempo , Resultado do Tratamento , Tricuríase/diagnóstico , Tricuríase/imunologia , Tricuríase/parasitologia , Trichuris/efeitos dos fármacos , Trichuris/imunologia , Trichuris/patogenicidade , Uganda
20.
Mem Inst Oswaldo Cruz ; 110(1): 145-7, 2015 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-25742276

RESUMO

Trichuris trichiura is a soil-transmitted helminth which is prevalent in warm, moist, tropical and subtropical regions of the world with poor sanitation. Heavy whipworm can result either in Trichuris dysenteric syndrome - especially in children - or in a chronic colitis. In heavy infections, worms can spread proximally and may cause ileitis. Here we provide first microscopic evidence for a T. trichiura adult worm embedded in the rectum of a post-Colonial Brazilian adult mummy. During Colonial and post-Colonial times, many European chroniclers described a parasitic disease named Maculo whose symptomatology coincides with heavy helminthiasis. Based on our findings and on comparison of ancient textual evidence with modern description of heavy whipworm, we feel confident in considering that the two syndromes are expressions of the same pathological condition.


Assuntos
Enteropatias Parasitárias/diagnóstico , Múmias/parasitologia , Tricuríase/diagnóstico , Trichuris/isolamento & purificação , Animais , Brasil , História do Século XVIII , História do Século XIX , Humanos , Reto/parasitologia , Síndrome , Trichuris/ultraestrutura
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