Tapeworms (cestodiasis)

Hymenolepis diminuta Infection in a Romanian Child from an Urban Area

Hymenolepis diminuta is primarily a rodent parasite that is ubiquitously distributed worldwide, but with only a few cases described as human infections. We report a case of Hymenolepis diminuta infection in a 15-month-old child, living in an urban setting, with no previous medical history. The patient presented with two episodes of seizures, and complaints of abdominal pain, vomiting, and diarrhea, with no apparent history of rodent contact. Furthermore, the patient’s gastrointestinal symptoms were linked to the emission of suspected tapeworm proglottids in the feces. After excluding other possible etiologies, a diagnosis of Hymenolepis diminuta infection was made, based on the examination of characteristic eggs in a concentrated stool specimen. The infant was successfully treated with praziquantel and fully recovered. After two weeks, the stool sample was free of Hymenolepis diminuta eggs. The clinical follow-up over the next 3 years was normal. Hymenolepis diminuta is rarely found in humans, and, when present, the infection is frequently asymptomatic. Abdominal pain, irritability, itching, eosinophilia, and seizures have also been reported. In this paper, we report, for the first time in the literature, an infection with Hymenolepis diminuta in a Romanian infant who had atypical neurological presentation, with full recovery, without subsequent neurological sequelae.

Prevalence of cestodes infection among school children of urban parts of Lower Dir district, Pakistan

Tapeworms of zoonotic importance have been described as a leading public health problem. Current research was aim to assess the prevalence of tapeworms among 5-12years school children residing in district Lower Dir, Pakistan from January 2019-December 2019. The wet mount preparation in saline/iodine/methods were used for stool examination. Data was analyzed using appropriate descriptive, static methods. Of the 400 children studied 71.7% were infected with one or more species of intestinal parasites. Single infection of cestode species was found in 69 individuals with 17.2% prevalence and multiple parasitic infections were identified in 19.7% (n=79/400) individuals. The multiple infection were comprised as 10% (n=40) double, 6.75% (n=27) triple and 3% (n=12) quadruple. A total of 9 species of helminths and one species of protozoan infection. Among the helminths Ascaris lumbricoides was the most prevalent 33.1% (n=95), Taenia saginata 22.6% (n=65), hookworm 19.8% (n=57), Hymenolepis nana 18.8% (n=54), Enterobius vermicularis and Hymenolepis diminuta 1.39% (n=4each), Trichuris trichura 1.04% (n=3), Toxocara spp 0.69% (n=2) and Schistosoma japonicum 0.34% (n=1) were reported. One protozoan species was Cryptosporidium spp 0.69% (n=2) in current study. In case of A.lumbricoides, hookworm, E.vermicularis, T.trichura, T.saginata, H.nana and H.diminuta the male children of below 8 years of age were highly infected. Other infections are reported in the same prevalence with slight difference if any. We conclude that there is a need for mass scale campaigns to create awareness regarding health and hygiene in children and the need for development of effective poverty control programs because deworming alone is not adequate to control parasitic infections.

Fatal Hymenolepis nana cestodiasis in a ring-tailed lemur (Lemur catta)

The cestode Hymenolepis nana is a common parasite of humans and mice. Fecal shedding in the absence of clinical disease has previously been reported in ring-tailed lemurs (Lemur catta). This report describes fatal, disseminated H. nana cestodiasis infection in an aged ring-tailed lemur in a zoological collection. The parasites were associated with severe multifocal to coalescing and regionally extensive pyogranulomatous hepatitis and moderate multifocal pneumonia. The morphology of the parasites was highly unusual. Profiles were variably sized, ellipsoid to irregularly serpiginous, lined by a thin tegument, and filled with lightly eosinophilic fibrillar stroma and numerous, round basophilic cells. Polymerase chain reaction targeting a portion of the 18S rRNA gene and DNA sequencing of the amplicon showed 100% homology with H. nana.

The Mouse Bile Duct Tapeworm, Hymenolepis Microstoma in Free-living Small Mammals in Slovakia: Occurrence and Genetic Analysis

The mouse bile duct tapeworm Hymenolepis microstoma, is a potentially zoonotic species with a wide variety of reported definitive hosts of rodent genera. In the present study the occurrence of H. microstoma in free-living small mammals in selected areas of Slovakia and the retrospective analysis of epidemiological data published in Slovakia were performed. Hymenolepis microstoma was detected in two animal species, the common shrew (Sorex araneus) and the European hamster (Cricetus cricetus) of 186 small mammals examined from two ecosystems, urban and natural ecosystem of national park. No mention about the presence of this parasite in Slovakia in the past was found following a bibliographical search. Partial sequences of the nuclear paramyosin gene showed the shrew isolate placed in a subclade together with H. microstoma from Portugal, with high bootstrap value for its differentiation from the sister species Hymenolepis nana. Similarly, the analysis of the nuclear ribosomal ITS region placed the hamster isolate in the cluster composed of H. microstoma from Australia, Spain and Portugal. The Slovak isolate was the most distinctive sample among available H. microstoma, differing in 1.4 - 1.9% of nucleotides from the remaining isolates. The difference (seven of 17 nucleotide positions) was partially due to indel polymorphisms associated with two and five nucleotides. To our knowledge, these are the first reports of H. microstoma in Central Europe and also the first record of infection in the common shrew. A recently indicated zoonotic potential of H. microstoma along with a possibility of its direct transmission between animals and/or humans without the need of intermediate hosts pose a public health concern in contaminated areas of Slovakia. The use of molecular techniques may substantially facilitate more thorough understanding of the epidemiological situation of H. microstoma and related tapeworms in various ecosystems of the country.

Morphological, Molecular, and Pathological Appraisal of Hymenolepis nana (Hymenolepididae) Infecting Laboratory Mice (Mus musculus)

Hymenolepis nana, typically a parasite found in conventionally established mouse colonies, has zoonotic potential characterized by autoinfection and direct life cycle. The objective of this study was to determine the rate of parasite infection in laboratory mice. The hymenolepidide cestode infected 40% of the 50 mice sampled. The rate of infection in males (52%) was higher than in females (28%). Morphological studies on the cestode parasite showed that worms had a globular scolex with four suckers, a retractable rostellum with 20-30 hooks, and a short unsegmented neck. In addition, the remaining strobila consisted of immature, mature, and gravid proglottids, irregularly alternating genital pores, lobulated ovaries, postovarian vitelline glands, and uteri with up to 200 eggs in their gravid proglottids. The parasite taxonomy was confirmed by using molecular characterization based on the sequence analysis of the mitochondrial cytochrome c oxidase subunit 1 (mtCOX1) gene. The parasite recovered was up to 80% identical to other species in GenBank. High blast scores and low divergence were noted between the isolated parasite and previously described H. nana (gb| AP017666.1). The phylogenetic analysis using the COX1 sequence places this hymenolepidid species of the order Cyclophyllidea.

Quantitative assessment of lesion load and efficacy of 3 cycles of albendazole in disseminated cysticercosis: a prospective evaluation

BACKGROUND

The management of disseminated cysticercosis is unclear and largely considered hazardous. The role of albendazole remains controversial in such patients.

METHODS

A tertiary care, University hospital-based prospective intervention study was conducted from December 2015 to December 2017. Patients with disseminated cysticercosis, defined as the presence of multiple viable neurocysticerci (≥ 3) in the brain along with involvement of an additional extra site, were included in the study. Patients with cysticercal encephalitis were excluded. A detailed evaluation, including ophthalmoscopy, ocular B scans, ultrasound abdomen, and X-rays were done. Albendazole was administered at a dose of 15 mg/kg/day in 3 cycles of 28 days each. All patients were also given adjuvant corticosteroids and anti-epileptic drugs. Clinical and radiological follow up was carried out at a difference of 3 months between each treatment cycle. For radiological quantification, lesions were counted at 10 pre-specified levels. Statistical analysis was done to estimate the difference in seizure frequency and lesion load.

RESULTS

Twenty-nine patients (21 with > 20 lesions; 8 with ≤ 20 lesions) were given albendazole as per the protocol. There was a significant reduction in the occurrence of seizures (P < 0.001) and headache (P < 0.001). A significant reduction in lesion load from baseline to third follow-up was seen in the estimations done at different levels (P < 0.001). No patient developed serious side-effect warranting cessation of therapy.

CONCLUSION

Cyclical use of albendazole appears efficacious in treating disseminated cysticercosis. The method of quantification described may be used in future studies for objective assessment.

TRIAL REGISTRATION

ISRCTN11630542; 28th September 2019; Retrospectively registered.

Molecular characterization of Hymenolepis nana based on nuclear rDNA ITS2 gene marker

Introduction

Hymenolepis nana is a zoonotic tapeworm with widespread distribution. The goal of the present study was to identify the parasite in the specimens collected from NorthWestern regions of Iran using PCR-sequencing method.

Methods

A total of 1521 stool samples were collected from the study individuals. Initially, the identification of hymenolepis nana was confirmed by parasitological method including direct wet-mount and formalin-ethyl acetate concentration methods. Afterward, PCR-sequencing analysis of ribosomal ITS2 fragment was targeted to investigate the molecular identification of the parasite.

Results

Overall, 0.65% (10/1521) of the isolates were contaminated with H. nana in formalin-ethyl acetate concentration. All ten isolates were succefully amplified by PCR and further sequenced. The determined sequences were deposited in GenBank under the accession numbers MH337810 -MH337819.

Conclusion

Our results clarified the presence of H. nana among the patients in the study areas. In addition, the molecular technique could be accessible when the human eggs are the only sources available to identify and diagnose the parasite.

A Case Report of an Intestinal Helminth Infection of Human Hymenolepiasis in Rural Gambia

Background

Hymenolepis nana, also called dwarf tapeworm infection, is an intestinal helminth not previously reported in The Gambia and only very rarely reported in West Africa.

Case presentation

We report a case of H. nana infection in a 29-month-old child living in a rural community of the north bank of the Upper River Region (URR) in The Gambia. The child presented with mild iron deficiency anaemia and granulocytosis but was otherwise mostly asymptomatic despite the moderate-intensity of infection.

Conclusions

We support treatment of H. nana infection even in largely asymptomatic children to prevent autoinfection and spread of this intestinal helminth in The Gambia and in other West African countries.

Abbreviations

GCP: Good Clinical Practice; HAZ: Height-for-age z-score; IHAT-GUT: Acronym for the Iron Hydroxide Adipate Tartrate Supplementation Study; ICH: International Conference on Harmonisation; SD: Standard Deviation; URR: Upper River Region; WAZ: Weight-for-age z-score; WHO: World Health Organization; WHZ: Weight-for-height z-score.

Diphyllobothrium latum Mimicking Subacute Appendicitis

Diphyllobothrium latum (D. latum) infection in humans is uncommon in the United States. Although there has been a drastic decline in the report of D. latum infection in this region, physicians should be aware of an uncommon presentation and its clinical relevance. We report a case of 55-year-old female of Ecuadorian/Peruvian origin who presented with an unknown cause of chronic right lower quadrant abdominal pain for 2 months without other particular symptoms. Initial workup revealed evidence of iron deficiency anemia, and stool occult blood test was positive. She was scheduled for a colonoscopy to assess the source of occult gastrointestinal bleeding. During her bowel preparation, she passed a 25 cm long white tapeworm-like material confirmed microscopically. Despite passing a worm she continued to have abdominal pain. During the colonoscopy, another worm was found lodged in the appendiceal orifice. The colonoscopic images revealed a segmented tapeworm showing contractile motility, approximately 12 cm in length and 6 mm wide in the appendiceal orifice. The scope was unsuccessful in removing the worm. The parasitological and microbiological examination of the passed worm was positive for D. latum. D. latum a fish tapeworm that infects humans after the ingestion of raw or undercooked fish. The patient had a history of often eating lightly marinated raw fish (“ceviche”) in Peru several months before presentation. It is uncommon for D. latum infection to present with iron deficiency anemia. As the worm absorbs approximately 80% of dietary vitamin B12, prolonged D. latum infection usually causes vitamin B12 deficiency and megaloblastic anemia, which is reported to affect about 40% of cases. Abdominal pain related to mechanical obstruction is reported, but this case is unique in that the worm preferentially attached to the appendiceal orifice causing subacute focal appendiceal pain. She was treated with a single dose of oral praziquantel. After the treatment, she developed minor cramping for the next 2 days which resolved by day 3, and recalled passing half-inch sized pieces of white tissue and subsequently improved. Although D. latum infection is an uncommon cause of chronic abdominal pain with iron deficiency anemia, it is crucial to consider because of the potentially treatable outcome.

The helminth community of a population of Rattus norvegicus from an urban Brazilian slum and the threat of zoonotic diseases

Urban slums provide suitable conditions for infestation by rats, which harbour and shed a wide diversity of zoonotic pathogens including helminths. We aimed to identify risk factors associated with the probability and intensity of infection of helminths of the digestive tract in an urban slum population of Rattus norvegicus. Among 299 rats, eleven species/groups of helminths were identified, of which Strongyloides sp., Nippostrongylus brasiliensis and, the human pathogen, Angiostrongylus cantonensis were the most frequent (97, 41 and 39%, respectively). Sex interactions highlighted behavioural differences between males and females, as eg males were more likely to be infected with N. brasiliensis where rat signs were present, and males presented more intense infections of Strongyloides sp. Moreover, rats in poor body condition had higher intensities of N. brasiliensis. We describe a high global richness of parasites in R. norvegicus, including five species known to cause disease in humans. Among these, A. cantonensis was found in high prevalence and it was ubiquitous in the study area - knowledge which is of public health importance. A variety of environmental, demographic and body condition variables were associated with helminth species infection of rats, suggesting a comparable variety of risk factors for humans.

Characterization of the complete mitochondrial genome of the cloacal tapeworm Cloacotaenia megalops (Cestoda: Hymenolepididae)

Background

The cloacal tapeworm Cloacotaenia megalops (Hymenolepididae) is one of the most common cestode parasites of domestic and wild ducks worldwide. However, limited information is available regarding its epidemiology, biology, genetics and systematics. This study provides characterisation of the complete mitochondrial (mt) genome of C. megalops.

Methods

The complete mt genome of C. megalops was obtained by long PCR, sequenced and annotated.

Results

The length of the entire mt genome of C. megalops is 13,887 bp; it contains 12 protein-coding, 2 ribosomal RNA and 22 transfer RNA genes, but lacks an atp8 gene. The mt gene arrangement of C. megalops is identical to that observed in Anoplocephala magna and A. perfoliata (Anoplocephalidae), Dipylidium caninum (Dipylidiidae) and Hymenolepis diminuta (Hymenolepididae), but differs from that reported in taeniids owing to the position shift between the tRNA (L1) and tRNA (S2) genes. The phylogenetic position of C. megalops was inferred using Maximum likelihood and Bayesian inference methods based on the concatenated amino acid data for 12 protein-coding genes. Phylogenetic trees showed that C. megalops is sister to Anoplocephala spp. (Anoplocephalidae) + Pseudanoplocephala crawfordi + Hymenolepis spp. (Hymenolepididae) indicating that the family Hymenolepididae is paraphyletic.

Conclusions

The complete mt genome of C. megalops is sequenced. Phylogenetic analyses provided an insight into the phylogenetic relationships among the families Anoplocephalidae, Hymenolepididae, Dipylidiidae and Taeniidae. This novel genomic information also provides the opportunity to develop useful genetic markers for studying the molecular epidemiology, biology, genetics and systematics of C. megalops.

Electronic supplementary material

The online version of this article (doi:10.1186/s13071-016-1782-0) contains supplementary material, which is available to authorized users.

Differential diagnosis and molecular characterization of Hymenolepis nana and Hymenolepis diminuta (Cestoda: Cyclophyllidea: Hymenolepididae) based on nuclear rDNA ITS2 gene marker

Given the widespread distribution and medical implication of members of the genus Hymenolepis, specific identification of the aetiological agent becomes imperative. For precise diagnosis of the species, molecular techniques such as PCR and RFLP of the nuclear ribosomal internal transcribed spacer 2 (rDNA-ITS2) gene marker were carried out. The results showed distinct restriction patterns for both Hymenolepis nana and Hymenolepis diminuta when digested with either of the enzymes RsaI, HaeIII or HhaI. The annotated rDNA-ITS2 sequences from the two species revealed differences in the length; the folded secondary structure also depicted clear demarcation between the two species with variations in length of the helices, pyrimidine-pyrimidine mismatches and sites where motifs occur. In phylogenetic analysis of the evolutionary relationship between the two species as well as with other members of the family Hymenolepididae, the species causing human hymenolepiasis were found to be distantly related as they diverged independently from the ancestral lineage.

The prevalence of Hymenolepis nana among preschool children of displacement communities in Khartoum state, Sudan: a cross-sectional study

BACKGROUND

Hymenolepis nana is among the most common intestinal parasitic infections causing a public health threat in poor communities in Sub-Saharan Africa. The present study was conducted to determine the prevalence of H. nana infections and associated risk factors among preschool children of displacement communities in Khartoum state, Sudan.

METHODS

A cross-sectional survey was conducted in May 2013 in displacement camps, Khartoum state, Sudan. A simple random sample of preschool children from the displacement camps, aged between 1 and 5 years, were included. Information was collected by presenting a questionnaire and taking 500 fresh stool specimens which were examined microscopically for the presence of eggs, using direct saline and formal-ether concentration techniques.

RESULTS

The prevalence of H. nana was determined to be 32.6% (163/500), 95% CI (28.5%-36.9%). Infections of H. nana were more prevalent among males than females, and this association was statistically significant (P < 0.001, OR = 2.125, 95% CI = 1.452-3.108). H. nana infections were significantly prevalent among the older age group (2.6-5.0 years) (P < 0.001, OR = 2.909, 95% CI = 1.914-4.420). Approximately 76.7% of infected preschool children had diarrhea and it was significantly associated with H. nana infection (P < 0.001, OR = 9.45, 95% CI = 6.10-14.64). None of the preschool children had access to a clean water supply. No significant association was found between use of latrines and infections of H. nana (P = 0.56, OR = 0.880, 95% CI = 0.73-1.763).

CONCLUSIONS

There was a high prevalence rate of H. nana infection among preschool children of displacement camps in Khartoum state, Sudan. Being male, aged between 2.6 and 5.0 years, and having diarrhea were identified as important risk factors for H. nana infection. Measures including health education, environmental hygiene, water supply and treatment should be taken into account to reduce the high prevalence of H. nana.

Zoonotic helminths of urban brown rats (Rattus norvegicus) in the UK: neglected public health considerations?

Urban brown rats (Rattus norvegicus) carry microbial human pathogens but their role as reservoir hosts for helminths of public health importance is less well known. In this study, 42 brown rats trapped on Merseyside were subject to thorough combined helminthological and pathohistological post-mortem examination. Eggs of the rodent-borne zoonotic nematode Calodium hepaticum were initially detected in histological sections of the livers of 9.5% of rats, but overall diagnostic sensitivity increased to 16.6% when entire liver tissue was disrupted and the resulting filtrates were examined for released eggs. In their rat host, mainly trapped inside the dockland, infections with C. hepaticum were associated with a chronic multifocal pyogranulomatous hepatitis with intralesional eggs and peripheral fibrosis. Mean intensity of hepatic C. hepaticum egg infections was 1041 eggs. This is the first report of C. hepaticum in an urban brown rat population in the UK and provides original data for liver egg burdens in this abundant commensal rodent. The zoonotic cestode Rodentolepis nana had a prevalence of infection of 14.3%. Rodent-specific, non-zoonotic helminths found were the spiruroid Mastophorus muris (16.0%) in the stomach, the trichuroid Trichosomoides crassicauda in the urinary bladder (31.0%); the ascarid Heterakis spumosa was the commonest helminth of the large intestine (76.2%). Many millions of brown rats inhabit cities and rural areas of the UK, and the infective stages of the zoonotic worm species, particularly C. hepaticum, are likely to be widely distributed in the environment presenting a threat to public health.

Transcription profiling of immune genes during parasite infection in susceptible and resistant strains of the flour beetles (Tribolium castaneum)

The flour beetle, Tribolium castaneum, is an intermediate host for the tapeworm Hymenolepis diminuta and has become an important genetic model to explore immune responses to parasite infection in insect hosts. The present study examined the immune responses to tapeworm infection in resistant (TIW1) and susceptible (cSM) strains of the red flour beetle, T. castaneum, using real-time quantitative reverse transcription PCR on 29 immunity-related genes that exhibit antimicrobial properties. Thirteen of the 29 genes showed constitutive differences in expression between the two strains. Fourteen to fifteen of the 29 genes exhibited significant differences in transcription levels when beetles were challenged with tapeworm parasite in the resistant and susceptible strains. Nine genes (GNBP3, cSPH2, lysozyme4, defensin1, PGRP-SA, defensin2, coleoptericin1, attacin2 and serpin29) in cSM and 13 genes (lysozyme2, proPO1, GNBP3, cSPH2, lysozyme4, defensin1, PGRP-SA, defensin2, coleoptericin1, attacin2, proPO2/3, PGRP-LE and PGRP-SB) in TIW1 were up-regulated by infections or showed parasite infection-induced expression. Seven genes (attacin2, coleoptericin1, defensin1, defensin2, lysozyme2, PGRP-SA and PGRP-SB) were more than 10 folds higher in the resistant TIW1 strain than in the susceptible cSM strain after exposure to tapeworm parasites. This study demonstrated the effects of genetic background, the transcription profile to parasite infection, and identified the immunity-related genes that were significantly regulated by the infection of tapeworms in Tribolium beetles.

Geographic correlation between tapeworm carriers and heavily infected cysticercotic pigs

Background

Neurocysticercosis is a leading cause of preventable epilepsy in the developing world. Sustainable community-based interventions are urgently needed to control transmission of the causative parasite, Taenia solium. We examined the geospatial relationship between live pigs with visible cysticercotic cysts on their tongues and humans with adult intestinal tapeworm infection (taeniasis) in a rural village in northern Peru. The objective was to determine whether tongue-positive pigs could indicate high-risk geographic foci for taeniasis to guide targeted screening efforts. This approach could offer significant benefit compared to mass intervention.

Methods

We recorded geographic coordinates of all village houses, collected stool samples from all consenting villagers, and collected blood and examined tongues of all village pigs. Stool samples were processed by enzyme-linked immunosorbent assay (ELISA) for presence of Taenia sp. coproantigens indicative of active taeniasis; serum was processed by enzyme-linked immunoelectrotransfer blot for antibodies against T. solium cysticercosis (EITB LLGP) and T. solium taeniasis (EITB rES33).

Findings

Of 548 pigs, 256 (46.7%) were positive for antibodies against cysticercosis on EITB LLGP. Of 402 fecal samples, 6 (1.5%) were positive for the presence of Taenia sp. coproantigens. The proportion of coproantigen-positive individuals differed significantly between residents living within 100-meters of a tongue-positive pig (4/79, 5.1%) and residents living >100 meters from a tongue-positive pig (2/323, 0.6%) (p = 0.02). The prevalence of taeniasis was >8 times higher among residents living within 100 meters of a tongue-positive pig compared to residents living outside this range (adjusted PR 8.1, 95% CI 1.4–47.0).

Conclusions

Tongue-positive pigs in endemic communities can indicate geospatial foci in which the risk for taeniasis is increased. Targeted screening or presumptive treatment for taeniasis within these high-risk foci may be an effective and practical control intervention for rural endemic areas.

Taenia solium, aka the pork tapeworm, is an important cause of epilepsy in developing nations. People with intestinal tapeworms, a condition known as taeniasis, pass infectious eggs in their feces which contaminate the environment. These eggs can cause serious disease in both humans and pigs if they are ingested. Treating taeniasis is one way to potentially control transmission of the parasite in affected communities. However, this is difficult because people with taeniasis usually have no symptoms and therefore don't know they are infected. As a result, control programs may resort to offering treatment to entire communities in order to reach a few tapeworm carriers. Focusing detection and treatment on high-risk subgroups is another approach which might reduce unnecessary treatments. In this study, we found that people with taeniasis are more likely to be found living nearby pigs with visible signs of infection, specifically tapeworm cysts on their tongues. This suggests that routine tongue examination by pig owners and buyers could identify neighborhoods where detection and treatment of taeniasis may be more efficient.

FLOTAC for the diagnosis of Hymenolepis spp. infection: proof-of-concept and comparing diagnostic accuracy with other methods

Hymenolepis nana is the most common cestode parasitizing humans, yet it is under-diagnosed. We determined the optimal flotation solution (FS) for the diagnosis of this intestinal parasite with the FLOTAC method, and compared its diagnostic accuracy with an ether-concentration technique and the Kato-Katz method. Zinc sulphate (specific gravity 1.20) proved to be the best-performing FS. Using this FS, we detected 65 H. nana infections among 234 fixed fecal samples from Tajik and Sahrawi children (prevalence 27.8 %). The ether-concentration technique detected 40 infections (prevalence 17.1 %) in the same samples. Considering the combined results as a reference, the sensitivities of FLOTAC and ether-concentration were 95.6 % and 58.8 %, respectively. The Kato-Katz method resulted in a prevalence of only 8.7 %. In terms of eggs per gram of stool, a significantly (P <0.05) higher value was obtained with the FLOTAC and Kato-Katz techniques compared to ether-concentration. In another study carried out in China, the FLOTAC method detected six Hymenolepis diminuta infections in 302 fecal samples, whereas five samples were found positive with the Kato-Katz technique. We conclude that FLOTAC is an accurate coprodiagnostic technique for H. nana and H. diminuta, two species which join a growing list of intestinal parasites that can be reliably diagnosed by this technique.

Cysticercosis control: bringing advances to the field

Progress towards Taenia solium control is evident in the development of new technologies and in increasing regional coordination, yet disease eradication remains unlikely in the near future. In the meantime, translation of research advances into functioning control programs is necessary to address the ongoing disease burden in endemic areas. Multiple screening assays, effective treatments for both human and porcine infection, and vaccines blocking transmission to pigs are currently available. Strategies based on identification and treatment of T. solium adult tapeworms, as well as interventions that block cysticercosis acquisition in pigs have temporarily reduced transmission. Building on these successes with controlled community trials in varying endemic scenarios will drive progress towards regional elimination.

Diphyllobothrium latum: A case of an incidental finding

Colorectal cancer screening can be performed by fecal occult blood testing, sigmoidoscopy, double contrast barium enema or colonoscopy. Colonoscopy has the significant advantage that polyps can be removed during the same procedure. Occasionally, colonoscopy can also reveal unexpected findings, including parasitic infections, even in asymptomatic patients. Tapeworms or cestodes are hermaphroditic parasites, which can live for considerable periods of time in the human gastrointestinal tract. Fish tapeworm (Diphyllobothrium species) are endemic in various parts of the world, the commonest species being Diphyllobothrium latum. Humans are the main definitive host for D. Latum and the majority of individuals harbouring the parasite are asymptomatic, while 40% of infected individuals may have low vitamin B12 levels. We describe a case of D. latum infection found on routine colonoscopic screening for colorectal cancer in an asymptomatic patient, which was successfully treated with praziquantel. The infection likely arose following raw fish (sushi) consumption.

Hymenolepis nana infection: symptoms and response to nitazoxanide in field conditions

A matched case-control study on clinical symptoms of Hymenolepis nana and an open trial of nitazoxanide treatment were conducted in a village on the northern coast of Peru. Interview data were obtained from 25 individuals with hymenolepiasis only and 46 matched controls. Individuals with other intestinal helminths or giardiasis were excluded. Twenty nitazoxanide-treated cases were followed with stool examination a month later. There were no significant differences between groups in the prevalence of symptoms except headache, which was less frequent in the cases. Treatment efficacy was 75%. Hymenolepiasis in this community did not have significant impact on specific symptoms.

Vitamin B12 deficiency as a worldwide problem

Pernicious anemia is a common cause of megaloblastic anemia throughout the world and especially in persons of European or African descent. Dietary deficiency of vitamin B12 due to vegetarianism is increasing and causes hyperhomocysteinemia. The breast-fed infant of a vitamin B12-deficient mother is at risk for severe developmental abnormalities, growth failure, and anemia. Elevated methylmalonic acid and/or total homocysteine are sensitive indicators of vitamin B12-deficient diets and correlate with clinical abnormalities. Dietary vitamin B12 deficiency is a severe problem in the Indian subcontinent, Mexico, Central and South America, and selected areas in Africa. Dietary vitamin B12 deficiency is not prevalent in Asia, except in vegetarians. Areas for research include intermittent vitamin B12 supplement dosing and better measurements of the bioavailability of B12 in fermented vegetarian foods and algae.

Detection of the rodent tapeworm Rodentolepis (=Hymenolepis) microstoma in humans. A new zoonosis?

A longitudinal survey of gastro-intestinal parasites was conducted over a 3-year period in remote communities in the north-west of Western Australia where, based on diagnosis by microscopy of faecal samples, Rodentolepis (=Hymenolepis) nana was found to be the most common enteric parasite. In the present study, using molecular tools, we describe the unexpected discovery, of a mixed infection with a second hymenolepidid species, Rodentolepis (=Hymenolepis) microstoma in four of the surveyed individuals. In the absence of any reliable earlier reports we believe this is to be the first instance of the detection of R. microstoma from human hosts. The development of a diagnostic restriction fragment polymorphism has enabled the study of R. microstoma in human populations and will greatly facilitate a more thorough understanding of the epidemiology of this parasite in the future.

Failure to infect laboratory rodent hosts with human isolates of Rodentolepis (= Hymenolepis) nana

Confusion exists over the species status and host-specificity of the tapeworm Rodentolepis (= Hymenolepis) nana. It has been described as one species, R. nana, found in both humans and rodents. Others have identified a subspecies; R. nana var. fraterna, describing it as morphologically identical to the human form but only found in rodents. The species present in Australian communities has never been identified with certainty. Fifty one human isolates of Rodentolepis (= Hymenolepis) nana were orally inoculated into Swiss Q, BALB/c, A/J, CBA/ CAH and nude (hypothymic) BALB/c mice, Fischer 344 and Wistar rats and specific pathogen free (SPF) hamsters. Twenty four human isolates of R. nana were cross-tested in flour beetles, Tribolium confusum. No adult worms were obtained from mice, rats or hamsters, even when immunosuppressed with cortisone acetate. Only one of the 24 samples developed to the cysticercoid stage in T. confusum; however, when inoculated into laboratory mice the cysticercoids failed to develop into adult worms. The large sample size used in this study, and the range of techniques employed for extraction and preparation of eggs provide a comprehensive test of the hypothesis that the human strain of R. nana is essentially non-infective to rodents.

Parasitic infections of the gastrointestinal tract

Parasitic infections of the gastrointestinal tract are a major cause of morbidity and mortality worldwide. Increased international travel means that gastroenterologists are now more likely to care for patients with parasitic diseases. This article reviews various aspects of the more common intestinal parasites and their infections, including epidemiology, life cycle, pathogenesis, clinical manifestations, diagnosis, and treatment.

The Impact of General Laboratory Animal Health on Experimental Models in Antimicrobial Chemotherapy

This chapter describes how the poor health of a laboratory animal can adversely the experimental models used in antimicrobial research. Concerns for the health of laboratory animals have mostly focused on spontaneous infections, although disease in laboratory animals may also be caused by genetic or environmental determinants. The presence of various pathogenic microorganisms may cause changes in the organs, resulting in difficulties in the interpretation of the pathological diagnosis included in the evaluation of many microbiological models. The immune system may be modulated by spontaneous infections in the absence of clinical disease. This effect may be either suppressive or activating or both at the same time, but on different parts of the immune system. Some microorganisms have a specific effect on enzymatic, haematological, and other parameters, which are monitored in the animal during an experiment. Organic function disturbances may change the outcome of the experiment without the knowledge of the scientist. Spontaneous infections in an experimental infection model may also compete with the experimental infection, which in the worst cases may fail. Microorganisms present in the animal may contaminate samples and tissue specimens, such as cells and sera. This may complicate the in vitro maintenance of cell lines, and may interfere with experiments performed on cell cultures or isolated organs. To avoid disease, microbial interference, and zoonoses, laboratory animals are produced according to a three-step principle, which include rederivation, barrier protection, and health monitoring. Rederivation means the production of animals to initiate breeding colonies by either caesarian section or embryo transfer.