Ascaris control: where do we stand?

Ascaris lumbricoides [the largest roundworm] is the most common and potentially serious pathogenic geo-helminth which is estimated of infect approximately 1300 million people. Its complications have been estimated cause 100, 000 deaths each year. World's population harbors 10, 000 million ascaris with a total burden of around 100 tons. Prevalence rates of the order of 16-97.6% have been recorded in many Asian and Latin countries. Ascariasis is a dirt disease, the load of which, unfortunately, its advancing, not receding. The toll is going high up because of increase in population and deterioration of sanitary conditions. Permanent freedom from the parasitions could not be expected till millions of residents of slum areas in developing countries succeed in getting clean environments. This does not seem to be an attainable goal in near future because the meager resource of these countries have already been over-stretched and provision of safe water and safe toilet facilities is a quite remote possibility

Giardiasis co-existing with pregnancy: a distressing and threatening condition

To treat or not to treat Giardia lamblia infection during pregnancy is a debatable issue since, at occasions, it may be advisable to withhold antiparasitic therapy till after delivery. There is no justification for a prescription simply because Giardia lamblia was detected on routine stool microscopy. There is convincing evidence that Giardiasis fits into the category of infectious diseases, which become more severe in pregnancy. The increased nutritional requirements, lowered immunological status and decreased gastric acidity may predispose the already existing Giardial infection to symptomatic Giardiasis which may cause intestinal mucosal injury resulting in disruption of the digestive and absorptive capacity of gut. Three cases of pregnancy associated Giardiasis, in a suburban setting in Punjab [Pakistan], are being reported. The severity of the disease in these patients, impending damage to their foetuses- and public health significance necessitated immediate intervention in the form of specific anti-giardial therapy. The choice of the drug was based on the clinical evaluation and obstetric status. The first patient [23 weeks gestation] was given Intravenous Metronidazole and the third one [30 weeks gestation] oral Secnidazole. Paromomycin [very poorly absorbed from gastrointestinal tract] was selected for the second case [11 weeks gestation]. Regular clinical, parasitological and ultrasonic follow ups of the cases, till term, were carried out. They had uneventful deliveries with normal healthy looking babies. Screening for Giardia lamblia in the family contacts of these patients revealed 11[8 children, 3 adults] parasitologically proven cases [linked to the index cases]. They were successfully treated. It was justifiably concluded that treating the pregnant ladies with acute symptomatic Giardiasis and search for index cases in their family contacts [and their management] were very well rewarding