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Hon KL, Leung AKC. An update on the current and emerging pharmacotherapy for the treatment of human ascariasis. Expert Opin Pharmacother 2024. [PMID: 38372051 DOI: 10.1080/14656566.2024.2319686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Accepted: 02/13/2024] [Indexed: 02/20/2024]
Abstract
INTRODUCTION Globally, Ascaris lumbricoides is the commonest helminthic infection that affects people in underdeveloped countries and returning immigrants in industrialized nations. This article aims to provide latest updates on the epidemiology, clinical manifestations, and pharmacotherapy of ascariasis. AREAS COVERED A PubMed search was conducted using Clinical Queries and the key terms 'human ascariasis' OR 'Ascaris lumbricoides.' Ascaris lumbricoides is highly endemic in tropical and subtropic regions and among returning immigrants in industrialized nations. Predisposing factors include poor sanitation and poverty. The prevalence is greatest in young children. Most infected patients are asymptomatic. Patients with A. lumbricoides infection should be treated with anti-helminthic drugs to prevent complications from migration of the worm. Mebendazole and albendazole are indicated for children and nonpregnant women. Pregnant individuals should be treated with pyrantel pamoate. EXPERT OPINION Cure rates with anthelmintic treatment are high. No emerging pharmacotherapy can replace these existing drugs of good efficacy, safety profile and low cost for public health. It is opinioned that advances in the management of ascariasis include diagnostic accuracy at affordable costs, Emodepside is highly effective in single doses against ascarids in mammals and in human trials. The drug could be registered for human use in multiple neglected tropical diseases.
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Affiliation(s)
- Kam Lun Hon
- Department of Paediatrics, The Chinese University of Hong Kong, and Department of Paediatrics and Adolescent Medicine, Hong Kong Children's Hospital, Hong Kong, China
| | - Alexander K C Leung
- Department of Pediatrics, The University of Calgary and the Alberta Children's Hospital, Calgary, Alberta, Canada
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Hailu S, Ayinie A, Tegegn E, Regasa T. A rare case of intestinal obstruction secondary to bolus of Ascaris Lumbricoides infestation: A case report and review of the literatures. INTERNATIONAL JOURNAL OF SURGERY OPEN 2022. [DOI: 10.1016/j.ijso.2022.100504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Romano G, Pepe P, Cavallero S, Cociancic P, Di Libero L, Grande G, Cringoli G, D'Amelio S, Rinaldi L. Ascariasis in a 75-year-old man with small bowel volvulus: a case report. BMC Infect Dis 2021; 21:1045. [PMID: 34627151 PMCID: PMC8501712 DOI: 10.1186/s12879-021-06718-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 09/22/2021] [Indexed: 11/10/2022] Open
Abstract
Background Ascaris lumbricoides and Ascaris suum are the most common soil-transmitted helminths of humans and pigs, respectively. The zoonotic potential of A. suum has been a matter of debate for decades. This study was aimed to present a case of human ascariasis caused by A. suum in southern Italy. Case presentation A 75-year-old man presented to the department of surgery in Avellino (southern Italy) complaining of abdominal pain and vomiting. Physical examination revealed bloating and abdominal tenderness. A computed tomography scan showed air-fluid levels and small bowel distension. During exploratory laparotomy a small bowel volvulus with mesenteritis was evident and surprisingly an intraluminal worm was detected. The worm was removed with a small enterotomy and identified as an adult female of A. suum based on morphological and molecular analysis. Faecal examination revealed the presence of unfertilized Ascaris eggs with an intensity of 16 eggs per gram (EPG) of faeces. The patient was treated with mebendanzole 100 mg twice a day for 3 days. The post-operative course was regular with re-alimentation after 3 days and discharge after 12 days. Conclusions This report shows as A. suum can function as a relevant agent of human zoonosis. Therefore, in patients with bowel obstruction with no evident aetiology a helminthic infestation should be considered for an accurate diagnosis, especially in patients living in rural areas.
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Affiliation(s)
- Giovanni Romano
- Department of General Surgery, Frieri-Criscuoli Hospital, Sant'Angelo dei Lombardi, AV, Italy
| | - Paola Pepe
- Department of Veterinary Medicine and Animal Production, University of Naples Federico II, CREMOPAR, WHO Collaborating Centre for Diagnosis of Intestinal Helminths and Protozoa (ITA-116), Naples, Italy.
| | - Serena Cavallero
- Department of Public Health and Infectious Diseases, Section of Parasitology, Sapienza University of Rome, Rome, Italy
| | - Paola Cociancic
- Department of Veterinary Medicine and Animal Production, University of Naples Federico II, CREMOPAR, WHO Collaborating Centre for Diagnosis of Intestinal Helminths and Protozoa (ITA-116), Naples, Italy.,Centro de Estudios Parasitológicos y de Vectores (CEPAVE-CONICET-UNLP-asociado a CICPBA), La Plata, Buenos Aires, Argentina
| | - Lorenzo Di Libero
- Department of General Surgery, Frieri-Criscuoli Hospital, Sant'Angelo dei Lombardi, AV, Italy
| | - Giovanni Grande
- Department of General Surgery, Frieri-Criscuoli Hospital, Sant'Angelo dei Lombardi, AV, Italy
| | - Giuseppe Cringoli
- Department of Veterinary Medicine and Animal Production, University of Naples Federico II, CREMOPAR, WHO Collaborating Centre for Diagnosis of Intestinal Helminths and Protozoa (ITA-116), Naples, Italy
| | - Stefano D'Amelio
- Department of Public Health and Infectious Diseases, Section of Parasitology, Sapienza University of Rome, Rome, Italy
| | - Laura Rinaldi
- Department of Veterinary Medicine and Animal Production, University of Naples Federico II, CREMOPAR, WHO Collaborating Centre for Diagnosis of Intestinal Helminths and Protozoa (ITA-116), Naples, Italy
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Leung AK, Leung AA, Wong AH, Hon KL. Human Ascariasis: An Updated Review. ACTA ACUST UNITED AC 2021; 14:133-145. [DOI: 10.2174/1872213x14666200705235757] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Revised: 05/25/2020] [Accepted: 06/11/2020] [Indexed: 11/22/2022]
Abstract
Background:
Ascaris lumbricoides is the most common helminthic infection. More than
1.2 billion people have ascariasis worldwide.
Objective:
This article aimed to provide an update on the evaluation, diagnosis, and treatment of ascariasis.
Methods:
A PubMed search was conducted in February 2020 in Clinical Queries using the key
terms “ascariasis” OR “Ascaris lumbricoides”. The search strategy included meta-analyses, randomized
controlled trials, clinical trials, observational studies, and reviews published within the
past 10 years. The search was restricted to English literature. The information retrieved from the
above search was used in the compilation of the present article. Patents were searched using the
key term “ascariasis” OR “Ascaris lumbricoides” in www.freepatentsonline.com.
Results:
Ascaris lumbricoides is transmitted through the ingestion of embryonated eggs from fecal-
contaminated material. Ascariasis has high endemicity in tropical and subtropical areas. Predisposing
factors include poverty, poor sanitation, inadequate sewage disposal, and poor personal hygiene.
The prevalence is greatest in children younger than 5 years of age. The majority of patients
with intestinal ascariasis are asymptomatic. For those with symptoms, anorexia, nausea, bloating,
abdominal discomfort, recurrent abdominal pain, abdominal distension, and intermittent diarrhea
are not uncommon. Other clinical manifestations vary widely, depending on the underlying complications.
Complications include Löeffler syndrome, intestinal obstruction, biliary colic, recurrent
pyogenic cholangitis, cholecystitis, acalculous cholecystitis, obstructive jaundice, cholelithiasis,
pancreatitis, and malnutrition. The diagnosis is best established by microscopic examination of fecal
smears or following concentration techniques for the characteristic ova. Patients with A. lumbricoides
infection warrant anthelminthic treatment, even if they are asymptomatic, to prevent complications
from migration of the parasite. Albendazole and mebendazole are the drugs of choice for
children and nonpregnant individuals with ascariasis. Pregnant women with ascariasis should be
treated with pyrantel pamoate. Recent patents related to the management of ascariasis are also discussed.
Conclusion:
The average cure rate with anthelminthic treatment is over 95%. Unfortunately, most
treated patients in endemic areas become re-infected within months. Health education, personal hygiene,
improved sanitary conditions, proper disposal of human excreta, and discontinuing the use
of human fecal matter as a fertilizer are effective long-term preventive measures. Targeting deworming
treatment and mass anthelminthic treatment should be considered in regions where A. lumbricoides
is prevalent.
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Affiliation(s)
- Alexander K.C. Leung
- Department of Pediatrics, The University of Calgary, Alberta Children’s Hospital, Calgary, Alberta, Canada
| | - Amy A.M. Leung
- Department of Family Medicine, The University of Alberta, Edmonton, Alberta, Canada
| | - Alex H.C. Wong
- Department of Family Medicine, The University of Calgary, Calgary, Alberta, Canada
| | - Kam L. Hon
- Department of Paediatrics, The Chinese University of Hong Kong, and Department of Paediatrics and Adolescent Medicine, Hong Kong Children’s Hospital, Shatin, Hong Kong
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Anti- Ascaris suum immunoglobulin Y as a novel biotechnological tool for the diagnosis of human ascariasis. J Helminthol 2019; 94:e71. [PMID: 31409433 DOI: 10.1017/s0022149x19000701] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Human ascariasis is a neglected tropical disease of great relevance to public health and is considered the most frequent helminthiasis in poor regions. Accurately diagnosing this parasite has been challenging due to limitations of current diagnostic methods. Immunoglobulin Y (IgY) technology is a very effective alternative for the production of highly specific and profitable antibodies. This study aimed to produce and apply anti-Ascaris suum IgY antibodies in the immunodiagnosis of human ascariasis. Five immunizations comprising total saline extract from A. suum adult life forms were given at 14-day intervals to Gallus gallus domesticus hens of the Isa Brown line. Eggs and blood samples were collected weekly and fortnightly, respectively, to monitor the production of antibodies. The specificity of antibodies was confirmed by dot-blot, kinetic enzyme-linked immunosorbent assay (ELISA), avidity ELISA, immunoblotting and indirect immunofluorescence antibody tests. The application for disease diagnosis was performed through the detection of immune complexes in human serum samples by sandwich ELISA. Peaks of IgY anti-A. suum production occurred at weeks 6 and 8. IgY showed high avidity levels after the second dose of immunization, ranging from 64% to 93%, with a mean avidity index of 78.30%. Purified IgY recognized 12 bands of proteins from A. suum saline extract. Eggs, the uterine portion and cuticles of A. suum female adult are reactive in immunofluorescence. The detection of immune complexes showed diagnostic values of 80% sensitivity and 90% specificity. In conclusion, specific IgY have been shown to be a potential immunodiagnostic tool with promising future applications in human ascariasis.
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Dong Y, Zou Z, Hu P, Dong B, Wang Z, Yang Z, Wen B, Ma Y, Song Y, Ma J, Lau PWC. Secular Trends of Ascariasis Infestation and Nutritional Status in Chinese Children From 2000 to 2014: Evidence From 4 Successive National Surveys. Open Forum Infect Dis 2019; 6:ofz193. [PMID: 31139673 PMCID: PMC6527090 DOI: 10.1093/ofid/ofz193] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 04/17/2019] [Indexed: 12/31/2022] Open
Abstract
Background This study aimed to assess secular trends and epidemiological status of ascariasis infestations and to explore its effects on the nutritional transition among Chinese children from 2000 to 2014. Methods Data were collected from 69 435 Chinese children aged 7-year-olds and 9-year-olds in 4 successive cross-sectional surveys of Chinese National Survey on Students’ Constitution and Health. Ascariasis infestation was defined by using the Kato-Katz method. Nutritional status was classified into stunting, thinness, overweight, and obesity by WHO definition. Results From 2000 to 2014, the ascariasis infestation rates decreased from 9.1% to 1.7%, the stunting and thinness prevalence decreased from 4.3% and 13.8% to 0.7% and 7.1%, while the overweight and obesity prevalence increased from 3.6% and 2.1% to 9.8% and 9.1%, respectively. Compared to children in the ascariasis noninfestation group, those infected with ascariasis had a worse nutritional status. Yet, the disparity in nutritional status between 2 groups disappeared over time. Provinces with a higher gross domestic product per capita simultaneously had lower ascariasis infestation rates, lower stunting and thinness prevalence, and higher overweight and obesity prevalence. Conclusions The retardation effects caused by ascariasis infestation on nutritional status in Chinese children seemed to be offset by the rapid economic development and nutritional transition over time; nevertheless, multiple prevention and control measures are still needed and should be continuously strengthened.
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Affiliation(s)
- Yanhui Dong
- Institute of Child and Adolescent Health, School of Public Health, Peking University, Beijing, China
| | - Zhiyong Zou
- Institute of Child and Adolescent Health, School of Public Health, Peking University, Beijing, China
| | - Peijin Hu
- Institute of Child and Adolescent Health, School of Public Health, Peking University, Beijing, China
| | - Bin Dong
- Institute of Child and Adolescent Health, School of Public Health, Peking University, Beijing, China
| | - Zhenghe Wang
- Institute of Child and Adolescent Health, School of Public Health, Peking University, Beijing, China
| | - Zhaogeng Yang
- Institute of Child and Adolescent Health, School of Public Health, Peking University, Beijing, China
| | - Bo Wen
- Institute of Child and Adolescent Health, School of Public Health, Peking University, Beijing, China
| | - Yinghua Ma
- Institute of Child and Adolescent Health, School of Public Health, Peking University, Beijing, China
| | - Yi Song
- Institute of Child and Adolescent Health, School of Public Health, Peking University, Beijing, China
| | - Jun Ma
- Institute of Child and Adolescent Health, School of Public Health, Peking University, Beijing, China
| | - Patrick W C Lau
- Department of Sport and Physical Education, Hong Kong Baptist University, Kowloon Tong, Hong Kong, China
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