Parasitic infections in relation to practices and knowledge in a rural village in Northern Thailand with emphasis on fish-borne trematode infection

Gastrointestinal Helminthic Infection among the Population in Northern Thailand

PURPOSE

Gastrointestinal (GI) helminthic infections pose substantial public health threat, particularly in northern Thailand, with a heightened concern in Nan province. This study aims to evaluate the prevalence of GI helminthic infections in Nan province and identify associated risk factors in local population.

METHODS

A cross-sectional survey was conducted in 2022. Fecal specimens were collected and examined using Kato-Katz technique and Formalin Ethyl-Acetate Concentration Technique (FECT). Univariate analysis employed the Chi-square test to explore correlations, while logistic regression was defined risk factors associated with parasite infections.

RESULTS

Among 739 individuals surveyed, 14.34% were revealed GI helminthic infections. Notably, infection rates were higher in males (20.40%) compared to females (8.95%), with a notable prevalence among individuals aged ≥ 60 (17.78%) and high infection rate was demonstrated in Kiew Chan village (21.67%). The most commonly detected helminths were minute intestinal flukes (MIFs) (10.01%) and Capillaria spp. (3.11%). Males were significantly associated with GI helminthic infections, while individuals aged 40-49 and aged 50-59 commonly displayed of parasite infections. Additionally, Kiew Chan village exhibited a significant association with GI helminthic infections, followed by Sop Puen village. Furthermore, fecal specimens of 13 rodent specimens were frequency revealed Strongyloides spp. (92.30%) and mostly exposed Ancylostoma caninum (41.93%) among 93 canines.

CONCLUSION

These findings highlight the imperative for immediate public health interventions in Nan province and analogous areas in northern Thailand. Implementing strategies to enhance sanitation infrastructure and promote hygiene education can significantly contribute for reducing the prevalence of GI helminthic infections and improve overall community health.

Paragonimiasis

Paragonimiasis is a zoonotic disease caused by lung flukes of the genus Paragonimus. Humans usually become infected by eating freshwater crabs or crayfish containing encysted metacercariae of these worms. However, an alternative route of infection exists: ingestion of raw meat from a mammalian paratenic host. Adult worms normally occur in pairs in cysts in the lungs from which they void their eggs via air passages. The pulmonary form is typical in cases of human infection due to P. westermani, P. heterotremus, and a few other species. Worms may occupy other sites in the body, notably the brain, but lung flukes have made their presence felt in almost every organ. Ectopic paragonimiasis is particularly common when infection is due to members of the P. skrjabini complex. Human paragonimiasis occurs primarily in the tropics and subtropics of Asia, Africa, and the Americas, with different species being responsible in different areas (Table 6.1).

Current prevalence and geographic distribution of helminth infections in the parasitic endemic areas of rural Northeastern Thailand

BACKGROUND

Helminth infection is a global health issue that not only causes acute helminthiasis but long-term infection may lead to complicated symptoms as well as severe complications. The World Health Organization cooperated with the Ministry of Public Health in many countries, particularly where high prevalence, spending a lot of resources for limiting the infection. In Thailand, the incidence of parasitic helminth infections was continuously declined in the last few decades according to several campaigns for parasitic elimination. However, the rural community in the northeast of Thailand where the highest prevalence of the country still needs to be monitored. This present study aims to report the current prevalence of parasitic helminth infections in Nakhon Ratchasima and Chaiyaphum provinces where sharing a huge area of the northeastern region of Thailand but only a few studies have been published.

METHODS

The stool specimens were collected from 11,196 volunteers and processed by modified Kato-Katz thick smear, PBS-ethyl acetate concentration techniques, and PCR. The epidemiological data were collected, analyzed, and used for generating of parasitic hotspots.

RESULTS

The results indicated that O. viverrini remains the major parasite in this area with a total prevalence of 5.05% followed by Taenia spp., Hookworms, T. trichiura, and Echinostoma spp., respectively. Mueang district of Chaiyaphum province has the highest prevalence especially O. viverrini with a prevalence of 7.15% that higher than the latest national surveillance. Interestingly, the prevalence of O. viverrini was hugely reported (more than 10%) in five subdistricts. The geographic localization of O. viverrini infections revealed that a lot of water reservoirs such as the lakes or branches of the river in the two-most prevalent subdistricts. Our finding indicated that gender and age were insignificantly different.

CONCLUSION

This finding suggested that the parasitic helminth infection in the rural areas of northeast of Thailand remains high and the housing location is a major contributing factor for the parasitic infection.

Prevalence and Associated Risk Factors of Intestinal Parasitic Infections: A Population-Based Study in Phra Lap Sub-District, Mueang Khon Kaen District, Khon Kaen Province, Northeastern Thailand

Intestinal parasitic infections are still a crucial problem among communities in Northeast Thailand. Misuse of antiparasitic drugs and unhealthy food behaviors are known. This study aimed to explore the prevalence, behavioral health factors, and motivation for self-treatment of anti-parasitic drugs in this area. A community-based cross-sectional study was conducted in Phra Lap sub-district, Mu Khon Kaen district, Khon Kaen province, Northeast Thailand, in 2016. A total of 419 participants were recruited to complete a self-administered questionnaire and stool examination. Binary logistic regression was used to assess the association between the risk factor and parasitic infection. Forty-two participants (10%; 95%CI 7.5-13.3) were positive for at least one parasite species. In this community, the most detected intestinal parasite was Opisthorchis viverrini (5.3%), followed by Strongyloides stercoralis (3.1%). A total of 67.5% of the participants had the experience of anti-parasitic drug treatment within previous 1 year, and "Often eat raw food" was the most common reason for the use of anti-parasitic drugs. On multivariate analysis, parasitic infections were significantly associated with male gender (ORadj. 2.42; 95%CI 1.00-5.85), age ≥ 60 years (ORadj. 7.55; 95%CI 1.60-35.76), and often consuming raw food of at least one type (ORadj. 2.37; 95%CI 1.03-5.44). Given these findings, correction of the dietary habit of eating raw fish/meat, which is the most important measure, and limitation of the use of anthelmintic treatment for individuals with stools positive for ova as well as emphasis on sanitary toilets will be implemented for the prevention and control of parasitic infection in endemic communities.

Lung flukes of the genus Paragonimus: ancient and re-emerging pathogens

The title of this article refers to Table 1 in Zhou (2022, Infectious diseases of poverty: progress achieved during the decade gone and perspectives for the future. Infectious Diseases of Poverty 11, 1), in which it is indicated that Paragonimus species, like many other foodborne trematodes, are ancient pathogens that are also re-emerging to cause disease in modern times. This article provides a general overview of Paragonimus species and the disease they cause. This is followed by comments on several specific topics of current interest: taxonomy and distribution of members of the genus; details of the life cycle; global and regional prevalence of paragonimiasis; genomics of lung flukes and possible effects of global environmental change. Unresolved questions relating to these topics are discussed and gaps in knowledge identified.

Infection rate of Opisthorchis viverrini metacercariae in cyprinoid fish from the markets and its association to human opisthorchiasis in the local community in the Northeast Thailand

The prevalence of Opisthorchis viverrini, a fish-borne zoonotic trematode that can provoke cholangiocarcinoma, is high in the Northeast Thailand. The aim of this study was to determine the prevalence of O. viverrini metacercariae in the cyprinid fish and determine its association of O. viverrini infection among the consumers who regularly buy fish in the markets. A cross-sectional study was conducted in nine provinces covering 20 districts of Thailand, and we examined 778 cyprinoid fish specimens belonging to five species purchased from local markets. Pepsin-HCl digestion method was used to recover O. viverrini metacercariae from fish. In all districts surveyed, O. viverrini metacercariae-positive fish were found with the infection rates ranging from 3.9 to 21.1%. All five fish species studied were positive for O. viverrini metacercariae: Henicorhynchus siamensis (13.7%), Cyclocheilichtys spp. (12.7%), Hampala spp. (8.1%), Systomus spp. (6.9%) and Barbonymus goniatus (5.0%). An average prevalence of O. viverrini infection was 7.1% in the fish consumers surveyed in the markets. The source of fish was determined and our results showed that parasitized fish are sold in markets up to 100 km away from the point of capture, which contributes to the dispersion and maintenance of this helminthiasis. Our results point to the transmission of liver flukes via markets, in spite of many active programs of health education, elimination, prevention and control aimed to reduce O. viverrini infection and subsequent cholangiocarcinoma in the endemic areas of Thailand.

A risk scoring system for seafood supply chain breaches and examination of freshwater fish imported to Australia

Legislative changes have altered the way imported edible seafood is inspected in Australia. Greater onus of responsibility has been placed on exporting countries to provide documentary evidence of adherence to internally recognized food safety standards. According to global trade agreements, any additional safety tests applied to freshwater fish imported into Australia must be justified. Therefore, the aim of this study was to develop a risk scoring method to provide justification for identifying countries as ‘Freshwater fish high risk’ and to examine the seafood they export to Australia for seafood supply chain breaches. Scoring was conducted using six predictor variables, identified in the literature as important contributors to seafood supply chain breaches, to achieve the outcome variable, Country considered ‘Freshwater fish high risk’. Sixty-seven fish fillets (9.55 kg) of the same species were examined from the third highest scoring country (Country 20) and 562 (5.6 kg) whole fish from the sixth highest scoring country (Country 22). Country 20 had supply chain breaches of 28 macroscopic yellow cysts in one fillet. Two hundred and thirteen parasites and other supply chain breaches were identified in fish from Country 22, including retained liver (91 per cent), visible mud (11 per cent), a variety of debris (16 per cent) and, depending on the commodity code, these fish were imported to Australia under full intestine (90 per cent), retained gills (89 per cent), and partial intestine (9 per cent). Three serious physical hazards were recovered from the edible portion of three ‘consumer-ready’ fish and snails of Genus Lymnaea and Indoplanorbis were recovered from gill mud also from ‘consumer-ready’ fish. The study showed variable results from the scoring system and vast differences in seafood supply chain breaches between the third and sixth highest scoring countries.

Analysis of D-A locus of tRNA-linked short tandem repeats reveals transmission of Entamoeba histolytica and E. dispar among students in the Thai-Myanmar border region of northwest Thailand

Intestinal parasitic infections, including those caused by Entamoeba species, are a persistent problem in rural areas of Thailand. The aims of this study were to identify pathogenic Entamoeba species and to analyze their genotypic diversity. Stool samples were collected from 1,233 students of three schools located in the Thai-Myanmar border region of Tak Province, Thailand. The prevalence of Entamoeba infection was measured by polymerase chain reaction (PCR) using species-specific primers. Thirty-one (2.5%) positive cases were detected for E. histolytica, 55 (4.5%) for E. dispar, and 271 (22.0%) for E. coli. Positive samples for E. histolytica and E. dispar were exclusively obtained from a few school classes, whereas E. coli was detected in all grades. No infections caused by E. moshkovskii, E. nuttalli, E. chattoni, and E. polecki were detected in the students studied. The D-A locus of tRNA-linked short tandem repeats was analyzed in samples of E. histolytica (n = 13) and E. dispar (n = 47) to investigate their diversity and potential modes of transmission. Five genotypes of E. histolytica and 13 genotypes of E. dispar were identified. Sequences of the D-A were divergent, but several unique genotypes were significantly prevalent in limited classes, indicating that intra-classroom transmission has occurred. As it was unlikely that infection would have been limited within school classes if the mode of transmission of E. histolytica and E. dispar had been through the intake of contaminated drinking water or food, these results suggest a direct or indirect person-to-person transmission mode within school classes. Positive rates for three Entamoeba species were 2-fold higher in students who had siblings in the schools than in those without siblings, suggesting that transmission occurred even at home due to heavy contacts among siblings.

Transmissions in endemic areas of the pathogen Entamoeba histolytica and other non-pathogenic Entamoeba species such as E. dispar and E. coli are caused by ingestion of drinking water and foods contaminated with cysts of the parasites. Cases of Entamoeba infections among school-aged children have been reported in several countries. However, it has not been demonstrated that transmission of protozoa of the Entamoeba genus occurs within school facilities. In addition, genetic information on E. histolytica and other morphologically indistinguishable species, including E. dispar and E. moshkovskii, in Thailand remains scarce. In the present study, we demonstrated that E. histolytica and/or E. dispar are prevalent among school-aged children, but limited to few classes in three rural schools in the Thai-Myanmar border region of northwest Thailand. Although various genotypes of these Entamoeba species were identified, identical genotypes were significantly more prevalent in certain school classes and also among siblings, suggesting that transmission occurred within the classrooms and at home. The possibility of person-to-person transmission among these students via direct or indirect contact during daily activities in classrooms and home is proposed.

Monitoring Silent Spillovers Before Emergence: A Pilot Study at the Tick/Human Interface in Thailand

Emerging zoonoses caused by previously unknown agents are one of the most important challenges for human health because of their inherent inability to be predictable, conversely to emergences caused by previously known agents that could be targeted by routine surveillance programs. Emerging zoonotic infections either originate from increasing contacts between wildlife and human populations, or from the geographical expansion of hematophagous arthropods that act as vectors, this latter being more capable to impact large-scale human populations. While characterizing the viral communities from candidate vectors in high-risk geographical areas is a necessary initial step, the need to identify which viruses are able to spill over and those restricted to their hosts has recently emerged. We hypothesized that currently unknown tick-borne arboviruses could silently circulate in specific biotopes where mammals are highly exposed to tick bites, and implemented a strategy that combined high-throughput sequencing with broad-range serological techniques to both identify novel arboviruses and tick-specific viruses in a ticks/mammals interface in Thailand. The virome of Thai ticks belonging to the Rhipicephalus, Amblyomma, Dermacentor, Hyalomma, and Haemaphysalis genera identified numerous viruses, among which several viruses could be candidates for future emergence as regards to their phylogenetic relatedness with known tick-borne arboviruses. Luciferase immunoprecipitation system targeting external viral proteins of viruses identified among the Orthomyxoviridae, Phenuiviridae, Flaviviridae, Rhabdoviridae, and Chuviridae families was used to screen human and cattle Thai populations highly exposed to tick bites. Although no positive serum was detected for any of the six viruses selected, suggesting that these viruses are not infecting these vertebrates, or at very low prevalence (upper estimate 0.017% and 0.047% in humans and cattle, respectively), the virome of Thai ticks presents an extremely rich viral diversity, among which novel tick-borne arboviruses are probably hidden and could pose a public health concern if they emerge. The strategy developed in this pilot study, starting from the inventory of viral communities of hematophagous arthropods to end by the identification of viruses able (or likely unable) to infect vertebrates, is the first step in the prediction of putative new emergences and could easily be transposed to other reservoirs/vectors/susceptible hosts interfaces.