Apendicitis y parásitos: a propósito de 2 casos / Appendicitis and parasites: Reporting of 2 cases

Objetivo: Enfatizar la importancia de sospechar esta etiología en la patogenia de la apendicitis aguda, especialmente en pacientes procedentes de países endémicos. Casos clínicos: Presentamos dos casos, con cursos clínicos divergentes.

Aim: We would like to emphasize the importance of having a high grade of suspect about the parasitic etiology of appendicitis acute, especially in patients from endemic countries. Case report: We present two cases with divergent clinical evolution.

High Prevalence of Haplorchiasis in Nan and Lampang Provinces, Thailand, Proven by Adult Worm Recovery from Suspected Opisthorchiasis Cases

Opisthorchiasis, a risk factor for cholangiocarcinoma in humans, is of public health importance in Thailand. The Annual Surveillance Reports from Nan and Lampang Provinces, Thailand, for the year 2011 showed an opisthorchiasis prevalence of over 70% by recovery of eggs in the feces. This study investigated whether most cases are actually due to minute intestinal flukes (MIF) rather than Opisthorchis viverrini, as the eggs of both can hardly be differentiated by morphology. Fifty and 100 cases from residents in Nan and Lampang, respectively, had stools positive for eggs initially assumed to be those of O. viverrini. Each patient was given praziquantel at 40 mg/kg in a single dose. After 2 hr, 30-45 ml of the purgative magnesium sulfate was given, and stools were collected up to 4 times sequentially. The stools were examined for adult worms by simple sedimentation. It was found that 39 of 50 cases (78.0%) from Nan Province had Haplorchis taichui, with intensities ranging from 5 to 1,250 with an average of 62 worms/case. Taenia saginata (7 cases) and Enterobius vermicularis (1 case) were other helminths recovered as the co-infectants. In Lampang Province, H. taichui was recovered from 69 cases (69.0%). The number of flukes recovered ranged from 1 to 4,277, with an average of 326 worms/case. Four cases had Phaneropsolus bonnei, and 10 T. saginata as the co-infectants. Adult specimens of O. viverrini were not recovered from any stool. Clearly, MIF infection, especially haplorchiasis, is more common in northern Thailand. These findings should encourage the Public Health Office to employ more specific tools than Kato's method for surveillance of opisthorchiasis in Thailand.

Environmental Factors Related to Enterobiasis in a Southeast Region of Korea

Pinworm infection can occur through contact with contaminated surfaces followed by ingestion or even through inhalation of infective eggs. We have limited information regarding environmental contamination by eggs of Enterobius vermicularis. In order to determine environmental risk factors associated with the rate of E. vermicularis infection, we investigated possible environmental risk factors using a questionnaire from 46 kindergartens in 3 different cities of the southeast area of Korea. In total, using the cellotape anal swab technique, 3,422 children were examined for E. vermicularis infection. We evaluated E. vermicularis egg of books, educational materials, toys, room door handles, dusts of window edges, desks, chairs, tables, and dusts of classrooms. The overall egg-positive rate for E. vermicularis was 6.0%, and the prevalence of enterobiasis in each kindergarten ranged between 0% and 16.9%. We found that 78.9% of egg positive kindergartens were managed by private foundations, which was significantly higher, compared with kindergartens managed by public foundations or the nation. Compared with public or national kindergartens, most private kindergartens were located in residential areas and the number of children in these areas was significantly higher. In conclusion, numbers of children in kindergartens was found to be an environmental risk factor associated with transmission of enterobiasis in Korea.

Distribution of intestinal parasites among school-age children in Delta and Edo state of Nigeria

School-age children are one of the highly susceptible groups to intestinal parasitic infections. There is a wide disparity in the prevalence and distribution of intestinal parasites globally. Once high-risk areas are identified, WHO recommends at least a yearly de-worming program of school children. The aim of this investigation was to assess the prevalence of intestinal parasites among school-age children in Delta and Edo States, Nigeria. Fecal samples of 386 school-age children between 6 and12 years old were examined for intestinal parasites in six schools of Delta and Edo States. Samples were examined for gastrointestinal parasites using formol-ether concentration and Kato-Katz techniques. Data were subjected to odd ratio analysis. Seven intestinal parasites were detected in the stool samples of these children: Ascaris lumbricoides, Hookworm, Trichuris trichiura, Strongyloides stercoralis, Enterobius vermicularis, Schistosoma mansoni and Giardia lamblia. The difference in prevalence was significantly lower in Edo State [35.98%] than in Delta State [51.54%]. A. lumbricoides followed by hookworm infections were observed to be the most prevalent in both States; Delta [42.78%, 28.35%, respectively] and Edo [25%, 13.02%, respectively]. Parasites of lowest prevalence were S. stercoralis [0.51%], G. lamblia [0.51%] and S. mansoni [0.51%] in Delta State, while T. trichiura and S. mansoni parasites were not recovered from the feces of Edo State school-age children. The prevalence of co-infection among infected children in Edo State was 43.47% while that in Delta State was 27%. The preponderance of co-infection by Ascaris and hookworm was recorded in Delta State [26%], with multiple parasitisms in Edo State [4.76%] and Delta State [11.32%]. Heavy infection with Ascaris was observed more in Delta [51.8%] than in Edo [12.5%]. Additionally, T. trichiura [11.34%] was seen only in Delta State children while the most prevalent protozoan parasite was Giardia in Edo State [3.1%]. Intestinal parasites are hyper-endemic among Delta and Edo States school children and thus, there is need for the institution of integrated intervention programs for sustainable elimination of these parasitic diseases

Prevalence of Enterobius vermicularis among Preschool Children in Muan-gun, Jeollanam-do, Korea

We assessed the prevalence of Enterobius vermicularis infection and changes in the egg positive rate (EPR) over 1-year time, using the adhesive cellophane-tape perianal swab method in 2,347 preschool children in Muan-gun, Jeollanam-do, Republic of Korea in 2008 and 2009. The overall EPR for E. vermicularis was 4.1% in 2008 and 4.5% in 2009. A study population of 389 children was repeatedly examined for 2 years. Within this group, the EPR in 2009 was twice higher than in 2008, and the EPR of the group of 5-7-year-old children was significantly higher than that of other age groups. Moreover, in the group of 5-7-year-old children in 2009, the rates of positive and negative conversion were significantly higher and lower, respectively, than in other age groups. Conclusively, enterobiasis was prevalent during 2008-2009 among preschool children in Muan-gun, Jeollanam-do, and the increased EPR in 2009 was due to an increase in newly acquired infections among 5-7-year-old children.

Prevalence of Enterobius vermicularis among Preschool Children in Gimhae-si, Gyeongsangnam-do, Korea

The present study was performed to determine the prevalence of Enterobius vermicularis among preschool children in Gimhae-si, Korea. A total of 6,921 preschool children in 76 kindergartens were examined using the cellotape perianal swab method. The overall egg positive rate (EPR) was 10.5%. The EPR in boys was higher than that in girls (adjusted odds ratio [AOR]: 1.5, P<0.001), and it was higher in rural than in urban children (AOR: 1.2, P=0.022). The present study confirmed that the prevalence of E. vermicularis infection is fairly high among preschool children in Gimhae-si. Therefore, systematic control and preventive measures should be adopted to reduce morbidity associated with this nematode infection.

Comparison of Egg Positive Rates of Enterobius vermicularis among Preschool Children in Three Korean Localities

This survey was performed to investigate and compare egg positive rates (EPRs) of Enterobius vermicularis among preschool children in 3 Korean localities (Chuncheon-si, Inje-gun, and Paju-si) in 2008. A total of 7,048 preschool children were examined. Overall, the total EPR was 4.0%; the EPR was the highest in Chuncheon-si (5.6%), followed by Inje-gun (4.5%) and Paju-si (3.4%). The EPR of boys (4.9%) was higher than that of girls (3.1%). The EPR significantly increased with age, with the highest observed in 5~7-year-olds. These findings demonstrate that E. vermicularis infection is widely prevalent among preschool children in Chuncheon-si, Inje-gun, and Paju-si, Republic of Korea.

Enterobius vermicularis Eggs Discovered in Coprolites from a Medieval Korean Mummy

While the presence of pinworm eggs in archaeological samples has been reported by many researchers in the New World, those have been detected very scarcely in the Old World, especially in East Asian countries. In fact, many parasite species were recovered from the archeological remains in Korea, eggs of Enterobius vermicularis had not been found. Recently, a female mummy buried in the 17th century was discovered in the Joseon tomb from Dangjin-gun, Chungcheongnam-do, Korea. After rehydration process for 12 days, investigations were carried on the luminal surface of the colon. From them, 3 eggs of E. vermicularis were recovered. They were elliptical, transparent with a thin egg shell, 50.3+/-5.2 microm (length) and 28.2+/-3.9 microm (width) in size. This is the first discovery of E. vermicularis eggs in East Asia.

Intestinal Helminthic Infections Diagnosed by Colonoscopy in a Regional Hospital during 2001-2008

The present study investigated characteristics of 24 parasite infection cases detected during colonoscopy in a regional hospital from January 2001 to December 2008. Sixteen patients were confirmed with Trichuris trichiura infection, 6 patients were with Ascaris lumbricoides infection, 1 patient with Enterobius vermicularis infection, and 1 patient with Anisakis infection. Among them, 7 patients (43.8%) were asymptomatic. Colonoscopy findings were normal in 18 patients (75.0%). Among the patients with T. trichiura infection, colonoscopy showed several erosions in 2 patients (8.3%) and non-specific inflammation of the affected segment of the colon in 3 patients (12.5%). In 1 patient with anisakiasis, colonoscopy revealed a markedly swollen colonic wall. Stool examinations were performed before treatment in 7 patients (29.2%) and were all negative for parasite eggs or worms. These results suggest that colonoscopy is a useful diagnostic approach for parasitic infections even for asymptomatic patients and for patients with negative stool examinations.

Intestinal parasites inside public restrooms and buses from the city of Uberlândia, Minas Gerais, Brazil / Parasitas intestinais no interior de sanitários públicos e ônibus na cidade de Uberlândia, Minas Gerais, Brasil

The objective of this study was to describe the occurrence of intestinal parasites inside public restrooms and buses from a Brazilian city. Sample material was obtained using a transparent adhesive tape. Thirty two public restrooms were investigated and two (6.25%) were contaminated with helminth eggs (Ascaris lumbricoides and Enterobius vermicularis). Of the sixteen different bus lines, three (18.7%) were found to harbor eggs of E. vermicularis. Public restrooms and buses can be an important source of parasite transmission and sanitary education could be improved by using these points.

O objetivo do presente estudo foi descrever a ocorrência de parasitas intestinais em sanitários públicos e ônibus de uma cidade do Brasil. As amostras foram obtidas utilizando-se fita adesiva transparente. Trinta e dois sanitários públicos foram investigados e dois (6,25%) estavam contaminados com ovos de helmintos (Ascaris lumbricoides e Enterobius vermicularis). Das 16 diferentes linhas de ônibus, três (18,7%) foram positivas para ovos de E. vermicularis. Sanitários públicos e ônibus podem ser uma importante via de transmissão de parasitas e a educação sanitária pode ser aperfeiçoada por meio do uso destes pontos.

Effectiveness of Repeated Examination to Diagnose Enterobiasis in Nursery School Groups

The aim of this study was to estimate the benefit from repeated examinations in the diagnosis of enterobiasis in nursery school groups, and to test the effectiveness of individual-based risk predictions using different methods. A total of 604 children were examined using double, and 96 using triple, anal swab examinations. The questionnaires for parents, structured observations, and interviews with supervisors were used to identify factors of possible infection risk. In order to model the risk of enterobiasis at individual level, a similarity-based machine learning and prediction software Constud was compared with data mining methods in the Statistica 8 Data Miner software package. Prevalence according to a single examination was 22.5%; the increase as a result of double examinations was 8.2%. Single swabs resulted in an estimated prevalence of 20.1% among children examined 3 times; double swabs increased this by 10.1%, and triple swabs by 7.3%. Random forest classification, boosting classification trees, and Constud correctly predicted about 2/3 of the results of the second examination. Constud estimated a mean prevalence of 31.5% in groups. Constud was able to yield the highest overall fit of individual-based predictions while boosting classification tree and random forest models were more effective in recognizing Enterobius positive persons. As a rule, the actual prevalence of enterobiasis is higher than indicated by a single examination. We suggest using either the values of the mean increase in prevalence after double examinations compared to single examinations or group estimations deduced from individual-level modelled risk predictions.

Prevalence of Enterobius vermicularis Infection among Preschool Children in Kindergartens of Taipei City, Taiwan in 2008

The prevalence of Enterobius vermicularis infection among preschool children was reported to be low based on a 5-year screening program in Taipei City, Taiwan. The Taipei City government intended to terminate the E. vermicularis screening program among preschool children. Thus, we were entrusted with confirming whether pinworm infections among preschool children in Taipei City had truly declined. From each of 12 administrative districts 2-3 kindergartens were randomly selected for investigation. In total, 4,349 children were examined, of which 2,537 were boys and 1,812 were girls. The cellophane tape adhered to a glass slide was used, and all examinations were done by certified medical technologists. Results indicated that the overall prevalence rate of pinworm infections was 0.62% (27/4,349). Although the infection rate was higher among boys (0.67%, 17/2,537) than in girls (0.55%, 10/1,812), no significant difference was found (chi2 = 0.399, P = 0.62). According to the administrative district, the infection rate ranged from no positive cases of E. vermicularis infection in the Xinyi, Zhongzhen, and Wanhua Districts (0%; 0/299, 0/165, and 0/358, respectively), to 0.26% (1/131) in Songshan District, with the highest rate of 1.88% (7/373) in Wenshan District. Because the overall infection rate (0.62%, 27/4,349) in the present study was unchanged compared to that (0.40%, 197/49,541) previously reported in 2005, we propose that regular pinworm screening and treatment programs should be continued in some parts of Taipei City.

Prolonged irritative voiding symptoms due to Enterobius vermicularis bladder infestation in an adult patient

Enterobius vermicularis (pinworm) is one of the most prevalent intestinal parasites in the world. The urinary tract is rarely affected and few cases have been reported. We report a case of bladder infestation by mature female worms of E. vermicularis in a woman presenting with irritative voiding symptoms.

Infecções parasitárias do apêndice cecal e suas relações com apendicite aguda / Parasitic infection of the appendix and its possible relationship to acute appendicitis

Investigou-se a prevalência de infecções parasitárias do apêndice cecal e suas relações com a apendicite. Dos 1.600 apêndices estudados 24 (1,5 por cento) apresentaram infecção parasitária. Enterobius vermicularis foi encontrado em 23 casos (95,8 por cento) e Taenia sp em apenas um (4,2 por cento). Dezesseis pacientes (66,7 por cento) eram menores de 10 anos; 15 eram masculinos e 9 femininos. A análise histopatológica demonstrou inflamação aguda supurativa em 12 casos (50 por cento), eosinofilia em 13 (54,2 por cento) e hiperplasia linfóide em 10 (41,7 por cento). Complicações como peritonite ocorreram em 11 e gangrena em 3 casos. As infecções parasitárias do apêndice são causa pouco freqüente de apendicite aguda em crianças e adolescentes.

From 1,600 surgically removed appendices, 24 (1.5 percent) were found to have helminths. Enterobius vermicularis was observed in 23 of the 24 specimens (95.8 percent) and Taenia sp was detected in only 1 (4.2 percent) case. Sixteen patients (66.7 percent) were less than 10 year-old; 15 patients were male and 9 female. Pathologic analysis disclosed acute neutrophilic inflammation in 12 cases and lymphoid hyperplasia in 10 of the 24 appendices. Gangrenous appendicitis was diagnosed in 3 cases and peritonitis was found in 11 of the 24 infested appendices. Parasitic infection of the appendix is an uncommon cause of acute appendicitis in children and adolescents.

Prevalence of intestinal parasitic infections among school children in the central region of Thailand.

OBJECTIVE: Survey the prevalence of intestinal parasitic infections in 14 primary schools of Central Thailand. MATERIAL AND METHOD: A cross sectional survey of the prevalence of intestinal parasitic infections in 14 primary schools of Central Thailand that included Ang Thong, Ayudthaya, and Suphanburi provinces was conducted One thousand and thirty seven children with age ranging from 3-12 years (540 males and 497 females) were examined for intestinal parasites by the formalin-ether concentration technique. RESULT: The overall prevalence was 4.24%. The pathogenic parasites found were Giardia lamblia (1.25%), Enterobius vermicularis (0.19%), Trichuris trichiura and Hookworm (0.19% each), respectively. The common non-pathogenic protozoa found were Entamoeba coli (1.64%) and Endolimax nana (0.48%). The infection rate of Blastocystis hominis was 0.19%. CONCLUSION: Interestingly, the area studied which is low and flat and contains rice and water chestnut fields and small rivers, did not demonstrate Fasciolopsis buski as highly found in the past five decades. However, Parasittic infections are still public health problems in Thailand Close monitoring and control of parasitic infections is needed

Enterobíase / Enterobiasis

Os autores fazem uma revisão da enterobíase com uma visão clínica, com maior ênfase no diagnóstico e apresentação de novas opções terapêuticas desta parasitose intestinal

Egg positive rate of Enterobius vermicularis and Taenia spp. by cellophane tape method in primary school children in Sivas, Turkey

The aim of the present study was to find out the number of students with enterobiasis and/or taeniasis in primary schools of Sivas. Among the 2, 029 students in 6 primary schools, 316 (15.6%) were positive to Enterobius vermicularis eggs and 32 (1.6%) were positive to Taenia spp. eggs by the cellophane tape method. The egg positive rates of E. vermicularis and Taenia spp. ranged from 9.4% to 27.2% and from 0.8% to 2.6% respectively among six schools. The egg positive rate of E. vermicularis was found to be significantly different among these schools (chi2 = 31.96, P 0.05). The rate (18.7%) of E. vermicularis in the urban slum regions was higher than the rate (11.5%) in the urban central regions (chi2 = 19.20; P < 0.05). Above results demonstrate that the egg positive rate of E. vermicularis and Taenia spp. was still prevalent among primary school children.

A survey of Enterobius vermicularis infection among children on western and southern coastal islands of the Republic of Korea

To determine the status of Enterobius vermicularis infection among children living on western and southern coastal islands of the Republic of Korea, children (3-10 years) in 39 kindergartens and primary schools were examined using the cello-tape anal swab method, during July and August 2000. Of 1, 661 children examined, 307 (18.5%) were found to be positive for E. vermicularis eggs. The highest infection rate (59.3%) was found in a kindergarten and a branch school of Shinyang primary school on Chujado, Jeju-do (Province). Remarkable differences in egg positive rates were observed in different localities. The egg positive rate for boys (21.3%) was significantly higher than that of girls (15.4%) (P = 0.02). However, positive rates were not significantly dependent on age. The results of the present study show that E. vermicularis infection is highly prevalent among pre-school and primary school children living on the western and southern coastal islands of the Republic of Korea, and indicate the need for efforts to control this infection.

Enterobiasis mimicking Crohn's disease.

We report a 20-year-old man who presented with abdominal discomfort for 2 months. Colonoscopy showed skip areas with ulceration, resembling Crohn's disease. Biopsies showed chronic inflammation and a non-necrotizing granuloma. An adult pinworm was found in the lumen from an uninvolved segment. The patient responded to mebendazole.