Simultaneous Paragonimus infection involving the breast and lung:A case report

BACKGROUND Paragonimiasis is a food-borne parasitic infection caused by lung flukes of the genus Paragonimus. Although the most common site of infection is the pleuropulmonary area, the parasite can also reach other parts of the body on its journey from the intestines to the lungs, ending up in locations such as the brain,abdomen, skin, and subcutaneous tissues. Ectopic paragonimiasis is difficult to diagnose due to the rarity of this disease.CASE SUMMARY Here, we report a rare case of simultaneous breast and pulmonary paragonimiasis in a woman presenting painless breast mass and lung nodule with a history of eating raw trout. To confirm the diagnosis, serologic testing and tissue confirmation of the breast mass were performed. The patient was treated with surgical resection of the mass and praziquantel medication.CONCLUSION Ectopic paragonimiasis is difficult to diagnose due to the rarity of this disease.Thus, thorough history-taking and clinical suspicion of parasitic infection are important.

A feasibility study to determine if minimally trained medical students can identify markers of chronic parasitic infection using bedside ultrasound in rural Tanzania

BACKGROUND: Parasitic infections pose a significant health risk in developing nations and are a major cause of morbidity and mortality worldwide. In the Republic of Tanzania, the CDC estimates that 51.5% of the population is infected with one or more intestinal parasites. If diagnosed early, the consequences of chronic parasitic infection can potentially be avoided.METHODS: Six first-year medical students were recruited to enroll patients in the study. They underwent ten hours of formal, hands-on, ultrasound which included basic cardiac, hepatobiliary, renal, pulmonary and FAST scan ultrasound. A World Health Organization protocol with published grading scales was adapted and used to assess for pathology in each patient's liver, bladder, kidneys, and spleen.RESULTS: A total of 59 patients were enrolled in the study. Students reported a sensitivity of 96% and specificity of 100% for the presence of a dome shaped bladder, a sensitivity and specificity of 100% for bladder thickening, a sensitivity and specificity of 100% for portal hypertension and ascites. The sensitivity was 81% with a specificity of 100% for presence of portal vein distention. The sensitivity was 100% with a specificity of 90% for dilated bowel.CONCLUSIONS: Ultrasound has shown a promise at helping to identify pathology in rural communities with limited resources such as Tanzania. Our data suggest that minimally trained first year medical students are able to perform basic ultrasound scans that can identify ultrasonographic markers of parasitic infections.

Two-day enema antibiotic therapy for parasite eradication and resolution of symptoms

BACKGROUND Blastocystis hominis(B.hominis)and Dientamoeba fragilis(D.fragilis)are two protozoan parasites of human bowel that are found throughout the world.There is still debate about the pathogenicity of these protozoans,despite them being commonly associated with gastrointestinal symptoms and can cause health issue in both children and adults.These parasites are usually transmitted through faecal-oral contact particularly under poor hygiene conditions or food/water contamination.Once a person is infected,the parasites live in the large intestine and are passed in the faeces.AIM To investigate the effect of triple antibiotic therapy using enema infusion in the treatment of B.hominis and D.fragilis infections.METHODS This retrospective longitudinal study was conducted in a single medical centre,which included fifty-four patients(≥18 years)who were positive for D.fragilis,B.hominis or both between 2017 and 2018.The treatment consisted of triple antibiotics that were infused over two consecutive days through rectal enema.Faecal samples were collected from participants pre-and post-treatment and were tested for parasites using microscopy and polymerase chain reaction.Patients’symptoms were recorded prior and after the treatment as well as patient demographic data.RESULTS Patients(n=54),were either positive for B.hominis(37%),D.fragilis(35%)or both(28%).All patients completed the two-day treatment and no serious adverse effect was reported.The most common side effect experienced by the patients during the treatment was urine discolouration which was cleared by six weeks of followup.Common symptoms reported prior to treatment were diarrhoea,abdominal pain,constipation and fatigue.Other symptoms included abdominal discomfort,dizziness and blood in the stool.Eighty-nine percent of patients completed a final stool test post-treatment.At six weeks post-treatment,79%of patients cleared the parasites from their faeces.Symptoms such as abdominal discomfort,dizziness and blood in the stool decreased significantly at both seven days and six weeks post-treatment(P<0.040).The enema retention time,bowel preparation,previous antibiotic treatment or previous gastrointestinal problems had no significant effect on parasite eradication.CONCLUSION Overall,eradication of parasites and improvement of clinical outcomes were observed in treated patients,showing the efficacy of this combination to eradicate the parasites and provide positive clinical outcome.

A Survey on Poultry Helminth Infection in Golestan Province （North of Iran）

Poultry breeding in a traditional and open environment will carry a great potential of causing parasitic infections in poultry At the present study, 110 domestic poultry were gathered randomly from wet areas （Gorgan, Minoodasht, Azadshahr, Ali Abad Katool, Kalaleh, Galikesh） and dry areas （Gonbad Kavoos, Agh Ghala） of Golestan province in 1388s. After dissecting, their bronchial tube and digestive system were examined for presenting of parasitic helminthes. Consequently, the rate of parasitic infection in domestic poultry was 92.73% which comprised： Heterakis gallinarum （18.18%）, Subulura brumpti （7.27%）, Acuaria spiralis （15.45%）, Capillaria sp （1.81%）, Ascaridia galli （48.18%）, Syngamus trachea （15.45%）, Syngamus trachea sp （2.73%）, Choanotaenia infundibulum （11.81%）, Raillietina tetragona （53.63%）, Raillietina cesticyllus （14.45%）, Raillietina echinobothrida （25.45%） Drepanidotaenia lanceolata （1.81%）. It is also necessary to cite that there is no relevance between helminth infection and age （P = 0.178）, species （P = 0.278） and geographical zone （P = 0.504）. Therefore, in order to reduce the parasitic infection, performing a directorial system beside the efforts for reducing its potentiality is extremely necessary.

Survey on Parasites in Sparrows of Amol （Mazandaran Province, Iran）

In order to survey on sparrows parasites （Passer domesticus）, 100 samples were collected from the citrus gardens of Amol＇s City. The surface of their body checked for presence of ectoparasites. The blood samples took from their wings for blood parasites. At the laboratory, the body of sparrows opened and the gastrointestinal checked for endoparasites. The intestine opened and scratched carefully to find worms. Worms kept in alcohol-glycerin （10%）. Eggs ＆ oocysts of the parasites checked, by fecal floatation test. The result shows that the infection with Railletina is 1%, Ascaridia galli （2%）, Heterakis gallinarum （4%）, eggs of A. galli （5%）, oocyst of Eimeri （28%）, Dermanyssus gallinae （1%）. 11% of the sparrows infected with Plasmodium in their bloods.

Prevalence of and risk factors for malaria,filariasis,and intestinal parasites as single infections or co-infections in different settlements of Gabon,Central Africa

Background:Malaria,filariasis,and intestinal parasitic infections(IPIs)are common and frequently overlap in developing countries.The prevalence and predictors of these infections were investigated in three different settlements(rural,semi-urban,and urban)of Gabon.Methods:During cross-sectional surveys performed from September 2013 to June 2014,451 individuals were interviewed.In addition,blood and stool samples were analysed for the presence of Plasmodium,filarial roundworm,intestinal protozoan,and helminth infections.Results:Intestinal parasitic infections(61.1%),including intestinal protozoa(56.7%)and soil-transmitted helminths(STHs)(22.2%),predominated,whereas Plasmodium falciparum(18.8%),Loa loa(4.7%),and Mansonella perstans(1.1%)were less prevalent.Filariasis and STHs were mainly found in rural settlements,whereas a higher plasmodial infection prevalence rate was observed in the periurban area.The most common IPI was blastocystosis(48.6%),followed by ascaridiasis(13.7%),trichuriasis(11.8%),amoebiasis(9.3%),giardiasis(4.8%),and strongyloidiasis(3.7%).Hookworm was detected in one adult from rural Dienga.Adults had a higher prevalence of Blastocystis hominis and STHs,whereas Giardia duodenalis was more frequently observed among children aged below 5 years(P<0.01).The polyparasitism rate was 41.5%,with 7.0%Plasmodium-IPIs and 1.8%Plasmodium-STH co-infections.The multivariate analysis showed that living in a suburban area,belonging to the age group of 5-15 years,having none or a secondary education,or having an open body water close to home were significant risk factors for malaria(P≤0.01).For STH infections,identified risk factors were drinking untreated water and living in a rural area(P≤0.04).No significant predictors were identified for IPIs and malaria-IPI co-infection.Conclusions:This study reports a high prevalence of IPIs and intestinal protozoa,but a low rate of malaria-IPI co-infections in the study sites.Improvements in the living conditions of the population such as adequate water supply and proper health education and sanitation should be integrated into control strategies for malaria,STHs,and IPIs.

Coinfection with malaria and intestinal parasites, and its association with anaemia in children in Cameroon

Background:The purpose of this study was to determine the prevalence of coinfection with malaria and intestinal parasites,as well as to determine its association with anaemia in children aged 10 years and below in Muyuka,Cameroon.Materials and methods:This was a cross-sectional study.Participants were febrile children who were admitted to the Muyuka district hospital between April and October 2012.Blood and stool samples were collected from those participants who gave consent to take part in the study.Haemoglobin concentration(Hb)and complete blood count(CBC)were performed using an automated haematology analyser(Mindray®,BC-2800).Giemsa-stained blood film was examined to detect malaria parasites,while the formol-ether concentration technique was used to detect intestinal parasitic infections(IPIs).The Pearson’s chi-square,Student’s T-test and correlation analysis were all performed as part of the statistical analyses.Results:Four hundred and eleven(411)children successfully took part in this study.The prevalence of malaria,IPIs,malaria and IPI coinfection,and anaemia observed were 98.5%,11.9%,11.9%and 44.8%,respectively.Anaemia and IPIs were significantly associated with age;anaemia was more prevalent in children under five years of age(p=0.000),whereas IPIs were more prevalent in children aged between five and 10 years(p=0.006).The parasite species isolated included Ascaris lumbricoides(36[73.5%]),Entamoeba histolytica/dispar(9[18.4%])and hookworm(4[8.2%]).The mean Hb observed was 10.64 g/dl(±1.82).A significant negative correlation was observed between malaria parasite density and Hb.There was no significant difference in the prevalence of anaemia among children infected with malaria,IPIs,or malaria and IPI coinfection,or among non-infected children.Similarly,the mean Hb did not differ among infected and non-infected children.Conclusion:This study showed that malaria and IPIs still constitute a major public health problem in the study area despite a lack of any significant association between these infections and anaemia.The findings suggest that there is a need for the implementation of control measures to curb the rate of malaria and IPIs in the study area.

Type I strain of Toxoplasma gondii from chicken induced different immune responses with that from human,cat and swine in chicken

In this study,four strains of Toxoplasma gondii with the same genetic type（Type I） originated from chicken,human,cat and swine were used to compare the immune responses in resistant chicken host to investigate the relationships between the parasite origins and the pathogenicity in certain host.A total of 300,10-day-old chickens were allocated randomly into five groups which named JS（from chicken）,CAT（from cat）,CN（from swine）,RH（from human） and a negative control group（—Ve） with 60 birds in each group.Tachyzoites of four different T.gondii strains（JS,CAT,CN and RH） were inoculated intraperitoneally with the dose of 1×10~7 in the four designed groups,respectively.The negative control（-Ve） group was mockly inoculated with phosphate-buffered saline（PBS） alone.Blood and spleen samples were obtained on the day of inoculation（day 0） and at days 4,11,25,39 and 53 post-infection to screen the immunopathological changes.The results demonstrated some different immune characters of T.gondii infected chickens with that of mice or swine previous reported.These differences included up-regulation of major histocompatibility complex class Ⅱ（MHC Ⅱ） molecules in the early stage of infection,early peak expressions of interleukin（IL）-12（IL-12） and-10（IL-10） and long keep of IL-17.These might partially contribute to the resistance of chicken to T.gondii infection.Comparisons to chickens infected with strains from human,cat and swine,chickens infected with strain from chicken showed significant high levels of CD4~＋ and CD8~＋ T cells,interferon gamma（IFN-γ）,IL-12 and IL-10.It suggested that the strain from chicken had different ability to stimulate cellular immunity in chicken.

Assessment of clinical dehydration using point of care ultrasound for pediatric patients in rural Panama

BACKGROUND: Dehydration and its associated symptoms are among the most common chief complaints of children in rural Panama. Previous studies have shown that intravascular volume correlates to the ratio of the diameters of the inferior vena cava(IVC) to the aorta(Ao). Our study aims to determine if medical students can detect pediatric dehydration using ultrasound on patients in rural Panama. METHODS: This was a prospective, observational study conducted in the Bocas del Toro region of rural Panama. Children between the ages of 1 to 15 years presenting with diarrhea, vomiting, or parasitic infection were enrolled in the study. Ultrasound measurements of the diameters of the IVC and abdominal aorta were taken to assess for dehydration. RESULTS: A total of 59 patients were enrolled in this study. Twenty-four patients were clinically diagnosed with dehydration and 35 were classified to have normal hydration status. Of the 24 patients with dehydration, half(n=12) of these patients had an IVC/Ao ratio below the American threshold of 0.8. Of the remaining asymptomatic subjects, about half(n=18) of these subjects also had an IVC/Ao ratio below the American threshold of 0.8.CONCLUSION: Our study did not support previous literature showing that the IVC/Ao ratio is lower in children with dehydration. It is possible that the American standard for evaluating clinical dehydration is not compatible with the rural pediatric populations of Panama.

Mediastinal and Pericardial Hydatidosis—A Case Report and Review of Literature

Hydatid disease caused by Echinococcus granulosus is endemic in Indian subcontinent and a common surgical problem. Although occurrence of hydatid cyst is common in liver and lungs, it can be encountered in almost every part of the body. Combined mediastinal and pericardial hydatid disease is a rare occurrence and only a few cases have been reported in the literature. Patients with hydatid cysts are usually asymptomatic. Our case report demonstrates a 57-year-old female patient who presented with chest pain and dyspnea on exertion for few months duration. Detailed imaging and laboratory investigation revealed a pericardial and mediastinal hydatid cyst. The patient underwent operation for curative excision. After surgery, the patient’s symptoms resolved and his clinical status improved.

Non-opportunistic intestinal parasitic infections among HIV-infected individuals at Wolaita Sodo Hospital, South Ethiopia

Objective:To determine the prevalence of non-opportunistic intestinal helminthic and protozoal infections among HIV-infected individuals and to determine socio-demographic determinants of intestinal parasitosis.Methods:A cross-sectional study was conducted on HIV-infected individuals attending antiretroviral therapy clinic of Wolaita Sodo Hospital.Stool in wet mount preparation and formalether concentration technique were used to diagnose intestinal parasitic infection.Sociodemographic variables were collected by using questionnaire.Chi-square test was used to test the associations between intestinal parasitosis and socio-demographic variables.Results:The overall prevalence of non-opportunistic intestinal parasitic infection was 32.4%out of which 11.0%was protozoal infection and 21.4%was helminthic infection.The most common intestinal parasite detected was Ascaris lumbricoides with 12.7%prevalence followed by Giardia lamblia with 7.5%prevalence.The prevalence of Strongyloides stercoralis,hookworm species,Entamoeba histolytica/Entamoeba dispar,Schistosoma mansoni and Taenia species was 2.9%,1.2%,3.5%,1.7%and 2.3%respectively.There was no significant difference in prevalence of intestinal parasite infection with regard to age,sex,residence area,job type and religion of participants but there was a significant association between the educational status and intestinal parasitic infection.The prevalence of intestinal parasitic infection was higher among illiterate participants.Conclusions:Ascaris lumbricoides was the most common intestinal parasite detected in HIV-infected individuals.Giardia lamblia was the most common protozoal parasite observed.Prevalence of intestinal helminthic infection was higher than protozoal infection.Intestinal parasitosis was significantly associated with an educational status of individuals.

Whatever happened to China’s neglected tropical diseases?

Before the founding of the People's Republic of China 70 years ago,both extreme poverty and parasitic infections and other neglected tropical diseases were highly prevalent.Owing to social development,particularly economic reforms since the 1980s,poverty has since been dramatically reduced,and China became increasingly urbanized and industrialized.In parallel,China's economic transformation translated into similar and remarkable reductions in neglected tropical diseases.Qian and colleagues report in their review published in Infectious Diseases of Poverty,the elimination or near elimination as a public health problem of lymphatic filariasis,trachoma,soil-transmitted helminth infections,schistosomiasis and other neglected tropical diseases.Of note,neglected tropical disease control and poverty reduction each appear to reinforce the other.China's formula for success in parasitic and neglected tropical disease control might translate to other parts of the world,such as in sub-Saharan Africa through China's new Belt and Road Initiative.

Prevalence and risk factors of undernutrition among schoolchildren in the Plateau Central and Centre-Ouest regions of Burkina Faso

Background:Multiple factors determine children’s nutritional status,including energy and nutrient intake,recurrent infectious diseases,access(or lack thereof)to clean water and improved sanitation,and hygiene practices,among others.The“Vegetables go to School:improving nutrition through agricultural diversification”(VgtS)project implements an integrated school garden programme in five countries,including Burkina Faso.The aim of this study was to determine the prevalence of undernutrition and its risk factors among schoolchildren in Burkina Faso before the start of the project.Methods:In February 2015,a cross-sectional survey was carried out among 455 randomly selected children,aged 8-14 years,in eight schools in the Plateau Central and Centre-Ouest regions of Burkina Faso.Nutritional status was determined by anthropometric assessment.Helminth and intestinal protozoa infections were assessed using the Kato-Katz and a formalin-ether concentration method.A urine filtration technique was used to identify Schistosoma haematobium eggs.Prevalence of anaemia was determined by measuring haemoglobin levels in finger-prick blood samples.Questionnaires were administered to children to determine their knowledge of nutrition and health and their related attitudes and practices(KAP).Questionnaires were also administered to the children’s caregivers to identify basic household socio-demographic and economic characteristics,and water,sanitation and hygiene(WASH)conditions.To determine the factors associated with schoolchildren’s nutritional status,mixed logistic regression models were used.Differences and associations were considered statistically significant if P-values were below 0.05.Results:Complete datasets were available for 385 children.The prevalence of undernutrition,stunting and thinness were 35.1%,29.4%and 11.2%,respectively.The multivariable analysis revealed that undernutrition was associated with older age(i.e.12-14 years compared to<12 years;adjusted odds ratio(aOR)=3.45,95%confidence interval(CI)2.12-5.62,P<0.001),multiple pathogenic parasitic infections(aOR=1.87,95%CI 1.02-3.43,P=0.044)and with moderate and severe anaemia in children(aOR=2.52,95%CI 1.25-5.08,P=0.010).Conclusions:We found high prevalence of undernutrition among the children surveyed in the two study regions of Burkina Faso.We further observed that undernutrition,anaemia and parasitic infections were strongly associated.In view of these findings,concerted efforts are needed to address undernutrition and associated risk factors among school-aged children.As part of the VgtS project,WASH,health education and nutritional interventions will be implemented with the goal to improve children’s health.Trial registration:ISRCTN17968589(date assigned:17 July 2015).