Impact of health education on knowledge and prevention behavior for congenital toxoplasmosis: the experience in Poznan, Poland.

In 1991-1997 educational activities were undertaken in the Poznan region of Poland to promote health education for the prevention of toxoplasmosis. The effect of education was measured in 2710 pregnant women by a questionnaire survey. Knowledge of toxoplasmosis and its prevention was almost doubled within 4 years. Similarly, the proportion of women having antenatal serological tests for toxoplasmosis significantly increased. In the examined population the knowledge of how Toxoplasma gondii is transmitted/acquired was better than the knowledge of individual risk factors for congenital toxoplasmosis. Correct hygienic behaviors in pregnancy were often practised by women who lacked good knowledge of toxoplasmosis. The experience from this study suggests the possible effectiveness of including prevention of toxoplasmosis into the whole package of preventing infectious diseases in pregnancy and into healthy lifestyle promotion. Health educational activities need to be realized by modern promotional technologies in addition to making available traditional written educational texts. There is a considerable role of medical services in promotion of a hygienic behavior in pregnant women preventing congenital toxoplasmosis in their offspring. Health education should be especially tailored to the population of pregnant women below the age of 21.

Neonatal screening for congenital toxoplasmosis in the Poznan region of Poland by analysis of Toxoplasma gondii-specific IgM antibodies eluted from filter paper blood spots.

OBJECTIVES: The aims of the study were to determine the prevalence of congenital toxoplasmosis at birth in the Poznan region of Poland, the value of the serologic examination of filter paper blood specimens collected from newborns for the diagnosis of congenital Toxoplasma infection and the duration of anti-Toxoplasma-specific IgM antibodies in infants' sera. MATERIALS AND METHODS: All neonates born in the maternity wards of the University Hospital of Gynaecology and Obstetrics in Poznan and in 10 selected obstetrics wards in the district hospitals were included. Blood samples were collected on filter paper cards, between the first and sixth day of life, screened for anti-Toxoplasma-specific IgM antibodies by an immunocapture enzyme-linked immunosorbent assay and if positive further analyzed for specific IgG and IgA antibodies. RESULTS: Between June, 1996, and October, 1998, filter paper samples from 27,516 liveborn infants were tested, which constituted approximately 75% of all births and 83% of liveborn neonates from the Poznan region. Anti-T. gondii-specific IgM antibodies were found in 13 newborns, equivalent to a prevalence of Toxoplasma-specific IgM in newborns of 1 per 2,117 liveborn children (0.47 per 1,000) or 1 per 870 children (1.15 per 1,000) born to seronegative women at risk of primary T. gondii infection during pregnancy. We identified two congenitally infected infants who were IgM-negative at birth, had a classic triad of clinical symptoms during the first year of life and had high levels of specific IgG. The birth prevalence of congenital toxoplasmosis in the Poznan region was at least 1 per 1,834 live births (0.55 per 1,000) or 1 per 754 live neonates born to seronegative women (1.33 per 1,000). The sensitivity of the IgM assay on eluate from filter paper was not more than 86.7%, and the mean duration of IgM detectable by enzyme-linked immunosorbent assay in serum samples was the first 4.8 weeks of life. CONCLUSION: In Poland the screening for congenital toxoplasmosis detecting one case per each 2,000 live births could be considered for inclusion in existing national neonatal screening programs for phenylketonuria and congenital hypothyroidism.

Differential serodiagnosis for cystic and alveolar echinococcosis using fractions of Echinococcus granulosus cyst fluid (antigen B) and E. multilocularis protoscolex (EM18).

Echinococcus granulosus cyst fluid and E. multilocularis protoscolex extract were fractionated by a single step of preparative isoelectric focusing, resulting in an antigen B-rich fraction (8-kD) and an Em18-rich fraction, respectively. The usefulness of both fractions for differential serodiagnosis of cystic (CE) and alveolar (AE) echinococcosis was evaluated by a large-scale immunoblot analysis on a battery of 354 serum samples. These included 66 from AE patients originating from four different endemic areas, 173 from CE patients originating from seven different endemic areas, 71 from patients with other parasitic diseases, 15 from patients with hepatomas, and 29 from healthy individuals. In an immunoblot with the antigen B-rich fraction, 92% (158 of 173) of the CE sera as well as 79% (52 of 66) of the AE sera reacted with the 8-kD subunit. No cross-reactivity occurred with any sera from patients with cysticercosis, other parasitic diseases, or with hepatomas, or from healthy controls. In an immunoblot with the Em18-rich fraction, all but two sera from AE patients (64 of 66, 97%) recognized Em18, and only nine of 34 CE sera from China reacted with it. All other (139) CE sera from six other countries were negative as were all (115) other non-echinococcosis sera. These findings indicate that antigen B (8-kD) is not species-specific for E. granulosus but is genus-specific for Echinococcus, and that the Em18 antigen is a reliable serologic marker for species-specific differentiation of AE from CE.

[Echinococcosis in humans in Poland and in the world. An introduction to the session on echinococcosis]. / Bablowica u ludzi w swiecie i w Polsce wprowadzenie do sesji nt echinokokozy.

The activities of Associacion International de Hidatidologia, Informal WHO Working Groups on Research in Echinocooccosis and Japanese parasitologists group in Hokkaido are summarized. Progress in studying both cystic and alveolar echinococcoses in Poland is reviewed. In the last five years at the University of Medical Sciences in Poznan Poland echinococcosis was a subject of three MD thesis and habilitation for docent degree.

[Up-dated progress in diagnosis and treatment of echinococcosis]. / Aktualne zasady rozpoznawania i leczenia bablowicy.

Diagnostic proces and choice of optimal management of cystic echinococcosis have to be related to the natural history of the parasite. The early and the late stages of invasion require a careful differential diagnosis with non-parasitic diseases. These are also the stages that many not require surgery. Chemotherapy, PAIR and "wait and observe approach" are alternative ways of cystic echinococcosis management. Em-18 WB test has a good diagnostic value in alveolar echinococcosis. Management of alveolar echinococcosis is based on radical surgery, prolonged chemotherapy and long-term observation.

Molecular genetic analysis of human cystic hydatid cases from Poland: identification of a new genotypic group (G9) of Echinococcus granulosus.

We have used nuclear (ribosomal ITS1) and mitochondrial (ND1) sequences to characterize human and pig isolates of Echinococcus granulosus collected by fine needle aspiration biopsy (FNAB) in Poland. The data indicate clearly that the Polish patients were not infected with the common sheep strain (G1 genotype) of E. granulosus, normally associated with human cystic hydatid infection. Instead, the hydatid parasite infecting the Polish patients shares very similar ND1 sequence with the previously characterized pig (G7) genotype but it also exhibits some clear differences. In particular, E. granulosus DNA from the Polish patients amplified a single ITS1 fragment in PCR and distinct ITS1-RFLP patterns were obtained after restriction digestion. The form of hydatid isolated from the Polish patients appears, therefore, to represent a distinct, previously undescribed genotype (designated G9) of E. granulosus.

Further evidence for the occurrence of a distinct strain of Echinococcus granulosus in European pigs.

The morphology, adult development and genetic characteristics of Echinococcus granulosus isolated from pigs in Poland were examined and compared with those of other recognised strains of E. granulosus. The isolates were characterised by their distinct morphology, rapid maturation and unique DNA hybridisation profiles. The form of E. granulosus that occurs in European pigs may therefore be a distinct strain that can be separated morphologically and genetically from other strains and that exhibits features of epidemiological significance, including a rapid rate of development in dogs and an apparent low infectivity to humans and domestic ungulates.

Infestation et anémie ankylostomiennes : méthodologie de la lutte / Z. S. Pawlowski, G. A. Schad, G. J. Stott / Hookworm infection and anaemia : approaches to prevention and control

Guide détaillé des nombreuses mesures simples, efficaces et peu coûteuses permettant de réduire la prévalence et la gravité de l'anémie ankylostomienne. Cet ouvrage a principalement pour but d'aider les praticiens qui travaillent sur le terrain à dépister l'infestation et l'anémie qui en résulte et à appliquer des mesures appropriées, qu'il s'agisse de cas individuels ou de communautés entières. Etant donné que l'on a couramment tendance à sous-estimer l'importance de l'infestation ankylostomienne et à ne lui accorder qu'un rang de priorité limité, l'ouvrage cherche à y remédier en évoquant les principales conséquences de l'anémie ankylostomienne dans le domaine de la santé publique, en décrivant les remarquables résultats des mesures de lutte et en encourageant les scientifiques à s'intéresser davantage à cette maladie qui mérite de retenir leur attention. A cette fin, il expose les mesures simples pouvant être utilisées pour la lutte en fonction des nombreux facteurs complexes sur lesquels doit se fonder leur choix pour qu'elles soient efficaces. L'ouvrage, qui comporte sept chapitres, commence par donner des informations de base sur les cycles biologiques d'Ancylostoma duodenale et de Necator americanus, leurs caractéristiques aux différents stades et leur distribution géographique. Les chapitres suivants décrivent les aspects anatomo-pathologique et clinique de l'infestation et expliquent comment elle entraîne l'anémie. Une attention particulière est accordée aux facteurs qui déterminent le bilan du fer dans un groupe donné, y compris ceux qui peuvent occasionner une anémie sévère lorsque la charge ankylostomienne est faible. Un chapitre consacré à l'épidémiologie décrit les comportements, les conditions climatiques et les pratiques agricoles qui favorisent l'entretien et la propagation de l'infestation et distingue trois grands modes épidémiologiques de transmission. Cette classification des modes de transmission constitue le cadre des informations détaillées sur la prévention et la lutte qui sont exposées par la suite. La confirmation de l'infection étant particulièrement simple, les chapitres sur la prévention et la lutte s'attachent à donner aux agents de santé les renseignements qui peuvent les aider à déterminer quand il y a lieu de soupçonner une infection et à faire les investigations appropriées. Des chapitres distincts exposent les principes de la lutte, passent en revue les différents objectifs et options, qu'il s'agisse de réduire la mortalité et la morbidité dans l'immédiat ou d'apporter des améliorations à long terme et expliquent comment mener des enquêtes générales et spéciales. Parmi les stratégies de lutte qui y sont décrites figurent le traitement classique, le traitement ciblé, le traitement de masse et la distribution de suppléments de fer. Pour le traitement classique, des conseils détaillés sont donnés sur les médicaments et doses recommandés pour l'administration de fer et le traitement par les anthelmintiques présentés comme le fondement de la lutte contre l'anémie ankylostomienne. Le dernier chapitre, consacré à la pratique de la lutte, énumère les approches préconisées pour les trois principaux profils de l'anémie ankylostomienne. Trois annexes concluent l'ouvrage : elles décrivent et illustrent les différentes techniques de laboratoire et autres à utiliser pour les enquêtes sur l'infestation et l'anémie ankylostomiennes et expliquent comment déterminer la base de sondage, la taille de l'échantillon et les méthodes d'enquête les plus appropriées

Experimental infection with Taenia saginata (Poland strain) in Taiwanese pigs.

Two 22-day-old Landrace-Small Ear Miniature (L-SEM) pigs, five 45 to 66-day-old Small Ear Miniature (SEM) pigs, and one 16-day-old Holstein calf were each fed 1000, 3000 or 10,000 Taenia saginata (Poland strain) eggs respectively and killed 34-77 days after inoculation. Four of the five SEM pigs and the Holstein calf were susceptible to this parasite. However, two L-SEM pigs and one SEM pig remained negative. The cysticerci recovery rates for the SEM pig and Holstein calf were 36% and 3%, respectively. All cysticerci from the SEM pigs were found in the livers, more in the parenchyma (89%) than on the surface (11%). Only eleven cysticerci in two SEM pigs were mature and the remainder were either immature, degenerated or calcified. The cysticerci in the calf were distributed throughout the body: leg muscles (248), heart (27), tongue (17), intercostal muscles (14), diaphragm (5), kidney (1) and liver (1). Most (299) of the cysticerci were mature, one was immature and 13 were degenerated or calcified. The length, width, diameter of the protoscolex and sucker of the cysticerci from the calf were larger than those from the SEM pigs. However, the diameter of the rostellum of the latter was slightly larger than the former. Hooklets were not found on any mature cysticercus recovered. The results of the present study provide evidence that the SEM pig can be used as an experimental intermediate host for T. saginata.

Infecci'on y anemia por anquilostomas : posibilidades de prevenci'on y lucha / Z. S. Pawlowski, G. A. Schad, G. J. Stott / Hookworm infection and anaemia : approaches to prevention and control

Este libro constituye una guía pormenorizada de los múltiples remedios sencillos, eficaces y baratos que pueden utilizarse para reducir la prevalencia y la gravedad de la anemia debida a infección por anquilostomas. Su objetivo principal consiste en ayudar a los profesionales que trabajan sobre el terreno a detectar la infección y la anemia asociada para aplicar seguidamente las medidas adecuadas, en el caso tanto de individuos como de comunidades enteras. Frente a la tendencia general a subestimar la importancia de la infección por anquilostomas y a concederle una escasa prioridad, esta obra cumple también una función persuasiva, aportando datos sobre las principales consecuencias de la anemia por anquilostomas para la salud pública, poniendo de relieve los espectaculares resultados de las medidas de control y animando a los especialistas científicos a interesarse más por esta problemática enfermedad. Con este fin, la descripción de las sencillas medidas de control que se pueden adoptar se sitúa en el contexto de los múltiples y complejos factores por los que se rige la selección y se determina la eficacia de las mismas. Puesto que confirmar la existencia de la infección es muy sencillo, los capítulos sobre prevención y lucha se centran en la información que puede ser útil a los agentes de salud para conocer los síntomas de la infección y para realizar a continuación el correspondiente trabajo de investigación. Entre las diferentes estrategias de lucha descritas cabe citar el tratamiento normalizado de los casos, el tratamiento dirigido a objetivos concretos, el tratamiento masivo y la distribución de suplementos de hierro. Respecto al tratamiento normalizado de los casos, se proporciona al lector asesoramiento detallado sobre los medicamentos y dosis más idóneos para el tratamiento con hierro y antihelmínticos, que se presentan como la base para combatir la anemia por anquilostomas. En el capítulo final, dedicado a los aspectos prácticos de la prevención y la lucha, se exponen las estrategias del programa aplicables a cada uno de los tres tipos principales de anemia anquilostomiásica. Concluye la obra con tres anexos, en los que se describen las técnicas de laboratorio y de otro tipo que se pueden emplear en las encuestas sobre los anquilostomas y la anemia, y se explica cómo determinar de forma idónea el ámbito de la encuesta, el tamaño de las muestras y los procedimientos de muestreo que se utilizarán en encuestas de familias o de grupos

Control of Taenia solium taeniasis and cysticercosis by focus-oriented chemotherapy of taeniasis.

The mortality, mortality, and disability due to Taenia solium neurocysticercosis are common and serious health problems in some regions, including several Asian countries. Neurocysticercosis in man and cysticercosis in pigs can be controlled by treatment, in man with a single, low (2 1/2 or 5 mg/kg) and safe dose of praziquantel. The problem which remains is the identification of a Taenia solium taeniasis foci. The definition of a focus is: T. solium-infected or suspected case; household with recent case of epilepsy in family or cysticercosis in pigs; group of houses or a village with high rate of cysticercosis in pigs. In a rural area a focus can be easily identified by tracing infected pigs to their place of origin, or in vivo tongue examination. All people with suspected T. solium taeniasis in a focus should be treated.

An enzyme-linked immunosorbent assay for diagnostic detection of Taenia saginata copro-antigens in humans.

An immunodiagnostic sandwich enzyme-linked immunosorbent assay (ELISA) was developed for the detection of soluble Taenia saginata antigens in stool samples (copro-antigens) of infected humans, using affinity-purified polyclonal antibodies obtained from rabbits hyperimmunized with excretory/secretory antigens derived from T. saginata maintained in vitro. Investigation of operating characteristics showed very low cross-reactivity with crude antigens from helminths other than Taenia, including Dipylidium caninum and Diphyllobothrium latum. The specificity of the assay was 95% when testing stool samples from 100 persons who were either infected with Ascaris lumbricoides, Trichuris trichiura, hookworms, Enterobius vermicularis or Hymenolepis nana, or who had no intestinal helminthosis detected. Analysis of diagnostic sensitivity demonstrated that in 85% of 34 samples from 23 untreated persons with intestinal T. saginata infection (selected by previous proglottid and/or egg detection) copro-antigens were detected by the T. saginata ELISA. In the same samples, Taenia eggs were detected in 62%. Only 41% of the samples reacted positively in a heterologous T. hydatigena ELISA. Post-treatment control revealed a high concentration of T. saginata copro-antigens for 1-4 d after administration of niclosamide or praziquantel, and negative values 9-17 d after treatment. The Taenia copro-antigens remained detectable by ELISA even after storage of untreated faeces at 25 degrees C for at least 5 d.

Hookworm infection and anaemia : approaches to prevention and control / Z. S. Pawlowski, G. A. Schad, G. J. Stott / Infección y anemia por anquilostomas : posibilidades de prevención y lucha / Infestation et anémie ankylostomiennes : méthodologie de la lutte

A detailed guide to the many simple, effective, and inexpensive measures that can be used to reduce the prevalence and severity of anaemia caused by hookworm infection. The main aim is to help practitioners, working in the field, know how to detect infection and associated anaemia, and then implement appropriate measures, whether for individual cases or entire communities. In view of the widespread tendency to underestimate the importance of hookworm infection and accord it low priority, the book also performs a persuasive function, documenting the major public health consequences of hookworm anaemia, illustrating the striking results of control measures, and encouraging scientists to take a greater interest in this challenging disease. To this end, descriptions of the simple measures available for control are placed within the context of the many complex factors that guide their selection and determine their effectiveness. The book opens with basic information about the life cycles of Ancylostoma duodenale and Necator americanus, their distinctive features at different stages, and geographical distribution. Subsequent chapters describe the clinical pathology of infection and explain how infection causes anaemia. Particular attention is given to the factors that determine iron balance in a given population, including factors that can precipitate severe anaemia even when hookworm loads are low. A chapter devoted to epidemiology explains the behaviours, climatic conditions, and agricultural practices that encourage the maintenance and spread of infection, and identifies three main epidemiological patterns of transmission. These patterns form the framework for subsequent advice on prevention and control. Because confirmation of infection is so simple, chapters on prevention and control concentrate on information that can help health workers know when to suspect infection and then carry out the relevant detective work. Different control strategies described include standard case management, targeted treatment, mass treatment, and supplementary iron distribution. For standard case management, readers are given detailed advice on the best drugs and doses for iron therapy and anthelminthic treatment, which are presented as the foundation for hookworm anaemia control. The final chapter, devoted to practical aspects of prevention and control, outlines programme approaches for each of the three main patterns of hookworm anaemia. The book concludes with a series of three annexes, which describe and illustrate laboratory and other techniques for use in hookworm and anaemia surveys, and explain how to determine the best sampling frame, sample size, and sampling procedures for use in household or group surveys