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Peretz A, Azrad M, Ken-Dror S, Strauss M, Sagas D, Parizada M, Loewnthal S, Amichay D, Ben Horin N, Shenhar Y, Sagi O, Bazarsky E, Amit S, Schwartz E. The epidemiology of intestinal protozoa in the Israeli population based on molecular stool test: a nationwide study. Microbiol Spectr 2024:e0061624. [PMID: 39012121 DOI: 10.1128/spectrum.00616-24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2024] [Accepted: 06/03/2024] [Indexed: 07/17/2024] Open
Abstract
Stool examination using microscopy was the traditional method for the diagnosis of intestinal parasites. Recently, the use of molecular tests to identify stool protozoa has become the main tool used in most clinical laboratories in Israel. This study aimed to evaluate the prevalence of intestinal parasites in Israel and to compare this prevalence in laboratories that use molecular tests vs a laboratory that uses microscopy. Samples collected from January to October 2021 at seven laboratories were analyzed by real-time PCR (RT-PCR) or by microscopy. The multiplex panel included the following pathogens: Giardia lamblia, Entamoeba histolytica, Cryptosporidium spp., Cyclospora, Dientamoeba fragilis, and Blastocystis spp. Overall, 138,415 stool samples were tested by RT-PCR and 6,444 by microscopy. At least one protozoa species was identified in 28.4% of the PCR-tested samples compared to 4.6% of the microscopy-tested samples. D. fragilis was the most common PCR-identified species (29%). D. fragilis, G. lamblia, and Cryptosporidium spp. were mainly found in pediatric population, while Blastocystis spp. was most prevalent among adults (P < 0.001). In a sub-cohort of 21,480 samples, co-infection was found in 4,113 (19.15%) samples, with Blastocystis spp. and D. fragilis being the most common (14.9%) pair. Molecular stool testing proved more sensitive compared to microscopy. D. fragilis was the most commonly detected pathogen. The above profile was identified during the COVID pandemic when traveling was highly restricted and most likely represents the locally circulating protozoa. IMPORTANCE This study sheds light on the prevalence of stool parasites in Israel. Additionally, this study indicates that the shift from microscope analysis to molecular tests improved protozoa diagnosis.
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Affiliation(s)
- Avi Peretz
- Clinical Microbiology Laboratory, Tzafon Medical Center, Poriya, Israel, affiliated with Azrieli Faculty of Medicine, Bar Ilan University, Israel, Safed
- The Azrieli Faculty of Medicine, Bar Ilan University, Safed, Tiberias, Israel
| | - Maya Azrad
- Clinical Microbiology Laboratory, Tzafon Medical Center, Poriya, Israel, affiliated with Azrieli Faculty of Medicine, Bar Ilan University, Israel, Safed
- The Azrieli Faculty of Medicine, Bar Ilan University, Safed, Tiberias, Israel
| | - Shifra Ken-Dror
- Clinical Microbiology Laboratory, Central Laboratories Haifa and Western Galilee, Clalit Health Services, Nesher, Israel
| | - Merav Strauss
- Clinical Microbiology Laboratory, Emek Medical Center, Clalit Health Services, Afula, Israel
| | - Dana Sagas
- Clinical Microbiology Laboratory, Emek Medical Center, Clalit Health Services, Afula, Israel
| | - Miriam Parizada
- Maccabi Health Services, Central Laboratories, Rehovot, Israel
| | | | - Doron Amichay
- Central Laboratories, Clalit Health Services, Tel Aviv, Israel
| | | | | | - Orli Sagi
- Microbiology Laboratory, Soroka University Medical Center, Beer-Sheva, Israel
- Faculty of health science, Ben-Gurion University, Beer-Sheva, Israel
| | - Elina Bazarsky
- Microbiology Laboratory, Soroka University Medical Center, Beer-Sheva, Israel
| | - Sharon Amit
- Clinical Microbiology, Sheba Medical Center, Ramat Gan, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eliezer Schwartz
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- The Institute of Tropical Medicine, Sheba Medical Center, Ramat Gan, Israel
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Pietilä JP, Häkkinen TA, Pakarinen L, Ollgren J, Kantele A. Treatment of Dientamoeba fragilis: A retrospective Finnish analysis of faecal clearance and clinical cure comparing four antiprotozoal drugs. New Microbes New Infect 2023; 54:101179. [PMID: 37786407 PMCID: PMC10542007 DOI: 10.1016/j.nmni.2023.101179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 09/08/2023] [Accepted: 09/09/2023] [Indexed: 10/04/2023] Open
Abstract
Background Dientamoeba fragilis (DF), the most common intestinal protozoal pathogen in affluent countries, causes asymptomatic or symptomatic infections with severity ranging from mild to disabling. Currently, many studies of treatment options only have small sample sizes and report results that are partly contradictory. Methods Investigating data retrieved from Helsinki University Hospital and Helsinki City patient records, we searched for the most effective antiprotozoal in treating DF infections. To study microbiological clearance of DF, we collected laboratory results of control samples from patients given one of four commonly used antiprotozoals: doxycycline, metronidazole, paromomycin, or secnidazole. For patients symptomatic prior to antiprotozoal treatment, we also retrieved data on clinical outcomes. Furthermore, we explored factors associated with faecal clearance and clinical cure. Results A total of 369 patients (median age 38) and 492 treatment episodes were included. Paromomycin (n = 297) proved effective (clearance rate 83%), showing strong association with faecal clearance (aOR 18.08 [7.24-45.16], p < 0.001). For metronidazole the rate was 42% (n = 84), for secnidazole 37% (n = 79), and doxycycline 22% (n = 32). In pairwise comparisons, paromomycin outdid the three other regimens (p < 0.001, χ2 test). Faecal clearance was associated with clinical cure (aOR 5.85 [3.02-11.32], p < 0.001). Conclusions Faecal clearance, strongly associated with clinical cure, is most effectively achieved with a course of paromomycin, followed by metronidazole, secnidazole and doxycycline. Our findings will be useful in devising treatment guidelines for adults with symptomatic D. fragilis infection.
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Affiliation(s)
- Jukka-Pekka Pietilä
- Meilahti Vaccine Research Center MeVac, Department of Infectious Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Human Microbiome Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Tuuve A Häkkinen
- Meilahti Vaccine Research Center MeVac, Department of Infectious Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Human Microbiome Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Laura Pakarinen
- Department of Infectious Diseases, Inflammation Center, Helsinki University Hospital, Helsinki, Finland
- Department of Social Services and Health Care, City of Helsinki, Finland
| | - Jukka Ollgren
- Department of Health Security, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Anu Kantele
- Meilahti Vaccine Research Center MeVac, Department of Infectious Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Human Microbiome Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Department of Infectious Diseases, Inflammation Center, Helsinki University Hospital, Helsinki, Finland
- Finnish Multidisciplinary Center of Excellence in Antimicrobial Resistance Research, FIMAR, University of Helsinki, Helsinki, Finland
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Wang T, Rampisela D. Visceral Leishmaniasis With Blastocystis Co-infection: A Case Report. Cureus 2023; 15:e44050. [PMID: 37746419 PMCID: PMC10517707 DOI: 10.7759/cureus.44050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 08/23/2023] [Indexed: 09/26/2023] Open
Abstract
Visceral leishmaniasis (VL) is a form of leishmaniasis, which causes significant mortality if untreated. The coexistence of VL with Blastocystis infection has not been well-documented in the literature. In this paper, we present the case of a 72-year-old male who experienced four months of recurrent diarrhea and later developed weight loss, fever, night sweats, and pancytopenia. The stool ova and parasite (O&P) examination revealed Blastocystis spp. vacuolar bodies and he was treated with metronidazole which resolved the diarrhea but not other symptoms. Further evaluation, including an abdominal Computed Tomogram (CT) scan and ultrasonography (USG), revealed splenomegaly. A splenic biopsy confirmed VL with numerous Leishmania amastigotes. Treatment with Amphotericin B led to clinical improvement. This paper discusses the clinical and diagnostic features of VL and Blastocystis, highlighting their differential diagnosis, and available treatments.
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Affiliation(s)
- Tengfei Wang
- Pathology, Baylor Scott & White Health, Temple, USA
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Montraveta-Querol M, Bovo MV, Roig-Abraham N, Romaní N, Alcaraz A, Fernández-Rivas G. Should Dientamoeba fragillis be looked for in pediatric digestive pathology of an unknown cause? A proposed pilot case-control study. ENFERMEDADES INFECCIOSAS Y MICROBIOLOGIA CLINICA (ENGLISH ED.) 2022; 40:436-440. [PMID: 36195407 DOI: 10.1016/j.eimce.2022.03.013] [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: 10/01/2021] [Accepted: 03/22/2022] [Indexed: 06/16/2023]
Abstract
INTRODUCTION Dientamoeba (D.) fragilis is a common intestinal protozoan with an unresolved clinical significance. The association between D. fragilis and the etiology of gastrointestinal symptoms in children is unclear. Metronidazole is often used for treatment. The aims of this study are to clarify the clinical relevance of D. fragilis in children with gastrointestinal symptoms, and to determine the clinical and microbiological efficacy of metronidazole in D. fragilis-infected children with gastrointestinal complaints. METHODS A prospective case-control study was performed from October 2017 to February 2019. A total of 106 individuals aged 1-17 were included. Out of the 106; 59 showed gastrointestinal symptoms (case group), and 47 were without gastrointestinal symptoms (control group). We excluded 2 patients from the case group. D. fragilis was diagnosed by real-time PCR in stool samples. A 10-day course of oral Metronidazole was prescribed in D. fragilis positive children with GI symptoms. Clinical data before and after the treatment as well as peripheral eosinophilia in previous blood samples, were recorded. RESULTS Of the 104 participants, D. fragilis was found in 17 (29.8%) children from the case group, whereas in the control group the parasite was detected in 11 patients (23.4%) with an odds ratio (OR) of 1.39 (IC 95% 0.53-3.75, p=0.46). The most prevalent clinical manifestation was abdominal pain (46/57, 80.7%). Seventeen cases with a positive PCR received anti-parasitic treatment according to the established protocol, although during the collection period we received only 11 stool samples to perform the post-treatment follow-up. The PCR of the D. fragilis remained positive in 3 patients (3/11, 27.27%). Despite achieving the eradication of the parasite, 4/8 patients (50%) continued with digestive symptoms. CONCLUSIONS According to our study there were no differences between the D. fragilis infection in children with or without gastrointestinal symptoms. No relation was found between the clinical and microbiological responses after said D. fragilis treatment. Therefore, we conclude that it is not justified to look specifically for D fragilis in pediatric patients with abdominal symptoms.
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Affiliation(s)
- Montse Montraveta-Querol
- Paediatric Gastroenterology Unit, Department of Pediatrics, Hospital Germans Trias i Pujol, Badalona, Spain; Department of Pediatrics, Obstetrics and Gynecology and Preventive Medicine, Universitat Autònoma de Barcelona (UAB), Spain.
| | - Maria Victoria Bovo
- Paediatric Gastroenterology Unit, Department of Pediatrics, Hospital Germans Trias i Pujol, Badalona, Spain
| | - Neus Roig-Abraham
- Paediatric Gastroenterology Unit, Department of Pediatrics, Hospital Germans Trias i Pujol, Badalona, Spain
| | - Nona Romaní
- Department of Microbiology, Hospital Germans Trias i Pujol, Badalona, Spain
| | - Alba Alcaraz
- Paediatric Gastroenterology Unit, Department of Pediatrics, Hospital Germans Trias i Pujol, Badalona, Spain
| | - Gema Fernández-Rivas
- Department of Microbiology, Hospital Germans Trias i Pujol, Badalona, Spain; Department of Genetics and Microbiology, Universitat Autònoma de Barcelona (UAB), Spain
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Should Dientamoeba fragillis be looked for in pediatric digestive pathology of an unknown cause? A proposed pilot case–control study. Enferm Infecc Microbiol Clin 2022. [DOI: 10.1016/j.eimc.2022.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Intestinal Parasites in Children up to 14 Years Old Hospitalized with Diarrhea in Mozambique, 2014-2019. Pathogens 2022; 11:pathogens11030353. [PMID: 35335676 PMCID: PMC8954659 DOI: 10.3390/pathogens11030353] [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: 02/18/2022] [Revised: 03/05/2022] [Accepted: 03/09/2022] [Indexed: 11/20/2022] Open
Abstract
Diarrhea remains a public health problem in Mozambique, even with control strategies being implemented. This analysis aimed to determine the proportion and factors associated with intestinal parasitic infection (IPI) in children up to 14 years old with diarrheal disease, in the southern, central and northern regions of Mozambique. A single diarrheal sample of 1424 children was collected in hospitals and examined using the formol-ether concentration and modified Ziehl−Neelsen techniques to identify intestinal parasites using optical microscopy. Sociodemographic characteristics were obtained by questionnaires. Descriptive statistics and cross-tabulation were performed, and p-values <0.05 were considered statistically significant. A single IPI was detected in 19.2% (273/1424) of the children. Cryptosporidium spp. was the most common parasite (8.1%; 115/1424). Polyparasitism was seen in 26.0% (71/273), with the co-infection of Ascaris lumbricoides and Trichuris trichiura (26.8%; 19/71) being the most common. Age and province were related to IPI (p-value < 0.05). The highest occurrence of IPI was observed in the wet period (October to March), with 21.9% (140/640), compared to the dry period (April to September), with 16.9% (131/776) (p-value = 0.017). Cryptosporidium spp. and the combination of A. lumbricoides/T. trichiura were the main intestinal parasites observed in children hospitalized with diarrhea in Mozambique.
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Sarzhanov F, Dogruman-Al F, Santin M, Maloney JG, Gureser AS, Karasartova D, Taylan-Ozkan A. Investigation of neglected protists Blastocystis sp. and Dientamoeba fragilis in immunocompetent and immunodeficient diarrheal patients using both conventional and molecular methods. PLoS Negl Trop Dis 2021; 15:e0009779. [PMID: 34613993 PMCID: PMC8494357 DOI: 10.1371/journal.pntd.0009779] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 08/30/2021] [Indexed: 02/07/2023] Open
Abstract
Introduction The clinical significance of Blastocystis sp. and Dientamoeba fragilis in patients with gastrointestinal symptoms is a controversial issue. Since the pathogenicity of these protists has not been fully elucidated, testing for these organisms is not routinely pursued by most laboratories and clinicians. Thus, the prevalence of these organisms and the subtypes of Blastocystis sp. in human patients in Turkey are not well characterized. This study aimed to determine the prevalence of Blastocystis sp. and D. fragilis in the diarrheic stool samples of immunodeficient and immunocompetent patients using conventional and molecular methods and to identify Blastocystis sp. subtypes using next generation sequencing. Material and methods Individual stool specimens were collected from 245 immunodeficient and 193 immunocompetent diarrheic patients between March 2017 and December 2019 at the Gazi University Training and Research Hospital in Ankara, Turkey. Samples were screened for Blastocystis sp. and D. fragilis by conventional and molecular methods. Molecular detection of both protists was achieved by separate qPCRs targeting a partial fragment of the SSU rRNA gene. Next generation sequencing was used to identify Blastocystis sp. subtypes. Results The prevalence of Blastocystis sp. and D. fragilis was 16.7% and 11.9%, respectively as measured by qPCR. The prevalence of Blastocystis sp. and D. fragilis was lower in immunodeficient patients (12.7% and 10.6%, respectively) compared to immunocompetent patients (21.8% and 13.5%, respectively). Five Blastocystis sp. subtypes were identified and the following subtype distribution was observed: ST3 54.4% (n = 37), ST2 16.2% (n = 11), ST1 4.4% (n = 3), ST6 2.9% (n = 2), ST4 1.5% (n = 1), ST2/ST3 11.8% (n = 8) and ST1/ST3 8.8% (n = 6). There was no statistically significant difference in the distribution of Blastocystis sp. subtypes between immunocompetent and immunodeficient patients. Conclusion and recommendation Our findings demonstrated that Blastocystis sp. and D. fragilis are commonly present in immunocompetent and immunodeficient patients with diarrhea. This study is the first to use next generation sequencing to address the presence of Blastocystis sp. mixed subtypes and intra-subtype variability in clinical samples in Turkey. Blastocystis sp. and Dientamoeba fragilis are single-cell parasites of the human intestine which are common worldwide and reported in cases with gastrointestinal symptoms. However, the role of Blastocystis sp. and D. fragilis in patients with gastrointestinal symptoms is still controversial because their presence is not always associated with symptoms. As some intestinal parasitic infections can cause severe illness in immunocompromised individuals careful consideration of intestinal protist infection is warranted. However, testing for Blastocystis sp. and D. fragilis is not routinely carried out by most laboratories and clinicians. Therefore, this study aimed to determine the prevalence of Blastocystis sp. and D. fragilis in immunocompetent and immunosuppressed patients with diarrhea by conventional and molecular methods. Both Blastocystis sp. and D. fragilis were detected more frequently by quantitative polymerase chain reaction than by conventional methods. Next generation sequencing was used to characterize the diversity and frequency of Blastocystis sp. subtypes and mixed subtypes in patients in Turkey. Five Blastocystis sp. subtypes (ST1, ST2, ST3, ST4 and ST6) were detected. ST3 was the most frequent subtype in both immunocompetent and immunosuppressed patients. Mono-infections were more common than mixed subtype infections. Our findings showed that Blastocystis sp. and D. fragilis are commonly present in immunocompetent and immunodeficient patients with diarrhea.
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Affiliation(s)
- Fakhriddin Sarzhanov
- Division of Medical Parasitology, Department of Medical Microbiology, School of Medicine, Gazi University, Ankara, Turkey
- Akhmet Yassawi International Kazakh-Turkish University, Faculty of Medicine, Turkestan, Kazakhstan
| | - Funda Dogruman-Al
- Division of Medical Parasitology, Department of Medical Microbiology, School of Medicine, Gazi University, Ankara, Turkey
- * E-mail: ,
| | - Monica Santin
- Environmental Microbial and Food Safety Laboratory, Agricultural Research Service, United States Department of Agriculture, Beltsville, Maryland, United States of America
| | - Jenny G. Maloney
- Environmental Microbial and Food Safety Laboratory, Agricultural Research Service, United States Department of Agriculture, Beltsville, Maryland, United States of America
| | - Ayse Semra Gureser
- Department of Medical Microbiology, School of Medicine, Hitit University, Corum, Turkey
| | - Djursun Karasartova
- Department of Medical Microbiology, School of Medicine, Hitit University, Corum, Turkey
| | - Aysegul Taylan-Ozkan
- Department of Medical Microbiology, School of Medicine, Hitit University, Corum, Turkey
- Department of Medical Microbiology, Faculty of Medicine, TOBB- University of Economics and Technology, Ankara, Turkey
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Mero S, Timonen S, Lääveri T, Løfberg S, Kirveskari J, Ursing J, Rombo L, Kofoed PE, Kantele A. Prevalence of diarrhoeal pathogens among children under five years of age with and without diarrhoea in Guinea-Bissau. PLoS Negl Trop Dis 2021; 15:e0009709. [PMID: 34587158 PMCID: PMC8504977 DOI: 10.1371/journal.pntd.0009709] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Revised: 10/11/2021] [Accepted: 08/05/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Childhood diarrhoea, a major cause of morbidity and mortality in low-income regions, remains scarcely studied in many countries, such as Guinea-Bissau. Stool sample drying enables later qPCR analyses of pathogens without concern about electricity shortages. METHODS Dried stool samples of children under five years treated at the Bandim Health Centre in Bissau, Guinea-Bissau were screened by qPCR for nine enteric bacteria, five viruses, and four parasites. The findings of children having and not having diarrhoea were compared in age groups 0-11 and 12-59 months. RESULTS Of the 429 children- 228 with and 201 without diarrhoea- 96.9% and 93.5% had bacterial, 62.7% and 44.3% viral, and 52.6% and 48.3% parasitic pathogen findings, respectively. Enteroaggregarive Escherichia coli (EAEC; 60.5% versus 66.7%), enteropathogenic E. coli (EPEC; 61.4% versus 62.7%), Campylobacter (53.2% versus 51.8%), and enterotoxigenic E. coli (ETEC; 54.4% versus 44.3%) were the most common bacterial pathogens. Diarrhoea was associated with enteroinvasive E. coli (EIEC)/Shigella (63.3%), ETEC (54.4%), astrovirus (75.0%), norovirus GII (72.6%) and Cryptosporidium (71.2%). The only pathogen associated with severe diarrhoea was EIEC/Shigella (p<0.001). EAEC was found more frequent among the infants, and EIEC/Shigella, Giardia duodenalis and Dientamoeba fragilis among the older children. CONCLUSIONS Stool pathogens proved common among all the children regardless of them having diarrhoea or not.
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Affiliation(s)
- Sointu Mero
- Human Microbiome Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Meilahti Infectious Diseases and Vaccine Research Center, MeiVac, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Suvi Timonen
- Division of Clinical Microbiology, Helsinki University Hospital, HUSLAB, Helsinki, Finland
| | - Tinja Lääveri
- Meilahti Infectious Diseases and Vaccine Research Center, MeiVac, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Sandra Løfberg
- Department of Infectious Diseases, Odense University Hospital, Odense, Denmark
- Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden
| | | | - Johan Ursing
- Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden
- Bandim Health Project, Indepth Network, Bissau, Guinea-Bissau
- Department of Infectious Diseases, Danderyds Hospital, Stockholm, Sweden
| | - Lars Rombo
- Unit of Infectious Diseases, Uppsala University, Uppsala, Sweden
- Centre for Clinical Research, Sörmland County Council, Eskilstuna, Sweden and Uppsala University, Uppsala, Sweden
| | - Poul-Erik Kofoed
- Bandim Health Project, Indepth Network, Bissau, Guinea-Bissau
- Department of Paediatrics and Adolescent Medicine, Lillebaelt Hospital, University Hospital of Southern Denmark, Kolding, Denmark
| | - Anu Kantele
- Human Microbiome Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Meilahti Infectious Diseases and Vaccine Research Center, MeiVac, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- * E-mail:
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MALATYALİ E, YILDIZ İ, TİLEKLİOGLU E, ERTABAKLAR H, ERTUĞ S. The high co-existence rate of Blastocystis and Dientamoeba fragilis in human faecal samples and the analysis of demographic and clinical findings. JOURNAL OF HEALTH SCIENCES AND MEDICINE 2021. [DOI: 10.32322/jhsm.904858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Bacterial, viral and parasitic pathogens analysed by qPCR: Findings from a prospective study of travellers' diarrhoea. Travel Med Infect Dis 2020; 40:101957. [PMID: 33359433 DOI: 10.1016/j.tmaid.2020.101957] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Revised: 12/19/2020] [Accepted: 12/21/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND The diagnostics of travellers' diarrhoea (TD) has been revolutionised by multiplex qPCR assays. While mostly of bacterial aetiology, viruses and parasites account for the disease among 10-20% of travellers. Despite this, prospective studies applying qPCR assays remain scarce that cover not only bacteria, such as the various diarrhoeagenic Escherichia coli (DEC), but also viral and parasitic pathogens. METHOD We analysed by qPCR pre- and post-travel stool samples of 146 Finnish travellers for bacterial, viral and parasitic pathogens: enteropathogenic (EPEC), enteroaggregative (EAEC), enterotoxigenic (ETEC), enterohaemorrhagic (EHEC), and enteroinvasive (EIEC) E. coli; Shigella, Campylobacter, Salmonella, Yersinia and Vibrio cholerae; norovirus G1 and G2, rotavirus, enteroviruses, and sapovirus; and Giardia lamblia, Entamoeba histolytica, and Cryptosporidium. Symptoms and medication data during travel were collected by questionnaires. RESULTS We detected bacterial pathogens in 102/146 samples (69.9%; EAEC, EPEC, ETEC most common), viral ones in 13 (8.9%; norovirus most common), and parasitic ones in one (0.7%; Giardia). Noroviruses were associated with severe symptoms (23.5% versus non-severe 4.9%). In the TD group, 41.7% (5/12) of those with viral pathogens (vs. 13.3%; 11/83 without) took antibiotics. CONCLUSION Viral pathogens, particularly noroviruses, prevail in severe TD. The symptoms of viral disease are often severe and lead to unwarranted use of antibiotics.
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Deksne G, Davidson RK, Buchmann K, Kärssin A, Kirjušina M, Gavarāne I, Miller AL, Pálsdóttir GR, Robertson LJ, Mørk T, Oksanen A, Palinauskas V, Jokelainen P. Parasites in the changing world - Ten timely examples from the Nordic-Baltic region. Parasite Epidemiol Control 2020; 10:e00150. [PMID: 32435705 PMCID: PMC7232095 DOI: 10.1016/j.parepi.2020.e00150] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Revised: 04/11/2020] [Accepted: 04/15/2020] [Indexed: 12/11/2022] Open
Abstract
The world is changing, and parasites adapt. The Nordic-Baltic region in northern Europe - including the Nordic countries Denmark, Finland, Iceland, Norway and Sweden, and the Baltic States Estonia, Latvia and Lithuania - is facing new parasitological challenges due to changes in populations of parasites and their hosts and the spread of new parasites to the region due to climate change. Some changes can also be ascribed to increased awareness and detection. In this paper, we review and discuss a convenience selection of ten timely examples of recent observations that exemplify trends and challenges from different fields of parasitology, with particular focus on climate change and potential changes in epidemiology of pathogens in northern Europe. The examples illustrate how addressing parasitological challenges often requires both intersectoral and international collaboration, and how using both historical baseline data and modern methodologies are needed.
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Affiliation(s)
- Gunita Deksne
- Institute of Food safety, Animal health and Environment “BIOR”, Lejupes Str. 3, Riga LV-1076, Latvia
- Faculty of Biology, University of Latvia, Jelgavas Str. 1, Riga LV-1004, Latvia
| | | | - Kurt Buchmann
- Laboratory of Aquatic Pathobiology, Department of Veterinary and Animal Sciences, University of Copenhagen, Stigbøjlen 7, DK-1870 Frederiksberg C, Denmark
| | - Age Kärssin
- Veterinary and Food Laboratory, Kreutzwaldi 30, 51006 Tartu, Estonia
- Institute of Veterinary Medicine and Animal Sciences, Estonian University of Life Sciences, Kreutzwaldi 62, 51006 Tartu, Estonia
| | - Muza Kirjušina
- Institute of Life Sciences and Technology, Daugavpils University, Parādes Str. 1A, Daugavpils LV-5401, Latvia
| | - Inese Gavarāne
- Institute of Life Sciences and Technology, Daugavpils University, Parādes Str. 1A, Daugavpils LV-5401, Latvia
| | - Andrea L. Miller
- Norwegian Institute for Nature Research, Department for Terrestrial Ecology, Postboks 5685 Sluppen, 7485 Trondheim, Norway
| | - Guðný Rut Pálsdóttir
- Institute for Experimental Pathology at Keldur, University of Iceland, Keldnavegur 3, IS-112 Reykjavík, Iceland
| | - Lucy J. Robertson
- Norwegian University of Life Sciences, Department of Food Safety and Infection Biology, Section for Microbiology, Immunology, and Parasitology, Parasitology Lab, Adamstuen Campus, Ullevålsveien 72, 0454 Oslo, Norway
| | - Torill Mørk
- Norwegian Veterinary Institute, Stakkevollvegen 23b, 9010 Tromsø, Norway
| | - Antti Oksanen
- Finnish Food Authority (FINPAR), Elektroniikkatie 3, 90590 Oulu, Finland
| | | | - Pikka Jokelainen
- Laboratory of Parasitology, Department of Bacteria, Parasites & Fungi, Infectious Disease Preparedness, Statens Serum Institut, Artillerivej 5, 2300 Copenhagen S, Denmark
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12
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Hawash YA, Ismail KA, Saber T, Eed EM, Khalifa AS, Alsharif KF, Alghamdi SA. Dientamoeba fragilis Infection in Patients with Digestive and Non-Digestive Symptoms: A Case-Control Study. THE KOREAN JOURNAL OF PARASITOLOGY 2020; 58:129-134. [PMID: 32418381 PMCID: PMC7231832 DOI: 10.3347/kjp.2020.58.2.129] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 03/02/2020] [Indexed: 12/23/2022]
Abstract
In most developing countries, Dientamoeba fragilis infection is an obscure protozoan infection. We aimed to determine a frequency and clinical importance of D. fragilis infection in Taif, Saudi Arabia. A 1-year case control study included patients with gastrointestinal (cases, n=114) or non-gastrointestinal symptoms (controls, n=90). The fecal samples were examined with the classical parasitological methods for intestinal protozoa, and by real time PCR for D. fragilis. The infection by D. fragilis was detected in 5.8% by PCR and in 4.4% patients by microscopy. The infection was identified more in control group (n=9) than in cases (n=3); a sole infection in 11 patients and mixed with Giardia in 1 patient. The other enteric parasites detected were Blastocystis sp. (8.3%), Giardia sp. (5.3%), Cryptosporidium sp. (2.9%), Entamoeba histolytica (1.4%), Entamoeba coli (0.9%) and Hymenolepis nana (0.4%). Our results tend to reinforce the need to increase awareness of D. fragilis infection in Saudi Arabia.
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Affiliation(s)
- Yousry A Hawash
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, Taif University, Saudi Arabia.,Department of Molecular and Clinical Parasitology, National Liver Institute, Menoufia University, Egypt
| | - Khadiga A Ismail
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, Taif University, Saudi Arabia.,Department of Medical Parasitology, Faculty of Medicine, Ain-Shams University, Egypt
| | - Taisir Saber
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, Taif University, Saudi Arabia.,Department of Medical Microbiology and Immunology, Faculty of Medicine, Zagazig University, Egypt
| | - Emad M Eed
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, Taif University, Saudi Arabia.,Department of Medical Microbiology and Immunology, Faculty of Medicine, Menoufia University, Egypt
| | - Amany S Khalifa
- Department of Clinical Pathology, Faculty of Medicine, Menoufia University, Egypt.,Department of Medical Microbiology and Immunology, Faculty of Pharmacy, Taif University, Saudi Arabia
| | - Khalaf F Alsharif
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, Taif University, Saudi Arabia
| | - Saleh A Alghamdi
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, Taif University, Saudi Arabia
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13
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van Kalleveen MW, van Gool T, Klarenbeek N, Benninga MA, Savelkoul PHM, de Meij T, Plötz FB. Dientamoeba fragilis in children: a systematic review on diagnostic considerations and efficacy of treatment. Expert Rev Gastroenterol Hepatol 2020; 14:231-242. [PMID: 32155096 DOI: 10.1080/17474124.2020.1739520] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Introduction: The presence of D. fragilis in feces is characterized by an asymptomatic carrier ship to a spectrum of gastrointestinal symptoms. However, a causal relationship remains to be elucidated. In this systematic review, we aimed to evaluate the relationship between the eradication of D. fragilis and symptoms to establish the strength of evidence that D. fragilis in symptomatic children warrants antibiotic treatment.Areas covered: This systematic review covers a challenge in daily clinical practice. Is it necessary to test for D. fragilis in children with gastrointestinal symptoms and does a positive fecal PCR test warrant treatment?Expert opinion: Testing for D. fragilis seems justified in a selection of children with persistent unexplained chronic abdominal pain and diarrhea. Treatment of D. fragilis should be withhold until other causes like celiac disease have been excluded. Both microscopic and Real Time-PCR methods (or a combination of the two) can be used for diagnosis. Paromomycin or clioquinol are antibiotics of choice based on their small spectrum of activity, fewer side effects, and better eradication rates than metronidazole. Future randomized studies, with strict inclusion criteria, appropriate diagnostic testing, and doses of antibiotics based on bodyweight are warranted.
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Affiliation(s)
- Michael W van Kalleveen
- Department of Pediatrics, Tergooi Hospital, Blaricum, The Netherlands.,Department of Gastroenterology, Noordwest Hospital, Alkmaar, The Netherlands
| | - Tom van Gool
- Department of Medical Microbiology, Section Clinical Parasitology, Amsterdam UMC, Amsterdam, The Netherlands
| | - Nikki Klarenbeek
- Department of Pediatrics, Tergooi Hospital, Blaricum, The Netherlands
| | - Marc A Benninga
- Department of Pediatric Gastroenterology, Amsterdam UMC, Amsterdam, The Netherlands
| | - Paul H M Savelkoul
- Department of Medical Microbiology, Section Clinical Parasitology, Amsterdam UMC, Amsterdam, The Netherlands.,Department of Medical Microbiology, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Tim de Meij
- Department of Pediatric Gastroenterology, Amsterdam UMC, Amsterdam, The Netherlands
| | - Frans B Plötz
- Department of Pediatrics, Tergooi Hospital, Blaricum, The Netherlands.,Department of Pediatrics, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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14
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Ögren J, Dienus O, Matussek A. Optimization of routine microscopic and molecular detection of parasitic protozoa in SAF-fixed faecal samples in Sweden. Infect Dis (Lond) 2019; 52:87-96. [DOI: 10.1080/23744235.2019.1682188] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Affiliation(s)
- Jessica Ögren
- Clinical Microbiology, Region Jönköping County, Jönköping, Sweden
- Division of Clinical Microbiology, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Olaf Dienus
- Clinical Microbiology, Region Jönköping County, Jönköping, Sweden
| | - Andreas Matussek
- Division of Clinical Microbiology, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
- Department of Laboratory Medicine, Region Jönköping County, Jönköping, Sweden
- Karolinska University Laboratory, Stockholm, Sweden
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