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Intestinal parasites in patients with diarrhea and human immunodeficiency virus infection in Zimbabwe.

OBJECTIVES: To determine the prevalence of intestinal parasites and risk factors for infection associated with diarrhea in HIV-infected patients in Harare, Zimbabwe. DESIGN: Prospective observational study. METHODS: Single stool samples were collected from 88 HIV-infected individuals presenting with diarrhea of greater than 1 week duration. Stools were examined for intestinal parasites using modified acid fast stain, fluorescence- labeled monoclonal antibody for Cryptosporidium parvum, as well as a modified trichrome stain and a PCR-based protocol for Enterocytozoon bieneusi. RESULTS: C. parvum was detected in 9% (seven out of 82) of samples evaluated, but no Cyclospora was detected. E. bieneusi was detected in 18% (10 out of 55) of stool by trichrome staining and in 51% (28 out of 55) of stool examined by PCR. Risk factors for E. bieneusi infection were: living in rural areas, consumption of nonpiped water, contact with cow dung and household contact with an individual with diarrhea. CONCLUSION: E. bieneusi infection was common in HIV-infected patients with diarrhea in Zimbabwe and may be acquired through person-to-person and fecal-oral transmission.

AIDS-Related Opportunistic Infections↗

Nitazoxanide in the treatment of cryptosporidial diarrhea and other intestinal parasitic infections associated with acquired immunodeficiency syndrome in tropical Africa.

Eighteen patients hospitalized with intestinal parasitic infections associated with diarrhea and dehydration completed a study of nitazoxanide in the treatment of Cryptosporidium parvum and other intestinal parasitic infections. Seventeen of the 18 patients were positive for human immunodeficiency virus. Twelve patients were diagnosed with clinical Stage 4 acquired immunodeficiency syndrome (AIDS) according to the 1990 World Health Organization proposed clinical classification system and cryptosporidiosis. Nitazoxanide (500 mg tablets) were administered orally, one tablet twice a day for seven consecutive days. Cryptosporidium parvum oocysts were eradicated or reduced by more than 95% in seven of the 12 Stage 4 AIDS patients who completed the study based upon two post-treatment fecal examinations conducted on days 7 and 14 following the initiation of treatment. The elimination or reduction of C. parvum oocysts was associated with a complete resolution of diarrhea in four of the seven patients. The test drug was also effective against cases of Isospora belli, Entamoeba histolytica, Giardia lamblia, Ascaris lumbricoides, Enterobius vermicularis, Hymenolepis nana, and Dicrocoelium dentriticum. Treatment with nitazoxanide was well tolerated by the patients. There were no abnormalities in blood chemistry or hematology data that were considered to be attributable to nitazoxanide therapy. Transient episodes of vomiting were observed in four patients, all with Stage 4 AIDS and cryptosporidiosis, which resolved spontaneously without discontinuation of treatment and were not considered to be related to administration of nitazoxanide.

AIDS-Related Opportunistic Infections↗

Some epidemiological aspects of intestinal parasites in women workers before going abroad.

A study was conducted in Jakarta on 903 women workers before going abroad through stool examination by Ritchie's technical method. Of the women workers studied, 640 subjects (70.87%) were found to be infected with intestinal parasites either helminthes, protozoa or combination. Out of those infected, 451 (70.47%) subjects were infected with intestinal helminthes, namely Ascaris lumbricoides (38.13%), Trichuris trichiura (28.13%), a combination of Necator americanus and Ancylostoma duodenale (13.59%) and Enterobius vermicularis (4.84%). In addition 319 (49.84%) subjects were infected with intestinal protozoa namely Giardia lamblia (22.03%), Entamoeba histolytica (14.53%), Blastocystis hominis (6.56%) and Entamoeba coli (6.72%). The youngest age to be affected was 14 years old (14.19% of the subjects studied). Majority (72.09%) of the study subjects received junior high school level of education. Home yard (46.51%) and ground under the trees (22.09%) were places favourable for the habits of defaecation, whereas garbage disposal took place in 52.33% home yards and 25.58% creeks. This study revealed that various life style habits and indiscriminate defaecation were the causes of the continuous transmission of intestinal parasitic infections. The different parasites that were found in women workers before going abroad relate to the various epidemiological aspects of intestinal parasites in women workers in Indonesia who came from different islands in the country and possessed different life style patterns, socioeconomic status, geographical condition and cultures.

Adolescent↗

Studies on fenbendazole for treating lung and intestinal parasites in horses and donkeys.

The efficacy of orally administered fenbendazole on lung and intestinal parasitism in equids was investigated in a mixed herd of pony mares, jenny donkeys and foals. A single dose of 7.5 mg fenbendazole/kg body weight effectively removed intestinal parasites from the ponies, donkeys and foals, but higher doses and repeated treatments failed to eliminate lungworm infections in donkeys. The finding of eosinophilia proved useful in detecting lungworm infections in donkeys.

Animals↗

Intestinal parasite infestation in HIV infected patients.

One of the major health problems among HIV-infected patients is the intestinal parasite infestations. It can be seen that intestinal helminth infestation in HIV-infected patients is common. However, the reported prevalence is usually similar to those of non HIV-infected patients in the same setting. The infestations are ordinary not opportunistic, hence, thus usually show no correlation to immune status of the patients. The suppression of immunity due to HIV infection shows no significant role in increasing the intestinal helminth infestations. On the other hand, having occult intestinal helminth infestations does also not worsen the outcome of HIV infection. Concerning the clinical manifestation, most of the helminth infestations are asymptomatic and the diagnosis is usually based on the stool examination. Treatments of the infestations as well as the outcomes are usually similar to immunocompetent host. Intestinal protozoa infestations are also important problems for HIV-infected patients. Some infections are ordinary, while the others are opportunistic infection. The important opportunistic intestinal parasites including C. parvum, I. belli, Cyclospora and the Microsporidia are found at high prevalence among the HIV-infected patients, especially in low immune cases with persistent diarrhea. Concerning the clinical manifestation, most of the infestations bring diarrhea and the diagnosis is usually based on the stool examination with special stains. The treatment of the opportunistic infection can usually get control of the present illness but not prevent the re-infection. Luckily, with the present wide distribution of HAART, the prevalence of the opportunistic intestinal protozoa infections is significantly decreased.

AIDS-Related Opportunistic Infections↗

[Comparative study of the incidence and dissemination of intestinal parasites in child day care centers of the district capital Schwerin].

Faecal specimens from 1166 children and also from 143 educators in day-nurseries of Schwerin-City were analysed for intestinal parasites. Analsmeers from 1147 children and 137 educators were proved for the evidence of Enterobius vermicularis. The results are compared with those of an earlier paper covering the same subject. Résumé: The intestinal parasites found are disseminated mostly faecal-oral. These dirt- and smear infections are an indicator on hygienical short-comings in the facility concerned. There is a correlation between existing outside circumstances in the facility, infection rate of the children and subsequent exposure towards the educators. However, since reunification the quality of day-nurseries has clearly improved, the extent of investigated intestinal parasites has dropped significantly. No more can be spoken of a dangerous situation for the educators to become infected.

Adult↗

Prevalence of malnutrition and intestinal parasites in preschool slum children in Lucknow.

OBJECTIVE: To assess the point prevalence of intestinal parasites and their association with nutritional parameters. SETTING: Anganwadi centers under the Integrated Child Development Scheme (ICDS) in Lucknow, North India. DESIGN: Cross-sectional survey. METHODS: By random draw, 32 out of 153 Anganwadi centers were selected. All eligible subjects registered with the Anganwadi worker were enrolled. These were 1061 children (48.3% girls and 51.7% boys) between the ages of 1.5 to 3.5 years. RESULTS: Of these, 67.6% were underweight (weight for age < -2 SD), 62.8% were stunted (height for age < -2 SD) and 26.5% were wasted (weight for height < -2 SD). Parasites were detected in 17.5% (95% CI 15.3%-19.9%) children by a single direct fecal smear examination. Of these, Ascaris lumbricoides was found in 124 (68.1%) and Giardia lamblia in 60 (32.9%). There was no association between weight or height and parasite positivity. The mean hemoglobin levels for children who were smear positive versus smear negative for ascaris or giardia were 9.1 g/dl and 9.6 g/dl, respectively (p < 0.0001). CONCLUSION: In the urban slums the point prevalence of intestinal parasites is 17.5% in the preschool children. Malnutrition and low hemoglobin levels are also widely prevalent. Urgent remedial steps are needed on community basis to improve their nutritional status and control parasitic infestation.

Animals↗

Intestinal parasitism in Peruvian children and molecular characterization of Cryptosporidium species.

Intestinal parasitism was studied in children of Trujillo (Peru) to create a prevention and control program. Fecal samples of 489 children were examined. The general prevalence of intestinal parasitosis was found to be 68%. The most frequent pathogenic enteroparasites were Giardia lamblia (26.4%), Cyclospora cayetanensis (13%), Hymenolepis nana (2%), Hymenolepis diminuta (1.6%), and Cryptosporidium spp. (1%). All these parasites appeared both in diarrheic and nondiarrheic children, except Cryptosporidium, which invariably caused diarrhea. Multiple parasitism was frequent, 45.6% of the children presenting two, three, or four intestinal parasites. Cryptosporidium was the only parasite that was not associated with the others. Only five children were affected of cryptosporidiosis, presenting explosive diarrhea, nausea, and vomiting. Cryptosporidium species and genotypes involved in the infantile cryptosporidiosis were determined by polymerase chain reaction-restriction fragment length polymorphism. Four children were parasitized by Cryptosporidium hominis and only one by Cryptosporidium parvum. Our results confirm that anthroponotic transmission of Cryptosporidium is predominant in Peru.

Animals↗

Frequency of intestinal parasitic infestation in children of 5-12 years of age in Abbottabad.

BACKGROUND: Worm infestation is a major problem in children from developing countries due to bad hygienic conditions. It produces nutritional deficiencies and anaemia in children, especially when hookworm infestation is present. METHODS: This cross-sectional study deals with investigation of the frequency of intestinal parasitic infestation in children between the ages 5-12 years. A total of 283 subjects were tested and screened for different intestinal parasites at of Department of Physiology, Ayub Medical College, Abbottabad. Negative cases were re-examined and if found free of intestinal pathogenic parasites were labelled as negative. RESULTS: Of the 283 children examined, 230 tested positive for various intestinal parasites. The frequency of helminthic infestation was found to be above 81%. There were 8 different species of helminths and protozoa found in the specimens. By far the highest frequency of 48% was noted for Ascaris lumbricoides while 6.9% (16 cases) of the specimens examined had mixed infestation. The mean Haemoglobin (Hb) level was found to be 9.82 g/dl in males and 9.0 g/dl in females. Virtually no Hookworm infestation was found which may be the reason of not so low Hb level of the subjects. CONCLUSIONS: A very high percentage (81%) of children from suburbs of Abbottabad have intestinal worm infestation and majority of them (48% of positive cases) have Ascaris lumbricoides. Children were not very severely anaemic because of virtually no hook worm cases.

Age Distribution↗

Dogs and intestinal parasites: a public health problem.

The stools of 239 stray dogs were examined for intestinal parasites. Of the helminths found, Toxocara canis (43.5%), tapeworms (25.5%), Ascaris species (21.3%) and hookworms (12.5%) were the commonest. Of the protozoans found, Isospora species and Entamoeba coli were the most prevalent. An unusual feature of the present study was the finding of Ascaris species. The importance of the high prevalence of intestinal parasites in dogs, the close contact of humans with dogs' excreta and the possible role of this environmental pollution in the spread of human disease are discussed.

Animals↗

Impact of sanitation and health education on intestinal parasite infection among primary school aged children of Sherpur, Bangladesh.

This study was carried out in 1999-2000 in the northern part of Bangladesh to determine the impact of sanitary latrine use and of health education on intestinal parasites in school-aged children. The children were between 5 and 13 years of age and stool samples revealed that more than half (53%) of the study sample was still infected with one or more intestinal parasites even after 4 years of intervention. Ascariasis was found to have the highest prevalence rate (36.2%) and hookworm the lowest (10.7%). Intestinal parasite infection was significantly lower (P < 0.05) among those who used a sanitary latrine and received health education. This result is consistent with observations that the effect of sanitation and health education is slow to develop. Concerted primary healthcare activities with community development efforts should be undertaken to improve the overall living condition of the people of this area to control this problem.

Adolescent↗

[Changes in the prevalence of intestinal parasites among Japanese expatriates in developing countries].

In order to study the prevalence of intestinal parasites among Japanese expatriates of developing countries, we conducted fecal specimen examinations annually from 1995 to 2000. Fecal specimens were collected from Japanese expatriates of each area: Asia, the Middle East, East Europe, Africa and Latin America. The specimens were fixed with 10% formalin in the local area, and then examined in Japan. We used the formalin-ether sedimentation method to find protozoan cysts or helminth eggs. In 1995, the infection ratio was 3.0% (N = 981), decreasing to 2.4% (N = 1,275) in 1996, 2.3% (N = 1,620) in 1997 and 1.6% (N = 1,574) in 1998. However, the ratio began to increase in 1999 (2.0%, N = 1,713) and 2000 (2.5%, N = 1,806). The ratio in Africa was the highest in each year, followed by Asia and Latin America. Heterophyidae (51 cases), Giardia lamblia (42) and Trichuris trichiura (30) were detected most frequently. In Egypt, the ratio of Heterophyidae rose by 28.8% in 2000. This was the prime reason for the increase in the overall ratio of infections worldwide. Most of the Japanese infected with Heterophyidae in Egypt had ingested dried mullet roe. This may explain the reason for the increase in the infection ratio there. Although the prevalence of intestinal parasites among Japanese expatriates in developing countries is decreasing, those who eat fish in these areas are still at risk. In order to eradicate intestinal parasitosis from this group, we must continue preventive measures such as health education.

Adult↗

Prevalence of tuberculosis, hepatitis B virus, and intestinal parasitic infections among refugees to Minnesota.

OBJECTIVE: The purpose of this study was to define the prevalence of infection with Mycobacterium tuberculosis, hepatitis B virus, and various intestinal parasites among different groups of primary refugees immigrating to Minnesota. METHODS: 2,545 refugees arriving in Minnesota during 1999 received a domestic health examination that included tuberculin skin testing, hepatitis B virus serologic testing, and stool ova and parasite examinations. The Refugee Health Assessment form asked specifically about screening results for amebiasis, ascariasis, clonorchiasis, giardiasis, hookworm, schistosomiasis, strongyloidiasis, and trichuriasis. RESULTS: Forty-nine percent of refugees had a reactive tuberculin test of >or=10 mm induration, with a higher prevalence in males (54%) and refugees >or=18 years of age (63%) (p<0.001). Seven percent had a positive hepatitis B surface antigen, with the highest prevalence in those people from sub-Saharan Africa (8%) (p=0.002) and those refugees >or=18 years of age (9%) (p=0.006). Twenty-two percent had one or more intestinal parasites asked about, including 30% of those refugees <18 years of age (p<0.001). The most commonly reported parasitic infections were trichuriasis (8%) and giardiasis (7%). CONCLUSIONS: Evidence of infection with M. tuberculosis, hepatitis B virus, or one of eight intestinal parasites was present in a substantial proportion of refugees receiving the domestic health assessment. Screening for such infections gives new immigrants the opportunity to receive important medical evaluation and treatment, provides valuable surveillance data, and allows appropriate public health measures to be taken.

Adolescent↗

Intestinal parasites in Kampuchea, Takeo Province.

Fresh stool samples obtained from 1407 adult patients who sought treatment in Takeo province hospital and 332 Takeo preschool and school-age children from 3 to 18 years of age were examined for the presence of intestinal parasites using the technique of native preparation and the flotation method of Faust with subsequent staining with Lugol solution to demonstrate cysts. In hospital patients, a total of 13 protozoan and 9 helminth species were diagnosed. The prevalence of Entamoeba histolytica (cysts and trophozoites) was highest in the age group 15-18 years (18.3%), the peak prevalence of Gairdia lamblia (27.6%) occurred in children of the age group 6-9 years. The highest frequency distribution of Pentatrichomonas hominis (20.1%) was recorded in 3 to 5 years old, that of Enteromonas hominis (12.8%) in 6 to 9 years old. The predominant helminth was Ancylostoma duodenale, with the peak prevalence (65.2%) in patients older than 18 years, followed by Ascaris lumbricoides and Strongyloides stercoralis. Almost half of children patients under 6 was infected with at least two species of parasites, patients over 6 were infected simultaneously with two or more intestinal parasites in an absolute majority of cases. In Takeo preschool and school children the spectrum of diagnosed protozoan and helminth species was somewhat narrower than seen in hospital patients, but their prevalence rates were higher, except for the flagellate Pentatrichomonas hominis. The highest prevalence rates recorded were for E. histolytica 29.5% (age category 10-14 years), for G. lamblia 34.8% (age category 6-9 years), for P. hominis 19.3% (age category 3-5 years), for E. hominis 10.5% (age category 3-5 years), for A. duodenale 85.9% (age category 15-18 years), for A. lumbricoides 26.1% (age category 6-9 years), and for S. stercoralis 18.8% (age category 6-9 years). As many as 70% of children at the age between 6 and 15 years were simultaneously infected with two or three species of intestinal parasites.

Adolescent↗

Prevalence of intestinal parasite infections among individuals with mental retardation in New York State.

The prevalence of intestinal parasite infection among program participants of the New York State Office of Mental Retardation and Developmental Disabilities for the period 1986-1987 was estimated, and demographic factors associated with increased risk for infection were identified. The overall prevalence of infection was 7.3%. The two most prevalent infections were Enterobius vermicularis (4.5%) and strongyloides stercoralis (1.2%). Males and individuals with severe or profound mental retardation were twice as likely to be positive for the presence of intestinal parasites as females and individuals with mild/moderate retardation. The relatively low prevalence found in this study compared with previous surveys suggests that management of parasitic infection is improving in conjunction with developments in delivery of medical and habilitative services.

Adolescent↗

Intestinal parasitism in the United States: update on a continuing problem.

To document patterns of intestinal parasitism in the United States, we analyzed results of 216,275 stool specimens examined by the state diagnostic laboratories in 1987; parasites were found in 20.0%. Percentages were highest for protozoans: Giardia lamblia (7.2%), Entamoeba coli and Endolimax nana (4.2% each), Blastocystis hominis (2.6%), and Entamoeba histolytica (0.9%). The most commonly identified helminths were nematodes: hookworm (1.5%), Trichuris trichiura (1.2%), and Ascaris lumbricoides (0.8%). Identifications of G. lamblia increased broadly from the 4.0% average found in 1979, with 40 states reporting increases and seven reporting decreases. Seasonally, Giardia identifications increased in the summer and fall, especially in the Midwest. Nine states reported hookworms in more than 2% of specimens; none were states with indigenous transmission. We analyzed similar, but abbreviated, data for 1991; parasites were found in 19.7% of the 178,786 specimens and Giardia was found in 5.6%. States reporting percentages of Giardia identification in the highest quartile for both 1987 and 1991 were located in the Midwest or in the Northwest. Cryptosporidium was identified in both the 1987 and 1991 surveys; it had not been identified in a previous survey. For each year, Cryptosporidium was reported from 25 states across the country (for both years in 17 states). We conclude that intestinal parasitism should not be overlooked as a cause of gastrointestinal illness in the United States and that the prevalence of Giardia may be increasing.

Animals↗

Intestinal parasites of sympatric gorillas and chimpanzees in the Lopé Reserve, Gabon.

A coprological survey of intestinal parasites of wild chimpanzees (Pan t. troglodytes) and western lowland gorillas (Gorilla g. gorilla) was carried out in the Lopé Reserve in central Gabon. Most samples (69%) were positive but the prevalence of intestinal parasites in the 61 gorilla samples (84%) was higher than in the 66 chimpanzee samples (56%). At least 11 species of parasite were observed: six protozoan, one trematode and at least four nematodes. Six of the species were found in gorillas and chimpanzees but the remainder only occurred in chimpanzees. All but one parasite occurred at low prevalences. Entodiniomorph ciliates, which occurred frequently in both ape species (particularly in gorillas) in the Lopé survey and in all previous coprological surveys of wild apes, may be symbionts involved in cellulose digestion. The dietary and behavioural strategies of wild primates that serve to reduce infection by pathogenic parasites are reviewed.

Animals↗

Intestinal parasites.

Although safe and efficacious broad-spectrum antiparasitic drugs have been developed, their availability for use in mass-treatment programs and for individual treatment worldwide can be limited by economic resources, existing manufacturing and distribution networks, and national regulations. Increasing population density, environmental pollution with human waste products, and global migration patterns will continue to promote transmission of human intestinal parasites in the foreseeable future because untreated or incompletely treated infected individuals can serve as roving reservoirs of infection for long-lived parasites. Asking primary care patients about possible geographic exposures and activities associated with an increased likelihood of intestinal parasite infection is an important part of the medical history. Many intestinal parasites can be treated effectively with oral medications, and treatment relatively early in the course of infection may prevent development of disease associated with chronic infections.

Antiparasitic Agents↗