Prevalence of Cyclospora cayetanensis in diarrheal patients in eastern region of India.

Cyclospora cayetanensis, a recently described coccidian parasite causes severe gastroenteric disease worldwide. Limited studies are found on the incidence of C. cayetanensis infection from India; hence remains largely unknown. To date, no case of cyclosporiasis from eastern India has been reported. In this study, we described an incidental case of C. cayetanensis in a 30 years old Bengali female patient with no travel history from eastern India. In June 2022, the patient presented with a history of diarrhoea persisting for more than two months with continuous passage foul smelling stools for which she took multiple antibiotics that were ineffective. There were no Salmonella, Shigella, or Vibrio-like organisms in the patient's faecal sample, and Toxin A/B of Clostridium difficile was also not detected by ELISA. The patient was HIV-negative. Finally, UV autofluorescence and DNA-based diagnosis confirmed the presence of C. cayetanensis, and the treatment with a combination of appropriate antibiotics was successful. This case report could raise awareness about C. cayetanensis associated diarrhoeal cases in India.

The emerging protozoan parasites Cryptosporidium, Cyclospora cayetanensis and Isospora belli have altered the etiological spectrum of diarrhea. The progressive decline in CD4 cell count in AIDS patients and lack of active immunity in the face of exposure to contaminated food and water in young children make these groups of persons particularly susceptible to protracted and severe diarrhea caused by the above parasites. Cryptosporidiosis is caused by human as well as several zoonotic species. The present study was undertaken to examine the prevalence of Cryptosporidium species, C. cayetanensis and I .belli among these two susceptible populations in comparison with adult immunocompetent individuals with diarrhea and to identify the Cryptosporidium species prevalent in these populations. A total of 447 children under the age of 5 years, 175 HIV-seropositive adults and 200 HIV seronegative adults with diarrhea attending tertiary care hospitals located in the twin cities of Secunderabad and Hyderabad in South India were included in the study. Single fecal samples were collected. Wet mounts and modified Ziehl Neelsen stained smears made from concentrated fecal specimens were screened microscopically for oocysts of Cryptosporidium, Cyclospora cayetanensis and Isospora belli. DNA extracted from fecal samples positive for Cryptosporidium was subjected to PCR RFLP for species identification. Cryptosporidium was detected in all the three groups, I.e. children (8.7%), HIV-seropositive adults (6.85%), and HIV-seronegative adults (1%). Isospora and Cyclospora were detected only among HIV- seropositive persons at a frequency of 16% and 1% respectively. C. hominis (71.7%) and C. parvum (18.9%) were the only 2 species of Cryptosporidium detected.

Long-term spatial and temporal trends of rainfall at monthly, seasonal, and annual scales have been studied for 12 meteorological stations of the Gangetic West Bengal located in Eastern India during 1901–2002 using 102 years of rainfall data. The non-parametric Mann-Kendall test and Sen’s slope estimator were used to detect trends and their slope. The changes are calculated in percentage over the time period. The results highlight a marked increase in post-monsoon (33.87%), the overall increase in annual (2.61%), a considerable decrease in winter (14.83%) as well as pre-monsoon (4.03%), and an inconsequential increase in monsoonal (1.21%) rainfall. In the annual and monsoonal series, the trend is positive in the southern half but negative in the northern counterpart. A considerable decrease in rainfall during June and August at most stations signifies that monsoon is losing in the early monsoonal months with an occurrence of mid-season dry spells. The increase in rainfall during September (13.80%) and October (34.38%) reveals that the monsoon is shifting toward these late monsoon and post-monsoon months, respectively. Both the decrease of rainfall in June (early monsoonal month), as well as an increase in rainfall in September (late monsoonal month) and October (start of post-monsoonal month), suggest that the monsoon is being delayed on its onset and withdrawal. In the Rarh region, monsoon rainfall is reducing whereas post-monsoon rainfall is increasing. In the Deltaic region, both monsoon and post-monsoon rainfalls are increasing. Such altering patterns of rainfall call for reviewing the agricultural practices and water use in this region.

Globally, more than 600 million school-age children are at risk of infection with soil-transmitted helminths (STH) and require treatment [1]. These infected children frequently carry the largest burden of disease in a community and are at greater risk of malnutrition and anaemia [2–5], with detrimental effects on educational access and learning as well as mental and physical performance [4,6–10]. Many of these detrimental effects of helminth infection, however, are reversible with antihelminthic drugs [9–11]; thus, the World Health Organization (WHO) advocates reaching a minimum target of regular administration of antihelminthics to at least 75%, and up to 100%, of school-age children at risk of morbidity from STH infection by 2020 [1,12]. The high levels of safety and efficacy of antihelminthic tablets make them ideal for mass drug administration (MDA), and recommended control efforts consist of antihelminthic treatment, administered through MDA, once a year for school-age children in whom STH infection prevalence is between 20% and 49% and twice a year for all school-age children in whom prevalence is at least 50% [13]. By providing easy access to large numbers of children in a structured setting, the school-based deworming model has been successfully used to administer these antihelminthics in multiple settings [14–16]. Thus, school-based deworming, in which the point of care for children is the school and the teachers are administers of the drugs, with critical oversight by health care staff, is recommended in order to cost-effectively and efficiently reach large numbers of children [14–17]. Despite the availability of cheap and efficacious drugs, WHO goals of reaching 75% of at-risk children by 2020 is not on target [18]. Clearly, in order to achieve WHO goals of reaching 75% by 2020, an effort needs to be taken to increase the scale and coverage of deworming programmes to regional and national levels. Box 1 highlights the key elements of a deworming programme implemented in Bihar, which presents a scalable and sustainable school-based model, using the tools available and harnessing existing structures to create a successful, structured deworming programme. Box 1. Key Elements for Success of the Deworming Programme in Bihar Institutional Framework ◆ Ownership of the programme by the government led to increased programme sustainability and continued financial and governmental support. ◆ Additionally, the existence of a multi-sectoral coordination committee (the State School Health Coordination Committee [SSHCC]) provided the necessary supervision, flexibility, and direction to address challenges arising during the programme while ensuring the sustained high profile of the programme. Evidence-Based Design and Implementation ◆ The catalytic role of development partners helped build a strong, evidence-based programme and resulted in overall reduced costs as well as additional high-level government support. Collaboration, Communication, and Coordination ◆ Throughout the design and implementation of the programme, close communication and collaboration among different state government bodies, in particular the health and education sectors, enabled the leveraging of their respective physical infrastructures and human resources and maximized coverage while reducing the overall cost of the programme. ◆ High levels of acceptability of the deworming programme by the community was a result of context-relevant community awareness campaigns that built local ownership of the programme, prevented a purely “top-down” approach to the programme, and increased participation on the deworming day. India is estimated to account for more than a quarter of all children requiring treatment for STH globally [1,19], and in 2009 the State Government of Bihar, in the eastern region of India, planned to initiate a state-wide, evidence-based deworming programme run out of state-schools and with technical support from Deworm the World (DtW). From inception, DtW was technically and administratively supported by Partnership for Child Development (PCD) and Innovations for Poverty Action (IPA) and led by PCD’s Executive Director Dr Lesley Drake, who was seconded to DtW to lead the campaign. This joint initiative is reflected in this paper with the term DtW/PCD. Bihar is one of India’s poorest states, with 8.5% of India’s population and only 1.6% of its gross domestic product (GDP) [20]. The population of Bihar was estimated to be over 104 million in the 2011 census [21] with approximately 28% between 6–14 years of age [21]. Surveys conducted in 2010–2011 found a high prevalence of STH throughout Bihar state [22], and subsequent predictive mapping indicated that at least annual, and in some cases biannual, MDA treatment would be required [17]. This paper outlines the political environment, development, and implementation of all stages of this pioneering and sustainable large-scale deworming programme, which led to the treatment of over 17 million school-age children in Bihar state. In addition, the synergistic support provided by all partners ensured a rapid rollout of the programme, which went from conception to implementation to treatment in less than 12 months, and deworming was rolled out across the state over three months.

The global prevalence of Cyclospora cayetanensis infection: A systematic review, meta-analysis, and meta-regression

Schistosomiasis maze

Cyclospora cayetanensis is a foodborne and waterborne pathogen that causes endemic and epidemic human diarrhea worldwide. A few epidemiological studies regarding C. cayetanensis infections in China have been conducted. During 2013, a total of 291 stool specimens were collected from patients with diarrhea at a hospital in urban Shanghai. C. cayetanensis was not detected in any of the stool specimens by traditional microscopy, whereas five stool specimens (1.72%, 5/291) were positive by PCR. These positive cases confirmed by molecular technology were all in the adult group (mean age 27.8 years; 2.94%, 5/170) with watery diarrhea. Marked infection occurred in the rainy season of May and July. Sequence and phylogenetic analyses of the partial 18S rRNA genes of C. cayetanensis isolated showed intra-species diversity of this parasite. This study showed, for the first time, that C. cayetanensis is a pathogen in outpatients with diarrhea in Shanghai, albeit at a low level. However, the transmission dynamics of this parasite in these patients remain uncertain.

Current knowledge on the burden of, and interactions between malaria and helminth co-infections, as well as the impact of the dual infections on anaemia, remains inconclusive. We have conducted a systematic review with meta-analysis to update current knowledge as a first step towards developing and deploying coordinated approaches to the control and, ultimately, elimination of malaria-helminth co-infections among children living in endemic countries. We searched Medline, Embase, Global Health and Web of Science from each database inception until 16 March 2020, for peer-reviewed articles reporting malaria-helminth co-infections in children living in endemic countries. No language restriction was applied. Following removal of duplicates, two reviewers independently screened the studies for eligibility. We used the summary odds ratio (OR) and 95% confidence intervals (CI) as a measure of association (random-effects model). We also performed Chi-square heterogeneity test based on Cochrane's Q and evaluated the severity of heterogeneity using I2 statistics. The included studies were examined for publication bias using a funnel plot and statistical significance was assessed using Egger's test (bias if p<0.1). Fifty-five of the 3,507 citations screened were eligible, 28 of which had sufficient data for meta-analysis. The 28 studies enrolled 22, 114 children in 13 countries across sub-Saharan Africa, Southeast Asia and South America. Overall, the pooled estimates showed a prevalence of Plasmodium-helminth co-infections of 17.7% (95% CI 12.7-23.2%). Summary estimates from 14 studies showed a lower odds of P. falciparum infection in children co-infected with Schistosoma spp (OR: 0.65; 95%CI: 0.37-1.16). Similar lower odds of P. falciparum infection were observed from the summary estimates of 24 studies in children co-infected with soil transmitted helminths (STH) (OR: 0.42; 95%CI: 0.28-0.64). When adjusted for age, gender, socio-economic status, nutritional status and geographic location of the children, the risk of P. falciparum infection in children co-infected with STH was higher compared with children who did not have STH infection (OR = 1.3; 95% CI 1.03-1.65). A subset of 16 studies showed that the odds of anaemia were higher in children co-infected with Plasmodium and STH than in children with Plasmodium infection alone (OR = 1.20; 95% CI: 0.59-2.45), and were almost equal in children co-infected with Plasmodium-Schistosoma spp or Plasmodium infection alone (OR = 0.97, 95% CI: 0.30-3.14). The current review suggests that prevalence of malaria-helminth co-infection is high in children living in endemic countries. The nature of the interactions between malaria and helminth infection and the impact of the co-infection on anaemia remain inconclusive and may be modulated by the immune responses of the affected children.

BackgroundCurrent knowledge on the burden of, and interactions between malaria and helminth co-infections, as well as the impact of the dual infections on anaemia, remains inconclusive. We have conducted a systematic review with meta-analysis to update current knowledge as a first step towards developing and deploying coordinated approaches to the control and, ultimately, elimination of malaria-helminth co-infections among children living in endemic countries.Methodology/Principal findingsWe searched Medline, Embase, Global Health and Web of Science from each database inception until 16 March 2020, for peer-reviewed articles reporting malaria-helminth co-infections in children living in endemic countries. No language restriction was applied. Following removal of duplicates, two reviewers independently screened the studies for eligibility. We used the summary odds ratio (OR) and 95% confidence intervals (CI) as a measure of association (random-effects model). We also performed Chi-square heterogeneity test based on Cochrane’s Q and evaluated the severity of heterogeneity using I2 statistics. The included studies were examined for publication bias using a funnel plot and statistical significance was assessed using Egger’s test (bias if p<0.1).Fifty-five of the 3,507 citations screened were eligible, 28 of which had sufficient data for meta-analysis. The 28 studies enrolled 22, 114 children in 13 countries across sub-Saharan Africa, Southeast Asia and South America. Overall, the pooled estimates showed a prevalence of Plasmodium-helminth co-infections of 17.7% (95% CI 12.7–23.2%). Summary estimates from 14 studies showed a lower odds of P. falciparum infection in children co-infected with Schistosoma spp (OR: 0.65; 95%CI: 0.37–1.16). Similar lower odds of P. falciparum infection were observed from the summary estimates of 24 studies in children co-infected with soil transmitted helminths (STH) (OR: 0.42; 95%CI: 0.28–0.64).When adjusted for age, gender, socio-economic status, nutritional status and geographic location of the children, the risk of P. falciparum infection in children co-infected with STH was higher compared with children who did not have STH infection (OR = 1.3; 95% CI 1.03–1.65).A subset of 16 studies showed that the odds of anaemia were higher in children co-infected with Plasmodium and STH than in children with Plasmodium infection alone (OR = 1.20; 95% CI: 0.59–2.45), and were almost equal in children co-infected with Plasmodium-Schistosoma spp or Plasmodium infection alone (OR = 0.97, 95% CI: 0.30–3.14).Conclusions/SignificanceThe current review suggests that prevalence of malaria-helminth co-infection is high in children living in endemic countries. The nature of the interactions between malaria and helminth infection and the impact of the co-infection on anaemia remain inconclusive and may be modulated by the immune responses of the affected children.

Cyclospora cayetanensis is a coccidian parasite of humans, with a direct fecal–oral transmission cycle. It is globally distributed and an important cause of foodborne outbreaks of enteric disease in many developed countries, mostly associated with the consumption of contaminated fresh produce. Because oocysts are excreted unsporulated and need to sporulate in the environment, direct person-to-person transmission is unlikely. Infection by C. cayetanensis is remarkably seasonal worldwide, although it varies by geographical regions. Most susceptible populations are children, foreigners, and immunocompromised patients in endemic countries, while in industrialized countries, C. cayetanensis affects people of any age. The risk of infection in developed countries is associated with travel to endemic areas and the domestic consumption of contaminated food, mainly fresh produce imported from endemic regions. Water and soil contaminated with fecal matter may act as a vehicle of transmission for C. cayetanensis infection. The disease is self-limiting in most immunocompetent patients, but it may present as a severe, protracted or chronic diarrhea in some cases, and may colonize extra-intestinal organs in immunocompromised patients. Trimetoprim-sulfamethoxazole is the antibiotic of choice for the treatment of cyclosporiasis, but relapses may occur. Further research is needed to understand many unknown epidemiological aspects of this parasitic disease. Here, we summarize the biology, epidemiology, outbreaks, clinical symptoms, diagnosis, treatment, control and prevention of C. cayetanensis; additionally, we outline future research needs for this parasite.

This study is designed to outline the likely patterns of treatment modalities based on patient demographics and mechanism of injury in eastern region of India (industrial area). To evaluate the various treatment patterns in eastern region of India and for better understanding of providing patient care. We conducted a retrospective study by collecting data from the records of the patients who reported at our institution from 2018 to 2020. The types of the major procedures done at the department were classified based on the type and the area of the trauma. The data were tabulated using Excel sheet and projected in percentages. Later with statistical analysis by one-way ANOVA, the different groups were compared with SPSS version 20.0. The total number of patients observed were 197. The gender distribution was M/F = 1.31:1. Comminuted mandibular fracture had the highest incidence with RTA (road traffic accident) being the most prevalent etiology, whereas no significant difference was found between the types of procedures performed and demography of the patients. Being a dominant industrial area (Jharkhand), it can be concluded that facial trauma is seen predominant in this part of eastern India due to road traffic accidents with heavy, high-speed vehicles and lack of awareness in using protective safety accessories. This study helped us evaluate the various major surgical procedures performed in the department of Oral and Maxillofacial Surgery. Such data would also act as an educational tool for trainees and for enhancing multidisciplinary meets.

BackgroundMass drug administration (MDA), targeted at school-aged children (SAC) is the method recommended by the World Health Organization for the control of morbidity induced by soil-transmitted helminth (STH) infection in endemic countries. However, MDA does not prevent reinfection between treatment rounds and research suggests that only treating SAC will not be sufficient to bring prevalence to low levels and possibly interrupt transmission of STH. In countries with endemic infection, such as Myanmar, the coverage, who is targeted, and rates of reinfection will determine how effective MDA is in suppressing transmission in the long-term.Methods/principal findingsIn this paper, data from an epidemiological study on STH, comprising three surveys conducted between June 2015 and June 2016 in the delta region of Myanmar, are analysed to determine how STH prevalence and intensity in the study community changes over the course of a year, including reinfection after two MDA rounds in which the whole study sample (all age groups, n = 523) were treated with albendazole. Prevalence in the first survey (August 2015) was 27.92% for any STH, 5.54% for Ascaris lumbricoides, 17.02% for Trichuris trichiura and 9.75% for hookworm. Over the year (survey one to survey three), prevalence of any STH decreased by 8.99% (P < 0.001) and mean EPG significantly decreased for T. trichiura (P < 0.01) and hookworm (P < 0.001). Risk ratios (RRs) for a four-month reinfection period (August to December) were statistically significant and were below one, indicating that STH prevalence had not bounced back to the prevalence levels recorded immediately prior to the last round of treatment (any STH RR = 0.67, 95% CI 0.56–0.81; A. lumbricoides RR = 0.31, 95% CI 0.16–0.59; T. trichiura RR = 0.70, 95% CI 0.55–0.88; hookworm RR = 0.69, 95% CI 0.50–0.95). The only statistically significant RR for the six-month reinfection period (December to June) was for A. lumbricoides infection in SAC (RR = 2.67, 95% CI 1.37–5.21). All six-month RRs were significantly higher than four-month RRs (P < 0.05). Evidence of predisposition to infection (low and high), as measured by the Kendall Tau-b statistic, was found for all species overall and within most age groups stratifications, except for hookworm infection in preschool-aged children.Conclusions/significanceThis study demonstrates that, for certain demographic groups, a six-month gap between MDA in these communities is enough time for STH infection to return to STH prevalence levels recorded immediately before the previous MDA round, and that on average the same individuals are being consistently infected between MDA rounds.

Including women in deworming the world

Cyclospora cayetanensis, a coccidian parasite that causes protracted and relapsing gastroenteritis, has a short recorded history. At least 54 countries have documented C. cayetanensis infections and 13 of them have recorded cyclosporiasis outbreaks. Cyclospora cayetanensis infections are commonly reported in developing countries with low-socioeconomic levels or in endemic areas, although large outbreaks have also been documented in developed countries. The overall C. cayetanensis prevalence in humans worldwide is 3.55%. Among susceptible populations, the highest prevalence has been documented in immunocompetent individuals with diarrhea. Infections are markedly seasonal, occurring in the rainy season or summer. Cyclospora cayetanensis or Cyclospora-like organisms have also been detected in food, water, soil and some other animals. Detection methods based on oocyst morphology, staining and molecular testing have been developed. Treatment with trimethoprim-sulfamethoxazole (TMP-SMX) effectively cures C. cayetanensis infection, whereas ciprofloxacin is less effective than TMP-SMX, but is suitable for patients who cannot tolerate co-trimoxazole. Here, we review the biological characteristics, clinical features, epidemiology, detection methods and treatment of C. cayetanensis in humans, and assess some risk factors for infection with this pathogen.

Background Soil-transmitted helminths are parasitic nematodes found in the intestine. They are more prevalent in the tropics and subtropics, including Ethiopia. However, low-sensitive direct wet mount microscopy fails to detect soil-transmitted helminths among infected cases. Therefore, more sensitive and cost-effective diagnostic methods are urgently needed to minimize soil-transmitted helminthiasis morbidity. Objective This study aimed to compare and evaluate the performance of diagnostic methods for soil-transmitted helminths against the “gold” standard. Methods An institution-based cross-sectional study was conducted among 421 schoolchildren from May to July, 2022 in the Amhara Region. Study participants were selected using a systematic random sampling technique. Stool samples were processed via Kato–Katz, McMaster, and spontaneous tube sedimentation techniques. Data were entered into epi-data version 3.1 and analyzed using SPSS version 25. The sensitivity, specificity, positive predictive value, and negative predictive value were calculated against the combined result as a “gold” standard. The strength of agreement between the diagnostic methods was determined by the Kappa value. Results The overall prevalence of soil-transmitted helminths was 32.8% (95% CI: 28.2–37.8%) using a combination of methods. The detection rates of Kato–Katz, McMaster, and spontaneous tube sedimentation were 28.5% (95% CI: 24.2–33.2%), 30% (95% CI: 25.6–34.8%), and 30.5% (95% CI: 26.1–35.3%), respectively. Sensitivity and negative predictive values were 87.1% (95% CI: 80.2–92.3%) and 95.1% (95% CI: 92.6–96.8%) for Kato–Katz; 91.7% (95% CI: 85.6–95.6%) and 96.5% (95% CI: 94.1–98.0%) for McMaster; and 93.2% (95% CI: 87.5–96.8%) and 97.1% (95% CI: 94.7–98.4%) for spontaneous tube sedimentation. Kappa values of Kato–Katz, McMaster, and spontaneous tube sedimentation for the diagnosis of soil-transmitted helminths were 0.901, 0.937, and 0.948, respectively. Conclusion Kato–Katz, McMaster, and spontaneous tube sedimentation techniques had comparable sensitivity with almost perfect agreement for the detection of soil-transmitted helminths. Therefore, the spontaneous tube sedimentation technique can be used as an alternative diagnostic method for soil-transmitted helminth infections in endemic countries.