A molecular and morphological study of Ascaris suum in a human-pig contact scenario in northeastern Brazil / Estudo molecular e morfológico de Ascaris suum em um cenário de contato entre suínos e humanos no nordeste brasileiro

The aim of the present study was to assess morphologic and genetic data on ascariasis in swine (Sus scrofa domesticus) and humans in low-resource rural and periurban communities in the state of Piauí, Brazil. Our cross-sectional survey included 100 fecal samples obtained from swine and 682 samples from humans. Fifteen pigs were necropsied. Human and porcine fecal samples were examined to identify Ascaris eggs. Parasites obtained in the swine necropsies were studied using scanning electron microscopy (SEM), and the mitochondrial gene encoding the cytochrome oxidase 1 (cox1) enzyme was partially amplified and sequenced for molecular taxonomy and phylogenetic analyses. The overall prevalence of Ascaris eggs in the swine fecal samples was 16/100 (16%). No Ascaris eggs were identified in the human fecal samples. SEM of six worms recovered from pigs demonstrated morphological characteristics of A. suum. Cox1 sequences were compatible with A. suum reference sequences. Original and reference (GenBank) nucleotide sequences were organized into clusters that did not segregate the parasites by host species or and region. The largest haplogroups were dominated by haplotypes H01, H02 and H31. In the communities studied, there was no epidemiological evidence of the zoonotic transmission of ascariasis at the human-swine interface.(AU)

O presente estudo teve como objetivo acessar dados morfológicos e genéticos sobre a ascaridíase em suínos (Sus scrofa domesticus) e humanos, em comunidades rurais e periurbanas no estado do Piauí. O estudo transversal incluiu 100 amostras fecais de suínos e 682 amostras obtidas de humanos. Quinze suínos foram necropsiados. Amostras fecais suínas e humanas foram examinadas para detecção de ovos de Ascaris. Os parasitas adultos, obtidos nas necropsias, foram estudados através de microscopia eletrônica de varredura (MEV), e o gene mitocondrial codificante da enzima citocromo oxidase 1 (cox1) foi parcialmente amplificado e sequenciado para análises filogenéticas e de taxonomia molecular. A prevalência de Ascaris em amostras fecais de suínos foi 16/100 (16%), não sendo identificado nenhum caso de infecção por este parasita em humanos. A análise por MEV de parasitas recuperados de suínos demonstrou características morfológicas de Ascaris suum. As sequências nucleotídicas de cox1 foram compatíveis com A. suum. As sequências originais e de referência (obtidas no GeneBank) foram organizadas em clusters que não segregaram os parasitas por hospedeiro ou região geográfica. Os maiores haplogrupos foram dominados pelos haplótipos H01, H02 e H31. Nas comunidades estudadas, não foi evidenciada transmissão zoonótica de A. suum na interface suíno-humana.(AU)

Ascariasis errática biliar como causa exótica de ictericia obstructiva / Erratic Biliary Ascariasis as an Exotic Cause of Obstructive Jaundice

Introducción: Áscaris lumbricoides es el helminto más frecuente en el tracto gastrointestinal humano; la mayor prevalencia se registra en países en desarrollo, tropicales y subtropicales. En Cuba constituye una causa exótica de ictericia obstructiva con pocos casos reportados. Objetivo: Describir el manejo terapéutico exitoso de un caso de un hombre con ictericia obstructiva secundaria a ascariasis coledociana. Caso clínico: Paciente de 74 años operado en el Hospital Clínico Quirúrgico "Lucía Íñiguez Landín" de la provincia Holguín por ictericia obstructiva por ascariasis coledociana, con evolución clínico-quirúrgica satisfactoria. Conclusiones: En países en desarrollo debe tomarse en cuenta la ascariasis como causa de enfermedad obstructiva biliar o pancreática. El conocimiento del cuadro clínico y sus complicaciones, además, de las diferentes opciones en el tratamiento, debe ser del dominio de todo médico. La ictericia obstructiva por áscaris lumbricoides constituye en Cuba una causa exótica de esta infestación por parásitos(AU)

Introduction: Ascaris lumbricoides is the most frequent helminthiasis in the human gastrointestinal tract; the highest prevalence is recorded in developing, tropical and subtropical countries. In Cuba, it constitutes an exotic cause of obstructive jaundice with few reported cases. Objective: To describe the successful therapeutic management of a case of a man with obstructive jaundice secondary to choledochal ascariasis. Clinical case report: We report the case of a 74-year-old patient operated on at Lucía Íñiguez Landín Surgical Clinical Hospital, in Holguín province, for obstructive jaundice due to choledochal ascariasis, with satisfactory clinical-surgical evolution. Conclusions: In developing countries, ascariasis should be taken into account as a cause of biliary or pancreatic obstructive disease. Knowledge of the clinical condition and its complications, in addition to the different treatment options, should be the domain of every physician. Obstructive jaundice due to ascaris lumbricoides constitutes an exotic cause of this parasite infestation in Cuba(AU)

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.

Revisão integrativa sobre doenças parasitárias em crianças de creches brasileiras / Integrative review on parasitic diseases in children in brazilian day care centers

As parasitoses intestinais constituem um importante problema de Saúde Pública, especialmente entre os pré-escolares, devido à imaturidade do sistema imune. Assim, este estudo objetivou realizar uma revisão integrativa dos estudos publicados entre os anos de 2010 a 2017 sobre parasitoses intestinais e os fatores associados ao desenvolvimento em crianças matriculadas em creches brasileiras. Foi realizada busca bibliográfica através das bases de dados Medline, Lilacs e SciELO, utilizando os descritores: infecção, parasitoses, diarreia e creches, e seus correspondentes em inglês: "infection", "parasitc diseases", "diarrhea" e "child day care centers". No caso das buscas no Medline o descritor Brazil também foi usado. Foram identificados 59 estudos, dos quais 11 foram incluídos no presente trabalho. Foi observado variação de 19,4% a 98,4% de parasitos e, a Giardia duodenalis foi o mais prevalente em crianças entre um e seis anos de idade, gênero masculino, com baixo peso, advindas de residências com alta densidade familiar e nível socioeconômico baixo. As análises mostraram a importância da compreensão dos fatores de risco para a incidência de parasitos, indicando a necessidade da promoção de estratégias efetivas para prevenção e controle das infecções parasitárias no país, visto que, tais infecções influenciam diretamente no desenvolvimento da criança, e em alguns casos, evoluindo a óbito.

Intestinal parasitosis is an important public health issue especially among pre-school children due to the immaturity of their immune system. Thus, this study aimed at carrying out an integrative review of studies published between 2010 and 2017 regarding intestinal parasites and associated factors in children registered in Brazilian day care centers. A bibliographic survey was performed through the Medline, Lilacs, and SciELO databases using the following descriptors: infection, parasitic diseases, diarrhea, and child day care centers, as well as their corresponding translations in Portuguese: "infecção", "parasitoses", "diarreia" and "creches". In the case of Medline searches, the descriptor Brazil was also used. Fifty-nine studies were identified, from which, 11 were included in this study. A variation of 19.4% to 98.4% of parasites could be observed, with Giardia duodenalis being the most prevalent in children between one and six years old, male, with low weight, coming from homes with high family density and low socioeconomic status. The analyzes showed the importance of understanding the risk factors for the incidence of parasites, showing the need to promote effective strategies for the prevention and control of parasitic infections in the country, since such infections have direct influence on the child's development, and in some cases, even evolving to death.

Ascariasis complicada en un infante / Complicated ascariasis in an infant

Introducción: La ascariasis es una enteroparasitosis con alta prevalencia en la población pediátrica tercermundista, la cual puede asociarse a otras enfermedades intestinales y tener graves complicaciones que requieren tratamiento quirúrgico. Objetivo: Informar el caso de un infante operado por coinfección de ascariasis intestinal y fiebre tifoidea complicadas. Presentación del caso: Paciente masculino de 9 años de edad asistido y operado en el hospital provincial N´gola Kimbanda de la provincia Namibe, Angola, por presentar evidencia clínica de peritonitis aguda generalizada por perforación intestinal de causa tifoidea y por cuyo orificio salían además áscaris lumbricoides vivos. Su evolución no fue satisfactoria y falleció 24 horas después de la operación. Conclusiones: El diagnóstico y tratamiento quirúrgico oportuno de la coinfección letal de ascariasis y fiebre tifoidea complicadas permitirá disminuir la morbilidad y mortalidad por esta prevalente asociación(AU)

Introduction: Ascariasis is an enteroparasitosis with high prevalence in the third-world pediatric population, which can be associated with other bowel diseases and have serious complications that require surgical treatment. Objective: Report the case of an infant operated by the co-infection of complicated intestinal ascariasis and typhoid fever. Case presentation: 9-year-old male patient attended and operated at N'gola Kimbanda Provincial Hospital in Namibe Province, Angola, after presenting clinical evidence of generalized acute peritonitis due to intestinal perforation of typhoid-causing and through which live ascaris lumbricoide also came out. His evolution was unsatisfactory and he died 24 hours after the operation. Conclusions: The timely diagnosis and surgical treatment of lethal co-infection of complicated ascariasis and typhoid fever will reduce morbidity and mortality from this prevalent association(AU)

Ascariasis, trichuriasis and fatal non-transfusion

Blood transfusion for chronic anemia can lead to acute or decompensated heart failure in patients who have fluid overload as part of their compensatory response and/or have intrinsic heart disease, and then it could be fatal in such clinical scenarios. This is the report of a case of profound chronic anemia in a young male patient, who was not transfused and then developed confusion followed by terminal cardiopulmonary arrest. Autopsy revealed severe trichuriasis to be the cause of the anemia, along with severe ascariasis, but minimal intrinsic brain disease. This supports the conclusion that anemia was the cause of the confusion, and the lesson that confusion may be a sign that the benefit of blood transfusion outweighs the risk in a patient with severe chronic anemia.

Ascaridiasis hepatobiliar en una adulta joven / Hepatobiliary ascaridiasis in a young adult woman

Se presenta el caso clínico de una paciente de 27 años de edad, con antecedentes de colecistectomía convencional desde hacía 10 meses por aparente colecistitis, quien acudió al Hospital Luis Vernaza de Guayaquil, Ecuador, por presentar ictericia y dolor abdominal. Teniendo en cuenta los hallazgos clínicos, de laboratorio e imagenológicos se le diagnosticó sepsis de foco abdominal, colangitis y coledocolitiasis. Durante la intervención quirúrgica se observó la presencia de 2 Ascaris lumbricoides y cálculo de colesterol en la vía biliar, por lo que se le realizó una derivación bilioentérica. Después de algunas complicaciones como insuficiencia respiratoria y descompensación hemodinámica, la paciente egresó de la institución a los 25 días de operada, con seguimiento por consulta externa durante 2 meses.

The case report of a 27 years patient is presented, with history of conventional cholecystectomy for 10 months due to apparent cholecystitis who went to Luis Vernaza Hospital in Guayaquil, Ecuador, presenting jaundice and abdominal pain. Taking into account the clinical, laboratory and imaging findings a sepsis of abdominal focus, cholangitis and choledocolithiasis was diagnosed. During the surgical intervention the presence of 2 Ascaris lumbricoides and cholesterol calculi in the bile duct was observed, reason why a bilioenteric bypass was carried out. After some complications such as breathing failure and hemodynamic upset, the patient was discharged from the institution 25 days after the surgery, with follow up in outpatient clinics during 2 months.

Ascaridiosis en la vía biliar intrahepática: a propósito de un caso pediátrico / Ascariasis in the intrahepatic biliary duct: about a case in pediatrics

El 25 % de la población mundial se encuentra infectada por Ascaris lumbricoides. La ascaridiosis hepatobiliar ocurre en zonas con alta endemicidad y gran carga parasitaria, y genera desde intensa inflamación hasta fibrosis. Se presenta a un paciente de 2 años, que consultó por distensión abdominal y tos de 1 mes de evolución asociada a fiebre en las últimas 72 h. Se realizó una ecografía abdominal que evidenció áscaris en la vía biliar, en el estómago y en el intestino delgado, y una radiografía de tórax con infiltrado inflamatorio intersticial, asociado a hiperleucocitosis con hipereosinofilia y gamma-glutamiltranspeptidasa elevada. Se administró un tratamiento antibiótico, antihelmíntico, sin lograr la eliminación de los parásitos de la vía biliar, por lo que se requirió su extracción mediante colangiografía percutánea

Twenty five percent of the world population is affected by Ascaris lumbricoides. Hepatobiliary ascariasis occurs in areas with high endemicity and great amount of parasitic load, generating intense inflammation to fibrosis. We report a two-year-old patient that consults about abdominal distension and cough of one month of evolution associated with 72 hours of fever. Abdominal ultrasound is performed, which shows bile duct, stomach, small intestine with ascaris and chest x-ray with interstitial inflammatory infiltrate, associated with hyperleukocytosis with hypereosinophilia and elevated gamma-glutamyl transpeptidase. Antibiotic, anthelminthic treatment is administered, without achieving the elimination of the bile duct parasites, requiring their removal by percutaneous cholangiography.

Ascaris lumbricoides, causa de la colecistitis aguda en el servicio de emergencia del Hospital "Alfredo Noboa Montenegro", 2018 / Ascaris lumbricoides, cause of acute cholecystitis in the emergency service of the "Alfredo Noboa Montenegro" Hospital, 2018

Ascaris lumbricoides provoca una de las helmintiasis más frecuentes en los países tropicales, pudiendo producir efectos patológicos en cualquier parte del organismo, siendo los conductos biliales uno de los sitios recurrentes provocando una colecistitis aguda. La CA es una de las principales causas de ingreso al servicio de Emergencia, es una inflamación de la vesícula cuyo diagnóstico oportuno es de vital importancia para la prevención de complicaciones. Por tal razón, determinar la frecuencia de las variables clínicas, de laboratorio y ecográficas, su relación con las comorbilidades asociadas a las características demográficas de los pacientes y el nivel de severidad de la colecistitis aguda causada por la A. lumbricoides de las Guías de Tokio 2018 del Servicio de Emergencia del Hospital Alfredo Noboa Montenegro durante el periodo junio - diciembre 2018, para la elaboración de un esquema diagnóstico. La metodología de investigación fue cuantitativa descriptiva de corte transversal. Dentro de los principales hallazgos, el CA aparece con prevalencia en el género femenino en un 69,41%, promedio de edad de 32 a 45 años, el 10% de 170 pacientes presentaron en su ecografía una forma parasitaria compatible con A. Lumbricoides, los resultados clínicos arrojaron presencia de dolor (67,34%), fiebre (68,65%), náuseas (45,93%); en los laboratorio la Proteína C Reactiva estuvo aumenta en el 94,18% de los casos, en imagenología se refleja presencia de líquido pericolecistico en un 78,82% y un engrosamiento de pared vesicular en un 34,12%. El nivel de severidad registrado según los criterios de las guías de Tokio 2018 fue grado I 35,3%, grado II 47,1% y grado III 17,6%. Se recomienda la estructuración de un esquema diagnóstico oportuno de colecistitis aguda causada por A. Lumbricoides(AU)

Ascaris lumbricoides causes one of the most frequent helminthiases in tropical countries, being able to produce pathological effects in any part of the body, being the bile ducts one of the recurrent sites causing acute cholecystitis. AC is one of the main causes of admission to the Emergency service, it is an inflammation of the gallbladder whose timely diagnosis is of vital importance for the prevention of complications. signs and symptoms, the timely diagnosis is of vital importance for the prevention of complications. For this reason, determine the frequency of clinical, laboratory and ultrasound variables, their relationship with the comorbidities associated with the demographic characteristics of the patients and the level of severity of acute cholecystitis cause of A. lumbricoides of the Tokyo Guidelines 2018 of the Hospital Emergency Service Alfredo Noboa Montenegro during the period June - December 2018, for the elaboration of a diagnostic scheme. The research methodology was quantitative cross-sectional descriptive. Among the main findings that were prevailed in the female gender in 69,41%, average age from 32 to 45 years, 10% of 170 patients presented in their ultrasound a parasitic form compatible with A. lumbricoides, clinical results that prevailed was presence of pain (67.34%), fever (68.65%), nausea (45.93%); in the laboratory findings the C Reactive Protein was increased in 94,18% of cases, in imaging the presence of pericolecist fluid is reflected in 78,82% and a thickening of the vesicular wall in 34,12%. The severity level recorded according to the criteria of the Tokyo 2018 guidelines was grade I 43,53%, grade II 48,24% and grade III 8,24%. The structuring of a timely diagnostic scheme for acute cholecystitis cause of A. lumbricoides is recommended(AU)

Ascariasis hepatobiliar en una lactante con desnutrición severa: reporte de caso / Hepatobiliary ascariasis in severely malnourished infant: case report

Resumen La Ascariasis es la geohelminitiasis más común del mundo, catalogándose como una enfermedad tropical desatendida, que puede causar compromiso pulmonar, gastrointestinal, hepatobiliar y nutricional. Se presenta el caso inusual de una lactante procedente de una zona de extrema pobreza quien consultó por fiebre, vómito, ausencia de deposiciones, distensión y dolor abdominal. Fue diagnosticada con pseudoobstrucción intestinal, desnutrición severa, choque séptico de origen intraabdominal, retraso del neurodesarrollo y deprivación psicoafectiva, cuyas imágenes reportaron ascariasis hepatobiliar y granulomas hepáticos calcificados y abscedados, con infestación severa por Ascaris lumbricoides. Recibió manejo antibiótico y antiparasitario con recuperación exitosa. En nuestro medio, las infecciones por helmintos son causa frecuente de anemia, retraso cognitivo y del crecimiento en niños en edad escolar. Sin embargo, la infestación y complicaciones hepatobiliares como colangitis, colecistitis, pancreatitis, litiasis biliar y hepatitis abscedada son inusuales en menores de dos años. A través de este caso se pretende resaltar la presentación atípica de la enfermedad en lactantes e incitar al fortalecimiento de las intervenciones en salud pública. MÉD.UIS.2020;33(1):67-72.

Abstract Ascariasis is the most common geohelminitiasis in the world. It is categorized as an unattended tropical disease, which can cause pulmonary, gastrointestinal, hepatobiliary and nutritional compromise. We present the unusual case of an infant from an extreme poverty area presenting fever, vomiting, absence of bowel movements, bloating and abdominal pain. She was diagnosed with intestinal pseudoobstruction, severe malnutrition, abdominal septic shock, neurodevelopmental delay and emotional deprivation. The images reported hepatobiliary ascariasis and calcified and abscessed hepatic granulomas, with severe infestation by Ascaris lumbricoides and Trichuris trichiura. She was treated with antibiotics and antiparasitic agents with successful recovery. In our environment, helminth infections are a frequent cause of anemia, stunting and neurodevelopmental delay in school-age children. However, infestation and hepatobiliary complications such as cholangitis, cholecystitis, pancreatitis, biliary lithiasis and hepatic abscess are unusual in children under two years old. Through this case, it is intended to highlight the atypical presentation of this disease at the age of this patient and encourage the strengthening of public health interventions. MÉD.UIS.2020;33(1):67-72.

Lagochilascariasis: an emerging parasitic disease

Lagochilascariasis, described for the first time in 1909, is caused by a helminth nematode within the Lagochilascaris genus, and Ascarididae family, which mainly affects the underprivileged, especially among rural populations. Brazil presents more than 75% of the cases worldwide, mostly in the Amazon region, where the illness is considered emergent. The main clinical manifestation in humans is the appearance of subcutaneous purulent lesions normally found around the neck, mastoid and middle ear regions, the originating form is a painless granulomatous reaction that may have a chronic course and lead to death. Considering the paucity of reports on this helminthiasis, a bibliographic study was performed with the intent of consolidating information found systemized as etiology, epidemiology, pathogeny, clinical aspects, diagnostic, treatment, prophylaxis and control, as well as guiding health professionals in the resolution of human lagochilasacariasis cases. The present review reinforces the need for further studies on the subject, with a view to increasing the appropriate management of the disease and learning from it, to improve control, based on adequate knowledge of its natural cycle, as well as health education of the population

Ascariasis intestinal. Tres casos pediátricos con complicaciones severas en Cauca, Colombia / Intestinal ascariasis. Three pediatric cases with severe complications in Cauca, Colombia

Se presentan tres casos clínicos de niños atendidos en el Hospital Universitario San José de Popayán en Cauca, Colombia, quienes consultaron por una infección severa causada por Ascaris lumbricoides. La severidad de la infección tuvo como consecuencia en el primer caso una colangitis aguda, en el segundo caso una obstrucción intestinal con peritonitis generalizada, y en el tercer caso una perforación intestinal y choque séptico. El objetivo de mostrar estos casos es dar a conocer estas presentaciones clínicas poco frecuentes en el entorno médico. Además, se resalta la importancia del conocimiento sobre esta especie de parásito, que termina siendo un problema más de salud pública, no solo en nuestro país, sino en gran parte del mundo

We report three clinical cases of children treated at the San José University Hospital in Cauca, Colombia, who consulted with a severe infection caused by Ascaris lumbricoides. The severity of the infection resulted in acute cholangitis in the first case, in intestinal obstruction with generalized peritonitis in the second case, and in intestinal perforation and septic shock in the third case. The objective of this report is to inform the medical community about these unusual clinical presentations. In addition, the importance of this parasite is highlighted as a public health concern, not only in our country but also globally

Assessing the Parasitic Burden in a Late Antique Florentine Emergency Burial Site

Excavation (2008–2014) carried out under the Uffizi Gallery (Florence, Italy) led to the discovery of 75 individuals, mostly buried in multiple graves. Based on Roman minted coins, the graves were preliminarily dated between the second half of the 4th and the beginning of the 5th centuries CE. Taphonomy showed that this was an emergency burial site associated with a catastrophic event, possibly an epidemic of unknown etiology with high mortality rates. In this perspective, paleoparasitological investigations were performed on 18 individuals exhumed from 9 multiple graves to assess the burden of gastrointestinal parasitism. Five out of eighteen individuals (27.7%) tested positive for ascarid-type remains; these are considered as “decorticated” Ascaris eggs, which have lost their outer mammillated coat. Roundworms (genus Ascaris) commonly infest human populations under dire sanitary conditions. Archaeological and historical evidence indicates that Florentia suffered a period of economic crisis between the end of 4th and the beginning of the 5th centuries CE, and that the aqueduct was severely damaged at the beginning of the 4th century CE, possibly during the siege of the Goths (406 CE). It is more than plausible that the epidemic, possibly coupled with the disruption of the aqueduct, deeply affected the living conditions of these individuals. A 27.7% frequency suggests that ascariasis was widespread in this population. This investigation exemplifies how paleoparasitological information can be retrieved from the analysis of sediments sampled in cemeteries, thus allowing a better assessment of the varying frequency of parasitic infections among ancient populations.

Ascaris lumbricoides coinfection reduces tissue damage by decreasing IL-6 levels without altering clinical evolution of pulmonary tuberculosis or Th1/Th2/Th17 cytokine profile

Abstract INTRODUCTION: Immunological control of Mycobacterium tuberculosis infection is dependent on the cellular immune response, mediated predominantly by Th1 type CD4+ T cells. Polarization of the immune response to Th2 can inhibit the host immune protection against pathogens. Patients with tuberculosis coinfected with helminths demonstrate more severe pulmonary symptoms, a deficiency in the immune response against tuberculosis, and an impaired response to anti-tuberculosis therapy. METHODS: We evaluated the cellular immune response and the impact of the presence of Ascaris lumbricoides on the immune and clinical response in pulmonary tuberculosis patients. Ninety-one individuals were included in the study: 38 tuberculosis patients, 11 tuberculosis patients coinfected with Ascaris lumbricoides and other helminths, 10 Ascaris lumbricoides patients, and 34 non-infected control individuals. Clinical evolution of pulmonary tuberculosis was studied on 0, 30, 60, and 90 days post-diagnosis of Mycobacterium tuberculosis and Ascaris lumbricoides. Furthermore, immune cells and plasma cytokine profiles were examined in mono/coinfection by Mycobacterium tuberculosis and Ascaris lumbricoides using flow cytometry. RESULTS: There were no statistical differences in any of the evaluated parameters and the results indicated that Ascaris lumbricoides infection does not lead to significant clinical repercussions in the presentation and evolution of pulmonary tuberculosis. CONCLUSIONS: The association with Ascaris lumbricoides did not influence the Th1, Th2, and Th17 type responses, or the proportions of T lymphocyte subpopulations. However, higher serum levels of IL-6 in tuberculosis patients may explain the pulmonary parenchymal damage.

Ascariasis biliar: caso clínico pediátrico reportado en Hospital General Enrique Garcés / Biliary ascariasis: pediatric clinical case reported in Hospital General Enrique Garcés

Áscaris lumbricoides, nemátodo frecuente en la población infantil, relacionado con situaciones socioeconómicas bajas y condiciones higiénicas desfavorables. El ciclo de vida del parasito inicia con la ingesta de huevos embrionados, tras esto desempeña un período hístico-tisular y transalveolocapilar, posteriormente alcanza el intestino delgado como parásito adulto. En ocasiones migra a diferentes sitios causando complicaciones, destacando la migración a vía biliar provocando colecistitis parasitaria. El siguiente caso trata de un adolescente de 12 años 9 meses que consulta por dolor abdominal localizado en epigastrio y cuadrante superior derecho. Es ingresada en el Hospital General Enrique Garcés de la ciudad de Quito, Ecuador donde se evidencia en ecografía la presencia de Áscaris lumbricoides en el interior de la vesícula biliar. Se realiza manejo clínico administrando antihelmíntico. Dos días posterior a su ingreso y culminado el tratamiento se solicita control ecográfico sin evidenciar la presencia del parásito

Ascaris lumbricoides is a frequently nematode in children associated with low socio-economic situations and unfavorable hygienic conditions. The life cycle of the parasite starts with the intake of embryonic eggs, then it plays an hyshc-hssue period and trans-capillary period. Subsequently reaches the bowel intestine as anadult parasite. Sometimes they migrate to different places causing complications, including migration to bile duct causing parasitic cholecystitis. The following case is a boy of 12 years 9 months old consulting for abdominal pain located in epigastrium and right upper quadrant. He was hospitalized in the General Hospital Enrique Garces in the city of Quito ­ Ecuador evidenciating the presence of on Ascaris lumbricoides in the interior of the gallbladder in the ultrasound. Antiprotoozarios were given. Two days after finishing the treatment, we requested a control ultrasound without observing the parasite

Is it necessary to take anthelmintics every year in Korea?

Is it necessary to intake anthelmintics every year in Korea? To answer to this question, the recent nation-wide egg positive rate of the intestinal nematodes in Korea was presented. The anthelminthics which are purchasable without physician's prescription were also introduced with their pharmacological reaction and indication. The egg positive rate of Ascaris lumbricoides in 2012 was 0.025%. Those of Trichuris trichiura and Enterobius vermicularis were 0.27% and 0.004%, respectively. In 2018, purchasable anthelmintics without physician's prescription in Korea were albendazole and flubendazole only. Those two anthelmintics were derivatives of benzimidazole that may cause some side effects such as hepatitis, increase of hepatic enzymes, granulocytopenia, or pancytopenia. These anthelmintics showed excellent effect to ascariasis; while, they are not sufficient to treat trichuriaiss. For treatment of enterobiasis, repeated taking 3 times with 3 weeks interval and mass treatment of the family of egg positive person are required. In conclusion, it is not necessary to take anthelmintics every year without specific diagnosis because of negligible egg positive rate of intestinal nematodes and complicated therapeutic module for enterobiasis. There was no specific symptom of ascariasis or trchuriasis if worm burden is not high. The common symptoms of enterobiasis were pain or itching at the perianal area, sleep difficulty, or diarrhea. If intestinal nematode infection is suspected, stool examination or perianal swab should be done before prescribing anthelmintics.

Effectiveness of immature Mangifera indica Linn (mango) fruit in reducing the Ascaris lumbricoides infection among children: a non-inferiority randomized controlled trial / The Health Sciences Journal

INTRODUCTION@#This study aimed to compare the effectiveness of immature Magnifera indica L. (mango) fruit with albendazole in reducing Ascaris lumbricoides infection among children.@*METHODS@#Children aged 2 to 14 years were enrolled in a randomized, controlled, non-inferiority trial. Participants were randomly allocated to receive 250 mL immature mango fruit puree daily for 3 days or one dose of albendazole 400 mg tablet. Egg reduction rates and cure rates were computed and compared. Adverse effects were monitored during and after administration of treatment.@*RESULTS@#There was a statistically significant decrease between the pre- and post-treatment EPG of those who took immature mango fruit (p < 0.001) and those who took albendazole (p < 0.001). There was a higher ERR and CR for the albendazole group, but the difference was not significant (p = 0.472, p = 785, respectively). Risk analysis of reduction in intensity showed mango is non-inferior to albendazole (RR = 0.80, 95% CI 0.67, 0.97; p = 0.026). Risk analysis of cure showed mango is noninferior to albendazole in both PP (RR = 0.92, 95% CI 0.68, 1.25; p = 0.607) and ITT (RR=0.79, 95% CI 0.58, 1.08; p = 0.139).@*CONCLUSION@#Immature Mangifera indica Linn is non-inferior to albendazole in terms of effectiveness in the reduction of ascariasis infection.

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.

Incidencia de Áscaris en vía biliar y factores asociados en pacientes que acuden al Hospital General Macas. Agosto 2015- junio 2016 / Ascaris Incidence in the bile duct and associated factors in patients who go to Hospital General Macas. August 2015- June 2016

Introducción:La ascaridiasis intestinal en ocasiones se complica con la migración del parásito a vía hepatobiliar o a vesícula, dando sintomatología parecida a la de una colecistitis o de una coledocolitiasis. Entre los principales medios para llegar al diagnóstico esta la colangiopancreatografía endoscópica (CPRE), la tomografía axial computarizada (TAC) y principalmente la ecografía. Materiales y métodos:Se realizó un estudio observacional, descriptivode corte transversal con una muestra de 183 pacientes que acudieron al Hospital General de Macas por presentar dolor abdominal superior. Se aplicó un cuestionario validado para obtener datos de las características sociodemográficas, clínicas y ecográficas de los pacientes. Se realizó análisis descriptivo univariado y bivariado. La asociación se determinó con la prueba chi cuadrado. Se consideró resultados estadísticamente significativos a valores de p<0.05. Resultados:La mayoría de pacientes tuvo edades entre los 19-44 años,fueron mujeres, de la etnia shuar, con condición socioeconómica baja y extrema pobreza. Más de la mitad de la población estudiada no tiene agua potable, muy pocos refirieron antecedentes quirúrgicos, y un cuarto de la muestra analizada manifestó expulsión de vermes. Los principales síntomas por los que acudieron los pacientes fueron: náusea, vómito,dolor abdominal y alza térmica. La incidencia de áscaris en vías biliares fue del 29.0%, con un 13.2% de complicaciones principalmente pancreatitis y abceso hepático. Se encontró asociación significativa con alza térmica; sin embargo, el sexo, el consumo de agua potable, los antecedentes quirúrgicosy el estado nutricional no estuvieron asociados con la enfermedad. Conclusiones:la incidencia de ascaridiasis es alta y está asociada con alzatérmica como factor de riesgo para migración del parásito a las víasbiliares.

Introduction:The intestinal ascaridiasis is sometimescomplicated by the migration of the parasite to thehepatobiliary pathway or to the gallbladder, givingsymptoms similar to that of cholecystitis or choledo-cholithiasis. The endoscopic cholangiopancreatography(ERCP), computerized axial tomography (CT), andmainly ultrasound are among the main means toreach the diagnosis.Materials and methods:An observational, descriptive,cross-sectional study was conducted with a sampleof 183 patients who attended to the Macas GeneralHospital due to upper abdominal pain. A validatedquestionnaire was applied to obtain data on the so-ciodemographic, clinical and ultrasound characteristicsof the patients. A descriptive univariate and bivariateanalysis was performed. The association was deter-mined with the chi square test. Statistically significantresults were considered at values of p <0.05.Results:The majority of patients were between 19-44 years old, everybody were women of the Shuarethnic group, with low socioeconomic status and ex-treme poverty. More than half of the populationstudied does not have drinking water, very fewpeople reported surgical history, and a quarter ofthe sample analyzed expressed expulsion of worms.The main symptoms for which the patients attendedwere: nausea, vomiting, abdominal pain and thermalrise. The incidence of ascaris in the biliary tract was29.0%, with 13.2% of complications, mainly pancre-atitis and hepatic abscess. There was an associationwith thermal rise; however, sex, drinking water con-sumption, surgical history and nutritional status werenot associated with the disease.Conclusions:the incidence of ascariasis is high andit is associated with thermal rise as a risk factor formigration of the parasite to the bile ducts.