Giardia Duodenalis Infection Research Articles

Detection and genotype analysis of Giardia duodenalis from asymptomatic Hungarian inhabitants and comparative findings in three distinct locations

The transmission route of giardiasis not yet understood and why some infected individuals remain asymptomatic while others become quite ill. The drinking water quality is supposedly responsible for the prevalence of asymptomatic Giardia duodenalis infections in different areas, therefore asymptomatic giardiasis has been investigated in three water supply areas of Hungary: three hundred stool samples from inhabitants of Budapest, Füzér and Mátrafüred were examined by immunological and molecular methods for the presence of G. duodenalis infections. Individuals were asked to fill out a validated questionnaire at the time of stool collection and the interview covered demographic data, family life, education and travel history.In Budapest and in Mátrafüred in one stool sample G. duodenalis Assemblage A, whereas in Füzér once G. duodenalis Assemblage A, once Assemblage B and twice mixed infection were detected. We found higher prevalence rate of 4% of G. duodenalis infections of asymptomatic people in the village Füzér, where the removal of the Giardia cysts of the drinking water treatment plant was not effective. This study throws a light the need to look into the possibility of other risks of Giardia infections such as water transmission routes. To our knowledge, this is the first study evaluating the prevalence of G. duodenalis infections in asymptomatic persons in Hungary.

Reduced prevalence of Giardia duodenalis in iron-deficient Rwandan children.

Acute symptomatic infection with Giardia duodenalis impairs iron absorption, but iron deficiency may protect against infections caused by various micro-organisms including parasites. We therefore examined the association of G. duodenalis infection and iron deficiency in 575 Rwandan children under 5 years of age. Giardia duodenalis infection was diagnosed by triplicate microscopy and PCR assays, and iron deficiency was defined as a ferritin concentration <12 ng/ml. Largely asymptomatic G. duodenalis infection was seen in 65.3% of the children and iron deficiency in 17.4%. G. duodenalis infection was less common in iron-deficient children (51%) than in non-deficient children (68%, P = 0.002). In multivariate analysis, the odds of G. duodenalis infection were almost halved in iron-deficient children (adjusted odds ratio, 0.54; 95% confidence interval, 0.33-0.86). In this highly endemic setting, there was no evidence that Giardia infection impairs iron status. Rather, iron deficiency appeared to protect against infection with this parasite.

Intestinal parasitic infections and atopic dermatitis among Venezuelan Warao Amerindian pre‐ school children

We evaluated the influence of intestinal parasitic infection on food sensitization associated to the severity of Atopic Dermatitis (AD) in a group of Warao Amerindian pre- school children. Feces examinations were performed in fresh stool specimens. Diagnosis of AD was done according to Hannifin and Rajka criteria and SCORAD index. Skin prick tests (SPT) were performed using extracts of cow's milk (CM), hen's egg (HE), Dermatophagoides pteronyssinus and Dermatophagoides farinae . Serum CM and HE-IgE levels (ELISA) were measured. Quantikine (R&D systems) assays were used for the determination of IL-13, TNF-α IL-6, and sCD23 in supernatants of CM- and HE- whole blood stimulated samples. Atopic Dermatitis was reported in 23% of the children. It was significantly (p<0.0001) associated toward both CM and HE- SPT positivity (p<0.001). Giardia duodenalis infection (37%) was associated to the presence of AD (p=0.005) and to a significant increase in the levels of CM stimulated TNF-α (p=0.006), IL-13 (p=0.01), sCD23 (p=0.001), CM-IgE (p=0.012) and CM-SPT (p<0.0001). Similarly, G.duodenalis infection was particularly associated with the increase on the levels of HE-stimulated TNF-α (p=0.001), sCD23 (p=0.001), HE-IgE levels (p=0.002) and HE-SPT (p=0.001). Gut inflammation caused by G.duodenalis may enhance food allergic reactivity contributing to the manifestation of AD in these children. However, other environmental factors (not considered in this work) as well as an atopic background among the Warao population would also contribute to the presence of AD.

Single dose of secnidazole treatment against naturally occuring Giardia duodenalis infection in Sakiz lambs

ABSTRACTObjective. The purposes of this study were to determine whether secnidazole administered at a single dose of 10 mg/kg, orally, lessens or eliminates Giardia cyst shedding, and to validate the benefit of secnidazole treatment on clinical signs and faecal consistency in lambs naturally infected with Giardia duodenalis. Materials and methods. To this extent weaned 12 weeks of age lambs were selected and randomly assigned into two groups based on placebo (group C, n=7 untreated control group) or treatment (group S, n=10 lambs treated with a single dose of secnidazole at 10 mg/kg). Results. On days 0 and 10, before and after treatment, respectively, reduction in cyst excretion was determined. The faecal consistency and general health were recorded at each sampling day. Conclusions. During the study there was a high (99.98%) reduction in cyst excretion in the secnidazol treatment group compared to the positive control group on day 10, resulting in a significant (p&lt;0.001) reduction, making secnidazole highly effective treatment option.

Epidemiology of Giardia duodenalis infection in ruminant livestock and children in the Ismailia province of Egypt: insights by genetic characterization.

BackgroundGiardia duodenalis is a common flagellated protozoan parasite that infects the small intestine of a wide range of vertebrate hosts. This study aimed to determine whether tracing of G. duodenalis isolates by current genetic typing tools is possible using an exemplary set of samples from infected cattle, buffalo and children from the Ismailia province, Egypt.MethodA total of 804 fecal samples from ruminant animals was collected from 191 herds and 165 samples from diarrheal children below the age of 10 years. Parasites were detected in these samples using the copro-antigen RIDA®QUICK test and by real-time PCR. Samples were then genetically characterized based on the triosephosphate isomerase, glutamate dehydrogenase and β-giardin genes.ResultsThe prevalence of G. duodenalis was 53% in ruminants and 21% in symptomatic children and infection was not positively correlated with diarrheal symptoms. Sequence typing analysis confirmed predominance of B-type sequences (>67%) in humans and E-type sequences (>81%) in ruminants over A-type sequences. For 39 samples the complete sequence information of the three marker gene fragments could be derived. Integration of the concatenated sequence information of the three marker gene fragments with the spatial data of the respective sample revealed that identical or near identical (only up to 1 out of 1358 bp different) concatenated sequencing types were spatially related in 4 out of 5 cases.ConclusionThe risk of zoonotic infection emanating from ruminants even in high prevalence areas is negligible. Genetic characterization indicated a predominant anthropogenic cycle of infection within the pediatric population studied. Integration of sequence typing data with information on geographic origins of samples allows parasite sub-population tracing using current typing tools.

Burden of Giardia duodenalis infection and its adverse effects on growth of schoolchildren in rural Malaysia.

Background Giardia duodenalis infection and malnutrition are still considered as public health problems in many developing countries especially among children in rural communities. This study was carried out among Aboriginal (Orang Asli) primary schoolchildren in rural peninsular Malaysia to investigate the burden and the effects of Giardia infection on growth (weight and height) of the children.Methods/FindingsWeight and height of 374 children aged 7–12 years were assessed before and after treatment of Giardia infection. The children were screened for Giardia parasite using trichrome staining technique. Demographic and socioeconomic data were collected via face-to-face interviews using a pre-tested questionnaire. Overall, 22.2% (83/374) of the children were found to be infected with Giardia. Nutritional status of children was assessed and the results showed that the mean weight and height were 23.9 kg (95% CI = 23.3, 24.5) and 126.6 cm (95% CI = 125.6, 127.5), respectively. Overall, the prevalence of severe underweight, stunting and wasting were 28.3%, 23.8% and 21.0%, respectively. Multiple linear regression analyses showed sex, Giardia infection and household monthly income as the significant determinants of weight while sex and level of mother's education were the significant determinants of height. Weight and height were assessed at 3 and 6 months after treatment of Giardia infection. It was found that Giardia infection has a significant association with the weight of children but not with height.Conclusions/SignificanceThis study reveals high prevalence of Giardia infection and malnutrition among Aboriginal children in rural Malaysia and clearly highlights an urgent need to identify integrated measures to control these health problems in the rural communities. Essentially, proper attention should be given to the control of Giardia infection in Aboriginal communities as this constitutes one of the strategies to improve the nutritional status of Aboriginal children.

Prevalence of Giardia duodenalis and Cryptosporidium species infections among children and cattle in North Shewa Zone, Ethiopia

BackgroundGiardia and Cryptosporidium are the most common causes of protozoan diarrhea that lead to significant morbidity and mortality worldwide. The purpose of this study was to determine the prevalence of Giardia duodenalis and Cryptosporidium species infections among children and cattle, and to assess the potential risk of zoonotic transmission.MethodsThis cross-sectional study was conducted between January and April 2009 in Girar Jarso and Dera Districts of North Shewa Zone, Oromia Region, Ethiopia. A total of 768 stool specimens were collected and examined for intestinal parasites using direct wet mount with saline and formalin ether concentration methods. The modified Ziehl-Neelsen staining method was used for the detection of Cryptosporidium species. Statistical analysis was performed using SPSS software version 15.ResultsOut of 384 children examined, 53 (13.8%) and 28 (7.3%) were positive for Giardia and Cryptosporidium infections, respectively. Similarly, of the total 384 cattle examined, 9 (2.3%) were positive for Giardia duodenalis and 30 (7.8%) were positive for Cryptosporidium infection. The prevalence of giardiasis was significantly higher among children who had close contact with cattle 33 (18.7%) compared to children who had no contact with cattle 20 (9.6%) (P < 0.05). Higher number of Cryptosporidium infection was also recorded in children who had close contact with cattle 15 (8.5%). Difference in prevalence of giardiasis and cryptosporidiosis among children was not statistically significant between males and females. On the other hand, difference in the prevalence of giardiasis among children was statistically significant between age groups.ConclusionsHigher prevalence of Giardia duodenalis infection detected among children was significantly associated with contact with cattle and manure that the children had. Further analysis using molecular techniques is needed to explain the existence of zoonotic transmission in the study area.

Characterization of Giardia duodenalis infections in dogs in Trinidad and Tobago

To our knowledge, the zoonotic potential of Giardia duodenalis has not been assessed in companion animals in Trinidad and Tobago. This report details the first attempt to evaluate the potential zoonotic risk of G. duodenalis in dogs and identify assemblages of G. duodenalis found in dog populations on both islands. Fecal samples were collected from free-roaming dogs and dogs at the Trinidad and Tobago Society for the Prevention of Cruelty to Animals from October 2010 to June 2011. A total of 168 samples were collected of which 104 samples were analyzed for the presence of G. duodenalis by PCR amplification of the ssu-rRNA gene with subsequent assemblage-typing. A subset of samples was also analyzed by ELISA. Twenty-six samples were positive for G. duodenalis by PCR for an overall prevalence of 25%. Four samples were identified as assemblage C (15.4%), 21 as assemblage D (80.8%), and one as assemblage E (3.8%). Puppies were four-times more likely to be infected with G. duodenalis than adult dogs (OR 4.61, 95% CI 1.73–12.2). There was a significant agreement between ELISA and PCR in the detection of the protozoa (κ=0.67). We infer from our results that while the prevalence of G. duodenalis is relatively high in Trinidad and Tobago, the zoonotic risk of infection in humans is low since neither assemblage A nor B was identified in the study population.

Burden of Giardia duodenalis infection and its adverse effects on growth of schoolchildren in rural Malaysia.

Burden of Giardia duodenalis infection and its adverse effects on growth of schoolchildren in rural Malaysia.

Epidemiological, parasitological and molecular aspects of Giardia duodenalis infection in children attending public daycare centers in southeastern Brazil

The purpose of this study was to determine the prevalence, associated risk factors and genotype of Giardia duodenalis infection in children attending public daycare centers in the city of Araguari, state of Minas Gerais, Brazil. Fecal samples were collected from 245 children aged 0–5 years, and questionnaires were asked about sociodemographic and hygiene-related characteristics. At the daycare centers where children tested positive, fecal samples were collected from the staff handling food, and from family members and domestic animals. Positive samples were analyzed at the dehydrogenase glutamate (gdh) locus to determine the genotype. The prevalence of G. duodenalis was 51.8%, and drinking unfiltered and unboiled water (OR 2.12, CI 1.26–3.69, p<0.001) and washing hands only with water (OR 2.14, CI 1.19–4.04, p<0.001) were related risk factors. No association was found between test-positive children and their family members, domestic animals and food handlers. An analysis of the sequences of 30 samples revealed that they all belonged to genotype B.

Saliva and sera IgA and IgG in Egyptian Giardia-infected children

Giardiasis is a gastrointestinal infection of wide distribution that is more prevalent in childhood. Easy and rapid diagnosis of giardiasis is essential for reduction of this infection. This cross-sectional study included 62 children in which collection of saliva, stool and serum samples was performed. An enzyme-linked immunosorbent assay (ELISA) technique was evaluated to detect IgA and IgG responses in both saliva and serum samples. Twenty-two children were positive for Giardia duodenalis infection by direct examination of faecal specimens, 20 non-infected and 20 infected with other parasites. Salivary and serum IgA and IgG responses against G. duodenalis infection were significantly higher in Giardia parasitized than non-Giardia parasitized children (p < 0.001). This concludes that specific salivary IgA may serve as a diagnostic tool and specific salivary IgG as a screening tool in monitoring the exposure of various populations to Giardia duodenalis. The advantage of salivary assays over serum immunoglobulin assay is being easy and non-invasive in sampling technique which is important especially for young children.

Prevalence and risk factors for Giardia duodenalis infection among children: A case study in Portugal

BackgroundGiardia duodenalis is a widespread parasite of mammalian species, including humans. The prevalence of this parasite in children residing in Portugal is currently unknown. This study intended to estimate G. duodenalis infection prevalence and identify possible associated risk factors in a healthy paediatric population living in the District of the Portuguese capital, Lisbon.MethodsBetween February 2002 and October 2008, 844 children were randomly selected at healthcare centres while attending the national vaccination program. A stool sample and a questionnaire with socio-demographic data were collected from each child. Giardia infection was diagnosed by direct examination of stools and antigen detection by ELISA.ResultsThe population studied revealed a gender distribution of 52.8% male and 47.2% female. Age distribution was 47.4% between 0-5 years and 52.6% between 6-15 years.The prevalence of Giardia infection was 1.9% (16/844) when estimated by direct examination and increased to 6.8% (57/844) when ELISA results were added. The prevalence was higher among children aged 0-5 years (7.8%), than among older children (5.8%), and was similar among genders (6.9% in boys and 6.5% in girls). The following population-variables were shown to be associated risk factors for G. duodenalis infection: mother's educational level (odds ratio (OR)= 4.49; confidence interval (CI): 1.20-16.84), father's educational level (OR = 12.26; CI: 4.08-36.82), presence of Helicobacter pylori infection (OR = 1.82; CI: 1.05-3.15), living in houses with own drainage system (OR = 0.10; CI: 0.02-0.64) and reported household pet contact, especially with dogs (OR = 0.53; CI: 0.31-0.93).ConclusionThe prevalence of giardiasis in asymptomatic children residing in the region of Lisbon is high. Several risk factors were associated with Giardia prevalence and highlight the importance of parents' education and sanitation conditions in the children's well being. The association between G. duodenalis and H. pylori seems an important issue deserving further investigation in order to promote prevention or treatment strategies.

Occurrence of Giardia duodenalis infection in chinchillas (Chincilla lanigera) from Italian breeding facilities

The present work investigated the occurrence of Giardia infection in Chinchilla lanigera reared in three Italian breeding facilities and determined their role as potential zoonotic reservoir. One hundred and four fecal samples were tested for the presence of Giardia spp. cysts using a Direct Fluorescent Assay (DFA). A high positivity rate (39.4%) was found despite all animals were asymptomatic at the time of sampling. Thirty-one positive samples were genetically characterized by sequence analysis of the ITS1–5.8S–ITS2 region of the Giardia ribosomal DNA. Assemblages B (29 isolates) and C (two isolates) were identified. These results showed that Giardia infection can be common in chinchillas, thus spurring further molecular epizootiological studies of the infection to assess the zoonotic potential or host specificity of their isolates, to determine the source of infections, to identify the routes of transmission, and to control the infection among animal populations.

Preliminary experiments on use of zebrafish as a laboratory model for Giardia duodenalis infection

Although Giardia duodenalis is considered a parasite of mammals, different genotypes have been identified as infecting several species of freshwater and marine fish in Australia. Establishment of G. duodenalis infection in common laboratory zebrafish (Danio rerio), could provide an excellent tool for a range of studies on Giardia. We conducted preliminary experiments to investigate this possibility. Zebrafish were inoculated with viable G. duodenalis cysts from two different Assemblages (A and D) using a modified oro-gastric tube. Direct microscopy and immunofluorescent antibody test were used to check for Giardia cysts/trophozoites in the intestine, and histology was performed on intestinal mucosa to evaluate possible pathological changes. Giardia cysts were successfully deposited in the zebrafish alimentary tract using a modified oro-gastric tube, and were maintained in the fish gut for at least 8 days. Although a single trophozoite was observed in one fish three days post-exposure, we were unable to demonstrate established, propagative infection under the conditions tested.

Does Silent Giardia Infection Need Any Attention?

Even though treatment of symptomatic cases as well as improving hygiene and sanitation conditions decrease giardiasis in underdeveloped and/or developing countries, Giardia duodenalis infection is still frequently encountered especially in children living in crowded conditions leading to public health problems. We studied the prevalence of G. duodenalis infection in 274 asymptomatic Thai boy orphans, living in/around the Bangkok metropolitan area, by use of direct fecal smear and formalin-ethyl acetate techniques. This was done to explore our hypothesis that children with asymptomatic giardiasis, who are not likely to be treated, have a high potential for spreading this pathogen. Positive Giardia cases were further genotyped by 2 genes: small subunit ribosomal RNA (ssrRNA) and glutamate dehydrogenase (gdh) to determine the distribution of each G. duodenalis assemblage. Positive G. duodenalis infection was 11.67 % and revealed at 10.63%, 12% and 15%, in PK, TMK, and MHK orphanages, respectively. The overall parasitic infection, including Giardia, was 48.54% consisting mostly of non-pathogenic organisms i.e. Blastocystis hominis, Entamoeba coli, Endolimax nana, Entamoeba histolytica-like, Chilomastix mesnili, Trichuris trichiura, Hymenolepis nana, Strongyloides stercoralis and Hookworm. Fourteen (70 %) and 4 (20 %) out of the 20 positive Giardia samples could be amplified by ssrRNA and gdh genes, respectively; three belonged to the sub-assemblage BIV and only one indicated sub-assemblage AII. Thus children infected with sub-assemblage BIV isolate are more common in this study. In conclusion, we focused on asymptomatic giardiasis children, hitherto unrecognized, who consistently contaminate their environments with cysts. We favor not only treating these children to eradicate the source of the infection, but also to encourage an active surveillance program consisting of highly sensitive methods to identify silent giardiasis cases. In addition to these 2 strategies, a continuous fruitful health education program for all stakeholders is another crucial tool. These actions will benefit the control of human giardiasis and reduce public health problems.

Prevalence of Giardia duodenalis assemblages among dairy herds in the New York City Watershed

A longitudinal herd-level study was carried out to determine the cumulative incidence of Giardia duodenalis infections in dairy cattle in the New York City Watershed. We also sought to assess the changes in infection pattern of animals diagnosed as shedding Giardia over time, determine risk factors that may be associated with G. duodenalis infections, and identify potentially zoonotic infections. A total of 2109 fecal samples were randomly collected from dairy cattle at 34 farms in the New York City Watershed on a seasonal basis. A total of 504 Giardia-positive samples were identified by zinc sulfate flotation. The overall cumulative incidence of G. duodenalis based on flotation results was 23.9% with 73.8% of all infections occurring in animals under 180 days of age (372/504). The intensity of infection ranged from 2 to 563,200 cysts/gram of feces. Cattle shedding Cryptosporidium spp. oocysts were twice as likely to shed G. duodenalis cysts in comparison to the animals that did not shed oocysts (1.81 95% CI 1.26–2.60 p=0.0012). In the multivariate analysis, only the age of the animal and the presence of dogs on the farm were significantly associated with the likelihood of shedding G. duodenalis. DNA was extracted from positive samples and analyzed by polymerase chain reaction (PCR) of the beta-giardin and triosephosphate isomerase genes of Giardia spp. 304 samples were analyzed by PCR of which 131 were sequenced. 22.1% of sequenced samples were identified as assemblage A and 77.9% were identified as assemblage E. Interestingly, 100% of specimens identified as assemblage A were from calves under 84 days of age indicating that younger cattle are important reservoirs for potentially zoonotic assemblages of G. duodenalis.

Impacts of naturally acquired protozoa and strongylid nematode infections on growth and faecal attributes in lambs

On two separate sampling occasions, faecal samples were collected from lambs (2–5 months of age) grazing pasture on two separate sheep farms in southern Western Australia. Live weight, body condition score (BCS), faecal consistency score (FCS) and faecal dry matter percentage (DM%) were measured. Faecal samples were screened by PCR for Cryptosporidium (18S rRNA, actin and 60kDa glycoprotein [gp60] loci), Giardia duodenalis (glutamate dehydrogenase [gdh] and β-giardin) and patent strongylid nematode infections (ITS-2 nuclear ribosomal DNA for Haemonchus contortus, Teladorsagia circumcincta, Trichostrongylus spp. Chabertia ovina and Oesophagostomum spp.). Faecal worm egg counts (WECs) were performed using a modified McMaster WEC technique. The WECs were adjusted for FCS and transformed using log10(adjusted WEC+25) prior to statistical analyses.Cryptosporidium, Giardia and Trichostrongylus spp. detected by PCR were associated with an increased risk of non-pelleted faeces (FCS≥3.0) for both flocks. Cryptosporidium-positive lambs were 2.8–11.6 times more likely to have non-pelleted faeces and Giardia-positive lambs were 2.4–14.0 times more likely to have non-pelleted faeces compared to lambs negative for each respective parasite. Lambs positive for both Cryptosporidium and Giardia were 2.9–11.8 times more likely to have non-pelleted faeces than lambs positive for only one or neither of these parasites. Mixed internal parasite infections were found to have greater impacts on FCS and BCS than single infections. A higher number of internal parasites detected per lamb was associated with lower BCS and more loose faeces. The relationship between parasite detection and live weight or growth rate were inconsistent for both flocks. Adjusted WEC was correlated with FCS and faecal DM% for one flock only, although little or no correlation was found with live weight and growth rate for both flocks. Cryptosporidium ubiquitum and Cryptosporidium parvum were the most prevalent Cryptosporidium species isolated in the two flocks. Giardia assemblage E was the most commonly isolated genotype assemblage from both flocks, while assemblage A was isolated almost as frequently as assemblage E in the one flock. One flock was a potential source of zoonotic Cryptosporidium and the other flock was a potential source of zoonotic Giardia.

The efficacy of a treatment with fenbendazole against an experimental Giardia duodenalis infection in lambs

The aim of the present study was to evaluate the efficacy of fenbendazole (Panacur 2.5%; Intervet/Schering-Plough) at 15mg/kg/day during 3 consecutive days in lambs experimentally infected with Giardia duodenalis, and to evaluate the benefit of the treatment with fenbendazole on growth, faecal consistency and general health. To this end, 42 weaned (∼12 weeks of age) and healthy lambs were selected and housed into three experimental groups based on weight. One group of 14 lambs remained uninfected (group 1: negative control group), while the other 28 lambs were infected with a total of 105G. duodenalis cysts, 11 days prior to treatment (D11). Based on the average individual cyst counts between D4 and D2, the infected animals were allocated on D1 into two groups of 14 animals each. Treatment was randomly assigned to one of these two groups, and all animals in the treatment group (group 3) were orally treated with fenbendazole at 15mg/kg/day during 3 consecutive days starting from D0 (day of treatment). The lambs in the positive (group 2) and negative control group received a placebo (water). From 3 days after treatment (D3) onwards, cyst excretion was determined three times a week during 4 consecutive weeks after the start of the treatment. The faecal consistency and general health were recorded at each sampling day. The weight was recorded prior to treatment and at the end of each week throughout the experimental period. During the experimental period, there was a high (≥97.8%) and continuous reduction in cyst excretion in the treatment group compared to the positive control group for 12 days, resulting in a significant (P<0.001) reduction of the cumulative cyst excretion until D21. There were no significant differences in general health and faecal consistency between the three groups, as there were no overt clinical symptoms in any of the infected animals. Prior to treatment the weight did not differ between the three groups. Although not significantly different, the animals in the treatment group gained on average 4.23kg over the 4-week period, while the infected and non-infected animals gained 3.78kg and 3.52kg, respectively.

Co-infection with Ascaris lumbricoides modulates protective immune responses against Giardia duodenalis in school Venezuelan rural children

We evaluated the effect of Ascaris lumbricoides on Giardia duodenalis infection and TH1/TH2 type immune mechanisms toward this parasite in 251 rural parasitized and 70 urban non-parasitized school children. The children were classified according to light (0–5000eggs/gfaeces) or moderate (>5001–50,000eggs/gfaeces) A. lumbricoides infection. Anti G. duodenalis skin hyper-reactivity, IgE, IgG, IL-13, IFN γ, IL6 and IL-10 levels were compared among G. duodenalis infected and non-infected children according to light or moderate A. lumbricoides infection. It was found that 62% of the A. lumbricoides moderately infected children were co-infected by G. duodenalis compared to 45% of the lightly infected group. After treatment, 42% of the A. lumbricoides moderately group were infected with G. duodenalis compared to 11% of their lightly counterparts, being A. lumbricoides IL-10 levels higher (p<0.0001) in the moderately infected group. In the A. lumbricoides lightly parasitized children, G. duodenalis infection was associated to a significant increase (p<0.005) of the levels of G. duodenalis IL-13, IFN-γ, IL-6, IgE, IgG and skin test hyper reactivity. In contrast, there was no effect of G. duodenalis infection in the elevation of these parameters among the A. lumbricoides moderately parasitized group, being those levels similarly lower as those observed in the control group. Inverse correlations were found between the levels of anti G duodenalis antibodies, skin test hyper-reactivity and cytokines with the intensity of A. lumbricoides infection (p>0.0001) and A. lumbricoides IL-10 levels (p>0.0001), suggesting that co-infection with A. lumbricoides may affect both TH1 and TH2 type immunity against G. duodenalis that may play an important role in the susceptibility to the infection after chemotherapy in children from endemic areas.

Impact of a citywide sanitation program in Northeast Brazil on intestinal parasites infection in young children.

BackgroundSanitation affects health, especially that of young children. Residents of Salvador, in Northeast Brazil, have had a high prevalence of intestinal parasites. A citywide sanitation intervention started in 1996 aimed to raise the level of sewer coverage from 26% to 80% of households.ObjectivesWe evaluated the impact of this intervention on the prevalence of Ascaris lumbricoides, Trichuris trichuria, and Giardia duodenalis infections in preschool children.MethodsThe evaluation was composed of two cross-sectional studies (1998 and 2003–2004), each of a sample of 681 and 976 children 1–4 years of age, respectively. Children were sampled from 24 sentinel areas chosen to represent the range of environmental conditions in the study site. Data were collected using an individual/household questionnaire, and an environmental survey was conducted in each area before and after the intervention to assess basic household and neighborhood sanitation conditions. Stool samples were examined for the presence of intestinal parasites. The effect of the intervention was estimated by hierarchical modeling, fitting a sequence of multivariate regression models.FindingsThe prevalence of A. lumbricoides infection was reduced from 24.4% to 12.0%, T. trichuria from 18.0% to 5.0%, and G. duodenalis from 14.1% to 5.3%. Most of this reduction appeared to be explained by the increased coverage in each neighborhood by the sewage system constructed during the intervention. The key explanatory variable was thus an ecological measure of exposure and not household-based, suggesting that the parasite transmission prevented by the program was mainly in the public (vs. the domestic) domain.ConclusionThis study, using advanced statistical modeling to control for individual and ecological potential confounders, demonstrates the impact on intestinal parasites of sanitation improvements implemented at the scale of a large population.