Echinochasmus caninus n. comb. (Trematoda: Echinostomatidae) Infection in Eleven Riparian People in Khammouane Province, Lao PDR

Adult specimens of Echinochasmus caninus n. comb. (Verma, 1935) (Trematoda: Echinostomatidae) (syn. Episthmium caninum Yamaguti, 1958) were recovered from 11 riparian people who resided along the Mekong River in Khammouane Province, Lao PDR. In fecal examinations done by the Kato-Katz technique, the cases revealed eggs of Opisthorchis viverrini/minute intestinal flukes, hookworms, and in 2 cases echinostome eggs. To recover the adult helminths, praziquantel 30–40 mg/kg and pyrantel pamoate 10–15 mg/kg in a single dose were given and purged with magnesium salts. Various species of trematodes (including O. viverrini and Haplorchis spp.), cestodes, and nematodes were recovered from their diarrheic stools. Among the trematodes, small echinostome flukes (n=42; av. 3.8 specimens per case) of 0.7–1.2 mm in length are subjected in this study. They are morphologically characterized by having 24 collar spines interrupted dorsally and anterior extension of vitellaria from the cirrus sac or genital pore level to the posterior end of the body. Particularly based on this extensive distribution of vitellaria, the specific diagnosis was made as Echinochasmus caninus. The cases were co-infected with various other helminth parasites; thus, clinical manifestations specific for this echinostome infection were difficult to determine. The present paper describes for the first time human E. caninus infections in Lao PDR. Our cases marked the 4–14th human infections with this echinostome around the world following the 3 previous cases reported from Thailand.

Administrative Factors and Processes Affecting Performance of Epidemiological Surveillance among Health Personnel at Health Centers in Khammouane Province, Lao PDR / Lao Medical Journal

Rational and Background: Epidemiological surveillance by Khammouane Provincial Health Centers has been inadequate with incomplete and untimely data collection, and insufficient information dissemination. However, difficulties and gaps in the surveillance system have not been identified. Study of the administrative factors and processes affecting performance of epidemiological surveillance by health center workers would help to identify problems and therefore identify appropriate solutions. Methodology: This was a descriptive, cross-sectional study involving two groups: (1) 143 health workers from 74 health centers who were interviewed using a questionnaire and (2) 9 heads of epidemiology teams from 9 districts of Khammouane Provinces, Lao PDR who were interviewed in-depth. Results: Fifty-nine percent of the respondents were female with mean (SD) age of 35.6 (8.5) years. The mean (SD) years of working in epidemiology was 4.1 (4.2) years. The overall mean (SD) score of performance in epidemiological surveillance by the health center workers was 3.30/5 (0.94). The mean (SD) score of administrative factors affecting the performance in epidemiological surveillance was 2.68/5 (0.80). Previous training in epidemiology and educational level were positively correlated with epidemiology surveillance performance (r=0.25, P<0.05) and (r=0.27, P<0.05). Manpower, material, and budget were related with work performance (r=0.54, P<0.01), (r=0.34, P<0.01), and (r=0.22, P<0.01), respectively. In a multivariate analysis, planning (P<0.01), organization (P<0.01), and staff training (P<0.01) were independently correlated with the epidemiological surveillance performance. Conclusion: The level of the performance of epidemiological surveillance by Khammouan Health Center staff was moderately satisfactory. Regular monitoring of the work performance by the Provincial and District Health is required to identify problems and solutions. At least 1-2 workshops on epidemiological surveillance should be organized in order to enhance knowledge and understanding of disease surveillance by the health center staff aimed at improving their work performance.

Echinostome Flukes Receovered from Humans in Khammouane Province, Lao PDR

Echinostome eggs were detected in 22 (1.1%) of 2,074 people residing in riparian villages along the Mekong River in Khammouane Province, Lao PDR. In order to recover the adult flukes, 9 persons were treated with praziquantel and purged with magnesium salts. A total of 55 echinostome specimens (4 species) were recovered from the 9 persons. Echinostoma revolutum (8 specimens) was recovered from 3 persons, Artyfechinostomum malayanum (8 specimens) was from 2 persons, Echinochasmus japonicus (33 specimens) was from 7 persons, and Euparyphium sp. (6 specimens) was from 1 person. In Lao PDR, only human infections with E. japonicus were previously known. Therefore, the present study describes human infections with E. revolutum, A. malayanum, and Euparyphium sp. for the first time in Lao PDR. These results indicate that the surveyed villages of Khammouane Province, Lao PDR are low-grade endemic foci of echinostomiasis.