Potential of herbal constituents as new natural leads against helminthiasis: A neglected tropical disease

The WHO reports that billions of people and animals in tropical and subtropical regions are affected by helminthiasis as neglected tropical disease. It is predominant in underdeveloped areas;nevertheless, the increase in the number of travelers and migrants has made this infection more common. The current mass drug treatment produces severe side effects and many strains of helminths are resistant to them. None of the chemotherapeutic drugs meets the ideal requirements of anthelmintics, such as broad spectrum of activity, single dose cure, free from side effect and cost-effectiveness. Today, many researchers are screening the traditional herbal system in search of the anthelmintic herbal constituents which overcome all the problems of synthetic drugs. Several researchers proclaim anthelmintic activity of herbal medicines by using different experimental models. The present review demonstrates natural product drug discovery, outlining potential of herbal constituents from natural sources as natural leads against helminthiasis.

Water Resource, Hygienic Practice, and Soil Transmitted Helminthiasis in Some Rural Communities of Osun State, Nigeria

Provision of water, sanitation and hygiene (WASH) resources has been advocated as necessary add-on strategy for sustainable control of soil-transmitted helminthiasis (STH) alongside annual mass drug administration (MDA) of albendazole to endemic communities. This study investigated the burden of STH and status of WASH resources in eight rural communities in Aiyedaade LGA, Osun State, Nigeria. Four of the communities were supported with improved water and hygiene resources (Category A), and another four supported only with improved water resources (Category B). Two hundred and sixteen (216) fresh stool samples were collected from consenting community members and screened for Ascaris lumbricoides, Hookworm and Trichuris trichiura infections using ether concentration method. The status and condition of WASH resources were determined using questionnaire and physical observation. An overall prevalence of 35.2% was observed for any STH infection. Species’ prevalence of Ascaris lumbricoides, Hookworm and Trichuris trichiura prevalence was 33.8%, 22.7%, and 0.5% respectively. Intensity of STH infection was significantly higher in Category A communities than in Category B communities. The prevalence of STH in Category A communities was higher (42.0%) than that in Category B communities (30.1%). There were significant differences (p = 0.000) in STH infections between the two categories. The status of improved water supply was not significantly different (p = 0.3153) in the two categories. Knowledge, attitude, and practices about STH, its transmission and control were low in both categories of communities. These results imply that current implementation of WASH which tends to focus on resource distribution, equity, and coverage, is unlikely to impact on STH transmission and control. Therefore, it is necessary for WASH providers to consider STH transmission control in their planning and implementation of WASH intervention for STH endemic communities.

Association between Intestinal Helminthiasis and Serum Ferritin Levels Among School Children

Background: Significant iron deficiency anaemia is a major concern in children with helminthiasis, because it may eventually contribute to the growing health challenges of severe anaemia This descriptive cross sectional study was carried out to determine the association between serum ferritin levels and intestinal helminthiasis among school children. Methods: A structured questionnaire was used to collect the study population data. Stool specimens were obtained and examined on the same day using the sedimentation method for identification of the parasite. Blood samples were also obtained for full blood count and serum ferritin measurement. Results: A total of 246 school children were studied with a response rate of 82%. The prevalence of intestinal helminthiasis was 29.7%. The different helminthes identified included Ascaris lumbricoides, Necator americanus, Trichuris trichiura, Strongyloides stercoralis. Of the population studied, 36.2% were anaemic, 15.9% had microcytosis, and 47.6% had hypochromia. The prevalence of ex-hausted iron stores was 3.7%. Serum ferritin levels were significantly lower in children with intestinal helminthiasis compared with controls. Conclusions: The findings in this study demonstrate an inverse re-lationship between intestinal helminthiasis and serum ferritin levels and this is more marked in pupils with hookworm infections. The control of intestinal hel-minthiasis and prevention of iron deficiency anaemia should be given high priority in the implementation of the school health programme.

Capacity gaps in health facilities for case management of intestinal schistosomiasis and soil-transmitted helminthiasis in Burundi

Background:Schistosomiasis and soil-transmitted helminthiasis(STH)are endemic diseases in Burundi.STH control is integrated into health facilities(HF)across the country,but schistosomiasis control is not.The present study aimed to assess the capacity of HF for integrating intestinal schistosomiasis case management into their routine activities.In addition,the current capacity for HF-based STH case management was evaluated.Methods:A random cluster survey was carried out in July 2014,in 65 HF located in Schistosoma mansoni and STH endemic areas.Data were collected by semi-quantitative questionnaires.Staff with different functions at the HF were interviewed(managers,care providers,heads of laboratory and pharmacy and data clerks).Data pertaining to knowledge of intestinal schistosomiasis and STH symptoms,human and material resources and availability and costs of diagnostic tests and treatment were collected.Findings:Less than half of the 65 care providers mentioned one or more major symptoms of intestinal schistosomiasis(abdominal pain 43.1%,bloody diarrhoea 13.9%and bloody stool 7.7%).Few staff members(15.7%)received higher education,and less than 10%were trained in-job on intestinal schistosomiasis case management.Clinical guidelines and laboratory protocols for intestinal schistosomiasis diagnosis and treatment were available in one third of the HF.Diagnosis was performed by direct smear only.Praziquantel was not available in any of the HF.The results for STH were similar,except that major symptoms were more known and cited(abdominal pain 69.2%and diarrhoea 60%).Clinical guidelines were available in 61.5%of HF,and albendazole or mebendazole was available in all HF.Conclusions:The current capacity of HF for intestinal schistosomiasis and STH detection and management is inadequate.Treatment was not available for schistosomiasis.These issues need to be addressed to create an enabling environment for successful integration of intestinal schistosomiasis and STH case management into HF routine activities in Burundi for better control of these diseases.

High infection rates for onchocerciasis and soil-transmitted helminthiasis in children under fve not receiving preventive chemotherapy:a bottleneck to elimination

Background:The current mainstay for control/elimination of onchocerciasis and soil-transmitted helminthiasis(STH)relies on ivermectin-and mebendazole/albendazole-based preventive chemotherapies.However,children under fve years of age have been excluded in both research activities and control programs,because they were believed to have insignifcant infection rates.There is therefore a need for up-to-date knowledge on the prevalence and inten‑sity of STH and onchocerciasis infections in this age group.This study aimed at assessing the rates and intensities of onchocerciasis and STH infections in children under fve years of age who are excluded from ivermectin-or mebenda‑zole/albendazole-based preventive chemotherapies.Methods:A series of cross-sectional surveys was conducted in four Health Districts in the Centre and Littoral Regions of Cameroon between 2018 and 2019.All subjects aged 2 to 4 years,were screened for prevalence(or infection rate)and intensity[number of eggs per gram of stool(epg)or number of microflariae per skin snip(mf/ss)]of STH and onchocerciasis infections respectively using the Kato-Katz and skin snip methodologies.Chi-square and the nonparametric tests(Mann Whitney and Kruskal Wallis)were used to compare infection rates and intensities of infections between Health Districts and genders,respectively.Results:A total of 421 children were enrolled in this study.The overall prevalence of onchocerciasis was 6.6%[95% confdence interval(CI):4.3‒9.9],ranging from 3.6%(in the Ntui Health District)to 12.2%(in the Bafa Health District).The intensity of infection ranged from 0.5 to 46 microflariae per skin snip[median:5;interquartile range(IQR):2.25‒8.5].The overall prevalence of STH was 9.6%(95%CI:6.5‒13.9),with a high infection rate(29.6%)in the Akonolinga Health District.Two STH species(Ascaris lumbricoides and Trichuris trichiura)were found among infected individuals.The median intensities of STH infections were 1,992 epg(IQR:210‒28,704)and 96 epg(IQR:48‒168)for A.lumbricoides and T.trichiura,respectively.Conclusions:This study reveals that children<5 years of age are highly infected with STH and onchocerciasis,and could contribute to the spread of these diseases,perpetuating a vicious circle of transmission and hampering elimi‑nation eforts.These fndings reveal the urgent need to provide(or scale)treatments(likely pediatric formulations)to these preschool-aged children,especially in areas of high transmission,to accelerate eforts to reach WHO 2030 target.

Interleukin (IL) 5 levels and eosinophilia in patients with intestinal parasitic diseases

AIM:Intestinal parasitic diseases are commonly accompanied with diarrhoeal symptoms and allergic reactions.Eosinophilia occurs as a result of IL-5 synthesized from Th2 cells during allergic reactions.IL-5 acts as a factor activating eosinophils. The aim of this study was to compare the IL-5 cytokine measurements in serum samples and cell cultures.And also to compare eosinophilia observed in helminth infections and protozoon infections accompanied with allergy. METHODS:Twenty-three patients who presented with diarrhoeal symptoms and allergic complaints were tested positive for intestinal parasites,as well as 21 controls with allergic complaints who did not have any intestinal parasites were included in this study.IL-5 production in in vitro cell cultures prepared by using phytohemaglutinin (PHA) to stimulate peripheral blood mononuclear cells (PBMC) obtained from the blood samples taken from these patients were compared with the IL-5 level in serum.Furthermore, the IL-5 production in protozoon and helminth infections was also compared.Absolute eosinophil values in 1 mm^3 of blood were calculated by means of peripheral smear in both groups within the scope of the study. RESULTS:Parasites such as helminth detected in 15 (65.2%) and protozoon in 8 (34.8%) of the patients were included in this study.As regards the values of the sera in both patients with parasite infection and controls,the IL-5 production was found to be higher in the cell culture supernatant (P<0.001 and P<0.05).When the IL-5 level of the patients with helminth parasites was compared with that of those with protozoon,it was determined that the IL-5 level in serum was more significant in the patients with protozoon than in those with helminth (P<0.05).In the study group,the patients were found to have parasites, the percentage of eosinophil was 7.0% compared to 6.5% in the control group.Thus,there was no significant difference between the eosinophil values (P>0.05). CONCLUSION:It was found that IL-5 cytokine levels in serum samples from the patients with helminth and protozoon displayed more measurable values as compared to the IL-5 levels after stimulation with mitogen.It is concluded that IL-5 acts as a triggering factor in the toxiallergic complaints commonly seen in helminth and protozoon infections.

Assessment of health education products aimed at controlling and preventing helminthiases in China

Background:Helminthiases have placed a huge burden of disease on the population in China.However,widespread control activities have led to significant achievements.As health education has been widely disseminated and plays an important role in the control and elimination of these diseases,we collected health education products aimed at controlling and preventing helminthiases in China.We analyzed their characteristics and assessed their quality.Methods:Firstly,health education products aimed at controlling and preventing helminthiases were collected from a diverse range of organizations.Secondly,the expert brainstorming and Delphi methods were applied to establish an evaluation system,which was then used to assess the collected products systematically.Those deemed excellent were awarded.Characteristics-including type,source,targeted disease(s),targeted population,and languages-of the collected products and the awarded products were presented here.Results:In total,96 health education products on helminthiases were collected from 53 organizations.Most products belonged to either the graphic design(47)or daily-use(24)category.Seventy were collected from Centers for Disease Control and Prevention and 20 from institutes or control stations of parasitic diseases,primarily at the provincial and county levels.Regarding disease targets of the products,67 focused on a single helminthiasis,25 on multiple helminthiases,and the remaining four on non-specific diseases.Of the 67 single helminthiasis-focused products,most targeted schistosomiasis(37),followed by echinococcosis(16).The majority of products(79)targeted the general population,while 11 targeted students specifically.Regarding languages,86 products were only in Chinese,while the other ten were in both Chinese and the minority languages of China.Out of these ten products,one targeted schistosomiasis and the other nine targeted echinococcosis.Thirty-four products were awarded.The characteristics of the awarded products were similar to those of the collected products.Conclusions:A diverse range of health education products have been designed and applied for the prevention and control of helminthiases in China.Many products have good features such as specifying the targeted diseases and populations.However,there are significant gaps in terms of both the quantity and quality of products pertaining to some of the diseases.Experiences from the awarded products could be drawn upon to design more products aimed at a range of different helminthiases.

Prevalence of intestinal schistosomiasis in pre-school aged children: a pilot survey in Marolambo District, Madagascar

School-aged children(SAC)have a considerable burden of intestinal schistosomiasis in Madagascar yet its burden in pre-school aged children(PSAC)is currently overlooked.To assess the at-risk status of PSAC,we undertook a pilot epidemiological survey in June 2019 examining children(n=89),aged 2-4-years of balanced gender,in six remote villages in Marolambo District,Madagascar.Diagnosis included use of urine-circulating cathodic antigen(CCA)dipsticks and coproscopy of stool with duplicate Kato-Katz(K-K)thick smears.

Community-based interventions for the prevention and control of helmintic neglected tropical diseases

In this paper,we aim to systematically analyze the effectiveness of community-based interventions(CBIs)for the prevention and control of helminthiasis including soil-transmitted helminthiasis(STH)(ascariasis,hookworms,and trichuriasis),lymphatic filariasis,onchocerciasis,dracunculiasis,and schistosomiasis.We systematically reviewed literature published before May 2013 and included 32 studies in this review.Findings from the meta-analysis suggest that CBIs are effective in reducing the prevalence of STH(RR:0.45,95%CI:0.38,0.54),schistosomiasis(RR:0.40,95%CI:0.33,0.50),and STH intensity(SMD:−3.16,95 CI:−4.28,−2.04).They are also effective in improving mean hemoglobin(SMD:0.34,95%CI:0.20,0.47)and reducing anemia prevalence(RR:0.90,95%CI:0.85,0.96).However,it did not have any impact on ferritin,height,weight,low birth weight(LBW),or stillbirths.School-based delivery significantly reduced STH(RR:0.49,95%CI:0.39,0.63)and schistosomiasis prevalence(RR:0.50,95%CI:0.33,0.75),STH intensity(SMD:−0.22,95%CI:−0.26,−0.17),and anemia prevalence(RR:0.87,95%CI:0.81,0.94).It also improved mean hemoglobin(SMD:0.24,95%CI:0.16,0.32).We did not find any conclusive evidence from the quantitative synthesis on the relative effectiveness of integrated and non-integrated delivery strategies due to the limited data available for each subgroup.However,the qualitative synthesis from the included studies supports community-based delivery strategies and suggests that integrated prevention and control measures are more effective in achieving greater coverage compared to the routine vertical delivery,albeit it requires an existing strong healthcare infrastructure.Current evidence suggests that effective community-based strategies exist and deliver a range of preventive,promotive,and therapeutic interventions to combat helminthic neglected tropical diseases(NTDs).However,there is a need to implement and evaluate efficient integrated programs with the existing disease control programs on a larger scale throughout resource-limited regions especially to reach the unreachable.

Herbal anthelmintic agents: a narrative review

Helminths or Parasitic worms of humans may cause chronic and sometimes deadly diseases,considered as neglected tropical diseases(NTDs)that infect around two billion people worldwide.Plants have been used as anthelmintics from ancient times.This review is a compilation of plants as source of anthelmintic drug.All information presented in this review article regarding the anthelmintic activities of plants from 2005 and has been acquired by approaching various electronic databases,including Scopus,Google scholar,Web of science and PubMed.Literature was surveyed for anthelmintic activity of plants which showed that secondary metabolites of plants like terpenes,glycosides,saponins,flavonoids,tannins and alkaloids were having anthelmintic activity.Since this review is a compilation of anthelmintic activity of plants from the year 2005,it will definitely be a fruitful study for researchers working in this field.