Stool Survey Research Articles

Factors associated with Cyclospora infection in a Venezuelan community: extreme poverty and soil transmission relate to cyclosporiasis.

Transmission dynamics of Cyclospora cayetanensis in endemic areas and the factors associated with soil contamination remain unclear. The effects of environmental factors on Cyclospora have been insufficiently studied, particularly in South America, thus a Venezuelan community was studied to profile risk factors for infection. A cross-sectional stool survey of 732 individuals was conducted. For Cyclospora screening, an acid-fast-stained smear of formalin-ethyl acetate concentrate and ultraviolet (UV) epifluorescence examination of a wet mount were used. Water (n=14), soil (n=50) and produce (n=77) samples were collected, processed and examined by UV epifluorescence. Data were analysed using multivariate logistic regression. Cyclospora infections were identified in 73 (9.9%) subjects. Variables associated with the infection were age ≤10y (odds ratio [OR] 14), hut living (OR 5), well water use (OR 18.5), drinking untreated water (OR 7.6), toilet absence (OR 8), having contact with faeces-contaminated soil (OR 4) and poultry exposure (OR 3). Infections (63%) were clustered in 25 huts. Oocysts were identified in 28.6%, 18% and 3.9% of the water, soil and produce samples, respectively. There was an explicit association of Cyclospora infection with extreme poverty and soil transmission reflecting the household socio-economic correlate of cyclosporiasis in this community.

Schistosoma mansoni infection and related knowledge among schoolchildren in an endemic area of Minas Gerais, Brazil, prior to educational actions

As a signatory to World Health Assembly Resolution WHA65.21 on eliminating schistosomiasis, the Brazilian Ministry of Health (MoH) recommends early identification and timely treatment of the infection carriers for morbidity control, plus complementary preventive measures, such as health education, for transmission control. This study reports infection and awareness of schistosomiasis among schoolchildren before the implementation of school-based educational actions in an endemic municipality with persisting moderate prevalence levels despite successive control campaigns since the late 1990s. A questionnaire was applied in April 2013 to schoolchildren in the middle years of schooling (6th to 8th year) of Malacacheta municipality to assess baseline knowledge and risk behaviour related to schistosomiasis. A stool survey was conducted in May/June 2013 in 2519 schoolchildren from all years of fundamental education (first to 9th year) to identify the infection carriers, as well as to assess baseline prevalence and intensity of infection using the Kato-Katz method (one sample, two slides). The infected schoolchildren were treated promptly with single-dose praziquantel 60mg/kg and followed up after 45days for treatment efficacy. Relevant outcomes from baseline stool survey, treatment and follow-up were statistically evaluated in relation to area of residence (rural/urban), gender, age group (<11/≥years) and infection. Adherence to baseline survey was 81.2%, and prevalence of infection was 21.4%. Of the 539 positives, 60 (11.1%) had ≥400 eggs per gram of faeces (heavy-intensity infection). Prevalence of infection was significantly higher among rural residents and≥11year olds, whereas intensity of infection was higher among rural residents,≥11year olds and boys. Adherence by the positives to treatment was 93.3% and adherence by the treated children to 45-day follow-up was 72.2%. At 45days after treatment, 97.0% of the 363 children surveyed were egg-negative; the egg reduction rate was 99.4%. Of the 924 children who responded to the questionnaire, 95.5% showed awareness of schistosomiasis, although 76.2% reported contact with natural, unsafe bodies of water. Reported contact with water was significantly more frequent among infected than non-infected, and boys than girls. The results show persisting infection and risk behaviour among schoolchildren, regardless of their basic knowledge about schistosomiasis. These are grounds for implementing specific educational actions to improve awareness and behavioural change, jointly with other control measures, to attain the MoH goals.

Faktor Risiko Kejadian Schistosomiasis di Dataran Tinggi Bada Kabupaten Poso Sulawesi Tengah

Schistosmiasis transmission occured due to contribution of some related factors. This study was observational study with cross sectional design that aimed to identify knowledge, attitude and practice of community to schistosmiasis in Bada Highland. Data collection was conducted by stool survey and interview using questioner on 246 respondent that choosen by simple random sampling o identify the risk factors of schistosomiasis incidence. The result showed positive practices that related to schistosomiasis incidence that were defecation in hygiene latrine (p=0,001) and wearing the protection tools while went to the focus area (p<0,001). The negative practice that related to schistosomiasis that were take a bath / wash in the river (p=<0,001). These result indicate that activities by defecation in hygiene latrine and wearing the protection tools while went to the focus area decrease schistosomiasis whereas take a bath/wash in the river reducting the transmission schistosomiasis. Schistosomiasis transmission was related to practice such as defecation in hygiene latrine, take a bath/wash in the river and wearing the protection tools while went to the focus area.

KO-INFEKSI SCHISTOSOMA JAPONICUM DAN SOIL TRANSMITTED HELMINTH DI DAERAH ENDEMIS SCHISTOSOMIASIS KECAMATAN LORE UTARA DAN LORE TIMUR, KAB. POSO, SULAWESI TENGAH

Schistosomiasis due to Schistosoma japonicum are still endemic in Indonesia, especially in Lindu, Sigi Regency, Napu and Bada Plateu, Poso Regency, Central Sulawesi. The proportion of co-infection soil transmitted helminths and schistosomiasis information in the endemic areas is still limited. The aim of this study was to determine the proportion of co-infection between schistosomiasis and soil transmitted helminth. The information was obtained from the stool survey conducted by Schistosomiasis Control Programme, Provincial Health Office Central Sulawesi, from January to June 2013 in North Lore and East Lore District, Poso Regency. Stool samples were examined with Kato Katz technique. The result shows in North Lore, Schistosoma japonicum infection was 1.62 %. Co-infection of Schistosoma japonicum and Ascaris was 0.25 %, S. japonicum and Hook worm 0.18%, and also S. japonicum and Trichuris trichiura 0.06%. In East Lore, the prevalence of Schistosoma japonicum was 3.00 %. Co-infection of S. japonicum and Ascaris 0.82 %, S. japonicum and Hookworm 0.37%, S. japonicum and Trichuris trichiura 0.22%. The proportion of soil transmitted helminths and Schistosoma japonicum was high in the location.

Increase number of mitochondrion-like organelle in symptomatic Blastocystis subtype 3 due to metronidazole treatment.

Blastocystis sp., an intestinal organism is known to cause diarrhea with metronidazole regarded as the first line of treatment despite reports of its resistance. The conflicting reports of variation in drug treatment have been ascribed to subtype differences. The present study evaluated in vitro responses due to metronidazole on ST3 isolated from three symptomatic and asymptomatic patients, respectively. Symptomatic isolates were obtained from clinical patients who showed symptoms such as diarrhea and abdominal bloating. Asymptomatic isolates from a stool survey carried out in a rural area. These patients had no other pathogens other than Blastocystis. Ultrastructural studies using transmission electron microscopy (TEM) and scanning electron microscopy (SEM) revealed drug-treated ST3 from symptomatic patients were irregular and amoebic with surface showing high-convoluted folding when treated with metronidazole. These organisms had higher number of mitochondrion-like organelle (MLO) with prominent cristae. However, the drug-treated ST3 from asymptomatic persons remained spherical in shape. Asymptomatic ST3 showed increase in the size of its central body with the MLO located at the periphery.

Helminth prevalence among adults in rural Kenya: a stool survey for soil-transmitted helminths and schistosomiasis in Nyanza province.

Soil-transmitted helminth (STH) prevalence in children is high in rural southwestern Kenya, but adult prevalence data are scarce. A 2010 study of a village in Nyanza province found a pediatric STH prevalence of 44% using a direct stool-smear method. Adult STH prevalence and associated predictors was measured in the same village. Adults (≥18 years) presenting at the out-patient department of the small hospital or community outreach events completed a short questionnaire and provided stool samples. Light microscopy for ova and larvae was conducted using a stool concentration technique to improve sensitivity. Multivariable regression models were used to identify predictors of STH prevalence. Among 344 adults, STH prevalence was 15.7% (54/344). Hookworm was most common (13.1%; 45/344), followed by Ascaris lumbricoides (6.1%; 21/344) and Trichuris trichiura (0.6%; 2/344). Twelve participants (3.5%; 12/344) had multiple STHs and three (0.9%; 3/344) had Schistosoma mansoni. Female sex, older age and lower education level were significant STH predictors. Adult STH prevalence was lower than previous studies of children from the same village. Adults with the identified risk factors had a prevalence of ≥20%, which may warrant periodic, targeted deworming of adults with these risk factors given the low cost and low toxicity of anthelmintic drugs.

Isolation and characterization of a Chinese strain of human enterovirus 74 from a healthy child in the Tibet Autonomous Region of China

Human enterovirus 74 (HEV74) is a recently described serotype within the species Human enterovirus B (HEV-B). Few nucleotide sequences of HEV74 are available, and only one complete genome sequence (the prototype strain) has been published. In this study, we report the complete genome sequence of an HEV74 strain isolated from a healthy child during a stool survey in the Tibet Autonomous Region of China. The results indicated that HEV74 may be a prevalent and common enterovirus type, and that HEV74 is globally distributed, especially in Asia. Sequence analysis revealed high variability among HEV74 strains and indicated frequent recombination within HEV-B.

BEBERAPA FAKTOR YANG BERHUBUNGAN DENGAN PENULARAN Schistosoma japonicum DI DATARAN TINGGI NAPU KABUPATEN POSO SULAWESI TENGAH

Abstract. The transmission of schistosomiasis is related with human behavior or habit factors in the schistosomiasis endemic area. The Purpose of this study was to identify several factors in relationship with schistosomiasis in Napu Highland. The Study was observational with cross sectional design. Data collection were coducted stool survey and interviewes in among 196 respondents using simple random sampling. Stool samples were examined by the Kato-Katz method and interviewed was used questionnaire to identify several factors in realtionship with schistosomiasis transmission. Out of 6 community behaviours suspected to contribute to infection of schistosomiasis, 5 were related with schistosomiasis, i. e. the habit of taking a bath and washing in the river (p=<0.001), always going to the focus area (p=0.04),utilizing water resources from well (p=0.001), washing legs or hand in the river(p=<0.001) and swimming (p=0.007). Schistosomiasis infection was related to the community behaviour of bathing and washing in the river, always going to the focus area, utilizing water resources from well, washing legs or hand in the river and swimming. Key word: Schistosomiasis, Schistosoma japonicum, behaviour, Napu Highland.Central Sulawesi

A rationale for schistosomiasis control in elementary schools of the rainforest zone of pernambuco, Brazil.

BackgroundSince its beginning in 1999, the Schistosomiasis Control Program within the Unified Health System (PCE-SUS) has registered a cumulative coverage of just 20% of the population from the Rainforest Zone of Pernambuco (ZMP), northeast Brazil. This jeopardizes the accomplishment of the minimum goal of the Fifty-Fourth World Health Assembly, resolution WHA54.19, of providing treatment for schistosomiasis and soil-transmitted helminthiases (STH) to 75% of school-aged children at risk, which requires attending at least 166,000 residents in the 7–14 age range by year 2010 in that important endemic area. In the present study, secondary demographic and parasitological data from a representative municipality of the ZMP are analyzed to provide evidence that the current, community-based approach to control schistosomiasis and STH is unlikely to attain the WHA-54.19 minimum goal and to suggest that school-based control actions are also needed.Methodology/Principal FindingsData available on the PCE-SUS activities related to diagnosis and treatment of the population from the study municipality were obtained from the State Secretary of Health of Pernambuco (SES/PE) for 2002–2006, complemented by the Municipal Secretary of Health (SMS) for 2003–2004. Data from a school-based stool survey carried out by the Schistosomiasis Reference Service of the Oswaldo Cruz Foundation (SRE/Fiocruz) in 2004 were used to provide information on infection status variation among school-aged children (7–14 years). According to the SES, from 2004 to 2006, only 2,977 (19.5%) of the estimated 15,288 residents of all ages were examined, of which 396 (13.3%) were positive for Schistosoma mansoni. Among these, only 180 (45.5%) were treated. According to the SMS, of the 1,766 examined in the 2003–2004 population stool survey 570 (32.3%) were children aged 7–14 years. One year later, the SRE/Fiocruz school survey revealed that the infection status among those children remained unchanged at 14%–15% prevalence. By 2006, the school-aged population was estimated at 2,981, of which 2,007 (67.3%) were enrolled as pupils.ConclusionsIt is suggested that in the most troubled municipalities individual diagnosis and treatment should be concentrated in school-aged children rather than the whole population. School-based actions involving teachers and children's families may help the health teams to scale up control actions in order to attain the WHA-54.19 minimum goal. This strategy should involve health and education organs and include both enrolled and non-enrolled children.

Prevalence survey of schistosomiasis in Mindanao and the Visayas, The Philippines

The first two phases of a national prevalence survey of schistosomiasis in The Philippines were completed in Mindanao in 2005 and the Visayas in the first quarter of 2007. The design was a stratified two-step systematic cluster sampling, with two Kato–Katz thick smears examined from each participant. In Mindanao, a total of 22 provinces spread in six regions were covered by the survey with five barangays (equivalent to a village) per province for a total of 110 barangays. The response rate was 70.9% with a total of 21,390 individuals examined. The province of Maguindanao, a known endemic area for schistosomiasis japonica, failed to take part in the survey. In the Visayas, 10 out of 11 provinces, spread out in three regions, participated in the survey. There were 6321 respondents for an overall participation rate of 32.2%. Mindanao showed a wider coverage of the disease than the Visayas (60% versus 45%). By region, Caraga or Region 13 ranked first in Mindanao and Region 8 in the Visayas. By province, Agusan del Sur is first on the list, followed by Northern Samar and then Eastern Samar. Overall, the prevalence rate among males is higher than that of females suggesting the occupational hazard of farming and fishing among the males. The higher exposure among farmers and fishermen is also borne out by the age distribution of the disease. Prevalence remains consistently high among the adults compared with the younger age groups. The survey also covered other helminth infections that can be detected in a stool survey, notably soil-transmitted helminthes and food-borne trematodes.

Continuation of Antibiotics Is Associated With Failure of Metronidazole for Clostridium difficile-Associated Diarrhea

Metronidazole is first-line therapy for C. difficile-associated diarrhea primarily because of its low cost relative to vancomycin. Currently, it is unknown which patients will fail metronidazole therapy. Our goal was to prospectively evaluate risk factors for metronidazole failure. Included patients had symptomatic C. difficile-associated diarrhea, either mild or severe. Once enrolled, detailed baseline data were gathered. All interviews were performed daily while the patient was in the hospital for up to 14 days. If discharged prior to 14 days, the patient received a follow-up phone call on day 5 and day 14. Enrolled patients were given a daily stool survey to complete. We enrolled 27 patients with C. difficile-associated diarrhea. All patients (10 of 10) who had their offending antibiotic(s) discontinued had symptomatic resolution of diarrhea by day 14 of metronidazole treatment. Conversely, 59% (10 of 17) of patients who remained on antibiotics during treatment had symptomatic resolution by day 14 (P=0.02). The risk ratio for treatment failure was 2.0 (95% confidence interval, 1.29-3.10) in patients who remained on antibiotics. In our treatment group, there would be one additional metronidazole treatment success for every 2.4 patients who discontinued antibiotics. Patients who remain on antibiotics while undergoing treatment of C. difficile-associated diarrhea have a high likelihood of treatment failure with metronidazole.

Epidemiology of Cyclospora cayetanensis and other intestinal parasites in a community in Haiti.

We conducted an exploratory investigation in a community in Haiti to determine the prevalence of Cyclospora cayetanensis infection and to identify potential risk factors for C. cayetanensis infection. In 2001, two cross-sectional stool surveys and a nested case-control study were conducted. In 2002, a follow-up cross-sectional stool survey was conducted among children < or =10 years of age. Stool specimens from study participants and water samples from their wells were examined for Cyclospora and other intestinal parasites. In stools, the prevalence of infection with Cyclospora in persons of all ages decreased from 12% (20 of 167 persons) in February 2001 to 1.1% (4 of 352 persons) in April 2001, a 90.8% decrease. For children < or =10 years of age, the prevalence rates were 22.5% (16 of 71 children) in February 2001, 3.0% (4 of 135 children) in April 2001, and 2.5% (2 of 81 children) in January 2002. Use of the water from the artesian well in the northern region of the community versus the one in the south was the only risk factor associated with Cyclospora infection in multivariate analyses (odds ratio, 18.5; 95% confidence interval, 2.4 to 143.1). The water sample from one of the nine wells or water sources tested (one sample per source) in January 2001, shortly before the investigation began, was positive for Cyclospora by UV fluorescence microscopy and PCR. None of the water samples from the 46 wells or water sources tested during the investigation (one sample per source per testing period, including the artesian wells) were positive for Cyclospora. Further studies are needed to assess the role of water as a possible risk factor for Cyclospora infection in Haiti and other developing countries.

Incidence of fecal carriage of Listeria monocytogenes in three healthy volunteers: a one-year prospective stool survey.

The aim of this study was to establish the incidence of fecal carriage of Listeria monocytogenes in healthy adults. A total of 868 stool specimens from three healthy volunteers (1 male and 2 females; ages 44, 39, and 60 years) were collected between 1 October 2000 and 30 September 2001. Culture was performed using Fraser broth and Palcam selective agar plates. Polymerase chain reaction (PCR) was performed using Probelia Listeria monocytogenes (BioRad, France). Overall, Listeria monocytogenes was detected in 31 of the 868 (3.57%) stool specimens using PCR. Sixteen of the 31 positive results were single events, i.e., samples collected from the same patient the day before and the day after the positive result were both negative. Positive results on two consecutive days were found four times, on three consecutive days one time, and on four consecutive days one time. Listeria monocytogenes was cultured from 10 of 868 (1.15%) stool specimens. These culture-positive samples, all positive by PCR as well, accounted for five independent episodes. Using automated ribotyping on up to 40 single colonies per stool specimen, 9 of 10 culture-positive samples yielded more than one strain. There was no obvious seasonal clustering of positive results. None of the documented episodes of Listeria monocytogenes carriage, all of which involved serotypes 1/2a and 1/2b, coincided with overt illness. The results of PCR indicate an incidence of five to nine exposures to Listeria monocytogenes per person per year. On average, the incidence of culture-confirmed fecal carriage in healthy adults is two episodes of Listeria monocytogenes carriage per person per year. Fecal shedding was of short duration (maximum 4 days), which argues against the appropriateness of routine stool screening in dairy workers as a tool for prevention of listeriosis.

Stool Survey of Asymptomatic Diapered Children in Day Care

A survey of diaper-wearing children in community-day-care centers was conducted by the San Diego Department of Health Services during the period February-April 1986 to determine the presence of enteric pathogens in asymptomatic children. Written consent to collect stool samples from diapers was obtained from parents of children at four preschools. No reportable enteric diseases or outbreaks had occurred at the schools in the preceding year. For each child, the preschool teachers maintained a record of symptoms (eg, diarrhea, fever) during the week of stool collection. Stool specimens were collected from 63 diapered children. The samples were examined for parasites and cultured for bacteria and viruses. Giardia lamblia was identified in 18% to 32% of stool samples collected from children at three of the four centers. Prevalence of Giardia varied with the age of the child (0% age &amp;lt;12 months to 33% age &amp;lt;23 months). Microscopic examinations for Cryptosporidium and pathogenic amoeba were negative. Stool cultures were negative for Salmonella, Shigella, and Campylobacter. The prevalence of adenoviruses identified by viral cultures ranged from 32% to 80% at four sites. Echovirus was isolated from 36% of samples at one center. All stools were negative for rotavirus. Giardia was identified in the stools of 22% of children in day care in the absence of diarrhea or of concurrent illness. These findings indicate that asymptomatic infection with Giardia occurs commonly among children attending day-care centers. The lack of any documented outbreak or symptoms of enteric disease among attendees suggests that these asymptomatic children with Giardia need not be excluded from day care.

Giardia transmission in a swimming pool.

In the fall of 1985, an outbreak of giardiasis occurred among several swimming groups at an indoor pool in northeast New Jersey. Nine clinical cases were identified, eight of whom had Giardia positive stool specimens. All were female; seven were adults (greater than 18 years) and two were children. The attack rate was highest (39 per cent, 5/13) for the ladies lap group who had exposure on one day. These cases had no direct contact with children or other risk factors for acquiring Giardia. Infection most likely occurred following the ingestion of swimming pool water contaminated with Giardia cysts. The source of Giardia contamination was a handicapped child who had a fecal accident in the pool. He was a member of a group that swam at the same time as the ladies lap group. A stool survey of the handicapped group showed that of the 20 persons tested, nine were positive for Giardia, including the specimen from this child. Examination of the pool records showed that no chlorine levels had been taken on the day of the fecal accident and that on the following day the chlorine level was zero. This is the second report of Giardia transmission among swimming pool attendees. It emphasizes the need to maintain appropriate chlorine levels in swimming pools and to institute measures to clear pools after a fecal accident.

Giardiasis in an infant and toddler swim class.

A Giardia infected Washington State child was found to participate in an infant and toddler swim class. A stool survey of 70 child participants revealed a 61 per cent prevalence of Giardia infection. Also, 39 per cent of 53 mothers and 28 per cent of 21 fathers were Giardia positive. None of the non-swimming playmates were positive. Thirty-five per cent of 23 children exposed only at a better maintained pool to which the classes had been moved four weeks prior to the survey were positive. No evidence of transmission to non-swim class pool users was found.

Epidemiologic features of Strongyloides stercoralis infection in an endemic area of the United States.

The epidemiologic features of Strongyloides stercoralis infection in Kentucky were studied by an analysis of clinical cases at the University of Kentucky Medical Center (UKMC); by an analysis of parasitologic records of the Kentucky Bureau for Health Services (KBHS); and by a prospective stool survey of school children in Clay County, located in southeastern Kentucky, an area of the state previously found to be highly endemic for intestinal parasites. S. stercoralis was the most common parasitic infection diagnosed at UKMC. The patients were predominantly white male adults who were over 50 years old, had an associated chronic or debilitating medical illness, were of low socioeconomic background, and resided in southeastern Kentucky. S. stercoralis was a common parasitic infection at KBHS ad the patients showed a similar geographic distribution. Of 561 Clay County children surveyed, 23.7% harbored one or more intestinal parasite pathogens and 3.0% had S. stercoralis. Thus, S. stercoralis remains highly endemic in Kentucky and may cause disease even in geriatric patients.

Malumfashi Endemic Diseases Research Project, XVI

A parasitological stool survey was conducted on a 10% random sample of villagers living around a recently constructed low-earth dam in an area in rural northern Nigeria. Hookworm (Necator americanus) was the most common intestinal parasite, with a prevalence as high as 89% in adult males from one farming community. However, the intensity of hookworm infection was low (less than 5000 eggs/g) and was unlikely to be responsible for an iron deficiency anaemia in the area studied. Giardiasis was also highly endemic and it was probable that most villagers experienced the infection in childhood. There was a low prevalence of Schistosoma mansoni infection (4% in children aged five to 15 years). Previous studies of the same population have concentrated on S. haematobium infection, but it will be important to monitor the long-term effects of the dam on transmission of both forms of schistosomiasis.A further study was then conducted on pre-school children living in the area surrounding the dam. Stool microscopy show...

The epidemiology of infection with Entamoeba histolytica in The Gambia, West Africa

A country-wide stool survey of The Gambia showed the prevalence of Entamoeba histolytica cysts to range from 13·7% up-country in the dry season to 52·3% near the coast. A longitudinal survey showed a near 100% infection rate over one year and a sharp rise in prevalence as the rains commence with an equally sharp fall as the rains progress. Specific antibody levels are elevated and reasonably constant through the year. Carriers generally show no specific lymphocyte reactivity to amoebic antigen but consistently parasite-negative individuals tended to show elevated lymphocyte reactivity. Attempts to discover the presence of cysts in the environment of villages by cultivation of specimens of water, soil, food, flies and washings from clothes and hands generally failed though E. histolytica was recovered once from a well.

A stool survey for enteric organisms in Aspen, Colorado.

A stool survey of about one-half the permanent population of Aspen, Colorado, was undertaken after an outbreak of giardiasis during the 1965–66 ski season. The prevalence of parasites, viruses, and enteric bacterial pathogens was determined. The chlorazol-black staining technique for fecal films was evaluated and found to be a simple, efficient technique for obtaining permanent stained slides in field studies. Parasitologic examinations of this middle-to-upper income population showed a Giardia lamblia infection rate of 5.0%, significantly higher than the prevalence of both Entamoeba coli and Endolimax nana (1.9%). Only about 1% of the 280 stools cultured were positive for enteric pathogens. Six polioviruses, antigenically classified as vaccine-like, four adenoviruses, and one untyped enterovirus were isolated from the 416 stools examined. No person was doubly infected with parasites, bacteria, or viruses.