Anthelmintics as a risk factor in intestinal obstruction by Ascaris lumbricoides in children]

In a retrospective study the authors analyzed the clinical records of 199 children ages one month to 16 years hospitalized, with the diagnosis of intestinal ascariasis, in the Instituto Nacional de Pediatria of Mexico from 1984 to 1999. The purpose of the study was to evaluate the use of anthelmintics drugs as a risk factor of intestinal obstruction by A. lumbricoides. Two groups were made for the study: Group A (n = 66) of children who presented intestinal obstruction, Group B (n = 133) children with no complications. A comparative analysis of clinical data of both groups was made by means of chi square with Yates correction and a stratified analysis by means of chi square. Possible confusing elements were overcrowding, age and the use of antiparasitic drugs. The calculus of risk factors for intestinal obstruction by A. lumbricoides was done by means of contingency tables of 2 x 2 and odds ratio with an IC of 95%. The significant risk factors were included in a model of logistics regression with an impact variable consting in the presence or absence of intestinal obstruction in order to establish a multivariate model of predictive risk at level of significance of p < 0.05. Twenty-seven patients (40.90%) in group A (n = 66) were given anthelmintics medications prior to the intestinal obstruction: mebendazol, 14 (51-85%); two, albedazol (7.4%); eight, a non-specified anthelmintic (29.6%). In addition, an anthelmintic medication without a specified time of ingestion: two with mebendazol and one with piperazine (11.3%). In the case of mebendazol, the drug most frequently associated with intestinal obstruction, seven patients received it on the same day of the obstruction; five patients received it between one and seven days prior to the obstruction; two received it seven days prior to the complication. In the control group, only 7% had taken the anthelmintic one to seven days before the diagnosis of uncomplicated intestinal ascariasis diagnosis was made. With the step by step (Backward) logistic regression conditioned by the treatment variable with an anthelmintic, an X2 = 38.15 gl, p < 0.000 was obtained for which reason it was considered by A. lumbricoides. Of the probable risk factors analyzed in this study, the only one capable of influencing and predicting the presentation of intestinal obstruction by A. lumbricoides in children, was the prior anthelmintic treatment particularly with mebendazol.     

Multiple infection diagnosis of intestinal helminthiasis in the assessment of health and environmental effect of development projects in Nigeria

Patterns of intestinal helminth infections among school-aged children have been assessed in Eko-ende and Ore, as part of an overall assessment of the public health impact of Erinle Dam Reservoir in Osun State, Nigeria. The investigation was carried out between January and May 2005 using the Kato Katz thick smear technique and simple questionnaire for information on the bio-data, knowledge, attitude and practice of individuals towards disease transmission and control. Ascaris lumbricoides, hookworm, Trichuris trichiura, Taenia spp., Strongyloides stercoralis and Schistosoma mansoni were recovered at an overall prevalence of 78.3% among 309 children examined. Ascaris lumbricoides, hookworm, T. trichiura and S. mansoni were the most common infections while S. stercoralis and Taenia spp. were found only among a few children. Infection patterns of the common diseases were age-specific with peaks in the 11-15 age bracket. Children not attending school were significantly (P < 0.05) more at risk of infection than those attending school. Multiple infections were pronounced with over 54% double infections and 6% four parasites or more infections. The need for urgent intervention to arrest the obviously serious public health situation attributable to Erinle Dam is emphasized.     

Infection status of intestinal parasites in children living in residential institutions in Metro Manila, the Philippines

A small scale survey was performed to know the infection status of intestinal parasite in children of the residential institutions and street communities in Metro Manila, Philippines. A total of 284 stool samples from 11 institutions and 3 street communities was examined by the formalin-ether concentration method. The scotch tape anal swab was adapted to 121 children to investigate the infection status of Enterovius vermicularis. It was found out that 62.0% of the children examined were positive for one or more intestinal parasites. Multiple infections were observed in 34.2% of the children. Among 172 children who gave detail information, the prevalence for Ascaris lumbricoides, Trichuris trichiura, and hookworm was 36.0%, 44.8%, and 7.0% respectively. Of the children examined, 47.7% were found to be harboring parasitic protozoans such as Entamoeba histolytica, Giardia lamblia, and Blastocystis hominis. The most prevalent of these protozoans was B. hominis with an infection rate of 40.7%. The prevalence of these infections among children living in institutions was relatively high. More efforts should be made to implement anthelminthic programs including bi-annual follow-up treatments.     

Prevalence, behavioural and social factors associated with Schistosoma intercalatum and geohelminth infections in São Tomé and Principe

A pilot study was conducted in schoolchildren from three main districts of S?o Tome to assess the relationship between the prevalence of infections caused by Schistosoma intercalatum or intestinal helminths and individual behaviour and social conditions. Coprological examination revealed an increase of schistosome infections and a persisting high endemicity for ascariasis and trichuriasis. Infection rates were 36.2% for S. intercalatum and 70.8%, 68.5% and 4.6% for Ascaris lumbricoides, Trichuris trichiura and Ancylostomidae, respectively. Out of the 47 children positive for S. intercalatum, 35 (74.5%) were co-infected with one or more geohelminths. Logistic regression analysis of data collected through questionnaire demonstrate that behaviour and/or social conditions in the house were positively associated with S. intercalatum or T. trichiura. Neither sex nor age groups were associated with infections, suggesting that low personal hygiene and sanitation practices were similar for all groups of children. These data are in accordance to those of other studies and highlight the importance of assessing multivariate factors that may contribute to the transmission of these diseases, in order to design integrated control approaches for schistosomiasis and geohelminthiasis which could have more rapid effects on reduction of infections as well as greater cost-effectiveness.     

Modes of transmission for Ascaris lumbricoides and Trichuris trichiura among Chinese children in Macao City

To obtain more information on the transmission of Ascaris lumbricoides and Trichuris trichiura in Macao City, 308 Chinese children were surveyed. The infection rates of A. lumbricoides and T. trichiura were 14.9 and 6.8%, respectively. There was no association between the infections. A. lumbricoides infection was associated with age and T. trichiura with new immigrants from China. No association was found between the infections and family socio-economic factors. The results suggest that the modes of transmission for A. lumbricoides and T. trichiura may be different in highly urbanized areas.     

Prevalence and intensity of infections of Ascaris lumbricoides and Trichuris trichiura and associated socio-demographic variables in four rural Honduran communities

Between January and March 1998, a cross-sectional survey was carried out in four rural communities in Honduras, Central America. We examined the prevalence and intensity of Ascaris lumbricoides and Trichuris trichiura infections among 240 fecal specimens, and the association between selected socio-demographic variables and infection for 62 households. The overall prevalence of A. lumbricoides and T. trichiura was 45% (95% CI 39.0-51.9) and 38% (95% CI 31.8-44.4) respectively. The most intense infections for Ascaris and Trichuris were found in children aged 2-12 years old. By univariate analysis variables associated with infections of A. lumbricoides were: number of children 2-5 years old (p=0.001), level of formal education of respondents (p=0.01), reported site of defecation of children in households (p=0.02), households with children who had a recent history of diarrhea (p=0.002), and the location of households (p=0.03). Variables associated with both A. lumbricoides and T. trichiura infection included: number of children 6-14 years old (p=0.01, p=0.04, respectively), ownership of a latrine (p=0.04, p=0.03, respectively) and coinfection with either helminth (p=0.001, p=0.001, respectively). By multivariate analysis the number of children 2-5 years living in the household, (p=0.01, odds ratio (OR)=22.2), children with a recent history of diarrhea (p=0.0, OR=39.8), and infection of household members with T. trichiura (p=0.02, OR=16.0) were associated with A. lumbricoides infection. The number of children 6-14 years old in the household was associated with both A. lumbricoides and T. trichiura infection (p=0.04, p=0.01, OR=19.2, OR=5.2, respectively).     

A comparative study of different albendazole and mebendazole regimens for the treatment of intestinal infections in school children of Usigu Division, western Kenya

A clinical trial to compare the effectiveness of 4- and 6-mo repeated treatment with albendazole 600 mg (Zentel, SmithKline Beecham) or mebendazole 600 mg (Vermox, Janssen) on geohelminth infections was carried out on children in 6 primary schools; the study included 1,186 children, ages 4 to 19 yr. Kato-Katz examination was performed on stool samples before and after treatment. Overall, albendazole produced better cure rates and egg reduction rates for geohelminths. The cure rates for albendazole were 92.4% for hookworm infection, 83.5% for Ascaris lumbricoides, and 67.8% for Trichuris trichiura. Mebendazole given either 2 or 3 times in a year had cure rates of 50 and 55.0% (respectively) for hookworm, 79.6 and 97.5% for A. lumbricoides, and 60.6 and 68.3% for T. trichiura infection. The geometric mean intensity of hookworm eggs per gram (epg) of stool decreased by 96.7% after albendazole treatment compared with 66.3 and 85.1%, respectively, for 2 or 3 doses of mebendazole (P < 0.05) over the same period. Reductions in epg for A. lumbricoides and T. trichiura were comparable for both drugs. Our results indicate that treatment with albendazole at a 6-mo interval was more effective than mebendazole regimens and may be the best choice for use in the control of the 3 geohelminths.     

Chronic ascariasis and malnutrition

Malnutrition is the most widespread ill of mankind. Its global distribution coincides indistinguishably with that of the common roundworm. Ascaris lumbricoides is common - infecting about one-quarter of the world's population. Acute clinical ascariasis sometimes requires hospital treatment, but chronic infections contribute to long-term malnutrition. This alone should justify greater expenditure on the treatment and control of Ascaris.     

Prevalence and intensity of soil-transmitted helminthiasis in the city of Portoviejo (Ecuador).

We studied the stool samples of 151 school children in a district of the city of Portoviejo (Ecuador) in order to determine the prevalence and intensity of soil-transmitted helminthiasis (STH) and their relationships with anthropometric indices. The samples were analyzed with the semiquantitative Kato-Katz technique and the intensity of infections was categorized as light, moderate or high according to the thresholds set by the World Health Organization. Prevalence of soil transmitted helmintiasis was 65% (92 out of 141 collected samples), Ascaris lumbricoides was the most common STH (63%) followed by Trichuris trichiura (10%) and hookworm (1.4%). Heavy intensity infections were found in 8.5% of the stool samples, with T. trichiura showing higher worm burdens than A. lumbricoides. Sixteen percent of the children were below the third percentile for weight (wasted), while 27% were below the third percentile for height (stunted). A significant relationship was found between the worm burden and the degree of stunting. This study suggests that the periodic administration of an antihelminthic drug should be targeted to preschool and school children to allow a normal growth spurt and prevent stunting.     

Intestinal parasites in Kampuchea, Takeo Province

Fresh stool samples obtained from 1407 adult patients who sought treatment in Takeo province hospital and 332 Takeo preschool and school-age children from 3 to 18 years of age were examined for the presence of intestinal parasites using the technique of native preparation and the flotation method of Faust with subsequent staining with Lugol solution to demonstrate cysts. In hospital patients, a total of 13 protozoan and 9 helminth species were diagnosed. The prevalence of Entamoeba histolytica (cysts and trophozoites) was highest in the age group 15-18 years (18.3%), the peak prevalence of Gairdia lamblia (27.6%) occurred in children of the age group 6-9 years. The highest frequency distribution of Pentatrichomonas hominis (20.1%) was recorded in 3 to 5 years old, that of Enteromonas hominis (12.8%) in 6 to 9 years old. The predominant helminth was Ancylostoma duodenale, with the peak prevalence (65.2%) in patients older than 18 years, followed by Ascaris lumbricoides and Strongyloides stercoralis. Almost half of children patients under 6 was infected with at least two species of parasites, patients over 6 were infected simultaneously with two or more intestinal parasites in an absolute majority of cases. In Takeo preschool and school children the spectrum of diagnosed protozoan and helminth species was somewhat narrower than seen in hospital patients, but their prevalence rates were higher, except for the flagellate Pentatrichomonas hominis. The highest prevalence rates recorded were for E. histolytica 29.5% (age category 10-14 years), for G. lamblia 34.8% (age category 6-9 years), for P. hominis 19.3% (age category 3-5 years), for E. hominis 10.5% (age category 3-5 years), for A. duodenale 85.9% (age category 15-18 years), for A. lumbricoides 26.1% (age category 6-9 years), and for S. stercoralis 18.8% (age category 6-9 years). As many as 70% of children at the age between 6 and 15 years were simultaneously infected with two or three species of intestinal parasites.     

Intestinal parasitic infections in pre-school children in the Niger Delta

Stool specimens from 1,062 pre-school children in the Niger Delta were examined for the presence of intestinal parasites. Of that number, 77.6% harboured one or more than one species of intestinal parasites. Ascaris lumbricoides (51.9%) and Trichuris trichiura (41.7%) were the most prevalent species recorded. Other parasites harboured by these children included Hymenolepis sp. (18.3%), Giardia lamblia (9.2%), Entamoeba histolytica (4.6%), Strongyloides stercoralis (1.4%). Hookworm, Taenia sp., Isospora sp. and Trichostrongylus sp. occurred in less than 1% of the children examined. These high rates of infection are associated with poor sanitary conditions prevalent in the area. Improvement of environmental sanitation is advised to reduce human sufferings caused by parasites in that area particularly among children.     

Intestinal parasites infestation and anemia in primary school children in Gaza Governorates--Palestine

A comparative study was carried out to identify the prevalence of anemia, nutritional indices and intestinal parasitic infestation in primary school children. The target population included 209 pupils aged 6-11 years, attending schools in two areas, Rimal area (urban) and Jabalia village (rural), in Gaza Governorates. Prevalence of intestinal parasites was high in Jabalia village (more than 53%) in comparison to Rimal area (33%). The main intestinal parasites were Entamoeba histolytica, Giardia intestinalis and Ascaris lumbricoides. Polyparasitism frequency is higher especially in rural area. In both areas anemia showed a high prevalence in children due to malnutrition and intestinal parasitic diseases. There was no association between intestinal parasitic infestation and children growth, but there was association between anemia and intestinal parasitic infestation in children, particularly in rural area. The correlation between anemia and mixed infestation reaches a highly significant level.     

The intestinal parasite infection status of inhabitants in the Roxas city,The Philippines

We carried out a small-scale survey to investigate the status of intestinal protozoa and helminthes infection of inhabitants in Roxas city, Mindoro, the Philippines. Total 301 stool samples were subjected to the formalin-ether concentration method for the detection of helminth ova and protozoan cysts. The overall positive rate was 64.5%, and that of male and female were 56.6% and 72.5%, respectively. The highest infected helminth was Ascaris lumbricoudes (51.2%), followed by Trichuris trichiura (27.6%), hookworm (8.0%) and Enterobius vermicularis (0.3%). The protozoa infection status revealed that Entamoeba coli was the most frequent (15.0%). Iodoamoeba buetschlii and E. histolytica were found but few. The multiple infection more than two parasites was 29.6%, and double infection with A. lumbricoides and T. trichiura was most common. The intestinal helminth infections were highly prevalent in this area, according to this result, and we concluded that anthelminthic drugs should be given to inhabitants, especially to children of 1 to 15 years-old.     

Prevalence of intestinal parasites and associated risk factors among schoolchildren in Srinagar City, Kashmir, India

Surveys on the prevalence of various intestinal parasitic infections in different geographic regions is a prerequisite for developing appropriate control strategies. The aim of the present study was to determine the prevalence of intestinal parasitic infections in schoolchildren enrolled in various schools in Srinagar City, Kashmir, India, and to assess epidemiological factors associated with the extent of endemic disease. Stool samples were collected from 514 students enrolled in 4 middle schools. The samples were processed with the use of both simple smear and zinc sulphate concentration methods, and then microscopically examined for intestinal parasites. Of the 514 students surveyed, 46.7% had 1, or more, parasites. Prevalence of Ascaris lumbricoides was highest (28.4%), followed by Giardia lamblia (7.2%), Trichuris trichiura (4.9%), and Taenia saginata (3.7%). Conditions most frequently associated with infection included the water source, defecation site, personal hygiene, and the extent of maternal education. The study shows a relatively high prevalence of intestinal parasites and suggests an imperative for the implementation of control measures.     

A small-scale survey of intestinal parasite infections among children and adolescents in Legaspi city, the Philippines

To determine the status of infection caused by intestinal parasites among children and adolescents living in Legaspi city, the Philippines, we performed a small survey by fecal examination for helminth ova and protozoan cysts with formalin-ether concentration method. Of the 64 examinees, the infection rate was 78.1%. The infection rates of primary school children, preschool children and adolescents were 95.5%, 64.7% and 87.5%, respectively. The infection rate in urban areas was 56%, and 92.3% in rural areas. The infection rates were 51% with Trichuris trichiura, 40% with Ascaris lumbricoides, 23.4% with hookworm, 15.6% with Iodamoeba butschlii, 14.1% with Endolimax nana, 9.4% with Entamoeba coli and 7.8% with Giardia lamblia. There were 33 cases with multiple infection (51.6%). Mixed infection with more than 3 parasites was observed in 15 cases, all of them being children and adolescents living in rural areas. By this survey, it was conjectured that helminthic infection is prevalent among children and adolescents in Legaspi, Philippines.     

Status of intestinal parasites infection among primary school children in Kampongcham,Cambodia

A survey was made to find the extent of intestinal parasite infection in Kampongcham, Cambodia in February 2002. A total of 251 fecal specimens were collected from Tonlebat primary school children and examined by formalin-ether sedimentation technique. The overall infection rate of intestinal parasite was 54.2% (males, 57.3%; females, 50.8%). The infection rate of intestinal helminths by the species were as follows: Ascaris lumbricoides 26.3%, Echinostoma sp. 15.6%, hookworm 6.4%, Opisthorchis sp. 4.0%, Rhabditis sp. 2.4%, and Trichuris trichiura 0.4%. The infection rate of intestinal protozoa were as follows: E. coli 7.6%, G. lamblia 3.2%, I. butschlii 3.2%, and E. histolytica 0.8%. More than two different kinds of parasites were found in 16.7% of the stool samples. All the children infected were treated with albendazole, praziquantel and metronidazole according to parasite species. The results showed that intestinal parasites are highly endemic in this area.     

Levamisole in the treatment of ascariasis in children

Levamisole (the laevorotatory isomer of tetramisole) is a new synthetic anthelmintic. A cure rate of 91% was obtained in a series of 111 ascariasis-infected children treated with a single oral dose of the drug. The failures, who were treated with the drug a second time one week later, were all cured. In a comparative study of levamisole and piperazine citrate in a series of 100 children with ascariasis a cure rate of 92% and 90% was obtained with a single dose of levamisole and piperazine respectively, indicating equal efficacy. Levamisole is better tolerated than piperazine citrate and is virtually free of toxic effects.     

Intestinal helminthiases and schistosomiasis among school children in an urban center and some rural communities in southwest Nigeria

Intestinal helminths and schistosomiasis among school children were investigated in an urban and some rural communities of Ogun State, southwest Nigeria. Fecal samples of 1,059 subjects (524 males, 535 females) aged 3-18 years were examined using direct smear and brine concentration methods between June 2005 and November 2006. The pooled prevalence of infection was 66.2%. Ascaris lumbricoides showed the highest prevalence (53.4%) (P < 0.001) followed by hookworms (17.8%), Trichuris trichiura (10.4%), Taenia sp. (9.6%), Schistosoma mansoni (2.3%), Strongyloides stercoralis (0.7%), Schistosoma haematobium (0.6%), and Enterobius vermicularis (0.3%). The prevalences of A. lumbricoides, hookworms, Taenia sp., S. mansoni, and S. stercoralis in the urban centre were similar (P > 0.05) to those in the rural communities. The fertile and infertile egg ratios of A. lumbricoides in the urban centre and the rural communities were 13: 1 and 3.7: 1, respectively. Each helminth had similar prevalences among both genders (P > 0.05). The prevalence of A. lumbricoides increased significantly with age (P < 0.001). The commonest double infections were Ascaris and hookworms, while the commonest triple infections were Ascaris, hookworms, and Trichuris. The study demonstrates the need for urgent intervention programmes against intestinal helminthiases and schistosomiasis in the study area.     

Efficacy of artemether-lumefantrine, the nationally-recommended artemisinin combination for the treatment of uncomplicated falciparum malaria, in southern Laos

ABSTRACT: BACKGROUND: The Lao Government changed the national policy for uncomplicated Plasmodium falciparum malaria from chloroquine to artemether-lumefantrine (AL) in 2005. Since then, no information on AL efficacy has been reported. With evidence of resistance to artemisinin derivatives in adjacent Cambodia, there has been a concern as to AL efficacy. Monitoring of AL efficacy would help the Lao Government to make decisions on appropriate malaria treatment. METHODS: The efficacy of a three-day, twice daily oral artemether-lumefantrine for the treatment of uncomplicated falciparum malaria in Xepon District, Savannakhet Province, southern Laos was studied over 42 days follow-up. This was part of a trial of thiamin supplementation in falciparum malaria. RESULTS: Of 630 patients with P. falciparum enrolled in the trial of thiamin treatment, 549 (87%, 357 children [less than or equal to]15 years and 192 adults) were included in this study. The per protocol 42-day cure rates were 97% (524/541) [96% (337/352) for children and 99% (187/189) for adults, p = 0.042]. By conventional intention-to-treat analysis, the 42-day cure rates adjusted for re-infection, were 97% (532/549) [96% (342/357) in children and 99% (190/192) in adults, p = 0.042]. The proportion of patients who remained parasitaemic at day 1 after treatment was significantly higher in children [33% (116/356)] compared to adults [15% (28/192)] (p < 0.001) and only one adult patient had detectable parasitaemia on day 2. There were no serious adverse events. Potential side effects after treatment were reported more commonly in adults (32%) compared to children (15%) (p < 0.001). Patients with recrudescent infections were significantly younger, had longer mean time to fever clearance, and had longer median time to parasite clearance compared to those who were cured. CONCLUSIONS: The current nationally-recommended anti-malarial treatment (artemether-lumefantrine) remains highly efficacious for the treatment of uncomplicated falciparum malaria five years after introduction in Laos. Regular monitoring is required in case artemisinin-resistant P. falciparum parasites should appear. Trial registration ISRCTN85411059.     

Status of intestinal parasite infections among children in Bat Dambang, Cambodia

A survey was conducted to determine the extent of intestinal parasite infection in Bat Dambang, Cambodia in March 2004. A total of 623 fecal specimens was collected from kindergarten and schoolchildren and examined using the formalin-ether sedimentation technique. The overall infection rate of intestinal parasites was 25.7% (boys, 26.2%; girls, 25.1%), and the infection rates of intestinal helminthes by species were as follows: Echinostoma sp. 4.8%, hookworm 3.4%, Hymenolepis nana 1.3%, and Rhabditis sp. 1.3%. The infection rates of intestinal protozoa were; Entamoeba coli 4.8%, Giardia lamblia 2.9%, Iodamoeba butschlii 1.4%, Entamoeba polecki 1.1%, and Entamoeba histolytica 0.8%. There were no egg positive cases of Ascaris lumbricoides or Trichuris trichiura. All children infected were treated with albendazole, praziquantel, or metronidazole according to parasite species. The results showed that intestinal parasites are highly endemic in Bat Dambang, Cambodia.