Diarrea del viajero: prevención y tratamiento / Traveler’s diarrhea: prevention and treatment

La diarrea del viajero (DV) afecta a 34 millones de personas que viajan a países en desarrollo todos los años. El destino representa el factor de riesgo más importante para el desarrollo de DV. Por mucho, los agentes etiológicos más frecuentes son bacterias patógenas (Escherichia coli enterotoxigénica, Escherichia coli enteroagregativa, Campylobacter, Salmonella). La reducción en la tasa de diarrea sería posible al evitar el consumo de alimentos y bebestibles contaminados. Una estrategia preventiva más eficaz consiste en administrar antibióticos todos los días durante viajes a áreas en que el riesgo de DV es alto. Rifaximina, antibiótico no absorbible recientemente aprobado, puede ser usado para el tratamiento de la DV en regiones donde la E. coli no invasora es el patógeno predominante. En áreas donde un organismo invasivo como el Campylobacter y Shigella son comunes, las fluoroquinolonas sigue siendo el medicamento escogido. La azitromicina es recomendada en áreas con Campylobacter resistente a las quinolonas y para el tratamiento de niños y mujeres embarazadas.

Traveler’s diarrhea (TD) affects 34 millions of people who travel to developing countries each year. Destination represents the single most important risk factor for developing TD. By far, the most frequent etiologic agents are bacterial pathogens (enterotoxigenic Escherichia coli, enteroaggregative E. coli, Campylobacter, Salmonella). Reduction in the rate of diarrhea maybe possible by avoiding contaminated foods and beverages. A more effective preventive strategy is daily administration of antibiotics during trips to areas where the risk of TD is high. Rifaximine, a recently approved non-absorbable antibiotic, can be used for the treatment of TD in regions where non invasive E. coli is the predominant pathogen. In areas where invasive organism such as Campylobacter and Shigella are common, fluoroquinolones remain the drug of choice. Azythromycin is recommended in areas with quinolone-resistant Campylobacter and for treatment of children and pregnant women.

Adaptação ao Método de Ritchie para diagnóstico de Helmintos e Protozoários em amostras de lodo de esgoto com minimização de produtos químicos / La adaptación del Método de Ritchie para la diagnosis de Helmintos y protozoos en muestras de aguas residuales con minimización de productos químicos / Adaptation of Ritchie Method for diagnosing Helminthes and Protozoa in samples of sewage silt with chemical substances minimization

O Método de Ritchie (1948) é uma metodologia eficiente para diagnóstico parasitário em matrizes ambientais, porém apresenta como desvantagem o uso do éter etílico e formaldeído, reagentes toxicológicos para a saúde ambiental e ocupacional. O objetivo do estudo foi padronizar uma técnica adaptada do Método de Ritchie para identificação de parasitas em lodo de esgoto, que evite o uso de substâncias tóxicas e possa ser utilizada em laboratórios de parasitologia. Amostras de lodo foram submetidas ao Método Ritchie (MR) e ao Método de Ritchie Modificado por Régis Anécimo (MRMRA), no qual substancias químicas são substituídas por água a 45 graus Ce detergente neutro. Os resultados demonstraram que, no MR, a porcentagem de Ancylostoma sp foi de 19%, Hymenolepis sp 79%, Ascaris sp 2% e Trichuris trichiura 0%, em um total de 1970 helmintos visualizados. Porém, no MRMRA, a porcentagem de Ancylostoma sp foi de 56%, Hymenolepis sp 40%, Ascaris sp 4% e Tricuris trichiura 0%, em um total de 398 helmintos. Avaliando quantitativamente o MRMRA foi menos eficiente, pois esses resultados demonstraram uma diferença significativa de helmintos visualizados entre os métodos. Porém, enquanto análise qualitativa, a técnica pode ser considerada válida, uma vez que a qualidade da visualização dos parasitas é correspondente em ambos os métodos. Pode ser concluído que o MRMRA é um método simples de realizar e de fácil implementação na rotina de laboratórios e estações de tratamento de esgoto.

El Método de Ritchie (1948) es una metodología eficiente para diagnosticar organismos parásitos en matrices ambientales, pero el uso de del éter etílico y del formaldehído es una desventaja, vez que son reactivos tóxicos para el ambiente y la salud ocupacional. El objetivo de este estudio fue estandardizar una técnica conveniente del Método de Ritchie como para la identificación de parásitos en el légamo de las aguas residuales, técnica que evita el uso de sustancias tóxicas y se puede utilizar en laboratorios parasitológicos. Las muestras de légamo fueron sometidas al Método de Ritchie (MR) y al Método de Ritchie Modificado por Régis Anécimo (MMRRA), en el cual quien el agua en 45 grados C y detergente neutral substituyen las sustancias químicas. Los resultados demuestran que en RM el porcentaje de Ancylostoma sp fue 19%, Hymenolepis sp 79%, Ascaris sp 2% y Trichuris trichiura 0% de un total de 1970 helmintos, mientras que enel MRMRA el porcentaje del de Ancylostoma sp fue 56%, Hymenolepis sp 40%, Ascaris sp 4% y Trichuris trichiura 0% de un total de 398 helmintos. Cuantitativamente evaluado MRMRA fue menos eficiente, porque estos resultados demuestran una diferencia significativa de los helmintos identificados por los métodos. Sin embargo, un análisis cualitativo demuestra que la técnica es válida, puesto que la calidad de la identificación de los parásitos está igual en ambos métodos. Se puede concluir que MRMRA es un método simple y fácil como para ser utilizado en la rutina de laboratorios y de estaciones del tratamiento de aguas residuales.

Ritchie Method (1948) is an efficient methodology for diagnosing parasitic organisms in environmental matrixes, but the use of ethylic ether and formaldehyde is an disadvantage, for these are toxic reagents that damages the environment and affects occupational health. The objective of this study was to standardize a suitable technique of Ritchie Method for the identification of parasites in sewage silt, which avoids the use of toxic substances and can be used in parasitological laboratories. Samples of silt were submitted to Ritchie Method (RM) and Method of Modified Ritchie by Régis Anécimo (MMRRA), in which water at 45 degrees C and neutral detergent substitute for chemical substances. Results show that in RM the percentage of Ancylostoma sp was 19%, Hymenolepis sp 79%, Ascaris sp 2% and Trichuris trichiura 0% from a total of 1970 visualized helminthes, whereas in MRMRA the percentage of Ancylostoma sp was 56%, Hymenolepis sp 40%, Ascaris sp 4% and Tricuris trichiura 0% in a total of 398 helminthes. Evaluated quantitatively MRMRA was less efficient, for these results show a significant difference in the number of helminthes identified by the methods. However, a qualitative analysis shows the technique to be valid, since the quality of parasites identification is the same in both methods. We may conclude that MRMRA is a simple and easy method to be used in the routine of laboratories and sewage treatment stations.

Effect of ozone on the viability of some protozoa in drinking water

In this study, water samples from household tanks in several districts of Alexandria were examined for protozoa contamination and studying the effect of ozone and chlorine on their viability. The parasitic protozoa encountered were Giardia, Cryptosporidia, Blastocystis, Cyclospora and Microsporidia. Distilled water was treated by ozone or chlorine. Ozonated water samples were prepared at a concentration of 1 ppm after contact times with ozone of three, five, seven and nine minutes. Chlorine concentrations were 4 and 8 ppm. Parasites were incubated overnight at room temperature with the treated distilled water. The viability of the parasites was assessed by examining the intestinal sections of the infected animals

Ichthyophthirius multifilis protozoa in gasteropelecus sternicola, Linnaeus 1758, collected in the area of Belém state of Pará Brazil

The present study describes for the first time Ichthyophthirius multifilis infecting twenty ornamental fishes Gasteropelecus sternicola (white butterfly fish). Parasites were found in 100 percent of examined fishes. Light microscopy and scanning electron microscopy (SEM) were used in this exam. SEM showed fins destroyed by the parasites action. High prevalence of the parasitism has a high concern as those fishes are of commercial importance for Brazil

Enteroparasitos en niños residentes en zona rural del Partido del Carmen de Patagones: Provincia de Buenos Aires, Argentina / Enteroparasites in children living in rural areas at the Partido de Carmen de Patagones: province of Buenos Aires, Argentina

Como parte del programa de atención primaria de la salud (APS) del año 1996, y en virtud que no existían datos epidemiológicos referidos a enteroparásitos hallados en niños de 0 a 14 años, residentes en una zona rural del Partido de Carmen de Patagones, Provincia de Buenos Aires, es que se realizó el presente estudio epidemiológico descriptivo. Se estudiaron 210 niños a los que se les efectúo un estudio parasitoscópico seriado de materia fecal y mucus anal. Los resultados mostraron que el 60,5 por ciento de la población estudiada era portadora de algún parásito intestinal. El monoparasitismo hallado fue de 67 por ciento, mientras que 33 por ciento restante presentó entre 2 y 5 formas parasitarias. El espectro parasitario fue el siguiente: entamoeba coli 31,5 por ciento, giardia lamblia 24,7 por ciento; enterobius vermicularis 18 por ciento; hymenolepis nana 10,4 por ciento; blastocystis hominis 10,4 por ciento; 10,3 por ciento; chilomastix mesnili 2,5 por ciento; entamoeba hystolytica 0,9 por ciento y trichuris 0,5 por ciento. La distribución parasitaria en los distintos sectores estudiados fue en general homogénea excepto para H. nana la cual presentó una prevalencia más altas en zonas de riesgos con relación a la zona seca. Los resultados obtenidos fueron comunicados a las autoridades sanitarias correspondientes

Studies on a newly emerging protozoal pathogen: cyclospora cayetanensis

Cyclospora is frequently misdiagnosed with Cryptosporidia. Stool samples were collected from 150 immunocompromised patients and concentrated by the parasep fecal parasite concentration and the discontinuous Percoll gradients methods. Wet mount examination was done and the parasite was successfully stained with modified Ziehl Neelsen [ZN] and safranin methylene blue stain. Cyclospora was detected in 4% of the examined cases. Cyclospora was easily differentiated from Cryptosporidia by using the modified detergent ZN stain, whereby Cyclospora resisted staining and Cryptosporidia pick up the pink coloration. Scanning and transmission electron microscopic examinations were done to the unsporulated Cyclospora oocysts. They appeared as spherical objects with an outer fibrillar coat, an indentation and sutures. These spherical objects also contained light and dark granules. In studying the possible sources of transmission of this parasite, sporulated and unsporulated oocysts were detected in tap water and lettuce heads, which supported the theory that water and food could be the sources of transmission of this parasite

Protozoos emergentes. Comparación de tres métodos de identificación / Emergent protozoos. Comparison between three identification methods

Se realizó un estudio comparativo-prospectivo en 541 muestras de heces blanda, muy blandas y líquidas, de niños de un año a 14 años de edad. Se procesaron tres técnicas coproparasitoscópicas (CPS): CPS directo, CPS de concentración por flotación Ferreira y tinción de Kinyoun, para la identificación de Cryptosporidium parvum, Cyclospora cayetanensis, Isospora belli y Blastocystis hominis. Los cuatro protozoarios patógenos emergentes fueron identificados en 158 muestras de heces (29.2 por ciento). Dentro de los positivos el 25.9 por ciento correspondió a C. parvum, 11.4 por ciento a C. cayetanensis, 62.0 por ciento a B. hominis y sólo un caso de I. belli. La sensibilidad de la tinción de Kinyoun para C. parbun y C. cayetanensis fue de 100 por ciento y la especificidad de 98.8 por ciento, comparada con CPS Ferreira (p<0.05). La sensibilidad del CPS Ferreira en B. hominis fue 100.0 por ciento y la especificidad de 84.9 por ciento comprada con el CPS directo (p<0.05). Se sugiere que a todas las muestras de heces alteradas en su consistencia se les realice la búsqueda intencionada de estos cuatro patógenos emergentes, mediante CPS convencionales y la tinción de Kinyoun

Cyclospora: a newly identified protozoan pathogen of man

A newly recognized protozoan human parasite, Cyclospora spp., has been incriminated as the cause of prolonged diarrhea. It has been isolated from children, immunocompetent and immunocompromised adults. 130 immunocompetent patients [80 children and 50 adults] were included in this study, their illness was characterized by prolonged watery diarrhea, were enrolled in this study. Stool sediments were examined as wet mounts and stained by both modified Ziehl-Neelsen and aniline carbol methyl violet stains. The protozoan pathogen was identified as spherical bodies measuring 9-10 mum in diameter in about 9% and 10% in both children and adult groups, respectively. The mean duration of illness was 28 +/- 8 and 37 +/- 12 days and the frequency of stool motions was >5/day with normal mucosal pattern on colonoscopic studies for adults group. It was concluded that cyclosporiosis is quite similar to cryptosporidiosis and both oocysts have the affinity to acid fast stain. So, the present recommendations for all laboratories screening stool for cryptosporidia should measure the oocyst to distinguish between these different parasites

Liver abscess: presentations and management

The clinical and management data of 19 patients,who reported to surgical unit2 of Sir Ganga Ram Hospital, Lahore with liver abscesses are presented. These patients were treated with, percutaneous drainge under Ultrasound control with the help of Radiology Department. In 11 patients[57.9%] No. 16 size needle was used while in 8 cases [42.1%] size 26 F Foley's Catheter was used.In 16 cases [84.2%] abscesses were in right lobe, in 1 patient [5.3%] left lobe and 2 patients [10.4%] had multiple abscesses of liver. There was one morfafity.[5.3%] and 3 patients [15.8%] showed post operative complications. Results show that percutaneous drainge is safe and effective procedure with low morbidity and negligible mortality

Prevalencia de infección por protozoos en roedores sinantrópicos de la ciudad de Valdivia en Chile / Prevalence of protozoa infections in synanthropic rodents in Valdivia city in Chile

Entre los meses de marzo y septiembre de 1986 se llevó a cabo un estudio de 57 roedores sinatrópicos en la ciudad de Valdivia, con el fin de determinar la prevalencia de la infección por protozoos en sangre y en los órganos del tracto digestivo. El grupo de animales estudiados comprendía roedores de ambos sexos, correspondiendo éstos a 42 machos y 15 hembras. El 70,2 por ciento de los animales investigados estaba parasitado, comprobándose la presencia de cinco especies de enteroprotozoos y una especie de hemoflagelado. El número y porcentaje encontrado fue el siguiente: giardia muris 21 (36,8 por ciento), hexamita muris 22 (38,6 por ciento), trichomonas muris 9 (15,8 por ciento), eimeria sp 15 (26,3 por ciento) y trypanosoma lewisi 9 (15,8 por ciento). Se analizaron los resultados en relación al sexo de los huéspedes, no encontrándose diferencias significativas. Además, se determinó el rendimiento del examen directo, flotación con solución de azúcar y SAFS en las muestras de deposiciones. La técnica de flotación mostró el más alto rendimiento en el diagnóstico de los coccidios, mientras que el SAFS fue más eficiente en la detección de giardia muris y entomoeba muris

Phalacrocorax olivaceus un huevo vector mecánico de henneguya sp en ecosistemas acuáticos del sur de Chile / Phalacrocorax olivaceus a new mechanical vector of henneguya sp in aquatic echosystems from the south of Chile

This is the first report of henneguya sp, a myxozoan parasite of fishes, in faeces of phalacrocorax olivaceus, a piscivorous bird, from Valdivia river, Chile. Phalacrocorax olivaceus would be a mechanical vector of henneguya sp an contributes to diseminate the infection in fishes

Enfoque diagnóstico y terapéutico de la diarrea crónica en pacientes con SIDA / Diagnosis and therapeutics approach to the chronic diarrhea in AIDSns patients

Estudia las infecciones intestinales en pacientes con SIDA, las que les provocan diarrea con compromiso del intestino delgado y/o del colon. Se identifican los principales agentes patógenos y las manifestaciones clínicas de las infecciones que producen enfermedad primaria intestinal (Cryptosporidium, Enterocytozoon bieneusi, Isospora belli, Giardia lamblia, Salmonella, Shigella, Campylobacer, Clostridium difficile, Virus Herpes Simplex) y que producen compromiso intestinal secundario a infecciones sistémicas (Cytomegalovirus, Mycobacterium avium intracelular, Histoplasma capsulatum) y otros patógenos (Blastocystis hominis, Entamoeba hystolitica y otras). Se discuten las hallazgos relacionados con la enteropatía idiopática asociada al SIDA y a los neoplasmas intestinales (Sarcoma de Kaposi y linfomas). Se exponen algunos estudios realizados sobre tratamiento de estas infecciones (drogas empleadas, respuesta a las mismas y efectos adversos observados)

Observation on incidence of intestinal parasitic infection in school going children of Quetta district, Pakistan

Stool samples from 450 children were examined coming from different areas in District Quetta. Frequencies of infection of pathogenic protozoan and helminthes were as follows: Giardia lamblia 20.01%, Entamoeba histolytica 19.0%, E. coli 32.50%, Ascaris lumbricoides 34.60%, Ancylostoma duodenale 2.60% Enterobius vermicularis 5.20%, Trichuris trichiura 2.40%, and Hymenolepis nana 18%

Comparative study on gastrointestinal parasites among different tribes settled in Quetta, Pakistan

Very little information on parasitic infection exists in Pakistan, particularly in the Province of Balochistan. An attempt has been made on a faecal survey of different ethnic groups settled in Quetta. A total of 4,147 faecal samples were collected, examined and processed through different methods and techniques for the preservation and observation of parasites ova, cysts and trophozoites. The recorded result showed that 57.99% persons suffered from either protozoan or helminthic infections. Three species of pathogenic and four species of non-pathogenic parasites were observed. Among protozoans, the highest incidence was E. coli 3b. 57, followed by G. lamblie 16.29 and E. histolytica 14.01. Helminthic infection was lower than protozoan and the highest incidence was of H. nora 11.16 followed by A. lumbricoides 6.25, E. vermicularis 2.30, T. saginata 1.25, H. diminuta 0.85, A. duodenale 0.20 and T. trichiura 0.16. Mixed infection among protozoan and helminthic was also observed. Blastocystis hominis with the incidence of 2.33, H. diminuta, T. saginata are reported for the first time from this province during the investigation. Incidence of parasitic infection according to tribes was observed. An attempt was also made to consider the role of age, sex, unhealthy environment and other socie-economic conditions or variations obtained among these incidences

Trichomonas tenax in Basrah, Iraq

One hundred and fortythree swabs from diseased mouths and 271 from healthy controls were examined by direct wet smear method for Trichomonas tenax. Negative swabs were cultured on suitable media. The frequency of trichomonas tenax was 8.4% and 4.1% in diseased and controls respectively. Of 23 positive samples, 14 [3.3%] were positive on direct wet smear method and 9 [2.1%] were positive on culture method. There were 12 males and 11 females. Highest frequency of infection [6.7%] was found in 6-10 years age group and lowest [3.7%] in 11 -20 years group. Only 1% university students were positive

A protozoologist in Amazonia: neglected parasites, with particular reference to members of the coccidia (protozoa: Apicomplexa)

In spite of the vast source of material available in Amazonia, the extraordinarily rich variety of protozoal parasites in its fauna remains virtually neglected. During some 26 years investigating the role of wild animals as reservoirs of Leishmania, the author has been able to take a brief but rewarding look at other parasites. This review discusses some of the more interesting ones, in particular some controversial, "malarial parasites" of lizards; haemogregarines of reptiles and fish; and a variety of intestinal Coccidia of birds, reptiles and mammals.