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Selective criteria for the microbiological examination of faecal specimens.

To assess the effectiveness of predetermined investigation criteria for the examination of faecal samples from inpatients, cultured stool specimens were prospectively examined for Salmonella spp, Shigella spp, Campylobacter spp and Clostridium difficile, and screened microscopically for intestinal parasites. Out of a total of 505 specimens, 421 (83%) fulfilled the criteria for examination for C difficile, 254 (50%) for Salmonella spp, Shigella spp, and Campylobacter spp, and 87 (17%) for intestinal parasites. Isolation rates for these organisms in those groups of patients where examination was indicated were 22.5% for C difficile and 9.1% for Salmonella spp, Shigella spp, and Campylobacter spp; the detection rate for parasites was 3.5%. In those patients where the criteria did not suggest investigation, the isolation or detection rates were 3.6% for C difficile, 0% for Salmonella spp, Shigella spp, and Campylobacter spp, and 1.7% for intestinal parasites, suggesting that the use of predetermined investigation criteria was effective.

Animals↗

Intestinal and blood parasites of man in Bireuen and Takengon, Aceh Province, Sumatra, Indonesia.

A survey for blood and intestinal parasites was carried out in Aceh Province of North Sumatra, Indonesia. A total of 348 stool specimens were obtained from 167 males and 181 females ranging in age from 6 months to 70 years. Over 98% of the population sampled were found infected with at least one intestinal parasite. Ascaris lumbricoides, Trichuris trichiura, hookworm and Entamoeba coli, in that order, were the most common parasites detected. Other intestinal parasites found less frequently were Entamoeba histolytica, Iodamoeba bütschlii, Entamoeba hartmanni, Endolimax nana and Giardia lamblia, Brugia malayi microfilaraemias were detected in 2% of those examined and only in the coastal villages of Cot Ketapang and Rusip Dayah. No malaria was found.

Adolescent↗

Intestinal parasitoses among Wayampi Indians from French Guiana.

Intestinal parasitism and its epidemiological characteristics were studied in an isolated Amerindian population from Upper Oyapock (French Guiana) that has retained its traditional social and cultural specificities. This population consisted of 138 Wayampi Indians, 68 adults and 70 children (below the age of 15 years), with a sex ratio (M/F) of 0.86, spread over the four villages of the community of Trois Sauts, corresponding to more than two thirds of the population recorded as inhabiting the sector in the last census (375 inhabitants). Fecal examination combined the direct examination of fresh feces with the quantitative techniques of Kato-Katz method, Baermann and MIF staining. Overall, 92% of the subjects were found to have intestinal parasites, 85% if only direct examination of fresh stools was taken into account. Fourteen species of human parasite were identified: seven protozoa and seven helminths. We observed in particular 1) a high frequency of hookworm infection due to Necator americanus. Over 50% of subjects were affected, with a range of 25% to 75% according to the village, but with only moderate parasite loads; 2) a high level of parasitism by E. histolytica/E. dispar (17%), Stongyloides stercoralis (16%) and Hymenolepis nana (18%); 3) a lower level of parasitism by Ascaris lumbricoides and very low levels (almost absent) of Trichiuris trichiura; 4) the absence of Schistosoma and fluke eggs. With the exception of H. nana, which was more frequent in children than in adults, there was no significant difference in the level of parasitism according to sex and age. Although the Wayampi of French Guiana are French citizens and consequently have quite high incomes and ready access to clinics and medicines, intestinal parasites are far from under control in this population. A lack of fecal hygiene and the habit of walking barefoot are widespread in the unchanging Amazonian environment and contribute to this phenomenon.

Adolescent↗

Medical evaluation of internationally adopted children.

BACKGROUND: Despite many reports of medical illness in children adopted from abroad, there are currently no accepted guidelines for medical evaluation of this population. METHODS: Two hundred ninety-three children adopted from 15 countries (mean age, 14.0 months; 55 percent girls) were evaluated by history taking, physical examination, and screening tests for hepatitis B virus (HBV), human immunodeficiency virus type 1, tuberculin reactivity, intestinal parasites, syphilis, excretion of cytomegalovirus, renal disease, and anemia. All but four were seen within one month of their arrival in the United States. RESULTS: Fifty-seven percent of the children (168 of 293) were found to have at least one important medical condition. Eighty-one percent of the diagnoses were established by screening test, rather than by history taking or physical examination. Infectious diseases made up the majority of the medical conditions (73 percent). Serologic testing for hepatitis B surface antigen was positive in 5 percent of the children. Characteristics associated with the acquisition of HBV infection included arrival within the first three years of the study (P = 0.017), Asian origin (P = 0.011), and receipt of a blood transfusion abroad (P = 0.008). Ten children (3 percent) had positive Mantoux skin tests, and four of these had active pulmonary tuberculosis. Tuberculin reactivity was significantly associated with older age (P less than 0.001) and lower weight (P = 0.037). Intestinal parasites were isolated from 14 percent of the international adoptees. Non-Korean adoptees were 16 times more likely to be harboring at least one intestinal parasite than were Korean adoptees (P = 0.005). CONCLUSIONS: Directed screening tests should be a routine component of the medical evaluation of all children adopted from abroad, regardless of age, sex, or country of origin.

Adoption↗

Tuberculosis skin testing, anergy and protein malnutrition in Peru.

SETTING: Malnutrition and intestinal parasites cause immunosuppression. This may cause false-negative tuberculin skin tests (TST) and failure to identify tuberculosis (TB) infection. OBJECTIVE: To assess factors associated with TST positivity and anergy in disadvantaged communities in Peru. DESIGN: A study of 212 randomly selected adults: 102 in a rural Amazonian village and 110 shanty town residents in urban Lima. RESULTS: Respectively 52% and 53% of urban and rural jungle populations were TST-positive. Using simultaneous tetanus and candida skin tests, 99% had at least one positive skin test. Generalised anergy was therefore rare, despite frequent intestinal parasitic infection, including 34% helminth infection prevalence in the jungle. TST positivity was associated with age (P = 0.001), known TB contact (P = 0.02) and poor household ventilation (P = 0.007). TST positivity was not significantly associated with crowding, reported past TB, single/multiple BCG vaccination, income, intestinal parasites, dietary factors, body mass index or body fat. Individuals with lower anthropometric body protein, as measured by corrected arm muscle area, were less likely to be TST-positive (P = 0.02), implying that protein malnutrition caused tuberculin-specific anergy. CONCLUSION: These results identify the importance of household ventilation for community TB transmission and add to the evidence that protein malnutrition suppresses TB immunity, causing false-negative TST results.

Adolescent↗

Entamoeba histolytica and other parasitic infections in south Kanara district, Karnataka.

Single stool specimens collected from 1,020 apparently healthy people of the South Kanara District, were processed for intestinal parasites using three parasitological methods viz. (a) Direct smear in physiological saline and D'Antoni's iodine, (b) Zinc sulfate concentration method and (c) by culture in modified Boek and Drbolhav medium. Of these 781 (76.51 per cent) were found to be infected with parasites. The prevalence of various intestinal parasites was: Ascaris lumbricoides (48.33 per cent), Necator americanus (46.86 per cent), Trichuris trichiura (42.75 per cent), Entamoeba coli (23.24 per cent), Entamoeba histolytica (7.94 per cent), Enterobius vermicularis (2.84 per cent), Giardia intestinalis (2.45 per cent), Iodamoeba buitschlii (1.57 per cent), Entamoeba hartmanni (1.37 per cent), Trichomonas hominis (0.88 per cent), Strongyloides stercoralis (0.68 per cent), Hymenolepis nana (0.49 per cent), Chilomastis mesnili (0.10 per cent) and Endolimax nana (0.10 per cent). High incidence of parasitic infections was recorded in females and age group of 6-14 years.

Adolescent↗

[A parasitologic survey conducted in Touraine (France) in a group of South East Asia refugees (author's transl)].

Forty refugees (23 from 5 lao families and 17 from 3 cambodian families) previously and routinely treated against intestinal parasites, underwent stools and serum controls: 77 p. 100 had still intestinal parasites but 61 p. 100 had a normal blood cells count without hypereosinophilia. The parasites so detected were: Clonorchis sinensis, Heterophyes heterophyes, Trichuris trichiura, Necator americanus, Strongyloides stercoralis, Giardia intestinals and Entamoeba coli.

Adolescent↗

Parasitic diarrhea in normal and malnourished children.

Diarrhea is only one of the many manifestations of intestinal parasites. Environmental influences are inescapable, regardless of an individual's state of health: in a highly endemic region, intestinal parasitic colonization is almost the rule. The clinical expression of the parasitoses, however, is largely determined by host defenses; and when they are weakened, parasitic diarrhea is frequent and severe. Protein-energy malnutrition is by far the most important cause of immune deficiency in developing countries. Diarrhea caused by Strongyloides or Giardia is common and severe in malnourished children, while well-nourished children remain healthy carriers. These parasites require specific treatment in the malnourished; and the well-nourished should have preventive treatment when they are to receive corticosteroids or immunosuppressive agents. Diarrhea caused by Cryptosporidium spp. may be severe in malnourished or immunodeficient children, and recovery is achieved only after renutrition or treatment of the immunodeficiency.

Antinematodal Agents↗

Epidemiological studies on intestinal helminth parasites of the patagonian grey fox (Pseudalopex griseus) in Tierra del Fuego, Patagonia Argentina.

The present work was performed to study the intestinal helminths of the patagonian grey fox (Pseudalopex griseus) and to obtain information about its possible role in the sylvatic life cycle of Echinococcu granulosus in Tierra del Fuego, Patagonia Argentina. Eighty-one foxes were captured and subject to post-mortem analysis. Thirty-one foxes (38.3%) harboured helminths. A total of six helminth species were recovered. Only one adult of E. granulosus was found in the studied samples. The current study is the first report of the intestinal helminths of the patagonian grey fox in Tierra del Fuego, Argentina and showed that this specie is probably not an important reservoir host for E. granulosus.

Animals↗

Enteric parasites and HIV infection: occurrence in AIDS patients in Rio de Janeiro, Brazil.

The occurrence of intestinal parasites, its relation with the transmission mechanism of HIV, and the clinical state of the AIDS patients, were analyzed in 99 Group IV patients (CDC, 1986), treated at "Hospital Universitário Pedro Ernesto" (HUPE), between 1986 and 1988. The group consisted of 79 (79.8%) patients whose HIV transmission mechanism took place through sexual contact and of 16 (20.2%) who were infected through blood. Feces samples from each patient were examined by four distincts methods (Faust et al., Kato-Katz, Baermann-Moraes and Baxby et al.). The most occurring parasites were: Cryptosporidium sp., Entamoeba coli and Endolimax nana (18.2%), Strongyloides stercoralis and Giardia lamblia (15.2%), E. histolytica and/or E. hartmanni (13.1%), Ascaris lumbricoides (11.1%) and Isospora belli (10.1%). Furthermore, 74.7% of the patients carried at least one species. Intestinal parasites were found in 78.5% of the patients who acquired the HIV through sexual intercourse and in 56.3% of those infected by blood contamination. The difference, was not statistically significant (p greater than 0.05). In the group under study, the increase of the occurrence of parasitic infections does not seem to depend on the acquisition of HIV through sexual contact. It appears that in developing countries, the dependency is more related to the classic mechanisms of parasites transmission and its endemicity.

Acquired Immunodeficiency Syndrome↗

High frequency of gastrointestinal parasites in refugees and asylum seekers upon arrival in Sweden.

The results of routine screening for intestinal parasites in 1377 refugees and asylum seekers within 2 weeks of arrival in Sweden showed that protozoa, mainly Giardia intestinalis, were found in 235/1377 (17%) and helminths, mainly hookworms, in 264/1377 (19%). Intestinal parasites were more frequently recovered in refugees coming from South East Asia, Africa and Latin America (infection rates 48%, 43% and 42%, respectively) than in those from Eastern Europe (22%) and the Middle East (32%). Refugees who reported gastrointestinal symptoms were less often infected than those without symptoms (p < 0.001). Of the European refugees, 127 came from Bosnia. A high rate of hookworms was found in this group (15%), suggesting that hookworms may also be transmitted in temperate areas under special conditions. We thus identified relatively high rates of pathogens in all groups of refugees. Screening may therefore be recommended, though more for the benefit of refugees than for the prevention of further spread of the infections.

Adolescent↗

Paradoxical helminthiasis and giardiasis in Cape Town, South Africa: epidemiology and control.

BACKGROUND: South Africa has endorsed a World Health Assembly (WHA) resolution calling for control of soil-transmitted helminths (STHs). In Cape Town, services and housing that exist in old-established suburbs should minimise the prevalence of intestinal parasitic infections, even when residents are poor. Where families live in shacks in densely-populated areas without effective sanitation, more than 90% of children can be infected by STHs. The humoral immune response to worms theoretically favours infection by Mycobacterium tuberculosis and HIV. OBJECTIVES: Obtain estimates of gender-, age-, school-related and overall prevalence of helminthiasis and giardiasis in a low-income but well-serviced community. Assess possible sources of infection. Alert health services to the need for control measures and the threat from protozoal pathogens. Warn that the immune response to intestinal parasites may favour tuberculosis (TB) and HIV/AIDS. METHODS: A cross-sectional study of the prevalence of helminthiasis and giardiasis was carried out in a large, non-selective sample of children attending nine schools. Gender, school and age effects were related to non-medical preventive services, sewage disposal practices and possible sources of infection. RESULTS: The overall STH infestation rate was 55.8%. Prevalence was inluenced by school and age but not by gender. Eggs and cysts were seen at the following prevalence: Ascaris 24.8%; Trichuris 50.6%; Hymenolepis nana 2.2%; Enterobius 0.6%; Giardia 17.3%; hookworm 0.08%; and Trichostrongylus 0.1%. Approximately 60% of sewage sludge is used in a form that will contain viable eggs and cysts. CONCLUSION: Prevalence trends in this old community in Cape Town could indicate infection by swallowing eggs or cysts on food or in water, more than by exposure to polluted soil. Sewage sludge and effluent might be sources of infection. In adjacent, under serviced, newer communities, promiscuous defecation occurs. Probable vectors are discussed. The immune response to intestinal parasites might be a risk factor for HIV/AIDS and TB.

Adolescent↗

Paradoxical helminthiasis and giardiasis in Cape Town, South Africa: epidemiology and control.

BACKGROUND: South Africa has endorsed a World Health Assembly (WHA) resolution calling for control of soil-transmitted helminths (STHs). In Cape Town, services and housing that exist in old-established suburbs should minimise the prevalence of intestinal parasitic infections, even when residents are poor. Where families live in shacks in densely-populated areas without effective sanitation, more than 90% of children can be infected by STHs. The humoral immune response to worms theoretically favours infection by Mycobacterium tuberculosis and HIV. OBJECTIVES: Obtain estimates of gender-, age-, school-related and overall prevalence of helminthiasis and giardiasis in a low-income but well-serviced community. Assess possible sources of infection. Alert health services to the need for control measures and the threat from protozoal pathogens. Warn that the immune response to intestinal parasites may favour tuberculosis (TB) and HIV/AIDS. METHODS: A cross-sectional study of the prevalence of helminthiasis and giardiasis was carried out in a large, non-selective sample of children attending nine schools. Gender, school and age effects were related to non-medical preventive services, sewage disposal practices and possible sources of infection. RESULTS: The overall STH infestation rate was 55.8%. Prevalence was influenced by school and age but not by gender. Eggs and cysts were seen at the following prevalences: Ascaris 24.8%; Trichuris 50.6%; Hymenolepis nana 2.2%; Enterobius 0.6%; Giardia 17.3%; hookworm 0.08%; and Trichostrongylus 0.1%. Approximately 60% of sewage sludge is used in a form that will contain viable eggs and cysts. CONCLUSIONS: Prevalence trends in this old community in Cape Town could indicate infection by swallowing eggs or cysts on food or in water, more than by exposure to polluted soil. Sewage sludge and effluent might be sources of infection. In adjacent, under-serviced, newer communities, promiscuous defaecation occurs. Probable vectors are discussed. The immune response to intestinal parasites might be a risk factor for HIV/AIDS and TB.

Adolescent↗

Intestinal helminth parasites in flounder Platichthys flesus from the River Thames: an infracommunity analysis.

An analysis was undertaken of intestinal helminth communities in flounder Platichthys flesus from two sites on the River Thames. A comparison was made between helminth community richness and diversity from these sites at the component and infracommunity levels. At the component community level, a richer and more diverse parasite community was found in flounder from the Tilbury location (marine influence) than that from the Lots Road location (freshwater influence). At the infracommunity level, more parasite species and parasite individuals per host were found at Lots Road and the percentage of similarity values were low at both locations. Helminth species with high prevalence values in the parasite communities of the flounder are the dominant species in any individual fish, harbouring multi-specific infections. The presence of more invertebrate species, which are intermediate hosts in the helminth life cycle in the Thames, fish vagility and the high prevalence and abundance values of Pomphorhynchus laevis in the flounder, may explain the differences between the two locations.

Animals↗

Gastrointestinal helminths of Cuvier's beaked whales, Ziphius cavirostris, from the western Mediterranean.

We examined the gastrointestinal helminth fauna of 2 Cuvier's beaked whales, Ziphius cavirostris, stranded on the Spanish Mediterranean coast. Information regarding intestinal parasites of this species is provided for the first time. Six helminth taxa were identified. Thirty type II larvae of the nematode Anisakis sp. were found in the stomach and the intestine of both hosts; 2 type I larvae of Anisakis sp. were found in the intestine of 1 host. One juvenile of the acanthocephalan Bolbosoma vasculosum was found in the intestine; the metacestode Scolex pleuronectis was found mainly in the terminal colon and the anal crypts of both hosts; adult cestodes of Tetrabothrius sp., which may represent a new species, were collected from the duodenum of 1 host. Composition of the intestinal parasitic community is similar to that of other oceanic cetaceans, which mostly include species of Bolbosoma and tetrabothriids (Cestoda).

Acanthocephala↗