Paragonimus paishuihoensis Metacercariae in Freshwater Crabs, Potamon lipkei, in Vientiane Province, Lao PDR

Among Paragonimus species, P. paishuihoensis is one of the most mysterious and poorly understood species. Metacercariae are characterized by having a unique dendritically branched excretory bladder. However, the morphology of the adult worm remains unknown. To date, metacercariae of this species have been reported only in China and Thailand. In this study, we first found P. paishuihoensis metacercariae in freshwater crabs, Potamon lipkei, in Hinheub District, Vientiane, Lao PDR, with a prevalence of 77.7% and the average intensity of 10.3 (range 1-28) metacercariae per crab. The molecular data based on ITS2 and CO1 markers indicated that P. paishuihoensis from Laos and Thailand were almost completely identical and were close to members of the Paragonimus bangkokensis/Paragonimus harinasutai complex. Attempts to infect experimental animals (cats, dogs, and rats) with P. paishuihoensis were unsuccessful, suggesting that these animals might be unsuitable definitive hosts for the species. Further studies are necessary to elucidate the taxonomic status and life cycle of P. paishuihoensis.

The Lao initiative on access to treatment for epilepsy

In Lao PDR research conducted over the last 7 years has highlighted the diffi cult challenges that the 52,000 patients living with epilepsy (PWE) have to face. Mortality and morbidity is high among untreated patients. The treatment gap is 90% or more. The highly traditional and poor knowledge of the disease and its treatment, low trust in modern treatment, restricted access to anti-epileptic drugs (phenobarbital is the fi rst line drug), and ignorance of requirement for long term treatment explain the high treatment gap. Stigma, misconceptions, and fear of the disease are common. Knowledge of medical staffs regarding epilepsy diagnosis and treatment is poor. The neurology investigational facilities are basic and mainly concentrated in the capital city. Using lessons from program of neighboring countries, the authors have been developing a step-by-step treatment intervention project since 2009. The intervention was adapted to the local constraints and a limited budget, which demanded regular feedbacks, analysis and reorientation of the activities.

Epilepsy in Lao PDR: From research to treatment intervention

Epilepsy in Lao Peoples’ Democratic Republic (Lao PDR) is a neglected condition. After 5 years of research, we established some baseline information for people living with epilepsy in Lao PDR. Prevalence was 7.7 per thousand population. Stigma and misconceptions were common. Traditional beliefs and practices were prevalent. The treatment gap was 90% or more. Phenobarbital was available in less than 55% of pharmacies in the capital city of Vientiane and not available in many rural areas. There are two neurologists in the country. The neurology investigational facilities are basic, mainly concentrated in the capital city. The studies demonstrate that epilepsy is a public health concern in Lao PDR. The authors proposed a treatment intervention project involving multiple partners and a step-by-step approach.