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Necator americanus infection: a longitudinal study of an urban area in Nigeria.

A longitudinal study was carried out in Owerri, capital of Imo State, Nigeria, to assess the pattern of Necator americanus infection during a 27-month period. The mean annual prevalence fell from 59.0% in 1978, to 55.5% in 1979 and 51.1% in 1980. The egg count (apparent intensity of infection) fell in a similar pattern. Maximum and minimum conversion rates were 55.2 and 13.7%, respectively, and conversion rates fell by approximately 20% between 1979 and 1980. The highest reversion rate was 55.0% between 1979 and 1980. The population density of available third-stage larvae fluctuated seasonally and this was significant in determining the pattern of infection.

Adolescent↗

Response of laboratory-adapted human hookworm and other nematodes to ivermectin.

The activity of ivermectin was examined in Necator americanus, a human hookworm, adapted to the laboratory hamster. A dose of 30 mg kg-1 X 1 or 10 mg kg-1 X 2 was required for complete clearance of pre-adult N. americanus; however, hamsters carrying adult N. americanus were completely cured of infection by doses of 15 mg kg-1 or 7.5 mg kg-1 X 2. The doses of ivermectin required for complete elimination of N. americanus were much higher than those reported for other intestinal nematodes. The probable reasons for these higher doses are discussed. Tests were also carried out with other rodent parasites, namely Nematospiroides dubius, Strongyloides ratti and Trichuris muris. Doses as low as 0.3 mg kg-1 X 1 completely eliminated adult N. dubius from mice, whereas++ S. ratti needed a repeated dose (0.3 mg kg-1 X 2). None of the mice was cured of T. muris infection even at doses of 10 mg kg-1 X 2, although some degree of cure was apparent at the toxic dose. It thus appears that ivermectin is in no way superior in its activity against N. americanus and T. muris than the existing anthelmintics.

Animals↗

Response of adult Necator americanus to some known anthelminthics in hamsters.

Adult Necator americanus infection in laboratory hamsters (the hamster-hookworm model) was examined as an anthelminthic screening system. Three reference anthelminthics--pyrantel (PYTL), mebendazole (MBZ) and ivermectin (IVRN)--were used to assess the sensitivity of adult N. americanus and also to investigate the value of the hamster-hookworm model for predicting clinical results. Serial drug dosages were used, and the ED50 was determined from the resulting cure rates. In addition, percentage worm reductions were calculated by reference to the worm burdens in control groups. The results showed that the hamster-hookworm model was able to differentiate anthelminthics on their efficacy. Absolute activity (100% worm reduction) followed treatment with 8 mg kg-1 MBZ, 38-40 mg kg-1 PYTL and 18 mg kg-1 IVRN. Based on ED50 data of PYTL and MBZ, adult N. americanus appeared to be two to five times more sensitive than pre-adult stages. However, with IVRN the reverse appeared true. MBZ appeared to be most active and PYTL least active in terms of curing infected animals, but there were no obvious differences between the rates of worm reductions following single or multiple doses of anthelminthics. It is considered that the hamster-hookworm model will prove of value in identifying and characterizing possible new anthelminthics.

Animals↗

The population biology and control of Necator americanus in a village community in south-eastern China.

The population dynamic parameters of Necator americanus infections were estimated from longitudinal intensity and prevalence data from a village in south-eastern China. The theoretical predictions of a deterministic model incorporating these parameters were then compared with observed, horizontal, age-prevalence data from an infected population (N = 565), and an estimate of the basic reproduction rate (R0 = 3.7) of N. americanus was obtained. The findings indicate that populations of N. americanus might be easier to control by mass-treatment chemotherapy (eradication requiring only 63% of the population to be treated every year for 4 years) than those of Ascaris lumbricoides and Trichuris trichiura.

Adolescent↗

Parasitic infections in villagers from three districts of the Brazilian Amazon.

A survey of intestinal parasites among 827 rural villagers in the Brazilian Amazon revealed that the prevalences of infection with Necator americanus, Trichuris trichiura and/or Ascaris lumbricoides were high. However, the intensities of infection with the two parasites for which there were enough data on intensity for further analysis, N. americanus and T. trichiura, were only low or moderate in each of the three districts studied. Possible reasons for the unusual (but not unique) absence of high intensities include moderately good sanitation, low population densities, the way in which work activities are located geographically, the use of indigenous anthelmintics and the geographical isolation of the communities which provided the subjects. Whether the light to moderate levels of infection observed require intervention is discussed.

Adolescent↗

The distribution of helminth infections along the coastal plain of Kwazulu-Natal province, South Africa.

The results of a previous study indicated that, in the province of KwaZulu-Natal, South Africa, Necator americanus and Strongyloides stercoralis were endemic to the coastal lowlands only. The prevalences of these helminths, as well as those of Trichuris trichiura and Ascaris lumbricoides, have now been investigated along a 1000-km-long transect through the coastal plain, at altitudes of < 300 m, from the Mozambique border (26 degrees 57'S) to the border with Eastern Cape province (30 degrees 53'S). Necator americanus was by far the most dominant hookworm species. Although prevalences of N. americanus and S. stercoralis infection decreased with increasing southerly latitude, those of T. trichiura and A. lumbricoides did not. Determinants of these distribution patterns are examined in terms of a suite of temperature- and rainfall-related variables.

Adolescent↗

A survey of parasites in primary school children in Dominica, West Indies.

A study of Dominican school children aged four to twelve years showed that infection with gastrointestinal parasites was very common. Trichuris was found in the stools in 92% of the children, Ascaris in 38%, Necator in 11%, Giardia in 18% and E. histolytica in 1%. In spite of the high prevalence of parasites, the general health of the children studied was remarkably good, and only 18 of the 1000 children were found to have a haemoglobin level below 10 g/dl.

Ascariasis↗

Platelet parameters in subjects infected with hookworm.

Hookworm is an important intestinal parasite infection with high prevalence in tropical countries. In addition to iron deficiency anaemia, the human hookworm appears to have evolved a number of complementary strategies to overcome the host's haemostatic processes. These include the inhibition of blood coagulation, platelet aggregation and mediator release, and the secretion of fibrinogenolytic enzymes. In this work, we studied the platelets in the subjects with detection of hookworm infection from screening stool examination comparing to those without. One hundred subjects were included, studied for stool parasite and platelet parameters. Of our 100 subjects, hookworms were identified in stools of six cases, giving an infection rate equal to 6%. The platelet parameters of the subjects showed a statistically significant lowering of mean platelet volume (MPV) in the subjects with hookworm infection. Also, we detected a non-significant lower platelet count in subjects with hookworm infections. Of interest, the alteration in platelet size, identified by platelet parameters, has never been documented in the literature. This observation might be a pathological process or might be an accidental finding in our study.

Animals↗

Emerging patterns of hookworm infection: influence of aging on the intensity of Necator infection in Hainan Province, People's Republic of China.

We examined risk factors associated with Necator americanus infection among persons aged > or =50 years in Hainan Province, People's Republic of China. Age and sex made the most important contributions to the variation in infection intensity (28%-30%), with age alone responsible for 27% of this variation. When stratified by 20-year age intervals, the influence of shared residence was 23% for persons aged > or =50 years and 27% for those aged <20 years, who had the highest and lowest levels of infection intensity, respectively. This points to shared residence as a means of capturing the complex relationship between aging and shared socioeconomic, environmental, and behavioral factors that influence transmission of Necator infection. None of the other 26 personal or 32 household risk factors were found to be significant. The importance of aging in Necator infection reveals an emerging public health problem among the elderly population of developing countries.

Adolescent↗

Functional significance of low-intensity polyparasite helminth infections in anemia.

BACKGROUND: We wanted to quantify the impact that polyparasite infections, including multiple concurrent low-intensity infections, have on anemia. METHODS: Three stool samples were collected and read in duplicate by the Kato-Katz method in a cross-sectional sample of 507 children from Leyte, The Philippines. The number of eggs per gram of stool was used to define 3 infection intensity categories--uninfected, low, and moderate/high (M+)--for 3 geohelminth species and Schistosomiasis japonicum. Four polyparasite infection profiles were defined in addition to a reference profile that consisted of either no infections or low-intensity infection with only 1 parasite. Logistic regression models were used to quantify the effect that polyparasitism has on anemia (hemoglobin level <11 g/dL). RESULTS: The odds of having anemia in children with low-intensity polyparasite infections were nearly 5-fold higher (P = .052) than those in children with the reference profile. The odds of having anemia in children infected with 3 or 4 parasite species at M+ intensity were 8-fold greater than those in children with the reference profile (P < .001). CONCLUSION: Low-intensity polyparasite infections were associated with increased odds of having anemia. In most parts of the developing world, concurrent infection with multiple parasite species is more common than single-species infections. This study suggests that concurrent low-intensity infections with multiple parasite species result in clinically significant morbidity.

Adolescent↗

Hookworm disease: host-pathogen biology.

The hallmark of hookworm infection, a common helminthic disease, is iron deficiency anemia. The development of anemia is dependent on the intensity of infection, the species of hookworm, and the ability of the host to resist infection and to maintain adequate stores of iron. When conditions are appropriate, the incidence of anemia caused by hookworm is high and has a significant economic impact since it results in a reduction of worker productivity. Loss of blood is caused by direct ingestion of red cells and by tissue trauma produced by worm attachment and feeding. This focal trauma may involve multiple villi and is characterized by local hemorrhage, tissue cytolysis, and neutrophilic response. Although focal intestinal lesions are apparent, their significance is questionable since diffuse mucosal changes are absent in intestinal biopsies of patients with heavy hookworm infection. Short-range control measures protecting against hookworm infection have not succeeded. Development of a vaccine against hookworm infection in humans is problematic since functional protective immunity in humans has not yet been demonstrated and no suitable animal model of hookworm infection in humans is available. At present, the most effective method of intervention appears to be supplementation of food staples with iron.

Ancylostomiasis↗

Hookworm disease: nutritional implications.

Iron-deficiency anemia resulting from intestinal blood loss is the major consequence of hookworm infection. Development of the anemia can be prevented, and it can be treated by administration of iron. Hypoproteinemia, often associated with hookworm infection, may be the result of either protein malnutrition or increased intestinal loss of protein. It is unlikely that the worms cause diffuse morphologic or functional alterations of the intestine. Fortification or supplementation with iron is a practical method to control hookworm disease in endemic areas.

Ancylostomiasis↗

Effects of the Zanzibar school-based deworming program on iron status of children.

We evaluated the effects of the Zanzibar school-based deworming program on the iron status of primary school children. Parasitologic and nutritional assessments were carried out at baseline, 6 mo, and 12 mo in 4 nonprogram schools (n = 1002), 4 schools in which students received twice-yearly deworming (n = 952), and 4 schools in which students received thrice-yearly deworming (n = 970) with 500 mg generic mebendazole. Schools were randomly selected for evaluation and allocated to program groups. Relative to no treatment, thrice-yearly deworming caused significant decreases in protoporphyrin concentrations and both deworming regimens caused marginally significant increases in serum ferritin concentrations. The average annual changes in protoporphyrin concentrations were -5.9 and -23.5 micromol/mol heme in the control and thrice-yearly deworming groups, respectively (P < 0.001). The average changes in ferritin concentration were 2.8 and 4.5 microg/L, respectively (P = 0.07). Deworming had no effect on annual hemoglobin change or prevalence of anemia. However, the relative risk of severe anemia (hemoglobin < 70 g/L) was 0.77 (95% confidence limits: 0.39, 1.51) in the twice-yearly deworming group and 0.45 (0.19, 1.08) in the thrice-yearly deworming group. The effects on prevalence of high protoporphyrin values and incidence of moderate-to-severe anemia (hemoglobin < 90 g/L) were significantly greater in children with > 2000 hookworm eggs/g feces at baseline. We estimate that this deworming program prevented 1260 cases of moderate-to-severe anemia and 276 cases of severe anemia in a population of 30,000 schoolchildren in 1 y. Where hookworm is heavily endemic, deworming programs can improve iron status and prevent moderate and severe anemia, but deworming may be needed at least twice yearly.

Ancylostomiasis↗