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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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Łanocha A, Łanocha-Arendarczyk N, Wilczyńska D, Zdziarska B, Kosik-Bogacka D. Protozoan Intestinal Parasitic Infection in Patients with Hematological Malignancies. J Clin Med 2022; 11:jcm11102847. [PMID: 35628973 PMCID: PMC9146298 DOI: 10.3390/jcm11102847] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 05/11/2022] [Accepted: 05/16/2022] [Indexed: 02/07/2023] Open
Abstract
The aim of this study was to evaluate the frequency of gastrointestinal protozoan infection in patients with hematological malignancies (HMs) undergoing intensive hemato-oncological treatment and to determine the influence of certain biological factors on the incidence of intestinal parasite infection. Stool samples were collected from hematological malignancy patients (n = 50) hospitalized at the Department of Hematology and Transplantology of the Pomeranian Medical University in Szczecin. The control group consisted of 50 healthy participants. We used a direct smear examination and a commercial immunoenzymatic test. Intestinal protozoans were detected in 16% of patients with hematological malignancies and in 6% of individuals in the control group. In stool samples from patients with HM, cysts of Giardia intestinalis (2%), oocysts of Cryptosporidium spp. (10%), vacuolar forms of potentially pathogenic Blastocystis spp. (2%), and cysts of nonpathogenic Entamoeba coli (2%) were found. Cryptosporidium spp. and Giardia intestinalis coproantigens were detected in 5 (10%) and 1 (2%) patients with HM, respectively. In three participants from the control group, vacuolar forms of Blastocystis spp. were found. In the patients with HM, a significantly higher prevalence of intestinal parasite infection was found in individuals working in the garden without protective gloves and those in contact with animals. In patients with hematological malignancies, intestinal parasites should be excluded, even during intensive chemotherapy treatment.
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Affiliation(s)
- Aleksandra Łanocha
- Department of Hematology with Bone Marrow Transplantation Unit, Pomeranian Medical University in Szczecin, 71-242 Szczecin, Poland; (A.Ł.); (B.Z.)
| | - Natalia Łanocha-Arendarczyk
- Department of Biology and Medical Parasitology, Pomeranian Medical University in Szczecin, 70-111 Szczecin, Poland;
- Correspondence:
| | - Dominika Wilczyńska
- Department of Biology and Medical Parasitology, Pomeranian Medical University in Szczecin, 70-111 Szczecin, Poland;
| | - Barbara Zdziarska
- Department of Hematology with Bone Marrow Transplantation Unit, Pomeranian Medical University in Szczecin, 71-242 Szczecin, Poland; (A.Ł.); (B.Z.)
| | - Danuta Kosik-Bogacka
- Independent Laboratory of Pharmaceutical Botany, Pomeranian Medical University in Szczecin, 70-111 Szczecin, Poland;
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Magalhães L, Nogueira DS, Gazzinelli-Guimarães PH, Oliveira FMS, Kraemer L, Gazzinelli-Guimarães AC, Vieira-Santos F, Fujiwara RT, Bueno LL. Immunological underpinnings of Ascaris infection, reinfection and co-infection and their associated co-morbidities. Parasitology 2021; 148:1-10. [PMID: 33843506 DOI: 10.1017/s0031182021000627] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Human ascariasis is the most common and prevalent neglected tropical disease and is estimated that ~819 million people are infected around the globe, accounting for 0.861 million years of disability-adjusted life years in 2017. Even with the existence of highly effective drugs, the constant presence of infective parasite eggs in the environment contribute to a high reinfection rate after treatment. Due to its high prevalence and broad geographic distribution Ascaris infection is associated with a variety of co-morbidities and co-infections. Here, we provide data from both experimental models and humans studies that illustrate how complex is the interaction of Ascaris with the host immune system, especially, in the context of reinfections, co-infections and associated co-morbidities.
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Affiliation(s)
- Luisa Magalhães
- Department of Parasitology, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Denise S Nogueira
- Department of Parasitology, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Pedro H Gazzinelli-Guimarães
- Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, NIH, Bethesda, Maryland, USA
| | - Fabricio M S Oliveira
- Department of Parasitology, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Lucas Kraemer
- Department of Parasitology, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | | | - Flaviane Vieira-Santos
- Department of Parasitology, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Ricardo T Fujiwara
- Department of Parasitology, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Lilian L Bueno
- Department of Parasitology, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
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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: 3.0] [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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Ravindran VB, Surapaneni A, Crosbie ND, Schmidt J, Shahsavari E, Haleyur N, Soni SK, Ball AS. A modified approach to recover and enumerate Ascaris ova in wastewater and sludge. PLoS Negl Trop Dis 2019; 13:e0007020. [PMID: 30789908 PMCID: PMC6383862 DOI: 10.1371/journal.pntd.0007020] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Affiliation(s)
- Vivek B. Ravindran
- School of Science, RMIT University, Melbourne, Victoria, Australia
- * E-mail:
| | | | | | | | | | | | - Sarvesh K. Soni
- School of Science, RMIT University, Melbourne, Victoria, Australia
| | - Andrew S. Ball
- School of Science, RMIT University, Melbourne, Victoria, Australia
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Gipson K, Avery R, Shah H, Pepiak D, Bégué RE, Malone J, Wall LA. Löffler syndrome on a Louisiana pig farm. Respir Med Case Rep 2016; 19:128-131. [PMID: 27709064 PMCID: PMC5043414 DOI: 10.1016/j.rmcr.2016.09.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Revised: 09/14/2016] [Accepted: 09/15/2016] [Indexed: 11/18/2022] Open
Abstract
Löffler syndrome, a fulminant eosinophilic pneumonitis associated with the larval migratory phase of human parasites, is rarely reported in the United States. A previously healthy 8-year-old male was hospitalized with tachypnea, cough, hypoxemia, and fever of one week's duration. History revealed exposure to pigs on his family's farm in southernmost Louisiana, where the patient was responsible for cleaning the farm's pigpens. His fingernails were soiled and extremely short, with the edge of the nail bed exposed secondary to onychophagia. Laboratory evaluation demonstrated peripheral eosinophilia (39%), pulmonary eosinophilia (86%), high total IgE, diffuse reticulonodular lung opacities, and mixed obstructive and restrictive pulmonary function pattern. Systemic corticosteroids were initiated for his acute respiratory insufficiency and produced rapid clinical improvement. Serum Ascaris-specific IgE was markedly elevated and he was treated with albendazole. An extensive evaluation for other infectious and allergic etiologies was negative. A site visit to the family farm and laboratory investigation was coordinated with the Louisiana Animal Disease Diagnostic Laboratory at LSU. Ascaris suum eggs were detected in fresh pig feces and in the soil immediately surrounding the pens. Ascariasis should be considered even in the absence of travel history, especially in swine raising areas that are endemic for Ascaris in pigs, such as the southeastern United States. Onychophagia is a highly probable mechanism of zoonotic fecal-oral transmission in this case, and such habits could lead to continual reinfection. Systemic corticosteroids were effective in treating the patient's acute respiratory compromise due to Löffler syndrome.
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Affiliation(s)
- Kevin Gipson
- Division of Pediatric Pulmonology, Department of Pediatrics, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Ryan Avery
- Louisiana State University School of Veterinary Medicine, Department of Pathobiological Sciences, Baton Rouge, LA, USA
| | - Heena Shah
- Section of Allergy Immunology, Department of Pediatrics, Louisiana State University Health Sciences Center and Children's Hospital New Orleans, New Orleans, LA, USA
| | - Derek Pepiak
- Division of Pediatric Pulmonology, Department of Pediatrics, Ochsner for Children and the University of Queensland School of Medicine, New Orleans, LA, USA
| | - Rodolfo E Bégué
- Section of Infectious Diseases, Department of Pediatrics, Louisiana State University Health Sciences Center and Children's Hospital New Orleans, New Orleans, LA, USA
| | - John Malone
- Louisiana State University School of Veterinary Medicine, Department of Pathobiological Sciences, Baton Rouge, LA, USA
| | - Luke A Wall
- Section of Allergy Immunology, Department of Pediatrics, Louisiana State University Health Sciences Center and Children's Hospital New Orleans, New Orleans, LA, USA
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