The Dynamics of Ascaris lumbricoides Infections

Diagnosis of helminths depends on worm fecundity and the distribution of parasites within hosts

Helminth transmission and morbidity are dependent on the number of mature parasites within a host; however, observing adult worms is impossible for many natural infections. An outstanding challenge is therefore relating routine diagnostics, such as faecal egg counts, to the underlying worm burden. This relationship is complicated by density-dependent fecundity (egg output per worm reduces due to crowding at high burdens) and the skewed distribution of parasites (majority of helminths aggregated in a small fraction of hosts). We address these questions for the carcinogenic liver fluke Opisthorchis viverrini, which infects approximately 10 million people across Southeast Asia, by analysing five epidemiological surveys (n = 641) where adult flukes were recovered. Using a mechanistic model, we show that parasite fecundity varies between populations, with surveys from Thailand and Laos demonstrating distinct patterns of egg output and density-dependence. As the probability of observing faecal eggs increases with the number of mature parasites within a host, we quantify diagnostic sensitivity as a function of the worm burden and find that greater than 50% of cases are misdiagnosed as false negative in communities close to elimination. Finally, we demonstrate that the relationship between observed prevalence from routine diagnostics and true prevalence is nonlinear and strongly influenced by parasite aggregation.

Comparison of the performance of MS enteroscope series and Japanese double- and single-balloon enteroscopes

BACKGROUND

Small intestine disease endangers human health and is not easy to locate and diagnose.

AIM

To observe the effect of the MS series of small intestine endoscopes on the gastrointestinal tract, the changes in serum gastrin levels and intestinal tissue, and the time required for the examination.

METHODS

In vivo experiments in 20 Living pigs were conducted, Bowel preparation was routinely performed, Intravenous anesthesia with propofol and ketamine was applied, the condition of the small intestine was observed and the detection time of the MS series of small intestine endoscopes were recorded, The changes in intestinal tissue using the MS series of small intestine endoscopes observed and compared before and after the examination, Venous blood (3-5 mL) from pigs was collected before and after the experiment; changes in intestinal tissue after use of the MS series of small intestine endoscopes observed after examination. After completion of each type of small intestine endoscope experiment, the pigs were allowed to rest and the next type of small intestine endoscope experiment was performed after 15 days of normal feeding. The detection time data of the single-balloon small intestine endoscope and double-balloon small intestine endoscope were collected from four hospitals.

RESULTS

One case of Ascarislumbricoides, one of suspected Crohn's disease, one small intestinal diverticulum and one anesthesia accident were observed in pigs. The small intestine showed no differences in the MS series of small intestine endoscopes and there were no differences in serum gastrin between the groups (P > 0.05). The time required for inspection was recorded, and the overall detection time for the Japanese small intestine endoscopes was approximately 1.68 ± 0.16 h.

CONCLUSION

Intestinal ascariasis is a common disease in pigs. Some pigs have abnormal intestinal variation. After continuous upgrade and improvement, the MS-3 and MS-4 small intestine endoscope appear superior in terms of detection time.

Integrating Infection Intensity into Within- and Between-Host Pathogen Dynamics: Implications for Invasion and Virulence Evolution

AbstractInfection intensity can dictate disease outcomes but is typically ignored when modeling infection dynamics of microparasites (e.g., bacteria, virus, and fungi). However, for a number of pathogens of wildlife typically categorized as microparasites, accounting for infection intensity and within-host infection processes is critical for predicting population-level responses to pathogen invasion. Here, we develop a modeling framework we refer to as reduced-dimension host-parasite integral projection models (reduced IPMs) that we use to explore how within-host infection processes affect the dynamics of pathogen invasion and virulence evolution. We find that individual-level heterogeneity in pathogen load-a nearly ubiquitous characteristic of host-parasite interactions that is rarely considered in models of microparasites-generally reduces pathogen invasion probability and dampens virulence-transmission trade-offs in host-parasite systems. The latter effect likely contributes to widely predicted virulence-transmission trade-offs being difficult to observe empirically. Moreover, our analyses show that intensity-dependent host mortality does not always induce a virulence-transmission trade-off, and systems with steeper than linear relationships between pathogen intensity and host mortality rate are significantly more likely to exhibit these trade-offs. Overall, reduced IPMs provide a useful framework to expand our theoretical and data-driven understanding of how within-host processes affect population-level disease dynamics.

Atto-Foxes and Other Minutiae

This paper addresses the problem of extinction in continuous models of population dynamics associated with small numbers of individuals. We begin with an extended discussion of extinction in the particular case of a stochastic logistic model, and how it relates to the corresponding continuous model. Two examples of ‘small number dynamics’ are then considered. The first is what Mollison calls the ‘atto-fox’ problem (in a model of fox rabies), referring to the problematic theoretical occurrence of a predicted rabid fox density of \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$10^{-18}$$\end{document}10-18 (atto-) per square kilometre. The second is how the production of large numbers of eggs by an individual can reliably lead to the eventual survival of a handful of adults, as it would seem that extinction then becomes a likely possibility. We describe the occurrence of the atto-fox problem in other contexts, such as the microbial ‘yocto-cell’ problem, and we suggest that the modelling resolution is to allow for the existence of a reservoir for the extinctively challenged individuals. This is functionally similar to the concept of a ‘refuge’ in predator–prey systems and represents a state for the individuals in which they are immune from destruction. For what I call the ‘frogspawn’ problem, where only a few individuals survive to adulthood from a large number of eggs, we provide a simple explanation based on a Holling type 3 response and elaborate it by means of a suitable nonlinear age-structured model.

Evaluating the Evidence for Lymphatic Filariasis Elimination

In the global drive for elimination of lymphatic filariasis (LF), 15 countries have achieved validation of elimination as a public health problem (EPHP). Recent empirical evidence has demonstrated that EPHP does not always lead to elimination of transmission (EOT). Here we show how the probability of elimination explicitly depends on key biological parameters, many of which have been poorly characterized, leading to a poor evidence base for the elimination threshold. As more countries progress towards EPHP it is essential that this process is well-informed, as prematurely halting treatment and surveillance programs could pose a serious threat to global progress. We highlight that refinement of the weak empirical evidence base is vital to understand drivers of elimination and inform long-term policy.

An Additional Asset for the FLOTAC Technique: Detection of Gastrointestinal Parasites in Vegetables

INTRODUCTION

Gastrointestinal parasites are considered amongst the most important threats to veterinary and human health worldwide. The transmission of these parasitic diseases usually involves the accidental ingestion of oocysts, cysts, eggs, and larvae, whose detection is generally achieved by classical coproparasitological methods, based on sedimentation and/or flotation techniques. These procedures might be inefficient or display a low sensitivity when performed on food matrices. This study aimed to assess the value of the FLOTAC technique for the detection of different parasitic stages of gastrointestinal parasites of domestic animals in fresh lettuce.

MATERIAL AND METHODS

Samples (n = 100) were purchased from public markets located in the metropolitan region of Recife (Brazil).

RESULTS

A total of 79% scored positive for eggs and/or cysts of gastrointestinal parasites. Protozoa and nematodes were detected in 32% (32/100) and 64% (64/100) of samples, respectively, with cysts of the genus Entamoeba (32%) and eggs of nematodes of the order Strongylida (30%) being the most frequently diagnosed.

CONCLUSIONS

The findings herein reported demonstrate that the FLOTAC technique can be successfully applied for recovering food-borne parasites of medical and veterinary concern in food matrices.

The impact of seasonality on the dynamics and control of Ascaris lumbricoides infections

Intestinal nematode infections affect a huge proportion of the world's population. Increasingly these infections, particularly amongst the poorest communities, are controlled through mass drug treatment programs. Seasonal variations of climate and behaviour in these regions can be significant, but their impact on the dynamics of infection and implications for the effectiveness of any mass drug treatment program (a pulsed reduction in worm burden in hosts) is not clearly understood. Here the effect of seasonality on the dynamics of the soil-based helminth, Ascaris lumbricoides, is investigated using a reformulated version of the Anderson-May model for macro-parasitic infections. Explicit analytical expressions are obtained for the stable oscillatory solution over the annual cycle, which provides a means of relating times of peak numbers of eggs, larvae and mature worms to seasonal variations. Numerical and analytical techniques are then used to consider the impact of seasonality on the optimal timing of drug treatment. Our results show that there is a relatively large window for the timing of optimal treatment, and the impact of repeated annual mass drug treatments can be substantially improved if they are timed to coincide with the months when the number of eggs and larvae are at their lowest - minimising reinfection. In terms of a more measurable quantity, in our example this corresponds to the months when the seasonal temperature is highest. Multiple annual treatments at (or close to) the optimal time each year are predicted to achieve local elimination in the community, whereas treatment at other times has a more limited impact. A key finding is that even for pronounced seasonality, perturbations in mean worm burden, and hence seasonal variation in observed egg output, may be small, potentially explaining why seasonal effects have been overlooked. Taken together these results suggest that seasonality of soil-transmitted helminths requires further experimental, field and mathematical study if the impact for mass drug administration programs is to be exploited.

Seasonally timed treatment programs for Ascaris lumbricoides to increase impact-An investigation using mathematical models

There is clear empirical evidence that environmental conditions can influence Ascaris spp. free-living stage development and host reinfection, but the impact of these differences on human infections, and interventions to control them, is variable. A new model framework reflecting four key stages of the A. lumbricoides life cycle, incorporating the effects of rainfall and temperature, is used to describe the level of infection in the human population alongside the environmental egg dynamics. Using data from South Korea and Nigeria, we conclude that settings with extreme fluctuations in rainfall or temperature could exhibit strong seasonal transmission patterns that may be partially masked by the longevity of A. lumbricoides infections in hosts; we go on to demonstrate how seasonally timed mass drug administration (MDA) could impact the outcomes of control strategies. For the South Korean setting the results predict a comparative decrease of 74.5% in mean worm days (the number of days the average individual spend infected with worms across a 12 month period) between the best and worst MDA timings after four years of annual treatment. The model found no significant seasonal effect on MDA in the Nigerian setting due to a narrower annual temperature range and no rainfall dependence. Our results suggest that seasonal variation in egg survival and maturation could be exploited to maximise the impact of MDA in certain settings.

When can we infer mechanism from parasite aggregation? A constraint-based approach to disease ecology

Few hosts have many parasites while many hosts have few parasites. This axiom of macroparasite aggregation is so pervasive it is considered a general law in disease ecology, with important implications for the dynamics of host-parasite systems. Because of these dynamical implications, a significant amount of work has explored both the various mechanisms leading to parasite aggregation patterns and how to infer mechanism from these patterns. However, as many disease mechanisms can produce similar aggregation patterns, it is not clear whether aggregation itself provides any additional information about mechanism. Here we apply a "constraint-based" approach developed in macroecology that allows us to explore whether parasite aggregation contains any additional information beyond what is provided by mean parasite load. We tested two constraint-based null models, both of which were constrained on the total number of parasites P and hosts H found in a sample, using data from 842 observed amphibian host-trematode parasite distributions. We found that constraint-based models captured ~85% of the observed variation in host-parasite distributions, suggesting that the constraints P and H contain much of the information about the shape of the host-parasite distribution. However, we also found that extending the constraint-based null models can identify the potential role of known aggregating mechanisms (such as host heterogeneity) and disaggregating mechanisms (such as parasite-induced host mortality) in constraining host-parasite distributions. Thus, by providing robust null models, constraint-based approaches can help guide investigations aimed at detecting biological processes that directly affect parasite aggregation above and beyond those that indirectly affect aggregation through P and H.