Trials and tribulations in the treatment of intestinal parasitic disease.
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In a study of intestinal parasites in 697 Aboriginal children under the age of 6 years in South-west Australia, Giardia lamblia was recorded in 26% and Hymenolepis nana in 13.9%. G. lamblia infections occurred above 4 months of age, and H. nana infections above 18 months of age. There was a close correlation between infection with these two species (chi 2, P less than 0.001). Campylobacter jejuni, the predominant bacterial species recorded, was isolated in 2.3%, and was related to bowel symptoms in one child. G. lamblia was more prevalent in the country areas than in the Perth metropolitan area (chi 2, P less than 0.05. H. nana was more prevalent in children whose weight was below the third percentile (chi 2, P less than 0.02), and in those with diarrhoea (chi 2, P less than 0.01). There were strong correlations between low weight (below third percentile), a history of recent diarrhoea, and discharging ears.
Gastro-intestinal parasitism of creole cows and calves, Limousin x creole cross calves and Brahman x creole cross calves was recorded during seasons of calving in a native grazing system in Guadeloupe, a wet tropical area. Calvings were pooled during the dry season for two herds and during the rainy season for two other herds. For each calving season, calves of one herd were drenched monthly with anthelmintic. A marked periparturient rise in egg excretion was observed in cows. Coccidial infection was always present in calves, but no clinical signs were observed. The main parasites during the first 2 months of life were Strongyloides papillosus and Toxocara vitulorum. Then, Haemonchus placei, Trichostrongylus spp. and Cooperia spp. were the dominant species encountered. Brahman cross calves were the most heavily infested animals. There was no clear relationship between third stage larvae (L3) population size on pasture and worm burdens in calves, except during the second month of life. Despite medium levels of infestation, parasitism inhibited the growth of creole calves: -10.5 kg of bodyweight at weaning (-59 g day-1 of daily bodyweight gain from birth to weaning). The pathological effects of subclinical parasitism were confirmed by a lower packed cell volume and albuminaemia in parasitized calves than in treated calves.
Evidence for the presence of 11 intestinal parasites in pre-school children from 4 rural villages in Ghana was obtained from an examination of stool samples. Striking differences were detected between the prevalence of some of the 6 common infections in the 4 villages. The prevalence of Ascaris lumbricoides varied from about 76% in one village (Oshiyie, coastal savanna) to apparently 0% in another (Akuma, forest zone). No differences in prevalence for any infection were observed to be sex dependent. Investigation of the relationship between age of the children and prevalence showed that the degree of prevalence of both A. lumbricoides and Trichuris trichiura had essentially levelled off by the time the children were 4 years old. There was no evidence to suggest that the prevalence of either Entamoeba sp. or spp. or hookworm was approaching a maximum value, even in the oldest children. These trends applied across the villages regardless of the differences in prevalence values for the infections. On average, the children of Oshiyie were found to harbour twice as many infections as the children of the other villages. The investigation of the prevalence data revealed evidence of associations between pairs of infections, particularly those involving hookworm and T. trichiura.
The anaerobic protozoan Giardia lamblia is a common intestinal parasite in humans, but is poorly defined at molecular and phylogenetic levels. We report here a structural characterization of the ribosomal RNA (rRNA) and rRNA genes of G. lamblia. Gel electrophoresis under native or non-denaturing conditions identified two high molecular weight rRNA species corresponding to the 16-18S and 23-28S rRNAs. Surprisingly, both species (1300 and 2300 nucleotides long, respectively) were considerably shorter than their counterparts from other protozoa (typically 1800 and 3400 nucleotides), and from bacteria as well (typically 1540 and 2900 nucleotides long). Denaturing polyacrylamide gel electrophoresis identified a major low molecular RNA of 127 nucleotides and several minor species, but no molecules with the typical lengths of 5.8S (160 nucleotides) and 5S (120 nucleotides) rRNA. The G. lamblia 1300, 2300, and 127 nucleotide RNAs are encoded within a 5.6 kilobase pair tandemly repeated DNA, as shown by Southern blot analysis and DNA cloning. Thus, the rRNA operon of this eukaryotic organism can be no longer than a typical bacterial operon. Sequence analysis identified the 127 nucleotide RNA as homologous to 5.8S RNA, but comparisons to archaebacterial rRNA suggest that Giardia derived from an early branch in eukaryotic evolution.
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We conducted a prospective, longitudinal study in a cohort of 36 Peace Corps volunteers (PCVs) in Guatemala to study the incidence and natural history of intestinal parasitic infections during the PCVs' >2-year overseas stay. PCVs collected stool specimens at least monthly and when ill with gastrointestinal symptoms. Of the 1,168 specimens tested, 453 (38.8%) were positive for at least one parasite and 48 (4.1%) were positive for a pathogenic parasite. A median interval of 187 days (range, 14 to 752 days) elapsed before the first documented parasitic infection, and the median intervals from arrival until subsequent infections (e.g., second or third) were >300 days. The PCVs had 116 episodes of infection with 11 parasites, including up to 4 episodes per PCV with specific nonpathogens and Blastocystis hominis. The incidence, in episodes per 100 person-years, was highest for B. hominis (65), followed by Entamoeba coli (31), Cryptosporidium parvum (17), and Entamoeba hartmanni (17). The PCVs' B. hominis episodes lasted 6,809 person-days (28.7% of the 23,689 person-days in the study), the E. coli episodes lasted 2,055 person-days (8.7%), and each of the other types of episodes lasted <2% of the person-days in the study. Gastrointestinal symptoms were somewhat more common and more persistent, but not significantly so, in association with pathogen episodes than with B. hominis and nonpathogen episodes. Although infections with pathogenic parasites could account for only a minority of the PCVs' diarrheal episodes, the continued acquisition of parasitic infections throughout the PCVs' >2-year stay in Guatemala suggests that PCVs repeatedly had fecal exposures and thus were at risk for infections with both parasitic and nonparasitic pathogens throughout their overseas service.
An epidemiological study on intestinal parasitic infections among schoolchildren in a suburban area of Hanoi, Vietnam, was conducted. Of the 217 schoolchildren involved in this study, 166 (76%) were positive for at least one of nine species of parasite (six helminths and three protozoa). Among the helminth parasites, Trichuris trichiura (67%) was detected the most frequently followed by Ascaris lumbricoides (34%) and hookworm (3%). In the case of protozoan parasites, Entamoeba coli (8%) was the most frequently detected followed by E. histolytica (2%). No Cryptosporidium parvum or Cyclospora sp were found. A questionnaire survey revealed that there was no positive relationship between parasite infection and the children's school records, educational background or parental income, which have been known to play a role.
The effects of age, sex, and neutering on the prevalence of feline intestinal parasitism were evaluated by fecal examination of 1,294 cats admitted to the University of Missouri Veterinary Teaching Hospital for the 3-year period, 1974 to 1976. Approximately 37% of the cats examined had 1 or more parasite species. Ascarids were the most commonly encountered parasites (24.4%), with coccidia (6.7%), hookworms (6.4%), tapeworms (5.2%), and trichurids (2.6%) being less frequently observed. Most parasitisms were monospecific. Considering age categories from birth to 5 years, patent ascarid infections were less prevalent in cats greater than 6 months old, whereas hookworm infections were most prevalent in cats 1 to 5 years old; trichurids (whipworms and capillarids) were most often found in cats greater than 6 months old; and coccidia were found with uniform frequency in cats of all age categories. Sex seemed to have no effect on prevalence of parasitism, and the only effect of neutering was on the occurrence of ascarid infection, with spayed females having a prevalance of 14.3%, castrated males, 17.8%, and their intact counterparts, 26%.
Laotian refugees relocated in the Columbus, Ohio, area were screened for intestinal parasites. Eight different pathogens were isolated. The prevalence of the various organisms ranged from 4 to 61 percent of persons affected and 18 to 100 percent of families. These data show a higher prevalence of parasitic disease than that revealed by previous observations by the Center for Disease Control among Southeast Asian refugees. It was also apparent that neither federal nor local programs were adequate to meet the special health care needs of these refugees nor to safeguard the health of communities they entered.
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The occurrence of intestinal parasites, their regional distribution and their relations to eosinophilia were studied in 133 human immunodeficiency virus (HIV) positive individuals from Honduras. After signing an informed consent, participants answered a socio-demographic and risk factor questionnaire, a complete physical examination, medical history, and a series of laboratory tests. All participants were HIV positive but not acquired immunodeficiency syndrome positive. Of them, 67% were co-infected with pathogen and non pathogen parasites. Overall occurrence of nematodes was: 44.3% for Trichuris trichiura, 24% for Ascaris lumbricoides, 12% for Hookworm and 7.5% for Strongyloides stercoralis. No cases of Giardia lamblia, acute amebiasis or cryptosporidiasis were diagnosed. Mean eosinophil percents for participants were consistently and significantly higher in infected than in non infected individuals: 22% for Hookworm vs 7.2% (p < 0.001), 11% for Trichuris compared to 5.2% (p < 0.001), 13.2% compared to 7.5% for S. stercoralis (p < 0.05), and 12% compared to 6% for Ascaris cases (p < 0.05). Helminths and non pathogenic protozoa, as single or mixed infections, occurred among the participants. There was a strong correlation between eosinophilia and helminthiasis infections; however, none was identified between CD4 levels and eosinophilia. Because parasitic infections aggravate malnutrition and promote a disbalanced Th2 response in a potentially immuno-compromised host, their effect on HIV disease progression needs further study, mainly in countries were HIV and parasitic infections are highly prevalent.
The presence of gastro-intestinal parasites in Tswana kids (n = 7) aged 1-3 weeks was studied for a period of 6 months at the Botswana College of Agriculture. The aims of this study were to find the time when they first contracted internal parasite infections, as well as to determine the severity of the infections and also its relation to production indicators (body mass and packed cell volume) of the kids as they grew older. The results indicate that they contracted coccidial and roundworm infections at approximately one month of age or immediately thereafter. The most prevalent internal parasite was coccidia, which occurred throughout the study period followed by roundworms and the least was the tapeworm, Moniezia expansa. Generally, the infection levels of all internal parasites were lower than the critical mean log (faecal oocyst/egg count + 1) of 3.3 inferred to cause reduced production in small stock. The correlation coefficients were all positive; 0.4-0.9 for individual internal parasites and production indicators, indicating that these internal parasites did not have any adverse effects on production. It was concluded that there was no need to treat kids of this age group for internal parasites.
The authors report on the prevalence of intestinal parasites in 1763 students of selected secondary schools in District Martin from 1988 to 1990 as continuation of parasitologic surveillance of pre-school children collectives and of elementary school pupils. The situation in occurrence of geohelminthiasis in the investigated group of students is considered to be very favorable and could reflect, in some degree, the parasitologic surveillance and treatment of positive cases in the seventies. The prevalence of intestinal protozoa, especially Giardia intestinalis, is in examined students only a little lower as the values given by our authors for population of children. This indicates a shift of epidemiologic importance from geohelminthiases towards the protozoal infections. (Tab. 5, Ref. 18).
Since 1955, when sanitary conditions were poor, the incidence of intestinal parasitism has steadily decreased. Similarly, the number of requests for fecal examinations by physicians has also decreased. However, in our hospital, the incidence of parasites detected in fecal material has been increasing since 1994, regardless of the decreasing number of stool exams performed. Possible reasons for this situation can be summarized as follows: First, an effective drug for treating Trichuris trichiura and Enterobius vermicularis infections has reduced the incidence of these two helminths. Second, an apparent increase in the incidence of infections with the tapeworms Diphyllobothrium latum and Diplogonoporus grandis may just be a reflection of patients gathering at a few facilities for treatment. Third, the number of individuals infected with a single Ascaris is significantly increasing. Fourth, parasites related with travel abroad (Schistosoma haematobium and Opisthorchis viverrini) are appearing due to the increase in travel to and from foreign countries. Of the above, we think particular attention should be paid to the increase in A. lumbricoides infections.