Changes in porcine nutrient transport physiology in response to Ascaris suum infection.

BACKGROUND: The roundworm Ascaris suum is one of the parasites with the greatest economic impact on pig farming. In this context, lower weight gain is hypothesized to be due to decreased nutrient absorption. This study aims at characterizing the effects of A. suum infection on intestinal nutrient transport processes and potential molecular mechanisms. METHODS: Three groups of six piglets each were infected orally (10,000 embryonated A. suum eggs) in a single dose ("single infection"). Another three groups were infected orally (1000 embryonated eggs) for 10 consecutive days ("trickle infection"). Animals were necropsied 21, 35 and 49 days post-infection (dpi). Three groups served as respective controls. The Ussing chamber technique was applied for the functional characterization of small intestinal tissues [short-circuit currents (Isc) as induced by glucose, alanine and peptides; 3H-glucose net flux rates; tissue conductance (Gt)]. Transcription and expression levels of relevant cytokines and nutrient transporters were evaluated (qPCR/western blot). RESULTS: Peptide- and alanine-induced changes in Isc were significantly decreased in the jejunum and ileum of the trickle-infected group at 49 dpi and in the ileum of the single-infected group at 49 dpi. No significant differences regarding glucose transport were observed between the Ascaris-infected groups and the control group in Ussing chamber experiments. Transcription levels of the glucose and peptide transporters as well as of selected transcription factors (transcription of signal transducer and activator of transcription 6 [STAT6] and hypoxia-inducible factor 1-alpha [Hif-1α]) were significantly increased in response to both infection types after some periods. The transcription of interleukins 4 and 13 varied between decrease and increase regarding the respective time points, as did the protein expression of glucose transporters. The expression of the peptide transporter PepT1 was significantly decreased in the ileal single-infected group at 35 dpi. Hif-1α was significantly increased in the ileal tissue from the single-infected group at 21 dpi and in the trickle-infected group at 35 dpi. The expression levels of Na+/K+-ATPase and ASCT1 remained unaffected. CONCLUSIONS: In contrast to the current hypothesis, these results indicate that the nutrient deprivation induced by A. suum cannot be explained by transcriptional or expression changes alone and requires further studies.

Whipworm and roundworm infections.

Trichuriasis and ascariasis are neglected tropical diseases caused by the gastrointestinal dwelling nematodes Trichuris trichiura (a whipworm) and Ascaris lumbricoides (a roundworm), respectively. Both parasites are staggeringly prevalent, particularly in tropical and subtropical areas, and are associated with substantial morbidity. Infection is initiated by ingestion of infective eggs, which hatch in the intestine. Thereafter, T. trichiura larvae moult within intestinal epithelial cells, with adult worms embedded in a partially intracellular niche in the large intestine, whereas A. lumbricoides larvae penetrate the gut mucosa and migrate through the liver and lungs before returning to the lumen of the small intestine, where adult worms dwell. Both species elicit type 2 anti-parasite immunity. Diagnosis is typically based on clinical presentation (gastrointestinal symptoms and inflammation) and the detection of eggs or parasite DNA in the faeces. Prevention and treatment strategies rely on periodic mass drug administration (generally with albendazole or mebendazole) to at-risk populations and improvements in water, sanitation and hygiene. The effectiveness of drug treatment is very high for A. lumbricoides infections, whereas cure rates for T. trichiura infections are low. Novel anthelminthic drugs are needed, together with vaccine development and tools for diagnosis and assessment of parasite control in the field.

Small bowel obstruction complicating an Ascaris lumbricoides infestation in a 4-year-old male: a case report.

BACKGROUND: Ascariasis is the leading helminthic infection worldwide, with its peak prevalence noted in children aged 2-10 years. Although mainly asymptomatic, chronic and heavy infestation could lead to severe complications such as malnutrition, poor physical and cognitive development, as well as intestinal obstruction. We report the case of a 4-year-old boy with intestinal obstruction due to Ascaris lumbricoides infestation and discuss its public health significance. CASE PRESENTATION: A 4-year-old Black African boy from the Menchum Division in the Northwest Region of Cameroon, with no history of deworming since birth, presented with a 3-day history of generalized abdominal pains, vomiting and obstipation, and abdominal distention evolving over a period of 6 months. Clinical and paraclinical findings were in favor of a subacute intestinal occlusion associated with an electrolyte imbalance. An exploratory laparotomy was done after correction of the electrolyte imbalance. Perioperative findings revealed a dilated small bowel obstructed by bundles of live worms. An enterotomy of 2 cm in length was done, and the bundles of Ascaris lumbricoides worms extracted manually and by milking through the stoma. His postoperative period was unremarkable, and he was discharged on postoperative day 7. He and his entire household were dewormed with a single dose of mebendazole 500 mg administered orally. A follow-up visit 1 week after discharge revealed a healed abdominal wound and normal bowel functions. CONCLUSION: Despite considerable progress made on the control of soil-transmitted helminthiasis in Cameroon, the program faces a number of bottlenecks. Funding is inadequate, making data acquisition and hence remapping of high-risk zones difficult. Accessibility to enclaved zones where most high-risk children live is difficult, while community sensitization on soil-transmitted helminthiasis and proper education on the right environmental hygienic practices are lacking. All these challenges once addressed could go a long way to help achieve recently set sustainable development goals.

Ascaris Larval Infection and Lung Invasion Directly Induce Severe Allergic Airway Disease in Mice.

Ascaris lumbricoides (roundworm) is the most common helminth infection globally and a cause of lifelong morbidity that may include allergic airway disease, an asthma phenotype. We hypothesize that Ascaris larval migration through the lungs leads to persistent airway hyperresponsiveness (AHR) and type 2 inflammatory lung pathology despite resolution of infection that resembles allergic airway disease. Mice were infected with Ascaris by oral gavage. Lung AHR was measured by plethysmography and histopathology with hematoxylin and eosin (H&E) and periodic acid-Schiff (PAS) stains, and cytokine concentrations were measured by using Luminex Magpix. Ascaris-infected mice were compared to controls or mice with allergic airway disease induced by ovalbumin (OVA) sensitization and challenge (OVA/OVA). Ascaris-infected mice developed profound AHR starting at day 8 postinfection (p.i.), peaking at day 12 p.i. and persisting through day 21 p.i., despite resolution of infection, which was significantly increased compared to controls and OVA/OVA mice. Ascaris-infected mice had a robust type 2 cytokine response in both the bronchoalveolar lavage (BAL) fluid and lung tissue, similar to that of the OVA/OVA mice, including interleukin-4 (IL-4) (P < 0.01 and P < 0.01, respectively), IL-5 (P < 0.001 and P < 0.001), and IL-13 (P < 0.001 and P < 0.01), compared to controls. By histopathology, Ascaris-infected mice demonstrated early airway remodeling similar to, but more profound than, that in OVA/OVA mice. We found that Ascaris larval migration causes significant pulmonary damage, including AHR and type 2 inflammatory lung pathology that resembles an extreme form of allergic airway disease. Our findings indicate that ascariasis may be an important cause of allergic airway disease in regions of endemicity.

EUS of pancreatic ascariasis.

Ascaris is a common cause of acute pancreatitis in developing countries. The mechanism of ascariasis induced acute pancreatitis include obstruction of papilla of Vater, invasion of common bile duct, or pancreatic duct (PD). PD ascariasis is a rare diagnosis. Endoscopic ultrasound is a highly accurate method to diagnose the aetiology of idiopathic acute pancreatitis with reference to biliary and pancreatic ascariasis. Treatment usually consist of endoscopic removal of worms with dormia basket or forceps on side viewing endoscopy. Ascaris induced pancreatitis is generally mild and worm extraction is associated with rapid relief of symptoms. We present a case of PD ascariasis diagnosed on endoscopic ultrasound.

Gallbladder ascariasis in Kosovo - focus on ultrasound and conservative therapy: a case series.

BACKGROUND: Ascaris lumbricoides is one of the most common intestinal infections in developing countries, including Kosovo. In contrast to migration to the bile duct, migration of the worm to the gallbladder, due to the narrow and tortuous nature of the cystic duct, is rare. When it does occur, it incites acalculous cholecystitis. CASE PRESENTATIONS: This case series describes a 16-month-old Albanian girl, a 22-month-old Albanian girl, a 4-year-old Albanian girl, and a 10-year-old Albanian boy. Here we report our experience with gallbladder ascariasis including clinical manifestations, diagnostic procedures, and treatment. Fever, diarrhea and vomiting, dehydration, pale appearance, and weakness were the manifestations of the primary disease. In all patients, a physical examination revealed reduced turgor and elasticity of the skin. Abdomen was at the level of the chest, soft, with minimal palpatory pain. The liver and spleen were not palpable. A laboratory examination was not specific except for eosinophilia. There were no pathogenic bacteria in coproculture but Ascaris was found in all patients. At an ultrasound examination in all cases we found single, long, linear echogenic structure without acoustic shadowing containing a central, longitudinal anechoic tube with characteristic movement within the gallbladder. Edema of the gallbladder wall was suggestive of associated inflammation. There were no other findings on adjacent structures and organs. All patients received mebendazole 100 mg twice a day for 3 days. They also received symptomatic therapy for gastroenteritis. Because of elevated markers of inflammation all patients were treated with antibiotics, assuming acute cholecystitis, although ultrasound was able to confirm cholecystitis in only two of our four patients. Since the length of stay was dependent on the primary pathology it was 7 to 10 days. At control ultrasounds on 14th day, third and sixth month, all patients were free of ascariasis. CONCLUSIONS: Gallbladder ascariasis should be considered in all patients presenting with abdominal pain, distension, colic, nausea, anorexia, and intermittent diarrhea associated with jaundice, nausea, vomiting, fever, and severe radiating pain. Eosinophilia, ova, and parasites on stool examination as well as an anechogenic tube with characteristic movement within the bile duct found on abdominal ultrasound are conclusive for diagnosis. Mebendazole is an effective drug for the treatment. Surgical treatment is rarely needed.

Wandering biliary ascariasis with hepatic abscess in a postmenopausal woman.

Hepatobiliary ascariasis is common in developing countries where there is a low standard of public health and hygiene. We are reporting a rare case of ascariasis which induced multiple liver abscesses in a post menopausal woman who presented with fever, anorexia, nausea, vomiting and mild hepatomegaly. Ultrasonography revealed biliary ascariasis with multiple hepatic abscesses. Laparoscopic drainage of hepatic abscesses was done and microscopic examination of drainage materials showed decorticated eggs of Ascaris Lumbricoides. The post operative recovery of the patient was uneventful. Ultrasonography is a reliable modality to diagnose and follow up of such cases.

[Efficiency of etiologic correction of concomitant ascaridosis in the complex treatment of chronic pancreatitis].

The of antihelmintic preparation albendazole using in the complex treatment of patients with chronic pancreatitis with the concomitant ascaridosis was promote regression of clinical demonstration of basic and concomitant diseases (P < 0.05). Options of coprogram and the structural state of pancreas from data of ultrasonography in marks by Marseille-Cambridge classification of chronic pancreatitis, after the conducted treatment became the better (P < 0.05), that established expedience of the use of albendazole in complex treatment of patients with a chronic pancreatitis with a concomitant ascaridosis.

Proliferative capacity and cytokine production by cells of HIV-infected and uninfected adults with different helminth infection phenotypes in South Africa.

BACKGROUND: It has been suggested that the proliferative capacity of cells from individuals with HIV or both HIV and helminth infections is attenuated and cytokine production is dysregulated. This study describes peripheral blood mononuclear cell proliferation capacity and cytokine profile from individuals with HIV or both HIV and helminth infections in South Africa. METHODS: Forty HIV-infected and 22 HIV-uninfected participants were randomly selected and stratified into different helminth infection phenotypes by egg excretion and Ascaris lumbricoides specific -immunoglobulin-E (IgE) levels. Five day cell cultures of participants, unstimulated or stimulated with Phytohaemaglutinnin, Streptokinase, HIV-1 p24 and Ascaris lumbricoides worm antigens were stained with monoclonal antibody-fluorochrome conjugates (Ki67-FITC and CTLA-APC-4). Percentage expression of Ki67 and CTLA-4 was measured to determine cell proliferation and regulation, respectively. Culture supernatants were analysed for the expression of 13 cytokines using the Bioplex (BioRad) system. Kruskal Wallis was used to test for differences in variables between helminth infected subgroups who were either having eggs in stool and high IgE (egg+IgEhi); or eggs in stool and low IgE (egg+IgElo); or no eggs in stool and high IgE (egg-IgEhi) and those without helminth infection (egg-IgElo). RESULTS: Individuals excreting eggs in stool with high serum IgE (egg+IgEhi phenotype) had potent mitogen responses but consistently produced low, but statistically non-significant antigen-specific (HIV-1 p24 (p = 0.41) and Ascaris (p = 0.19) and recall antigen (Streptokinase; p = 0.31) Ki67 responses. The group also had reduced type 1 cytokines. Individuals excreting eggs in stool with low serum IgE( egg+IgElo phenotype) had a more favourable antiviral profile, characterized by higher IFNγ, IL-2, lower IL-4 and higher IL-10 production. CONCLUSION: The findings suggest that dual HIV/helminth infection with egg excretion and/or high Ascaris IgE phenotye may be linked with poor proliferative capacity and deleterious cytokine profile with regards to HIV control.

Diarrhea and novel dietary factors emerge as predictors of serum vitamin B12 in Panamanian children.

BACKGROUND: The role of gastrointestinal infection as a factor determining vitamin B12 status in populations with low intake of animal-source foods is unclear. OBJECTIVE: To determine dietary adequacy and serum concentrations of vitamin B12 in an extremely impoverished indigenous population of Panamanian children aged 12 to 60 months, and to identify predictors of both dietary and serum vitamin B12. METHODS: A previous community-based survey provided the usual dietary intake and personal, household, and infection (Ascaris and diarrheal disease) information for 209 weaned children. Serum vitamin B12 was assayed using electrochemiluminescence for 65 of these children. Children with adequate or inadequate dietary vitamin B12 intake were compared, and predictors of dietary and serum vitamin B12 were identified using stepwise regression analyses of one index child per household. RESULTS: Dietary vitamin B12 intake was inadequate in 43% of children; these children were poorer, had less frequent diarrhea, and obtained a higher percentage of their energy from carbohydrate than children with adequate intake. Energy intake positively predicted dietary vitamin B12 intake. In contrast, serum vitamin B12 concentrations were normal in all but 3% of the children. Serum vitamin B12 was positively associated with weekly servings of fruit, corn-based food, and name (a traditional starchy food), but not with animal-source foods. Finally, serum vitamin B12 was not associated with Ascaris intensity but was lowered with increasing frequency of diarrhea. CONCLUSIONS: Although inadequate dietary intake of vitamin B12 was common, most serum values were normal. Nevertheless, diarrheal disease emerged as a negative predictor of serum vitamin B12 concentration.

Effect of Ascaris suum infection on performance of fattening pigs.

Scientific investigations of production losses in pigs due to roundworms are rarely conducted in commercial farms, despite the fact that this information is needed to decide whether anthelmintic treatment is cost-effective or not. Therefore, the aim of our study was to compare performance in fattening pigs treated or not treated for Ascaris suum infections. Two Danish pig farms producing fatteners and showing A. suum-induced liver white spot prevalences of 10-33% were selected for the study. In each farm, pens with fattening pigs were randomly assigned to either treatment with an anthelmintic (Flubenol, Janssen Animal Health), or a placebo. Pigs were treated by administering anthelmintic or placebo mixed in the feed for five consecutive days (5mg/kg body weight) on day 2-6 and day 36-40 after introduction to the finishing unit. Fecal egg excretion before first shipment, liver lesion scores (white spots), lean meat percentage at slaughter, average daily gain, and feed conversion were recorded weekly per pen and evaluated for the entire fattening period (30-100kg). A. suum egg excretion was detected in none of the 57 pens where pigs were treated with anthelmintic compared to 18.2% of 57 pens in the placebo group. Pen floor fecal sampling underestimated the prevalence of A. suum in the fattening units compared to individual rectal sampling; only 22% of pens where A. suum was present were diagnosed correctly by both sampling methods. The prevalence of white spots did not differ significantly between pigs treated with anthelmintic (26.7%) and pigs treated with placebo (23.7%), but considerable variation between batches and over time was observed. Liver lesion scores (none, few, moderate, many) were not significantly influenced by de-worming twice during the fattening period. There were no significant differences in average daily gain, feed conversion and lean meat percentage between pigs treated with anthelmintic or placebo. This lack of effect may be explained in part by a rather low infection intensity, as measured by fecal egg counts, but in contrast, white spot numbers were moderate to high. A possible negative influence of other disease, mainly diarrhea due to Lawsonia intracellularis, on performance could not be excluded. Treatment with flubendazole twice during fattening prevented A. suum egg excretion but did not reduce the occurrence of liver white spots. To improve performance significantly, repeated treatments over several consecutive rounds might be necessary.

Effect of helminthic infections together with mite allergen exposure on the risk of wheeze in preschool children.

Although some studies have indicated that helminthic infections and house dust mite exposure may have an alleviating effect on wheeze, an interaction effect of both risk factors has not been examined in Thailand. The objective of this study was to investigate whether exposure to helminthic infections together with house dust mite allergen was associated with wheeze in children aged 18-36 months, living in an area of southem Thailand where helminthic infections are endemic. This study was undertaken as a part of The Prospective Cohort Study of Thai Children which recruited 1,076 children born between December 2000 and November 2001. A home dust sample was collected once when the infants were 12-18 months old to measure house dust mite allergen (Der p1). Questionnaire data on wheeze and a stool specimen for soil-transmitted helminth analysis were collected at age 18-36 months. Prevalence of exposure to house dust mite allergen (Der p1) > 10 microg/g dust was 31.8%. Soil-transmitted helminths were present in 25.0%, predominately Ascaris lumbricoides. Hookworm infection was associated with a physician's diagnosis of wheeze (OR 4.20, 95% CI 1.45-12.10) and hospitalized wheeze (OR 5.40, 95% Cl 1.26-23.01). Hospitalized wheeze was significantly higher in subjects exposed to Der p1 2-10 microg/g dust. Helminthic infections were not associated with a significant interaction effect with mite allergen against a risk of wheeze. Our survey confirms that hookworm infection and mite allergen exposure are independent risk factors for childhood wheeze and there is no evidence of important interaction between the two.

Foodborne nematodal infections in hospitalized patients from a southwestern Romanian county.

OBJECTIVES: Caras-Severin County presented the highest incidence of human trichinellosis (108.5 cases per 100,000 inhabitants) throughout Romania in 1993. This study aimed at providing an overview of the epidemiological and clinical characteristics of persons from this county hospitalized with nematodal infections between 1996 and 2008. PATIENTS AND METHODS: Data were collected from the medical records of 269 patients admitted to two infectious diseases hospitals and found to have nematode helminthic infections. RESULTS: Of the study group, 250 patients (92.9%) presented with trichinellosis, 10 (3.7%) with ascariasis, 7 (2.6%) with trichuriasis, and 2 (0.8%) with ascariasis and trichuriasis coinfections. Geohelminthic infections prevailed in children (68.4%). Giardiasis, a protozoan parasitic disease, was also found in 21 patients (7.8%). CONCLUSIONS: Although trichinellosis cases decreased in this county, public health authorities must remain aware because new outbreaks may occur at any time as it happened in the neighboring counties. Regarding geohelminthiasis, parents must be aware of the potential risk of acquiring these infections and the major complications that may follow.

Recurrent pancreatitis secondary to pancreatic ascariasis.

Ascaris lumbricoides infestations are endemic in tropical countries. Ascaris lumbricoides can occasionally cause biliary obstruction and result in obstructive jaundice or pancreatitis. We present a 34-year-old Bangladeshi woman with biliary ascariasis, resulting in recurrent pancreatitis. Her diagnosis was made with endoscopic retrograde cholangiopancreatography performed during an acute attack of pain.