Observation of the Free-living Adults of Strongyloides stercoralis from a Human Stool in Korea / 감염과화학요법

A 76-year-old Korean man living in Cheonan, Chungcheongnam-do, visited one University Hospital with dyspnea and abdominal pain. He has been undergoing transcatheter arterial chemoembolization (TACE) for the past three years for the treatment of hepatocellular carcinoma. Abdominal pain developed 10 days ago, and became worse several days prior to coming to the emergency room. Physical examination revealed tenderness over the umbilicus. Eosinophil count was 22% without increase in the number of white blood cells. Stool examination showed adult and larval nematodes, which were subsequently identified as free-living adult worms and rhabditiform larvae of Strongyloides stercoralis. Follow-up stool examination performed six days later demonstrated only rhabditiform larvae of S. stercoralis. This is the first report on the recovery of free- living adult worms from human stool in the world.

Observation of the Free-living Adults of Strongyloides stercoralis from a Human Stool in Korea / 감염과화학요법

A 76-year-old Korean man living in Cheonan, Chungcheongnam-do, visited one University Hospital with dyspnea and abdominal pain. He has been undergoing transcatheter arterial chemoembolization (TACE) for the past three years for the treatment of hepatocellular carcinoma. Abdominal pain developed 10 days ago, and became worse several days prior to coming to the emergency room. Physical examination revealed tenderness over the umbilicus. Eosinophil count was 22% without increase in the number of white blood cells. Stool examination showed adult and larval nematodes, which were subsequently identified as free-living adult worms and rhabditiform larvae of Strongyloides stercoralis. Follow-up stool examination performed six days later demonstrated only rhabditiform larvae of S. stercoralis. This is the first report on the recovery of free- living adult worms from human stool in the world.

Echinostome Infections in the Striped-Field Mouse, Apodemus agrarius, and the Ussuri White-Toothed Shrew, Crocidura lasiura, Caught Near the Demilitarized Zone, Gyeonggi-do (Province), Republic of Korea

A total of 1,498 small mammals (rodents and insectivores), including Apodemus agrarius (n = 1,366), Crocidura lasiura (54), Mus musculus (32), Micronytus fortis (28), Eothenomys regulus (9), Micronys minutes (6), and Cricetulus triton (3), were live-trapped in Gyeonggi-do (Province) (Paju-si, Pocheon-gun, and Yeoncheon-gun) near the demilitarized zone (DMZ) from December 2004 to September 2005. A. agrarius was found to be infected with 3 species of echinostomes (Echinostoma hortense, Echinostoma cinetorchis, and Euparyphium murinum), while C. lasiura was infected with 1 species (Echinochasmus japonicas) of echinostome. Other mammals were free from echinostome infections. Total 16 E. hortense were detected in 7 (0.5%) mice, 9 E. cinetorchis from 5 (0.4%), and 3 E. murinum from 2 (0.1%) out of 1.366 A. agrarius examined. E. japonicus was found only in 1 (1.9%; total 3 specimens) C. lasiura. These results demonstrate that A. agrarius and C. lasiura, inhabiting near the DMZ of Gyeonggi-do serve as the natural definitive hosts for several species of echinostomes, although their infection rates are low. This is the first record of natural infections of A. agrarius with E. cinetorchis and C. lasiura with E. japonicus in the Republic of Korea.

Intestinal Helminth Infections in Feral Cats and a Raccoon Dog on Aphaedo Island, Shinan-gun, with a Special Note on Gymnophalloides seoi Infection in Cats

Four feral cats and a raccoon dog purchased from a local collector on Aphaedo Island, Shinan-gun, where human Gymnophalloides seoi infections are known to be prevalent, were examined for their intestinal helminth parasites. From 2 of 4 cats, a total of 310 adult G. seoi specimens were recovered. Other helminths detected in cats included Heterophyes nocens (1,527 specimens), Pygidiopsis summa (131), Stictodora fuscata (4), Acanthotrema felis (2), Spirometra erinacei (15), toxocarids (4), and a hookworm (1). A raccoon dog was found to be infected with a species of echinostome (55), hookworms (7), toxocarids (3), P. summa (3), and S. erinacei (1). No G. seoi was found in the raccoon dog. The results indicate that feral cats and raccoon dogs on Aphaedo are natural definitive hosts for intestinal trematodes and cestodes, including G. seoi, H. nocens, and S. erinacei. It has been first confirmed that cats, a mammalian species other than humans, play the role of a natural definitive host for G. seoi on Aphaedo Island.

Tegumental Ultrastructure of Adult Gynaecotyla squatarolae (Digenea: Microphallidae)

Gynaecotyla squatarolae (Digenea: Microphallidae) adult flukes were recovered from experimental chicks at day 4-6 post-infection and their tegumental ultrastructure was observed with a scanning electron microscopy. They were pyriform in shape, and their anterior halves were concaved ventrally. The whole body surface was covered with tegumental spines, which were wide and 16-17 digitated between oral and ventral suckers. The density of spines and number of digits decreased posteriorly. The oral sucker was subterminal and the excretory pore was at the posterior end of the worm. wo ventral suckers were similar in appearance and protruded near midline of the worm. The genital atrium was dextral to the small ventral sucker. The dorsal surface was covered with tegumental spines, but the spines were sparser than on the ventral surface. On the middle portion of the dorsal surface, a small opening presumed to be the Laurer's canal was een. From these findings, it has been confirmed that the adult G. squatarolae has unique characteristics in the surface ltrastructure.

The Ruddy Turnstone, Arenaria interpres interpres, a New Definitive Host for Gynaecotyla squatarolae (Digenea: Microphallidae)

The ruddy turnstone, Arenaria interpres interpres, a migratory Korean bird, was proved to be a natural definitive host for Gynaecotyla squatarolae (Digenea: Microphallidae). The ruddy turnstone was found dead at the seashore of Okgueup, Gunsan-si, Jeollabuk-do. The intestinal tract was examined, and 98 unknown flukes were recovered. The worms were 600 x 284 micrometer in size, and had 2 ventral suckers. The seminal vesicle was large, the genital atrium was prominent, and the average egg size was 20 x 12.5 micrometer. Based on these results, the worms were identified as G. squatarolae. This is the first report on the ruddy turnstone as a natural definitive host of G. squatarolae in the Republic of Korea.

The Ruddy Turnstone, Arenaria interpres interpres, a New Definitive Host for Gynaecotyla squatarolae (Digenea: Microphallidae)

The ruddy turnstone, Arenaria interpres interpres, a migratory Korean bird, was proved to be a natural definitive host for Gynaecotyla squatarolae (Digenea: Microphallidae). The ruddy turnstone was found dead at the seashore of Okgueup, Gunsan-si, Jeollabuk-do. The intestinal tract was examined, and 98 unknown flukes were recovered. The worms were 600 x 284 micrometer in size, and had 2 ventral suckers. The seminal vesicle was large, the genital atrium was prominent, and the average egg size was 20 x 12.5 micrometer. Based on these results, the worms were identified as G. squatarolae. This is the first report on the ruddy turnstone as a natural definitive host of G. squatarolae in the Republic of Korea.

Antibody Responses to Cryptosporidium Antigen in HIV-positive Patients in the Republic of Korea

The diagnosis of cryptosporidiosis has been carried out using coprologic techniques in the Republic of Korea. However, antibody responses to Cryptosporidium have rarely been studied. Serum antibodies from HIV-positive/oocyst-positive Korean patients recognized significantly 31 and 27 kDa antigens, and HIV-negative/oocyst-positive individuals clearly reacted to 15/17 kDa antigens. Compared with oocyst-positive cases, 18.7% and 75.8% of sera from HIV-positive patients reacted to 31 and 27 kDa antigens. Only 11.1% of HIV-negative individuals reacted to 15/17 kDa. Based on these findings, serum antibody responses were different between HIV-positive and HIV-negative individuals infected with Cryptosporidium, and it is suggested that HIV-positive patients are more frequently exposed to C. parvum compared to HIV-negative individuals.

Holostephanus metorchis (Digenea: Cyathocotylidae) from Chicks Experimentally Infected with Metacercariae from a Fish, Pseudorasbora parva, in the Republic of Korea

Holostephanus metorchis (Digenea: Cyathocotylidae) is a patrrasite of birds, transmitted by freshwater fishes. H. metorchis adults were recovered from chicks experimentally infected with metacercariae collected from freshwater fishes, Pseudorasbora parva. The metacercariae were oval, surrounded with thick fibrous capsules. In adult flukes, the holdfast organ occupied the ventral concavity, and the anterior testis did not reach the level of the ventral sucker. Based on these morphological characteristics, these flukes were identified as H. metorchis.

Microphallus koreana n. sp. (Trematoda: Microphallidae) Transmitted by a Marine Crab, Macrophthalmus dilatatus

Microphallus species occur primarily as intestinal parasites of birds and mammals, and metacercariae of a new species belonging to this genus have been discovered from the crab, Macrophthalmus dilatatus, in the Republic of Korea. The metacercaria of this fluke was round with 2 thick walls, and the excysted one had mature genital organs. The adult flukes recovered from experimentally infected chicks had numerous intrauterine eggs, well-developed pars prostatica, widely bifurcating ceca, and prominent uterine bulge. After observing internal structures, it was concluded that this species is different from any other known Microphallus spp. Based on the morphology of metacercariae and adult flukes, we describe this specimen as a new species, Microphallus koreana n. sp.

Role of murine Peyer's patch lymphocytes against primary and challenge infections with Cryptosporidium parvum

In order to determine the role of Peyer's patch lymphocytes (PPL) in self-clearing of Cryptosporidium parvum infection in murine models, changes in PPL subsets, their cytokine expression, and in vitro IgG1 and IgA secretions by PPL were observed in primary- and challenge-infected C57BL/6 mice. In primary-infected mice, the percentages of CD4+ T cells, CD8+ T cells, sIgA+ B cells, IL-2+ T cells, and IFN-gamma+ T cells among the PPL, increased significantly (P 0.05) than those in primaryinfected mice. The results suggest that murine PPL play an important role in self-clearing of primary C. parvum infections through proliferation of CD4+, CD8+, IL-2+, and IFN-gamma+ T cells, and IgG1 and IgA-secreting B cells. In challenge infections, the role of T cells is reduced whereas that of B cells secreting IgA appeared to be continuously important.

Gynaecotyla squatarolae (Digenea: Microphallidae) from rats experimentally infected with metacercariae from the shore crab, Macrophthalmus dilatatus

Metacercariae of Gynaecotyla squatarolae (Digenea: Microphallidae) were discovered from the shore crab, Macrophthalmus dilatatus, purchased at a market in a coastal town of Taean-Eup, Chungcheongnam-do, Republic of Korea. Their adult flukes were confirmed by experimental infection of rats. The metacercariae of G. squatarolae were elliptical (391.1 x 362.5 micrometer), and the excysted metacercariae had progenetic genital organs, including the ovary and testes. To obtain adult flukes, 6 Sprague-Dawley rats were fed 500 metacercariae each, and killed at days 2, 4, and 6 post-infection. The adult flukes were identified as G. squatarolae (Yamaguti, 1934) Yamaguti, 1939, based on morphological characters, including 2 ventral suckers (1 large and 1 small), a large genital atrium equipped with the cirrus and the metraterm, separated male and female genital pores, a transversely long cirrus pouch, and extensive vitelline follicles. In the present study, it has been first proven that the shore crab M. dilatatus is a second intermediate host for G. squatarolae in the Republic of Korea.

A survey of Heterophyes nocens and Pygidiopsis summa metacercariae in mullets and gobies along the coastal areas of the Republic of Korea

The infection status of mullets Mugil cephalus (n = 139) and gobies (n = 35) Acanthogobius flavimanus with metacercariae of Heterophyes nocens and Pygidiopsis summa was examined in 11 western, southern, and eastern coastal areas of the Republic of Korea, using a digestion technique. Heterophyid metacercariae were highly prevalent in mullets from western and southern coastal areas; Shinan-gun (100% for H. nocens and 100% for P. summa), Muan-gun (93% and 100%), Buan-gun (42% and 75%), Seocheon-gun (73% and 53%), Ganghwa-gun (47% and 100%), Sacheon-shi (47% and 77%), and Gangjin-gun (50% and 70%, respectively). Only 1 (10%) of 10 mullets from an eastern coastal area, i.e., Donghae-shi, was positive for P. summa metacercariae. Metacercarial densities were the highest in the trunk of mullets for H. nocens and the gill for P. summa. Gobies from Muan-gun were positive for H. nocens (40%) and P. summa metacercariae (40%), and gobies from Seocheon-gun revealed H. nocens metacercariae (20%). The metacercarial density was remarkably higher in mullets than in gobies. The results revealed that H. nocens and P. summa metacercariae are prevalent in mullets and gobies from coastal areas of the Republic of Korea, and the prevalence and intensity of infection vary according to geographical locality.

High prevalence of liver and intestinal fluke infections among residents of Savannakhet Province in Laos

The prevalence of liver and intestinal fluke infections was surveyed on residents of Savannakhet Province, Laos. Fecal specimens were collected from a total of 981 residents in 4 Mekong riverside villages and examined by the Kato-Katz thick smear technique. The results revealed that the overall helminth egg positive rate was 84.2%, and the positive rate for small trematode eggs, including Opisthorchis viverrini, heterophyids, or lecithodendriids, was 67.1%. To obtain adult flukes, 38 small trematode egg positive cases were treated with a 20-30 mg/kg single dose of praziquantel and purged. Diarrheic stools were then collected from 29 people and searched for helminth parasites using stereomicroscopes. Mixed infections with O. viverrini and 6 kinds of intestinal flukes were found, namely, Haplorchis taichui, Haplorchis pumilio, Haplorchis yokogawai, Prosthodendrium molenkampi, Phaneropsolus bonnei, and echinostomes. The total number of flukes collected was 7,693 specimens (av. no. per treated person; 265.3). The most common species was O. viverrini, followed by H. taichui, P. molenkampi, echinostomes, H. pumilio, P. bonnei, and H. yokogawai. The results indicate that foodborne liver and intestinal fluke infections are prevalent among residents of Savannakhet Province, Laos.

A new endemic focus of Heterophyes nocens and other heterophyid infections in a coastal area of Gangjin-gun, Jeollanam-do

To know the prevalence of heterophyid trematodes among inhabitants of a southern coastal village, i.e., Sacho-ri, Gangjin-gun, Jeollanam-do (Province), 82 stool samples were examined on helminth eggs and protozoan cysts using Kato-Katz and formalin-ether sedimentation techniques. Total 33 people (40.2%) were positive for trematodes (Heterophyes nocens; 15 people, Pygidiopsis summa; 3, Metagonimus sp.; 4, Clonorchis sinensis; 7, Gymnophalloides seoi; 6) and/or protozoa (Entamoeba coli; 3). Among intestinal trematode egg positive cases, 17 were treated with praziquantel and their whole diarrheic stools were collected after purgation. Adult flukes of H. nocens (number of specimens=1,294), P. summa (386), Stellantchasmus falcatus (5), Stictodora lari (4), and Heterophyopsis continua (1) were collected using a stereomicroscope. To know the source of human H. nocens infections in this village, metacercarial infections in mullets (10) were examined and most H. nocens metacercariae (101/105, 96.2%) were found in the trunk portion. From above results, the surveyed coastal village has been newly known as an endemic focus of human H. nocens infection and consuming raw mullets was the presumable source of human heterophyid infections.

A new endemic focus of Gymnophalloides seoi infection on Aphae Island, Shinan-gun, Jeollanam-do

A new endemic focus of Gymnophalloides seoi infection has been discovered on Aphae Island (Shinangun, Jeollanam-do), Republic of Korea. This area, which is referred to as Bokyong-ri, is a small seashore village located in the northern portion of the island. Fecal samples were collected from a total of 57 residents and examined by the Kato-Katz and formalin-ether sedimentation techniques. Helminth eggs were detected in 37 samples (64.9%); 33 samples were positive for G. seoi eggs (57.9%), 4 for Pygidiopsis summa (7.0%), 13 for other heterophyids (22.8%), 1 for Clonorchis sinensis (1.7%), and 1 for Trichuris trichiura (1.7%). Women (70.4%) revealed higher rates of G. seoi infection than did men (46.7%), and individuals older than 50 years of age also evidenced higher rates of G. seoi infection than in other age groups (P<0.05). In worm collection from 13 G. seoi egg positive cases, G. seoi (total 86,558 specimens), Heterophyes nocens (278), Stictodora sp. (10), Heterophyopsis continua (3), P. summa (3), and unidentified flukes (42) were collected. Oysters, the source of G. seoi infection, were collected from an area proximal to the village and 50 were examined for metacercariae; 47 (94%) were found infected and the observed metacercarial density was 9.5+/-8.9 per oyster. The results of this study indicate that Bokyong-ri is a new endemic area of G. seoi infection, with high rates of infection in humans and oysters.

Plagiorchis muris infection in Apodemus agrarius from northern Gyeonggi-do (Province) near the demilitarized zone

The small intestines of 6 species of rodents and 1 species of insectivore were examined seasonally for Plagiorchis muris infection in 3 different localities in northern Gyeonggi-do (Province), near the demilitarized zone (DMZ). A total of 1,496 animals, including 1,366 Apodemus agrarius, 54 Crocidura lasiura (insectivore), 32 Mus musculus, 28 Micronytus fortis, 9 Eothenomys regulus, 6 Micronys minutus, and 3 Cricetulus triton, were live-trapped at Yeoncheon-gun (n = 351), Paju-shi (804) and Pocheon-gun (343) at 3-mo intervals from December 2004 to September 2005. A total of 1,647 P. muris were collected from 72 (5.3%) A. agrarius. The infection rate was the highest in Pocheon-gun (8.2%), followed by Yeoncheon-gun (5.0%) and Paju-shi (4.2%). A higher infection rate was observed in A. agrarius captured during September (19.4%) than those captured during December (3.0%), June (2.6%), or April (0%). However, the worm burden was the highest in June (av. 32.1/animal), followed by September (24.7), December (4.0), and April (0). None of the other animal species were found infected with P. muris. The results reveal that A. agrarius is a natural definitive host for P. muris, and infection rates and worm burdens vary seasonally and geographically.

Apodemus agrarius as a new definitive host for Neodiplostomum seoulense

A total of 1,496 rodents and insectivores were live-trapped at Yeoncheon-gun (n = 351), Paju-shi (804), and Pocheon-gun (343), Gyeonggi-do (Province), and examined for intestinal helminths, including Neodiplostomum seoulense, seasonally from December 2004 to September 2005. Six species of rodents, including Apodemus agrarius (1,366), Mus musculus (32), Micronytus fortis (28), Eothenomys regulus (9), Micronys minutus (6), and Cricetulus triton (3), and 1 species of insectivores Crocidura lasiura (54) were collected. A total of 321 adult N. seoulense were collected from 19 (1.4%) A. agrarius. The worm burden ranged from 1 to 101 per A. agrarius (mean; 16.9). No N. seoulense was observed in other rodent or insectivore species examined. The infection rate during autumn (4.5%) was higher than those during spring (0.8%), summer (0.8%), and winter (0.5%). The average number of N. seoulense in infected A. agrarius was the highest in spring (66.0 specimens), followed by autumn (15.2), winter (4.5), and summer (3.3). This study first confirms that A. agrarius is a natural definitive host for N. seoulense, and demonstrates that the infection rates and intensities vary seasonally and geographically.

Status of Intestinal Parasite Infections among 4,137 Residents from Provinces Nationwide and Metropolitan Areas in the Republic of Korea(2004) / 감염과화학요법

BACKGROUND: The status of intestinal parasite infections among the residents of nationwide geographical areas in the Republic of Korea has been little investigated since 1997. The present study was designed to estimate the infection status of intestinal parasites among residents of several geographical areas in the Republic of Korea. MATERIALS AND METHODS: Fecal samples of 4,137 people (men:2,170, women:1,967) who visited the Korea Association of Health Promotion for a health check-up were collected from July to September, 2004. Specimens were examined for helminth eggs, larvae, and protozoan cysts using the Kato-Katz thick smear, formalin-ether sedimentation, and modified acid-fast staining techniques. RESULTS: Helminth eggs, larvae, and protozoan cysts were found in 322 (7.8%) of the 4,137 specimens examined. The helminth species detected were Clonorchis sinensis (in 259 specimens; 6.3%), Metagonimus sp. (14; 0.34%), Pygidiopsis summa (5; 0.12%), unidentified heterophyids (24; 0.58%), Echinostoma sp. (4; 0.1%), Gymnophalloides seoi (4; 0.1%), Paragonimus westermani (1; 0.02%), Trichuris trichiura (10; 0.24%), Ascaris lumbricoides (1; 0.02%), hookworms (1; 0.02%), and Strongyloides stercoralis (larva positive) (1; 0.02%). The protozoans detected were Entamoeba coli (9; 0.22%), Giardia lamblia (1; 0.02%), and Isospora sp. (1; 0.02%). The parasite positive rate was the highest in Gyeongsangnam-do (38 specimens; 15.3%), followed in decreasing order by Gwangju/ Jeollanam-do (56; 13.9%), Busan (58; 12.3%), Gyeongsangbuk-do (18; 11.2%), Daejeon/Chungcheongnam-do (42; 8.1%), Chungcheongbuk-do (18; 8.0%), Incheon (10; 7.0%), Daegu (22; 6.8 %), Gyeonggi-do (25; 5.0%), Jeollabuk-do (7; 4.4%), Gangwon-do (6; 3.5%), Seoul (20; 2.6%), and Jeju-do (2; 2.0%). The male positive rate (225/2,170; 10.4%) was significantly higher than that of females (95/1,967; 4.8%) (P<0.01). CONCLUSION: Fish-borne trematodes including C. sinensis and heterophyids appear to be the major intestinal parasites among residents of the Republic of Korea. Control efforts are required against these fish-borne parasitic zoonoses.

Status of Intestinal Parasite Infections among 4,137 Residents from Provinces Nationwide and Metropolitan Areas in the Republic of Korea(2004) / 감염과화학요법

BACKGROUND: The status of intestinal parasite infections among the residents of nationwide geographical areas in the Republic of Korea has been little investigated since 1997. The present study was designed to estimate the infection status of intestinal parasites among residents of several geographical areas in the Republic of Korea. MATERIALS AND METHODS: Fecal samples of 4,137 people (men:2,170, women:1,967) who visited the Korea Association of Health Promotion for a health check-up were collected from July to September, 2004. Specimens were examined for helminth eggs, larvae, and protozoan cysts using the Kato-Katz thick smear, formalin-ether sedimentation, and modified acid-fast staining techniques. RESULTS: Helminth eggs, larvae, and protozoan cysts were found in 322 (7.8%) of the 4,137 specimens examined. The helminth species detected were Clonorchis sinensis (in 259 specimens; 6.3%), Metagonimus sp. (14; 0.34%), Pygidiopsis summa (5; 0.12%), unidentified heterophyids (24; 0.58%), Echinostoma sp. (4; 0.1%), Gymnophalloides seoi (4; 0.1%), Paragonimus westermani (1; 0.02%), Trichuris trichiura (10; 0.24%), Ascaris lumbricoides (1; 0.02%), hookworms (1; 0.02%), and Strongyloides stercoralis (larva positive) (1; 0.02%). The protozoans detected were Entamoeba coli (9; 0.22%), Giardia lamblia (1; 0.02%), and Isospora sp. (1; 0.02%). The parasite positive rate was the highest in Gyeongsangnam-do (38 specimens; 15.3%), followed in decreasing order by Gwangju/ Jeollanam-do (56; 13.9%), Busan (58; 12.3%), Gyeongsangbuk-do (18; 11.2%), Daejeon/Chungcheongnam-do (42; 8.1%), Chungcheongbuk-do (18; 8.0%), Incheon (10; 7.0%), Daegu (22; 6.8 %), Gyeonggi-do (25; 5.0%), Jeollabuk-do (7; 4.4%), Gangwon-do (6; 3.5%), Seoul (20; 2.6%), and Jeju-do (2; 2.0%). The male positive rate (225/2,170; 10.4%) was significantly higher than that of females (95/1,967; 4.8%) (P<0.01). CONCLUSION: Fish-borne trematodes including C. sinensis and heterophyids appear to be the major intestinal parasites among residents of the Republic of Korea. Control efforts are required against these fish-borne parasitic zoonoses.