Food handlers: an important reservoir of protozoans and helminth parasites of public health importance / Manipuladores de alimentos: um importante reservatório de protozoários e helmintos parasitas de importância para a saúde pública

Food handlers plays a primary role in the transmission of pathogenically important protozoans and helminth parasites. This study was aimed to evaluate the prevalence of intestinal pathogenic protozoans and helminth parasites among food handlers in and around University of Malakand, Lower Dir, Pakistan. Stool samples were collected from 642 food handlers (all of male) in a cross-sectional study from January to November, 2017. Wet Mount Techniques and concentration methods by using salt and formol–ether solutions. Three hundred and eighty four cases (59.8%) were found infected with one more parasites. Most of the individuals were found infected with helminth (47.6%) as compared to intestinal protozoans (0.93%). Seventy two cases (11.2%) of the cases presented mixed infection with both intestinal protozoan and helminth parasites. The order of prevalence for intestinal helminth was Ancylostoma duodenale (n = 258, 40.1%), followed by Taeniasa ginata (n=96, 14.9%) Ascaris lumbricoides (n = 54, 8.40%) and Trichuris trichura (n=30, 4.60%). For intestinal protozoa, Entamoeba histolytica/dispar (n = 36, 5.64%) was the only protozoan detected. Mono-parasitism was higher than poly-parasitism. Family size income and education level were the factors significantly (P<0.05) associated in the parasites prevalence. Current research showed that IPIs are primarily the foodborne pathogens still an important public health problem in Pakistan. Effective control programs on parasitic diseases transfer and their associated factors are recommended.

Os manipuladores de alimentos desempenham um papel fundamental na transmissão de protozoários e helmintos parasitas patogenicamente importantes. Este estudo teve como objetivo avaliar a prevalência de protozoários patogênicos intestinais e helmintos parasitas entre manipuladores de alimentos na Universidade de Malakand, Lower Dir, Paquistão. Amostras de fezes foram coletadas de 642 manipuladores de alimentos (todos do sexo masculino) em um estudo transversal de janeiro a novembro de 2017. Técnicas de montagem úmida e métodos de concentração usando soluções de sal e formol-éter. Trezentos e oitenta e quatro casos (59,8%) foram encontrados infectados com mais um parasita. A maioria dos indivíduos foi encontrada infectada por helmintos (47,6%) em comparação com protozoários intestinais (0,93%). Setenta e dois casos (11,2%) dos casos apresentavam infecção mista com protozoários intestinais e helmintos parasitas. A ordem de prevalência de helmintos intestinais foi Ancylostoma duodenale (n = 258, 40,1%), seguido por Taeniasa ginata (n = 96, 14,9%) Ascaris lumbricoides (n = 54, 8,40%) e Trichuris trichura (n = 30, 4,60 %). Para protozoários intestinais, Entamoeba histolytica / dispar (n = 36, 5,64%) foi o único protozoário detectado. Monoparasitismo foi maior do que poliparasitismo. A renda familiar e o nível de escolaridade foram os fatores significativamente (P <0,05) associados na prevalência de parasitos. A pesquisa atual mostrou que os IPIs são principalmente os patógenos de origem alimentar, ainda um importante problema de saúde pública no Paquistão. Programas eficazes de controle da transferência de doenças parasitárias e seus fatores associados são recomendados.

Una experiencia ecuatoriana en la determinación del comportamiento clínico del síndrome de fragilidad en el adulto mayor con ancylostomiasis / An Ecuadorian experience in determining the clinical behavior of frailty syndrome in the elderly with ancylostomiasis

En adultos mayores, la ancylostomiasis tiene manifestaciones básicas como pérdida del apetito y masa muscular, evacuación excesiva, debilidad y otras que hacen propenso al adulto mayor a un estado de fragilidad, un tipo de síndrome de fallo multiorgánico crónico, donde interviene la disfunción de diversos sistemas. Este agravante fundamenta el objetivo de la presente investigación, centrado en identificar el comportamiento de los criterios clínicos, funcionales, mentales y sociodemográficos en la evaluación geriátrica del síndrome de fragilidad en adultos mayores parasitados por Ancylostoma spp. en el cantón Santiago de Píllaro. La muestra resultó integrada por un total de 102 adultos mayores a 65 años. Mediante la revisión de las historias clínicas y la aplicación de una encuesta a los participantes, se evaluó el comportamiento de los criterios sociodemográficos, médicos, funcionales, mentales y de comorbilidad asociada. Los datos obtenidos fueron procesados estadísticamente mediante análisis bivariado y regresión logística múltiple. Los factores estadísticamente asociados a la fragilidad fueron el sexo femenino (p= 0,003, IC 95% ,LI= 1,564 y LS= 8,950), los bajos ingresos económicos (p= 0,011, IC 95%: LI= 1,786 y LS= 7,433), la polifarmacia (p= 0,006, IC 95%: LI= 2,452 y LS= 14,415) ), las evacuaciones frecuentes (p=0,009, con IC95%: LI=2,704 y LS=7,536) y las afecciones bucodentales (p= 0,004, IC 95%: LI= 1,895 y LS= 6,572), por lo que se justifica la elaboración de estrategias y acciones de salud que minimicen los efectos del estado de fragilidad en la población estudiada(AU)

In older adults, ancylostomiasis has basic manifestations such as loss of appetite and muscle mass, excessive evacuation, weakness and others that make the older adult prone to a state of fragility, a type of chronic multi-organ failure syndrome, where dysfunction of various systems. This aggravating factor supports the objective of the present investigation, focused on identifying the behavior of the clinical, functional, mental and sociodemographic criteria in the geriatric evaluation of frailty syndrome in elderly adults parasitized by Ancylostoma spp. in the canton Santiago de Pillaro. The sample was made up of a total of 102 adults over 65 years of age. By reviewing the medical records and applying a survey to the participants, the behavior of the sociodemographic, medical, functional, mental and associated comorbidity criteria was evaluated. The data obtained were statistically processed using bivariate analysis and multiple logistic regression. The factors statistically associated with frailty were female sex (p = 0.003, 95% CI, LI = 1.564 and LS = 8.950), low income (p = 0.011, 95% CI: LI = 1.786 and LS = 7.433) , polypharmacy (p = 0.006, 95% CI: IL = 2.452 and LS = 14.415)), frequent bowel movements (p = 0.009, with 95% CI: IL = 2.704 and LS = 7.536) and oral disorders (p = 0.004 , 95% CI: LI = 1.895 and LS = 6.572), which is why the development of health strategies and actions that minimize the effects of the state of frailty in the population studied is justified(AU)

Anemia crónica grave por Ancylostoma duodenale en Ecuador: diagnóstico por duodenoscopia / Chronic and severe anemia caused by Ancylostoma duodenale in Ecuador: diagnosis by duodenoscopy

Resumen Durante 11 años un varón de 38 años de edad, residente en una región subtropical de Ecuador, había sido diagnosticado de anemia crónica y tratado con transfusiones de sangre en un hospital de la provincia de Cotopaxi, Ecuador. Fue transferido a Quito por una anemia grave, con hemoglobina de 4 g/dL. Se realizó una duodenoscopia en que se observaron nemátodos adultos, identificados posteriormente como Ancylostoma duodenale. El paciente fue tratado exitosamente con albendazol durante cinco días consecutivos y transfusiones de sangre. En el seguimiento a los ocho meses, no se encontró anemia ni huevos de anquilostomas en el examen de heces.

For 11 years, a 38-year-old male residing in a subtropical region of Ecuador, was repeatedly diagnosed with chronic anemia, and treated with blood transfusions in a hospital of province of Cotopaxi, Ecuador. He was transferred to Quito for severe anemia, having hemoglobin of 4 g/dL. Duodenoscopy was performed and adult nematodes, identified later as Ancylostoma duodenale, were observed. The patient was successfully treated with albendazole for five consecutive days and given blood transfusions. In the control visit at eight months, without anemia and no hookworm ova in the stool examined were found.

Hemorragia digestiva en neonato con uncinarias, Hospital Nacional San Bartolomé: Reporte de caso / Gastrointestinal bleeding in newborn with hookworm, National Hospital San Bartolome: Case report

Se presenta un caso de hemorragia digestiva por uncinariasis en una recién nacida de 27 días, procedente de la comunidad de Tangoshiri ubicada en la provincia de La Convención, en el departamento de Cuzco, quien ingresa al servicio de neonatología del Hospital Nacional Docente San Bartolomé de la ciudad de Lima, por anemia severa descompensada. Presentó, desde los 4 días de nacida, melena que se incrementa a la tercera semana de vida, con hematocrito de 12% por lo que se hospitaliza, recibiendo transfusión sanguínea y al persistir la hemorragia digestiva, se le realiza endoscopia digestiva alta evidenciándose múltiples larvas de Ancylostoma duodenal. Se le dio tratamiento con mebendazol a ella y a la madre con negativización de los exámenes de heces para la presencia del parásito.

We present the case of gastrointestinal bleeding uncinariasis in a newborn baby of 27 days old from anindigenous town of Tangoshiri, located in the province of La Convencion, department of Cuzco, who enters to the service of neonatology National Teaching Hospital San Bartolome in Lima, Peru, with decompensated severe anemia. The baby has melena since the fourth day of his birth, which increased in the third week of life, with hematocrit of 12%. She was hospitalized, receiving blood transfusion and she continue with gastrointestinal bleeding, so she underwent an upper endoscopy that showed multiple larvae Ancylostoma duodenale. She and her mother were treated with mebendazole. Afterwords they had stool examinations without the presence of the parasite.

Prevalência e fatores associados às geo-helmintíases em crianças residentes em municípios com baixo IDH no Norte e Nordeste brasileiros / Prevalence and factors associated with geohelminth infections in children living in municipalities with low HDI in North and Northeast Brazil

Para determinar a prevalência de geo-helmintíases e identificar fatores associados a sua ocorrência, foram realizados inquéritos coprológicos em amostra de crianças entre 5 e 14 anos de idade, residentes em dez municípios brasileiros com baixo Índice de Desenvolvimento Humano. Aplicou-se questionário aos responsáveis, obtendo-se informações sócio-econômicas e ambientais e foi feita coleta de fezes. Estimaram-se prevalências de geohelmintos segundo variáveis de interesse e se avaliaram os fatores de risco mediante regressão logística multinível. Das 2.523 crianças estudadas, 36,5 por cento eram portadoras de um ou mais geohelmintos (Ascaris lumbricoides 25,1 por cento; ancilostomídeos 15,3 por cento, Trichuris trichiura 12,2 por cento). A proporção de geo-helmintíases para o conjunto na zona rural foi 45,7 por cento; na urbana, 32,2 por cento. Baixa renda familiar (OR = 1,75; 1,38-2,23), baixa escolaridade materna (OR = 1,69; 1,39-2,06), presença de lixo próximo ao domicílio (OR = 1,50; 1,22-1,84) e maior número de pessoas no domicílio (OR = 1,41; 1,17-1,71) mostraram-se associadas a tais infecções. Conclui-se que a ocorrência destas parasitoses está relacionada às condições sócio-econômicas e evidencia a importância de intervenções públicas direcionadas à melhoria das condições de vida para sua prevenção.

Stool surveys were conducted to estimate the prevalence and identify risk factors for geohelminth infections among children in ten Brazilian municipalities with low human development indices (HDI). Socioeconomic and environmental data were obtained from the children's parents or guardians, and stool samples were examined. The proportion of geohelminth infections according to target variables was calculated. Risk factors were evaluated using multilevel logistic regression. Of the 2,523 children, 36.5 percent were infected with one or more geohelminths (Ascaris lumbricoides, 25.1 percent; hookworm, 15.3 percent; Trichuris trichiura, 12.2 percent). Overall prevalence of geohelminth infections was 45.7 percent in rural areas and 32.2 percent in urban areas. Low family income (OR = 1.75; 1.38-2.23), low maternal schooling (OR = 1.69; 1.39-2.06), presence of garbage near the home (OR = 1.50; 1.22-1.84), and number of individuals in the household (OR = 1.41; 1.17-1.71) were associated with infection. In conclusion, geohelminth infections were closely related to socioeconomic conditions, thus emphasizing the importance of targeted public interventions to improve living conditions as part of sustainable prevention.

Ancilostomíase / Ancylostomiasis

A ancilostomíase é uma doença parasitária causada pelos helmintos Ancylostoma duodenale e Necator americanus, com importante.

Differential diagnosis of Trichostrongylus and hookworm eggs via PCR using ITS-1 sequence

Trichostrongylus eggs observed in cellophane-thick smears are difficult, in practice, to distinguish from hookworm eggs. In order to overcome these limitations, a molecular approach was conducted. A Trichostrongylus colubriformis adult worm was obtained from a human in Laos, which was identified morphologically. ITS-1 sequence of this worm was determined, and found to be most similar with that of T. colubriformis among the Trichostrongylus spp. reported so far. Then, this sequence was compared with those of human hookworm species, Ancylostoma duodenale and Necator americanus, and species-specific oligonucleotide primers were designed. Polymerase chain reaction (PCR) using these primers evidenced specifically amplified PCR products of Trichostrongylus sp., A. duodenale and N. americanus from the eggs of each (520 bp, 690 bp, and 870 bp, respectively). A species-specific PCR technique can be developed in order to study the epidemiology of Trichostrongylus spp. and hookworms in endemic areas.

Differential diagnosis of Trichostrongylus and hookworm eggs via PCR using ITS-1 sequence

Trichostrongylus eggs observed in cellophane-thick smears are difficult, in practice, to distinguish from hookworm eggs. In order to overcome these limitations, a molecular approach was conducted. A Trichostrongylus colubriformis adult worm was obtained from a human in Laos, which was identified morphologically. ITS-1 sequence of this worm was determined, and found to be most similar with that of T. colubriformis among the Trichostrongylus spp. reported so far. Then, this sequence was compared with those of human hookworm species, Ancylostoma duodenale and Necator americanus, and species-specific oligonucleotide primers were designed. Polymerase chain reaction (PCR) using these primers evidenced specifically amplified PCR products of Trichostrongylus sp., A. duodenale and N. americanus from the eggs of each (520 bp, 690 bp, and 870 bp, respectively). A species-specific PCR technique can be developed in order to study the epidemiology of Trichostrongylus spp. and hookworms in endemic areas.

Evaluation of the role of ancylostoma caninum in human as a cause of acute and recurrent abdominal pain

Ninety-five patients with obscure acute or recurrent abdominal pain and ten asymptomatic healthy parasite free cases were subjected to thorough history taking, clinical examination, sonography, routine laboratory investigations and sero-testing by IgG ELISA to detect antibodies to excretory/secretory [ES] antigens of adult A. caninum and by IgG and IgG4 Western blot [WB] to detect antibodies to Ac68 antigen. Eleven male patients [5 with acute abdomen, 3 diagnosed as appendicitis and 3 had recurrent mild to moderate abdominal pain] fulfilled the criteria of case definition of human enteric infection with A. Caninum [GI]. The study also detected human hookworm infection in 14 patients [G.IIb], other parasites in 34 patients [GIIc] and 36 patients had no parasite [G.IIa]. Although 3 patients from group I were diagnosed as appendicitis and were dealt with surgically, the pain recurred and mebendazole only ameliorated the patients complaints. The obtained appendices of these operated cases showed marked eosinophilic infiltration, but no adult canine hookworms were detected. IgG ELISA was positive in 72.7%, 8.3%, 100%, 23.5% and 0% in groups and control, respectively

Parámetros hematológicos en niños portadores de uncinarias en una población de la provincia de Corrientes / Hematologic parameters in hookworm infested children of a Corrientes province population

Se investigó la prevalencia de enteroparasitosis en 207 escolares de ambos sexos de la población rural de San Cayetano, Corrientes y en los parasitados con uncinaria se evaluó hemoglobina, valores de hierro sérico, capacidad total de fijación de hierro del plasma y saturación de transferrina. Se halló que 171 niños (82 por ciento de la población estudiada) eran portadores de un parásito o más, de los cuales 46 niños (28 varones y 18 mujeres) presentaron examen coproparasitológico positivo para uncinaria. De los 46 niños parasitados con uncinaria, el 67,4 por ciento fueron portadores de Necator americano; 23,91 por ciento de Necator americano + Ancylostoma duodenale; y 8,69 por ciento sólo de Ancylostoma duodenale. Una alta proporción de varones (78,57 por ciento) y de niñas (83,33 por ciento) presentaron anemia; definida con valores de hemoglobina inferiores al percentilo 3 de las tablas de Dallman y Siimes, aunque sólo el 7,14 por ciento de varones y el 11,11 por ciento de niñas presentaron valores de hemoglobina menores de 9 g por ciento. Un 21,42 por ciento de los varones y 33,33 por ciento de las niñas presentaron valores de hierro sérico menores de 35 µg/dl y 28,57 por ciento de varones y 27,77 por ciento de niñas presentaron saturación de transferrina menor de 13 por ciento. Los resultados hallados hacen necesaria la implementación de estrategias destinadas tanto a la disminución como a la prevención de la parasitosis y de la anemia en los niños de esta población rural

Avaliaçäo do método de Kato & Miura: estudo comparativo das modificaçöes propostas a esse método por Borda & Pellegrino e por Katz, Chaves & Pellegrino em relaçäo ao método do Stoll & Hausheer no diagnóstico quantitativo da ancilostomose

Avaliando-se, o método de KATO & MIURA (1954) nas modificaçöes que lhe foram propostas por BORDA & PELLEGRINO (1971) e por KATZ e cols. (1972), tendo como parâmetro o método de STOLL & HAUSHEER (1926), concluiu-se pela evidente superioridade deste último no diagnóstico quantitativo da ancilostomose. Assim sendo, a aplicabilidade daquele ficaria limitada apenas ao controle de cura de pacientes submetidos a tratamento, ou a circunstâncias muito especiais. No entanto, com relaçäo ao desempenho técnico exigido na aplicaçäo dos métodos em questäo, o método de KATO & MIURA (1954), em suas modificaçöes, foi comprovadamente o de mais fácil aplicaçäo. Além disso, apresenta ele superioridade como método de diagnóstico qualitativo, como também indica claramente a possibilidade de ser usado no diagnóstico das principais helmintoses