Prevalence, incidence, intensity and associated morbidity of intestinal helminths in south Thailand

The high prevalence of intestinal parasitic infections is associated with stunting among children aged 6-59 months in Boricha Woreda, Southern Ethiopia: a cross-sectional study

Background

Prior studies reported controversial results about the association between intestinal parasitic infections and childhood under-nutrition. We investigated the association of intestinal parasitic infections with under-nutrition among children aged 6–59 months in Boricha Woreda, Southern Ethiopia.

Methods

This community-based prospective cross-sectional study was carried out from January 1–30, 2019 among 622 children aged 6–59 months. A two-stage stratified sampling procedure was used. Data were collected using a structured, face-to-face interviewer-administered questionnaire and standard anthropometric measurements. The stool specimens were collected using standard technique and examined for the existence and species of intestinal parasites using direct wet mount, Kato Katz and staining technique. We have entered data using Epi Data 3.1 and WHO Anthro software and all analyses were conducted using SPSS version 20. The descriptive analyses were done to find descriptive measures for the socio-demographic and other important variables. Multivariable logistic regression analysis was used to identify factors associated with under-nutrition. Adjusted odds ratios (AORs) with a 95% confidence interval (CI) were computed to assess the presence and strength of associations.

Results

The total prevalence of intestinal parasitic infection was 48.7% (95% CI, 44.77–52.62). Approximately one-fourth (22%) of the children were infected with moderate intensity infections. Prevalence of stunting, underweight, wasting were 39.3, 24 and 11.6%, respectively. The prevalence of stunting among children infected with the intestinal parasite (59.4%) was significantly higher than the prevalence in non-infected children (20.6%) (p < 0.001). The absence of sanitation facility, living in medium and large family size, lack of shoes wearing practice, consuming raw vegetables and fruits were positively associated with intestinal parasitic infections. The presence of intestinal parasitic infections was positively associated with stunting (AOR = 2.18, 95% CI: 1.36–3.50) but not with wasting (AOR = 0.58, 95% CI: 0.3–1.13) and underweight (AOR: 0.92, 95% CI = 0.55–1.54).

Conclusions

Under-nutrition and intestinal parasitic infections were serious public health concerns. Consolidating the prevailing water, sanitation and hygiene packages and routine deworming of children aged 6–59 months may aid to decrease the burden of both stunting and intestinal parasitic infection in children. Also, improving modern contraceptive methods utilization to reduce family size is recommended.

The extent, nature, and pathogenic consequences of helminth polyparasitism in humans: A meta-analysis

Background

Individual helminth infections are ubiquitous in the tropics; geographical overlaps in endemicity and epidemiological reports suggest areas endemic for multiple helminthiases are also burdened with high prevalences of intestinal protozoan infections, malaria, tuberculosis (TB), and human immunodeficiency virus (HIV). Despite this, pathogens tend to be studied in isolation, and there remains a need for a better understanding of the community ecology and health consequences of helminth polyparasitism to inform the design of effective parasite control programs.

Methodology

We performed meta-analyses to (i) evaluate the commonality of polyparasitism for helminth-helminth, helminth-intestinal protozoa, helminth-malaria, helminth-TB, and helminth-HIV co-infections, (ii) assess the potential for interspecies interactions among helminth-helminth and helminth-intestinal protozoan infections, and (iii) determine the presence and magnitude of association between specific parasite pairs. Additionally, we conducted a review of reported health consequences of multiply-infected individuals compared to singly- or not multiply-infected individuals.

Principal findings

We found that helminth-helminth and helminth-intestinal protozoan multiple infections were significantly more common than single infections, while individuals with malaria, TB, and HIV were more likely to be singly-infected with these infections than co-infected with at least one helminth. Most observed species density distributions significantly differed from the expected distributions, suggesting the potential presence of interspecies interactions. All significant associations between parasite pairs were positive in direction, irrespective of the combination of pathogens. Polyparasitized individuals largely exhibited lower hemoglobin levels and higher anemia prevalence, while the differences in growth-related variables were mostly statistically insignificant.

Conclusions

Our findings confirm that helminth polyparasitism and co-infection with major diseases is common in the tropics. A multitude of factors acting at various hierarchical levels, such as interspecies interactions at the within-host infra-parasite community level and environmental variables at the higher host community level, could explain the observed positive associations between pathogens; there remains a need to develop new frameworks which can consider these multilevel factors to better understand the processes structuring parasite communities to accomplish their control.

Helminth infections are a highly prevalent global health problem. These parasitic worm infections occur in areas also burdened with intestinal protozoan infections, malaria, tuberculosis, and human immunodeficiency virus. While these pathogens tend to be studied in isolation, there remains a need to better understand the nature, extent, and health consequences of helminth polyparasitism and co-infection with major diseases. Here, we reviewed the literature and performed meta-analyses to evaluate the commonality of helminth polyparasitism and co-infection, the potential for interspecies interactions between parasites, the association between parasite pairs, and the health consequences among multiply-infected individuals. We confirmed that polyparasitism and co-infection with major diseases are common in the global South and found that multiply-infected individuals experienced worse health consequences when compared to singly or not-multiply infected individuals. Our analysis suggested the potential presence of interspecies interactions and we identified the existence of positive associations between parasite pairs. These findings support the call for integrating deworming into malaria, TB, and HIV treatment protocols and suggest there remains a need to improve our understanding of the factors influencing co-transmission to achieve sustainable parasite control.

Assessment of seasonality in soil-transmitted helminth infections across 14 schools in Jimma Town, Ethiopia

Introduction

Up to date, the frequency of preventive chemotherapy based on the prevalence is the only strategy in the control programmes of soil-transmitted helminths (STHs). However, prevalence of STHs may be affected by climatic and/or seasonal changes, particularly when these are important determinants of transmission of STH infections. Our objective was to describe the prevalence and infection intensity and seasonal variation (mainly dry vs rainy season) of any STHs among school age children.

Methods

Assessment of infection intensity and prevalence of STHs was carried out during dry season (February-March, 2012) and end of rainy season (September-October, 2012) across 14 primary schools in Jimma Town, Jimma, Ethiopia. A total of 1,680 school children (840 in each season) were included. All stool samples were processed by the McMaster egg counting method. Odds of infection and intensity was performed to assess any differences in prevalence and infection intensity between the schools and the two seasons. The pooled odd ratio and their 95% confidence interval was also computed and presented using the "metafor" package of the statistical software R. The level of significance was declared at p < 0.05.

Results

Infections with any STH were observed in 824/1,680 (49.0%) subjects. T. trichiura was the most prevalent (35.5%), followed by A. lumbricoides (23.4%) and hookworms (9.9%). Among the schools there were a huge variation in prevalence, ranging from 16.7% to 68.3% for any STH, 6.7% to 39.2% for A. lumbricoides, 10.8% to 55.0% for T. trichiura and 0 % to 28.3% for hookworms. A significant difference in prevalence (for T. trichiura) and in infection intensity (for A. lumbricoides and T. trichiura) across seasons was observed. Generally, STH infections were more prevalent in the dry season (52.4%) compared to the rainy season (45.7%) and as well intensity of all three STH infections was higher in the dry season.

Conclusion

Our data suggested that there were huge variation in STH prevalence among schools and a significant difference in infection intensity and prevalence across seasons. This in turn might limits how national governments and international organizations define and target resources to combat the disease burden due to STH infection. Long term studies are needed to confirm the influence of seasonal factors and related ecological, environmental and socio-economic factors.

Detecting and Accommodating Outliers in Meta-Analysis for Evaluating Effect of Albendazole on Ascaris lumbricoides Infection

Background:

Meta-analysis is a statistical technique in which the results of two or more independent studies, with similar objectives, are mathematically combined in order to improve the reliability of the results. The outliers, which may exist even in random models, can affect the validity and strength of meta-analysis results.

Objectives:

The current study uses "random effects variance shift model" to evaluate and correct the outliers in performing a meta-analysis study of the effect of albendazole in treating patients with Ascaris lumbricoides infection.

Patients and Methods:

The study used data from 14 clinical trials; each article was composed of two groups, a treatment group and a placebo group. These articles compared the effect of single dose intakes of 400 mg albendazole in treating two groups of patients with Ascaris lumbricoides infection. The articles were published in a number of internationally indexed journals between 1983 to 2013. For both groups in each article, the total number of participants, the number of those with Ascaris lumbricoides infection, and the number of those recovered following the intake of albendazole were identified and recorded. The relative risk (RR) and variance were computed for each article individually. Then, using meta-analysis, the RR was computed for all the articles together. In order to detect outliers the "random effects variance shift model" and "likelihood ratio test" (LRT) were used. Adopting the bootstrap method, the accuracy rates for sampling distribution of the tests, which were used for multiple testing, were obtained and the relevant graphs were depicted. For data analysis, STATA and R software were used.

Results:

According to meta-analysis results, the estimate for RR was 2.91, with a 95% confidence interval of 2.6 to 3.25. According to the method used in this study, three articles (articles number 4, 7, and 12) were outliers and, as such, they were detected in the graphs.

Conclusions:

We can detect and accommodate outliers in meta-analysis by using random effects variance shift model and likelihood ratio test.

Phytoplankton chytridiomycosis: community structure and infectivity of fungal parasites in aquatic ecosystems

Fungal parasitism is recurrent in plankton communities, especially in the form of parasitic chytrids. However, few attempts have been made to study the community structure and activity of parasites at the natural community level. To analyse the dynamics of zoosporic fungal parasites (i.e. chytrids) of phytoplankton, samples were collected from February to December 2007 in two freshwater lakes. Infective chytrids were omnipresent in lakes, with higher diversity of parasites and infected phytoplankton than in previous studies. The abundance and biomass of parasites were significantly higher in the productive Lake Aydat than in the oligomesotrophic Lake Pavin, while the infection prevalence in both lakes were similar and averaged about 20%. The host species composition and their size appeared as critical for chytrid infectivity, the larger hosts being more vulnerable, including pennate diatoms and desmids in both lakes. The highest prevalence (98%) was noted for the autumn bloom of the cyanobacterium Anabaena flosaquae facing the parasite Rhizosiphon crassum in Lake Aydat. Because parasites killed their hosts, this implies that cyanobacterial blooms, and other large size inedible phytoplankton blooms as well, may not totally represent trophic bottlenecks because their zoosporic parasites can release dissolved substrates for microbial processes through host destruction, and provide energetic particles as zoospores for grazers. Overall, we conclude that the parasitism by zoosporic fungi represents an important ecological driving force in the food web dynamics of aquatic ecosystems, and infer general empirical models on chytrid seasonality and trophodynamics in lakes.

Impact of antihelminthic treatment on infection by Ascaris lumbricoides, Trichuris trichiura and hookworms in Covas, a rural community of Pernambuco, Brazil

This work aims to evaluate the impact of drug treatment on infection by Ascaris lumbricoides (Al), Trichuris trichiura (Tt) and hookworms (Hook) in a rural community from the sugar-cane zone of Pernambuco, Brazil. Four parasitological surveys were carried out from March 2001 to March 2002. Individual diagnosis was based on eight slides (four by the Kato-Katz method and four by the Hoffman method) per survey. Infected subjects were assigned to two groups for treatment with either albendazole (n = 62) or mebendazole (n = 57). Prevalence of infection fell significantly (p < 0.05) one month after treatment: Al (from 47.7% to 6.6%); Tt (from 45.7% to 31.8%) and Hook (from 47.7% to 24.5%). One year after treatment, infections by Tt and Hook remained significantly below pre-control levels. A substantial decrease in single-infection cases and multiple infections was found. Egg-negative rate was significant for Al (94.0%), Hook (68.3%) but not for Tt (45.5%), and did not differ significantly between subjects treated with mebendazole or albendazole. Egg counts fell significantly in the individuals remaining positive for Tt. It is recommended that antihelminthic treatment should be selective and given at yearly intervals preferably with albendazole, due to its cost-effectiveness.

Massive gastrointestinal bleeding in infants with ascariasis

Although infestation with Ascaris lumbricoides causes various intestinal complications, massive gastrointestinal bleeding is rare. The authors report on 2 infants who presented with massive hematemesis. In the first patient, a gastroduodenoscopy was performed. Roundworms were found adhering to an oozing duodenal ulcer. Duodenal perforation occurred after extraction of the parasites. The second case was hematemesis together with peritonitis. Exploration found volvulus and a gangrenous segment of the distal ileum. Both infants previously passed roundworms with their stool. The authors conclude that the intestinal ascariasis can be a cause of massive gastrointestinal bleeding, especially in temperate and tropical countries.

Multiparasite communities in animals and humans: frequency, structure and pathogenic significance

Individual humans and animals are subject to infection by a variety of parasites (broadly defined to include viruses, bacteria and other non-protozoan microparasites) at any one time. Multiple parasite infections occur frequently in populations of wild animals as well as in humans from developing countries. In some species and regions, hosts with multiple infections are more common than hosts with either no infection or a single infection. Studies, predominantly on animals, show that a wide variety of environmental and host-dependent factors can influence the structure and dynamics of the communities of parasites that make up these multiple infections. In addition, synergistic and competitive interactions can occur between parasite species, which can influence the likelihood of their successful transmission to other hosts and increase or decrease their overall pathogenic impact. This review summarises aspects of our current knowledge on the frequency of multiparasite infections, the factors which influence them, and their pathogenic significance.

Estimating the number of multiple-species geohelminth infections in human communities

Infections with Ascaris lumbricoides, Trichuris trichiura and the hookworm species are often found in the same communities and individuals. Hosts infected by more than one species are potentially at risk of morbidity associated with each infection. This paper describes the use of a probabilistic model to predict the prevalence of multiple-species infections in communities for which only overall prevalence data exist. The model is tested against field data, using log-linear analysis, and is found to be more effective at estimating the numbers of multiple infections involving hookworms than those involving only A. lumbicoides and T. trichiura. This latter combination of infections is found, in half the communities examined, to be more common than expected by chance. An age-stratified analysis reveals that the degree of interaction between these two infections does not alter significantly with age in the child age classes of a Malaysian population.

Predisposition to reinfection by intestinal helminths after chemotherapy in south Thailand

Rates of reinfection by the intestinal helminths hookworm, Ascaris lumbricoides and Trichuris trichiura after chemotherapy were studied in two villages in Phang-Nga Province, southern Thailand. It was found that intensity of infection levels attained after reinfection correlated positively with pretreatment intensities of infection for all parasites. This implies that certain persons in the community are predisposed to receiving high numbers of worms, due either to environmental or personal risk factors. Therefore, it would be advantageous to identify such persons and treat them preferentially. Targeted chemotherapy, however, should be combined with efforts to identify the risk factors that vary within the community and direct educational efforts or environmental intervention towards the section of the community most affected by the parasites.

Necator americanus in the DSN hamster: density-dependent expulsion of adult worms during primary infection

Neonatal hamsters were exposed to varying doses of Necator americanus larvae and changes in the stability of the resulting worm burdens were monitored over a period of 25 weeks. No change in worm burdens was evident for the first 5 weeks of infection, irrespective of the infection intensity, but the more heavily infected groups subsequently lost worms in a density-dependent manner. Male and female hamsters lost comparable proportions of their established parasite burdens indicating that there was no host sex-linked difference in this respect. By week 15 infections had stabilized and the residual worm burdens, usually a maximum of 30 worms survived for a considerably longer period of time. Initially the percentage of male worms varied from 45% to 50% but as infection progressed male worms comprised a significantly increasing proportion of the total worm burden. By week 25 the percentage of male worms was usually in excess of 60%. The growth of infected animals was not severely affected by N. americanus, even when heavy worm burdens established initially, but a significant effect was detected particularly in week 5, prior to worm loss, when the adult worms would have been feeding on intestinal tissues and causing blood loss for a period of about 2 weeks. The most severe depression in the packed cell volume was also recorded in week 5, indicating that anaemia had been initiated in infected hamsters. Whilst, the regulation of parasite burdens in weeks 5-10 post-infection may have resulted from host immunity, the persistence of the residual worm burdens, the marked density-dependent anaemia and the subtle effect on host weight, all reflected well-documented aspects of chronic human necatoriasis.