Tropical Parasitic Infections Research Articles

Analysis of serum proteomic profiles of endangered Siamese and Burmese Eld's deer infected with subclinical Babesia bovis in Thailand

The endangered Eld's deer is a conserved species in Thailand, where tropical parasitic infections are endemic. Although Eld's deer with babesiosis are generally asymptomatic, they can still harbor the parasite and serve as reservoirs for ticks, spreading the infection to healthy animals within the herd. The present study aimed to investigate potential serum proteome biomarkers of Eld's deer with subclinical Babesia bovis infection. A total of 67 blood samples were collected from captive Siamese and Burmese Eld's deer showing no signs of parasitic infection. The nested polymerase chain reaction (nPCR) of a conserved spherical body protein 2 (sbp-2) gene of B. bovis was utilized to classify Eld's deer groups, with 25.37 % (17/67) testing positive for B. bovis. Additionally, the application of proteomic studies showed that six B. bovis proteins, such as Obg-like ATPase 1 (OLA1) and heat shock protein 90 (HSP90), were significantly upregulated by more than a two-fold change compared with the PCR-negative samples. Of the 55 overexpressed serum proteins in the PCR-positives, alpha 2-HS glycoprotein (AHSG) and immunoglobulin lambda variable 2–8 (IGLV2–8) were notably among the top 10 proteins with the highest area under curve (AUC) values. Hence, they were proposed as potential biomarkers for subclinical B. bovis infection in Eld's deer. Analysis of the protein interaction network revealed interactions between Eld's deer AHSG and B. bovis OLA1 and HSP90, alongside associations with other proteins such as erb-b2 receptor tyrosine kinase 2 (ERBB2) and epidermal growth factor receptor (EGFR). These interactions were involved in the immune system pathway and inflammatory responses. Our findings shed light on subclinical infection of B. bovis in Eld's deer and identify potential biomarkers, contributing to the further effective detection and monitoring of B. bovis infection in this endangered species.

Reduced Glutathione Peroxidase (GPx) Activity in Patients with Cutaneous Leishmaniasis

Background: Cutaneous leishmaniasis (CL) is a tropical parasitic infection that involves several factors in its pathogenesis, including oxidative stress. The oxidative stress in CL may deplete antioxidant nutrients. Objectives: The aim of the study was to measure glutathione peroxidase (GPx) activity in patients with CL. Methods: The investigation included 80 patients with CL and 80 healthy participants. A diagnostic kit was used to measure GPx activity. Results: The results showed a significant decrease in GPx activity in the CL patient group compared to the control group (P < 0.001), which is related to increased oxidative stress in patients. Conclusions: According to the results, GPx enzyme activity can serve as a biomarker for the diagnosis, prognosis, and monitoring of treatment in patients with CL.

Identification and characterization of a novel nematode pan allergen (NPA) from Wuchereria bancrofti and their potential role in human filarial tropical pulmonary eosinophilia (TPE).

Tropical pulmonary eosinophilia (TPE) is a chronic respiratory syndrome associated with Lymphatic Filariasis (LF), a tropical parasitic infection of the human, transmitted by mosquitoes. The larval form of LF (microfilariae) are trapped in the lungs of TPE subjects have a major role in initiating the TPE syndrome. To date, there are no reports on the potential allergen that is responsible for generating parasite-specific IgE in TPE. In this project, we screened a cDNA expression library of the microfilarial stages of Wuchereria bancrofti with monoclonal IgE antibodies prepared from subjects with clinical filarial infections. Our studies identified a novel molecule that showed significant sequence similarity to an allergen. A blast analysis showed the presence of similar proteins in a number of nematodes parasites. Thus, we named this molecule as Nematode Pan Allergen (NPA). Subsequent functional analysis showed that NPA is a potent allergen that can cause release of histamine from mast cells, induce secretion of proinflammatory cytokines from alveolar macrophages and promote accumulation of eosinophils in the tissue, all of which occur in TPE lungs. Based on our results, we conclude that the NPA protein secreted by the microfilariae of W. bancrofti may play a significant role in the pathology of TPE syndrome in LF infected individuals. Further studies on this molecule can help design an approach to neutralize the NPA in an attempt to reduce the pathology associated with TPE in LF infected subjects.

Grasp of dihydroartemisinin resistance in Indonesia: Focused on genetic polymorphisms and new antimalarial.

The eastern region of Indonesia is endemic to malaria, a tropical parasitic infection that causes significant mortality. The Sustainable Development Goals (SDGs) encompass the global commitment to prevent and eliminate malaria by the end of 2030. Nevertheless, the biggest issue lies in the antimalarial drug resistance in Indonesia. Genetic polymorphism has been a considerable factor in the mechanism of antimalarial drug resistance of which could lead to inadequate activity of antimalarial drugs to undertake Plasmodium infection by several molecular mechanisms. Hence, first-line therapy for malaria in Indonesia such as dihydroartemisinin, piperaquine, and primaquine, becomes ineffective. However, the resistance is unavoidable. This review aims to summarize the genetic polymorphism possible mechanisms contributing to antimalarial resistance in the Indonesian population and to discuss the potential new antimalarial drug candidates.

Epidemiology of bovine schistosomiasis and associated risk factors in Ethiopia: A systematic review with meta-analysis of published articles, 2008-2018.

Schistosomiasis is a tropical and subtropical parasitic infection that affects both animals and humans. It's caused by the Schistosoma genus and spreads via snails as an intermediate host. Schistosoma bovis is widely spread in Ethiopia's Northern, Eastern, Southwestern, and Central regions. It is an economically significant cattle disease with global health implications. Despite numerous prevalence studies of bovine schistosomiasis in different regions of the country, no systematic review and meta-analysis of the disease has ever been undertaken. As a reason, the purpose of this research was to provide information that can be used in the planning and design of Schistosoma interventions in Ethiopia, as the world aims to eliminate schistosomiasis as a public health problem by 2030. The PRISMA statement guidline was used to check the eligiblities of the included studies. Electronic bibliographic databases such as PubMed, Google Scholar, HINARI, and Web of science, reference lists from retriv articles, books, libraries, megazins and existing reviews manaually were employed for literature searches. The pooled prevalence of bovine schistosomiasis and heterogeneity among included studies was estimated by employing random effect models and the inverse variance index, respectively. To investigate the source of heterogeneity across and within studies, subgroup analysis was undertaken based on sample size, study years, and study regions. To assess publication bias and small study effects, funnel plotsand Egger's regression test were used. The pooled prevalence was calculated with a 95% confidence interval using STATA 17 software. To identify the various risk variables related to the prevalence of bovine schistosomiasis, a pooled odd ratio was used Based on the inclusion criteria, a total of 20 studies were discovered and included in the meta-analysis. The prevalence of bovine schistosomiasis was found to range from 22 to 45.7%. In this meta-analysis, the estimated pooled prevalence of bovine schistosomiasis was 24% (95% CI: 17% to 31%). Substantial heterogeneity was observed across the included studies (I2 = 88.04%; p< 0.001). The results of the funnel plot and Egger'stests revealed no substantial publication bias (Egger's test; p = 0.509). The pooled odds ratio indicated that poor body condition was positively associated with the infection rate of bovine schistosomiasis (OR: 4.915, 95% CI: 2.675 to 9.030; p<0.001), with poor body conditioned animals having 4.915 times higher likelihood to schistosomiasis infection. This review found that the overall prevalence of bovine schistosomiasis was high and the body condition of animals was identified risk factor for Schistosoma infection among the studied factors. Therefore, this review found that the occurrence of bovine schistosomiasis was strongly associated with the state of body condition of animals. Further, sufficient numbers of prospective studies should be conducted to address other potential risk factors of bovine schistosomiasis in Ethiopia.

BI27 Strongyloides stercoralis screening in dermatology

Abstract Strongyloidiasis is a major neglected tropical disease and chronic parasitic infection caused by Strongyloides stercoralis. An estimated 30–100 million people are infected worldwide, with acquisition via contact with contaminated soil. Accurate data for the UK are unavailable, but there is a prevalence of &amp;gt; 20% in certain immigrant populations. Many cases are asymptomatic; without therapy, the infection may be lifelong. Testing is more common in dermatology since the advent of dupilumab as infection can be life-threatening in the immunocompromised. Symptoms reported with strongyloidiasis include not only pruritus and urticaria but also abdominal and respiratory issues. Standard diagnostic testing of strongyloidiasis relies on demonstration of the parasite in faeces, body fluids or tissue samples, although serology is most often used in dermatology. The aim of our study was to assess why dermatologists are ordering Strongyloides serology and whether the results could identify features of infection. All Strongyloides serology tests sent by dermatology from two centres from January 2021 to December 2022 were analysed. Data collected included demographics, reason for testing, symptoms, foreign travel, test results and treatment. In total, 187 tests were sent. Patient demographics are provided in Table 1. The reasons for testing were before starting dupilumab in 57.2% (n = 107), pruritus in 13.4% (n = 25) and urticaria in 3.2% (n = 6/187). There was a recorded history of other symptoms of strongyloidiasis in five patients, and a recorded history of foreign travel in four. Twelve per cent of results were positive (n = 23/187), 6.9% (n = 13) were borderline and 80.7% (n = 151) were negative. There was no major skew toward a reason for testing in those who were positive/borderline. Eight per cent (n = 3/36) of those with positive/borderline results had other recorded symptoms. Of the positive/borderline results, 31% (n = 11/36) were not treated (mostly because they did not go on to have immunosuppression), 28% (n = 10) were treated with a single dose of ivermectin, 31% (n = 11) with two doses and 8% (n = 3) with four doses. The main reason for Strongyloides testing in dermatology is before starting dupilumab. A low proportion of the patients with positive/borderline results had symptoms, although often this was not recorded. A higher proportion of individuals of Asian or African ancestry had positive/borderline results. We shall also discuss evidence behind the methods of and reasons for Strongyloides testing.Table 1Patient demographicsDemographicAll tests (n = 187)Positive/borderline tests (n = 36)Male115 (61.5)22 (61)Female72 (38.5)14 (39)White52 (27.8)5 (14)Asian95 (50.8)22 (61)Black21 (11.2)5 (14)Other/not stated19 (10.2)5 (14)Data are presented as n (%).

Pre-clinical development of a vaccine for human lymphatic filariasis

This study was conducted to optimize a fusion protein vaccine for translational development as a vaccine against the human tropical parasitic infection, lymphatic filariasis (LF). The vaccine candidate, His-tagged rBmHAXT was developed previously in our laboratory and was tested in various animal models including mouse, gerbils and Rhesus macaque where it exhibited significant levels of vaccine-induced protection. However, for commercial manufacturing and for regulatory approval for human use, there was a need to modify the vaccine antigen and its production and analytical release methods. Therefore, the major focus of this study was to develop a process for manufacturing an affinity tag-free rBmHAXT and evaluate its immunogenicity, potency and protective efficacy in both inbred and outbred mouse models, as well as in outbred gerbil models. Our results demonstrate that the tag-free rBmHAXT vaccine produced with a process suitable for cGMP production had protective properties equivalent to the original His-tagged rBmHAXT.

Genus Zanthoxylum as Sources of Drugs for Treatment of Tropical Parasitic Diseases

The tropical parasitic infections account for more than 2 billion infections and cause substantial morbidity and mortality, and account for several million deaths every year. Majorly parasitic infections in humans and animals are caused by protozoa and helminths. Chronic infections in the host can cause retardation, impairment of cognitive skills, development in young children and weaken the immune system. The burden is felt to a greater extent in developing countries due to poverty, inaccessibility to medicines and resistance observed to drugs. Thus, human health continues to be severely harmed by parasitic infections. Medicinal plants have received much attention as alternative sources of drugs. Zanthoxylum genus has been used ethnobotanically as an antiparasitic agent and the phytoconstituents in Zanthoxylum, show a wide variety of chemical substances with proven pharmacological actions such as alkaloids (isoquinolines and quinolines responsible for antitumor activity, antimalarial, antioxidant and antimicrobial actions), lignans, coumarins (antibacterial, antitumour, vasodilatory and anticoagulant activities), alkamide (strong insecticidal properties, anthelminthic, antitussive and analgesic anti antimalarial property). Therefore, this article is an attempt to review the existing literature that emphasizes on potential of genus Zanthoxylum as a source of lead compounds for the treatment of parasitic diseases.

Critical Insight into Plausible Acquired Tocopherol Pathway in Neglected Human Trypanosomatids.

Despite global therapeutic advancements, tropical parasitic infections like trypanosomiasis and leishmaniasis continue to be a major health concern in developing countries. These two tropical infectious diseases lead to enormous economic loss, significant disability, and morbidity, accounting for over one million deaths per year worldwide. The causative parasites, which shuttle between an insect vector and a mammalian host, thrive either in the bloodstream or in the intramacrophage environments. Essentially, the parasites live in an environment of oxidative stress and therefore require metabolic pathways to counterbalance the host immune response and survive the adverse conditions. Apart from the trypanothione pathway elucidated in the parasites, there exists a tocopherol pathway that functions to scavenge the reactive chemical species. This pathway, unique to photosynthetic organisms, is essential for the parasite’s survival, though the enzymes involved remain largely uncharacterized. Consequently, an understanding of the origin of the pathway and where and how the interconnected tocopherol pathway functions may result in the identification of promising and potential therapeutic interventions to combat these deadly diseases. Recent works underline the presence of the tocopherol pathway in trypanosomatids and hypothesize that trypanosomatids may be tocopherol prototrophs. This review focuses on the biosynthesis of tocopherols in Trypanosoma and Leishmania in light of the current evidence.

Nano-Medicines a Hope for Chagas Disease!

Chagas disease, is a vector-mediated tropical disease whose causative agent is a parasitic protozoan named Trypanosoma cruzi. It is a very severe health issue in South America and Mexico infecting millions of people every year. Protozoan T. cruzi gets transmitted to human through Triatominae, a subfamily of the Reduviidae, and do not have any effective treatment or preventative available. The lack of economic gains from this tropical parasitic infection, has always been the reason behind its negligence by researchers and drug manufacturers for many decades. Hence there is an enormous requirement for more efficient and novel strategies to reduce the fatality associated with these diseases. Even, available diagnosis protocols are outdated and inefficient and there is an urgent need for rapid high throughput diagnostics as well as management protocol. The current advancement of nanotechnology in the field of healthcare has generated hope for better management of many tropical diseases including Chagas disease. Nanoparticulate systems for drug delivery like poloxamer coated nanosuspension of benzimidazole have shown promising results in reducing toxicity, elevating efficacy and bioavailability of the active compound against the pathogen, by prolonging release, thereby increasing the therapeutic index. Moreover, nanoparticle-based drug delivery has shown promising results in inducing the host’s immune response against the pathogen with very few side effects. Besides, advances in diagnostic assays, such as nanosensors, aided in the accurate detection of the parasite. In this review, we provide an insight into the life cycle stages of the pathogen in both vertebrate host and the insect vector, along with an overview of the current therapy for Chagas disease and its limitations; nano carrier-based delivery systems for antichagasic agents, we also address the advancement of nano vaccines and nano-diagnostic techniques, for treatment of Chagas disease, majorly focusing on the novel perspectives in combating the disease.

Nanotechnological interventions for treatment of trypanosomiasis in humans and animals.

Trypanosomiasis is a parasitic infection caused by Trypanosoma. It is one of the major causes of deaths in underprivileged, rural areas of Africa, America and Asia. Depending on the parasite species responsible for the disease, it can take two forms namely African trypanosomiasis (sleeping sickness) and American trypanosomiasis (Chagas disease). The complete life-cycle stages of trypanosomes span between insect vector (tsetse fly, triatomine bug) and mammalian host (humans, animals). Only few drugs have been approved for the treatment of trypanosomiasis. Moreover, current trypanocidal therapy has major limitations of poor efficacy, serious side effects and drug resistance. Due to the lack of economic gains from tropical parasitic infection, it has always been neglected by the researchers and drug manufacturers. There is animmense need of more effective innovative strategies to decrease the deaths associated with this diseases. Nanotechnological approaches for delivery of existing drugs have shown significant improvement in efficacy with many-fold decrease in their dose. The review emphasizes on nanotechnological interventions in the treatment of trypanosomiasis in both humans and animals. Current trypanocidal therapy and their limitations have also been discussed briefly. Graphical abstract.

Improving Detection of Trichomonas vaginalis Infection among Adult Females in a Resource-poor Setting in Ogoniland, Niger Delta, Nigeria

Aim: Trichomonas vaginalis infection is a neglected tropical parasitic infection affecting mostly women of child bearing age, especially those of low socio-economic status and those that have poor hygiene lifestyle. Unfortunately, the traditional wet mount microscopy routinely used in the rural health care settings, for the detection of this parasite from clinical specimen, hardly detect this parasite (false negative), thus making the diagnosis of trichomoniasis a huge challenge in the rural settings. The aim of this study was to determine the prevalence rate of Trichomonas vaginalis among adult females in Bori, a rural resource-poor setting in Ogoniland, Niger Delta, Nigeria using modified Parasite Concentration-Giemsa staining technique.&#x0D; Study Design: This was a randomized study of adult females attending Government Health Centers in the Ogoni areas of Rivers State, Nigeria between April and August, 2018.&#x0D; Methodology: A total of five hundred (500) women, grouped into married (128) and unmarried (372), were enrolled in this study. A structured questionnaire was also administered to the participants for demographic data. Using sterile specula, high vaginal swab samples were collected and analyzed using the wet mount preparation and 10% Giemsa staining of centrifuged specimens.&#x0D; Results: Results obtained showed that the prevalence rate was 1.8% (9 out of 500 subjects). The sensitivity of wet mount and Giemsa stain methods were 56.2% and 100% respectively while their specificity were 100% and 98.2% respectively. While wet mount detected 0.4%, Giemsa staining method detected 1.8%. Two (1.6%) out of 128 married women examined had T. vaginalis while 7 (1.9%) out of 372 unmarried women examined had T. vaginalis.&#x0D; Conclusion: Although study recorded a low prevalence, Trichomonas vaginalis infections, exists in rural areas of Rivers State and therefore a source of concern because of its attendant morbidities. Early detection using improved diagnostic methods and in this case, the relatively inexpensive Parasite Concentration-Giemsa staining method, will improve management within the rural setting. A meta screening of more rural communities is advocated.

Parasitic Infections and Cancer: A Status Report

AbstractThere are many tropical parasitic infections that are still present public health problem in tropical medicine. Of interest, some diseases are proved for the relationship with carcinogenesis. Many cancers are proved for the etiopathogenesis due to parasitic infections. The well-known tropical parasitic infections that can induce carcinogenesis are opisthorchiasis, clonorchiasis, and schistosomiasis. To prevent parasitic infection related cancer is an important consideration in clinical oncology. The standard practice is the prevention of the infection, but the hope is the development of the new vaccines for cancer prevention. Here, the authors briefly review on the current status on the cancer vaccines against the three important tropical diseases that can result in cancers, opisthorchiasis, clonorchiasis, and schistosomiasis.

Evaluating the Vaccine Potential of a Tetravalent Fusion Protein (rBmHAXT) Vaccine Antigen Against Lymphatic Filariasis in a Mouse Model.

Lymphatic filariasis (LF) is a tropical parasitic infection of human transmitted by mosquitoes. Chronic infection results in severe physical disability in the infected patients. Although several potential vaccine antigens were identified by several groups, there are no licensed prophylactic vaccine to date against this infection in the human. Previous attempts from our laboratory to develop a trivalent prophylactic vaccine against LF showed that >90% protection could be achieved in rodent models. However, this trivalent vaccine gave only 35% protection in non-human primates. The major focus of this study was to develop a tetravalent prophylactic vaccine (rBmHAXT) and test the vaccine potential in a mouse model. We evaluated three different adjuvant formulations; alum, glucopyranosyl lipid adjuvant in stable emulsion (GLA/SE) alum (AL019), and mannosylated chitosan (MCA) to determine the optimum adjuvant formulation for rBmHAXT. Results presented in this study show that rBmHAXT + AL019 gave the highest rate of protection (>88%) against challenge infection, compared to rBmHAXT + AL007 (79%), rBmHAXT + MCA (79%) and controls. Analysis of the immune correlates of protection showed that all three adjuvants elicited high titer of antigen-specific IgG1, IgG2a, and IgG2b antibodies. High number of IFN-γ-producing antigen-specific memory cells were generated in the vaccinated animals irrespective of the adjuvants used. Similarly, spleen cells from rBmHAXT-vaccinated animals secreted IL-4, IL-10, and IFN-γ in response to rBmHAXT suggesting the generation of a balanced Th1/Th2 response. There was also an increase in IL-17-secreting cells in rBmHAXT-vaccinated animals. These findings thus suggest that rBmHAXT + AL019 is a better prophylactic formulation for LF.

Tropical Parasitic Infections in Individuals Infected with HIV.

Neglected tropical diseases share both geographic and socio-behavioral epidemiological risk factors with HIV infection. In this literature review, we describe interactions between parasitic diseases and HIV infection, with a focus on the impact of parasitic infections on HIV infection risk and disease progression, and the impact of HIV infection on clinical characteristics of tropical parasitic infections. We limit our review to tropical parasitic infections of the greatest public health burden, and exclude discussion of classic HIV-associated opportunistic infections that have been well reviewed elsewhere. Tropical parasitic infections, HIV-infection, and treatment with antiretroviral therapy alter host immunity, which can impact susceptibility, transmissibility, diagnosis, and severity of both HIV and parasitic infections. These relationships have a broad range of consequences, from putatively increasing susceptibility to HIV acquisition, as in the case of schistosomiasis, to decreasing risk of protozoal infections through pharmacokinetic interactions between antiretroviral therapy and antiparasitic agents, as in the case of malaria. However, despite this intimate interplay in pathophysiology and a broad overlap in epidemiology, there is a general paucity of data on the interactions between HIV and tropical parasitic infections, particularly in the era of widespread antiretroviral therapy availability. Additional data are needed to motivate clinical recommendations for detection and management of parasitic infections in HIV-infected individuals, and to consider the implications of and potential opportunity granted by HIV treatment programs on parasitic disease control.

Abnormal parathyroid in some important tropical parasitic infections: a new trend

The parathyroid disorder is an important problem in clinical endocrinology. There are several possible causes of parathyroid disorder. Infection is an uncommon cause of parathyroid disorder. The parasitic infection induced parathyroid disorder is an important problem in tropical medicine. In this paper, the authors briefly summarize and discuss on the important abnormalities of parathyroid due to important tropical parasitic infections.

Overcoming research barriers in Chagas disease-designing effective implementation science.

Chagas disease is a complex tropical parasitic infection. It affects a significant portion of the population in Latin America, especially in areas of poverty and poor access to health care. It also affects immigrants in high-income countries who lack access to health care due to their legal status. Millions of people are at risk of contracting the disease, and approximately 30% of chronically infected patients will develop cardiomyopathy. The cost of caring for patients that have been infected is substantial. Basic science research has introduced new concepts and knowledge for the parasite and vector biology as well as better understanding of the pathophysiology of the disease. These research findings nevertheless require effective and timely translation into clinical practice. Likewise, the design of new research projects should account for the multiple system-based barriers. Implementation science facilitates the applicability of research findings and identifies barriers to its execution. Creation of implementation science measures to reach and sustain research programs with greater potential to impact Chagas disease are lacking. This point of view proposes opportunities for implementation science in Chagas disease and strategies for researching effective interventions for preventing and treating the disease.

Cytotoxic Activity of Holothuria leucospilota Extract against Leishmania infantum In Vitro.

Leishmaniasis is a tropical parasitic infection. The resistance and toxicity issues are the major complications and remain significant consequences related to the treatment of leishmaniasis with the recent and classical drugs. Thus there is an immediate requirement to develop new compounds for the treatment of this protozoan disease. Sea cucumbers or holothurians are potentially presented as the marine sources of antimicrobial and cytotoxic compounds. The aim of this study was investigation of in vitro antileishmanial activity of methanol extract of body wall, coelomic fluid, and cuvierian organs of Holothuria leucospilota obtained from coastal parts of Persian Gulf against Leishmania infantum promastigotes and axenic amastigotes. The colorimetric MTT assay was used to determine L. infantum promastigotes and axenic amastigotes viability at different concentrations of the extracts and drug control (Glucantime®) at time dependent manner and the results are represented as IC50 (50% of inhibitory concentration). Coelomic fluid was the most active extract among the three different extracts of H. leucospilota against L. infantum promastigotes and axenic amastigotes with IC50s of 62.33 μg/mL and 22.4 μg/mL and 73 μg/mL and 46 μg/mL at 48 and 72 hours after treatment, respectively. Cuvierian organs extract showed less toxicity with IC50s more than 1000 μg/mL for both Leishmania infantum axenic amastigotes and promastigotes forms after 48 and 72 hours of exposure. Results acquired from the present study propose that the sea cucumber H. leucospilota may be a provoking source of antileishmanial compounds and could be a lead source in the development of the potent antileishmanial and cytotoxic drugs.

Spectrum of chronic small bowel diarrhea with malabsorption in Indian subcontinent: is the trend really changing?

Background/AimsThis study aimed to document the recent etiological spectrum of chronic diarrhea with malabsorption and also to compare features that differentiate tropical sprue from parasitic infections, the two most common etiologies of malabsorption in the tropics.MethodsWe analyzed 203 consecutive patients with malabsorption. The etiological spectrum and factors that differentiated tropical sprue from parasitic infections were analyzed.ResultsThe most common etiology was tropical sprue (n=98, 48.3%) followed by parasitic infections (n=25, 12.3%) and tuberculosis (n=22, 10.8%). Other causes were immunodeficiency (n=15, 7.3%; 12 with human immunodeficiency virus and 3 with hypogammaglobulinemia), celiac disease (n=11, 5.4%), Crohn's disease (n=11, 5.4%), small intestinal bacterial overgrowth (n=11, 5.4%), hyperthyroidism (n=4, 1.9%), diabetic diarrhea (n=4, 1.9%), systemic lupus erythematosus (n=3, 1.4%), metastatic carcinoid (n=1, 0.5%) and Burkitt's lymphoma (n=1, 0.5%). On multivariate analysis, features that best differentiated tropical sprue from parasitic infections were larger stool volume (P=0.009), severe weight loss (P=0.02), knuckle hyperpigmentation (P=0.008), low serum B12 levels (P=0.05), high mean corpuscular volume (P=0.003), reduced height or scalloping of the duodenal folds on endoscopy (P=0.003) and villous atrophy on histology (P=0.04). Presence of upper gastrointestinal (GI) symptoms like bloating, nausea and vomiting predicted parasitic infections (P=0.01).ConclusionsTropical sprue and parasitic infections still dominate the spectrum of malabsorption in India. Severe symptoms and florid malabsorption indicate tropical sprue while the presence of upper GI symptoms indicates parasitic infections.

Tissue schistosomiasis in accra ghana: a retrospective histopathologic review at the korle-bu teaching hospital (2004-2011)

Abstract Background: Schistosomiasis is a neglected tropical parasitic infection. The aim of this study was to determine how frequently different structures within the pelvis and perineum were infected with