Mapeamento de áreas críticas de cólera em moçambique / Mapping critical cholera areas in Mozambique

Moçambique é signatário da iniciativa global para a eliminação da cólera até ao ano de 2030, estratégia voltada para a interrupção da transmissão da doença, redução da mortalidade e eliminação da cólera como problema de saúde pública. Em Moçambique, a cólera é altamente sazonal, com acentuada concentração de casos durante o período quente e chuvoso, especialmente nas províncias de Cabo Delgado, Nampula, Tete e Sofala. É neste contexto, que se conduziu a análise de situação da cólera com o objectivo de identificar e mapear todas as zonas quentes e de alto risco para a doença em todo território nacional. E através de uma análise epidemiológica multinível da cólera e da Diarréia aguda, em todos os distritos e Postos administrativos do país, com recurso a dados retrospetivos dos anos 2017 à 2021, foram identificadas as zonas quentes e de alto risco da cólera em Moçambique de que se faz a presente descrição. Os métodos para mapeamento de zonas quentes foram concebidos a partir da orientação do GTFCC para identificação de zonas quentes de cólera, revistos e adaptados ao contexto nacional. Os dados utilizados foram dos casos de cólera, casos, internamentos e óbitos por Diarréia aguda notificados a nível distrital, registados na base de dados nacional de saúde (SIS-MA) e reportados pelos sistemas de gestão de dados da vigilância epidemiológica das Direcções Provinciais de Saúde (DPS's). Uma "abordagem experimental" para inferir a ocorrência de cólera a partir da ocorrência de doença diarreica foi realizada, através de dados de doença grave e óbitos por Diarréia aguda em adultos. Uma ferramenta Excel foi desenvolvida para facilitar a entrada e análise de dados por província. Todos os distritos do país foram classificados de acordo com a carga de cólera ou doença diarreica aguda e os com elevada pontuação foram selecionados e seus postos administrativos (PA) foram mapeados. Indicadores epidemiológicos adicionais e factores de risco foram utilizados para afinar e qualificar a selecção dos PA zonas quentes ou de alto risco da cólera. Foram identificados 250 Postos administrativos críticos para intervenção no contexto da eliminação da cólera, destes 75 são zonas quentes e 175 são zonas de alto risco com uma estimativa global de 14 587 782 habitantes afectados. Neste contexto, recomenda-se conceber, validar e implementar um plano nacional de eliminação da cólera com os subplanos específicos para cada pilar anexados e estabelecer um programa nacional de eliminação da cólera.

Doença Diarreica Aguda por Norovírus / Acute Diarrheal Norovirus Disease

A Doença Diarréica Aguda (DDA) é um grupo de gastroenterites compreendida como uma síndrome que apresentam sinais e sintomas em comuns, sendo os principais a diarreia (mais de 3 episódios em 24 horas) com duração limitada (1 a 14 dias), vômitos, desidratação que varia de leve a grave, podendo aparecer dores abdominais, náuseas, febre e cefaleia. Pode ser causada por vários agentes etiológicos como vírus (norovírus, rotavírus, entre outros), bactérias (salmonelas não tifóide, Escherichia coli, entre outras) e parasitas (Entamoeba histolytica, Giardia lamblia, etc) (BRASIL, 2021). Sendo o norovírus (NoV) o principal responsável por surtos de gastroenterite aguda de origem não bacteriana em todo o mundo (ROCHA, 2012). O tratamento é sintomático e é baseado na hidratação oral ou endovenosa, reposição de sais e minerais, e repouso.

ADD is a group of gastroenteritis understood as a syndrome with signs and symptoms in common, the main ones being diarrhea (more than 3 episodes in 24 hours) with limited duration (1 to 14 days), vomiting, dehydration ranging from mild to severe, abdominal pain, nausea, fever and headache may appear. It can be caused by several etiological agents such as viruses (noroviruses, rotaviruses, among others), bacteria (non-typhoid salmonellae, Escherichia coli, among others) and parasites (Entamoeba histolytica, Giardia lamblia, etc.) (BRASIL, 2021). Norovirus (NoV) is the main responsible for outbreaks of acute gastroenteritis of non-bacterial origin worldwide (ROCHA, 2012). Treatment is symptomatic and is based on oral or intravenous hydration, replacement of salts and minerals, and rest.

Diagnostic challenge: an atypical presentation of infective endocarditis.

It is recognised that infective endocarditis is frequently a challenging diagnosis to make, as it may present with a range of non-specific symptoms. A middle-aged man was admitted with an 8-day history of profuse non-bloody diarrhoea and vomiting. He had no medical history and no identifiable risk factors for infective endocarditis, and so this in combination with the patient's atypical symptoms presented a diagnostic challenge. The patient was eventually diagnosed with a Staphylococcus aureus right-sided infective endocarditis. This case report explores the events which led to this diagnosis and demonstrates a number of unique learning points. It also highlights the importance of maintaining an open mind and being prepared to revise an initial diagnosis in the face of medical uncertainty.

Common Diarrheal Illnesses in the Elderly.

Diarrhea is a fairly common problem among the elderly that has a higher morbidity and mortality compared with the general population. There are multiple reasons for diarrhea in the elderly that can be stratified by different mechanisms: infectious, osmotic, secretory, inflammatory, and malabsorptive. Oral hydration and dietary management are the basic management principles for all forms of diarrhea but specific treatment should address the root cause of diarrhea in order to improve outcomes.

Factores que influyen en la variabilidad de diarreas por parásitos. Policlínico 13 de Marzo. 2018-2019 / Factors that influence the variability of diarrhea due to parasites. Polyclinic March 13. 2018-2019

Se realizó un estudio coproparasitológico a la población que asistió al Centro Provincial de Higiene y Epidemiología de Bayamo, provincia Granma, con un total de 2725 pacientes en el periodo de mayo 2018 a mayo 2019. Conjuntamente estos estudios fueron tomados de hospitales, de brotes de escuelas y centros de trabajo correspondientes en su mayoría al área de salud del Policlínico 13 de Marzo, etc. El objetivo principal de este estudio es identificar el agente bacteriano y parasitario que ocasiona cuadros de disentería, deshidratación y diarrea con sangre, diarrea secretora, diarreas profusas, apareciendo en los resultados un 4 por ciento correspondiente a las diarreas por shigella con 111 casos, el 3,7 por ciento correspondiente a la vibrocholerae para 102 casos. Las diarreas por salmonella ocupan el 3,3 por ciento para un total de 91 casos. En el caso de la diarrea secretora y con sangre lo ocupo la E. histolítica, la shigella ocasionando un 4 por ciento de las diarreas asintomáticas, con síntomas leves lo ocupó coccideas y dentro de ellas el crystoporidium en niños en el hospital infantil y círculos infantiles con edades entre 1 a 5 años para ocupar un 23,5 por ciento de 50 casos aislados de coccideas y un 5 por ciento encontrados de helmintos (oxiuros) en edad escolar. Con el desarrollo de este trabajo arribamos a conclusiones de las cuales se desprenden recomendaciones y sugerencias que se pondrán en práctica para mejorar el diagnóstico en las áreas de salud y así mejorar la salud y calidad de vida de la población(AU)

A coproparasitological study was carried out on the population that attended the Provincial Hygiene and Epidemiology Center of Bayamo, Granma province, with a total of 2725 patients in the period from May 2018 to May 2019. Together these studies were taken from hospitals, from outbreaks of schools and work centers corresponding mostly to the health area of polyclinic 13 de Marzo, etc. The main objective of this study is to identify the bacterial and parasitic agent that causes symptoms of dysentery, dehydration and bloody diarrhea, secretory diarrhea, profuse diarrhea, with 4 percent corresponding to shigella diarrhea with 111 cases, 3,7 percent corresponding to vibrocholerae for 102 cases. Salmonella diarrhea occupies 3.3 percent for a total of 91 cases. In the case of secretory and bloody diarrhea it was occupied by histolytic E, shigella causing 4 percent of asymptomatic diarrhea, with mild symptoms it was occupied by coccideas and within them the crystoporidium in children in the children's hospital and nursery schools with ages between 1 to 5 years to occupy 23.5 percent of 50 isolated cases of coccideas and 5 percent found of helminths (pinworms) in school age. With the development of this work we arrive at conclusions from which recommendations and suggestions emerge that will be put into practice to improve the diagnosis in the health areas and thus improve the health and quality of life of the population(EU)

[Epidemiologic characteristics of Norovirus among adult patients with infectious diarrhea, in Shanghai, 2013-2018].

Objective: To investigate the epidemiologic characteristics of Norovirus among adult patients suffering from infectious diarrhea in Shanghai, so as to provide evidence for developing related strategies on prevention and control of the disease. Methods: Diarrheal outpatients were monitored at the 'Intestinal clinic' from 22 hospitals involved in the sentinel surveillance program in Shanghai. Information on demographic and epidemiologic features of the patients was collected while data and clinical, fecal specimens were collected and sent to the district CDC for Norovirus detection. Positive rates of Norovirus were also compared in various populations and seasons during 2013-2018. Multivariate logistic regression model was adopted to fit into the comparisons between non-Norovirus and Norovirus groups. Results: 19.28% of the 12 083 diarrheal cases were found to have carried the Norovirus, with GⅡgroup the most commonly identified genotype. Rates of detection was seen higher in males (20.78%) than in females (17.73%). 30-44 year-old were found having the highest positive rate (21.51%). The positive rates were found the highest (23.60%) in the year of 2015. All the above shown differences were statistically significant (P<0.05). Diarrheal patients affected with Norovirus would present watery stool (75.94%) and vomiting (35.84%). Data from the multivariate logistic analysis showed that factors as: being males, 30-44 years old, officials/clerks, in winter season and with histories of travelling etc., were related to higher risks on Norovirus infection. Conclusions: Infectious diarrhea caused by Norovirus occurred all year round, with seasonal peaks seen in winter and spring, in Shanghai. Specific prevention and control measures should be taken on Norovirus- caused infectious diarrhea, according to the difference on age, gender and season.

[Seasonality and etiological characteristics of infectious diarrhea in outpatients of 18 or above-year-old in Shanghai, 2014-2017].

Objective: To understand the seasonality and etiological characteristics of infectious diarrhea in adults from Shanghai. Methods: Adult patients with diarrhea who had visited the enteric disease clinics in 22 hospitals that carrying on the Diarrhea Comprehensive Surveillance sentinel programs in Shanghai during 2014-2017, were surveyed. Stool specimens were collected according to the different intervals of sampling and detected for 12 bacteria and 5 viruses. Concentration ratio and circular distribution method were used for data analysis. Results: From 2014 to 2017, a total of 9 573 stool specimens were collected from the targeted diarrhea patients ≥18 years old (n=96 067), through the Shanghai Diarrhea Comprehensive Surveillance program. The positive rate of detection was 46.44%. Seasonal peaks of infectious diarrhea were both seen in summer (bacteria peak, diarrheagenic Escherichia coli and Vibrio parahaemolyticus, etc.) and in winter (virus peak, Norovirus, etc.). Both bacterial and viral infections presented seasonal concentration (Raleigh's test P<0.001) but more obvious with bacterial infection. Viral infection accounted for 60.19% of the cause of infectious diarrhea. The top five predominant pathogens appeared as Norovirus, Rotavirus, diarrheagenic Escherichia coli, Vibrio parahaemolyticus, and Salmonella spp.. Conclusions: Among the adult outpatients with infectious diarrhea in Shanghai, obvious seasonality was seen, with peaks in both summer and winter. Viral infection with Norovirus in particular, appeared as the predominant source of infection. Active, continuous and comprehensive diarrhea-related surveillance programs would be able to monitor the changing dynamic of pathogen spectrum, and lead to the adoption of targeted preventive measures.

[Lag effect and influencing factors of temperature on other infectious diarrhea in Zhejiang province].

Objective: To study the lag effect of temperature and the source of heterogeneity on other infectious diarrhea (OID) in Zhejiang province, so as to identify related vulnerable populations at risk. Methods: Data on OID and meteorology in Zhejiang province from 2014 to 2016 were collected. A two-stage model was conducted, including: 1) using the distributed lag non-linear model to estimate the city-specific lag effect of temperature on OID, 2) applying the multivariate Meta- analysis to pool the estimated city-specific effect, 3) using the multivariate Meta-regression to explore the sources of heterogeneity. Results: There were 301 593 cases of OID in Zhejiang province during the study period. At the provincial level, temperature that corresponding to the lowest risk of OID was 16.7 ℃, and the temperature corresponding to the highest risk was 6.2℃ (RR=2.298, 95%CI: 1.527- 3.459). 16.7 ℃ was recognized as the reference temperature. P(5) and P(95) of the average daily temperature represented low and high temperature respectively. When the temperature was cold, the risk was delayed by 2 days, with the highest risk found on the 5(th) day (RR=1.057, 95%CI: 1.030-1.084) before decreasing to the 23(rd) day. When the temperature got hot, the risk of OID occurred on the first day (RR=1.081, 95%CI: 1.045-1.118) and gradually decreasing to the 8(th) day. Differences on heterogeneous sources related to the risks of OID in different regions, presented on urban latitude and the rate of ageing in the population. Conclusions: Both high or low temperature could increase the risk of OID, with a lag effect noticed. Prevention program on OID should be focusing on populations living in the high latitude and the elderly population at the low temperature areas.

Health Extension Workers' diagnostic accuracy for common childhood illnesses in four regions of Ethiopia: a cross-sectional study.

AIM: The Ethiopian primary care of sick children is provided within the integrated Community Case Management of childhood illnesses by Health Extension Workers (HEW). There is limited knowledge whether this cadre correctly assess and classify common diseases. The aim was to study their ability to correctly classify common childhood illnesses. METHODS: A survey was conducted from December 2016 to February 2017 in four regions of Ethiopia. Observations of the HEWs' assessment and classification of sick children were followed by child re-examination by a trained health officer. RESULTS: The classification by the HEWs of 620 sick children as compared to the re-examiner had a sensitivity of 89% and specificity of 94% for diarrhoea, sensitivity 52% and specificity 91% for febrile disorders, and a sensitivity of 59% and specificity of 94% for acute respiratory tract infection. Malnutrition and ear infection had a sensitivity of 39 and 61%, and a specificity of 99 and 99%, respectively. CONCLUSION: Most cases of diarrhoea were correctly classified, while other illnesses were not frequently identified. The identification of malnutrition was especially at fault. These findings suggest that a significant number of sick children were undiagnosed that could lead to absent or incorrect management and treatment.

Serum procalcitonin levels can be used to differentiate between inflammatory and non-inflammatory diarrhea in acute infectious diarrhea.

In this study, we assess the possibility of using procalcitonin levels to differentiate between inflammatory diarrhea and non-inflammatory diarrhea in acute infectious diarrhea.We reviewed the records of 1176 patients who had symptoms of diarrhea, fever (≥37.8 °C), and abdominal pain between March 2011 and May 2015. After applying exclusion criteria, a sample of 514 patients was considered for study. The patient sample was divided into Group A and Group B for inflammatory diarrhea and non-inflammatory diarrhea, respectively. The assessment involved comparing the laboratory characteristics with the clinical characteristics of the groups.The characteristics of Group A, such as white blood cell (WBC), C-reactive protein (CRP), absolute neutrophil count (ANC), and procalcitonin levels, were relatively higher than those of Group B (P < .001 for Group A). A receiver operator characteristic (ROC) analysis revealed that the highest area-under-the-curve (AUC) value of procalcitonin (0.797; 95% confidence interval [CI] [0.760, 0.831]; P < .001), could be used to differentiate between the 2 groups. Procalcitonin exhibited a sensitivity and a specificity of 87.03% and 68.75%, respectively, at a 0.08 ng/mL cut-off level.Procalcitonin was a good candidate biomarker of inflammatory diarrhea than other inflammatory markers.

Efficacy and safety of fixed-dose combination of drotaverine hydrochloride (80 mg) and paracetamol (500 mg) in amelioration of abdominal pain in acute infectious gastroenteritis: A randomized controlled trial.

BACKGROUND AND AIM: This randomized controlled trial was undertaken to assess efficacy and safety of fixed-dose combination of drotaverine hydrochloride (80 mg) and paracetamol (PCM) (500 mg). This was performed by comparison of mean pain intensity difference, total pain relief at 2 h, onset of pain relief, decrease in number of pain episodes, global improvement, and adverse effects. METHODS: A randomized double-blind controlled trial for adults between 18 and 59 years of either gender with acute infectious diarrhea (≥ 3 unformed, watery, or soft stools with symptoms at least within the last 24 h preceding randomization with duration of illness not more than 72 h) with moderate-to-severe abdominal pain. Participants were treated with either a fixed-dose combination of oral drotaverine hydrochloride (80 mg) and PCM (500 mg) or oral PCM (500 mg) three times a day for 3 days. RESULTS: Of 252 (126 in each group) participants, all received at least one dose of medication. Two hundred forty-two completed the study. Mean pain intensity difference at 60 min after administration of study medication by Visual Analogue Scale (VAS) and total pain relief at 2 h using both VAS and Verbal Rating Scale showed statistically significant improvement in drotaverine hydrochloride (80 mg) and PCM (500 mg) group. The onset of pain relief was also significantly better in drotaverine hydrochloride (80 mg) and PCM (500 mg) group when using VAS. CONCLUSION: Fixed-dose combination of drotaverine hydrochloride (80 mg) and PCM (500 mg) is an effective and safe antispasmodic agent in abdominal pain associated with acute infectious gastroenteritis.

A facile one-step method for cell lysis and DNA extraction of waterborne pathogens using a microchip.

Globally, waterborne organisms are the primary causative agents for the transmission of various forms of diarrheal diseases. For accurate diagnosis, molecular tools have gained considerable attention in the recent past. Molecular tools require DNA as the starting material for diagnosis, and hence, a prerequisite is the quality and integrity of DNA. To obtain high quality DNA rapidly, we have fabricated a microchip in poly(dimethyl siloxane) (PDMS) by soft lithography process. The microchip facilitated in-flow coating of chitosan on the magnetic nanoparticles, which under external mechanical vibration caused cell lysis and released DNA in the supernatant. The released DNA was captured by the nanoparticles owing to its positive charge (chitosan coating). The magnetic nanoparticle-DNA complex was then isolated from the in-flow matrix using permanent magnet, Further, removal of the cell debris, proteins, and carbohydrates was done using wash buffer. DNA extracted using the microchip was pure with absorbance (260/280) ratio of 1.77±0.04, as compared to 1.79±0.03 obtained by TRIzol method. The complete isolation of the DNA using the microchip took ~ 15min as against>2h with a TRIzol method. Six gram-negative waterborne pathogens were used to demonstrate the efficacy of the microchip based DNA extraction process. The integrity of the isolated DNA was assessed by amplifying the 16S rRNA gene using Com1 and Com2 universal primers. The presence of a band at 407bp on gel electrophoresis confirmed the amplified product. Further, the gel image was used for quantification of the amplified product using ImageJ software. Higher regression values obtained using microchip confirmed better quality and integrity of the extracted DNA as opposed to the conventional method. The lower (<2%) relative standard deviation values obtained from the data suggested that the microchip process was reproducible. The quality and integrity of the obtained DNA proved the simplicity, rapidity, and sensitivity of the microchip-assisted DNA extraction process.

Diarrea aguda infecciosa: ¿qué debe saber un gastroenterólogo?, ¿cómo mejoramos el diagnóstico etiológico? / Acute infectious diarrhea: what should a gastroenterologist know? how do we improve the etiological diagnosis?

Acute infectious diarrhea is still a major public health problem, both in developing and developed countries, causing morbidity, mortality and high costs. Acute diarrhea particularly affects people in extrema age ranges, travelers and immunosuppressed individuals. Traditional microbiological study, based on cultures, direct microscope analysis, and antigen tests show poor performance, due to low sensitivity and specificity, slowness and the diversity of bacteria, viruses and parasites that complicate getting the results. New molecular techniques based on multiple polymerase chain reaction (PCR) kits allow for the identification, in few hours and simultaneously, of many agents, such as bacteria, viruses and parasites, with high sensitivity and specificity; which will probably transform etiological diagnosis of acute diarrhea

La diarrea aguda infecciosa continúa siendo un problema de salud pública tanto en países en vías de desarrollo como en países desarrollados, causando morbi-mortalidad y grandes gastos económicos. Las diarreas agudas son especialmente importantes en personas con edades extremas, viajeros e inmunodeprimidos. El estudio microbiológico tradicional basado en cultivos, análisis microscópico directo y pruebas de antígenos tiene un rendimiento pobre, dado por su baja sensibilidad y especificidad, lentitud y la gran diversidad de bacterias, virus y parásitos que dificultan la obtención de resultados. Las nuevas técnicas de diagnóstico molecular basadas en kits de reacción de polimerasa en cadena (PCR) múltiple permiten identificar en pocas horas y en forma simultánea una gran cantidad de agentes, tanto bacterias, virus, como parásitos, con alta sensibilidad y especificidad, lo que probablemente transformará el diagnóstico etiológico de las diarreas agudas.

Enfermedades diarreicas agudas en menores de 5 años, Centro de Salud de Villa Adela / Acute diarrheal diseases in children under 5 years old, Villa Adela

La diarrea aguda es el aumento en el número de evacuaciones, con disminución en su consistencia, de instalación súbita, generalmente infecciosa, adquirida por contaminación fecal oral y con amenaza al equilibrio hidroelectrolítico. Objetivo: evaluar los casos de enfermedad diarreica aguda en niños menores de cinco años, en el centro de salud Dr. Odilón Renderos, ubicado en el Barrio Villa Adela de Comayagüela, durante el período de enero a abril del 2017. Material y Métodos: mediante investigación- acción participativa se realizó un estudio descriptivo retrospectivo transversal; la población de estudio la constituyó 45 expedientes clínicos con diagnóstico de diarrea aguda durante un periodo de 4 meses. La muestra fue de 23 expedientes con la información completa. Se hizo visita domiciliaria, con el propósito de observación directa del ambiente casero, condición de la vivienda y el sistema de obtención de agua. Se solicitó al jefe de familia autorización para la toma de muestras de agua y análisis bacteriológico, a su vez se realizaron charlas a las familias, con demostraciones de purificación y uso de agua en forma adecuada. Resultados: se observó un aumento de la frecuencia de casos de diarrea en el periodo de estudio, en enero de 8(17.7%) al mes de abril 13(28.9%); los más afectados fueron los menores de un año y la frecuencia fue de 12(52.2%); la complicación que presentaron fue la deshidratación 1(4.4%) y el tratamiento fue sales de rehidratación oral 22(95.6%). En relación al abastecimiento de agua para consumo de las familias 13(57%) usó agua embotellada; 6(29%) agua de la llave y 4(14%) hierve el agua. El análisis bacteriológico del agua, de 7 muestras, 6(85%) resultaron positivas con coliformes y 1(15%) resultó negativa. Conclusión: en la atención médica general se presentan casos de diarrea, las más frecuentes son las agudas, causadas por bacterias de origen hídrico, la tendencia de las diarreas en el periodo de estudio fue ascendente en los meses de enero y abril, estacionaria en los otros dos meses.

Building and Rebuilding: The National Public Health Laboratory Systems and Services Before and After the Earthquake and Cholera Epidemic, Haiti, 2009-2015.

Before the 2010 devastating earthquake and cholera outbreak, Haiti's public health laboratory systems were weak and services were limited. There was no national laboratory strategic plan and only minimal coordination across the laboratory network. Laboratory capacity was further weakened by the destruction of over 25 laboratories and testing sites at the departmental and peripheral levels and the loss of life among the laboratory health-care workers. However, since 2010, tremendous progress has been made in building stronger laboratory infrastructure and training a qualified public health laboratory workforce across the country, allowing for decentralization of access to quality-assured services. Major achievements include development and implementation of a national laboratory strategic plan with a formalized and strengthened laboratory network; introduction of automation of testing to ensure better quality of results and diversify the menu of tests to effectively respond to outbreaks; expansion of molecular testing for tuberculosis, human immunodeficiency virus, malaria, diarrheal and respiratory diseases; establishment of laboratory-based surveillance of epidemic-prone diseases; and improvement of the overall quality of testing. Nonetheless, the progress and gains made remain fragile and require the full ownership and continuous investment from the Haitian government to sustain these successes and achievements.

Trichuris trichiura Infection in North Korean Defector Resulted in Chronic Abdominal Pain and Growth Retardation.

Trichuris trichiura infection is a common helminth infection, which is transmitted via soil, with worldwide distribution, especially in rural areas of developing countries. Occasionally, sporadic cases occur in non-endemic, developed areas due to the widespread of immigration. We experienced a case of Trichuris dysentery syndrome in a young North Korean defector, who had been suffering from chronic abdominal pain for 10 years. He is relatively short and thin compared with his older brother. Unexpectedly, the diagnosis, made by a colonoscopy, revealed numerous, small, white, and gently moving worms at the cecum and ascending colon. After 3 days of albendazole (400 mg once daily) administration, clinical symptoms subsided dramatically. On the follow-up colonoscopy, which was performed two months after the completion of his treatment, complete eradication was identified. Soil-transmitted helminths, including Trichuris trichiura, are disappearing becoming less prevalent in South Korea as a result of both national driving force and environmental improvement. However, these diseases should be considered when we meet foreign patients from developing countries, like North Korea, presenting chronic abdominal pain. Moreover, proper treatment of North Korean defectors and performing cohort studies of them would help to prepare for the possible unification era in the field of gastroenterology.