Bacilli load in PTB- intestinal helminths co-infected and PTB non -infected patients at selected public health facilities in Jimma zone, Oromia, Ethiopia: comparative cross-sectional study.

BACKGROUND: Tuberculosis (TB) and intestinal helminths are diseases that pose a dual burden on public health in low-income countries. Previous studies have shown that helminths can affect the shedding of bacteria or the bacterial load in the sputum of active TB patients. However, there is limited information on bacterial load in TB patients with helminth infections. OBJECTIVE: This study aimed to compare bacterial load in helminths-infected and non-infected pulmonary tuberculosis patients at selected public health facilities in Jimma zone, Oromia, Ethiopia. METHODS: The study was conducted in Jimma Zone, Oromia, Ethiopia. A facility-based comparative cross-sectional study was employed from August 01, 2020, to January 2021. A total of 124 (55 intestinal helminths-infected and 69 non-infected) newly diagnosed smear-positive pulmonary tuberculosis (PTB) patients were included in the study. A convenience sampling technique was employed to recruit study participants, and a semi-structured questionnaire was used to collect data regarding socio-demographic characteristics and possible risk factors for intestinal helminths co-infection. Stool examination was performed using both wet mount and Kato Katz technique. Additionally, weight and height measurements, sputum, and blood samples were taken to determine body mass index, bacilli load, and diabetic mellitus, respectively. Data were entered into Epi-Data software version 3.1 and analyzed using Statistical Packages for Social Sciences (SPSS) Version 25. A statistically significant difference was defined as a P-value of less than 0.05. RESULTS: Intestinal helminths reduced bacilli load 3 times more than intestinal helminths non-infected PTB (AOR = 3.44; 95% CI; 1.52, 7.79; P = 0.003) However, diabetes mellitus, HIV, drinking alcohol and cigarette smoking were not associated with bacilli load. The rate of co-infection TB with intestinal helminths was 44%. The three most prevalent parasites detected were Trichuris trichiura 29 (66%), hookworm 19 (43%), and Ascaris lumbricoides 11(25%)). Among co-infected patients about 36 (81.8%) had a single parasite infection, and 19 (43.2%) had multiple infections. A body mass index < 18.5 (AOR = 3.26; 95% CI; 1.25, 8.56;P = 0.016) and untrimmed fingernail status (AOR = 3.63; 95%CI;1.32,9.93;P = 0.012) were significantly associated with PTB- intestinal helminth -co-infection. CONCLUSION: Helminth infection was associated with a lower bacilli load compared to helmenths non-infected PTB. The rate of co-infection TB with intestinal helminths was 44%. Trichuris trichiura was the most prevalent helminth. Untrimmed fingernail and a body mass index were associated with PTB-intestinal helminth co-infection.

Diagnosis of Human Trematode Infections.

Digenetic trematodes form a major group of human parasites, affecting a large number of humans, especially in endemic foci. Over 100 species have been reported infecting humans, including blood, lung, liver and intestinal parasites. Traditionally, trematode infections have been diagnosed by parasitological methods based on the detection and the identification of eggs in different clinical samples. However, this is complicated due to the morphological similarity between eggs of different trematode species and other factors such as lack of sensitivity or ectopic locations of the parasites. Moreover, the problem is currently aggravated by migratory flows, international travel, international trade of foods and changes in alimentary habits. Although efforts have been made for the development of immunological and molecular techniques, the detection of eggs through parasitological techniques remains as the gold standard for the diagnosis of trematodiases. In the present chapter, we review the current status of knowledge on diagnostic techniques used when examining feces, urine, and sputum and also analyze the most relevant characteristics used to identify eggs with a quick key for the identification of eggs.

Paragonimiasis: Neglected, Re-Emerging or Expanding Frontiers. Lessons from a Case Presenting in Jos, Plateau State.

BACKGROUND AND OBJECTIVES: Paragonimiasis is endemic in Eastern Nigeria. An upsurge was recorded after the Nigeria/Biafra war as protein lack in Biafra forced people to eat fresh water crabs. Its protean manifestations create confusion with several diseases. Elimination was assumed after a while and suspicion index fell. The interest in reporting this case follows its presentation outside the traditional endemic zone. RESULTS: The patient, though living in Eastern Nigeria and manifesting several pointers of Paragonimiasis, was treated as tuberculosis despite negative sputum AFB; without improving. He then presented up-country in Jos where history led to suspicion and confirmation of Paragonimiasis. By this time he had severe cor-pulmonale and died despite treatment. CONCLUSION: In this current economic downturn in Nigeria which may drive people to cheaper protein sources, a high index of suspicion should be raised for paragonimiasis when a patient presents with chronic cough productive of AFB-negative sputum and haemoptysis.

Evaluating respiratory cryptosporidiosis in pediatric diarrheal disease: protocol for a prospective, observational study in Malawi.

BACKGROUND: Cryptosporidium is among the most common causes of severe diarrhea in African children 0-23 months old. It is associated with excess mortality, stunting and malnutrition. The most common manifestation of cryptosporidium is intestinal diarrheal disease. However, respiratory cryptosporidiosis has been documented in up to a third of children presenting with diarrhea. It is unclear whether respiratory involvement is a transient phenomenon or a reservoir for gastrointestinal (GI) disease. This study aims to evaluate the role of respiratory cryptosporidiosis in pediatric diarrheal disease. METHODS: This is a prospective, observational study conducted at Queen Elizabeth Central Hospital (QECH) in Blantyre, Malawi. Young children aged 2-24 months hospitalized with diarrhea will be enrolled. Enrolled children will have induced sputum, nasopharyngeal (NP) swab and stool samples collected. All participants positive for cryptosporidium on sputum/NP/stool PCR testing will be followed up fortnightly after discharge from the hospital up to 8 weeks post-discharge. Sputum/NP/stool sample collection will be done at each visit. The primary outcomes will be presence of Cryptosporidium spp. in sputum/NP/stool. The secondary outcome will be presence of respiratory and GI symptoms, mortality and stunting. Ethical approval was obtained from the University of Malawi College of Medicine Research Ethics Committee (COMREC) and the Liverpool School of Tropical Medicine (LSTM) research ethics committee. DISCUSSION: The study began recruitment activities at QECH in February 2019. The protocol allows for expansion of recruitment to secondary sites within Blantyre and Chikwawa districts in the event that targets are not met at QECH. Study recruitment is expected to continue until early 2020.

Diagnosis of Human Trematode Infections.

Digenetic trematodes form a major group of human parasites, affecting a large number of humans, especially in endemic foci. Over 100 species have been reported infecting humans, including blood, lung, liver, and intestinal parasites. Traditionally, trematode infections have been diagnosed by parasitological methods based on the detection and the identification of eggs in different clinical samples. However, this is complicated due to the morphological similarity between eggs of different trematode species and other factors such as lack of sensitivity or ectopic locations of the parasites. Moreover, the problem is currently aggravated by migratory flows, international travel, international trade of foods, and changes in alimentary habits. Although efforts have been made for the development of immunological and molecular techniques, the detection of eggs through parasitological techniques remains as the gold standard for the diagnosis of trematodiases. In this chapter, we review the current status of knowledge on diagnostic techniques used when examining feces, urine, and sputum and also analyze the most relevant characteristics used to identify eggs with a quick key for the identification of eggs.

Coinfection of Pulmonary Paragonimiasis and Pulmonary Tuberculosis in Thailand.

The authors report a case of coinfection of pulmonary paragonimiasis and pulmonary tuberculosis which is an uncommon coinfection. The patient presented with a one-week history of nonmassive hemoptysis about 1 month after completion of treatment for smear-negative pulmonary tuberculosis (sputum polymerase chain reaction positive for Mycobacterium tuberculosis). She lived in Nakhon Nayok province and reported taking raw crabs from time to time. The complete blood count revealed eosinophilia and her chest radiograph showed patchy infiltration at right lower lung field. Computed tomography scan of the chest revealed consolidation with internal air bubbles at anterobasal segment of right lower lobe. The diagnosis of pulmonary paragonimiasis was confirmed by detecting eggs of the genus Paragonimus in her wet-mount sputum. She was treated with oral praziquantel for 3 consecutive days with improvement. To our knowledge, although coinfection of pulmonary paragonimiasis and pulmonary tuberculosis is rare, it should be considered as the differential diagnosis in patients who live in the endemic area presenting with hemoptysis and eosinophilia.

Pulmonary Paragonimiasis Mimicking Tuberculosis.

Paragonimiasis is a disease which is frequently misdiagnosed as pulmonary tuberculosis. In the areas where people eat crab/crayfish this disease should be considered in the differential diagnosis to avoid antituberculosis treatment for a non-tubercular condition. We are reporting a case of pulmonary paragonimiasis who had been treated for tuberculosis.

[A LOCAL CASE OF CHRONIC STRONGYLOIDIASIS IN THE VOLGOGRAD REGION].

The paper describes a case of disseminated strongyloidosis in a 52-year-old woman living in Volgograd. Filariform and. rhabditiform larvae of the nematode Strongyloides stercoralis were found when analyzing her urine, sputum, and feces. She had been followed up and treated for duodenal ulcer for more than 15 years. During that time, the patient periodically underwent radiographic and ultrasonic studies and clinical and biochemical blood tests. Fecal tests were not been carried out. This case could convince that there was a risk for human strongyloidosis in the arid region having a temperate climate in European Russia and when timely detection of invasion and specific treatment were not performed, there might be disseminated strongyloidosis. The reason for late diagnosis was epidemiological history (possible contact with soil) underestimation and improper-patient examination.

Co-infection with Nocardia asteroides complex and Strongyloides stercoralis in a patient with autoimmune hemolytic anemia.

We describe an unusual case of pulmonary nocardiosis co-existing with Strongyloides stercoralis hyperinfection syndrome in a patient with autoimmune hemolytic anemia who was being treated with corticosteroids. This case highlights the importance of being aware of the possibility that infections can co-exist in immunosuppressed patients. To the best of our knowledge, this is the first report of co-infection with Nocardia asteroides and S. stercoralis.

First Molecular Evidence of Emerging Lophomonas Pathogen Among Patients Suspected of Having Pulmonary Tuberculosis in Mazandaran Province, Northern Iran.

PURPOSE: Lophomoniasis is a chronic protozoan respiratory disease in humans with main clinical symptoms such as chronic cough, productive sputum, breath shortness, and occasionally hemoptysis. Differentiation diagnosis of lophomoniasis from tuberculosis (TB) and asthma is crucial. METHODS: In this study, 210 participants with suspected TB referred to tuberculosis laboratories in Mazandaran province, northeastern Iran, were enrolled during 2021. All patients showed low grade fever, chronic cough or sputum on referral. Sputum specimens were collected from the participants, and Lophomonas DNA was detected through a conventional genus-specific polymerase chain reaction (PCR). RESULTS: Out of 210 participants, 67 (31.9%) had Lophomonas spp., infection, 38 (18.1%) had TB (Smear and culture-positive), and 20 (9.5%) had both TB and Lophomonas co-infection. CONCLUSION: Based on our results, a relatively high occurrence of Lophomonas infection was found among patients suspected of having TB. Accordingly, due to the high similarity of clinical symptoms between both pulmonary diseases, it is highly recommended to accurately and early diagnose the parasite in the sputum specimen.

Paragonimus & paragonimiasis in India.

Ever since the discovery of the first indigenous case in 1981, paragonimiasis has gained recognition as a significant food borne parasitic zoonosis in India. The data available on the occurrence of paragonimiasis, until today, may be just the tip of an iceberg as the study areas covered were restricted to Northeast Indian States. Nevertheless, the results of research on paragonimiasis in India have revealed valuable information in epidemiology, life cycle, pathobiology and speciation of Indian Paragonimus. Potamiscus manipurensis, Alcomon superciliosum and Maydelliathelphusa lugubris were identified as the crab hosts of Paragonimus. Paragonimus miyazakii manipurinus n. sub sp., P. hueit'ungensis, P. skrjabini, P. heterotremus, P. compactus, and P. westermani have been described from India. P. heterotremus was found as the causative agent of human paragonimiasis. Ingestion of undercooked crabs and raw crab extract was the major mode of infection. Pulmonary paragonimiasis was the commonest clinical manifestation while pleural effusion and subcutaneous nodules were the common extra-pulmonary forms. Clinico-radiological features of pulmonary paragonimiasis simulated pulmonary tuberculosis. Intradermal test, ELISA and Dot-immunogold filtration assay (DIGFA) were used for diagnosis and epidemiological survey of paragonimiasis. Phylogenitically, Indian Paragonimus species, although nested within the respective clade were distantly related to others within the clade.

Respiratory cryptosporidiosis in HIV-seronegative children in Uganda: potential for respiratory transmission.

BACKGROUND: Respiratory cryptosporidiosis is recognized as a late-stage complication in persons with human immunodeficiency virus (HIV) infection and AIDS. However, respiratory signs and symptoms are common in otherwise healthy children with intestinal cryptosporidiosis, which suggests that respiratory infection may occur in immunocompetent hosts. METHODS: We recruited children 9-36 months of age who presented with diarrhea to Mulago Hospital in Kampala, Uganda, from November 2007 through January 2009. Children with stool samples positive or negative for Cryptosporidium species were selected for further evaluation, including sputum induction in those with cough or unexplained respiratory signs and collection of saliva and blood specimens. Sputum samples were subjected to comprehensive bacteriologic testing, and both sputum and saliva specimens were tested for Cryptosporidium species by nested polymerase chain reaction. RESULTS: Of 926 fecal samples screened, 116 (12.5%) were positive for Cryptosporidium. Seventeen (35.4%) of 48 sputum samples tested from children with positive stool samples were positive for Cryptosporidium. Sixteen (94.1%) of the 17 children with confirmed respiratory cryptosporidiosis were HIV seronegative, and 10 (58.8%) of 17 children were not malnourished. None of the 12 sputum specimens from children with negative stool samples tested positive for Cryptosporidium (P = .013, compared with children who tested positive for Cryptosporidium in the stool). Parasite DNA was detected in only 2 (1.9%) of 103 saliva samples (P < .001, compared with sputum samples). CONCLUSIONS: Respiratory cryptosporidiosis was documented in one-third of HIV-seronegative children who were tested. These novel findings suggest the potential for respiratory transmission of cryptosporidiosis. Trial registration. ClinicalTrials.gov identifier: NCT00507871.

Paragonimiasis in a person whose symptoms were shown 22 years after emigrating to Japan from Laos.

We report a patient, a 52-year-old man from Laos, who had come to Japan at 30 years of age, but had maintained a habit of eating raw freshwater crabs. The patient visited a physician for left chest pain in January 2007. Infiltration and mass-like shadows were noted in the left superior and inferior lobes on chest X-ray. Diagnosis could not be made by bronchial brushing, but eggs were present in sputum cytology 3 days after bronchoscopy. Therefore, paragonimiasis was diagnosed. The peripheral eosinophil count had increased to 2550/µl and the serum IgE level was elevated, at 71000 IU/ml. Multiple-dot enzyme-linked immunosorbent assay (ELISA) for specific IgG antibodies in serum was positive for Paragonimus westermani and P. miyazakii. Paragonimiasis may have been caused by the style of Laotian cooking without heating. Because the habit of eating raw freshwater crabs is common in Laos, Laos is one of the countries where paragonimiasis is prevalent. For patients from Laos with lung diseases, differentiation including paragonimiasis is required.

First case report of paragonimiasis in a Malaysian man.

Paragonimiasis is an infection caused by Paragonimus, a lung fluke and is acquired by eating raw or undercooked crustaceans containing the infective metacercariae. Herein, we report a case of paragonimiasis in a Malaysian man who presented with incidental findings from chest radiographs. Examination of his biopsied lung tissue and sputum specimen revealed Paragonimus sp. eggs, whereas stool examination showed the presence of Giardia cysts. Patient was succesfully treated with praziquantel and metronidazole respectively.

Pulmonary strongyloidiasis.

In patients with abnormalities of cell-mediated immunity, strongyloides hyperinfection syndrome may occur producing pulmonary infection that may manifest as asthma, chronic bronchitis, haemoptysis, eosinophilia and pulmonary infiltrates. We report a case of an uncontrolled asthma patient who presented with fever and haemoptysis. She had no evidence of immunosuppression and CT chest showed a lesion suspicious of malignancy, sputum cytology showed strongyloides larvae and the patient had complete recovery with treatment.

[Paragonimus westermani infection confirmed by the detection of Paragonimus ova in the sputum with bilateral pleural effusion].

A 28-year-old man had a 1-year history of hemoptysis. Consequently, he underwent a medical examination. A right pleural effusion, left hydropneumothorax, and multiple pulmonary nodular shadows were found on chest radiography. During a detailed interview, he reported that the hemoptysis began after eating "kejang" (a raw crab preparation) with a friend a year previously. His peripheral blood eosinophil count and serum IgE level were elevated. In addition, ova were detected in the sputum and bilateral pleural effusion. Morphological examination of the ova and immunoserological examination led to the diagnosis of Paragonimus westermani infection. The pleural effusion could be partially drained, and his symptoms and radiographic results showed improvement after treatment with Praziquantel administered at a dose of 75 mg/(kg x day) for 3 days. After one month, he and his friend ate seasoned raw crabs, Paragonimus was diagnosed in his friend. This case suggests that on encountering a paragonimus infection, everyone who ate food prepared in the same kitchen should be contacted because of possible infection with paragonimus.

Strongyloides stercoralis infection: A systematic review of endemic cases in Spain.

BACKGROUND: Strongyloides stercoralis infection, a neglected tropical disease, is widely distributed. Autochthonous cases have been described in Spain, probably infected long time ago. In recent years the number of diagnosed cases has increased due to the growing number of immigrants, travelers and refugees, but endemically acquired cases in Spain remains undetermined. METHODOLOGY: We systematically searched the literature for references on endemic strongyloidiasis cases in Spain. The articles were required to describe Strongyloides stercoralis infection in at least one Spanish-born person without a history of travel to endemic areas and be published before 31st May 2018. Epidemiological data from patients was collected and described individually as well as risk factors to acquisition of the infection, diagnostic technique that lead to the diagnosis, presence of eosinophilia and clinical symptoms at diagnosis. FINDINGS: Thirty-six studies were included, describing a total of 1083 patients with an average age of 68.3 years diagnosed with endemic strongyloidiasis in Spain. The vast majority of the cases were described in the province of Valencia (n = 1049). Two hundred and eight of the 251 (82.9%) patients in whom gender was reported were male, and most of them had current or past dedication to agriculture. Seventy percent had some kind of comorbidity. A decreasing trend in the diagnosed cases per year is observed from the end of last decade. However, there are still nefigw diagnoses of autochthonous cases of strongyloidiasis in Spain every year. CONCLUSIONS: With the data provided by this review it is likely that in Spain strongyloidiasis might have been underestimated. It is highly probable that the infection remains undiagnosed in many cases due to low clinical suspicion among Spanish population without recent travel history in which the contagion probably took place decades ago.