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Kirby T. Jennifer Keiser-Improving treatment of helminth infections. Lancet Infect Dis 2021; 21:1504. [PMID: 34717814 DOI: 10.1016/s1473-3099(21)00641-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
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Abstract
Parasitic helminths have coevolved with humans over millennia, intricately refining and developing an array of mechanisms to suppress or skew the host’s immune system, thereby promoting their long-term survival. Some helminths, such as hookworms, cause little to no overt pathology when present in modest numbers and may even confer benefits to their human host. To exploit this evolutionary phenomenon, clinical trials of human helminth infection have been established and assessed for safety and efficacy for a range of immune dysfunction diseases and have yielded mixed outcomes. Studies of live helminth therapy in mice and larger animals have convincingly shown that helminths and their excretory/secretory products possess anti-inflammatory drug-like properties and represent an untapped pharmacopeia. These anti-inflammatory moieties include extracellular vesicles, proteins, glycans, post-translational modifications, and various metabolites. Although the concept of helminth-inspired therapies holds promise, it also presents a challenge to the drug development community, which is generally unfamiliar with foreign biologics that do not behave like antibodies. Identification and characterization of helminth molecules and vesicles and the molecular pathways they target in the host present a unique opportunity to develop tailored drugs inspired by nature that are efficacious, safe, and have minimal immunogenicity. Even so, much work remains to mine and assess this out-of-the-box therapeutic modality. Industry-based organizations need to consider long-haul investments aimed at unraveling and exploiting unique and differentiated mechanisms of action as opposed to toe-dipping entries with an eye on rapid and profitable turnarounds.
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Affiliation(s)
- Stephanie M. Ryan
- Centre for Molecular Therapeutics, Australian Institute of Tropical Health and Medicine, James Cook University, Cairns, Queensland, Australia
| | - Ramon M. Eichenberger
- Centre for Molecular Therapeutics, Australian Institute of Tropical Health and Medicine, James Cook University, Cairns, Queensland, Australia
| | - Roland Ruscher
- Centre for Molecular Therapeutics, Australian Institute of Tropical Health and Medicine, James Cook University, Cairns, Queensland, Australia
| | - Paul R. Giacomin
- Centre for Molecular Therapeutics, Australian Institute of Tropical Health and Medicine, James Cook University, Cairns, Queensland, Australia
| | - Alex Loukas
- Centre for Molecular Therapeutics, Australian Institute of Tropical Health and Medicine, James Cook University, Cairns, Queensland, Australia
- * E-mail:
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Panagiota K, Dimitrios F. On the Work of Alexander of Tralles. Acta Med Hist Adriat 2019; 17:295-304. [PMID: 32390447 DOI: 10.31952/amha.17.2.7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Helminthiasis is known to man since antiquity, but it still remains a significant public health problem. In ancient times many plants have been tried as possible therapeutics in search of an effective drug. This manuscript investigates ancient beliefs on parasitic worm infestation. Moreover, Alexander of Tralles' (525 - 605 CE) suggestions on the treatment of this condition are discussed as found in his lesser-known work "A letter on helminths", along with comments on the use of those herbal cures by modern medicine.
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Affiliation(s)
- Kripouri Panagiota
- Department of Anatomy and Surgical Anatomy, Medical School, National and Kapodistrian University of Athens, Athens, Greece; Gymnasiarchou Stefanou 24, GR-54250, Harilaou, Thessaloniki, Greece. E‑pošta:
| | - Filippou Dimitrios
- Department of Anatomy and Surgical Anatomy, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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Gall S, Adams L, Joubert N, Ludyga S, Müller I, Nqweniso S, Pühse U, du Randt R, Seelig H, Smith D, Steinmann P, Utzinger J, Walter C, Gerber M. Effect of a 20-week physical activity intervention on selective attention and academic performance in children living in disadvantaged neighborhoods: A cluster randomized control trial. PLoS One 2018; 13:e0206908. [PMID: 30408073 PMCID: PMC6224098 DOI: 10.1371/journal.pone.0206908] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Accepted: 10/19/2018] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES To evaluate the effect of a 20-week school-based physical activity intervention program on academic performance and selective attention among disadvantaged South African primary school children. DESIGN Cluster randomized control trial. METHODS The study cohort included 663 children from eight primary schools, aged 8-13 years. Data assessment took place between February 2015 and May 2016 following the implementation of a 20-week school-based physical activity program. The d2 test was employed to assess selective attention, while the averaged end-of-year school results (math, life skills, home language, and additional language) were used as an indicator of academic performance. Physical fitness was assessed using the 20-m shuttle run test (VO2 max) and grip strength tests. We controlled for cluster effects, baseline scores in selective attention or academic performance, and potential confounders, such as children's age, gender, socioeconomic status, self-reported physical activity (as determined by a pre-tested questionnaire), body mass index, hemoglobin (as a proxy for anemia, as measured by blood sampling), and soil-transmitted helminth infections (as assessed by the Kato-Katz technique). RESULTS Our multivariate analysis suggested that the physical activity intervention had a positive effect on academic performance (p = 0.032), while no effect was found on selective attention (concentration performance; p = 0.469; error percentage; p = 0.237). After controlling for potential confounders, the physical activity condition contributed to the maintenance of academic performance, whereas a decrease was observed in learners in the control condition. Furthermore, physically active and fit children tend to have better concentration performance (CP) than their less fit peers (self-reported activity; p<0.016, grip strength; p<0.009, VO2 max p>0.021). CONCLUSION A 20-week physical activity intervention contributes to the maintenance of academic performance among socioeconomically deprived school children in South Africa. School administrators should ensure that their school staff implements physical activity lessons, which are a compulsory component of the school by the curriculum.
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Affiliation(s)
- Stefanie Gall
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
- * E-mail:
| | - Larissa Adams
- Department of Human Movement Science, Nelson Mandela University, Port Elizabeth, South Africa
| | - Nandi Joubert
- Department of Human Movement Science, Nelson Mandela University, Port Elizabeth, South Africa
| | - Sebastian Ludyga
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | - Ivan Müller
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
- University of Basel, Basel, Switzerland
- Swiss Tropical and Public Health Institute, Basel, Switzerland
| | - Siphesihle Nqweniso
- Department of Human Movement Science, Nelson Mandela University, Port Elizabeth, South Africa
| | - Uwe Pühse
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | - Rosa du Randt
- Department of Human Movement Science, Nelson Mandela University, Port Elizabeth, South Africa
| | - Harald Seelig
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | - Danielle Smith
- Department of Human Movement Science, Nelson Mandela University, Port Elizabeth, South Africa
| | - Peter Steinmann
- University of Basel, Basel, Switzerland
- Swiss Tropical and Public Health Institute, Basel, Switzerland
| | - Jürg Utzinger
- University of Basel, Basel, Switzerland
- Swiss Tropical and Public Health Institute, Basel, Switzerland
| | - Cheryl Walter
- Department of Human Movement Science, Nelson Mandela University, Port Elizabeth, South Africa
| | - Markus Gerber
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
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Abstract
More than a quarter of the world's population is at risk of infection with the soil-transmitted helminths Ascaris lumbricoides, hookworm (Ancylostoma duodenale and Necator americanus), Trichuris trichiura, and Strongyloides stercoralis. Infected children and adults present with a range of medical and surgical conditions, and clinicians should consider the possibility of infection in individuals living in, or returning from, endemic regions. Although safe and effective drugs are donated free to endemic countries, only half of at-risk children received treatment in 2016. This Seminar describes the epidemiology, lifecycles, pathophysiology, clinical diagnosis, management, and public health control of soil-transmitted helminths. Previous work has questioned the effect of population-level deworming; however, it remains beyond doubt that treatment reduces the severe consequences of soil-transmitted helminthiasis. We highlight the need for refined diagnostic tools and effective control options to scale up public health interventions and improve clinical detection and management of these infections.
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Affiliation(s)
- Peter Mark Jourdan
- Schistosomiasis Control Initiative, Imperial College London, St Mary's Campus, London, UK; DEWORM3, Natural History Museum, London, UK; Norwegian Centre for Imported and Tropical Diseases, Department of Infectious Diseases, Oslo University Hospital, Ullevål, Oslo, Norway
| | - Poppy H L Lamberton
- Department of Infectious Disease Epidemiology, Imperial College London, St Mary's Campus, London, UK; Institute of Biodiversity, Animal Health and Comparative Medicine, The University of Glasgow, Glasgow, UK; Wellcome Centre for Molecular Parasitology, The University of Glasgow, Glasgow, UK.
| | - Alan Fenwick
- Schistosomiasis Control Initiative, Imperial College London, St Mary's Campus, London, UK
| | - David G Addiss
- The Task Force for Global Health, Decatur, GA, USA; Eck Institute for Global Health, University of Notre Dame, Notre Dame, IN, USA
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Cross M, Klepzig E, Dallaston M, Young ND, Bailey UM, Mason L, Jones MK, Gasser RB, Hofmann A. Exploring the molecular mechanisms of parasite-host interactions with a view towards new therapeutics and vaccines. Postepy Biochem 2016; 62:370-376. [PMID: 28132492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Accepted: 03/03/2016] [Indexed: 06/06/2023]
Abstract
Despite the massive disease burden worldwide caused by parasitic nematodes and other infectious pathogens, the molecular basis of many infectious diseases caused by these pathogens has been unduly neglected for a long time. Therefore, accelerated progress towards novel therapeutics, and ultimately control of such infectious diseases, is of crucial importance. Capitalising on the wealth of data becoming available from proteomic and genomic studies, new protein targets at the pathogen-host interface can be identified and subjected to protein-based explorations of the molecular basis of pathogen-host interactions. By combining the use of systems and structural biology methodologies, insights into the structural and molecular mechanisms of these interactions can assist in the development of therapeutics and/or vaccines. This brief review examines two different proteins from the body wall of blood flukes - annexins and the stress-induced phosphoprotein 1 - both of which are presently interesting targets for the development of therapeutics.
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Affiliation(s)
- Megan Cross
- Structural Chemistry Program, Eskitis Institute, Griffith University, Nathan, Queensland, Australia
| | - Emma Klepzig
- Structural Chemistry Program, Eskitis Institute, Griffith University, Nathan, Queensland, Australia
| | - Madeleine Dallaston
- Structural Chemistry Program, Eskitis Institute, Griffith University, Nathan, Queensland, Australia
| | - Neil D Young
- Faculty of Veterinary and Agricultural Sciences, The University of Melbourne, Parkville, Victoria, Australia
| | - Ulla-Maja Bailey
- Structural Chemistry Program, Eskitis Institute, Griffith University, Nathan, Queensland, Australia
| | - Lyndel Mason
- Structural Chemistry Program, Eskitis Institute, Griffith University, Nathan, Queensland, Australia
| | - Malcolm K Jones
- School of Veterinary Sciences, The University of Queensland, Gatton, Queensland, Australia
| | - Robin B Gasser
- Faculty of Veterinary and Agricultural Sciences, The University of Melbourne, Parkville, Victoria, Australia
| | - Andreas Hofmann
- Structural Chemistry Program, Eskitis Institute, Griffith University, Nathan, Queensland, Australia
- Faculty of Veterinary and Agricultural Sciences, The University of Melbourne, Parkville, Victoria, Australia
- Queensland Tropical Health Alliance, Smithfield, Queensland, Australia
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Abstract
Rhizobiales (formerly named Rickettsiales) cause in rare instances meningitis and meningovasculitis, respectively. In case of history of exposure, infection by Rhizobiales needs to be considered since both diagnosis and therapy may be extremely difficult and pathogen-specific. The same applies to protozoa; in this chapter, Babesia species, free-living amoebae and Entamoeba histolytica infection, including severe meningitis and brain abscess, infection by Trypanosoma species (South American and African trypanosomiasis) are discussed with respect to history, epidemiology, clinical signs, and symptoms as well as differential diagnosis and therapy. Parasitic flatworms and roundworms, potentially able to invade the central nervous system, trematodes (flukes), cestodes (in particular, Cysticercus cellulosae), but also nematodes (in particular, Strongyloides spp. in the immunocompromised) are of worldwide importance. In contrast, filarial worms, Toxocara spp., Trichinella spp., Gnathostoma and Angiostrongylus spp. are seen only in certain geographically confined areas. Even more regionally confined are infestations of the central nervous system by metazoa, in particular, tongue worms (=arthropods) or larvae of flies (=maggots). The aim of this chapter is (1) to alert the neurologist to these infections, and (2) to enable the attending emergency neurologist to take a knowledgeable history, with an emphasis on epidemiology, clinical signs, and symptoms as well as therapeutic management possibilities.
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Affiliation(s)
- Erich Schmutzhard
- Department of Neurology, Medical University Hospital Innsbruck, Innsbruck, Austria.
| | - Raimund Helbok
- Department of Neurology, Medical University Hospital Innsbruck, Innsbruck, Austria
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Karani F, Muthami L, Kihara JH, Mberia HK. COMMUNITY KNOWLEDGE AND PERCEPTIONS ON NATIONAL SCHOOL-BASED DE-WORMING PROGRAMME. East Afr Med J 2013; 90:396-403. [PMID: 26848499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
OBJECTIVES To determine the community level of knowledge, attitude and perception of soil transmitted helminthes and the national school-based de-worming programme in selected villages of Busia County in Kenya. DESIGN A cross-sectional survey. SETTING Busia and Bunyala districts in Busia County. SUBJECTS A total of 384 participants were studied. MAIN OUTCOME MEASURES Socio-demographic characteristics, then knowledge, causes and effects of Soil Transmitted Infections on health and education, prevention strategies, knowledge of national school-based de-worming programs, implementing strategies of the programme, benefits of the programme, community satisfaction and health seeking behaviour. RESULTS Eating the uncooked food as a cause for soil transmitted infections constituted 27.16% (63) followed by 16.38% (38) notusing latrines, 15.95% (37) eating left over foods, 12.93% (30) eating cold food, 10.78% (25) eating not well cooked pork, 9.48% (22) eating contaminated soil, and 7.33% (17) changing of diet. One head teacher interviewed stated that "One can be able to notice if his/her child has worm infection if the child eats without getting satisfied, eating all the time and yet his belly is big."Community Health Extension Worker in the FGD stated that: "During flood seasons most of the areas in Budalangi become flooded and all latrines are filled with water and the excreta start overflowing. Most of the residents don't have shoes especially the children and therefore they are prone to the worm infection."99.57% of the parents were aware of the national school based de-worming programme of which (92%) learnt about the programme after their children were de-wormed in their various schools. Seventy five percent (174) were satisfied about the programme; 65.1% (151) and 10.3% indicated that the programme improves the children's health and student's school performance respectively. CONCLUSION Most of the parents do not have adequate knowledge on worms, their causes, and signs and symptoms of the intestinal worms. Low educational levels and poverty levels also contribute to the lack of awareness on intestinal worms and putting the prevention measures across the board. The study also found out that the community perception towards the de-worming programme was good because the de-worming programme improved the children's health and performance in school.
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Klaewsongkram J. Complex interactions between host and environment in allergic diseases and the roles of integrative management. Asian Pac J Allergy Immunol 2013; 31:89-90. [PMID: 23859406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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Soil-transmitted helminthiases: number of children treated in 2010. Wkly Epidemiol Rec 2012; 87:225-32. [PMID: 24340403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Abstract
Hypereosinophilic syndromes (HES) are a heterogeneous group of disorders that range from asymptomatic eosinophilia > 1,500/mL to aggressive disease complicated by life-threatening end organ involvement, including endomyocardial fibrosis and thromboembolism. To complicate matters further, similar clinical manifestations can occur in the setting of marked eosinophilia due to helminth infection, drug hypersensitivity, and other causes. In the past, therapy was guided only by the exclusion of these secondary causes of eosinophilia and the severity of the clinical manifestations. More recently, the availability of novel targeted therapies and a better understanding of the etiologies of some subtypes of HES have necessitated a more structured approach.
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Affiliation(s)
- Hans-Uwe Simon
- Institute of Pharmacology, University of Bern, Bern, Switzerland
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Senn N, Fasel E, de Vallière S, Genton B. [Gastrointestinal complaints associated to helminth and protozoan: management by the general practitioner]. Rev Med Suisse 2010; 6:2292-2301. [PMID: 21207722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Protozoan and helminthes are frequently associated with persistent digestive complaints, not only in returning travelers from the tropics, but also in industrialized countries. The symptoms are often more vague than those associated to bacterial or viral infections and diarrhea is not always a key feature of the clinical presentation. Three stool examinations and a full blood cells count looking for eosinophilia is the comer stone of the investigations looking for digestive parasites. This article reviews the epidemiology, clinical presentation, diagnostic and management of digestive protozoans and helminthes.
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Müller A. [Unjustly neglected. Worm infestations]. Pharm Unserer Zeit 2010; 39:42-48. [PMID: 20033949 DOI: 10.1002/pauz.201000351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Affiliation(s)
- Andreas Müller
- Tropenmedizinische Abteilung, Missionsärztliche Klinik gGmbH, Salvatorstr. 7, 97074 Würzburg.
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Abstract
BACKGROUND The author reports on the plants, rituals and spells used against worms and the so-called scantu (fright) in some areas of Sicily. The work is based on ethnobotanical research carried out, prevalently, between 2002-2006, in some areas of Eastern, South-Eastern, North-Central and South-Central Sicily. METHODS This research is based on dialogue. Senior 'healers' were contacted; furthermore, doctors, teachers, farmers and in general 'experts' with herbs and 'magic' rituals. Information was collected about the way the plants of folk medicine are prepared. The interviewees were also invited to recite prayers and spells against helminthiasis. RESULTS The author has highlighted the importance of how, in some parts of Sicily, some ailments like helminthiasis and other correlated pathologies like scantu are 'treated' and, especially within the rural social classes, by folk medicine remedies, herbal practises, particular prayers, rituals and spells. CONCLUSION As regards health/illness, it should be noted that in the last ten years conventional medicine has provided very satisfactory results even resolving potentially mortal pathologies. However, in certain social classes, there is no real collaboration between conventional and folk medicine; so for some senior citizens, the 'healer' with his rituals and empirical and magical herbs is still the person to turn to for the 'cure' of particular ailments. Interest in these practises from ancestral heritage in an advanced country like Italy, is only relevant if the aim is to recoup a cultural identity which is already in decline.It is significant to report a piece: on 14 October 2007 the news on a well-known national Italian TV channel reported an interview with a 94 year-old man from Arbatax (Sardinia) referred to as a 'healer' because both his townspeople and others from all over the world go to him for his cures. He is not paid except in kind and has been known to cure St. Anthony's fire, burns, scalding and marine fungal infections, by smearing his saliva over the infected part and reciting 'special words'.
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Affiliation(s)
- Mariangela Napoli
- Dipartimento di Botanica, Università di Catania, Via A, Longo 19 - 95125 - Catania, Italy.
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Abstract
Eosinophils normally account for only one to three percent of peripheral-blood leukocytes, and the upper limit of the normal range is 450 cells per cubic millimeter of blood. Eosinophilia occurs in a variety of disorders. The most common cause of eosinophilia worldwide is helminthic infections, and the most common cause in industrialized nations is atopic disease. The diverse causes, clinical signs and symptoms, the diagnostic work-up as well as the therapeutic strategies will be discussed in this review. The "hypereosinophilic syndrome" constitutes an evolving concept and is most likely the result of a clonal (neoplastic) disorder. A number of new therapeutic approaches for these conditions have been developed and will be discussed in this article.
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Affiliation(s)
- J L Pérez-Arellano
- Unidad de Enfermedades Infecciosas y Medicina Tropical, Hospital Universitario Insular de Gran Canaria, Las Palmas de Gran Canaria, Las Palmas, Spain.
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Moncayo AL, Cooper PJ. Geohelminth infections: impact on allergic diseases. Int J Biochem Cell Biol 2005; 38:1031-5. [PMID: 16413997 DOI: 10.1016/j.biocel.2005.11.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2005] [Revised: 07/22/2005] [Accepted: 11/07/2005] [Indexed: 01/08/2023]
Abstract
Geohelminth infections are highly prevalent infections with a worldwide distribution. Epidemiological studies have shown an inverse relationship between geohelminth infection and allergy leading to the suggestion that geohelminths protect against allergy. A causal association is supported by the findings of intervention studies in humans and experimental animal models. Geohelminths cause chronic infections during which an intimate host-parasite interaction develops permitting the parasite to survive but protecting the host from damaging inflammation. Geohelminth parasites modulate allergic inflammation directed against parasite antigens and the same mechanisms may affect responses to inhalant aeroallergens. The mechanisms proposed to explain the allergy-modulatory effect of geohelminths include the induction of regulatory T cells and the creation of an immunosuppressive environment in relevant tissues. New treatments being considered for the treatment of asthma include live infections with hookworms. Insights provided by how geohelminths modulate inflammatory responses may allow the development of new treatments that mimic these effects.
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Affiliation(s)
- Ana-Lucia Moncayo
- Laboratorio de Investigaciones, Hospital Pedro Vicente Maldonado, Pichincha Province, Ecuador
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Göksu T, Junghanss T. Der Wurm in der Leber. Therapeutische Umschau 2005; 62:787-92. [PMID: 16350543 DOI: 10.1024/0040-5930.62.11.787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Patienten mit parasitär bedingten Leberleiden stellen in den meisten europäischen Ländern ein sehr kleines Kollektiv dar. Sie werden in der Differentialdiagnose von hepatischen Raumforderungen, Leberparenchymveränderungen, Schmerzen im rechten Oberbauch, Cholestase oder Transaminasenerhöhung, wenn überhaupt, meist zuletzt in Betracht gezogen. Den meisten Gesundheitseinrichtungen mangelt es an diagnostischer und therapeutischer Erfahrung. Diese Erkrankungen sind in spezialisierten Zentren (dies sind traditionsgemäß meist tropenmedizinische Einrichtungen) am besten aufgehoben. Wichtige Komponenten bei der Abklärung sind: Risikoanamnese (Herkunft, Reisen, Exposition), die geographische Verbreitung der Parasitosen, Inkubations- und Präpatenzzeit, Labor (Eosinophilie, IgE-Erhöhung, direkter Parasitennachweis, Serologie), sowie bildgebende Verfahren. Es werden die wichtigsten Parasitosen der Leber dargestellt: Schistosomiasis, Echinokokkose, Faszioliasis, Toxocariasis.
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Affiliation(s)
- T Göksu
- Sektion Klinische Tropenmedizin, Universitätsklinikum Heidelberg, Heidelberg.
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20
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Abstract
Die Lunge kann bei einer Vielzahl von Helminthiasen beteiligt sein. Sie ist entweder das Habitat der Würmer oder die pulmonalen Symptome sind Folge der Passage von Helminthenlarven während deren Reife- und Migrationsprozess im menschlichen Organismus. Entsprechend vielfältig und unspezifisch können bei einer pulmonalen Helminthiase die klinischen Symptome sein. Die klassische Trias von respiratorischen Symptomen, Eosinophilie im peripheren Blut und Infiltrate im Thorax-Röntgenbild ist nur eine der vielen möglichen Manifestationen. Es gibt kaum pathognomonische Zeichen, die sich spezifisch einer Helminthiase zuordnen lassen. Bei klinischem Verdacht kann mit einer detaillierten Anamnese das in Frage kommende Erregerspektrum eingegrenzt werden. Die Diagnose einer Helminthiase erfolgt entweder durch direkten Erregernachweis oder indirekt mit serologischen Methoden.
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Affiliation(s)
- R Nüesch
- Medizinische Poliklinik, Universitätsspital Basel, Basel.
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21
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Abstract
Bei neurologischen Zeichen einer fokalen Entzündung, eines Tumors oder einer Meningoenzephalitis sollte vor allem bei wechselnder Lokalisation der Symptome, einer bereits bekannten Helminthiase oder bei einer positiven Expositionsanamnese (Reiseanamnese, Einnahme nicht genügend gekochter Lebensmittel oder Tierkot) an eine Wurmerkrankung gedacht werden. Als erster Abklärungsschritt wird eine Eosinophilie im Blut und/oder Liquor gesucht. Später werden serologische Abklärungen und bildgebende Verfahren eingesetzt. Da eine Wurmbehandlung zu einer entzündlichen Reaktion mit Verschlechterung des klinischen Bildes führen kann, sollte sie vorsichtig und unter Schutz von Kortikosteroiden durchgeführt werden.
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Affiliation(s)
- J Blum
- Schweizerisches Tropeninstitut, Basel.
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22
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Magnaval JF, Magdeleine J. [Human Mammomonogamus infection]. Med Trop (Mars) 2004; 64:21-2. [PMID: 15224551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Affiliation(s)
- J F Magnaval
- Service de Parasitologie des Hôpitaux de Toulouse, CHU Rangueil, 31059 Toulouse 09, France.
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Abstract
Biliary parasitosis is one of the common causes of biliary obstruction in developing countries and can often be confused with stone disease. With increased worldwide travel and immigration, these conditions are not limited to the developing countries alone. Ascariasis, hydatid liver disease, clonorchiasis, and fascioliasis are the commonly encountered parasitic infestations of the biliary tract usually presenting with biliary colic or cholangitis. Endoscopy has an important role in the diagnosis and emergent management of these conditions and in elective endoscopic therapy of associated complications. Endoscopic sphincterotomy and bile ductal clearance, along with pharmacotherapy, are the mainstays of treatment.
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Elliott AM, Mawa PA, Joseph S, Namujju PB, Kizza M, Nakiyingi JS, Watera C, Dunne DW, Whitworth JA. Associations between helminth infection and CD4+ T cell count, viral load and cytokine responses in HIV-1-infected Ugandan adults. Trans R Soc Trop Med Hyg 2003; 97:103-8. [PMID: 12886815 DOI: 10.1016/s0035-9203(03)90040-x] [Citation(s) in RCA: 74] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
It has been proposed that helminth infection may exacerbate HIV progression by promoting activation of 'type 2' immune responses. To examine this hypothesis, we investigated helminth infection in a cohort of HIV-1-seropositive adults in Entebbe, Uganda, during November 1999 to January 2000. Individuals with helminths were treated. At enroLlment, after 5 weeks and after 4 months, CD4+ and CD8+ T cell counts and viral load were measured. Cytokine responses (interferon [IFN]-gamma, interleukin [IL]-2, IL-4 and IL-5) to Schistosoma mansoni adult worm antigen (SWA), Mycobacterium tuberculosis culture filtrate proteins (CFPs) and phytohaemagglutinin (PHA) were measured in a whole blood assay. At baseline, CD4+ T cell counts and CD4+: CD8+ ratios were higher in individuals with helminths than in those without (median CD4+ T cell counts 467/microL and 268/microL, respectively, P = 0.005). Viral load was lower among those with helminths but this was not statistically significant. During follow-up, CD4+ T cell counts and cytokine responses to PHA fell among individuals without helminths. Among those treated for helminths, CD4+ counts remained stable. Viral loads showed a transient increase at 5 weeks, which was more marked among those treated for helminths, but the levels at 4 months were similar to baseline in both groups. Among those with schistosomiasis, IFN-gamma and IL-2 responses to CFP, and IL-2 and IL-4 responses to PHA declined but there was a sustained increase in cytokine responses to SWA following treatment. These data do not support the hypothesis that helminth infection exacerbates HIV infection. The possibility that chronic helminth infection may suppress HIV replication and that effects on HIV replication may vary during helminth infection and treatment should be considered.
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Weinstock JV, Summers RW, Elliott DE, Qadir K, Urban JF, Thompson R. The possible link between de-worming and the emergence of immunological disease. J Lab Clin Med 2002; 139:334-8. [PMID: 12066130 DOI: 10.1067/mlc.2002.124343] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Joel V Weinstock
- Division of Gastroenterology-Hepatology, Department of Internal Medicine, University of Iowa, Iowa City, IA 52242, USA.
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Abstract
Parasitic diseases are receiving increasing attention in developed countries in part because of their importance in travelers, immigrants, and immunocompromised persons. The main purpose of this review is to educate laboratorians, the primary readership, and health care workers, the secondary readership, about the potential hazards of handling specimens that contain viable parasites and about the diseases that can result. This is accomplished partly through discussion of the occupationally acquired cases of parasitic infections that have been reported, focusing for each case on the type of accident that resulted in infection, the length of the incubation period, the clinical manifestations that developed, and the means by which infection was detected. The article focuses on the cases of infection with the protozoa that cause leishmaniasis, malaria, toxoplasmosis, Chagas' disease (American trypanosomiasis), and African trypanosomiasis. Data about 164 such cases are discussed, as are data about cases caused by intestinal protozoa and by helminths. Of the 105 case-patients infected with blood and tissue protozoa who either recalled an accident or for whom the likely route of transmission could be presumed, 47 (44.8%) had percutaneous exposure via a contaminated needle or other sharp object. Some accidents were directly linked to poor laboratory practices (e.g., recapping a needle or working barehanded). To decrease the likelihood of accidental exposures, persons who could be exposed to pathogenic parasites must be thoroughly instructed in safety precautions before they begin to work and through ongoing training programs. Protocols should be provided for handling specimens that could contain viable organisms, using protective clothing and equipment, dealing with spills of infectious organisms, and responding to accidents. Special care should be exercised when using needles and other sharp objects.
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Affiliation(s)
- B L Herwaldt
- Division of Parasitic Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia 30341-3724, USA.
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27
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Tomar BS. Intestinal infections. Indian J Pediatr 2001; 68 Suppl 3:S8-18. [PMID: 11980461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
Gastrointestinal infections are the significant cause of childhood morbidity and mortality worldwide. Gastrointestinal infections reflects the balance between the intrinsic virulence factors of the enteropathogens and host mechanisms which defend against enteric infections. Host defense factors include gastric acidity, intestinal motility, the normal indigenous intestinal microflora, mucous secretion, and specific mucosal and systemic immune mechanisms. Majority of GI infections are self limited so on one hand antibiotics are not needed and on the other hand the irrational use of antibiotics produces resistant strains. Acute diarrheal diseases which are one of the important intestinal infections, in majority of the cases are viral and have short course. Antibiotics are recommended only in specific cases and in immunocompromised individuals. Gastrointestinal disease is one of the most common manifestations of HIV infection. The gastrointestinal tract contains abundant quantities of lymphoid tissue and is likely to function as a reservoir of HIV infection, a site of profound immune dysregulation, and a target for opportunistic infections. In this situation specific antibiotics are indicated.
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Affiliation(s)
- B S Tomar
- Institute of Pediatric Gastroenterology, S.M.S. Medical College, Jaipur.
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28
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Abstract
Estimates suggest that almost half of the population of the world is affected by water-borne and food-borne infections. Parasitic food-borne and water-borne zoonoses contribute to this statistic by inflicting a heavy toll on human health and causing serious direct and indirect losses to the agricultural industry. The inability of non-industrialised countries to keep pace with population growth, migration from rural to urban areas and the demand for clean, safe drinking water and proper sanitation means that water-borne zoonoses will continue to exact an increasing burden of ill health in these countries. The consumption of raw or undercooked meat, crustaceans, and fresh-water fish and vegetables facilitates transmission of large numbers of zoonotic infections. The burgeoning tourist industry, emigration and the importation of food from endemic regions has resulted in increasing diagnosis of these infections in non-endemic countries. The authors examine the epidemiology, medical and veterinary public health importance and recent developments in diagnosis, treatment and control of the most important parasitic food-borne and water-borne infections.
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Affiliation(s)
- C N Macpherson
- Windward Islands Research and Education Foundation, St George's University, P.O. Box 7, St George's, Grenada, West Indies
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29
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Bialek R, Knobloch J. [Parasitic infections in pregnancy and congenital parasitoses. II. Helminth infections]. Z Geburtshilfe Neonatol 1999; 203:128-33. [PMID: 10448707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
The main sequela of helminthic infections is anemia, causing increased perinatal mortality and morbidity worldwide. During pregnancy symptomatic treatment is usually sufficient to control the disease. The specific and very effective treatment with albendazole, mebendazole, ivermectin and praziquantel has embryo-, fetotoxic, mutagenic and teratogenic potential. Therefore, it should be delayed until after delivery. In some cases immediate specific therapy might be mandatory. Congenital helminthic infection in humans is a rarely described event.
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Affiliation(s)
- R Bialek
- Institut für Tropenmedizin, Universitätsklinikum Tübingen.
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31
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Fincham JE, Markus MB, Appleton CC, Evans AC, Arendse VJ, Dhansay MA, Schoeman S. Complications of worm infestation--serious, costly, predictable and preventable. S Afr Med J 1998; 88:952-3. [PMID: 9754203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Affiliation(s)
- J E Fincham
- Parasitology Research Programme, University of the Witwatersrand, Johannesburg
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32
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Abstract
While programmes such as the Rockefeller campaign were specifically targeted at a particular parasite species, the current trend is towards the simultaneous control of all the major geohelminth species. New, broad-spectrum, low-cost anthelmintics and new understanding of epidemiology have led to more cost-effective and sustainable strategies. The WHO, UNICEF and the World Bank all now support global and regional efforts to achieve control of morbidity from intestinal worms. In this paper, we aim to show what's new in clinical helminthology and what has brought about the great improvement in the success of the new approaches to control.
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Affiliation(s)
- D A Bundy
- WHO Collaborating Centre for the Epidemiology of Intestinal Parasitic Infections, Wellcome Trust Centre for the Epidemiology of Infectious Disease, University of Oxford, UK
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33
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Walker AR, Labadarios D. Feed the children, not the parasites--an essential part of primary health care in South Africa. S Afr Med J 1997; 87:176-8. [PMID: 9107228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
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34
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Fincham JE, Evans AC, Woodroof CW, Seager JR, Benadé AJ, Appleton CC. Feed the children, not the parasites--an essential part of primary health care in South Africa. S Afr Med J 1996; 86:647-9. [PMID: 8764416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
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35
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Affiliation(s)
- P M Brophy
- Pharmacy Department, De Montfort University, Leicester, United Kingdom
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36
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Mertens P, Unshelm J. [Veterinary surveillance in animal shelters--defects and potentials]. Dtsch Tierarztl Wochenschr 1994; 101:232-7. [PMID: 8062637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Looking after the stock of local animal shelters takes a considerable part of the field of activity of veterinarians. Because of the recent situation on the job market it is of interest for the veterinary profession to provide and extend this scope of duties. In order to give a comprehensive survey of the possibilities of curative and preventive herd advising in animal shelters, 369 managers of German animals shelters were asked to answer a questionnaire containing 92 answers, concerning the situation in the animal shelter. The answers of 144 animal shelters go to prove the following results. In 41% of the animal shelters veterinarians are visiting for rounds in regular intervals, 46% of the shelters are calling the veterinarians only if needed. 1% of the animal shelters bring sick animals into the clinic and 1% does not provide any medical care for the animals. At the moment 11% of the questioned animal shelters offer positions for veterinarians. In these case a significantly better, mainly preventive medical care is found compared to shelters without regular medical care. Deworming (98%) and vaccinations (91%) are provided routinely for dogs being brought to the animal shelter recently. In 46% of the animal shelters employees vaccinate dogs during the absence of a veterinarian. Therefore, 36% of the animal shelters bring new dogs into contact with the others without a soundness examination. Even though 60% of the animal shelters dispose quarantine units, dogs are only isolated for 7 days in average in 15% of the animal shelters. The most common disease of dogs in animal shelters is diarrhoea.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- P Mertens
- Institut für Tierhygiene, Verhaltenskunde und Tierschutz, Tierärztlichen Fakultät, Ludwig-Maximilians-Universität, München
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37
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Suter RJ. Lack of anthelmintic effect of Calliandra calothyrsus in sheep. Aust Vet J 1992; 69:70. [PMID: 1586323 DOI: 10.1111/j.1751-0813.1992.tb07458.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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38
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Affiliation(s)
- S K Singh
- Medicinal Chemistry Division, Central Drug Research Institute, Lucknow, India
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39
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Nahmias J, Greenberg Z, Djerrasi L, Giladi L. Mass treatment of intestinal parasites among Ethiopian immigrants. Isr J Med Sci 1991; 27:278-83. [PMID: 2050509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Intestinal parasites are common among the Ethiopian immigrants to Israel and mass treatment is necessary to prevent local transmission. For this purpose, stool samples obtained from the immigrants in absorption centers were examined. Of 5,412 samples obtained, 4,399 (81.3%) were positive: 2,644 (54.2%) for Necator americanus, 2,273 (46.6%) for Schistosoma mansoni, 990 (20.3%) for Ascaris lumbricoides, 1,040 (21.3%) for Hymenolepsis nana, 940 (19.2%) for Trichuris trichiura, 219 (4.5%) for Strongyloides stercoralis, 17 (0.4%) for Fasciola hepatica, 551 (11.3%) for Giardia lamblia, and 499 (9.2%) for Entamoeba histolytica. The cure rate for necatoriasis by treatment with 400 mg of albendazole was 84.4% (better than with other drugs), either alone or in combination (pyrantel with bephenium or pyrantel with praziquantel, or praziquantel with albendazole). Albendazole, 400 mg for 3 days, cured 92% of the cases of S. stercoralis infection. Praziquantel, 40 mg/kg body weight, in a single dose was effective in 89.7% of cases of S. mansoni, and 60% of cases of H. nana, although a 100% cure rate for H. nana was achieved with praziquantel at a dose of 20 mg/kg per day for 2 days. Two persons infected with F. hepatica were cured by 40 mg/kg praziquantel for 7 days. Tinidazole, 2 g in a single dose, cured 100% of persons infected with G. lamblia, while 60% of persons infected with E. histolytica were cured when treated with 2 g tinidazole for 3 days. Mass treatment of all the immigrants with 400 mg albendazole and 40 mg/kg praziquantel concomitantly resulted in a cure rate of 84.4% of all intestinal worms.
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Affiliation(s)
- J Nahmias
- Zevulun Clinic, Kupat Holim, Kiryat Motzkin, Israel
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40
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Piacentino R, Marchino GL, Zaccheo F, Ferrara L, Mazza O, Ardissone D, Malara D, Giobbe C, Grio R, Vergano RM. [Intestinal parasitosis in pregnancy]. Minerva Ginecol 1991; 43:65-9. [PMID: 2057105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- R Piacentino
- Istituto di Ginecologia e Ostetricia, Università di Torino
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41
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Abdiev TA, Zubitskaia MA, Kovalenko AF, Fuzaĭlov IM, Baratov RD, Ziganshina NK, Isaeva KB, Borukhov SM, Priezzhaeva NG, Musaeva GA. [An evaluation of the economic loss from intestinal helminthiases in the Uzbek SSR]. Med Parazitol (Mosk) 1990:37-9. [PMID: 2142991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Calculations of economic loss costs due to procedures for helminth detection and the out-patient treatment of recognized cases of enterobiasis, hymenolepiasis, taeniasis, ascariasis, trichocephaliasis in the Uzbek SSR in 1985 were made as were the costs of inpatient treatment in the specialized clinics in 1986 with account for the loss due to the related decrease in the national output and payments for disability. Their total turned to be about 1.8 million rubles.
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42
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al Karawi MA, Mohamed AR, Khuroo MS, Neuhaus H. [Significance of endoscopy in the diagnosis and therapy of gastrointestinal and biliary parasites]. Internist (Berl) 1988; 29:807-14. [PMID: 3069797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Affiliation(s)
- M A al Karawi
- Riyadh Armed Forces Hospital, Kingdom of Saudi Arabia
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43
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Didier JM, Bundy DA, McKenzie HI. Traditional treatment and community control of gastrointestinal helminthiasis in St Lucia, West Indies. Trans R Soc Trop Med Hyg 1988; 82:303-4. [PMID: 3188160 DOI: 10.1016/0035-9203(88)90454-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Affiliation(s)
- J M Didier
- Parasite Epidemiology Project, Castries, St Lucia, West Indies
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44
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Loosli J. [Acute infectious diarrhea--meaningful clarification and therapy]. Schweiz Rundsch Med Prax 1987; 76:843-4. [PMID: 3659684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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45
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46
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Maruashvili GM, Zirakishvili LM. [Results of helminthiasis control in the 10th Five-Year Plan in the Georgian SSR and the scientific and practical tasks in this field 1981-1985]. Med Parazitol (Mosk) 1983:63-5. [PMID: 6226860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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47
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Magdiev RR. [Organizational problems of helminthological services to the population]. Med Parazitol (Mosk) 1982; 60:72-4. [PMID: 6211605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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48
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Wang JR. [Acanthocephaliasis (author's transl)]. Zhonghua Wai Ke Za Zhi 1981; 19:159-60. [PMID: 7261771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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49
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Fabizhevskiĭ BS. [District sanitary-epidemiological stations in the control of helminthiasis]. Med Parazitol (Mosk) 1980; 49:66-7. [PMID: 6448340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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50
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Padelt H, Hölzer E. ["Imported" infectious diseases--selected helminthiases]. Z Arztl Fortbild (Jena) 1979; 73:673-5. [PMID: 574340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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