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1.  Prevalence and risk factors of helminths and intestinal protozoa infections among children from primary schools in western Tajikistan 
Parasites & Vectors  2011;4:195.
Intestinal parasitic infections represent a public health problem in Tajikistan, but epidemiological evidence is scarce. The present study aimed at assessing the extent of helminths and intestinal protozoa infections among children of 10 schools in four districts of Tajikistan, and to make recommendations for control.
A cross-sectional survey was carried out in early 2009. All children attending grades 2 and 3 (age: 7-11 years) from 10 randomly selected schools were invited to provide a stool sample and interviewed about sanitary situation and hygiene behaviour. A questionnaire pertaining to demographic and socioeconomic characteristics was addressed to the heads of households. On the spot, stool samples were subjected to duplicate Kato-Katz thick smear examination for helminth diagnosis. Additionally, 1-2 g of stool was fixed in sodium acetate-acetic acid-formalin, transferred to a specialised laboratory in Europe and examined for helminths and intestinal protozoa. The composite results from both methods served as diagnostic 'gold' standard.
Out of 623 registered children, 602 participated in our survey. The overall prevalence of infection with helminths and pathogenic intestinal protozoa was 32.0% and 47.1%, respectively. There was pronounced spatial heterogeneity. The most common helminth species was Hymenolepis nana (25.8%), whereas the prevalences of Ascaris lumbricoides, hookworm and Enterobius vermicularis were below 5%. The prevalence of pathogenic intestinal protozoa, namely Giardia intestinalis and Entamoeba histolytica/E. dispar was 26.4% and 25.9%, respectively. Almost half of the households draw drinking water from unimproved sources, such as irrigation canals, rivers and unprotected wells. Sanitary facilities were pit latrines, mostly private, and a few shared with neighbours. The use of public tap/standpipe as a source of drinking water emerged as a protective factor for G. intestinalis infection. Protected spring water reduced the risk of infection with E. histolytica/E. dispar and H. nana.
Our data obtained from the ecological 'lowland' areas in Tajikistan call for school-based deworming (recommended drugs: albendazole and metronidazole), combined with hygiene promotion and improved sanitation. Further investigations are needed to determine whether H. nana represents a public health problem.
PMCID: PMC3205355  PMID: 21981979
2.  Prevalence of Intestinal Parasitic Infections among Children under Five Years of Age with Emphasis on Schistosoma mansoni in Wonji Shoa Sugar Estate, Ethiopia 
PLoS ONE  2014;9(10):e109793.
Intestinal parasite infections are major public health problems of children in developing countries causing undernutrition, anemia, intestinal obstruction and mental and physical growth retardation. This study was conducted to assess the prevalence of intestinal helminthic infections among children under five years of age with emphasis on Schistosoma mansoni in Wonji Shoa Sugar Estate, Ethiopia. A cross-sectional parasitological survey was conducted in under-five children living in Wonji Shoa Sugar Estate Ethiopia, April, 2013. Stool samples were collected and examined for intestinal parasites using single Kato-Katz and single Sodium acetate-acetic acid-formalin (SAF) solution concentration methods. Out of 374 children examined using single Kato-Katz and single SAF-concentration methods, 24.3% were infected with at least one intestinal parasite species. About 10.4%, 8.8%, 4.6%, 2.9%, 1.6% and 0.8% of the children were infected with Hymenolepis nana, Schistosoma mansoni, Ascaris lumbricoides, Trichuris trichiura, Enterobius vermicularis and hookworm, respectively. Prevalence of double, triple and quadruple intestinal helminthic infection was 6.4%, 0.54% and 1.1%, respectively. A significant increase in prevalence of S. mansoni (8.3% versus 3.2%) and T. trichiura (2.7% versus 0.5%) infection was observed when determined via the single Kato-Katz method compared to the prevalence of the parasites determined via the single SAF-concentration method. On the other hand, the single SAF-concentration method (9.1%) revealed a significantly higher prevalence of H. nana infection than the single Kato-Katz (1.6%) does. In conclusion, intestinal helminths infections particularly S. mansoni and H. nana were prevalent in under-five children of Wonji Shoa Sugar Estate. Including praziquantel treatment in the deworming program as per the World Health Organization guidelines would be vital to reduce the burden of these diseases in areas where S. mansoni and H. nana infections are prevalent among under-fives. Kato-Katz can be used in estimating the prevalence of S. mansoni and other helminth infections.
PMCID: PMC4190315  PMID: 25296337
3.  Mini-FLOTAC, Kato-Katz and McMaster: three methods, one goal; highlights from north Argentina 
Parasites & Vectors  2014;7:271.
Copro-parasitological diagnosis is still a challenge in management of helminth infections at individual and community levels in resource-limited settings.
The aim of our study was to compare the performance of three quantitative techniques: Kato-Katz, McMaster and Mini-FLOTAC methids. The study was carried out in Oran, Northern Argentina.
200 schoolchildren were enrolled to provide a single stool sample, which was tested for helminth infections with Kato-Katz, McMaster and Mini-FLOTAC methods. The Mini-FLOTAC was performed with two flotation solutions (FS2 saturated saline and FS7 zinc sulphate). Preparation and reading time for each of the three methods was calculated both when processing single and multiple samples.
Out of 193 schoolchildren examined, 40% were positive for any helminth infection by any method; the most prevalent was Hymenolepis nana (23%) followed by Ascaris lumbricoides (17%) and a third group of less prevalent helminths: Enterobius vermicularis, Trichuris trichiura and hookworms (11% all together). Mini-FLOTAC FS2 was more sensitive than FS7 for H. nana (93% vs 78%) and for other helminths (85% vs 80%), whereas FS7 was more sensitive for A. lumbricoides (87% vs 61%). Kato-Katz method was more sensitive than McMaster method for A. lumbricoides (84% vs 48%) and for other helminths (48% vs 43%) except for H. nana (49% vs 61%). As for egg counts, Mini-FLOTAC FS2 reported 904 eggs per gram of faeces (EPG) for H. nana (vs 457 with McMaster and 111 with Kato-Katz) and 1177 EPG for A. lumbricoides (vs 1315 with Kato-Katz and 995 with McMaster); FS2 detected the highest EPG for both H.nana and A.lumbricoides (904 vs 568 and 1177 vs 643 respectively), the differences were not statistically significant. The technique feasibility was calculated: Kato-Katz mean time was 48 minutes/sample, Mini-FLOTAC 13 minutes/sample and McMaster 7 minutes/sample. However, especially for Kato-Katz and Mini-FLOTAC, the mean time (min/sample) decreased significantly when processing multiple samples.
Mini-FLOTAC is a promising technique for helminth diagnosis, it is more sensitive than Kato-Katz and McMaster for H. nana and as sensitive as Kato-Katz and more sensitive than McMaster for A. lumbricoides identification. Egg counts differences although relevant, did not reach statistical significance.
PMCID: PMC4074144  PMID: 24929554
Soil-transmitted helminths; Diagnostic techniques; Mini-FLOTAC technique; Kato-Katz thick smear; McMaster method
4.  Clinical study on the effect of decoction of Pavetta indica Linn. in treatment of Purishaja Krimi with special reference to Enterobius vermicularis infestation 
Ayu  2013;34(3):254-258.
Pavetta indica Linn. (Family: Rubiaceae; Sanskrit name: Papata) is 2-5 m tall, shrub or small tree with opposite branches and grows in the Asia - Pacific region including Sri Lanka. Purishaja Krimi is one of the worm infestations described in Ayurveda. Enterobius vermicularis is among the most common of worms affecting children and adults. E. vermicularis is considered as one type of Purishaja Krimi. Sri Lankan traditional and ayurvedic physicians use P. indica to treat different ailments including Purishaja Krimi (E. vermicularis) infestations successfully. Since no scientific studies have been undertaken to study these effects so far, the present clinical study was carried out to evaluate the effect of P. indica in treatment of E. vermicularis infestation. Fifty patients between age of 5 and 12 years (Group A and B) and 50 patients between 13 and 65 years (Group C and D) with symptoms of E. vermicularis infestations such as itching in the anal region, impaired appetite, abdominal pain, eructation, diarrhea or constipation and presence of ova in stools were selected. Two decoction of the trail drug with different concentration was prepared. Group A and Group B were treated with 60 ml of decoction 1 and 60 ml of placebo respectively, twice daily for 14 days. Group C and Group D were treated with 120 ml of decoction 2 and 120 ml of placebo respectively, twice daily for 14 days. Groups A and C showed complete or partial reduction of symptoms, that is; itching in the anal region, impaired appetite, abdominal pain, eructation, diarrhea and also ova of E. vermicularis were absent in stools after treatment with P. indica. Decoction of P. indica can be recommended as an effective treatment for Purishaja Krimi (E. vermicularis infestation).
PMCID: PMC3902589  PMID: 24501518
Enterobius vermicularis; Pavetta indica; Purishaja Krimi; thread worm
5.  Fascioliasis and Intestinal Parasitoses Affecting Schoolchildren in Atlixco, Puebla State, Mexico: Epidemiology and Treatment with Nitazoxanide 
The Atlixco municipality, Puebla State, at a mean altitude of 1840 m, was selected for a study of Fasciola hepatica infection in schoolchildren in Mexico. This area presents permanent water collections continuously receiving thaw water from Popocatepetl volcano (5426 m altitude) through the community supply channels, conforming an epidemiological scenario similar to those known in hyperendemic areas of Andean countries.
Methodology and Findings
A total of 865 6–14 year-old schoolchildren were analyzed with FasciDIG coproantigen test and Lumbreras rapid sedimentation technique, and quantitatively assessed with Kato-Katz. Fascioliasis prevalences ranged 2.94–13.33% according to localities (mean 5.78%). Intensities were however low (24–384 epg). The association between fascioliasis and the habit of eating raw vegetables was identified, including watercress and radish with pronouncedly higher relative risk than lettuce, corncob, spinach, alfalfa juice, and broccoli. Many F. hepatica-infected children were coinfected by other parasites. Entamoeba histolytica/dispar, Giardia intestinalis, Blastocystis hominis, Hymenolepis nana and Ascaris lumbricoides infection resulted in risk factors for F. hepatica infection. Nitazoxanide efficacy against fascioliasis was 94.0% and 100% after first and second treatment courses, respectively. The few children, for whom a second treatment course was needed, were concomitantly infected by moderate ascariasis burdens. Its efficacy was also very high in the treatment of E. histolytica/E. dispar, G. intestinalis, B. hominis, H. nana, A. lumbricoides, Trichuris trichiura, and Enterobius vermicularis. A second treatment course was needed for all children affected by ancylostomatids.
Fascioliasis prevalences indicate this area to be mesoendemic, with isolated hyperendemic foci. This is the first time that a human fascioliasis endemic area is described in North America. Nitazoxanide appears as an appropriate alternative to triclabendazole, the present drug of choice for chronic fascioliasis. Its wide spectrum efficacy against intestinal protozooses and helminthiasis, usually coinfecting liver fluke infected subjects in human endemic areas, represents an important added value.
Author Summary
A human fascioliasis endemic area is described for the first time in North America. In Atlixco, Puebla State, Mexico, prevalences of 2.94–13.33% by F. hepatica were found in 865 6–14-year-old schoolchildren by FasciDIG coproantigen test and Lumbreras rapid sedimentation technique, and quantitatively assessed with Kato-Katz. Prevalences peaked in the 8–10-year age group. The use of a coproantigen test proved to be useful, as most children (72%) did not shed eggs. The link of fascioliasis risk with consumption of raw vegetables other than watercress suggests contamination when washing terrestrial vegetables with untreated water and/or in plant cultures using natural water for irrigation. The relatively high coinfection percentage with Giardia intestinalis and the lack of a treated water supply system reaching all dwellings suggest that infection may also occur by water drinking. Nitazoxanide efficacy against fascioliasis is worth mentioning, becoming an alternative to triclabendazole. Its wide spectrum against intestinal protozooses and helminthiases, usually coinfecting Fasciola infected subjects in human endemic areas, represents an important added value. In Atlixco, the low fascioliasis intensities indicate that no special precaution will be needed for child treatment (epg<400). The mesoendemic situation, with hyperendemic foci, adds concern about possible human fascioliasis underestimation in other areas of Mexico.
PMCID: PMC3836726  PMID: 24278492
6.  Parasitic Contamination of Commonly Consumed Fresh Leafy Vegetables in Benha, Egypt 
This study evaluated the degree of parasitic contamination of vegetables which are commercialized and consumed fresh in Benha, Egypt. It included 530 vegetables: lettuce, watercress, parsley, green onion, and leek. Vegetables were collected randomly from markets within Benha. Samples were washed in saline, and the resulting washing solution was filtered and centrifuged to concentrate the parasitic stages. Sediments and supernatants were examined by iodine and modified Ziehl-Neelsen stained smears. Intestinal parasites were detected in 157/530 (29.6%) samples. Giardia lamblia cysts were the most prevalent parasite (8.8%) followed by Entamoeba spp. cysts (6.8%), Enterobius vermicularis eggs (4.9%), various helminth larvae (3.6%), Hymenolepis nana eggs (2.8%), Hymenolepis diminuta eggs (2.1%), and Ascaris lumbricoides eggs (0.6%). The highest contaminated vegetable was lettuce (45.5%) followed by watercress (41.3%), parsley (34.3%), green onion (16.5%), and leek (10.7%). These results indicate a significant seasonal variation (P < 0.05), with highest prevalence in summer (49%) and the lowest in winter (10.8%). These findings provide evidence for the high risk of acquiring parasitic infection from the consumption of raw vegetables in Benha, Egypt. Effective measures are necessary to reduce parasitic contamination of vegetables.
PMCID: PMC4084512  PMID: 25024845
7.  Prevalence of Intestinal Helminths among Inhabitants of Cambodia (2006-2011) 
In order to investigate the status of intestinal helminthic infections in Cambodia, epidemiological surveys were carried out on a national scale, including 19 provinces. A total of 32,201 fecal samples were collected from schoolchildren and adults between 2006 and 2011 and examined once by the Kato-Katz thick smear technique. The overall egg positive rate of intestinal helminths was 26.2%. The prevalence of hookworms was the highest (9.6%), followed by that of Opisthorchis viverrini/minute intestinal flukes (Ov/MIF) (5.7%), Ascaris lumbricoides (4.6%), and Trichuris trichiura (4.1%). Other types of parasites detected were Enterobius vermicularis (1.1%), Taenia spp. (0.4%), and Hymenolepis spp. (0.2%). The northwestern regions such as the Siem Reap, Oddar Meanchey, and Banteay Meanchey Provinces showed higher prevalences (17.4-22.3%) of hookworms than the other localities. The southwestern areas, including Koh Kong and Preah Sihanouk Provinces showed higher prevalences of A. lumbricoides (17.5-19.2%) and T. trichiura (6.1-21.0%). Meanwhile, the central and southern areas, in particular, Takeo and Kampong Cham Provinces, showed high prevalences of Ov/MIF (23.8-24.0%). The results indicate that a considerably high prevalence of intestinal helminths has been revealed in Cambodia, and thus sustained national parasite control projects are necessary to reduce morbidity due to parasitic infections in Cambodia.
PMCID: PMC4277029  PMID: 25548418
Hookworm; intestinal helminth; prevalence; Cambodia
8.  Echinostoma ilocanum Infection in Oddar Meanchey Province, Cambodia 
Fecal examinations using the Kato Katz technique were performed on a total of 1,287 villagers (945 students and 342 general inhabitants) of Oddar Meanchey Province, Cambodia in May 2007 and November 2009. The overall intestinal helminth egg positive rate was 23.9%, and the most prevalent helminth species was hookworms (21.6%). Other helminth eggs detected included echinostomes (1.0%), Enterobius vermicularis (0.8%), small trematode eggs (0.7%), which may include Opisthorchis viverrini and Haplorchis spp., and Hymenolepis nana (0.4%). In order to recover adult echinostomes, we treated 2 patients with 10-15 mg/kg praziquantel and purged. Total 14 adult echinostomes, 1 and 13 worms from each patient, were collected. The echinostomes characteristically had 49-51 collar spines and 2 round or slightly lobated testes. They were identified as Echinostoma ilocanum (Garrison, 1908) Odhner, 1911. So far as literature are concerned, this is the first record on the discovery of human E. ilocanum infection in Cambodia.
PMCID: PMC3121079  PMID: 21738278
Echinostoma ilocanum; worm recovery; trematode; echinostome; Cambodia
9.  High Prevalence of Haplorchis taichui, Phaneropsolus molenkampi, and Other Helminth Infections among People in Khammouane Province, Lao PDR 
The prevalence of liver and intestinal helminth infections, including Opisthorchis, Haplorchis, Phaneropsolus, hookworms, Enterobius, and Taenia, was surveyed in Khammouane province, Lao PDR. Fecal specimens were collected from 1,242 people (590 men and 652 women) in 3 Mekong riverside villages and were examined by the Kato-Katz thick smear technique. The overall helminth egg positive rate was 81.1%. The positive rate for small trematode eggs, including Opisthorchis viverrini, heterophyids, and lecithodendriids, was 81.1% and the positive rate for hookworms was 6.7%. To obtain adult worms, 35 people who were positive for small trematode eggs were treated with 20-30 mg/kg praziquantel and 10-15 mg/kg pyrantel pamoate, and then purged. Diarrheic stools were collected from 33 of these people and searched for helminth parasites using a stereomicroscope. Mixed infections with various helminths (Haplorchis taichui, Haplorchis yokogawai, Prosthodendrium molenkampi, Phaneropsolus bonnei, echinostomes, hookworms, Trichostrongylus spp., Trichuris trichiura, Enterobius vermicularis, and/or Taenia saginata) were found. The total number of helminth specimens collected was 20,907 (approximately 634 per person). The most common species was H. taichui, followed by P. molenkampi, O. viverrini, P. bonnei, E. vermicularis, hookworms, and Trichostrongylus spp. These results show that diverse species of intestinal nematodes, trematodes, and cestodes are infecting humans in Khammouane province, Lao PDR.
PMCID: PMC2735689  PMID: 19724697
Opisthorchis viverrini; Haplorchis taichui; Haplorchis yokogawai; Prosthodendrium molenkampi; Phaneropsolus bonnei; hookworm; Trichostrongylus; Taenia saginata; prevalence; Khammouane province; Laos
10.  Prevalence of Microsporidium and Other Intestinal Parasites in Children from Malatya, Turkey 
Indian Journal of Microbiology  2011;51(3):345-349.
Parasite infections are common during the critical developmental period in children. The occurrences of intestinal parasites are also common in orphanage, nurseries and schools in Turkey. The study was carried out to determine the percentage of microsporidium and intestinal parasites in children from Malatya, Turkey. This study was carried out at the Department of Parasitology of Inonu University, Turgut Ozal Medical Center, during January–December 2006. Totally, 1,181 stool samples were examined using the native-Lugol, sedimentation-techniques, modified trichrome (MTS), acid-fast-trichrome stain and calcofluor staining methods. In addition, perianal region material was taken from the children to examine with cellophane tape method. Power analyses were performed for statistical analyses used. Microsporidia were found in 92 (7.8%) of the samples, and also intestinal parasites were detected in 329 (27.8%). The numbers of infections according to the species were as follows: 69 (5.8%) Entamoeba coli, 7 (0.6%) Blastocystis hominis, 114 (9.7%) Giardia intestinalis, 15 (1.3%) Iodomoeba butchlii, 8 (0.7%) Dientamoeba fragilis, 7 (0.6%) Taenia spp. 70 (5.9%) Enterobius vermicularis, 11 (0.9%) Hymenolepis nana, 25 (2.1%) Trichomonas intestinalis, 1 (0.1%) Ascaris lumbricoides and 2 (0.2%) Chilomastix mesnilii. Also, greater than 90% power values were achieved for statistical analyses. Whereas the detection rates of microsporidium and intestinal parasites were found to be low, it was concluded that in addition to intestinal parasites, microsporidium should be also searched for in children with complaints of intestinal system.
PMCID: PMC3209917  PMID: 22754014
Children; Microsporidia; Intestinal parasites
11.  The intestinal parasite infection status of inhabitants in the Roxas city, the Philippines 
We carried out a small-scale survey to investigate the status of intestinal protozoa and helminthes infection of inhabitants in Roxas city, Mindoro, the Philippines. Total 301 stool samples were subjected to the formalin-ether concentration method for the detection of helminth ova and protozoan cysts. The overall positive rate was 64.5%, and that of male and female were 56.6% and 72.5%, respectively. The highest infected helminth was Ascaris lumbricoudes (51.2%), followed by Trichuris trichiura (27.6%), hookworm (8.0%) and Enterobius vermicularis (0.3%). The protozoa infection status revealed that Entamoeba coli was the most frequent (15.0%). Iodoamoeba buetschlii and E. histolytica were found but few. The multiple infection more than two parasites was 29.6%, and double infection with A. lumbricoides and T. trichiura was most common. The intestinal helminth infections were highly prevalent in this area, according to this result, and we concluded that anthelminthic drugs should be given to inhabitants, especially to children of 1 to 15 years-old.
PMCID: PMC2717489  PMID: 12815323
infection rate; protozoa; helminths; Philippines
12.  Review of Zoonotic Parasites in Medical and Veterinary Fields in the Republic of Korea 
The Korean Journal of Parasitology  2009;47(Suppl):S133-S141.
Zoonotic parasites are animal parasites that can infect humans. The major zoonotic protozoa in the Republic of Korea are Babesia bovis, Chilomastix mesnili, Cryptosporidium parvum, Endolimax nana, Entamoeba coli, Entamoeba hitolytica, Giardia lamblia, Iodamoeba bütschlii, Pneumocystis carinii, Sarcocystis cruzi, and Toxoplasma gondii. The major zoonotic helminths in Korea include trematodes, cestodes, and nematodes. Trematodes are Clonorchis sinensis, Echinostoma hortense, Echinostoma spp., Fasciola hepatica, Heterophyes nocens, Metagonimus yokogawai, and Paragonimus westermani. Cestodes are Diphyllobothrium latum, Dipylidium caninum, Echinococcus granulosus, Hymenolepis nana, Raillietina tetragona, sparganum (Spirometra spp.), Taenia saginata, T. solium, and T. asiatica. Nematodes are Ancylostoma caninum, Brugia malayi, Capillaria hepatica, Dirofilaria immitis, Gnathostoma dololesi, Gnathostoma spinigerum, Loa loa, Onchocerca gibsoni, Strongyloides stercoralis, Thelazia callipaeda, Trichinella spiralis, Trichostrongylus orientalis, Trichuris trichiura, and Trichuris vulpis. The one arthropod is Sarcoptes scabiei. Many of these parasites have disappeared or were in decline after the 1990's. Since the late 1990's, the important zoonotic protozoa have been C. parvum, E. nana, E. coli, E. hitolytica, G. lamblia, I. buetschlii, P. carinii and T. gondii. The important zoonotic helminths have been C. sinensis, H. nocens, M. yokogawai, P. westermani, D. latum, T. asiatica, sparganum, B. malayi, T. orientalis, T. callipaeda and T. spiralis. However, outbreaks of these parasites are only in a few endemic areas. The outbreaks of Enterobius vermicularis and head lice, human parasites, have recently increased in the kindergartens and primary schools in the Republic of Korea.
PMCID: PMC2769215  PMID: 19885329
zoonotic parasite; animal; human; protozoa; helminth
13.  Intestinal parasite infections at an institution for the handicapped in Korea 
Stool and cellotape anal swab examinations were carried out in August 1997 on handicapped people at an institution located in Chorwon-gun, Kangwon-do, Korea. A total of 112 stool samples (78 males and 34 females) revealed three cases of Trichuris trichiura infection and one case of Enterobius vermicularis infection. Other helminth eggs were not detected. The overall prevalence rate was 35.7% (38.5% for males and 29.4% for females). More than two different kinds of parasites were found in 42.0% of the positive stool samples (17 cases). The infection rates for protozoan cysts are as follow: Entamoeba coli (25.0%), E. histolytica (1.8%), Endolimax nana (21.4%), Iodoamoeba bütschlii (1.8%) and Giardia lamblia (0.9%). In cellotape anal swab examinations (165 samples), the prevalence rate of E. vermicularis was 20.6% (25.7% of males and 9.6% of females). In conclusion, the handicapped people in the institution showed higher infection rates of protozoan parasites and E. vermicularis, possibly due to more accessibility to the infection.
PMCID: PMC2721199  PMID: 11002655
Enterobius vermicularis; epidemiology; infection rate; intestinal parasite; intestinal parasitic protozoa; Korea
14.  Factors Associated with High Prevalence of Intestinal Protozoan Infections among Patients in Sana'a City, Yemen 
PLoS ONE  2011;6(7):e22044.
Intestinal protozoan diseases in Yemen are a significant health problem with prevalence ranging from 18% to 27%. The present study is a cross-sectional study aimed at determining the factors associated with the high prevalence of intestinal protozoan infections among patients seeking health care in Sana'a City, the capital of Yemen.
Methodology/Principal Findings
Stool samples were collected from 503 patients aged between 1 and 80 years old; 219 were males and 284 females. Biodata were collected via pretested standard questionnaire. Faecal samples were processed and examined for (oo)cysts or ova using a wet mount preparation after formal-ether concentration technique. Cryptosporidium oocysts were detected using the Ziehl-Neelsen staining technique. The overall prevalence of intestinal protozoan infections was 30.9%. Infection rates of Giardia duodenalis, Entamoeba histolytica/dispar and Cryptosporidium were 17.7%, 17.1% and 1%, respectively. Other parasites detected included Ascaris lumbricoides (2.4%), Schistosoma mansoni (0.3%), Hymenolepis nana (1.4%) and Enterobius vermicularis (0.4%). Multivariate analysis using forward stepwise logistic regression based on intestinal protozoan infections showed that contact with animals (OR = 1.748, 95% CI = 1.168–2.617) and taking bath less than twice a week (OR = 1.820, 95% CI = 1.192–2.779) were significant risk factors of protozoan infections.
This present study indicated that intestinal protozoan infections are still a public health problem in Yemen, with Giardia and Entamoeba infections being most common. Statistical analysis indicated that low personal hygiene and contact with animals were important predictors for intestinal protozoan infections. As highlighted in this study, in order to effectively reduce these infections, a multi-sectoral effort is needed. Preventive measures should include good hygienic practices, good animal husbandry practices, heightened provision of educational health programs, health services in all governorates including rural areas. Furthermore, it is also essential to find radical solutions to the recent water crises in Yemen.
PMCID: PMC3138770  PMID: 21789210
15.  Intestinal parasitic infection in Bhil tribe of Rajasthan, India 
A total of 224 Bhil tribal individuals (115 males and 109 females) of different age groups inhabiting tribal rural areas of Udaipur district of Rajasthan, India were investigated for the prevalence of intestinal parasitic (protozoan and helminths) infections. Fresh stool samples of these tribal subjects were examined microscopically by direct wet smear with saline and 1 % Lugol’s iodine and formaline ether concentration. Of these 116 (51.78 %) were found to be infected with diverse species of intestinal parasites. Male individuals showed relatively higher (56.52 %) prevalence of infection as compared to their counterparts (46.78 %). Out of 116 infected tribal subjects, 53 (23.66 %), 33 (14.73 %) and 30 (13.39 %) were infected with protozoan, helminths and mixed (protozoan + helminths) parasitic infections, respectively. Maximum number of parasitic infections occurred in the age group of 6–10 years (69.23 %) in both sexes. Among the intestinal parasites, Entamoeba histolytica was the commonest (14.73 %) followed by Entamoeba coli (8.92 %), Taenia solium (5.35 %), Ascaris lumbricoides (4.46 %), Hymenolepis nana (2.23 %), Ancylostoma duodenale (0.89 %), Strongyloides stercoralis (0.89 %), Trichuris trichiura (0.44 %) and Hymenolepis diminuta (0.44 %). Data pertaining to distribution of parasite species in different age groups, and variation in prevalence of their infection in relation to age and sex were also analysed statistically and found to be significant. Possible causes for variation in prevalence of protozoan and helminthic infection are discussed.
PMCID: PMC3427671  PMID: 24082517
Bhil tribe; Helminths; Intestinal parasites; Prevalence; Protozoan; Rajasthan; India
16.  Prevalence of gastrointestinal helminth infections in rodents of Tarai region of Uttarakhand 
The present work was aimed to investigate helminth biodiversity among rodents in order to evaluate the threat for helminth transmission to humans since they act as a potential source of parasitic zoonoses. In this study, faeces of 43 black rats (Rattus rattus) and 35 house mice (Mus musculus) were collected from various habitats viz. domestic places and agricultural fields of different parts of tarai region of Uttarakhand. These faecal samples were examined for the presence of parasitic eggs, adult and segments of the worms. The study revealed that the rodents were infected with 5 genera of helminth parasites, i.e. Hymenolepis nana, Hymenolepis diminuta, Syphacia muris, Capillaria hepatica, Trichuris muris and other strongyle eggs (2 species of cestodes and 4 species of nematodes). Adult Syphacia muris and segments of Hymenolepis nana were also recovered from faecal droppings. Of the 43 samples of black rat, all (100 %) and of the 35 samples of mice 9 (25.71 %) were found positive for one or more than one species of parasitic infections. Greater infection of H. diminuta 19 (44.18 %) followed by H. nana 17 (39.53 %) was seen in rat whereas mice were mostly infected with H. nana. The diversity and prevalence of various parasites reported here within domestic habitats may suggest that these can pose a high risk of helminth transmission to human population and are thus of considerable public health importance.
PMCID: PMC3793097  PMID: 24431566
Rodents; Parasitic zoonoses; Gastrointestinal helminths
17.  Enterobiasis and strongyloidiasis and associated co-infections and morbidity markers in infants, preschool- and school-aged children from rural coastal Tanzania: a cross-sectional study 
BMC Infectious Diseases  2014;14(1):644.
There is a paucity of data pertaining to the epidemiology and public health impact of Enterobius vermicularis and Strongyloides stercoralis infections. We aimed to determine the extent of enterobiasis, strongyloidiasis, and other helminth infections and their association with asymptomatic Plasmodium parasitaemia, anaemia, nutritional status, and blood cell counts in infants, preschool-aged (PSAC), and school-aged children (SAC) from rural coastal Tanzania.
A total of 1,033 children were included in a cross-sectional study implemented in the Bagamoyo district in 2011/2012. Faecal samples were examined for intestinal helminth infections using a broad set of quality controlled methods. Finger-prick blood samples were subjected to filariasis and Plasmodium parasitaemia testing and full blood cell count examination. Weight, length/height, and/or mid-upper arm circumference were measured and the nutritional status determined in accordance with age.
E. vermicularis infections were found in 4.2% of infants, 16.7%, of PSAC, and 26.3% of SAC. S. stercoralis infections were detected in 5.8%, 7.5%, and 7.1% of infants, PSAC, and SAC, respectively. Multivariable regression analyses revealed higher odds of enterobiasis in children of all age-groups with a reported anthelminthic treatment history over the past six months (odds ratio (OR): 2.15; 95% confidence interval (CI): 1.22 - 3.79) and in SAC with a higher temperature (OR: 2.21; CI: 1.13 - 4.33). Strongyloidiasis was associated with eosinophilia (OR: 2.04; CI: 1.20-3.48) and with Trichuris trichiura infections (OR: 4.13; CI: 1.04-16.52) in children of all age-groups, and with asymptomatic Plasmodium parasitaemia (OR: 13.03; CI: 1.34 - 127.23) in infants. None of the investigated helminthiases impacted significantly on the nutritional status and anaemia, but moderate asymptomatic Plasmodium parasitaemia was a strong predictor for anaemia in children aged older than two years (OR: 2.69; 95% CI: 1.23 – 5.86).
E. vermicularis and S. stercoralis infections were moderately prevalent in children from rural coastal Tanzania. Our data can contribute to inform yet missing global burden of disease and prevalence estimates for strongyloidiasis and enterobiasis. The association between S stercoralis and asymptomatic Plasmodium parasitaemia found here warrants further comprehensive investigations.
PMCID: PMC4271451  PMID: 25486986
Asymptomatic Plasmodium parasitaemia; Anaemia; Anthropometric measures; Co-infection; Enterobius vermicularis; Haematology; Hookworm; Soil-transmitted helminths; Strongyloides stercoralis; Tanzania; Trichuris trichiura
18.  Intestinal Helminthiasis in Children of Gurez Valley of Jammu and Kashmir State, India 
This paper is a part of the helminthological studies carried out on school-going children of the Kashmir Valley and deals with the status of intestinal helminths in the children of Gurez Valley and to assess epidemiological factors associated with the extent of endemic disease so that control measures are adopted.
Material and Methods:
Stool samples were collected from 352 children from Gurez Valley. The samples were processed using Kato-Katz thick smear technique, and microscopically examined for intestinal parasites.
Of the 352 children surveyed, 75.28% had one or more types of intestinal helminthes. Prevalence of Ascaris lumbricoides was highest (71.18%), followed by Trichuris trichiura (26.42%), Enterobius vermicularis (13.92) and Taenia saginata (5.39%). Conditions most frequently associated with infection included the water source, defecation site, personal hygiene, and the extent of maternal education.
The study shows a relatively high prevalence of intestinal helminths and suggests an imperative for the implementation of control measures.
PMCID: PMC2889670  PMID: 20606959
Children; Gurez valley; Helminth infection; Prevalence rates
19.  HIV/AIDS-Associated Opportunistic Protozoal Diarrhea 
Human immunodeficiency virus (HIV) infection has altered both the epidemiology and outcome of enteric opportunistic parasitic infections. This study was done to determine the prevalence and species/genotypes of intestinal coccidian and microsporidial infections among HIV/AIDS patients with diarrhea and/or a history of diarrhea alternately with an asymptomatic interval, and their association with CD4 T cell count. This cross-sectional study was done from May 2010 to May 2011 in Shiraz University of Medical Sciences, South of Iran. A blood sample was obtained from HIV-positive patients for a CD4 T cell count upon enrollment. Sociodemographic data and a history of diarrhea were collected by interviewing 356 consecutive participants (273 males and 83 females). Whenever possible more than a fecal sample was collected from all the participants and examined for parasites using direct, physiological saline solution ethyl acetate, an acid-fast trichrome stain, nested polymerase chain reaction, and sequencing techniques for the detection, confirmation, and genotyping of Cryptosporidium spp., Cyclospora cayetanensis, Isospora belli, and intestinal microsporidia (Enterocytozoon bieneusi). The most common opportunistic and nonopportunistic pathogens were Cryptosporidium spp. (C. parvum and C. andersoni), E. bieneusi, Giardia lamblia, Sarcocystis spp., and Blastocystis homonis affecting 34, 8, 23, 1, and 14 patients, respectively. C. cayetanensis, I. belli, Enterobius vermicularis, and Hymenolepis nana were observed in few patients. A CD4 count <200 cells/μl was significantly associated with the presence of opportunistic parasites and diarrhea (p<0.05). Opportunistic intestinal parasites should be suspected in any HIV/AIDS patient with chronic diarrhea. Tropical epidemic nonopportunistic enteric parasitic infections among such patients should not be neglected in Iran.
PMCID: PMC3537293  PMID: 22873400
20.  Changing trends in intestinal parasitic infections among long-term-residents and settled immigrants in Qatar 
Parasites & Vectors  2010;3:98.
The rapid socio-economic development in Qatar in the last two decades has encouraged a mass influx of immigrant workers, the majority of whom originate from countries with low socio-economic levels, inadequate medical care and many are known to carry patent intestinal helminth and protozoan infections on arrival in Qatar. Some eventually acquire residency status but little is known about whether they continue to harbour infections.
We examined 9208 hospital records of stool samples that had been analysed for the presence of intestinal helminth and protozoan ova/cysts, over the period 2005-2008, of subjects from 28 nationalities, but resident in Qatar and therefore not recent arrivals in the country.
Overall 10.2% of subjects were infected with at least one species, 2.6% with helminths and 8.0% with protozoan species. Although hookworms, Ascaris lumbricoides, Trichuris trichiura and Hymenolepis nana were observed, the majority of helminth infections (69%) were caused by hookworms, and these were largely aggregated among 20.0-39.9 year-old male subjects from Nepal. The remaining cases of helminth infection were mostly among Asian immigrants. Protozoan infections were more uniformly spread across immigrants from different regions when prevalence was calculated on combined data, but this disguised three quite contrasting underlying patterns for 3 taxa of intestinal protozoa. Blastocystis hominis, Giardia duodenalis and non-pathogenic amoebae were all acquired in childhood, but whereas prevalence of B. hominis rose to a plateau and then even further among the elderly, prevalence of G. duodenalis fell markedly in children aged 10 and older, and stayed low (< 2%) gradually falling even further in the elderly. In contrast the prevalence of non-pathogenic amoebae (Entamoeba coli, E. hartmanni, Endolimax nana and Iodamoeba buetschlii) peaked in the 30.0-39.9 age group and only then dropped to very low values among the oldest subjects examined. A worrying trend in respect of both helminth and protozoan parasites was the increase in prevalence over the period 2005-2008, in helminth infections prevalence increasing 2-3 fold by 2008, and in protozoan infections by 1.5-2.0 fold.
We suggest that helminth infections are probably acquired abroad when immigrants visit their home villages, whilst protozoan infections are reinforced by transmission in Qatar, possibly in the poorer areas of the state where immigrant workers live. We discuss the significance of these findings and emphasize that they have clear implications for the health authorities.
PMCID: PMC2972266  PMID: 20946623
21.  Prevalence and epidemiology of intestinal parasitism, as revealed by three distinct techniques in an endemic area in the Brazilian Amazon 
This survey aims to estimate the prevalence of intestinal parasitic infections in Santa Isabel do Rio Negro, Amazonian Brazil, through three distinct techniques, correlating the prevalence rates with family income and age groups as well as assessing the household clustering of infections. Prevalence rates were assessed through Graham (n = 113), Baermann-Moraes (n = 232) and Ritchie (n = 463) methods. The Graham method was adopted only for children under 5 years old, 15% of whom were positive for Enterobius vermicularis. By the Baermann-Moraes technique, 5.6% of the samples were positive for Strongyloides stercoralis larvae. The Ritchie technique disclosed the following results: Ascaris lumbricoides (26%), Trichuris trichiura (22.5%), hookworms (9.5%), Entamoeba histolytica/Entamoeba dispar (25.3%), Giardia lamblia (12.5%) and E. vermicularis (0.6%). Children aged 5–14 years presented the highest prevalence for pathogenic parasites. Giardiasis and hookworm infection rates were inversely related to family income. The presence of positive contacts in the same household substantially increased the risk of infection by enteric parasites: odds ratio (OR) = 2.70, 95% confidence interval (CI) = 1.69–4.29 for ascariasis; OR = 2.17, 95% CI = 1.34–3.51 for trichuriasis; OR = 2.13, 95% CI = 1.08–4.17 for hookworm disease; OR = 3.42, 95% CI = 1.86–6.30 for giardiasis; and OR = 2.16, 95% CI = 1.35–3.47 for amoebiasis, supporting infection clustering in the home. Intestinal parasitoses are extremely frequent in the studied area, and routine methods for diagnosis may underestimate the prevalence of enterobiasis and strongyloidiasis.
PMCID: PMC4100303  PMID: 22117850
22.  Demographic and parasitic infection status of schoolchildren and sanitary conditions of schools in Sanliurfa, Turkey 
BMC Public Health  2003;3:29.
The design and development of school health programmes will require information at demographic characteristics of schoolchildren and the major health burdens of the school-age group, the opportunities for intervention and the appropriateness of the available infrastructure. This study aims to analyse demographic and parasitic infections status of schoolchildren and sanitary conditions of schools in Sanliurfa province of south-eastern Turkey.
Three primary schools were randomly selected in the shantytown, apartment and rural districts. A total of 1820 schoolchildren between 7–14 years age were took part to the survey of whom 1120 (61.5%) were boys and 700 (38.4%) were girls. A child form (including child's name, sex, age, school grade and parasitic infections) and school survey form (including condition of water supply, condition of latrines, presence of soaps on the basins and presence of garbage piles around to the schools) were used for demographic, parasitic and sanitary surveys. Stool samples were examined by cellophane thick smear technique for the eggs of intestinal helminths.
The demographic survey showed that number of schoolchildren was gradually decreased as their age's increase in shantytown school. The sex ratio was proportional until the second grade, after which the number of females gradually decreased in children in shantytown and rural schools while, in apartment area, schoolchildren was proportionally distributed between age groups and gender even the high-grade students. The prevalence of helminthic infections was %77.1 of the schoolchildren in shantytown, 53.2% in apartment district and 53.1% of rural area. Ascaris lumbricoides was the most prevalent species and followed by Trichuris trichiura, Hymenolepis nana and Taenia species in three schools. Sanitation survey indicated that the tap water was limited in shantytown school, toilet's sanitation was poor, available no soaps on lavatories and garbage piles were accumulated around the schools in shantytown and rural area, while, the school in apartment area was well sanitised.
These results indicated that burden of parasitic infections and poor sanitation conditions constituted public health importance among to the shantytown schoolchildren. School health programmes including deworming and sanitation activities through the health education and improvement of sanitation conditions in the schools have a potential to better health and education for schoolchildren. These programmes also offer the potential to reach significant numbers of population in the shantytown schools with high level of absenteeism.
PMCID: PMC200976  PMID: 12952553
sanitary; demographic; parasites; and schoolchildren
23.  Prevalence of Strongyloides stercoralis and other intestinal parasitic infections among mentally retarded residents in central institution of southern Iran 
To determine the prevalence of intestinal parasitic infections among mentally retarded residents of rehabilitation center of Bandar Abbas, Hormozgan province, southern Iran.
A cross-sectional study was carried out in central rehabilitation institute of Hormozgan province in summer 2010. Fecal samples of all 133 residents (72 males, 61 females) aged 3–52, were collected in triplicate. Specimens were examined by direct smear, formalin-ether concentration techniques and stained by permanent Trichrome, Ziehl-Neelsen stains. Statistical analysis was conducted by SPSS 13.5.
Intestinal parasitic infections were seen in 48.5% (64 out of 133 subjects: 53.4% in males and 46.6% in females). Strongyloides stercoralis with 17.3% showed the highest incidence followed by Entamoeba coli (9.8%), Blastocystis hominis (7.5%), Giardia lamblia (2.3%), Endolimax nana (2.3%), Hymenolepis nana (0.8%), Oxyuris vermicularis (0.8%), and Chilomasix mesnili (0.8%). Double infections were found to be as: Strongyloides stercoralis + Giardia lamblia (2.3%), Entamoeba coli + Giardia lamblia (1.5%), Entamoeba coli + Blastocystis hominis (1.5%), Oxyuris vermicularis + Entamoeba coli (0.8%), Strongyloides stercoralis + Entamoeba coli (0.8%), respectively.
Our findings reveal that strongyloidiasis is a common disease among mentally retarded population in southern Iran.
PMCID: PMC3609260  PMID: 23569874
Intestinal pararsites; Mentally retarded; Hormozgan; Iran; Strongyloides stercoralis; Strongyloidiasis; Parasitic infection; Rehabilitation centre
24.  Efficacy of Trikatrayadi Lauha in Panduroga with reference to Iron Deficiency Anemia 
Ayu  2012;33(1):62-67.
The common nutritional deficiency, iron deficiency, causes Iron Deficiency Anemia (IDA) throughout the world especially in the developing countries. In Ayurveda, different herbal, mineral or herbomineral drugs have been emphasized to combat anemia (Panduroga). Trikatrayadi Lauha and Fersolate-CM (a modern medicine taken as standard control) were administered to the patients to evaluate their role in Panduroga. A simple random sampling method was followed for the clinical study. The 56 iron deficiency anemic patients of both sexes and age group between 16 to 70 years divided into two groups – Group-A (n=34) and Group-C (n=22) were treated with Trikatrayadi lauha and Fersolate-CM, respectively. Both drugs provided significant effect on the signs and symptoms of Shrama (fatigue), Shwasa (dyspnea on exertion), Daurbalya (weakness), Pandu Varna (pallor/yellowish-whitish), Hridspandana (palpitation), Hatanala (diminished digestive capacity), Bhrama (giddiness), Aruchi (anorexia), Arohana Ayasa (exhaustion during climbing), Shiroruja (headache) and Shotha (edema). Trikatrayadi Lauha provided significant results on Hb gm%, RBC, PCV, MCV, serum iron, percent transferrin saturation and TIBC where as insignificant changes were found in MCH and MCHC. Fersolate-CM provided significant results on Hb gm%, RBC, PCV, MCV, MCH, serum iron, percent transferrin saturation and TIBC whereas insignificant change was found in MCHC. Trikatrayadi Lauha showed significant results on Panduroga and Iron Deficiency Anaemia (IDA).
PMCID: PMC3456866  PMID: 23049186
Anemia; Fersolate-CM; iron deficiency anemia; Panduroga; Trikatrayadi Lauha
25.  Intestinal Helminthic Infections in Striped Field Mice, Apodemus agrarius, from Two Southern Regions of Korea 
The present study was performed to know the infection status of intestinal helminths in a most common species of field mice, Apodemus agrarius, from 2 southern regions of Korea. Total 133 and 103 mice were collected by the mouse trap in Hapcheon-gun, Gyeongsangnam-do and Gurye-gun, Jeollanam-do, respectively, from July 2005 to June 2006. The small intestine of each mouse was resected and longitudinally opened with a pair of scissors. The intestinal contents were washed with 0.85% saline until the supernatant became clear. Helminths were collected with naked eyes or under a stereomicroscope from the sediment of the intestinal content. More than 11 species of helminths (4 nematode spp., 5 trematode spp., and 2 cestode spp.) were recovered. Among these, heligmosomoid nematodes (97.5%) was the most highly and heavily infected species. As the members of trematodes, Plagiorchis muris, Brachylaima sp., Echinostoma hortense, Echinostoma cinetorchis, and unidentified echinostome larvae were found in the small intestines of 35 (14.8%), 12 (5.1%), 6 (2.5%), 1 (0.4%), and 1 (0.4%) mice respectively. Two species of tapeworms, Hymenolepis nana and Hymenolepis diminuta were also detected in 79 (33.5%) and 21 (8.9%) mice, respectively. Conclusively, heligmosomoid nematodes were the most prevalent (dominant) species among more than 11 helminth species detected, and Brachylaima sp. fluke is newly added in the list of intestinal trematodes in Korea.
PMCID: PMC4170038  PMID: 25246721
Intestinal helminth; striped field mouse; Apodemus agrarius; southern region of Korea

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