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.

Prevalencia e intensidad de infección por geohelmintos, caracterizando los factores socio culturales y ambientales que inciden en la infección de escolares, Paraguay, 2015 / Prevalence and intensity of geohelminths infection characterizing the socio-cultural and environmental factors that affect the infection of school children, Paraguay, 2015

Resumen Introducción: Actualmente Paraguay no cuenta con estudios de prevalencia de infección por geohelmintos transmitidos por contacto con el suelo en escolares de 6 a 12 años. Objetivo: Determinar la prevalencia e intensidad de infección por Ascaris lumbricoides, Trichuris trichiura y las uncinarias y las características socio culturalesambientales de la población afectada. Materiales y Métodos: Estudio descriptivo, de corte transversal, en tres zonas climáticas: semi tropical continental, semi tropical semi estépico y semi tropical húmedo. Se seleccionaron 1.404 escolares de 20 escuelas de ocho departamentos, de las tres zonas climáticas del país. Se analizaron exámenes coproparasitológicos in situ con el método Kato-Katz. Resultados: La prevalencia nacional de geohelmintiasis fue de 3,7% (IC95% = 2,8-4,8). Los factores de riesgo fueron el consumo de agua de pozo OR: 2,88 (IC95% = 1,64-2,07), piso de tierra en la vivienda OR: 2,56 (IC95% = 1,45-4,50) y falta de baño con arrastre de agua en los hogares OR: 2,29 (IC95% = 1,23-4,28). Conclusión: A pesar de que la prevalencia nacional de geohelmintiasis fue baja, se recomienda promocionar buenas prácticas higiénicas, el uso de calzado, y consumo de agua segura, así como diseñar intervenciones con los sectores pertinentes para mejorar el acceso al agua segura y a instalaciones mejoradas de saneamiento básico.

Introduction: Currently, Paraguay has no data on the prevalence of soil-transmitted geohelminth infection in schoolchildren aged 6 to 12 years. Aim: To determine the prevalence and intensity of infection by Ascaris lumbricoides, Trichuris trichiura and hookworms and the socio-cultural-environmental characteristics of the affected population. Methods: Descriptive, cross-sectional study, in three semi-tropical climatic zones: continental, semi steppe and humid. A total of 1,404 schoolchildren from 20 schools in eight departments were selected from the country's three climate zones. Copro-parasitological exams were analyzed in situ with the Kato-Katz method. Results: The national prevalence for geohelminthiasis was 3.73% (95% CI = 2.8-4.8). The risk factors found were consumption of well water OR: 2.88 (95% CI = 1.64-2.07), ground floor in housing OR: 2.56 (95% CI = 1.45-4.50) and lack of flushing water baths in households OR: 2.29 (95% CI = 1.23-4.28). Conclusion: Although the national prevalence of geohelminthiasis was low, it is recommended to promote good hygienic practices, use of footwear, and safe water consumption, as well as designing interventions with all relevant sectors to improve access to safe water and improved basic sanitation facilities.

Trichuris vulpis (Froelich, 1789) Infection in a Child: A Case Report

We present a human infection with the canine whipworm, Trichuris vulpis, in a child suffering from rhinitis with a diagnosis of rhinitis. T. vulpis eggs resemble those of T. trichiura but they can be differentiated based on their morphological features and egg size, using micrometry with an ocular micrometer. T. vulpis eggs measured an average of 90 microm by 44 microm (range 86-99 microm by 38-47 microm). Prevalence of hookworms (28.1%), Toxocara canis (11.8%), and Trichuris vulpis (3.5%) was found in 292 fecal samples of dogs collected at the peri-domicile, which showed that the risk of infection was not only fortuitous. The treatment of canine whipworm infections is similar to that of T. trichiura infection. We recommend differentiation of the 2 species for their epidemiological and prevention implications.

Tricuríase / Trichuriasis

A tricuríase é uma doença parasitária causada pelo Trichuris trichiura, com importante impacto universal. No presente artigo é apresentada uma revisão sobre os aspectos mais relevantes da tricuríase.

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.

Trichuris trichiura Infection Diagnosed by Colonoscopy: Case Reports and Review of Literature

Trichuris trichiura, commonly referred to as a whipworm, has a worldwide distribution, particularly among countries with warm, humid climates. In Korea, trichuriasis was a highly prevalent soil-transmitted helminthiasis until the 1970s. However, the nationwide prevalence decreased to 0.02% in 2004 as a result of national control activities and improvement in the socioeconomic status of Koreans. Most infected individuals have no distinct symptoms, if lightly infected. The diagnosis is typically confirmed by detection of T. trichiura eggs on examination of a stool sample; few reports have described detection of the parasite during colonoscopy. Recently, we managed 4 patients with trichuriasis who were diagnosed by detection of the parasite on colonoscopy, and we reviewed the literature on the colonoscopic diagnosis of T. trichiura in Korea. We suggest that colonoscopy might be a useful diagnostic tool, especially when infected by only a few male worms with no eggs in the stool.

Prevalence and intensity of soil-transmitted helminthiasis in the city of Portoviejo (Ecuador)

We studied the stool samples of 151 school children in a district of the city of Portoviejo (Ecuador) in order to determine the prevalence and intensity of soil-transmitted helminthiasis (STH) and their relationships with anthropometric indices. The samples were analyzed with the semiquantitative Kato-Katz technique and the intensity of infections was categorized as light, moderate or high according to the thresholds set by the World Health Organization. Prevalence of soil transmitted helmintiasis was 65 percent (92 out of 141 collected samples), Ascaris lumbricoides was the most common STH (63 percent) followed by Trichuris trichiura (10 percent) and hookworm (1.4 percent). Heavy intensity infections were found in 8.5 percent of the stool samples, with T. trichiura showing higher worm burdens than A. lumbricoides. Sixteen percent of the children were below the third percentile for weight (wasted), while 27 percent were below the third percentile for height (stunted). A significant relationship was found between the worm burden and the degree of stunting. This study suggests that the periodic administration of an antihelminthic drug should be targeted to preschool and school children to allow a normal growth spurt and prevent stunting

Tricocefalosis masiva en un adulto diagnosticada por colonoscopía / Massive trichuriasis in an adult diagnosed by colonoscopy

A case of massive trichuriasis in a 37 year old female from a rural locality of the Metropolitan Region of Chile, with antecedentes of alcoholism, chronic hepatic damage and portal cavernomatosis, is presented. Since 12 year ago she has had geophagia. In the las six months she has frequently presented liquid diarrhea, colic abdominal pains, tenesmus and sensation of abdminal distention. Clinical and laboratory test confirmed her hepatic affection associated with a celiac disease with anemia and hypereosinophilia. Within a week diarrhea became worse and dysentery appeared. A colonoscopy revealed and impressive and massive trichuriasis. The patient was succesfully treated with two cures of 200 mg tablets of mebendazole twice daily for three days with a week interval. After the first cure she evacuated a big amount of tricuris trichiura, fecal evacuations became normal, geophagia disappeared and recovered 4 kg of body weight

Trichuris vulpis infection in slum children.

Trichuris vulpis was identified in two children from urban slums. Both of them had nonspecific abdominal pain and one had episodes of diarrhea. Clinical recovery was good after treatment with mebendazole.

The prevalence of Trichuris, Ascaris and hookworm infection in Orang Asli children.

A community study on the age and sex related prevalence, intensity infection and frequency distribution of Ascaris, Trichuris and hookworm was carried out in 205 Orang Asli (Aborigines) children (95 boys, 110 girls) aged 1-13 years. The overall prevalence of Ascaris, Trichuris and hookworm was 62.9%, 91.7% and 28.8%, respectively. Almost two-thirds of the children were infected with moderate and severe intensity infection of Trichuris, 46.3% had moderate to severe intensity infection of Ascaris. However only 1.5% had moderate intensity of hookworm infection. The prevalence and mean intensity infection (measured by eggs per g) of Ascaris was age-dependent; lower in age group 1-4 years reached peak and stable at age group 5 years and above. The prevalence of Trichuris was high in all age groups and it fluctuated with age; the mean intensity of infection of Trichuris (measured by eggs per g) was age-dependent. Hookworm infection also rose with age and reached peak at 5-6 years, following that the prevalence declined. The frequency distributions of Ascaris, and hookworm were overdispersed. A strong positive correlation (p < 0.001) were observed between Ascaris and Trichuris and between hookworm and Trichuris. A positive correlation (p < 0.01) were also observed between Ascaris and hookworm.

Manifestaciones clínicas en niños con asociación exclusiva de geohelmintos: Ascaris lumbricoides y Trichuris trichiura / Clinical manifestations in children with exclusive association of geohelminths: Ascaris lumbricoides and Trichuris trichiura

Se estudiaron 75 pacientes en forma retrospectiva con ascariasis, tricocefalosís y con asociación de ambos helmintos, en forma pura. Hubo 25 pacientes para cada parasitosis, demostrada con exámenes CPS (Faust), y cuantificados con CPS por el método de Stoll. Se realizó biometría hemática para investigar la presencia o ausencia de anemia y/o eosinofilia. Los grupos de edad más afectados fueron los preescolares con el 57% y los escolares con el 30.6%. No hubo diferencia con respecto al sexo. Los casos masivos se asociaron más al sexo masculino. La ascariasis fue la que presentó mayor frecuencia de estos mismos con un 29.3%. La anemia predominó en los casos con tricocefalosis (24%) y la asociación de ambos parásitos, 32%. La eosinofilia se presentó con igual frecuencia en la ascariasis (32%) y en la tricocefalosis (36%) pero fue mayor en los casos con asociación de ambos parásitos: 60%. Los síntomas más frecuentes en la asociación de ambos helmintos fueron dolor abdominal 52%; hiporexia, geofagia y palidez 32%; flatulencia y expulsión de helmintos 24%. Desde el punto de vista clínico no es posible hacer el diagnóstico de asociación de A. lumbricoides y T. trichiura, debido a que la sintomatología no es característica, ya que ésta se puede encontrar en otros padecimientos. Por lo tanto, es necesario realizar exámenes CPS para hacer el diagnóstico certero de dicha asociación