Ivermectin versus albendazole or thiabendazole for Strongyloides stercoralis infection.

BACKGROUND: Strongyloidiasis is a gut infection with Strongyloides stercoralis which is common world wide. Chronic infection usually causes a skin rash, vomiting, diarrhoea or constipation, and respiratory problems, and it can be fatal in people with immune deficiency. It may be treated with ivermectin or albendazole or thiabendazole. OBJECTIVES: To assess the effects of ivermectin versus benzimidazoles (albendazole and thiabendazole) for treating chronic strongyloides infection. SEARCH METHODS: We searched the Cochrane Infectious Diseases Group Specialized Register (24 August 2015); the Cochrane Central Register of Controlled Trials (CENTRAL), published in the Cochrane Library; MEDLINE (January 1966 to August 2015); EMBASE (January 1980 to August 2015); LILACS (August 2015); and reference lists of articles. We also searched the metaRegister of Controlled Trials (mRCT) using 'strongyloid*' as a search term, reference lists, and conference abstracts. SELECTION CRITERIA: Randomized controlled trials of ivermectin versus albendazole or thiabendazole for treating chronic strongyloides infection. DATA COLLECTION AND ANALYSIS: Two review authors independently extracted data and assessed risk of bias in the included trials. We used risk ratios (RRs) with 95% confidence intervals (CIs) and fixed- or random-effects models. We pooled adverse event data if the trials were sufficiently similar in their adverse event definitions. MAIN RESULTS: We included seven trials, enrolling 1147 participants, conducted between 1994 and 2011 in different locations (Africa, Southeast Asia, America and Europe).In trials comparing ivermectin with albendazole, parasitological cure was higher with ivermectin (RR 1.79, 95% CI 1.55 to 2.08; 478 participants, four trials, moderate quality evidence). There were no statistically significant differences in adverse events (RR 0.80, 95% CI 0.59 to 1.09; 518 participants, four trials, low quality evidence).In trials comparing ivermectin with thiabendazole, there was little or no difference in parasitological cure (RR 1.07, 95% CI 0.96 to 1.20; 467 participants, three trials, low quality evidence). However, adverse events were less common with ivermectin (RR 0.31, 95% CI 0.20 to 0.50; 507 participants; three trials, moderate quality evidence).In trials comparing different dosages of ivermectin, taking a second dose of 200 µg/kg of ivermectin was not associated with higher cure in a small subgroup of participants (RR 1.02, 95% CI 0.94 to 1.11; 94 participants, two trials).Dizziness, nausea, and disorientation were commonly reported in all drug groups. There were no reports of serious adverse events or death. AUTHORS' CONCLUSIONS: Ivermectin results in more people cured than albendazole, and is at least as well tolerated. In trials of ivermectin with thiabendazole, parasitological cure is similar but there are more adverse events with thiabendazole.

Irritable bowel syndrome and intestinal parasites: a view from South America.

Irritable bowel syndrome (IBS) is a functional gastrointestinal disorder of uncertain etiology. Several studies have proposed the possible role of intestinal parasites in the pathogenesis of IBS. We aimed to summarize the epidemiological studies that describe a possible link between intestinal parasites and IBS, with special interest in endemic areas for intestinal parasitism such as South America. A comprehensive review of the literature was conducted by using the keywords: irritable bowel syndrome, intestinal parasites, protozoan infection, soil-transmitted helminths and South America. Giardia lamblia may cause IBS symptoms that can persist several years after effective treatment. Dientamoeba fragilis can cause IBS-like symptoms, but low sensitive parasitological techniques may fail to detect it. Entamoeba histolytica can cause a chronic non-dysenteric colitis, but several studies have failed to find an association with IBS. The role of Blastocystis hominis in IBS remains controversial. In addition, epidemiological studies evaluating the effect of soil-transmitted helminths in IBS are scant. Symptoms elicited by intestinal parasites may resemble to those in IBS, especially in endemic areas such as South America, where both the prevalence of IBS and intestinal parasitism are high. Whether these organisms are the cause or contributing factors in IBS remains a subject of study. Routine parasitologicalexamination of stools in individuals who full-fit the criteria for IBS should be included upon initial assessment in endemic countries.

Differences in prevalence of geohelminth infections between indigenous and settler populations in a remote Amazonian region of Peru.

OBJECTIVE: To compare prevalences of intestinal helminths and waterborne protozoa in indigenous and settler populations in a remote area of Peru. These populations live in adjacent but segregated small urban villages. METHODS: Stool samples were collected from representative members of these two populations and analysed for geohelminths and protozoa. RESULTS: The risk of soil-transmitted helminths is significantly higher in the settler than the indigenous population in the same isolated region of Peru (OR 5.18; 95% CI 3.44-7.81; P < 0.001). In contrast, the rates of protozoa presence were similar in both populations (OR 1.28; 95% CI 0.77-2.14; P = 0.336). CONCLUSIONS: Potential explanations for unexpected finding of a lower prevalence of helminths in indigenous relative to the settler population could include housing design in flood - prone areas and the use of local medicinal plants that possibly have antihelmintic properties.

The global prevalence of human fascioliasis: a systematic review and meta-analysis.

Background: Fascioliasis is a parasitic zoonosis that can infect humans and be a source of significant morbidity. The World Health Organization lists human fascioliasis as a neglected tropical disease, but the worldwide prevalence of fascioliasis data is unknown. Objective: We aimed to estimate the global prevalence of human fascioliasis. Data sources and methods: We performed a systematic review and prevalence meta-analysis. We used the following inclusion criteria: articles published in the English, Portuguese, or Spanish languages from December 1985 to October 2022 and studies assessing the prevalence of Fasciola in the general population with an appropriate diagnostic methodology, including longitudinal studies, prospective and retrospective cohorts, case series, and randomized clinical trials (RCTs). We excluded animal studies. Two reviewers independently reviewed the selected studies for methodological quality, performing critical standard measures from JBI SUMARI. A random-effects model was conducted of the summary extracted data on the prevalence proportions. We reported the estimates according to the GATHER statement. Results: In all, 5617 studies were screened for eligibility. Fifty-five studies from 15 countries were selected, including 154,697 patients and 3987 cases. The meta-analysis revealed a pooled prevalence of 4.5% [95% confidence interval (CI): 3.1-6.1; I2 = 99.4%; T2 = 0.07]. The prevalence in South America, Africa, and Asia was 9.0%, 4.8%, and 2.0%, respectively. The highest prevalence was found in Bolivia (21%), Peru (11%), and Egypt (6%). Subgroup analysis showed higher prevalence estimates in children, in studies from South America, and when Fas2-enzyme-linked immunosorbent assay (ELISA) was used as a diagnostic method. A larger study sample size (p = 0.027) and an increase in female percentage (p = 0.043) correlated with a decrease in prevalence. Multiple meta-regression showed a higher prevalence for hyperendemic than hypoendemic (p = 0.002) or mesoendemic (p = 0.013) regions. Conclusion: The estimated prevalence and projected disease burden of human fascioliasis are high. Study findings support that fascioliasis continues to be a globally neglected tropical disease. Strengthening epidemiological surveillance and implementing measures to control and treat fascioliasis is imperative in the most affected areas.

Update on strongyloidiasis in the immunocompromised host.

Immunocompromised persons are the most vulnerable population at risk for developing life-threatening clinical syndromes associated with strongyloidiasis, such as hyperinfection syndrome (HS) or dissemination. This review focuses on describing Strongyloides infection in the immunocompromised host, including immune response against this infection, analyzing the cases with HS published during the past 4 years in the United States, and describing the most sensitive diagnostic tools and the most effective treatment for each clinical syndrome. Strongyloidiasis is becoming an important parasitic disease in the United States, especially in the immunocompromised immigrant population. Because the transplant population is particularly at risk for developing HS, both recipients and donors should be screened for Strongyloides. Clinicians should also be aware that the development of HS can follow unexpectedly a few days after appropriate anthelminthic therapy. Highly sensitive screening tests are still not available in the major tertiary medical centers. Parenteral ivermectin has been used in some severe cases. Further therapy developments and improving diagnostic tools are warranted.

Triclabendazole for the treatment of human fascioliasis and the threat of treatment failures.

INTRODUCTION: The only drug effective against the infection caused by Fasciola hepatica or F. gigantica is triclabendazole (TCBZ), recommended by the WHO and recently approved by the FDA. Here, we describe the evolution of TCBZ regimens and the emergence of TCBZ failure to Fasciola infection. AREAS COVERED: The present review focuses on the evidence of TCBZ for the treatment of fascioliasis. For acute fascioliasis, there is a lack of studies to measure the presence of eggs of Fasciola in stool samples on the follow-up after initial TCBZ treatment. For chronic fascioliasis, WHO recommends a single oral dose of TCBZ 10 mg/kg whereas CDC recommends two doses of TCBZ 10 mg/kg 12 h apart. Incremental number of treatment failures have been documented worldwide. There are currently no therapeutic alternatives for the treatment of fascioliasis in humans. EXPERT OPINION: Most cases of human fascioliasis are successfully treated with TCBZ, but some continue excreting eggs in the stools despite 1-2 standard of care regimens of TCBZ. A precise regimen is unclear for those patients who fail the initial treatment with TCBZ. Further clinical trials are needed to address the possible TCBZ emerging resistance.

Observational study on the effectiveness and safety of multiple regimens of triclabendazole in human fascioliasis after failure to standard-of-care regimens.

OBJECTIVES: Triclabendazole (TCBZ) is the recommended anthelmintic against Fasciola hepatica at a dose of 10 mg/kg body weight administered as a single or double dose. However, treatment failures to TCBZ standard-of-care (SOC) doses have been reported in humans. The aim of this study was to describe the effectiveness and tolerability of alternative TCBZ regimens in those patients who failed the SOC regimen for fascioliasis in Peru. METHODS: A retrospective study was conducted at a major referral centre for fascioliasis in Peru between 2002 and 2018. Inclusion criteria were cases with chronic F. hepatica infection who failed the SOC regimen for human fascioliasis with TCBZ at 10 mg/kg orally as single dose with food. RESULTS: A total of 27 cases (59% female; mean age 39.4 years, range 6-71 years) with chronic fascioliasis failed at least once the current SOC regimen of TCBZ. Of 27 cases, 21 failed a second treatment regimen. Multiple regimens of TCBZ were given to these patients until three consecutive stool examinations were negative for Fasciola eggs. The overall cure rate was 74%. TCBZ was well tolerated with minimal side effects. CONCLUSION: According to the results of this study, patients labelled as having 'TCBZ resistance' may respond to multiple regimens of TCBZ with a cure rate of 74%. Thus, the term 'TCBZ resistance' should be re-evaluated using biomarkers.

[Parasite intestinal infection and factors associated with coccidian infection in adults at public hospital in Lima, Peru]. / Infecciones parasitarias intestinales y factores asociados a la infección por coccidias en pacientes adultos de un hospital público de Lima, Perú.

OBJECTIVE: To evaluate the frequency of intestinal parasites and risk factors associated with coccidian infection in patients cared for at a public hospital in Lima-Peru. METHODS: A descriptive, cross-sectional study was conducted using reports of the parasitology laboratory. Patients included were >18 years, who gave at least one faecal sample for parasitologic evaluation. Logistic regression was used to calculate Odd Ratios (OR) and 95%) confidence intervals. RESULTS: 2.056 patients were included in the analysis, 55.2% of them were males and 334 (16.3%) were HIV positive. Overall, Blastocystis hominis was the most frequent parasite (35.4%). The multivariate model adjusted for sex shows that HIV infection (OR = 4.53; 95% CI: 3.03-6.77), being hospitalized (OR = 2.42; 95% CI: 1.06-5.52), and age > or = 40 years (OR = 0.57; 95% IC: 0.37-0.86) were associated with coccidian infection. CONCLUSIONS: Blastocystis hominis was the most frequent parasite in HIV positive and negative patients. Being hospitalized and HIV infection were risk factors for coccidian infection, but age > or = 40 years was a protective factor.

Strongyloides stercoralis infection after the use of emergency corticosteroids: a case report on hyperinfection syndrome.

BACKGROUND: In clinical practice, identification of a case of severe asthma exacerbation prompts initiation of corticosteroids. However, not all that wheezes is asthma. CASE PRESENTATION: A 61-year-old man from the Peruvian Amazon presented with progressive dyspnea, abdominal pain, and cough for the past week. His medical history was remarkable for asthma since childhood; he was treated with beta-agonists, ipratropium, and orally administered corticosteroids. On evaluation, he was febrile and ill-appearing. His chest examination revealed diffuse wheezing and bilateral crackles. He was diagnosed as having community-acquired pneumonia and asthma exacerbation and was started on empiric antibiotics, nebulized beta-agonists, and orally administered corticosteroids. His clinical status continued deteriorating and he became critically ill despite broad-spectrum antibiotics and antifungals. Considering the epidemiological background of our patient, bronchoalveolar and fecal samples were obtained to investigate soil-transmitted helminths. Larvae of Strongyloides stercoralis were found in both specimens. Ivermectin was initiated and corticosteroids were discontinued. He experienced remarkable improvement of clinical condition over the next weeks. The literature on this topic was reviewed. CONCLUSION: Cases of severe asthma exacerbation warrant careful evaluation before the initiation of corticosteroids, especially in patients at risk for parasitic infections. A high index of suspicion is critical. Alternative etiologies of respiratory decompensation should be considered in patients who fail to improve with broad-spectrum antibiotics and antifungals.

Strongyloides stercoralis hyperinfection syndrome: a deeper understanding of a neglected disease.

Strongyloides stercoralis hyperinfection syndrome (SHS) is a life-threatening condition that warrants early detection and management. We describe the pathogenesis, organ-specific clinical manifestations, and risk factors associated to this condition. A comprehensive review of the literature was conducted in PubMed, LILACS, EBSCO and SciELO by using the keywords: "hyperinfection syndrome"; "Strongyloides stercoralis"; "disseminated strongyloidiasis"; "systemic strongyloidiasis", "pathogenesis" and "pathophysiology". Relevant articles on this topic were evaluated and included by consensus. Also, a secondary search of the literature was performed. Articles in English and Spanish language were included. SHS has been described in tropical and sub-tropical regions. However, there is growing evidence of cases detected in developed countries favored by increasing migration and the advance in immunosuppressive therapies for oncologic and inflammatory diseases. SHS is characterized by massive multiplication of larvae, typically in immunocompromised hosts. Clinical manifestations vary according to the organ involved and include diarrhea, intestinal bleeding, alveolar hemorrhages, heart failure, jaundice, bacteremia among others. Despite advances in the understanding of this condition, fatality rates are near 90%. Clinicians should consider SHS in the differential diagnosis of acutely ill patients with multiple organ damage and epidemiological risk factors. Adverse outcomes are common, especially with delayed anti-parasitic treatment.

Soil-Transmitted Helminthiasis in Children from a Rural Community Taking Part in a Periodic Deworming Program in the Peruvian Amazon.

Children in the Peruvian Amazon Basin are at risk of soil-transmitted helminths (STH) infections. This study aimed to determine the prevalence of STH infection in children from a rural Amazonian community of Peru and to elucidate epidemiological risk factors associated with its perpetuation while on a school-based deworming program with mebendazole. Stool samples of children aged 2-14 years and their mothers were analyzed through direct smear analysis, Kato-Katz, spontaneous sedimentation in tube, Baermann's method, and agar plate culture. A questionnaire was administered to collect epidemiological information of interest. Among 124 children, 25.8% had one or more STH. Individual prevalence rates were as follows: Ascaris lumbricoides, 16.1%; Strongyloides stercoralis, 10.5%; hookworm, 1.6%; and Trichuris trichiura, (1.6%). The prevalence of common STH (A. lumbricoides, T. trichiura, and hookworm) was higher among children aged 2-5 years than older children (31.6% versus 12.8%; P = 0.01). In terms of sanitation deficits, walking barefoot was significantly associated with STH infection (OR = 3.28; CI 95% = 1.11-12.07). Furthermore, STH-infected children more frequently had a mother who was concomitantly infected by STH than the non-STH-infected counterpart (36.4% versus 14.1%, P = 0.02). In conclusion, STH infection is highly prevalent in children from this Amazonian community despite routine deworming. Institutional health policies may include hygiene and sanitation improvements and screening/deworming of mothers to limit the dissemination of STH. Further studies are needed to address the social and epidemiological mechanics perpetuating these infections.

Update on hepatobiliary flukes: fascioliasis, opisthorchiasis and clonorchiasis.

PURPOSE OF REVIEW: Hepatobiliary flukes--Fasciola, Opisthorchis, Clonorchis- are a major public health problem in east Asia, east Europe, Africa and Latin America. The present review focuses on current knowledge of clinical, diagnostic and treatment aspects caused by hepatobiliary flukes that can be applied to current protocols in endemic areas. RECENT FINDINGS: Specific risk factors and geographic areas for these flukes have been heavily reported recently, with millions of people infected worldwide. Human cases in nonendemic areas, related to immigration and the international food trade (i.e. raw vegetables and fish), have also been reported. Diagnostic imaging changes include track-like lesions that are a characteristic feature of acute fascioliasis on computed tomography scanning of the liver. Newly available diagnostic serological tests may detect early infection and, therefore, help reduce severe clinical complications such as recurrent cholangitis, cholecystitis, hepatic tumours, cysts, calcification, cholelithiasis, pancreatitis, most importantly, cholangiocarcinoma related to Opisthorchis viverrini and possibly Clonorchis sinensis, and liver fibrosis associated with Fasciola hepatica infections. Highly effective antiparasitic treatment is available for all flukes. SUMMARY: There is a better understanding of risk factors, clinical manifestations and complications, novel diagnosis tests and effective treatment, which together should help reduce the morbidity and mortality of these infections.

Natural history, clinicoradiologic correlates, and response to triclabendazole in acute massive fascioliasis.

Fascioliasis is highly endemic in the Andean region of South America. Newer serological assays have improved our ability to diagnose acute fascioliasis. The diagnosis was established by Fasciola hepatica serology (Fas2-ELISA or Western blot) in 10 patients. Identifiable exposure included ingestion of watercress (N = 8), alfalfa juice (N = 5), and lettuce (N = 1). Computed tomography of the abdomen showed hepatomegaly (N = 9), track-like hypodense lesions with subcapsular location (N = 8), and subcapsular hematoma (N = 2). Radiologic sequelae included cyst calcifications detectable at least 3 years after treatment. Stool examinations were negative for F. hepatica eggs; serology was positive (Arc II [N = 2], Fas2-ELISA [N = 6], Western blot [N = 2]). The syndrome of eosinophilia, fever, and right upper quadrant pain, elevated transaminases without jaundice, hypodense liver lesions on CT, and an appropriate exposure history suggests acute fascioliasis. Fascioliasis is specifically treatable with a single dose of triclabendazole.

Strongyloides hyperinfection syndrome: an emerging global infectious disease.

The hyperinfection syndrome (HS) caused by Strongyloides stercoralis has a high mortality rate (15% to 87%). A variety of risk factors and predisposing conditions have been described, including new immunosuppressive therapies; HTLV-1 infection; cadaveric transplantation; immune reconstitution syndrome; haematological malignancies (especially lymphoma); tuberculosis; malnutrition secondary to chronic Strongyloides diarrhoea; international travel and immigration. Inhibition of Th2 cell-mediated, humoral or mucosal immunity is associated with HS. HS is more frequently seen in HTLV-1 than HIV patients. In AIDS, there is an increase in Th2 cytokines, while in HTLV-1 infection there is a decrease in the Th2 response, leading to an increased risk of autoinfection. Corticosteroid use remains the most frequent risk factor for HS. A number of ELISAs are useful for diagnosis and post-treatment evaluation. Once diagnosed, the disease may be managed effectively with anthelminthic drugs, including ivermectin. HS causes diverse symptoms and signs, with unusual manifestations leading to misdiagnosis and medical errors related to healthcare providers' lack of familiarity with the condition. HS is an example of an emerging tropical infection migrating to developed countries and requiring greater clinician awareness.

Prevalencia de Giardia lamblia por ecorregiones en preescolares y escolares peruanos: Propuesta de estratificación de riesgo

Introducción. La giardiasis es ocasionada por el protozoario intestinal Giardia lamblia, su transmisión tiene variabilidad geográfica y a pesar de ser muy frecuente, no existe una herramienta de estratificación de riesgo para priorizar las intervenciones. Objetivo. Estimar la prevalencia de G. lamblia en preescolares y escolares peruanos por ecorregiones entre 1990 a 2018. Métodos. A partir de un metaanálisis previo, se realizó un subanálisis por ecorregiones de la prevalencia de G. lamblia en 26 estudios en preescolares y escolares peruanos entre 1990 a 2018. Se extrajeron los datos por distrito y utilizando Google Earth fueron clasificados en ecorregiones. La heterogeneidad fue analizada mediante la prueba de Q de Cochrane y el sesgo de publicación mediante el método de Egger con StatsDirect versión 3.2.7. Se utilizó el método de riesgo absoluto para estratificar la prevalencia a nivel de distrito y se definió 4 estratos en base a los percentiles o arbitrariamente. Resultados. Se identificaron 43 datos de prevalencia a nivel de distrito que incluyeron 7606 participantes. Las prevalencias combinadas más altas por el método de efectos aleatorios de G. lamblia fueron de 47,0% intervalo de confianza (IC) 95%: 40,0 -54,0) en el desierto del Pacífico; 27,9% (IC95%: 22,8 - 33,2) en selva baja y 26,9% (IC95%: 22,5 -31,5) en la Puna. Conclusiones. De cada 100 preescolares y escolares que viven en las ecorregiones del desierto del Pacífico, selva baja y Puna, 47, 28 y 27 menores de edad, respectivamente, están infectados con G. lamblia. Asimismo, se propone 4 estratos de riesgo en función de la prevalencia: esporádico (0 a <1%), hipoendémico (1 a <25%), mesoendémico (≥ 25 a <50%) e hiperendémico (≥50%).

Introduction. Giardiasis is caused by an intestinal protozoan, Giardia lamblia. Despite its high prevalence and geographical transmission variability, there is no risk stratification tool available to prioritize interventions. Objective. To estimate the prevalence of G. lamblia in Peruvian preschoolers and schoolchildren by ecoregion from 1990 to 2018. Methods. Based on a previous meta-analysis, we conducted a G. lamblia prevalence sub-analysis by ecoregions from data of 26 studies in Peruvian preschoolers and school-aged children between 1990 and 2018. The data was extracted by district, a classification by ecoregions was made through Google Earth. Heterogeneity was analyzed using Cochrane Q test and publication bias applying the Egger method with StatsDirect version 3.2.7. The absolute risk method was performed to stratify the prevalence at district level, and 4 strata were defined based on percentiles or arbitrarily. Results. Forty-three district-level prevalence data was estimated, including 7,606 participants. The highest pooled prevalences by the random effects method of G. lamblia were 47.0% (95% CI: 40.0-54.0) in the Pacific desert, 27.9% (95% CI: 22.8-33.2) in the lowland forest and 26.9% (95% CI 22.5-31.5) in the Puna. Conclusions. Of every 100 preschoolers and school-aged children living in the Pacific desert, lowland forest, and in the Puna ecoregions, 47, 28, and 27 minors are infected with G. lamblia, respectively. Likewise, 4 risk strata are proposed based on prevalence: sporadic (0 to <1%), hypoendemic (1 to <25%), mesoendemic (≥25 to <50%) and hyperendemic (≥50%).

Occurrence and molecular characterization of Giardia duodenalis cysts and Cryptosporidium oocysts in raw water samples from the Rímac River, Peru.

Giardia and Cryptosporidium are potentially pathogenic protozoa which are ubiquitous in ambient surface water. The present study included 60 samples of surface water from three sampling sites from the Rímac River, Lima and Callao, Peru, to detect the occurrence of Giardia spp. and Cryptosporidium spp. and to perform molecular characterization of specimens found. Water samples were concentrated using the membrane filtration technique, and following elution, cysts and oocysts were visualized by direct immunofluorescence assay (IFA). For molecular characterization, tpi and bg gene fragments and 18S rRNA were amplified by nested PCR for Giardia and Cryptosporidium, respectively, followed by sequencing and phylogenetic analysis. Giardia cysts were found in 93.3% of the analyzed samples, whereas Cryptosporidium oocysts were detected in 15%. The positivity of the Giardia cysts was 86.6% (n = 26) in 2014, while Cryptosporidium oocysts were not detected. In 2015, both protozoa were found in raw water samples, with all 30 samples collected positive for Giardia cysts (100.0%) and 9 positive for Cryptosporidium oocysts (30.0%). Oocysts were detected in 20.0% of water samples from sites 1 (mean 5.25 oocysts/L) and 2 (mean 52.3 oocysts/L), while at site 3, oocysts were detected in 50.0% of raw water samples (mean 193.6 oocysts/L). The presence of Giardia duodenalis assemblage A was confirmed in several samples by the phylogenetic positioning of the bg and tpi genes, and the sub-assemblage AII was predominant (8/9). Sequencing for Cryptosporidium resulted in profiles compatible with Cryptosporidium hominis, Cryptosporidium meleagridis, and Cryptosporidium baileyi. This is the first time that the presence of G. duodenalis assemblage A/sub-assemblage AII and Cryptosporidium species has been reported in surface water samples in Peru. These Cryptosporidium species and the Giardia duodenalis assemblage are associated with human disease which highlights the potential risk to public health and the need to increase environmental monitoring measures to protect this water body.

Use of ivermectin to treat an institutional outbreak of scabies in a low-resource setting.

In a limited-resource hospital in Lima, Peru, 23 (63.9%) of 36 healthcare workers developed pruritus and/or skin lesions after contact with a patient with classic scabies. Of these 23, a total of 5 healthcare workers had scabies confirmed by microscopy. Oral ivermectin was used to control the outbreak effectively.

Evaluation of Fas2-ELISA for the serological detection of Fasciola hepatica infection in humans.

The performance of Fas2-ELISA for the diagnosis of Fasciola hepatica infection in children living in areas of high endemicity for fascioliasis in the Peruvian Andes is analyzed. Fas2-ELISA is based on the detection of circulating IgG antibodies elicited in infected individuals against a F. hepatica antigen termed Fas2. The study was conducted in three Andean localities, Huertas-Julcan in Junin, Asillo in Puno, and Cajamarca, with a total population of 634 children in an age range 1 to 16 years old. Child fascioliasis prevalence was 21.1% in Huertas-Julcan, 25.4% in Asillo, and 24% in Cajamarca, estimated by coprological inspection. The seroprevalence of F. hepatica infection, determined by Fas2-ELISA, was 27.8% in Huertas-Julcan, 44.6% in Asillo, and 29.1% in Cajamarca. The overall sensitivity of Fas2-ELISA was 92.4%, the specificity 83.6%, and the negative predictive value 97.2%. No association between OD(450) Fas2-ELISA and infection intensity measured by egg counting was observed. Results show that Fas2-ELISA is a highly sensitive immunodiagnostic test for the detection of F. hepatica infection in children living in human fascioliasis endemic areas.