1
|
Henke K, Ntovas S, Xourgia E, Exadaktylos AK, Klukowska-Rötzler J, Ziaka M. Who Let the Dogs Out? Unmasking the Neglected: A Semi-Systematic Review on the Enduring Impact of Toxocariasis, a Prevalent Zoonotic Infection. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6972. [PMID: 37947530 PMCID: PMC10649795 DOI: 10.3390/ijerph20216972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 09/28/2023] [Accepted: 10/17/2023] [Indexed: 11/12/2023]
Abstract
Toxocariasis remains an important neglected parasitic infection representing one of the most common zoonotic infections caused by the parasite Toxocara canis or, less frequently, by Toxocara cati. The epidemiology of the disease is complex due to its transmission route by accidental ingestion of embryonated Toxocara eggs or larvae from tissues from domestic or wild paratenic hosts. Even though the World Health Organization and Centers for Disease Control classified toxocariasis amongst the top six parasitic infections of priority to public health, global epidemiological data regarding the relationship between seropositivity and toxocariasis is limited. Although the vast majority of the infected individuals remain asymptomatic or experience a mild disease, the infection is associated with important health and socioeconomic consequences, particularly in underprivileged, tropical, and subtropical areas. Toxocariasis is a disease with multiple clinical presentations, which are classified into five distinct forms: the classical visceral larva migrans, ocular toxocariasis, common toxocariasis, covert toxocariasis, and cerebral toxocariasis or neurotoxocariasis. Anthelmintic agents, for example, albendazole or mebendazole, are the recommended treatment, whereas a combination with topical or systemic corticosteroids for specific forms is suggested. Prevention strategies include educational programs, behavioral and hygienic changes, enhancement of the role of veterinarians, and anthelmintic regimens to control active infections.
Collapse
Affiliation(s)
- Katrin Henke
- Department of Internal Medicine, Thun Hospital, Krankenhausstrasse 12, 3600 Thun, Switzerland;
- Department of Emergency Medicine, Inselspital, University Hospital, University of Bern, 3008 Bern, Switzerland; (S.N.); (A.K.E.); (J.K.-R.)
| | - Sotirios Ntovas
- Department of Emergency Medicine, Inselspital, University Hospital, University of Bern, 3008 Bern, Switzerland; (S.N.); (A.K.E.); (J.K.-R.)
- Department of Visceral Surgery and Medicine, lnselspital, University Hospital, University of Bern, 3008 Bern, Switzerland
| | - Eleni Xourgia
- Department of Heart Surgery, lnselspital, University Hospital, University of Bern, 3008 Bern, Switzerland;
| | - Aristomenis K. Exadaktylos
- Department of Emergency Medicine, Inselspital, University Hospital, University of Bern, 3008 Bern, Switzerland; (S.N.); (A.K.E.); (J.K.-R.)
| | - Jolanta Klukowska-Rötzler
- Department of Emergency Medicine, Inselspital, University Hospital, University of Bern, 3008 Bern, Switzerland; (S.N.); (A.K.E.); (J.K.-R.)
| | - Mairi Ziaka
- Department of Internal Medicine, Thun Hospital, Krankenhausstrasse 12, 3600 Thun, Switzerland;
- Department of Emergency Medicine, Inselspital, University Hospital, University of Bern, 3008 Bern, Switzerland; (S.N.); (A.K.E.); (J.K.-R.)
| |
Collapse
|
2
|
Ulloque-Badaracco JR, Hernandez-Bustamante EA, Alarcón-Braga EA, Huayta-Cortez M, Carballo-Tello XL, Seminario-Amez RA, Rodríguez-Torres A, Casas-Patiño D, Herrera-Añazco P, Benites-Zapata VA. Seroprevalence of human toxocariasis in Latin America and the Caribbean: a systematic review and meta-analysis. Front Public Health 2023; 11:1181230. [PMID: 37441649 PMCID: PMC10335805 DOI: 10.3389/fpubh.2023.1181230] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 05/30/2023] [Indexed: 07/15/2023] Open
Abstract
Introduction The current study aimed to quantitatively synthesize available evidence regarding the seroprevalence of human toxocariasis in Latin America and the Caribbean. Methods A systematic research involving six electronic databases was conducted using a research strategy that combined MeSH terms with free terms. Article selection and information extraction were performed using a double and independent approach. The Newcastle-Ottawa tool was used to assess the risk of bias in the included articles. The meta-analysis used the random-effects approach, with subgroup analysis and sensitivity analysis for risk of bias also being performed. Results We included 101 articles with a total of 31,123 participants. The studies were conducted between 1990 and 2022, with Brazil accounting for the largest number of studies (n = 37). The overall seroprevalence of human toxocariasis was 31.0% (95% CI: 27.0-35.0%, I2 = 99%). The prevalence of the main characteristics observed in seropositive patients were as follows: ocular toxocariasis (30.0%), asymptomatic (26.0%), and presence of dogs at home (68.0%). In addition, the seroprevalence was lower in studies including only adults than in those including children or both. In contrast, no differences in seroprevalences were found between studies conducted in the community and hospital. Conclusion The overall seroprevalence of human toxocariasis in Latin America and the Caribbean was high. Notably, our findings showed that the seroprevalence was increased among populations who kept a dog at home but was decreased in populations comprising only adults. Our findings can be used to establish epidemiological surveillance strategies for the prevention and early identification of toxocariasis.
Collapse
Affiliation(s)
| | - Enrique A. Hernandez-Bustamante
- Sociedad Cientifica de Estudiantes de Medicina de la Universidad Nacional de Trujillo, Trujillo, Peru
- Grupo Peruano de Investigación Epidemiológica, Unidad Para la Generación y Síntesis de Evidencias en Salud, Universidad San Ignacio de Loyola, Lima, Peru
| | | | | | | | | | - Alejandra Rodríguez-Torres
- Universidad Autónoma del Estado de México, CU Amecameca, Mexico
- Red Internacional en Salud Colectiva y Salud Intercultural, Amecameca, Mexico
| | - Donovan Casas-Patiño
- Universidad Autónoma del Estado de México, CU Amecameca, Mexico
- Red Internacional en Salud Colectiva y Salud Intercultural, Amecameca, Mexico
| | - Percy Herrera-Añazco
- Universidad Privada del Norte, Trujillo, Peru
- Red Peruana de Salud Colectiva, Lima, Peru
| | - Vicente A. Benites-Zapata
- Unidad de Investigación Para la Generación y Síntesis de Evidencias en Salud, Vicerrectorado de Investigación, Universidad San Ignacio de Loyola, Lima, Peru
| |
Collapse
|
3
|
Abstract
Toxocara canis (from dogs) is recognised as a potential cause of human toxocarosis, but Toxocara cati (from cats) and other species (eg, Toxascaris leonina found in foxes) are also possible causes. Most colonisation with Toxocara species does not lead to symptomatic infection in well-cared for adult animals; young and debilitated animals are at greater risk. Humans can acquire infection from infected animals, for example, via soil contaminated with faeces; however, most human infections are asymptomatic, with symptomatic infection being very rare in the UK. The risk of human infection is reduced by measures such as hand washing and responsible disposal of dog faeces. Some organisations recommend regular prophylactic treatment of pet dogs and cats. However, there are concerns that some parasiticides are contaminating the environment. As an example of a One-Health problem there is a potential conflict between the needs of animal health, human health and the health of the wider ecosystem. Also, considering that only about 5% of non-juvenile household dogs shed Toxocara eggs at a given time, it has been questioned whether it is worthwhile to invest in frequent blind treatments. British veterinary organisations have suggested less frequent treatment may be more appropriate and should be based on individual risk assessment and faecal examinations for worms rather than blanket regular prophylactic treatment, which could reduce the impact of parasiticides on the environment without greatly increasing the risks to animal or human health.
Collapse
|
4
|
Wu Y, Duffey M, Alex SE, Suarez-Reyes C, Clark EH, Weatherhead JE. The role of helminths in the development of non-communicable diseases. Front Immunol 2022; 13:941977. [PMID: 36119098 PMCID: PMC9473640 DOI: 10.3389/fimmu.2022.941977] [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: 05/12/2022] [Accepted: 08/01/2022] [Indexed: 12/15/2022] Open
Abstract
Non-communicable diseases (NCDs) like cardiovascular disease, chronic respiratory diseases, cancers, diabetes, and neuropsychiatric diseases cause significant global morbidity and mortality which disproportionately affect those living in low resource regions including low- and middle-income countries (LMICs). In order to reduce NCD morbidity and mortality in LMIC it is imperative to understand risk factors associated with the development of NCDs. Certain infections are known risk factors for many NCDs. Several parasitic helminth infections, which occur most commonly in LMICs, have been identified as potential drivers of NCDs in parasite-endemic regions. Though understudied, the impact of helminth infections on the development of NCDs is likely related to helminth-specific factors, including species, developmental stage and disease burden. Mechanical and chemical damage induced by the helminth in combination with pathologic host immune responses contribute to the long-term inflammation that increases risk for NCD development. Robust studies from animal models and human clinical trials are needed to understand the immunologic mechanisms of helminth-induced NCDs. Understanding the complex connection between helminths and NCDs will aid in targeted public health programs to reduce helminth-induced NCDs and reduce the high rates of morbidity that affects millions of people living in parasite-endemic, LMICs globally.
Collapse
Affiliation(s)
- Yifan Wu
- Department of Pediatrics, Division of Tropical Medicine, Baylor College of Medicine, Houston, TX, United States
| | - Megan Duffey
- Department of Pediatrics, Division of Tropical Medicine, Baylor College of Medicine, Houston, TX, United States,Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine, Houston, TX, United States
| | - Saira Elizabeth Alex
- National School of Tropical Medicine, Baylor College of Medicine, Houston, TX, United States
| | - Charlie Suarez-Reyes
- Department of Pediatrics, Division of Tropical Medicine, Baylor College of Medicine, Houston, TX, United States
| | - Eva H. Clark
- Department of Pediatrics, Division of Tropical Medicine, Baylor College of Medicine, Houston, TX, United States,Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine, Houston, TX, United States,National School of Tropical Medicine, Baylor College of Medicine, Houston, TX, United States
| | - Jill E. Weatherhead
- Department of Pediatrics, Division of Tropical Medicine, Baylor College of Medicine, Houston, TX, United States,Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine, Houston, TX, United States,National School of Tropical Medicine, Baylor College of Medicine, Houston, TX, United States,*Correspondence: Jill E. Weatherhead,
| |
Collapse
|
5
|
Merigueti YFFB, Giuffrida R, da Silva RC, Kmetiuk LB, Santos APD, Biondo AW, Santarém VA. Dog and Cat Contact as Risk Factor for Human Toxocariasis: Systematic Review and Meta-Analysis. Front Public Health 2022; 10:854468. [PMID: 35836995 PMCID: PMC9273826 DOI: 10.3389/fpubh.2022.854468] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 04/12/2022] [Indexed: 11/25/2022] Open
Abstract
Toxocariasis, a neglected parasitic zoonosis with worldwide distribution, has been reportedly associated to different risk factors in several epidemiological and meta-analysis studies. However, dog and cat contact (environmental and animal exposure) as isolated associated risk factor for children and adults remains to be fully established. Accordingly, the present meta-analysis has aimed to directly assess dog and cat contact for toxocariasis seropositivity in under-18 and adult persons, using a survey strategy of PubMed/Medline, Embase, Scopus and Scielo Databases, from January 2009 to December 2021. A meta-analysis model of random effects was applied to estimate odds ratio (OR) with 95% Confidence Interval (CI). The statistical heterogeneity was evaluated by the Cochran Q-Test and I2 values. A total of 41 transversal studies (n = 20.515 individuals) from different geographic regions (classified by the World Health Organization) were included herein. In overall, 1,882/13,496 (13.95%; 95% IC = 13.4–14.5) youngers and 513/7.019 (7.3%; 95% CI = 6.7–7.9) adults in contact with dogs or cats were serologically reagent for anti-Toxocara antibodies. Association of dog and cat contact was observed only in youngers, with both dogs (OR = 1.53; p < 0.0001) and cats (OR = 1.64; p = 0.0001). In addition, association of dog and contact and serology was statistically significant in populations of Americas (OR = 1.37; 95% CI = 1.1–1.7), Middle East (OR = 2.9; 95% CI = 1.6–5.1) and West Pacific (OR = 1.6; 95% IC = 1.3–1.9). In conclusion, contact with dogs and cats, particularly by younger individuals and in regions such as Americas, Middle East, and West Pacific, should be always a public health concern for toxocariasis. Moreover, dogs and cats should be periodically dewormed, washed and hair cleaned prior to contact with youngers. Finally, robust statistical results herein may serve as basis for future strategies and preventive measures for safer dog and cat contact.
Collapse
Affiliation(s)
| | - Rogerio Giuffrida
- Graduate College of Animal Science, University of Western São Paulo (UNOESTE), Presidente Prudente, Brazil
| | - Rodrigo Costa da Silva
- Graduate College of Animal Science, University of Western São Paulo (UNOESTE), Presidente Prudente, Brazil
| | - Louise Bach Kmetiuk
- Laboratory of Cell Biology, Instituto Carlos Chagas, Fundação Oswaldo Cruz, Curitiba, Brazil
| | - Andrea Pires Dos Santos
- Department of Comparative Pathobiology, College of Veterinary Medicine, Purdue University, West Lafayette, IN, United States
| | | | - Vamilton Alvares Santarém
- Graduate College of Animal Science, University of Western São Paulo (UNOESTE), Presidente Prudente, Brazil
- *Correspondence: Vamilton Alvares Santarém
| |
Collapse
|
6
|
Alizadeh Khatir A, Sepidarkish M, Rajabalizadeh MR, Alizadeh Moghaddam S, Aghapour S, Mehravar S, Hotez PJ, Gasser RB, Rostami A. Case-Control Study to Assess the Association between Epilepsy and Toxocara Infection/Exposure. Microorganisms 2021; 9:microorganisms9102091. [PMID: 34683412 PMCID: PMC8537584 DOI: 10.3390/microorganisms9102091] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 09/29/2021] [Accepted: 10/01/2021] [Indexed: 11/16/2022] Open
Abstract
Although causes and etiology of epilepsy are mostly obscure, some zoonotic parasites, such as Toxocara species, have been proposed as a risk factor for this disease. Here, we conducted an age-matched case-control study to evaluate whether there is an association between epilepsy and the presence of serum antibodies to Toxocara in incident cases. We included 94 idiopathic epileptic patients as cases, and—from the same geographical region—88 people with no own history of epilepsy or neurological disease as control subjects. Epilepsy was confirmed by a physician using the International League Against Epilepsy (ILAE) definition. All participants were screened for the anti-Toxocara IgG serum antibody by enzyme-linked immunosorbent assay (ELISA). Univariate and mutltivariate statistical analyses were applied to calculate the crude and adjusted odds ratios (OR) and 95% confidence intervals (CIs). Anti-Toxocara serum antibody was detected in 37 epileptic patients and in 23 control subjects, giving respective seroprevalences of 39.3% (95% CI, 29.4–49.9%) and 26.1% (95% CI, 17.3–36.5%), respectively. Adjusted multivariate logistic regression analysis estimated an OR of 2.38 (95% CI, 1.25–4.63), indicating a significant association between epilepsy and Toxocara seropositivity. There was also a significant association between seropositivity to Toxocara and partial (OR, 2.60; 95% CI, 1.14–6.04) or generalized (OR, 2.17; 95% CI, 1.09–4.40%) seizures. Findings from the present study of incident epileptic cases support previous studies proposing that Toxocara infection/exposure is a risk factor for epilepsy. However, further well-designed population-based surveys and mechanistic/experimental studies in animal models are required to better understand the reason(s) for this association.
Collapse
Affiliation(s)
- Ali Alizadeh Khatir
- Mobility Impairment Research Center, Health Research Institute, Babol University of Medical Sciences, Babol 4714871167, Iran;
| | - Mahdi Sepidarkish
- Department of Biostatistics and Epidemiology, School of Public Health, Babol University of Medical Sciences, Babol 4714871167, Iran;
| | - Mohammad Reza Rajabalizadeh
- Student Research Committee, Babol University of Medical Sciences, Babol 4714871167, Iran; (M.R.R.); (S.A.M.)
| | - Solmaz Alizadeh Moghaddam
- Student Research Committee, Babol University of Medical Sciences, Babol 4714871167, Iran; (M.R.R.); (S.A.M.)
| | - Saeed Aghapour
- Department of Neurosurgery, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari 1353447416, Iran;
| | - Saeed Mehravar
- Department of Epidemiology and Statistics, School of Public Health, Tehran University of Medical Science, Tehran 1666663111, Iran;
| | - Peter J. Hotez
- Texas Children’s Hospital Center for Vaccine Development, Department of Pediatrics and Molecular Virology and Microbiology, National School of Tropical Medicine, Baylor College of Medicine, Houston, TX 77030, USA;
| | - Robin B. Gasser
- Department of Veterinary Biosciences, Melbourne Veterinary School, The University of Melbourne, Parkville, VIC 3010, Australia
- Correspondence: (R.B.G.); (A.R.); Tel.: +98-11-32190557 (A.R.)
| | - Ali Rostami
- Infectious Diseases and Tropical Medicine Research Center, Health Research Institute, Babol University of Medical Sciences, Babol 4714871167, Iran
- Correspondence: (R.B.G.); (A.R.); Tel.: +98-11-32190557 (A.R.)
| |
Collapse
|
7
|
Angwafor SA, Bell GS, Ngarka L, Otte W, Tabah EN, Nfor LN, Njamnshi TN, Njamnshi AK, Sander JW. Incidence and prevalence of epilepsy and associated factors in a health district in North-West Cameroon: A population survey. Epilepsy Behav 2021; 121:108048. [PMID: 34083120 DOI: 10.1016/j.yebeh.2021.108048] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 04/28/2021] [Accepted: 04/28/2021] [Indexed: 11/25/2022]
Abstract
This population-based cross-sectional survey with a follow-up case-control study assessed the prevalence, incidence, and risk factors for epilepsy in a rural health district in the North-West Region of Cameroon. Community-based epilepsy screening targeted all inhabitants, six years and older, in all 16 health areas in the Batibo Health District. During door-to-door visits, trained fieldworkers used a validated questionnaire to interview consenting household heads to screen for epilepsy in eligible residents. Trained physicians subsequently assessed people with suspected seizures. After clinical assessment, they confirmed or refuted the diagnosis and estimated the date of epilepsy onset. A trained nurse interviewed people with epilepsy and randomly selected healthy individuals, obtaining relevant demographic details and information on exposure to risk factors for epilepsy. Out of 36,282 residents screened, 524 had active epilepsy. The age-standardized prevalence of active epilepsy was 33.9/1,000 (95% CI: 31.0-37.1/1,000). We estimated the one-year age-standardized epilepsy incidence at 171/100,000 (95%CI: 114.0-254.6). Active epilepsy prevalence varied widely between health areas, ranging between 12 and 75 per 1,000. The peak age-specific prevalence was in the 25-34 age group. In adults, multivariate analysis showed that having a relative with epilepsy was positively associated with epilepsy. Epilepsy characteristics in this population, geographical heterogeneity, and the age-specific prevalence pattern suggest that endemic neurocysticercosis and onchocerciasis may be implicated. Further investigations are warranted to establish the full range of risk factors for epilepsy in this population.
Collapse
Affiliation(s)
- Samuel A Angwafor
- NIHR University College London Hospitals Biomedical Research Centre, UCL Queen Square Institute of Neurology, London WC1N 3BG and Chalfont Centre for Epilepsy, Chalfont St Peter, Bucks SL9 0RJ, United Kingdom; Faculty of Health Sciences, University of Bamenda, Cameroon
| | - Gail S Bell
- NIHR University College London Hospitals Biomedical Research Centre, UCL Queen Square Institute of Neurology, London WC1N 3BG and Chalfont Centre for Epilepsy, Chalfont St Peter, Bucks SL9 0RJ, United Kingdom
| | - Leonard Ngarka
- Neurology Department, Central Hospital Yaoundé/Faculty of Medicine and Biomedical Sciences (FMBS), The University of Yaoundé I, Yaoundé, Cameroon; Brain Research Africa Initiative (BRAIN), Yaoundé, Cameroon/Geneva, Switzerland
| | - Willem Otte
- Department of Pediatric Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht and Utrecht University, Utrecht, Netherlands
| | - Earnest N Tabah
- Department of Public Health, Faculty of Medicine and Biomedical Sciences, University Of Dschang, Cameroon & Department of Disease Control, Ministry of Public Health, Yaounde, Cameroon
| | - Leonard N Nfor
- Neurology Department, Central Hospital Yaoundé/Faculty of Medicine and Biomedical Sciences (FMBS), The University of Yaoundé I, Yaoundé, Cameroon; Brain Research Africa Initiative (BRAIN), Yaoundé, Cameroon/Geneva, Switzerland
| | - Theophilus N Njamnshi
- Department of Medical Laboratory Science, School of Health and Medical Science, Kumbo, Catholic University of Cameroon, Bamenda, Cameroon
| | - Alfred K Njamnshi
- Neurology Department, Central Hospital Yaoundé/Faculty of Medicine and Biomedical Sciences (FMBS), The University of Yaoundé I, Yaoundé, Cameroon; Brain Research Africa Initiative (BRAIN), Yaoundé, Cameroon/Geneva, Switzerland.
| | - Josemir W Sander
- NIHR University College London Hospitals Biomedical Research Centre, UCL Queen Square Institute of Neurology, London WC1N 3BG and Chalfont Centre for Epilepsy, Chalfont St Peter, Bucks SL9 0RJ, United Kingdom; Stichting Epilepsie Instelligen Nederland (SEIN), Heemstede, Netherlands
| |
Collapse
|
8
|
Taghipour A, Habibpour H, Mirzapour A, Rostami A. Toxocara infection/exposure and the risk of schizophrenia: a systematic review and meta-analysis. Trans R Soc Trop Med Hyg 2021; 115:1114-1121. [PMID: 33822228 DOI: 10.1093/trstmh/trab056] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 02/05/2021] [Accepted: 03/09/2021] [Indexed: 12/24/2022] Open
Abstract
Toxocariasis is an important neglected disease that could have a role in the development of some neurological disorders, such as schizophrenia (SCZ). We performed the first systematic review and meta-analysis on observational studies to evaluate the possible association between Toxocara infection/exposure and SCZ. Systematic searching (PubMed, Scopus, Web of Science and Google Scholar) was performed, up to 15 August 2020, to identify the relevant studies. We used a random effects meta-analysis model to generate the pooled OR and 95% CIs. The research process resulted in the identification of six studies related to the subject of interest entailing 411 SCZ patients and 2047 controls. Our results demonstrated that the SCZ patients (15%; 95% CI 6.8 to 29.9%) had higher pooled seroprevalence of Toxocara infection/exposure than the control group (3.3%; 95% CI 1.1 to 9.4%), showing a significant association (pooled OR, 4.06; 95% CI 1.14 to 14.43). Our findings suggested that Toxocara infection/exposure might have an important but neglected contribution to SCZ development. However, further well-designed and large-scale observational studies are needed to illuminate this association. Because many other environmental and genetic factors may be strong confounders, more mechanistic/experimental studies in animal models are also necessary to further define the mechanism of this association.
Collapse
Affiliation(s)
- Ali Taghipour
- Department of Parasitology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Haniyeh Habibpour
- Department of Microbiology, Islamic Azad University, Varamin Pishva Branch, Tehran, Iran
| | - Aliyar Mirzapour
- Innovative Medical Research Center, Department of Medical Parasitology and Mycology, School of Medicine, Mashhad Branch, Islamic Azad University, Mashhad, Iran
| | - Ali Rostami
- Infectious Diseases and Tropical Medicine Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran.,Immunoregulation Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| |
Collapse
|
9
|
Bossi G, Bruno R, Novati S, Maserati R, Mussati G, Gorone MP, Nepita EV, Regalbuto C, Gola G, Simoncelli AM, Bruno A, Musso P, Clerici E, Marseglia GL. Cerebral Toxocariasis as a Cause of Epilepsy: A Pediatric Case. Neuropediatrics 2021; 52:142-145. [PMID: 33472248 DOI: 10.1055/s-0040-1721701] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Toxocarosis is the consequence of human infection by Toxocara spp. larvae and is one of the most common ascarioses, not only in developing countries, but also in the European region, where its prevalence reaches 14%. Due to their particular behavior, children are at higher risk of this parasitic infection, whose clinical features depend on the localization of the Toxocara larvae. Neurotoxocariasis is very uncommon in children and may take different forms depending on the underlying physiopathologic process: immune reaction against the parasite antigens, vasculitis, treatment complications, or, very rarely, brain localization of Toxocara spp. larvae. The association between neurotoxocariasis and the onset of childhood epilepsy has been postulated but is still debated. Moreover, a Toxocara spp. abscess causing epileptic seizures in children has been rarely described, especially in western countries. Hereby we present a 9-year-old patient with a new diagnosis of epilepsy definitely secondary to brain abscess due to the localization of Toxocara canis larvae. Diagnosis was confirmed by neuroimaging and serological test. The successful treatment with albendazole and steroids was documented with a close and long-term clinical and neuroradiological follow-up. Our experience confirms that every case of cryptogenetic epilepsy in children deserves a neuroimaging study and, in case of cystic images, Toxocara serology is mandatory to avoid further unnecessary invasive diagnostic investigations and to set the specific drug therapy.
Collapse
Affiliation(s)
- Grazia Bossi
- Department of Pediatrics, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Raffaele Bruno
- Department of Infectious Diseases, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.,Department of Clinical-Surgical Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Stefano Novati
- Department of Infectious Diseases, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Roberta Maserati
- Microbiology and Virology Department, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Georgia Mussati
- Department of Diagnostic and Interventional Radiology and Neuroradiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | | | | | - Corrado Regalbuto
- Department of Pediatrics, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Gioia Gola
- Department of Diagnostic and Interventional Radiology and Neuroradiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Anna Maria Simoncelli
- Department of Diagnostic and Interventional Radiology and Neuroradiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Antonella Bruno
- Microbiology and Virology Department, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Paola Musso
- Department of Pediatrics, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Edoardo Clerici
- Department of Pediatrics, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Gian Luigi Marseglia
- Department of Pediatrics, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.,Department of Clinical-Surgical Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| |
Collapse
|
10
|
Potential Parasitic Causes of Epilepsy in an Onchocerciasis Endemic Area in the Ituri Province, Democratic Republic of Congo. Pathogens 2021; 10:pathogens10030359. [PMID: 33803565 PMCID: PMC8002919 DOI: 10.3390/pathogens10030359] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 03/14/2021] [Accepted: 03/16/2021] [Indexed: 11/30/2022] Open
Abstract
A high burden of epilepsy is observed in Africa where parasitological infections are endemic. In 2016, in an Onchocerciasis endemic area in the Logo health zone, in Ituri province in the Democratic Republic of Congo, a door-to-door study showed an epilepsy prevalence of 4.6%, and 50.6% of persons with epilepsy were infected with Onchocerca volvulus. In the current study, the serum of 195 people infected with O. volvulus persons with epilepsy were tested to determine the proportion of co-infections with Taenia solium, Toxocara canis and Strongyloides. These proportions were, respectively, 8.2, 18.5 and 12.8%. Persons with a T. solium co-infection were older than those without co-infection (p = 0.021). In six (37.5%) of the T. solium co-infected persons, the first seizures appeared after the age of 30 years compared to three (2.1%) persons without a co-infection (p < 0.0001). Our study suggests that an O. volvulus infection is the main parasitic cause of epilepsy in the Ituri province, but in some persons, mainly in those with late onset epilepsy and with focal seizures, the epilepsy may be caused by neurocysticercosis. As the population in the area rears pigs, activities to limit T. solium transmission should be implemented.
Collapse
|
11
|
Abstract
Probiotics have been shown to reduce the intensity of Toxocara canis infection in mice. However, larval transmission of this nematode also occurs via transplacental and transmammary routes. Thus, the aim of this study was to evaluate the effect of the Saccharomyces boulardii probiotic on the vertical transmission of T. canis in Swiss mice. The mice received 107S. boulardii colony-forming units per gram of food. The supplementation began 15 days before mating and was maintained throughout pregnancy and lactation. The animals were inoculated with 300 T. canis embryonated eggs on the 14th day of pregnancy. The presence of larvae was examined in the organs of the females and their offspring. The examined organs included the following: brain, liver, lungs, heart, kidneys, spleen, eye, skeletal muscle (carcass) and mammary glands of lactating females. There was a 42% (P = 0.041) reduction in the number of larvae transmitted to offspring in the group that received probiotic-supplemented food (GI). Additionally, there was a 50% reduction (P = 0.023) in the number of larvae found in the brains of lactating offspring in the GI group. These results reveal the potential of S. boulardii probiotic use as an auxiliary method of controlling visceral toxocariasis.
Collapse
|
12
|
"Begging the Question"-Does Toxocara Infection/Exposure Associate with Multiple Sclerosis-Risk? Pathogens 2020; 9:pathogens9110938. [PMID: 33187271 PMCID: PMC7696196 DOI: 10.3390/pathogens9110938] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Revised: 11/01/2020] [Accepted: 11/04/2020] [Indexed: 12/14/2022] Open
Abstract
Although the cause of multiple sclerosis (MS) is unclear, infectious agents, including some parasitic roundworms (nematodes), have been proposed as possible risk factors or contributors. Here, we conducted a systematic review and meta-analysis of published observational studies to evaluate whether there is a possible association between infection with, or exposure to, one or more members of the genus Toxocara (phylum Nematoda; superfamily Ascaridoidea) and MS. We undertook a search of public literature databases to identify relevant studies and then used a random-effects meta-analysis model to generate the pooled odds ratio (OR) and 95% confidence intervals (CIs). This search identified six of a total of 1371 articles that were relevant to the topic; these published studies involved totals of 473 MS patients and 647 control subjects. Anti-Toxocara IgG serum antibodies were detected in 62 MS patients and 37 controls, resulting in respective seroprevalences of 13.1% (95% CI: 8.2-20.3) and 4.8% (95% CI: 2.5-9.2), indicating an association (pooled OR, 3.01; 95% CI: 1.46-6.21). Because of the publication bias identified (six eligible studies), well-designed and -controlled studies are required in the future to rigorously test the hypothesis that Toxocara infection/exposure has an association with MS.
Collapse
|
13
|
A Systematic Review and Meta-analysis of Toxocariasis in Iran: Is it Time to Take it Seriously? Acta Parasitol 2020; 65:569-584. [PMID: 32319035 DOI: 10.2478/s11686-020-00195-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 03/11/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND Toxocariasis is one of the neglected zoonosis with considerable public health importance around the world. The current study aimed to elucidate the overall prevalence of Toxocara infection in human and definitive hosts and also the contamination of soil and raw vegetables with the ova of these parasites, in Iran, using systematic review and meta-analysis. METHODS Six English and Persian databases were explored from 2000 to 2017 using the terms toxocariasis, Toxocara spp., visceral larva migrans, Iran, epidemiology, and prevalence. This meta-analysis conducted using STATA, and for all statistical tests, a p value less than 0.05 was considered significant. The random-effects model was used to the report of the pooled prevalence with a 95% confidence interval (CI). RESULTS The pooled prevalence of toxocariasis in human was calculated as 11% (95% CI 8-13%). In terms of definitive hosts, the pooled prevalence of Toxocara infection in dogs and cats were calculated as 17% (95% CI 14-20%) and 37% (95% CI 26-48%), respectively. Also, the pooled prevalence of Toxocara spp. eggs in the soil and raw vegetable samples were calculated as 18% (95% CI 13-23%) and 2% (95% CI 1-3%), respectively. CONCLUSIONS The results of current study demonstrate that toxocariasis should be taken more seriously by health authorities. Implementing an appropriate control program is necessary to reduce the incidence of this disease in Iran.
Collapse
|
14
|
Sadeghi M, Riahi SM, Mohammadi M, Saber V, Aghamolaie S, Moghaddam SA, Aghaei S, Javanian M, Gamble HR, Rostami A. An updated meta-analysis of the association between Toxoplasma gondii infection and risk of epilepsy. Trans R Soc Trop Med Hyg 2020; 113:453-462. [PMID: 31034025 DOI: 10.1093/trstmh/trz025] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 03/08/2019] [Accepted: 03/26/2019] [Indexed: 12/19/2022] Open
Abstract
Toxoplasma gondii is a neurotropic pathogen with worldwide distribution. To evaluate the association between Toxoplasma infection and the risk of epilepsy by meta-analysis, observational peer-reviewed studies were retrieved from PubMed, Embase, Web of Science, Scopus and Google Scholar (up to 10 October 2018) and by reference review. Pooled risk estimates were calculated using a random effects model. Heterogeneity was assessed using Cochrane's Q-test and I2. In total, 16 eligible studies involving 19 data sets were included for the final analysis. A total 7897 participants (3771 epileptic patients, 4026 healthy controls) were included. The pooled odds ratio (OR) for Toxoplasma infection was increased to 1.72 (95% confidence interval [CI] 1.37 to 2.16) among patients with epilepsy. There was moderate heterogeneity among the studies (χ2=39.8, I2=62.3%, p=0.001). The ORs from subgroup analyses showed that both cryptogenic epilepsy (OR 2.65 [95% CI 1.91 to 3.68]) and active convulsive epilepsy (OR 1.37 [95% CI 1.09 to 1.72]) were significantly associated with Toxoplasma infection. Another subgroup analyses according to age showed a significant positive association in children (OR 1.33), adults (OR 1.57) and in all ages (OR 1.89). Our findings support the association between Toxoplasma infection and epilepsy. More prospective studies with larger sample sizes and more experimental studies are recommended to elucidate a causative relationship.
Collapse
Affiliation(s)
- Maryam Sadeghi
- Department of Medical Parasitology and Mycology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Seyed Mohammad Riahi
- Department of Medical Parasitology and Mycology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mona Mohammadi
- Clinical Parasitology Center, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Vafa Saber
- Department of Microbiology, Islamic Azad University, Varamin Pishva Branch, Tehran, Iran
| | - Somayeh Aghamolaie
- Department of Medical Parasitology and Mycology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Shima Aghaei
- Department of Medical Mycology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Mostafa Javanian
- Infectious Diseases and Tropical Medicine Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - H Ray Gamble
- National Academy of Sciences, Washington, DC, USA
| | - Ali Rostami
- Infectious Diseases and Tropical Medicine Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran.,Immunoregulation Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| |
Collapse
|
15
|
Kamgno J, Tchatchueng-Mbougua JB, Nana-Djeunga HC, Esso L, Zouré HG, Mackenzie CD, Boussinesq M. Community-based door to door census of suspected people living with epilepsy: empowering community drug distributors to improve the provision of care to rural communities in Cameroon. BMC Public Health 2020; 20:871. [PMID: 32503495 PMCID: PMC7275343 DOI: 10.1186/s12889-020-08997-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 05/27/2020] [Indexed: 11/12/2022] Open
Abstract
Background Epilepsy is a severe neurological disorder with huge psychological, social, and economic consequences, including premature deaths and loss of productivity. Sub-Saharan Africa carries the highest burden of epilepsy. The management of epilepsy in Cameroon remains unsatisfactory due to poor identification of cases and a limited knowledge of the distribution of the disease. The objective of this study was to determine whether community drug distributors (CDDs) - volunteers selected by their communities to distribute ivermectin against onchocerciasis and who have been proven efficient to deliver other health interventions such as insecticide-treated bed nets to prevent malaria, vitamin A tablets, and albendazole to treat soil transmitted helminthiasis - can be used to reliably identify people living with epilepsy to promote better management of cases. Methods This study was carried out in three health Districts in Cameroon. An exhaustive house to house census was carried out by trained CDDs under the supervision of local nurses. In each household, all suspected cases of epilepsy were identified. In each health district, five communities were randomly selected for a second census by trained health personnel (research team). The results of the two censuses were compared for verification purposes. Results A total of 53,005 people was registered in the 190 communities surveyed with 794 (1.4%) individuals identified as suspected cases of epilepsy (SCE) by the CDDs. In the 15 communities where the SCE census was verified, the average ratio between the number of suspected cases of epilepsy reported in a community by the research team and that reported by the CDDs was 1.1; this ratio was < 0.8 and > 1.2 in 6 communities. Conclusions The results of this study suggest that CDDs, who are present in about 200,000 communities in 31 Sub Saharan African countries where onchocerciasis is endemic, can be successfully used to assess epilepsy prevalence, and therefore map epilepsy in many African countries.
Collapse
Affiliation(s)
- Joseph Kamgno
- Centre for Research on Filariasis and other Tropical Diseases (CRFilMT), P.O. Box 5797, Yaoundé, Cameroon. .,Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon.
| | - Jules B Tchatchueng-Mbougua
- Centre for Research on Filariasis and other Tropical Diseases (CRFilMT), P.O. Box 5797, Yaoundé, Cameroon.,Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon.,Service d'épidémiologie, Centre Pasteur du Cameroun, Membre du Réseau International des Instituts Pasteur, Yaoundé, Cameroon
| | - Hugues C Nana-Djeunga
- Centre for Research on Filariasis and other Tropical Diseases (CRFilMT), P.O. Box 5797, Yaoundé, Cameroon
| | - Lynda Esso
- Centre for Research on Filariasis and other Tropical Diseases (CRFilMT), P.O. Box 5797, Yaoundé, Cameroon
| | - Honorat G Zouré
- Expanded Special Project for Elimination of NTDs (ESPEN), World Health Organization, African Regional Office, Brazzaville, Republic of Congo
| | - Charles D Mackenzie
- Filarial Programmes Support Unit (FPSU), Liverpool School of Tropical Medicine, Pembroke Place Liverpool, Liverpool, L3 5QA, UK
| | - Michel Boussinesq
- Institut de Recherche pour le Développement (IRD), UMI233/ INSERM U1175/ Université de Montpellier, 911 Avenue Agropolis, 34394, Montpellier Cedex 5, France
| |
Collapse
|
16
|
Pennelegion C, Drake J, Wiseman S, Wright I. Survey of UK pet owners quantifying internal parasite infection risk and deworming recommendation implications. Parasit Vectors 2020; 13:218. [PMID: 32336273 PMCID: PMC7184696 DOI: 10.1186/s13071-020-04086-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 04/15/2020] [Indexed: 11/21/2022] Open
Abstract
Background Dogs and cats in the UK are exposed to many internal parasites which can pose risks to the health of both the pet and their owners. By understanding these endemic parasites and the risks they pose, we can assess the lifestyle of pets and recommend the correct deworming frequency. Studies identifying risk factors were discussed in the European Scientific Counsel Companion Animal Parasites (ESCCAP) guidelines. To this date, there has been very little information on how pet owners in the UK deworm their pets and if the protocols they follow align with ESCCAP recommendations. The objective of this study was to look at the current deworming protocols of UK cat and dog owners in conjunction with their lifestyle and risk. Methods An online survey was conducted in the UK targeting pet owners who own at least one dog and/or cat and were responsible for product purchase, the pet’s health care and veterinary visits. These survey results were analysed against the ESCCAP guidelines and each pet placed into a risk category. By comparing the current deworming frequency with that recommended for their risk category, the compliance of UK pet owners with ESCCAP recommendations was evaluated. Results A total of 500 dog owners and 500 cat owners completed surveys. Overall, the study found none of the pets fell into risk group A, with all pets meeting the risk level for at least deworming four times a year (risk group B and above). The majority of animals fell into the highest risk category D with 97% of dogs and 68% of cats. The average deworming per year in the UK was 3.1 for dogs and 3.1 cats, below the minimum recommended by ESCCAP. Conclusions For both felines and canines, the dosing frequencies are lower than recommended to both reduce zoonotic risk for reducing Toxocara spp. egg-shedding and improve pet health. This research highlights the need for improved education around dog and cat patient risk assessments and greater adherence to recommended deworming aligned with the ESCCAP guidelines.![]()
Collapse
Affiliation(s)
| | - Jason Drake
- Elanco Animal Health, 2500 Innovation Way, Greenfield, IN, 46140, USA.
| | - Scott Wiseman
- Elanco Animal Health, Lilly House, Priestley Road, Basingstoke, Hampshire, RG24 9NL, UK
| | - Ian Wright
- Mount Veterinary Practice, 1 Harris St, Fleetwood, FY7 6QX, UK.,ESCCAP UK & Ireland, PO Box 358, Malvern, WR14 9HQ, UK
| |
Collapse
|
17
|
Ma G, Rostami A, Wang T, Hofmann A, Hotez PJ, Gasser RB. Global and regional seroprevalence estimates for human toxocariasis: A call for action. ADVANCES IN PARASITOLOGY 2020; 109:275-290. [PMID: 32381202 DOI: 10.1016/bs.apar.2020.01.011] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Human toxocariasis is a parasitic disease transmitted usually from dogs and/or cats that are infected with Toxocara species, and can be associated with a range of allergic, neurological and/or visual disorders. Recent epidemiological research has estimated that ~1.4 billion people worldwide, particularly in subtropical and tropical regions, are infected with, or exposed to Toxocara species, indicating that human toxocariasis is a neglected tropical disease. Here, we review recent research efforts, consider risk factors, discuss limitations in current seroprevalence estimates, and propose some future research directions towards improved awareness, surveillance, prevention and control of this neglected disease.
Collapse
Affiliation(s)
- Guangxu Ma
- Department of Veterinary Biosciences, Melbourne Veterinary School, Faculty of Veterinary and Agricultural Sciences, The University of Melbourne, Parkville, VIC, Australia
| | - Ali Rostami
- Infectious Diseases and Tropical Medicine Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Tao Wang
- Department of Veterinary Biosciences, Melbourne Veterinary School, Faculty of Veterinary and Agricultural Sciences, The University of Melbourne, Parkville, VIC, Australia
| | - Andreas Hofmann
- Department of Veterinary Biosciences, Melbourne Veterinary School, Faculty of Veterinary and Agricultural Sciences, The University of Melbourne, Parkville, VIC, Australia
| | - Peter J Hotez
- Texas Children's Hospital Center for Vaccine Development, Departments of Pediatrics and Molecular Virology & Microbiology, National School of Tropical Medicine, Baylor College of Medicine, Houston, TX, United States; Department of Biology, Baylor University, Waco, TX, United States; Hagler Institute for Advanced Studies at Texas A&M University, College Station, TX, United States
| | - Robin B Gasser
- Department of Veterinary Biosciences, Melbourne Veterinary School, Faculty of Veterinary and Agricultural Sciences, The University of Melbourne, Parkville, VIC, Australia.
| |
Collapse
|
18
|
Bradbury RS, Panicker IS. Toxocara seroprevalence in Canada-Climate, environment and culture. ADVANCES IN PARASITOLOGY 2020; 109:291-316. [PMID: 32381203 DOI: 10.1016/bs.apar.2020.03.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Human infection with larvae of canine and feline roundworms belonging to the genus Toxocara can lead to devastating visceral, neural or ocular larvae migrans disease. However, such overt disease represents a fraction of cases. Far more common is covert toxocariasis, a less severe, but clinically symptomatic form of disease, and those who are exposed to infective larvae and seroconvert, but appear to be asymptomatic. Canada represents a unique epidemiological environment for Toxocara infection and exposure. Although the freezing conditions of the vast Arctic Tundra region of the North are thought unlikely to support the lifecycle of Toxocara spp., exposure and seroconversion does occur in people belonging to Inuit communities of this region. Further south, in the sub-Arctic of northern Quebec and Saskatchewan, there is a higher seroprevalence in many Canadian First Nations communities. The epidemiology of these infections is different to that seen in the non-Indigenous communities of the Humid Continental region. Poverty and climate play a major part in the risk of Toxocara seropositive status in Canada, but other factors such as unique cultural practices, population density of humans and reservoir hosts, and contact with wildlife are also factors in exposure and subsequent seroconversion in Canadian communities. This review discusses previous Toxocara seroprevalence studies performed in Canada, summarizes the data for domestic and wild animal reservoir hosts of Toxocara canis, Toxocara cati, Toxocara vitulorum and the closely related helminth, Toxascaris leonina. It also discusses how the unique and varied aspects of climate, culture and environment impacts human Toxocara exposure in Canada.
Collapse
Affiliation(s)
- Richard S Bradbury
- School of Health and Life Sciences, Federation University Australia, Berwick, VIC, Australia.
| | - Indu S Panicker
- School of Health and Life Sciences, Federation University Australia, Berwick, VIC, Australia
| |
Collapse
|
19
|
Adeel AA. Seroepidemiology of human toxocariasis in North Africa. ADVANCES IN PARASITOLOGY 2020; 109:501-534. [PMID: 32381215 DOI: 10.1016/bs.apar.2020.01.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Seroprevalence studies on human toxocariasis help to assess the burden and the morbidity associated with this zoonosis. This review searched the seroprevalence studies and case reports in six North African countries: Algeria, Egypt, Libya, Morocco, Sudan and Tunisia, since 1990. The search also included studies on the environmental factors related to the risk of transmission. Most of the published epidemiological studies were done in Egypt. Cross-sectional and case-control studies in Egypt demonstrated that toxocariasis is a significant zoonosis that could be associated with conditions like bronchial asthma allergies and certain neuropsychiatric disorders. The population at risk of this infection includes all ages, both genders, in contact with dogs, resident in rural areas with poor housing conditions. The publications from Tunisia, Morocco and Algeria are limited to case reports and retrospective analyses of cases, but the disease is probably under-diagnosed in these three countries. There are no published reports on human toxocariasis in Libya and Sudan during the period covered by the review. Animal studies confirm high infection rates of dogs with Toxocara canis in North Africa. There is also evidence of wide-spread contamination of soil and water with Toxocara spp. eggs. Moreover, the use of untreated wastewater for irrigation in parts of North Africa could be a source of contamination of agricultural products with eggs of Toxocara spp. Population-based studies on human toxocariasis are recommended, using standardized diagnostic tests. These surveys should also assess risk factors to guide preventive measures.
Collapse
|
20
|
Baalbaki M, El Najjar M, Atweh S, El Ayoubi NK. Toxocara infection in the differential diagnosis of multiple sclerosis in the Middle East. Mult Scler J Exp Transl Clin 2020; 6:2055217319855757. [PMID: 35145728 PMCID: PMC8822452 DOI: 10.1177/2055217319855757] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 05/18/2019] [Indexed: 01/03/2023] Open
Abstract
A critical step in the diagnosis of multiple sclerosis is to rule out a heterogeneous variety of multiple sclerosis mimickers, which is crucial in the era of powerful immune-modulator treatments. In this review, we discuss the background of toxocariasis in general, present central nervous system Toxocara infection as one of the multiple sclerosis mimickers in the Middle East, and share our experience about the diagnosis and management of this condition. This entity seems very relevant in a region such as the Middle East, where displacement of populations and conflict can result in non-hygienic food and water management bundles. The diagnosis should be entertained, especially when assessing patients with myelopathy. The presence of a single lesion in the spinal cord with inflammatory features should prompt serological testing for Toxocara IgG and IgM in serum and the cerebrospinal fluid. This infection is treatable, with the regimen of high-dose albendazole being one of the most accepted treatments. Although most cases exhibit a good prognosis, some have residual deficits localized to the affected spinal cord level.
Collapse
Affiliation(s)
| | - Mayssam El Najjar
- Nehme and Therese Tohme Multiple Sclerosis Center, American University of Beirut Medical Center, Lebanon
| | - Samir Atweh
- Department of Neurology, American University of Beirut Medical Center, Lebanon
| | - Nabil K El Ayoubi
- American University of Beirut, Cairo street, Beirut, 1107 2020, Lebanon
| |
Collapse
|
21
|
A systematic review and meta-analysis of canine, feline and human Toxocara infections in sub-Saharan Africa. J Helminthol 2019; 94:e96. [PMID: 31679534 DOI: 10.1017/s0022149x19000889] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Toxocariasis is an emerging zoonotic disease caused by Toxocara canis and T. cati. Toxocariasis and its etiological agents are of global public health importance, whose burden appears underestimated, especially in sub-Saharan Africa (SSA). The diversity in the transmission routes of these parasites contributes to disease prevalence and often hinders disease control measures. This study aimed to review the epidemiological distribution of Toxocara infections in SSA region. A systematic review and meta-analysis were performed using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis). We identified 94 relevant, peer-reviewed articles, out of which, 75 articles were found eligible based on Toxocara infections in dogs, cats and humans. Overall, 27,102 samples were examined for T. canis in dogs, T. cati in cats and Toxocara serology in humans, out of which 6142 were positive for Toxocara infection: 3717 (13.7%) in dogs (faecal, 3487; necropsy, 180; hair, 50); 266 (1%) in cats (faecal, 101; necropsy, 165); and 2159 (8%) in humans (serology). Overall mean prevalences of 19% (95% confidence interval (CI): 14-23%), 9% (95% CI: 0-28%) and 36% (95% CI: 24-49%) were recorded in dogs, cats and humans, respectively. Substantial heterogeneity was observed between studies and subgroups (I2 = 99%, P < 0.01). Findings from the review showed that studies on the epidemiology of Toxocara infections in the SSA region are limited. We strongly recommend focused, collaborative and coordinated studies to determine Toxocara spp. prevalence in various hosts, including food animals and the environment, through a 'One Health' approach across SSA countries.
Collapse
|
22
|
Angwafor SA, Bell GS, Njamnshi AK, Singh G, Sander JW. Parasites and epilepsy: Understanding the determinants of epileptogenesis. Epilepsy Behav 2019; 92:235-244. [PMID: 30711777 DOI: 10.1016/j.yebeh.2018.11.033] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 11/25/2018] [Accepted: 11/26/2018] [Indexed: 12/25/2022]
Abstract
There is a large body of evidence suggesting that parasites could be a major preventable risk factor for epilepsy in low- and middle-income countries. We review potentially important substrates for epileptogenesis in parasitic diseases. Taenia solium is the most widely known parasite associated with epilepsy, and the risk seems determined mainly by the extent of cortical involvement and the evolution of the primary cortical lesion to gliosis or to a calcified granuloma. For most parasites, however, epileptogenesis is more complex, and other favorable host genetic factors and parasite-specific characteristics may be critical. In situations where cortical involvement by the parasite is either absent or minimal, parasite-induced epileptogenesis through an autoimmune process seems plausible. Further research to identify important markers of epileptogenesis in parasitic diseases will have huge implications for the development of trials to halt or delay onset of epilepsy.
Collapse
Affiliation(s)
- Samuel A Angwafor
- NIHR University College London Hospitals Biomedical Research Centre, UCL Queen Square Institute of Neurology, London WC1N 3BG, United Kingdom; Chalfont Centre for Epilepsy, Buckinghamshire, United Kingdom
| | - Gail S Bell
- NIHR University College London Hospitals Biomedical Research Centre, UCL Queen Square Institute of Neurology, London WC1N 3BG, United Kingdom; Chalfont Centre for Epilepsy, Buckinghamshire, United Kingdom
| | - Alfred K Njamnshi
- Neurology Department, Central Hospital Yaoundé/Faculty of Medicine and Biomedical Sciences (FMBS), The University of Yaoundé 1, Cameroon; Brain Research Africa Initiative (BRAIN), Yaoundé, Cameroon
| | - Gagandeep Singh
- NIHR University College London Hospitals Biomedical Research Centre, UCL Queen Square Institute of Neurology, London WC1N 3BG, United Kingdom; Chalfont Centre for Epilepsy, Buckinghamshire, United Kingdom; Department of Neurology, Dayanand Medical College, Ludhiana, India
| | - Josemir W Sander
- NIHR University College London Hospitals Biomedical Research Centre, UCL Queen Square Institute of Neurology, London WC1N 3BG, United Kingdom; Chalfont Centre for Epilepsy, Buckinghamshire, United Kingdom; Stichting Epilepsie Instelligen Nederland (SEIN), the Netherlands.
| |
Collapse
|
23
|
Modi M, Singh R, Goyal MK, Gairolla J, Singh G, Rishi V, Thakur JS, Sehgal RK, Garg VK, Khandelwal N, Kharbanda PS, Prabhakar S, Lal V. Prevalence of Epilepsy and its Association with Exposure to Toxocara canis: A Community Based, Case-control Study from Rural Northern India. Ann Indian Acad Neurol 2018; 21:263-269. [PMID: 30532354 PMCID: PMC6238566 DOI: 10.4103/aian.aian_384_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Objectives: Many community-based and hospital-based studies across the world have yielded contradictory results regarding association of positive Toxocara canis serology and epilepsy. The present study was planned to analyze disease burden of epilepsy in rural community of North India and its association with exposure to T. canis in this part of the world. Methods: A door-to-door screening survey was carried out in the rural community using a validated questionnaire for epilepsy by trained field workers, which was finally confirmed by trained neurologists. The risk factors for epilepsy and for predisposing infections were also enquired. The results were compared with an equal number of age- and sex-matched healthy controls enrolled from the same community. Serologic evaluation was carried out to detect antibodies against T. canis. Results: A total of 41,973 persons from the rural community in 49 villages were enrolled in the study. Two hundred and eleven persons were confirmed to be suffering from active epilepsy, resulting in a crude prevalence of 5 per 1000 population. More than 50% of people with epilepsy were in the second or third decade of life. The prevalence of antibodies to T. canis was similar in people with epilepsy (13.7%; 29 of 211 individuals) and controls (9.95%; 21 of 211 individuals). Of the 151 persons with epilepsy, who underwent CT scan, 34 people (22.3%) had evidence of inflammatory granuloma, thereby confirming high incidence of this infestation in rural Northern India. Significance: Our study does not support the association between epilepsy and exposure to T. canis in rural Northern Indian population.
Collapse
Affiliation(s)
- Manish Modi
- Department of Neurology, Postgraduate Institute of Medical Education and Research, Chandigarh, Punjab, India
| | - Rajveer Singh
- Department of Neurology, Postgraduate Institute of Medical Education and Research, Chandigarh, Punjab, India
| | - Manoj Kumar Goyal
- Department of Neurology, Postgraduate Institute of Medical Education and Research, Chandigarh, Punjab, India
| | - Jitender Gairolla
- Department of Neurology, Postgraduate Institute of Medical Education and Research, Chandigarh, Punjab, India
| | - Gagandeep Singh
- Department of Neurology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Vivek Rishi
- Department of Neurology, Postgraduate Institute of Medical Education and Research, Chandigarh, Punjab, India
| | - J S Thakur
- Department of Community Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, Punjab, India
| | - R K Sehgal
- Department of Parasitology, Postgraduate Institute of Medical Education and Research, Chandigarh, Punjab, India
| | - Vivek Kumar Garg
- Department of Neurology, Postgraduate Institute of Medical Education and Research, Chandigarh, Punjab, India
| | - Niranjan Khandelwal
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, Punjab, India
| | - Parampreet S Kharbanda
- Department of Neurology, Postgraduate Institute of Medical Education and Research, Chandigarh, Punjab, India
| | - Sudesh Prabhakar
- Department of Neurology, Postgraduate Institute of Medical Education and Research, Chandigarh, Punjab, India
| | - Vivek Lal
- Department of Neurology, Postgraduate Institute of Medical Education and Research, Chandigarh, Punjab, India
| |
Collapse
|
24
|
Updated evidence of the association between toxocariasis and epilepsy: Systematic review and meta-analysis. PLoS Negl Trop Dis 2018; 12:e0006665. [PMID: 30028858 PMCID: PMC6070292 DOI: 10.1371/journal.pntd.0006665] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 08/01/2018] [Accepted: 07/05/2018] [Indexed: 01/07/2023] Open
Abstract
Objective To gain further insight on the association between human toxocariasis and epilepsy in light of the new evidence in the last years. Methods A systematic review was conducted without date and language restriction in the following electronic databases: MEDLINE (PubMed), Ingenta Connect, Science Direct (Elsevier), RefDoc, Scopus, HighWire, Scielo and the database of the Institute of Neuroepidemiology and Tropical Neurology of the Limoges University (IENT). Two investigators independently conducted the search up to November 2017. A pooled odds ratio (OR) was estimated using a random effects model. Meta-regression was conducted to investigate potential sources of heterogeneity. Results Database search produced 204 publications. Eleven case-control studies were included that were carried out in 13 countries worldwide. A total number of 4740 subjects were considered (2159 people with epilepsy and 2581 people without epilepsy). The overall pooled OR was 1.69 (95% CI 1.42–2.01) for the association between epilepsy and Toxocara spp. seropositivity. A positive association was constantly reported in the restricted analysis (WB as confirmatory or diagnostic test, younger population, and population–based studies). Meta-regression showed no statistically significant association between covariates and outcome. Conclusion The updated meta-analysis provides epidemiological evidence of a positive association between Toxocara seropositivity and epilepsy. New surveys supported the association, mainly population-based studies. On this basis, health strategies to reduce the impact of Toxocara spp are strongly advised. Further research should be performed to understand the physiopathological mechanisms of toxocara-associated epileptogenesis. Human toxocariasis is a parasitic zoonosis caused by the larval stages of Toxocara canis (T. canis), the common roundworm of dogs, and by the roundworm of cats, Toxocara cati (T. cati). Toxocariasis is one of the most prevalent helminthiasis worldwide. Humans become infected by the ingestion of contaminated food or soil or by direct contact with dogs and cats. Epilepsy is the most common chronic neurological disorder worldwide with a global estimate of about 70 million cases of lifetime epilepsy. Early studies suggested high rate of toxocara exposure (toxocara seropositivity) among people with epilepsy. Despite several studies support the possible role of toxocariasis in the incidence of epilepsy, this association is still debated. We updated our previous research to gain further insight on the association. This study provides new evidence of a positive association between the two diseases. On this basis, health strategies to reduce the impact of Toxocara spp are strongly advised. Further studies are necessary to clarify the role of certain parasites in epilepsy.
Collapse
|
25
|
Sánchez SS, García HH, Nicoletti A. Clinical and Magnetic Resonance Imaging Findings of Neurotoxocariasis. Front Neurol 2018; 9:53. [PMID: 29472889 PMCID: PMC5809457 DOI: 10.3389/fneur.2018.00053] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Accepted: 01/19/2018] [Indexed: 01/08/2023] Open
Abstract
Human toxocariasis is one of the most prevalent helminthiases worldwide. Toxocara canis larvae can cross the blood-brain barrier leading to the neurotoxocariasis. The clinical presentation consists of a wide spectrum of neurological manifestations, but asymptomatic infection is probably common. Neurotoxocariasis is not a frequent diagnosis probably due to the non-specific nature of its symptoms as well as the lack of confirmatory diagnostic tests. Diagnosis of neurotoxocariasis is based on the presence of a high titer of anti-Toxocara antibody in the cerebrospinal fluid or in the serum, presence of eosinophilia in the serum or cerebrospinal fluid, and clinical and radiological improvement after anthelmintic therapy; however, universally accepted diagnostic criteria are lacking. Magnetic resonance imaging (MRI) findings include single or multiple, subcortical, cortical or white matter hyperintense lesions, best visualized on FLAIR and T2-weighted imaging, and usually isointense or hypointense on T1. These imaging findings are suggestive but not specific to neurotoxocariasis. Definitive diagnosis is made by histological confirmation, but it is rarely followed. This review provides an overview of the clinical manifestations, management options, and MRI findings of neurotoxocariasis.
Collapse
Affiliation(s)
- Sofia S Sánchez
- Department of Microbiology, School of Public Health (SSS), Center for Global Health - Tumbes (HHG), Universidad Peruana Cayetano Heredia, Lima, Peru.,School of Sciences (HHG), Center for Global Health - Tumbes (HHG), Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Hector H García
- Department of Microbiology, School of Public Health (SSS), Center for Global Health - Tumbes (HHG), Universidad Peruana Cayetano Heredia, Lima, Peru.,School of Sciences (HHG), Center for Global Health - Tumbes (HHG), Universidad Peruana Cayetano Heredia, Lima, Peru.,Cysticercosis Unit, Instituto Nacional de Ciencias Neurologicas, Lima, Peru
| | - Alessandra Nicoletti
- Department G. F. Ingrassia, Section of Neurosciences, University of Catania, Catania, Italy
| |
Collapse
|
26
|
Novák J, Panská L, Macháček T, Kolářová L, Horák P. Humoral response of mice infected with Toxocara canis following different infection schemes. Acta Parasitol 2017; 62:823-835. [PMID: 29035857 DOI: 10.1515/ap-2017-0099] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Accepted: 08/11/2017] [Indexed: 12/19/2022]
Abstract
The study was focused on the dynamics of humoral response to Toxocara canis excretory-secretory antigens (TES antigens) in mice experimentally infected by T. canis L3 larvae in different ways. In particular, we compared the effect of infection with two doses of 1000 larvae vs. repeated infections with a low number of larvae (daily infection with 10 larvae and weekly infection with 100 larvae in the course of 22 weeks). In ELISA, all infections, including both schemes with lower larval doses, elicited significant antibody response. Elevated levels of total IgE and TES-antigen-specific IgM were detected on day 12 after the first infection, followed by IgG and IgG1, and later by IgG3, IgG2a and IgG2b; specific IgE response was not detected. It seems that the high levels of IgM and IgG1 represent the best markers of infection. In addition, gradual increase of IgG2a and IgG2b could help in determination of the infection course. As a byproduct of our work, a new method of infection by repeated drinking of larvae was introduced; it minimizes the pain and discomfort for the experimental mice.
Collapse
|
27
|
Gordon CA, Kurscheid J, Jones MK, Gray DJ, McManus DP. Soil-Transmitted Helminths in Tropical Australia and Asia. Trop Med Infect Dis 2017; 2:E56. [PMID: 30270913 PMCID: PMC6082059 DOI: 10.3390/tropicalmed2040056] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Revised: 10/16/2017] [Accepted: 10/17/2017] [Indexed: 12/21/2022] Open
Abstract
Soil-transmitted helminths (STH) infect 2 billion people worldwide including significant numbers in South-East Asia (SEA). In Australia, STH are of less concern; however, indigenous communities are endemic for STH, including Strongyloides stercoralis, as well as for serious clinical infections due to other helminths such as Toxocara spp. The zoonotic hookworm Ancylostoma ceylanicum is also present in Australia and SEA, and may contribute to human infections particularly among pet owners. High human immigration rates to Australia from SEA, which is highly endemic for STH Strongyloides and Toxocara, has resulted in a high prevalence of these helminthic infections in immigrant communities, particularly since such individuals are not screened for worm infections upon entry. In this review, we consider the current state of STH infections in Australia and SEA.
Collapse
Affiliation(s)
- Catherine A Gordon
- QIMR Berghofer Medical Research Institute, Molecular Parasitology Laboratory, Queensland 4006, Australia.
| | - Johanna Kurscheid
- Australian National University, Department of Global Health, Research School of Population Health, Australian Capital Territory 2601, Australia.
| | - Malcolm K Jones
- School of Veterinary Science, University of Queensland, Brisbane, QLD 4067, Australia.
| | - Darren J Gray
- Australian National University, Department of Global Health, Research School of Population Health, Australian Capital Territory 2601, Australia.
| | - Donald P McManus
- QIMR Berghofer Medical Research Institute, Molecular Parasitology Laboratory, Queensland 4006, Australia.
| |
Collapse
|
28
|
Giuliano L, Cicero CE, Crespo Gómez EB, Padilla S, Bruno E, Camargo M, Marin B, Sofia V, Preux PM, Strohmeyer M, Bartoloni A, Nicoletti A. A screening questionnaire for convulsive seizures: A three-stage field-validation in rural Bolivia. PLoS One 2017; 12:e0173945. [PMID: 28301557 PMCID: PMC5354446 DOI: 10.1371/journal.pone.0173945] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2016] [Accepted: 03/01/2017] [Indexed: 11/30/2022] Open
Abstract
Introduction Epilepsy is one of the most common neurological diseases in Latin American Countries (LAC) and epilepsy associated with convulsive seizures is the most frequent type. Therefore, the detection of convulsive seizures is a priority, but a validated Spanish-language screening tool to detect convulsive seizures is not available. We performed a field validation to evaluate the accuracy of a Spanish-language questionnaire to detect convulsive seizures in rural Bolivia using a three-stage design. The questionnaire was also administered face-to-face, using a two-stage design, to evaluate the difference in accuracy. Methods The study was carried out in the rural communities of the Gran Chaco region. The questionnaire consists of a single screening question directed toward the householders and a confirmatory section administered face-to-face to the index case. Positive subjects underwent a neurological examination to detect false positive and true positive subjects. To estimate the proportion of false negative, a random sample of about 20% of the screened negative underwent a neurological evaluation. Results 792 householders have been interviewed representing a population of 3,562 subjects (52.2% men; mean age 24.5 ± 19.7 years). We found a sensitivity of 76.3% (95% CI 59.8–88.6) with a specificity of 99.6% (95% CI 99.4–99.8). The two-stage design showed only a slightly higher sensitivity respect to the three-stage design. Conclusion Our screening tool shows a good accuracy and can be easily used by trained health workers to quickly screen the population of the rural communities of LAC through the householders using a three-stage design.
Collapse
Affiliation(s)
- Loretta Giuliano
- Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia", Section of Neurosciences, University of Catania, Catania, Italy
| | - Calogero Edoardo Cicero
- Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia", Section of Neurosciences, University of Catania, Catania, Italy
| | | | - Sandra Padilla
- Center of Anthropological Researches of the Teko Guaraní, Gutierrez, Bolivia
| | - Elisa Bruno
- Department of Neurology, Guy's & St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Mario Camargo
- The Bolivian League Against Epilepsy, Santa Cruz, Bolivia
| | - Benoit Marin
- INSERM, U1094, Tropical Neuroepidemiology, Limoges, France
| | - Vito Sofia
- Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia", Section of Neurosciences, University of Catania, Catania, Italy
| | | | - Marianne Strohmeyer
- Department of Experimental and Clinical Medicine, Infectious and Tropical Diseases Unit, University of Florence, Florence, Italy
| | - Alessandro Bartoloni
- Department of Experimental and Clinical Medicine, Infectious and Tropical Diseases Unit, University of Florence, Florence, Italy
| | - Alessandra Nicoletti
- Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia", Section of Neurosciences, University of Catania, Catania, Italy
| |
Collapse
|
29
|
Zyoud SH. Global toxocariasis research trends from 1932 to 2015: a bibliometric analysis. Health Res Policy Syst 2017; 15:14. [PMID: 28231792 PMCID: PMC5324285 DOI: 10.1186/s12961-017-0178-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Accepted: 02/14/2017] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Toxocariasis is a highly prevalent parasitic disease in the tropical regions of the world, with its impact on public health being typically underestimated. To better recognise the trends and characteristics of toxocariasis research, this study is a bibliometric analysis of the global toxocariasis research. METHODS Searches were completed on April 5, 2016, using the Scopus database. A search without any language restriction was performed to extract publications dealing with toxocariasis. Terms related to toxocariasis were used to perform a title keyword search. RESULTS A total of 2765 publications comprising 11 document types and published between 1932 and 2015 were included in the analysis. Articles were the most popular document form, accounting for 83.62% of all publications, followed by letters (3.80%) and reviews (3.4%). The annual number of research publications increased from 30 in 1980 to 111 in 2015, indicating that the number of publications on toxocariasis has increased slowly over the past 35 years. The United States of America and Japan are the predominant countries of origin, with 303 articles and 207 articles, respectively, followed by Brazil and the United Kingdom, with 180 (6.5%) each. The h-index for all the publications was 60. The highest h-index were for publications from the United Kingdom (h-index value = 43) and the United States (h-index value = 39); these two countries were also involved with the highest number of international collaborations, with 27 and 28 countries, respectively. CONCLUSIONS Developed countries, including the United States, Japan, the United Kingdom, France, Germany and Italy, are the world's leaders in toxocariasis research, contributing to more than 34% of the total published literature. In addition, developing countries, such as Brazil, Poland, Argentina and India, showed a noticeable increase in published papers on toxocariasis research in recent years. A push for more collaboration is needed to achieve a superior research strategy related to toxocariasis at the global level from the viewpoint of epidemiological data, clinical aspects, medical ecology, molecular aspects and treatment practices associated with toxocariasis.
Collapse
Affiliation(s)
- Sa'ed H Zyoud
- Division of Clinical and Community Pharmacy, Department of Pharmacy, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, 44839, Palestine.
- Poison Control and Drug Information Center (PCDIC), Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, 44839, Palestine.
| |
Collapse
|
30
|
Zhou RQ, Ma GX, Korhonen PK, Luo YL, Zhu HH, Luo YF, Gasser RB, Xia QY. Comparative transcriptomic analyses of male and female adult Toxocara canis. Gene 2017; 600:85-89. [DOI: 10.1016/j.gene.2016.11.024] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Revised: 10/17/2016] [Accepted: 11/10/2016] [Indexed: 12/22/2022]
|
31
|
Lötsch F, Obermüller M, Mischlinger J, Mombo-Ngoma G, Groger M, Adegnika AA, Agnandji ST, Schneider R, Auer H, Ramharter M. Seroprevalence of Toxocara spp. in a rural population in Central African Gabon. Parasitol Int 2016; 65:632-634. [PMID: 27594568 DOI: 10.1016/j.parint.2016.09.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Revised: 08/24/2016] [Accepted: 09/01/2016] [Indexed: 11/18/2022]
Abstract
Toxocara spp. are zoonotic parasites with global distribution infecting humans by incidental ingestions of eggs shed in feces of dogs or cats. High seroprevalences have been reported from several regions of Africa, however data from the Central African region remain limited. Although several clinical entities caused by larvae of Toxocara spp. have been described, the public heath impact of this infection has so far often been neglected. This study was conducted to estimate the prevalence in a rural central African population. The population based study was performed in volunteers in a rural region of Gabon. A two-step testing approach was applied using an ELISA as screening test and a Western Blot (immunoblot) as confirmatory assay. Basic demographic data and risk factors were collected and compared between seropositive and negative participants. In total, 199 out of 332 serum samples were tested positive for Toxocara spp. antibodies (59.9%). After standardization for age to the overall Gabonese population seroprevalence was 53.6% (95% CI 48.2-59.0%). There was a trend towards higher seroprevalence in participants with agricultural activity. Seroprevalence of antibodies against Toxocara spp. is high in this rural population in Gabon. These results are comparable with previous reports from other sub-regions of Africa and add to our understanding of the epidemiology of toxocariasis in Africa. Given the high prevalence of toxocariasis in tropical regions, it may be speculated that clinically relevant presentations (e.g. visceral or ocular larva migrans syndrome) may occur in considerable numbers. A formal assessment of the burden of disease and the public health impact of human toxocariasis is therefore warranted.
Collapse
Affiliation(s)
- Felix Lötsch
- Division of Infectious Diseases and Tropical Medicine, Department of Medicine I, Medical University of Vienna, Austria; Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon
| | - Markus Obermüller
- Division of Infectious Diseases and Tropical Medicine, Department of Medicine I, Medical University of Vienna, Austria
| | - Johannes Mischlinger
- Division of Infectious Diseases and Tropical Medicine, Department of Medicine I, Medical University of Vienna, Austria; Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon
| | | | - Mirjam Groger
- Division of Infectious Diseases and Tropical Medicine, Department of Medicine I, Medical University of Vienna, Austria; Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon
| | - Akim Ayola Adegnika
- Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon; Institut für Tropenmedizin, Universität Tübingen, Tübingen, Germany
| | - Selidji Todagbe Agnandji
- Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon; Institut für Tropenmedizin, Universität Tübingen, Tübingen, Germany
| | - Renate Schneider
- Department for Medical Parasitology, Institute of Specific Prophylaxis and Tropical Medicine, Medical University of Vienna, Austria
| | - Herbert Auer
- Department for Medical Parasitology, Institute of Specific Prophylaxis and Tropical Medicine, Medical University of Vienna, Austria
| | - Michael Ramharter
- Division of Infectious Diseases and Tropical Medicine, Department of Medicine I, Medical University of Vienna, Austria; Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon; Institut für Tropenmedizin, Universität Tübingen, Tübingen, Germany.
| |
Collapse
|
32
|
Abstract
PURPOSE Toxocariasis is a widespread zoonosis, which may result in central nervous system injury. METHODS We conducted a systematic literature review in MEDLINE, SciELO, ScienceDirect and Google Scholar up to April 2015 using a combination of the following search terms: "neurotoxocariasis" or "neurotoxocarosis", "toxocariasis" or "toxocarosis" and "cerebral" or "neurologic". RESULTS One hundred cases of neurotoxocariasis were identified in literature. The majority of patients were male (58 %), with a median age of 42 years. The predominant clinical pictures were myelitis (60 %), encephalitis (47 %) and/or meningitis (29 %). Fever was inconstant (23 %). The suspected mode of transmission, mentioned in only 49 % of cases, was mainly contact with dogs and/or cats (67 %) and ingestion of contaminated food (31 %). Diagnostic imaging examinations found hypodense lesions in cerebral scanner sequences and hyperintense lesions in cerebral MRI T2-weighted sequences in 65 and 57 % of encephalitis cases respectively, and in 92 % of myelitis cases in medullary MRI T2-weighted sequences. The detection of antibodies against Toxocara spp. was almost constant in blood and cerebrospinal fluid (CSF), 99 and 93 %, respectively. The two most commonly used drugs were corticosteroids (72 %) and/or albendazole (68 %) for a period of at least 3 weeks, which often needed to be repeated. Despite a low mortality rate (6 %), complete remission was observed in only 40 % of cases. CONCLUSIONS Neurotoxocariasis, a completely preventable zoonosis, could lead to severe sequelae failing prompt diagnosis. A compatible clinical picture, presence of risk factors, blood eosinophilia and high titers of antibodies against Toxocara spp. in CSF should alert physicians.
Collapse
|
33
|
Carpio A, Romo ML, Parkhouse RME, Short B, Dua T. Parasitic diseases of the central nervous system: lessons for clinicians and policy makers. Expert Rev Neurother 2016; 16:401-14. [PMID: 26894629 PMCID: PMC4926779 DOI: 10.1586/14737175.2016.1155454] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Parasitic diseases of the central nervous system are associated with high mortality and morbidity, especially in resource-limited settings. The burden of these diseases is amplified as survivors are often left with neurologic sequelae affecting mobility, sensory organs, and cognitive functions, as well as seizures/epilepsy. These diseases inflict suffering by causing lifelong disabilities, reducing economic productivity, and causing social stigma. The complexity of parasitic life cycles and geographic specificities, as well as overlapping clinical manifestations in the host reflecting the diverse pathogenesis of parasites, can present diagnostic challenges. We herein provide an overview of these parasitic diseases and summarize clinical aspects, diagnosis, therapeutic strategies and recent milestones, and aspects related to prevention and control.
Collapse
Affiliation(s)
- Arturo Carpio
- a Escuela de Medicina , Universidad de Cuenca , Cuenca , Ecuador.,b GH Sergievsky Center, College of Physicians and Surgeons , Columbia University , New York , NY , USA.,c Consultorios Sta Inés, F. Proaño y D. Cordova (esquina) , Cuenca , Ecuador
| | - Matthew L Romo
- d Epidemiology and Biostatistics Program, CUNY School of Public Health, Hunter College , New York , NY , USA.,e Dirección de Investigación , Universidad de Cuenca , Cuenca , Ecuador
| | | | - Brooke Short
- g World Health Organization (WHO Geneva) , Geneva , Switzerland
| | - Tarun Dua
- g World Health Organization (WHO Geneva) , Geneva , Switzerland
| |
Collapse
|
34
|
Momeni T, Mahami-Oskouei M, Fallah E, Safaiyan A, Mahami-Oskouei L. Latent and Asymptomatic Toxocara Infection among Young Population in Northwest Iran: The Necessity of Informing People as a Potential Health Risk. SCIENTIFICA 2016; 2016:3562056. [PMID: 27022503 PMCID: PMC4789035 DOI: 10.1155/2016/3562056] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Accepted: 02/10/2016] [Indexed: 06/05/2023]
Abstract
Objectives. This study was designed to determine the frequency of anti-Toxocara antibodies in youngsters aging from 2 to 20 years in northwest Iran. Materials and Methods. 397 samples were taken randomly almost equally from four locations in Urmia, west Azerbaijan, during August 2014 to September 2015. Anti-Toxocara IgG antibody assays were done on sera by using ELISA kit (IBL, Germany). In order to prevent cross-reaction, the samples of the patients who are infected with other parasites in stool exam, especially Ascarididae family, were also excluded. SPSS 16.0 software was used for statistical analysis. Results. 12 (3%) of the serum samples were positive for anti-Toxocara IgG. According to the Chi-square analysis, risk factors such as mother's educational level, keeping dogs or cats as pets, and history of coughing were related to Toxocara infection (P < 0.05). There was no relationship between toxocariasis and gender, history of onychophagy, pica, fever, abdominal pain, and anorexia; however, we found a significant relationship between Toxocara infection and chronic coughing (P = 0.045). Conclusion. Toxocariasis in northwest Iran can be considered as a public health problem. This study may also help to increase the awareness about this infection.
Collapse
Affiliation(s)
- Tina Momeni
- Immunology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
- Department of Parasitology and Mycology, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mahmoud Mahami-Oskouei
- Immunology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
- Department of Parasitology and Mycology, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Esmaeil Fallah
- Immunology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
- Department of Parasitology and Mycology, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Abdolrasoul Safaiyan
- Department of Biostatistics and Epidemiology, Faculty of Health, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Leyla Mahami-Oskouei
- Department of Parasitology and Mycology, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| |
Collapse
|
35
|
Vezzani A, Fujinami RS, White HS, Preux PM, Blümcke I, Sander JW, Löscher W. Infections, inflammation and epilepsy. Acta Neuropathol 2016; 131:211-234. [PMID: 26423537 DOI: 10.1007/s00401-015-1481-5] [Citation(s) in RCA: 299] [Impact Index Per Article: 37.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Revised: 09/18/2015] [Accepted: 09/20/2015] [Indexed: 12/15/2022]
Abstract
Epilepsy is the tendency to have unprovoked epileptic seizures. Anything causing structural or functional derangement of brain physiology may lead to seizures, and different conditions may express themselves solely by recurrent seizures and thus be labelled "epilepsy." Worldwide, epilepsy is the most common serious neurological condition. The range of risk factors for the development of epilepsy varies with age and geographic location. Congenital, developmental and genetic conditions are mostly associated with the development of epilepsy in childhood, adolescence and early adulthood. Head trauma, infections of the central nervous system (CNS) and tumours may occur at any age and may lead to the development of epilepsy. Infections of the CNS are a major risk factor for epilepsy. The reported risk of unprovoked seizures in population-based cohorts of survivors of CNS infections from developed countries is between 6.8 and 8.3 %, and is much higher in resource-poor countries. In this review, the various viral, bacterial, fungal and parasitic infectious diseases of the CNS which result in seizures and epilepsy are discussed. The pathogenesis of epilepsy due to brain infections, as well as the role of experimental models to study mechanisms of epileptogenesis induced by infectious agents, is reviewed. The sterile (non-infectious) inflammatory response that occurs following brain insults is also discussed, as well as its overlap with inflammation due to infections, and the potential role in epileptogenesis. Furthermore, autoimmune encephalitis as a cause of seizures is reviewed. Potential strategies to prevent epilepsy resulting from brain infections and non-infectious inflammation are also considered.
Collapse
Affiliation(s)
- Annamaria Vezzani
- Department of Neuroscience, IRCCS-"Mario Negri" Institute for Pharmacological Research, Milan, Italy
| | - Robert S Fujinami
- Department of Pathology, University of Utah, Salt Lake City, UT, USA
| | - H Steve White
- Department of Pharmacology, University of Utah, Salt Lake City, UT, USA
| | - Pierre-Marie Preux
- INSERM UMR1094, Tropical Neuroepidemiology, Limoges, France
- Institute of Neuroepidemiology and Tropical Neurology, School of Medicine, University of Limoges, Limoges, France
- Center of Epidemiology, Biostatistics, and Research Methodology, CHU Limoges, Limoges, France
| | - Ingmar Blümcke
- Department of Neuropathology, University Hospital Erlangen, Erlangen, Germany
| | - Josemir W Sander
- NIHR University College London Hospitals Biomedical Research Centre, UCL Institute of Neurology, London, WC1N £BG, UK
- Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, The Netherlands
| | - Wolfgang Löscher
- Department of Pharmacology, Toxicology, and Pharmacy, University of Veterinary Medicine, 30559, Hannover, Germany.
- Center for Systems Neuroscience, Hannover, Germany.
| |
Collapse
|
36
|
Mata-Santos T, Pinto NF, Mata-Santos HA, De Moura KG, Carneiro PF, Carvalho TDS, Del Rio KP, Pinto MDCFR, Martins LR, Fenalti JM, Da Silva PEA, Scaini CJ. ANTHELMINTIC ACTIVITY OF LAPACHOL, β-LAPACHONE AND ITS DERIVATIVES AGAINST Toxocara canis LARVAE. Rev Inst Med Trop Sao Paulo 2016. [PMID: 26200958 PMCID: PMC4544242 DOI: 10.1590/s0036-46652015000300003] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Anthelmintics used for intestinal helminthiasis treatment are generally effective; however, their effectiveness in tissue parasitosis (i.e. visceral toxocariasis) is moderate. The aim of this study was to evaluate the in vitro activity of lapachol, β-lapachone and phenazines in relation to the viability of Toxocara canis larvae. A concentration of 2 mg/mL (in duplicate) of the compounds was tested using microculture plates containing Toxocara canis larvae in an RPMI-1640 environment, incubated at 37 °C in 5% CO2 tension for 48 hours. In the 2 mg/mL concentration, four phenazines, lapachol and three of its derivatives presented a larvicide/larvistatic activity of 100%. Then, the minimum larvicide/larvistatic concentration (MLC) test was conducted. The compounds that presented the best results were nor-lapachol (MLC, 1 mg/mL), lapachol (MLC 0.5 mg/mL), β-lapachone, and β-C-allyl-lawsone (MLC, 0.25 mg/mL). The larvae exposed to the compounds, at best MLC with 100% in vitro activity larvicide, were inoculated into healthy BALB/c mice and were not capable of causing infection, confirming the larvicide potential in vitro of these compounds.
Collapse
Affiliation(s)
- Taís Mata-Santos
- Laboratório de Parasitologia, Faculdade de Medicina, Universidade Federal do Rio Grande, Rio Grande, RS, Brazil
| | - Nitza França Pinto
- Laboratório de Parasitologia, Faculdade de Medicina, Universidade Federal do Rio Grande, Rio Grande, RS, Brazil
| | - Hilton Antônio Mata-Santos
- Departamento de Análises Clínicas e Toxicológicas, Faculdade de Farmácia, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Kelly Gallan De Moura
- Núcleo de Pesquisa de Produtos Naturais, Faculdade de Farmácia, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Paula Fernandes Carneiro
- Núcleo de Pesquisa de Produtos Naturais, Faculdade de Farmácia, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Tatiane Dos Santos Carvalho
- Núcleo de Pesquisa de Produtos Naturais, Faculdade de Farmácia, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Karina Pena Del Rio
- Núcleo de Pesquisa de Produtos Naturais, Faculdade de Farmácia, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | | | - Lourdes Rodrigues Martins
- Laboratório de Parasitologia, Faculdade de Medicina, Universidade Federal do Rio Grande, Rio Grande, RS, Brazil
| | - Juliana Montelli Fenalti
- Laboratório de Parasitologia, Faculdade de Medicina, Universidade Federal do Rio Grande, Rio Grande, RS, Brazil
| | | | - Carlos James Scaini
- Laboratório de Parasitologia, Faculdade de Medicina, Universidade Federal do Rio Grande, Rio Grande, RS, Brazil
| |
Collapse
|
37
|
Abstract
Toxocara canis and T. cati are highly prevalent nematode infections of the intestines of dogs and cats. In paratenic hosts, larvae do not mature in the intestine but instead migrate through the somatic tissues and organs of the body. The presence of these migrating larvae can contribute to pathology. Toxocara larvae can invade the brains of humans, and while case descriptions of cerebral toxocariasis are historically rare, improved diagnosis and greater awareness have contributed to increased detection. Despite this, cerebral or neurological toxocariasis (NT) remains a poorly understood phenomenon. Furthermore, our understanding of cognitive deficits due to toxocariasis in human populations remains particularly deficient. Recent data describe an enhanced expression of biomarkers associated with brain injury, such as GFAP, AβPP, transforming growth factor β1 (TGF-β1), NF-L, S100B, tTG, and p-tau, in mice receiving even low doses of Toxocara ova. Finally, this review outlines a hypothesis to explore the relationship between the presence of T. canis larvae in the brain and the progression of Alzheimer's disease (AD) due to enhanced AD-associated neurodegenerative biomarker expression.
Collapse
|
38
|
Cong W, Meng QF, You HL, Zhou N, Dong XY, Dong W, Wang XY, Qian AD, Zhu XQ. Seroprevalence and risk factors of Toxocara infection among children in Shandong and Jilin provinces, China. Acta Trop 2015; 152:215-219. [PMID: 26384456 DOI: 10.1016/j.actatropica.2015.09.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Revised: 09/05/2015] [Accepted: 09/12/2015] [Indexed: 11/18/2022]
Abstract
This cross-sectional study was aimed to investigate the Toxocara serology in children in Shandong and Jilin provinces, China using an enzyme-linked immunosorbent assay (ELISA). The overall Toxocara seroprevalence among the study population (n=1458) was 19.3%, sick children (26.4%) had significantly higher seroprevalence than clinically healthy children (14.4%) (P<0.05), and the highest Toxocara seroprevalence was found in children suffering from chronic cough (40.6%), followed by recurrent abdominal pain (40.0%), recurrent headache (38.1%), slight fever (36.2%), and recurrent vomiting (31.6%). Place of residence, education level, type of school, keeping dogs at home, contact with dogs and cats and exposure with soil were found to be associated with Toxocara infection. Our findings show that children infection with Toxocara is common in Shandong and Jilin provinces, eastern and northeastern China, indicating an immediate need for implementing strategies and measures to prevent and control Toxocara infection in children in China.
Collapse
Affiliation(s)
- Wei Cong
- State Key Laboratory of Veterinary Etiological Biology, Key Laboratory of Veterinary Parasitology of Gansu Province, Lanzhou Veterinary Research Institute, Chinese Academy of Agricultural Sciences, Lanzhou, Gansu Province 730046, PR China; College of Animal Science and Technology, Jilin Agricultural University, Changchun, Jilin Province 130118, PR China
| | - Qing-Feng Meng
- Jilin Entry-Exit Inspection and Quarantine Bureau, Changchun, Jilin Province 130000, PR China
| | - Hai-Long You
- The First Affilliated Hospital of Jilin University, Changchun, Jilin Province 130000, PR China
| | - Na Zhou
- Affilliated Hospital of Medical College, Qingdao University, Qingdao, Shandong Province 266000, PR China
| | - Xiao-Yan Dong
- Wendeng Stomatological Hospital, Weihai, Shandong Province 264400, PR China
| | - Wei Dong
- Weihaiwei People's Hospital, Weihai, Shandong Province 264200, PR China
| | - Xiang-Yang Wang
- Wendeng Municipal Hospital, Weihai, Shandong Province 264400, PR China
| | - Ai-Dong Qian
- College of Animal Science and Technology, Jilin Agricultural University, Changchun, Jilin Province 130118, PR China
| | - Xing-Quan Zhu
- State Key Laboratory of Veterinary Etiological Biology, Key Laboratory of Veterinary Parasitology of Gansu Province, Lanzhou Veterinary Research Institute, Chinese Academy of Agricultural Sciences, Lanzhou, Gansu Province 730046, PR China.
| |
Collapse
|
39
|
Lack of Association between Toxocara Exposure and Suicide Attempts in Psychiatric Patients. J Parasitol Res 2015; 2015:608604. [PMID: 26483971 PMCID: PMC4592907 DOI: 10.1155/2015/608604] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Revised: 08/21/2015] [Accepted: 08/23/2015] [Indexed: 11/30/2022] Open
Abstract
Infection with Toxocara may affect the central nervous system. A high seroprevalence of Toxocara infection has been reported in psychiatric patients. To the best of our knowledge, there is no previous report about an association of Toxocara infection with suicide attempts. Therefore, we sought to determine whether Toxocara exposure is associated with suicide attempts in psychiatric patients. We studied 282 psychiatric outpatients (156 with suicide attempts and 126 without suicide attempts). Sera of patients were analyzed for the presence of anti-Toxocara IgG antibodies by using a commercially available enzyme immunoassay. One of the 156 (0.6%) suicide attempters and 1 (0.8%) of the 126 controls were positive for anti-Toxocara IgG antibodies (OR = 0.80; 95% CI: 0.04–13.02; P = 1.00). Toxocara seropositivity was significantly higher (P = 0.01) in male patients with consumption of raw dried goat meat than male patients without this consumption. Results suggest that Toxocara exposure is not associated with suicide attempts in psychiatric outpatients in Durango City, Mexico. However, further studies with larger samples sizes to confirm our results should be conducted. Too few patients were seropositive to assess further associations of Toxocara exposure with sociodemographic, clinical, and behavioral characteristics of the psychiatric patients.
Collapse
|
40
|
Erickson LD, Gale SD, Berrett A, Brown BL, Hedges DW. Association between toxocariasis and cognitive function in young to middle-aged adults. Folia Parasitol (Praha) 2015; 62. [DOI: 10.14411/fp.2015.048] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Accepted: 07/04/2015] [Indexed: 11/19/2022]
|
41
|
Abstract
• On the basis of research evidence, worm infections are important global child health conditions causing chronic disability that lasts from childhood into adulthood (Table 1). (2)(3) Evidence Quality: B • On the basis of research evidence, the major worm infections found in developing countries include ascariasis, trichuriasis, hookworm infection, and schistosomiasis; toxocariasis, enterobiasis, and cysticercosis are also found in poor regions of North America and Europe. (4)(9)(13) Evidence Quality: B • On the basis of expert consensus, children and adolescents are often vulnerable to acquiring large numbers of worms, ie, high-intensity infections (Fig 1)(21)(22)(23) Evidence Quality: D • On the basis of expert consensus and research evidence, moderate and heavy worm burdens cause increased morbidity because of growth and intellectual stunting in children and adolescents. Many of these effects may result from helminth-induced malnutrition. (21)(22)(23) Evidence Quality: C • On the basis of expert consensus and research evidence, worm infections are also commonly associated with eosinophilia. (48) (49) Evidence Quality: B • On the basis of research evidence as well as consensus, helminthes can cause inflammation in the lung (asthma), gastrointestinal tract (enteritis and colitis), liver (hepatitis and fibrosis), and urogenital tract. (7)(21)(22)(23)(27)(28)(40)(41)(43) Evidence Quality: B • On the basis of research evidence, microscopy techniques for diagnosis of worm infections in children often exhibit suboptimal sensitivities and specificities, necessitating new or improved diagnostic modalities such as polymerase chain reaction. (54)(55) Evidence Quality: A • On the basis of research evidence and expert consensus, mass drug administration (“preventive chemotherapy”) has becomea standard practice for ministries of health in low- and middle-income countries to control intestinal helminth infections and schistosomiasis. (67)(68) Evidence Quality: B.
Collapse
Affiliation(s)
- Jill E Weatherhead
- Department of Pediatrics (Sections of Infectious Diseases and Tropical Medicine), National School of Tropical Medicine, Baylor College of Medicine, Houston, TX. Sabin Vaccine Institute and Texas Children's Hospital Center for Vaccine Development, Houston, TX
| | - Peter J Hotez
- Department of Pediatrics (Sections of Infectious Diseases and Tropical Medicine), National School of Tropical Medicine, Baylor College of Medicine, Houston, TX. Sabin Vaccine Institute and Texas Children's Hospital Center for Vaccine Development, Houston, TX
| |
Collapse
|
42
|
Affiliation(s)
- Jill E. Weatherhead
- Department of Pediatrics (Sections of Infectious Diseases and Tropical Medicine), National School of Tropical Medicine, Baylor College of Medicine, Houston, TX
- Sabin Vaccine Institute and Texas Children’s Hospital Center for Vaccine Development, Houston, TX
| | - Peter J. Hotez
- Department of Pediatrics (Sections of Infectious Diseases and Tropical Medicine), National School of Tropical Medicine, Baylor College of Medicine, Houston, TX
- Sabin Vaccine Institute and Texas Children’s Hospital Center for Vaccine Development, Houston, TX
| |
Collapse
|
43
|
Abstract
Neuroinvasive larvae of the common dog and cat roundworms, Toxocara canis and Toxocara cati, may cause severe neurological and neuropsychological disturbances in humans. Despite their pathogenic potential and high prevalence worldwide, little is known about their cell-specific influences and cerebral host-pathogen interactions in neurotoxocarosis. To address this discrepancy, a co-culture system of viable larvae with murine neuronal (CAD), oligodendrocytal (BO-1) and microglial (BV-2) cell lines has been established. Additionally, murine adult brain slices have been co-cultured with Toxocara larvae to consider complex organotypic cell-cell interplay. Cytotoxicity of larval presence was measured enzymatically and microscopically. Microscopic evaluation using trypan blue exclusion assay revealed to be less reliable and sensitive than the lactate dehydrogenase activity assay. Ultimately, even low numbers of both T. canis and T. cati larvae have impaired survival of differentiated CAD cells, which morphologically resemble primary neurons. In contrast, viability of oligodendrocytal and microglial cells as well as brain slices was not impaired by larval presence. Therefore, immune-mediated mechanisms or trauma by migrating larvae presumably induce the in vivo pathology rather than acute cytotoxic effects. Conclusively, the helminthic larvae co-culture system presented here is a valuable in vitro tool to study cell-specific effects of parasitic larvae and their products.
Collapse
|
44
|
Gyang PV, Akinwale OP, Lee YL, Chuang TW, Orok AB, Ajibaye O, Liao CW, Chen PC, Chou CM, Huang YC, Barghouth U, Fan CK. Seroprevalence, disease awareness, and risk factors for Toxocara canis infection among primary schoolchildren in Makoko, an urban slum community in Nigeria. Acta Trop 2015; 146:135-40. [PMID: 25812836 DOI: 10.1016/j.actatropica.2015.03.018] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Revised: 03/14/2015] [Accepted: 03/16/2015] [Indexed: 01/03/2023]
Abstract
In this study, we investigated the seroprevalence of Toxocara canis infection in southern Nigeria, which previously was unknown, in addition to evaluating disease awareness and potential risk factors for schoolchildren in an urban slum community. In total, 366 primary schoolchildren were investigated for the presence of anti-Toxocara IgG antibodies. Blood was collected and screened by a Western blot analysis based on the excretory-secretory antigens of larval T. canis (TcES), targeting low molecular weight bands of 24-35kDa specific for T. canis. Children were considered seropositive if their serum reacted with TcES when diluted to a titer of 1:32. Questionnaires concerning possible risk factors were given to the schoolchildren to acquire data on this infection. The overall seroprevalence of Toxocara infection was 86.1% (315/366). The logistic regression analysis of risk factors showed that children's age (odds ratio (OR)=2.88, 95% confidence interval (CI)=1.08-7.66, p=0.03), contact with dogs (OR=0.51, 95% CI=0.28-0.94, p=0.03), the age of the dog (OR=0.34, 95% CI=0.18-0.68, p=0.002), the feeding location of the dog (OR=0.31, 95% CI=0.12-0.79, p=0.01), the consumption of raw vegetables (OR=0.89, 95% CI=0.54-1.48, p=0.004), and the drinking of unboiled water (OR=0.48, 95% CI=0.26-0.90, p=0.02) were risk factors associated with Toxocara infection. Although there was a high awareness of dogs being hosts of some parasites in this study, not much was known about T. canis. This is the first serological investigation of T. canis infection among primary schoolchildren in southern Nigeria. The high seroprevalence recorded is an indication of high transmission with the consequent risk of visceral or ocular larval migrans and neurologic toxocariasis in these children. Our findings suggest the need for prompt interventional measures, particularly health education on personal hygiene.
Collapse
|
45
|
Sebera F, Munyandamutsa N, Teuwen DE, Ndiaye IP, Diop AG, Tofighy A, Boon P, Dedeken P. Addressing the treatment gap and societal impact of epilepsy in Rwanda--Results of a survey conducted in 2005 and subsequent actions. Epilepsy Behav 2015; 46:126-32. [PMID: 25936276 PMCID: PMC4464509 DOI: 10.1016/j.yebeh.2015.03.028] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Revised: 02/23/2015] [Accepted: 03/27/2015] [Indexed: 01/03/2023]
Abstract
This study, supported by the Rwandan Ministry of Health and the World Health Organization, was conducted in 2005 to determine the prevalence of epilepsy and its sociocultural perception in Rwanda, as well as epilepsy-related knowledge and practices of health-care professionals (HCPs). A cross-sectional, nationally representative survey was conducted throughout Rwanda by trained investigators. Participants were recruited by random cluster sampling based on the organization of administrative units in the country. Overall, 1137 individuals (62% from rural areas) were interviewed. The prevalence of epilepsy was estimated to be 49 per 1000 people or 41 per 1000 for active epilepsy. Onset of epilepsy before the age of 2years was reported in 32% of the cases. Family history of epilepsy, head trauma, and premature delivery were reported in 53%, 50%, and 68% of the cases, respectively. Most (68%) patients did not receive any medical treatment for epilepsy; 21.5% had received some form of traditional treatment. According to responses from the general population, people with epilepsy should not be entitled to schooling (according to 66%), to work (according to 72%), to the use of public places (according to 69%), or to marriage (according to 66%). Furthermore, 50% believed that epilepsy was untreatable, and 40% thought that it was transmissible. Of the 29 HCPs interviewed, the majority knew the definition of epilepsy and status epilepticus, as well as basic treatment options and side effects. However, 90% believed that treatment was only necessary in the first week after a seizure. Living with epilepsy was associated heavily with stigma, and a significant treatment gap (68%) was identified. Following this study, numerous actions have been taken by the Rwandan government, the Rwandan League Against Epilepsy, and several nongovernmental organizations to increase awareness about epilepsy and to close the treatment gap. An overview of these activities is provided.
Collapse
Affiliation(s)
- Fidèle Sebera
- Hôpital Neuro-Psychiatrique, Fracarita Ndera, Kigali, Rwanda.
| | | | | | | | | | | | | | | |
Collapse
|
46
|
King CH. Health metrics for helminth infections. Acta Trop 2015; 141:150-60. [PMID: 24333545 DOI: 10.1016/j.actatropica.2013.12.001] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2013] [Revised: 11/30/2013] [Accepted: 12/03/2013] [Indexed: 01/13/2023]
Abstract
Health metrics based on health-adjusted life years have become standard units for comparing the disease burden and treatment benefits of individual health conditions. The Disability-Adjusted Life Year (DALY) and the Quality-Adjusted Life Year (QALY) are the most frequently used in cost-effect analyses in national and global health policy discussions for allocation of health care resources. While sometimes useful, both the DALY and QALY metrics have limitations in their ability to capture the full health impact of helminth infections and other 'neglected tropical diseases' (NTDs). Gaps in current knowledge of disease burden are identified, and interim approaches to disease burden assessment are discussed.
Collapse
|
47
|
ALLAHDIN S, KHADEMVATAN S, RAFIEI A, MOMEN A, RAFIEI R. Frequency of Toxoplasma and Toxocara Sp. Antibodies in Epileptic Patients, in South Western Iran. IRANIAN JOURNAL OF CHILD NEUROLOGY 2015; 9:32-40. [PMID: 26664439 PMCID: PMC4670975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Epilepsy is a disorder of the brain characterized by an enduring predisposition to generate seizures. Infectious agents are mentioned in its etiology. With identifying and appropriate treatment of these infectious agents, preventing their secondary outcomes, including seizure is possible. This study was conducted to determine frequency of anti-Toxoplasma antibodies (IgG, IgM) and anti-Toxocara antibody (IgG) in epileptic patients. MATERIALS & METHODS Study sample consisted of 141 epileptic patients and 144 healthy people. After obtaining informed consents and completing demographic questionnaire, serum samples were taken from participants. The diagnostic test of Toxoplasma IgG & IgM and Toxocara antibodies was performed under the same conditions using ELISA method in a qualified private laboratory. Samples from patients and control groups with positive ELISA test in terms of anti-Toxocara antibody were also used for confirmatory Western blot test. RESULT According to ELISA results, 28 (19.85%) epileptic patients and 2(1.38%) of healthy people had anti-Toxocara antibodies (P<001), while 39 (30.46%) of the control group people and 14.18% of patients had anti-Toxoplsma antibodies (P=0.001). CONCLUSION Frequency of anti-Toxoplasma gondii is lower in epileptic than healthy individuals and this result is contrary to investigations that have reported higher levels of this antibody in such patient groups. ELISA results for Toxocara showed that the frequency of anti-Toxocara antibody in epileptic patients might empower the probability that this parasite may cause central nervous system damage. Western blotting has high specificity and is a proper confirmative method for diagnosis of toxocariasis.
Collapse
Affiliation(s)
- Sudabeh ALLAHDIN
- Cellular and Molecular Research Center & Dept. Parasitology, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Shahram KHADEMVATAN
- Department of Medical Parasitology and Mycology & Cellular and Molecular Research Center, Urmia University of Medical Sciences, Urmia, Iran ,Cellular and Molecular Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Abdollah RAFIEI
- Dept. of Medical Parasitology &Infectious and Tropical Diseases Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Aliakbar MOMEN
- Dept. of Pediatrics, Neurology Ward, Golestan Teaching Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Reza RAFIEI
- Dept. of Medical Parasitology &Infectious and Tropical Diseases Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| |
Collapse
|
48
|
HOSSEINI-SAFA A, MOUSAVI SM, BAHADORAN BAGH BADORANI M, GHATREH SAMANI M, MOSTAFAEI S, YOUSOFI DARANI H. Seroepidemiology of Toxocariasis in Children (5-15 yr Old) Referred to the Pediatric Clinic of Imam Hossein Hospital, Isfahan, Iran. IRANIAN JOURNAL OF PARASITOLOGY 2015; 10:632-7. [PMID: 26811731 PMCID: PMC4724841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Human toxocariasis, a helminthozoonosis, is due to the migration of Toxocara species larvae into human organisms. Humans, especially children become infected by ingesting of embryonated eggs from soil, dirty hands, and raw vegetables. Seroprevalence of this infection is high in developed countries, especially in rural areas. The aim of this study was to investigate the seroepidemiology of Toxocariasis in children referred to the pediatric clinic of Imam Hossein hospital, Isfahan, Iran. METHODS In this cross sectional study the sera of children aged 5 to 15 years old, admitted to Imam Hossein Pediatric Hospital were collected during 2013-14. Then the sera were examined for anti Toxocara canis antibodies using commercial ELISA kit. RESULTS From 427 children, 196 (45.9%) were female and 231(54.1%) were male. 107(25.1%) were from rural and 320 (74.9%) were from urban area. Of them 129 (30.2%) were contacted with dog. One child (0.2%) had hypereosinophilia, 33 (7.7%) eosinophlia, and 6 (1.39%) were positive for T. canis IgG (two male and four female). Four of infected children with T. canis were from urban (1.25%) and two from rural areas (1.9%). There was no significant correlation between education of parents, gender, age, place of living and contact with dog with ELISA results test. CONCLUSION Toxocariasis is prevalent in the children of Isfahan region. Results suggest a low Toxocara exposure in children in this area. Therefore, more risk factors associated with Toxocara exposure should be identified in the further investigation.
Collapse
Affiliation(s)
- Ahmad HOSSEINI-SAFA
- Student Research Committee, Isfahan University of Medical Sciences, Isfahan, Iran,Dept. of Medical Parasitology and Mycology School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed Mohammad MOUSAVI
- Dept. of Medical Parasitology and Mycology Isfahan University of Medical Sciences, Isfahan, Iran
| | | | | | - Shayan MOSTAFAEI
- Dept. of Epidemiology and Biostatistics, School of Public Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Hossein YOUSOFI DARANI
- Dept. of Medical Parasitology and Mycology Isfahan University of Medical Sciences, Isfahan, Iran,Infectious Diseases and Tropical Medicine Research Center, Isfahan University of Medical Sciences, Isfahan, Iran,Correspondence:
| |
Collapse
|
49
|
Sick C, Hennerici MG. Expect the unexpected: a case of isolated eosinophilic meningitis in toxocariasis. Case Rep Neurol 2014; 6:259-63. [PMID: 25535488 PMCID: PMC4265852 DOI: 10.1159/000369060] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
We present the case of a young police officer suffering from headache without other neurological symptoms caused by isolated eosinophilic meningitis, which resulted from an infection with Toxocara cati, along with a discussion of the differential diagnosis.
Collapse
Affiliation(s)
- Christian Sick
- Department of Neurology, University Hospital Mannheim, Mannheim, Germany
| | | |
Collapse
|
50
|
Ba-Diop A, Marin B, Druet-Cabanac M, Ngoungou EB, Newton CR, Preux PM. Epidemiology, causes, and treatment of epilepsy in sub-Saharan Africa. Lancet Neurol 2014; 13:1029-44. [PMID: 25231525 PMCID: PMC5497080 DOI: 10.1016/s1474-4422(14)70114-0] [Citation(s) in RCA: 192] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
SUMMARY Epilepsy is a common neurological disease in tropical countries, particularly in sub-Saharan Africa. Previous work on epilepsy in sub-Saharan Africa has shown that many cases are severe, partly a result of some specific causes, that it carries a stigma, and that it is not adequately treated in many cases. Many studies on the epidemiology, aetiology, and management of epilepsy in sub-Saharan Africa have been reported in the past 10 years. The prevalence estimated from door-to-door studies is almost double that in Asia, Europe, and North America. The most commonly implicated risk factors are birth trauma, CNS infections, and traumatic brain injury. About 60% of patients with epilepsy receive no antiepileptic treatment, largely for economic and social reasons. Further epidemiological studies should be a priority to improve understanding of possible risk factors and thereby the prevention of epilepsy in Africa, and action should be taken to improve access to treatment.
Collapse
Affiliation(s)
- Awa Ba-Diop
- INSERM UMR1094, Tropical Neuroepidemiology, and Institute of Neuroepidemiology and Tropical Neurology, School of Medicine, University of Limoges, Limoges, France
| | - Benoît Marin
- INSERM UMR1094, Tropical Neuroepidemiology, and Institute of Neuroepidemiology and Tropical Neurology, School of Medicine, University of Limoges, Limoges, France; CEBIMER: Center of Epidemiology, Biostatitics, and Research Methodology, CHU Limoges, France
| | - Michel Druet-Cabanac
- INSERM UMR1094, Tropical Neuroepidemiology, and Institute of Neuroepidemiology and Tropical Neurology, School of Medicine, University of Limoges, Limoges, France
| | - Edgard B Ngoungou
- INSERM UMR1094, Tropical Neuroepidemiology, and Institute of Neuroepidemiology and Tropical Neurology, School of Medicine, University of Limoges, Limoges, France; Unit of Neuroepidemiology and Tropical Infectious Diseases, Department of Epidemiology, Biostatistics, University of Health Sciences, Libreville, Gabon
| | - Charles R Newton
- KEMRI/Wellcome Trust Collaborative Programme, Centre for Geographical Medicine, Kilifi, Kenya; Department of Psychiatry, University of Oxford, Oxford, UK
| | - Pierre-Marie Preux
- INSERM UMR1094, Tropical Neuroepidemiology, and Institute of Neuroepidemiology and Tropical Neurology, School of Medicine, University of Limoges, Limoges, France; CEBIMER: Center of Epidemiology, Biostatitics, and Research Methodology, CHU Limoges, France.
| |
Collapse
|