A Case-Control Study on the Association Between Intestinal Helminth Infections and Treatment Failure in Patients With Cutaneous Leishmaniasis.

BACKGROUND: Endemic regions of cutaneous leishmaniasis (CL) and intestinal helminthiasis overlap. CL treatment with systemic pentavalent antimonial drugs (Sb5+) fails in 10%-30% of patients. The study objective was to assess the etiological role of intestinal helminthiasis in CL treatment failure. METHODS: An unmatched case-control study was done in 4 CL treatment sites in Peru in 2012-2015. Cases were CL patients with Sb5+ treatment failure; controls were CL patients with Sb5+ treatment success. Patients with a parasitologically confirmed CL diagnosis who had received supervised Sb5+ treatment and could be classified as cases or controls were eligible. The main exposure variables were intestinal helminthiasis and strongyloidiasis, diagnosed through direct examination, rapid sedimentation, Baermann, Kato-Katz, or agar culture of stool samples. Additional exposure variables were other infections (HIV, human T-lymphotropic virus 1, tuberculosis, hepatitis B, intestinal protozoa) and noninfectious conditions (diabetes, renal insufficiency, and immunosuppressive medication). Age, gender, CL history, probable exposure place, and Leishmania species were treated as potential confounders in multiple logistic regression. RESULTS: There were 94 case and 122 control subjects. Overall, infectious and noninfectious comorbidities were frequent both among cases (64%) and controls (71%). The adjusted odds ratio (OR) for the association between any intestinal helminth infection and CL treatment failure was 0.65 (95% confidence interval [CI], 0.30-1.38), and the adjusted OR for the association between strongyloidiasis and CL treatment failure was 0.34 (95% CI, 0.11-0.92). CONCLUSIONS: In the Peruvian setting, high Sb5+ treatment failure rates are not explained by intestinal helminthiasis. On the contrary, strongyloidiasis had a protective effect against treatment failure.

Helminthiases in North Korea: a neglected public health challenge.

Helminthiasis is a neglected public health challenge threatening North Koreans. However, there is no precise estimate on the burden of helminthiasis in the region. This study therefore reviewed existing literature with the aim of analyzing the current state of helminthiasis among North Koreans, as well as highlighting the difference in the prevalence of helminthiasis between North Korean residents and refugees. All published resources citing helminthiasis among North Koreans were screened through the PubMed and a Korean bibliographic database as of April 2019. Official papers reported by the government and international agencies, as well as reports and books published in North Korea, were reviewed. After removing duplicated government reports, a total of 37 records were screened, and four were determined to be included for review. The total number of study subjects was 621 from the four eligible studies. Forty percent of them were refugees living outside North Korea. Total positive rate of any kind of helminths was 37.7%. Ascaris was the most widespread helminths with a prevalence estimate of 41.1%. The total positive rate of helminthiasis among residents living in North Korea was significantly higher than that among North Korean refugees (47.2% vs. 23.4%, chi-square p-value < 0.001). Poor hygiene, malfunctioning public health infrastructure, and feculent agricultural practices accounted for the spread of helminthiasis. Appropriate strategies and policies should be developed to prevent and alleviate helminthiasis in North Korea.

Persistent eosinophilia in rheumatoid arthritis: a prospective observational study.

Eosinophilia is an uncommon manifestation in Rheumatoid arthritis (RA), and there is a paucity of data regarding the relationship of eosinophilia with disease-related factors. We prospectively evaluated the clinical and disease-specific characteristics of RA patients with eosinophilia. Consecutive patients with RA with an absolute eosinophil count ≥ 500/mm3 without an apparent cause for eosinophilia, were investigated for parasitic infestation. Patients with a definite parasitic infestation received targeted therapy, and the rest were treated with albendazole empirically. The RA disease-specific characteristics of the patients with persistent eosinophilia were compared with the patients without eosinophilia. Of the 160 patients with eosinophilia, 30 patients (19%) had allergic diseases, six patients had bronchiectasis, and one patient had hypereosinophilia of undetermined significance. Intestinal helminthiasis was found in 34 patients (21%). Eosinophilia was unexplained in 89 patients (56%) and it resolved after empirical albendazole therapy in about two-thirds (58 patients). Thirty-one patients had persistent eosinophilia. Nonsteroidal anti-inflammatory drug and disease-modifying antirheumatic drug modification did not show any effect on eosinophilia. The disease-related characteristics were similar between patients with persistent eosinophilia and those without eosinophilia. Eosinophilia is due to secondary causes in the majority of RA patients, and the most common cause in our setting is an intestinal helminthic infection. Persistent eosinophilia in our cohort of RA did not indicate a more severe disease phenotype.

Parasitological and nutritional status of school-age and preschool-age children in four villages in Southern Leyte, Philippines: Lessons for monitoring the outcome of Community-Led Total Sanitation.

While preventive chemotherapy remains to be a major strategy for the prevention and control of soil-transmitted helminthiases (STH), improvements in water, sanitation, and hygiene (WASH) comprise the long-term strategy to achieve sustained control of STH. This study examined the parasitological and nutritional status of school-age and preschool-age children in four villages in Southern Leyte, Philippines where two of the villages attained Open-Defecation-Free (ODF) status after introduction of Community-Led Total Sanitation (CLTS). A total of 341 children (89.0% of the total eligible population) submitted stool samples which were examined using the Kato-Katz technique. Results showed that 27.9% of the total stool samples examined had at least one type of STH (cumulative prevalence), while 7.9% had moderate-heavy intensity infections. Between the two villages where CLTS was introduced, Buenavista had a significantly higher cumulative prevalence of STH at 67.4% (p<0.001) and prevalence of moderate-heavy intensity STH at 23.5% (p=0.000), while Caubang had a significantly lower cumulative prevalence at 4.9% and prevalence of moderate-heavy intensity at 1.8%. On the other hand, the non-CLTS villages of Bitoon and Saub had similar rates for cumulative prevalence (16.7% and 16.8%, respectively; p=0.984) and prevalence of moderate-heavy intensity STH (2.0% and 3.1%, respectively; p=1.000). The findings may be explained by factors that include possible reversion to open defecation, non-utilization of sanitary facilities, and mass drug administration (MDA) coverage, although further studies that can accurately assess the impact of CLTS are recommended. While this study was descriptive, the data indicate no clear pattern among the parasitological and nutritional parameters, as well as the presence of CLTS in the village, suggesting the need to monitor the ODF status of villages on a regular basis even after the end of CLTS activities to ensure the sustainability of the CLTS approach. In order to achieve effective control of STH, deeper collaboration between the WASH and STH sectors are recommended where partners can work together in the area of monitoring and evaluation that may include improved parasitological and nutritional status in high-risk groups, as well as sustainable behavior change as outcome indicators.

Soil-transmitted helminthiases in secondary school students in selected sites in two provinces in the Philippines: policy implications.

The latest World Health Organization (WHO) strategic plan for eliminating soil-transmitted helminthiases (STHs) as a public health problem in children puts the emphasis on school-age children. On the other hand, the Philippine national helminth control program excludes secondary school students in mass deworming for STH. This study determined the prevalence and intensity of STH in a sample of 633 students (14-15 years old) in selected secondary schools in two Philippine provinces. Stool specimens were processed following the Kato-Katz technique and examined for the presence of helminth ova. Overall cumulative prevalence of STH was 31.3%, while prevalence of moderate-heavy-intensity infections was 7.7%, well beyond the WHO target of ≤1% for reducing morbidity in school-age children. Recommendations were made to update the Philippine helminth control program and to re-examine the WHO strategic plan so that helminth prevention and control strategies may also be emphasized for secondary school students especially in high-prevalence areas.

Control of soil-transmitted helminthiasis in Myanmar: results of 7 years of deworming.

After a baseline survey in 2003 which showed an overall parasitological prevalence of soil-transmitted helminths of 69.7% in school children (prevalence of ascariasis 48.5%, prevalence of trichuriasis 57.5% and prevalence of hookworm infection 6.5), a national deworming programme was established. After 7 years of implementation, it had resulted in a significant reduction of STH prevalence (prevalence of any STH 21%, prevalence of ascariasis 5.8%, prevalence of trichuriasis 18.6% and prevalence of hookworm infection 0.3%) as well as a reduction of the infections of moderate-heavy intensity from 18.5% at baseline to less than 7%. The results are encouraging and a reduction of the frequency of deworming can be envisaged in two of four ecological areas of Myanmar.

[Intestinal helminthiasis diagnosed in Dakar, Senegal]. / Prévalence des helminthoses digestives diagnostiquées à l'hôpital Le Dantec de Dakar, Sénégal.

The goal of this study was to determine the prevalence of digestive helminthiasis among patients referred to the laboratory of Parasitology and mycology at Le Dantec Hospital in Dakar for examination of stool samples from 2004 to 2009. Of 1 526 direct stool examinations (Ritchie and Baerman techniques) analyzed at the laboratory of Parasitology and Mycology of Le Dantec Hospital from 2004 to 2009, 310 were positive for intestinal helminthiasis, for a prevalence of 20.3%. The main species found were: Ascaris lumbricoides, Trichuris trichiura, Strongyloides stercoralis, Tænia saginata and Tænia solium. Most patients had a single parasite (90.1%, versus 9% with two and 0.9% with three). Men are infected more often than women, accounting respectively for 58% and 42% of the infections, for a sex ratio of 1.38. Children aged 10 to 15 years had the highest prevalence of infection: 34.5%. The results show that digestive helminthiasis is endemic in Dakar, where it is necessary to implement campaigns of deworming, health education and environmental improvement.

A human case of Hymenolepis diminuta in a child from eastern Sicily.

We report a case of Hymenolepis diminuta infection in a 2-year-old child living in a suburban area of Catania, Italy. This case was initially referred to us as Dipylidium caninum infection, which was not cured after being treated twice with mebendazole. However, by analyzing the clinical presentation and stool samples we arrived to the diagnosis of H. diminuta infection. The case presented with atypical allergic manifestations which had never been reported as clinical features of symptomatic H. diminuta infection; remittent fever with abdominal pain, diffuse cutaneous itching, transient thoracic rash, and arthromyalgias. The patient was treated with a 7-day cycle of oral niclosamide, which proved to be safe and effective. This case report emphasizes that a correct parasitological diagnosis requires adequate district laboratories and trained personnel. In addition, we recommend the importance of reporting all H. diminuta infection cases, in order to improve knowledge on epidemiology, clinical presentation, and treatment protocols.

A Human Case of Hymenolepis diminuta in a Child from Eastern Sicily

We report a case of Hymenolepis diminuta infection in a 2-year-old child living in a suburban area of Catania, Italy. This case was initially referred to us as Dipylidium caninum infection, which was not cured after being treated twice with mebendazole. However, by analyzing the clinical presentation and stool samples we arrived to the diagnosis of H. diminuta infection. The case presented with atypical allergic manifestations which had never been reported as clinical features of symptomatic H. diminuta infection; remittent fever with abdominal pain, diffuse cutaneous itching, transient thoracic rash, and arthromyalgias. The patient was treated with a 7-day cycle of oral niclosamide, which proved to be safe and effective. This case report emphasizes that a correct parasitological diagnosis requires adequate district laboratories and trained personnel. In addition, we recommend the importance of reporting all H. diminuta infection cases, in order to improve knowledge on epidemiology, clinical presentation, and treatment protocols.

Frecuencia de helmintiasis intestinal y su asociación con deficiencia de hierro y desnutrición en niños de la región occidente de México / Frequency of intestinal helminthiasis and its association with iron deficiency and malnutrition in children from western Mexico

Objetivo: Determinar la frecuencia de helmintiasis intestinal y su asociación con desnutrición y deficiencia de hierro. Material y métodos: Se realizó un estudio transversal analítico en el municipio de Comala, Colima, México. A todos los niños, se les determinó coproparasitoscópico seriado de tres días con la técnica de Kato-Katz. Para evaluar el grado de desnutrición; se establecieron los siguientes índices antropométricos: mediana y puntajes Z para peso/ talla, talla/edad y peso/edad. Se consideró que había deficiencia de hierro severa, moderada o leve con ferritina ≤ 12 ng/ ml, de 12 a 18 ng/mL y de 19 a 24 ng/mL respectivamente. Resultados: Se estudiaron 243 niños con una edad promedio de 65.3 ± 8.7 meses. El 60.9 % (n = 148) y el 2.5 % (n = 6) de los niños presentaron disminución de la ferritina y anemia respectivamente. El 16 % (n = 39) mostró trichuriasis, el 6.9 % (n = 17) ascariasis y el 5.3 % (n = 13) ambas. La infección por Trichuris trichiura se asoció a desmedro (OR 11.0, IC 3.9-30.8; p < 0.001) y a deficiencia de hierro con puntos de corte de < 24 ng (OR 2.0, IC 1.0-3.9, p = 0.02) y < 18 ng/dL (OR 2.2, IC 1.2-4.2, p = 0.009). La infección por ascaris no se asoció con desnutrición o deficiencia de hierro. Conclusiones: La infección de T. trichiura se asoció con desmedro y deficiencia de hierro grado leve y moderado.

OBJECTIVE: To determine intestinal helminthiasis frequency and its association with malnutrition and iron deficiency. Material and METHODS: An analytical cross-over study was carried out on children in the municipality of Comala, Colima, Mexico. Coproparasitoscopic exams in series of three using the Kato-Katz technique were performed in all children. To evaluate the degree ofmalnutrition, the following anthropometric indices were determined: means and z-scores for weight/height, height/age, weight/age. Severe, moderate and minimal iron deficiency was considered when ferritin was: < or = 12 ng/ml, 12 to 18 ng/mL and 19 to 24 ng/mL, respectively. RESULTS: 243 children were studied with an average age of 65.3+/-8.7 months. 60.9% (n = 148) of the children showed a decrease in ferritin levels and 2.5% (n = 6) had anemia. 16% (n = 39) had trichuriasis, 6.9% (n = 17) ascariasis and 5.3% (n = 13) had both parasites. Trichiura infection was associated with declining health (OR 11.0, CI 3.9-30.8; p<0.001) and with iron deficiency, with cut-off points of <24 ng (OR 2.0, CI 1.0-3.9, p = 0.02) and <18 ng/ dL (OR 2.2, CI 1.2-4.2, p= 0.009). Ascaris infection was not associated with malnutrition or iron deficiency. CONCLUSIONS: Trichiura infection was associated with declining health and slight and moderate degrees of iron deficiency.

Intestinal helminthiasis in primary school children and its control in Kien Giang province

Mass deworming with mebendazol 500mg was made in three schools in the districts of Tan Hiep, Hon Dat and An Bien. A prior treatment survey showed a cumulative infection rate of helminth of 15.6% in the school children of which a light infection of Ascariasis, Trichuris and hookworm but high rate of mixed infection (23%) were found. The post-treatment survey showed a 10.7% of the cumulative infection and 9.2% of the mixed infection. The density of three species was light reduced. Six months after treatment, in Hon Dat where the treatment was combined with IEC, the infection rate was found 6.4%, and it was 13.3% in Tan Hiep where no IEC was made. Mass drug administration is thought to be a simple, safe and highly effective method of deworming that can be supported by both teachers and parents of school children. Periodical mass treatment will be more helpful if combined with IEC.