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Tchamwa Bamini G, Charpentier E, Guemas E, Chauvin P, Fillaux J, Valentin A, Cassaing S, Ménard S, Berry A, Iriart X. No evidence of pathogenicity of Dientamoeba fragilis following detection in stools: A case-control study. Parasite 2024; 31:40. [PMID: 39052010 PMCID: PMC11271704 DOI: 10.1051/parasite/2024041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 06/28/2024] [Indexed: 07/27/2024] Open
Abstract
Dientamoeba fragilis is a ubiquitous intestinal parasite with detection in the stools that has become increasingly frequent following the advent of PCR as a routine screening tool. However, the pathogenicity of this parasite is still much debated. In order to assess the potentially pathogenic nature of this protozoan, a retrospective case-control study was carried out between January and December 2020 on patients from Toulouse University Hospital, with the aim of evaluating the potential clinical effects and changes in laboratory parameters linked to the presence and load of D. fragilis in stools. After matching age, sex and mode of care (consultation or hospitalisation), no significant difference was observed in the frequency of clinical signs between the 36 patients who tested positive for Dientamoeba fragilis PCR in their stools and the 72 control patients who were PCR negative for this protozoan. The presence of D. fragilis in the faeces was not associated with changes in laboratory parameters. Furthermore, a high digestive load of D. fragilis had no identifiable impact on clinical and laboratory parameters. Only the concomitant presence of Blastocystis sp. in stools was significantly more frequent in the D. fragilis group (uni- and multivariate analysis). Finally, this study showed no significant difference in clinical or laboratory signs between patients carrying Dientamoeba fragilis and the control group, regardless of the intestinal parasite load, suggesting that D. fragilis could be considered a commensal of the digestive tract.
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Affiliation(s)
| | - Eléna Charpentier
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Parasitology-Mycology Department, Toulouse University Hospital 31059 Toulouse France
| | - Emilie Guemas
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Parasitology-Mycology Department, Toulouse University Hospital 31059 Toulouse France
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Toulouse Institute for Infectious and Inflammatory Diseases (Infinity), Toulouse University, CNRS UMR5051, INSERM UMR1291, Paul Sabatier University 31024 Toulouse France
| | - Pamela Chauvin
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Parasitology-Mycology Department, Toulouse University Hospital 31059 Toulouse France
| | - Judith Fillaux
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Parasitology-Mycology Department, Toulouse University Hospital 31059 Toulouse France
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RESTORE Institute, UMR 1301-Inserm 5070-CNRS EFS Paul Sabatier University 31100 Toulouse France
| | - Alexis Valentin
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Parasitology-Mycology Department, Toulouse University Hospital 31059 Toulouse France
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UMR 152 PHARMA-DEV, IRD, UPS, Toulouse University 31062 Toulouse France
| | - Sophie Cassaing
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Parasitology-Mycology Department, Toulouse University Hospital 31059 Toulouse France
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RESTORE Institute, UMR 1301-Inserm 5070-CNRS EFS Paul Sabatier University 31100 Toulouse France
| | - Sandie Ménard
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Toulouse Institute for Infectious and Inflammatory Diseases (Infinity), Toulouse University, CNRS UMR5051, INSERM UMR1291, Paul Sabatier University 31024 Toulouse France
| | - Antoine Berry
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Parasitology-Mycology Department, Toulouse University Hospital 31059 Toulouse France
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Toulouse Institute for Infectious and Inflammatory Diseases (Infinity), Toulouse University, CNRS UMR5051, INSERM UMR1291, Paul Sabatier University 31024 Toulouse France
| | - Xavier Iriart
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Parasitology-Mycology Department, Toulouse University Hospital 31059 Toulouse France
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Toulouse Institute for Infectious and Inflammatory Diseases (Infinity), Toulouse University, CNRS UMR5051, INSERM UMR1291, Paul Sabatier University 31024 Toulouse France
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Peretz A, Azrad M, Ken-Dror S, Strauss M, Sagas D, Parizada M, Loewnthal S, Amichay D, Ben Horin N, Shenhar Y, Sagi O, Bazarsky E, Amit S, Schwartz E. The epidemiology of intestinal protozoa in the Israeli population based on molecular stool test: a nationwide study. Microbiol Spectr 2024; 12:e0061624. [PMID: 39012121 DOI: 10.1128/spectrum.00616-24] [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: 03/24/2024] [Accepted: 06/03/2024] [Indexed: 07/17/2024] Open
Abstract
Stool examination using microscopy was the traditional method for the diagnosis of intestinal parasites. Recently, the use of molecular tests to identify stool protozoa has become the main tool used in most clinical laboratories in Israel. This study aimed to evaluate the prevalence of intestinal parasites in Israel and to compare this prevalence in laboratories that use molecular tests vs a laboratory that uses microscopy. Samples collected from January to October 2021 at seven laboratories were analyzed by real-time PCR (RT-PCR) or by microscopy. The multiplex panel included the following pathogens: Giardia lamblia, Entamoeba histolytica, Cryptosporidium spp., Cyclospora, Dientamoeba fragilis, and Blastocystis spp. Overall, 138,415 stool samples were tested by RT-PCR and 6,444 by microscopy. At least one protozoa species was identified in 28.4% of the PCR-tested samples compared to 4.6% of the microscopy-tested samples. D. fragilis was the most common PCR-identified species (29%). D. fragilis, G. lamblia, and Cryptosporidium spp. were mainly found in pediatric population, while Blastocystis spp. was most prevalent among adults (P < 0.001). In a sub-cohort of 21,480 samples, co-infection was found in 4,113 (19.15%) samples, with Blastocystis spp. and D. fragilis being the most common (14.9%) pair. Molecular stool testing proved more sensitive compared to microscopy. D. fragilis was the most commonly detected pathogen. The above profile was identified during the COVID pandemic when traveling was highly restricted and most likely represents the locally circulating protozoa. IMPORTANCE This study sheds light on the prevalence of stool parasites in Israel. Additionally, this study indicates that the shift from microscope analysis to molecular tests improved protozoa diagnosis.
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Affiliation(s)
- Avi Peretz
- Clinical Microbiology Laboratory, Tzafon Medical Center, Poriya, Israel, affiliated with Azrieli Faculty of Medicine, Bar Ilan University, Israel, Safed
- The Azrieli Faculty of Medicine, Bar Ilan University, Safed, Tiberias, Israel
| | - Maya Azrad
- Clinical Microbiology Laboratory, Tzafon Medical Center, Poriya, Israel, affiliated with Azrieli Faculty of Medicine, Bar Ilan University, Israel, Safed
- The Azrieli Faculty of Medicine, Bar Ilan University, Safed, Tiberias, Israel
| | - Shifra Ken-Dror
- Clinical Microbiology Laboratory, Central Laboratories Haifa and Western Galilee, Clalit Health Services, Nesher, Israel
| | - Merav Strauss
- Clinical Microbiology Laboratory, Emek Medical Center, Clalit Health Services, Afula, Israel
| | - Dana Sagas
- Clinical Microbiology Laboratory, Emek Medical Center, Clalit Health Services, Afula, Israel
| | - Miriam Parizada
- Maccabi Health Services, Central Laboratories, Rehovot, Israel
| | | | - Doron Amichay
- Central Laboratories, Clalit Health Services, Tel Aviv, Israel
| | | | | | - Orli Sagi
- Microbiology Laboratory, Soroka University Medical Center, Beer-Sheva, Israel
- Faculty of health science, Ben-Gurion University, Beer-Sheva, Israel
| | - Elina Bazarsky
- Microbiology Laboratory, Soroka University Medical Center, Beer-Sheva, Israel
| | - Sharon Amit
- Clinical Microbiology, Sheba Medical Center, Ramat Gan, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eliezer Schwartz
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- The Institute of Tropical Medicine, Sheba Medical Center, Ramat Gan, Israel
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Weitzel T, Brown A, Libman M, Perret C, Huits R, Chen L, Leung DT, Leder K, Connor BA, Menéndez MD, Asgeirsson H, Schwartz E, Salvador F, Malvy D, Saio M, Norman FF, Amatya B, Duvignaud A, Vaughan S, Glynn M, Angelo KM. Intestinal protozoa in returning travellers: a GeoSentinel analysis from 2007 to 2019. J Travel Med 2024; 31:taae010. [PMID: 38245913 PMCID: PMC11285061 DOI: 10.1093/jtm/taae010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 01/08/2024] [Accepted: 01/11/2024] [Indexed: 01/23/2024]
Abstract
BACKGROUND Prolonged diarrhoea is common amongst returning travellers and is often caused by intestinal protozoa. However, the epidemiology of travel-associated illness caused by protozoal pathogens is not well described. METHODS We analysed records of returning international travellers with illness caused by Giardia duodenalis, Cryptosporidium spp., Cyclospora cayetanensis or Cystoisospora belli, reported to the GeoSentinel Network during January 2007-December 2019. We excluded records of travellers migrating, with an unascertainable exposure country, or from GeoSentinel sites that were not located in high-income countries. RESULTS There were 2517 cases, 82.3% giardiasis (n = 2072), 11.4% cryptosporidiosis (n = 287), 6.0% cyclosporiasis (n = 150) and 0.3% cystoisosporiasis (n = 8). Overall, most travellers were tourists (64.4%) on long trips (median durations: 18-30 days). Cryptosporidiosis more frequently affected people < 18 years (13.9%) and cyclosporiasis affected people ≥ 40 years (59.4%). Giardiasis was most frequently acquired in South Central Asia (45.8%) and sub-Saharan Africa (22.6%), cryptosporidiosis in sub-Saharan Africa (24.7%) and South-Central Asia (19.5%), cyclosporiasis in South East Asia (31.3%) and Central America (27.3%), and cystoisosporiasis in sub-Saharan Africa (62.5%). Cyclosporiasis cases were reported from countries of uncertain endemicity (e.g. Cambodia) or in countries with no previous evidence of this parasite (e.g. French Guiana). The time from symptom onset to presentation at a GeoSentinel site was the longest amongst travellers with giardiasis (median: 30 days). Over 14% of travellers with cryptosporidiosis were hospitalized. CONCLUSIONS This analysis provides new insights into the epidemiology and clinical significance of four intestinal protozoa that can cause morbidity in international travellers. These data might help optimize pretravel advice and post-travel management of patients with travel-associated prolonged gastrointestinal illnesses. This analysis reinforces the importance of international travel-related surveillance to identify sentinel cases and areas where protozoal infections might be undetected or underreported.
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Affiliation(s)
- Thomas Weitzel
- Travel Medicine Program, Clínica Alemana, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago 7650568, Chile
- Instituto de Ciencias e Innovación en Medicina (ICIM), Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago 7590943, Chile
| | - Ashley Brown
- Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA
| | - Michael Libman
- J.D. MacLean Centre for Tropical Diseases, McGill University Health Centre, Montreal, QC H4A 3J1, Canada
| | - Cecilia Perret
- Department of Pediatric Infectious Diseases and Immunology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago 8320000, Chile
| | - Ralph Huits
- Department of Infectious Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Verona 37024, Italy
| | - Lin Chen
- Division of Infectious Diseases, Mount Auburn Hospital, Cambridge, MA 02138, USA
| | - Daniel T Leung
- International Travel Clinic, University of Utah Hospital and Clinics, Salt Lake City, UT 84132, USA
| | - Karin Leder
- Victorian Infectious Diseases Service, Royal Melbourne Hospital, Parkville, Victoria 3050, Australia
| | - Bradley A Connor
- New York Center for Travel and Tropical Medicine, New York, NY 10022, USA
| | - Marta D Menéndez
- Tropical Medicine Department, Hospital Universitario La Paz Carlos III, CIBERINFECT, Madrid 28046, Spain
| | - Hilmir Asgeirsson
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm 171 76, Sweden
- Division of Infectious Diseases, Department of Medicine Huddinge, Karolinska Institutet, Stockholm 141 57, Sweden
| | - Eli Schwartz
- The Center of Geographical Medicine and Tropical Diseases, Sheba Medical Center, Tel HaShomer 52621, Israel
- Ramat Gan & Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Fernando Salvador
- Tropical Medicine Unit, Vall d'Hebron-Drassanes, Infectious Diseases Department, Vall d'Hebron University Hospital, PROSICS, Barcelona 08001, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid 28029, Spain
| | - Denis Malvy
- Department of Infectious Diseases and Tropical Medicine, Hôpital Pellegrin, Bordeaux 33076, France
| | - Mauro Saio
- Department of Tropical and Travel Medicine, The Nairobi Hospital, Nairobi 00100, Kenya
| | - Francesca F Norman
- National Referral Unit for Tropical Diseases, Infectious Diseases Department, Ramón y Cajal University Hospital, CIBERINFEC, IRYCIS, Madrid 28034, Spain
- Department of Medicine, Universidad de Alcalá, Alcalá de Henares 28801, Spain
| | - Bhawana Amatya
- CIWEC Hospital and Travel Medicine Center, Kathmandu 44600, Nepal
| | - Alexandre Duvignaud
- Department of Infectious Diseases and Tropical Medicine, Hôpital Pellegrin, Bordeaux 33076, France
| | - Stephen Vaughan
- Division of Infectious Diseases, University of Calgary, South Health Campus, Calgary, AB T3M 1M4, Canada
| | - Marielle Glynn
- Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA
| | - Kristina M Angelo
- Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA
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Jasuja JK, Bub F, Veit J, Fofana HKM, Sacko M, Saye R, Chatigre JK, N'Goran EK, Yao JA, Khanal B, Koirala K, Bhattarai NR, Rijal S, von Müller L, Bottieau E, Boelaert M, Chappuis F, Polman K, Utzinger J, Becker SL. Multiplex PCR for bacterial, viral and protozoal pathogens in persistent diarrhoea or persistent abdominal pain in Côte d'Ivoire, Mali and Nepal. Sci Rep 2024; 14:10926. [PMID: 38740833 DOI: 10.1038/s41598-024-60491-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 04/23/2024] [Indexed: 05/16/2024] Open
Abstract
In contrast to acute diarrhoea, the aetiology of persistent digestive disorders (≥ 14 days) is poorly understood in low-resource settings and conventional diagnostic approaches lack accuracy. In this multi-country study, we compared multiplex real-time PCR for enteric bacterial, parasitic and viral pathogens in stool samples from symptomatic patients and matched asymptomatic controls in Côte d'Ivoire, Mali and Nepal. Among 1826 stool samples, the prevalence of most pathogens was highest in Mali, being up to threefold higher than in Côte d'Ivoire and up to tenfold higher than in Nepal. In all settings, the most prevalent bacteria were EAEC (13.0-39.9%) and Campylobacter spp. (3.9-35.3%). Giardia intestinalis was the predominant intestinal protozoon (2.9-20.5%), and adenovirus 40/41 was the most frequently observed viral pathogen (6.3-25.1%). Significantly different prevalences between symptomatic and asymptomatic individuals were observed for Campylobacter, EIEC and ETEC in the two African sites, and for norovirus in Nepal. Multiple species pathogen infection was common in Côte d'Ivoire and Mali, but rarely found in Nepal. We observed that molecular testing detected multiple enteric pathogens and showed low discriminatory accuracy to distinguish between symptomatic and asymptomatic individuals. Yet, multiplex PCR allowed for direct comparison between different countries and revealed considerable setting-specificity.
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Affiliation(s)
- Jasmin K Jasuja
- Institute of Medical Microbiology and Hygiene, Saarland University, Kirrberger Straße, Building 43, 66421, Homburg/Saar, Germany
- Department for Infectious Diseases, University Hospital Heidelberg, Heidelberg, Germany
| | - Florian Bub
- Institute of Medical Microbiology and Hygiene, Saarland University, Kirrberger Straße, Building 43, 66421, Homburg/Saar, Germany
| | - Jonas Veit
- Institute of Medical Microbiology and Hygiene, Saarland University, Kirrberger Straße, Building 43, 66421, Homburg/Saar, Germany
| | | | - Moussa Sacko
- Institut National de Recherche en Santé Publique, Bamako, Mali
| | - Rénion Saye
- Institut National de Recherche en Santé Publique, Bamako, Mali
| | | | - Eliézer K N'Goran
- Unité de Formation et de Recherche Biosciences, Université Félix Houphouët-Boigny, Abidjan, Côte d'Ivoire
- Centre Suisse de Recherches Scientifiques en Côte d'Ivoire, Abidjan, Côte d'Ivoire
| | - Joel A Yao
- Unité de Formation et de Recherche Biosciences, Université Félix Houphouët-Boigny, Abidjan, Côte d'Ivoire
- Centre Suisse de Recherches Scientifiques en Côte d'Ivoire, Abidjan, Côte d'Ivoire
| | - Basudha Khanal
- Department of Microbiology, B P Koirala Institute of Health Sciences, Dharan, Nepal
| | - Kanika Koirala
- Department of Internal Medicine, B P Koirala Institute of Health Sciences, Dharan, Nepal
| | - Narayan R Bhattarai
- Department of Microbiology, B P Koirala Institute of Health Sciences, Dharan, Nepal
| | - Suman Rijal
- Department of Internal Medicine, B P Koirala Institute of Health Sciences, Dharan, Nepal
| | - Lutz von Müller
- Institute of Medical Microbiology and Hygiene, Saarland University, Kirrberger Straße, Building 43, 66421, Homburg/Saar, Germany
- Institute for Laboratory Medicine, Microbiology and Hygiene, Christophorus Kliniken, Coesfeld, Germany
| | - Emmanuel Bottieau
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Marleen Boelaert
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - François Chappuis
- Division of Tropical and Humanitarian Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Katja Polman
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Jürg Utzinger
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Sören L Becker
- Institute of Medical Microbiology and Hygiene, Saarland University, Kirrberger Straße, Building 43, 66421, Homburg/Saar, Germany.
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland.
- University of Basel, Basel, Switzerland.
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España-Cueto S, Oliveira-Souto I, Salvador F, Goterris L, Treviño B, Sánchez-Montalvá A, Serre-Delcor N, Sulleiro E, Rodríguez V, Aznar ML, Bosch-Nicolau P, Espinosa-Pereiro J, Pou D, Molina I. Post-infectious irritable bowel syndrome following a diagnosis of traveller's diarrhoea: a comprehensive characterization of clinical and laboratory parameters. J Travel Med 2023; 30:taad030. [PMID: 36881659 DOI: 10.1093/jtm/taad030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 02/20/2023] [Accepted: 02/21/2023] [Indexed: 03/09/2023]
Abstract
BACKGROUND Prolonged or recurrent gastrointestinal symptoms may persist after acute traveller's diarrhoea (TD), even after adequate treatment of the primary cause. This study aims to describe the epidemiological, clinical and microbiological characteristics of patients with post-infectious irritable bowel syndrome (PI-IBS) after returning from tropical or subtropical areas. METHODS We conducted a retrospective study of patients presenting between 2009 and 2018 at the International Health referral centre in Barcelona with persistent gastrointestinal symptoms following a diagnosis of TD. PI-IBS was defined as the presence of persistent or recurrent gastrointestinal manifestations for at least 6 months after the diagnosis of TD, a negative stool culture for bacterial pathogens and a negative ova and parasite exam after targeted treatment. Epidemiological, clinical and microbiological variables were collected. RESULTS We identified 669 travellers with a diagnosis of TD. Sixty-eight (10.2%) of these travellers, mean age 33 years and 36 (52.9%) women, developed PI-IBS. The most frequently visited geographical areas were Latin America (29.4%) and the Middle East (17.6%), with a median trip duration of 30 days (IQR 14-96). A microbiological diagnosis of TD was made in 32 of these 68 (47%) patients, 24 (75%) of whom had a parasitic infection, Giardia duodenalis being the most commonly detected parasite (n = 20, 83.3%). The symptoms persisted for a mean of 15 months after diagnosis and treatment of TD. The multivariate analysis revealed that parasitic infections were independent risk factors for PI-IBS (OR 3.0, 95%CI 1.2-7.8). Pre-travel counselling reduced the risk of PI-IBS (OR 0.4, 95%CI 0.2-0.9). CONCLUSIONS In our cohort, almost 10% of patients with travellers' diarrhoea developed persistent symptoms compatible with PI-IBS. Parasitic infections, mainly giardiasis, seem to be associated with PI-IBS.
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Affiliation(s)
- Sergio España-Cueto
- International Health Unit Vall d'Hebron-Drassanes, Infectious Diseases Department, Vall d'Hebron University Hospital, PROSICS Barcelona, Universitat Autònoma de Barcelona, Barcelona, Spain
- Infectious Diseases Department, Germans Trias i Pujol University Hospital, Badalona, Spain
- The Fight Infections Foundation, Badalona, Spain
| | - Inés Oliveira-Souto
- International Health Unit Vall d'Hebron-Drassanes, Infectious Diseases Department, Vall d'Hebron University Hospital, PROSICS Barcelona, Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Fernando Salvador
- International Health Unit Vall d'Hebron-Drassanes, Infectious Diseases Department, Vall d'Hebron University Hospital, PROSICS Barcelona, Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Lidia Goterris
- Department of Microbiology, Vall d'Hebron University Hospital and PROSICS, Barcelona, Spain
| | - Begoña Treviño
- International Health Unit Vall d'Hebron-Drassanes, Infectious Diseases Department, Vall d'Hebron University Hospital, PROSICS Barcelona, Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Adrián Sánchez-Montalvá
- International Health Unit Vall d'Hebron-Drassanes, Infectious Diseases Department, Vall d'Hebron University Hospital, PROSICS Barcelona, Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Núria Serre-Delcor
- International Health Unit Vall d'Hebron-Drassanes, Infectious Diseases Department, Vall d'Hebron University Hospital, PROSICS Barcelona, Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Elena Sulleiro
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
- Department of Microbiology, Vall d'Hebron University Hospital and PROSICS, Barcelona, Spain
| | - Virginia Rodríguez
- Department of Microbiology, Vall d'Hebron University Hospital and PROSICS, Barcelona, Spain
| | - Maria Luisa Aznar
- International Health Unit Vall d'Hebron-Drassanes, Infectious Diseases Department, Vall d'Hebron University Hospital, PROSICS Barcelona, Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Pau Bosch-Nicolau
- International Health Unit Vall d'Hebron-Drassanes, Infectious Diseases Department, Vall d'Hebron University Hospital, PROSICS Barcelona, Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Juan Espinosa-Pereiro
- International Health Unit Vall d'Hebron-Drassanes, Infectious Diseases Department, Vall d'Hebron University Hospital, PROSICS Barcelona, Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Diana Pou
- International Health Unit Vall d'Hebron-Drassanes, Infectious Diseases Department, Vall d'Hebron University Hospital, PROSICS Barcelona, Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Israel Molina
- International Health Unit Vall d'Hebron-Drassanes, Infectious Diseases Department, Vall d'Hebron University Hospital, PROSICS Barcelona, Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
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6
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Hommes F, Dörre A, Behnke SC, Stark K, Faber M. Travel-related giardiasis: incidence and time trends for various destination countries. J Travel Med 2023; 30:taad107. [PMID: 37561417 PMCID: PMC10628773 DOI: 10.1093/jtm/taad107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 07/31/2023] [Accepted: 08/02/2023] [Indexed: 08/11/2023]
Abstract
BACKGROUND Giardiasis is a common gastrointestinal illness in travellers. Data on the actual giardiasis risk of travellers to different travel destinations are scarce. We aim to estimate the risk of giardiasis in travellers from Germany by destination country and region. METHODS We analysed travel-related giardiasis cases, their countries and regions of exposure and the age and sex distribution of cases reported in 2014-19 in Germany. We defined a travel-related giardiasis case as a laboratory-confirmed (i.e. positive microscopy, antigen test or nucleic acid test) symptomatic individual with outbound travel abroad within 3-25 days before symptom onset. Based on the number of reported cases per exposure country and UNWTO travel data for Germany, we calculated the number of travel-related giardiasis cases per 100 000 travellers and compared the incidence in 2014-16 and 2017-19 to identify potential trends. RESULTS In 2014-19, 21 172 giardiasis cases were reported in Germany, corresponding to an overall incidence of 4.3 per 100 000 population. Of all cases, 6879 (32%) were travel-related with a median age of 34 [interquartile range (IQR): 25-50], 51% were male. Southern Asia was the most frequently reported exposure region and had the highest incidence in travellers (64.1 per 100 000 returning travellers) in 2017-19, followed by Latin America (19.2) and Sub-Saharan Africa (12.9). We observed statistically significant decreasing trends for Southern Asia and Sub-Saharan Africa. Latin America was the only region with a statistically significant increasing trend. CONCLUSIONS Almost one-third of recent giardiasis cases in Germany were travel-related. Giardiasis incidence in travellers differs greatly depending on the destination region. Decreasing trends in many regions might be due to improvements in food hygiene or travel conditions. Our results may inform medical consultation pre and post patient's travel.
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Affiliation(s)
- Franziska Hommes
- Department of Infectious Disease Epidemiology, Robert Koch Institute, 13353 Berlin, Germany
- Postgraduate Training for Applied Epidemiology (PAE), Robert Koch Institute, 13353 Berlin, Germany
- ECDC Fellowship Programme, Field Epidemiology Path (EPIET), European Centre for Disease Prevention and Control (ECDC), 171 83 Stockholm, Sweden
| | - Achim Dörre
- Department of Infectious Disease Epidemiology, Robert Koch Institute, 13353 Berlin, Germany
- Postgraduate Training for Applied Epidemiology (PAE), Robert Koch Institute, 13353 Berlin, Germany
| | - Susanne C Behnke
- Department of Infectious Disease Epidemiology, Robert Koch Institute, 13353 Berlin, Germany
| | - Klaus Stark
- Department of Infectious Disease Epidemiology, Robert Koch Institute, 13353 Berlin, Germany
| | - Mirko Faber
- Department of Infectious Disease Epidemiology, Robert Koch Institute, 13353 Berlin, Germany
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Pietilä JP, Häkkinen TA, Pakarinen L, Ollgren J, Kantele A. Treatment of Dientamoeba fragilis: A retrospective Finnish analysis of faecal clearance and clinical cure comparing four antiprotozoal drugs. New Microbes New Infect 2023; 54:101179. [PMID: 37786407 PMCID: PMC10542007 DOI: 10.1016/j.nmni.2023.101179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 09/08/2023] [Accepted: 09/09/2023] [Indexed: 10/04/2023] Open
Abstract
Background Dientamoeba fragilis (DF), the most common intestinal protozoal pathogen in affluent countries, causes asymptomatic or symptomatic infections with severity ranging from mild to disabling. Currently, many studies of treatment options only have small sample sizes and report results that are partly contradictory. Methods Investigating data retrieved from Helsinki University Hospital and Helsinki City patient records, we searched for the most effective antiprotozoal in treating DF infections. To study microbiological clearance of DF, we collected laboratory results of control samples from patients given one of four commonly used antiprotozoals: doxycycline, metronidazole, paromomycin, or secnidazole. For patients symptomatic prior to antiprotozoal treatment, we also retrieved data on clinical outcomes. Furthermore, we explored factors associated with faecal clearance and clinical cure. Results A total of 369 patients (median age 38) and 492 treatment episodes were included. Paromomycin (n = 297) proved effective (clearance rate 83%), showing strong association with faecal clearance (aOR 18.08 [7.24-45.16], p < 0.001). For metronidazole the rate was 42% (n = 84), for secnidazole 37% (n = 79), and doxycycline 22% (n = 32). In pairwise comparisons, paromomycin outdid the three other regimens (p < 0.001, χ2 test). Faecal clearance was associated with clinical cure (aOR 5.85 [3.02-11.32], p < 0.001). Conclusions Faecal clearance, strongly associated with clinical cure, is most effectively achieved with a course of paromomycin, followed by metronidazole, secnidazole and doxycycline. Our findings will be useful in devising treatment guidelines for adults with symptomatic D. fragilis infection.
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Affiliation(s)
- Jukka-Pekka Pietilä
- Meilahti Vaccine Research Center MeVac, Department of Infectious Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Human Microbiome Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Tuuve A Häkkinen
- Meilahti Vaccine Research Center MeVac, Department of Infectious Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Human Microbiome Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Laura Pakarinen
- Department of Infectious Diseases, Inflammation Center, Helsinki University Hospital, Helsinki, Finland
- Department of Social Services and Health Care, City of Helsinki, Finland
| | - Jukka Ollgren
- Department of Health Security, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Anu Kantele
- Meilahti Vaccine Research Center MeVac, Department of Infectious Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Human Microbiome Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Department of Infectious Diseases, Inflammation Center, Helsinki University Hospital, Helsinki, Finland
- Finnish Multidisciplinary Center of Excellence in Antimicrobial Resistance Research, FIMAR, University of Helsinki, Helsinki, Finland
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Potes-Morales C, Crespo-Ortiz MDP. Molecular diagnosis of intestinal protozoa in young adults and their pets in Colombia, South America. PLoS One 2023; 18:e0283824. [PMID: 37220135 DOI: 10.1371/journal.pone.0283824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 03/20/2023] [Indexed: 05/25/2023] Open
Abstract
Intestinal parasitic infections have been considered a relevant public health problem due to the increased incidence worldwide. In developing countries, diarrhea and gastrointestinal symptoms cause impaired work capacity in adults and delayed rate growth in children. Enteric infections of unknown etiology can often lead to misdiagnosis, increased transmission, and morbidity. The aim of this study was to determine the prevalence of intestinal parasites in a young adult population and their pets. Stool samples from 139 university students and 44 companion animals were subjected to microscopy diagnosis using wet mounts, concentration by zinc sulphate flotation and staining techniques (Kinyoun and trichrome stain). Molecular diagnosis of protozoa was also performed by conventional PCR. The mean age was 24 years, 54% individuals were female, 46% were men, and 66% had at least one pet. The overall prevalence for at least one parasite was 74.8% and the rate of polyparasitism was 37.5%. Eighty-three patients (59.7%) were positive for Blastocystis spp., followed by Cryptosporidium spp. 24.5%, Endolimax nana 13.6%, Entamoeba dispar/E. moshkovskii 7.8% and Giardia intestinalis 1.4%. Molecular diagnosis substantially improved Cryptosporidium spp. and Blastocystis spp. detection and allowed to distinguish E. histolytica from commensals in the Entamoeba complex. Student's pets were also examined for parasitism. Samples from 27 dogs, 15 cats, one rabbit and one hen were analyzed, and parasites were detected in 30 (68.2%) as follows: Cryptosporidium spp. (24) Giardia spp. (4), hookworm (3), Endolimax nana (2) and Toxoplasma gondii (1). Overall, university students showed high prevalence of parasitism and polyparasitism suggesting exposure to parasite infected animals and contaminated environments. Cryptosporidium spp. was the predominant pathogen in human and domestic animals, and it was only detected by PCR, pointing out the need for sensitive tests in diagnosis and surveillance. Control strategies to prevent the effects of parasitic infections in young population should consider pets as reservoirs and transmission source.
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Affiliation(s)
- Caterine Potes-Morales
- Department of Microbiology, Section of Parasitology, Universidad del Valle, Cali, Colombia
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Schwartz E, Connor BA. Persistent abdominal symptoms: a persistently neglected topic in travel medicine. J Travel Med 2022; 29:6549177. [PMID: 35294014 DOI: 10.1093/jtm/taac016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 01/28/2022] [Accepted: 01/31/2022] [Indexed: 11/14/2022]
Abstract
Persistent abdominal symptoms are a common complaint in returning travellers; yet, there is very sparse evidence to support the causes and potential aetiologies. New molecular stool-testing techniques and accurate clinical studies may shed light on this gap in our knowledge, paving ways for more successful management of this common and difficult problem.
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Affiliation(s)
- Eli Schwartz
- The Center for Geographic Medicine and Tropical Diseases, Sheba Medical Center, Ramat Gan 52621, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv 6997801, Israel
| | - Bradley A Connor
- The New York Center for Travel and Tropical Medicine, Weill Cornell Medical College, New York, NY 10022, USA
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