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Parasitology International Jun 2022Intestinal parasites are considered a growing public health problem, being protozoa the main cause of intestinal disease. The objective of our study is to compare the... (Observational Study)
Observational Study
INTRODUCTION
Intestinal parasites are considered a growing public health problem, being protozoa the main cause of intestinal disease. The objective of our study is to compare the detection of intestinal protozoa by microscopy versus real-time PCR, as well as to determine the most prevalent protozoa in our environment in the paediatric population.
METHOD
An observational longitudinal study was carried out, both by microscopy and real time-PCR in stool samples from children (0- 15 years) received from April 2019 to March 2021.Children were classified in two groups according if they had or not had clinical parasitosis. Microscopic examination was performed in all samples using the Ritchie concentration technique with the commercial Mini PARASEP system (Movaco-Grifols®). The presence of Cryptosporidium sp. was evaluated with the modified Ziehl-Neelsen acid-fast stain. The real-time PCR was performed to all samples using the Allplex ™ gastrointestinal parasite panel 4 (Seegene®).
RESULTS
During the study period, 500 samples were received, being positive 31 (6.2%) by microscopy and 256 (51.2 %) by PCR. By microscopy, Blastocystis hominis was the most frequently observed (4.8%), followed by Giardia lamblia (1.6%), Dientamoeba fragilis (0.2%) and Cryptosporidium species (0.2%). Regarding the identification by PCR, D. fragilis (35.2%) was mainly identified, followed by B. hominis (28.1%), G. lamblia (7%) and Cryptosporidium sp. (0.8%) without finding clear differences in aetiology according to age. In the case of B. hominis and D. fragilis, there were not differences in the detection of these protozoa between the control group and children with clinical parasitosis (p = 0.11).
CONCLUSIONS
Real-time PCR increases the detection of intestinal protozoa, being underdiagnosed by microscopy, especially D. fragilis, in which PCR is considered the most appropriate method for its detection.
Topics: Child; Cryptosporidiosis; Cryptosporidium; Entamoeba histolytica; Feces; Giardia lamblia; Humans; Intestinal Diseases, Parasitic; Longitudinal Studies; Real-Time Polymerase Chain Reaction
PubMed: 35149177
DOI: 10.1016/j.parint.2022.102558 -
Infection & Chemotherapy May 2024Enterocolitis and gastroenteritis remain major health problems, particularly in children living in developing countries. Intestinal protozoa, such as , and are...
BACKGROUND
Enterocolitis and gastroenteritis remain major health problems, particularly in children living in developing countries. Intestinal protozoa, such as , and are frequently associated with these conditions. Amebic colitis can cause serious complications, including fulminant necrotizing colitis, toxic megacolon, extraintestinal amebiasis, and stunting in children. The diagnosis of amoebiasis is challenging, relying on microscopic examination, which cannot distinguish from the nonpathogenic and Therefore, this study aimed to identify intestinal parasites, particularly , their prevalence, and the clinical characteristics of patients admitted for enterocolitis and gastroenteritis at a tertiary-referral hospital.
MATERIAL AND METHODS
A cross-sectional, retrospective study was conducted at a national, tertiary-referral government hospital, in Jakarta. Of the 111 retrieved medical records from hospitalized patients with enterocolitis and gastroenteritis, 54 (48.6%) fecal samples were still available in the laboratory storage and referred to the parasitology laboratory. All fecal samples underwent the following tests: 1) direct stool examination, after staining with 1% Lugol's solution, and using the water-ether concentration method; 2) modified acid-fast staining for coccidian parasites; 3) Jones' culture medium to detect ; 4) copro-antigen assay to detect and and 5) a polymerase chain reaction (PCR) assay to identify . Clinical and demographic data were obtained from the medical records.
RESULTS
Largely, patients (44.1%) were from the cohort of young children ≤5 years old, followed by adults aged 19-60 years old (24.3%). Both cohorts exhibited polyparasitism. Intestinal parasites were detected in 17 out of the 54 samples (31.4%). These included 6 (11.1%), 2 (3.7%),5 (9.2%), 3 (5.5%), 2 (3.7%), and 1 (1.8%) samples that were positive for , , , , and respectively. PCR analysis revealed that 10 samples were positive for infection, eight of which originated from pediatric patients.
CONCLUSION
At a national tertiary-referral hospital in Indonesia, infection was most prevalent among pediatric patients with enterocolitis. and were the two main species identified by PCR. Therefore, PCR assays and fecal occult-blood tests are recommended in cases of enterocolitis and gastroenteritis.
PubMed: 38859717
DOI: 10.3947/ic.2023.0099 -
Microorganisms Oct 2023Indigenous people live in remote areas of Colombia. Multiple infections with bacteria, protozoa and/or helminths are common, as well as colonization in various forms....
Indigenous people live in remote areas of Colombia. Multiple infections with bacteria, protozoa and/or helminths are common, as well as colonization in various forms. This study focused on the question of whether and to what extent various pathogens interact with each other. Therefore, a mathematical approach was retrospectively applied to PCR-based data of 244 stool samples, collected in two datasets. A stable cluster solution of the pathogens assessed was determined, and a unique configuration between / spp./ forming cluster 1 and was verified. A pathogen density-dependent interplay appeared between the / spp./ cluster, and . The applied mathematical approach demonstrated that co-infections with parasites of questionable pathological relevance such as and can be of diagnostic relevance due to their ability to promote or repress other pathogens. With the increasing availability of highly sensitive multiplexed molecular diagnostic approaches even in resource-limited settings, where multiple colonization of infection events with enteric pathogens in parallel are common, the importance of interpreting whole pathogen patterns rather than just individual pathogen detection may become more and more relevant.
PubMed: 38004654
DOI: 10.3390/microorganisms11112642 -
Zoonoses and Public Health Aug 2022The protozoan Dientamoeba fragilis is one of the most common parasites in the digestive system of humans worldwide. The host range and transmission routes of...
The protozoan Dientamoeba fragilis is one of the most common parasites in the digestive system of humans worldwide. The host range and transmission routes of D. fragilis, including the role of animals, are still ambiguous with few reports from non-human primates, sheep, rodents, pigs, a cat and a dog. In this study, we used microscopic and TaqMan qPCR analyses to investigate D. fragilisin 150 faecal samples from pet budgerigars (Melopsittacus undulatus) in the Central Anatolia Region of Turkey. Dientamoeba fragilis DNA was detected in 32 samples, resulting in a mean prevalence of 21.3%. In microscopic examination, trophozoites/cysts of D. fragilis were detected in 13 of 32 qPCR-positive samples. SSU rRNA sequence analyses of the qPCR-positive isolates identified genotype 1 of D. fragilis as predominant in budgerigars. Phylogenetic analyses of the SSU rRNA gene region clustered D. fragilis genotypes, as well as other trichomonads, in separate monophyletic clusters with bootstrap values ≥79.0. Our study provides the first evidence for the natural host status of pet budgerigars for D. fragilisand contributes to the knowledge of the epidemiology of this parasite. The high prevalence of genotype 1 of D. fragilis suggests that pet budgerigars are suitable reservoirs for zoonotic transmission. Our findings contribute to an increased awareness and knowledge of D. fragilis infections in the context of a one-health approach.
Topics: Animals; Dientamoeba; Dientamoebiasis; Dog Diseases; Dogs; Feces; Genotype; Melopsittacus; Phylogeny; Sheep; Sheep Diseases; Swine; Swine Diseases
PubMed: 35467079
DOI: 10.1111/zph.12949 -
Inflammatory Bowel Diseases Jul 2015Increasing demand for fecal microbiota transplantation (FMT) has created a need for stool banks sourced from long-term healthy donors. Here, we describe our experience... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Increasing demand for fecal microbiota transplantation (FMT) has created a need for stool banks sourced from long-term healthy donors. Here, we describe our experience in recruiting and screening fecal donors.
METHODS
Mailbox, newspaper, and online advertisements were used. Potential donors were required to satisfy a prescreen telephone conversation, pass blood and stool investigations, then undertake a screening interview including medical history, physical examination, and evaluation of donor selection criteria.
RESULTS
One hundred sixteen potential donors were prescreened of whom 74 failed-47 declined based on study donation requirements (primarily related to frequency and duration of donations), 13 had medical comorbidities, 6 variant Creutzfeldt-Jakob disease risk factors, 8 for other reasons. Thirty-eight completed stool and blood testing-1 failed blood testing (indeterminate hepatitis C serology), whereas 15 failed stool investigations (5 Dientamoeba fragilis, 5 Blastocystis hominis, 1 B. hominis and D. fragilis, 1 Giardia intestinalis plus D. fragilis, 1 Norovirus plus Clostridium difficile toxin positive, and 2 leucocytes or erythrocytes on stool microscopy). Of the 18 potential donors proceeding to screening interview, 6 were excluded (3 body mass index >30, 1 illicit drug use, 1 uncontrolled anxiety and concerns regarding compliance, 1 irregular bowel movements after new medication commencement). In total, only 12 of 116 (10%) potential donors were enrolled as study donors.
CONCLUSIONS
Recruitment of fecal donors for FMT is challenging with only a small percentage ultimately serving as donors. Many were unable or unwilling to meet the donor commitment requirements. A surprisingly large proportion of healthy asymptomatic donors failed stool testing, primarily due to gastrointestinal parasites.
Topics: Adolescent; Adult; Aged; Fecal Microbiota Transplantation; Female; Humans; Inflammatory Bowel Diseases; Male; Microbiota; Middle Aged; Treatment Outcome; Young Adult
PubMed: 26070003
DOI: 10.1097/MIB.0000000000000405 -
Parasitology International Feb 2021Dientamoeba fragilis is an intestinal protozoan, an inhabitant of the human gastrointestinal tract, with a worldwide distribution. The reported prevalence of D. fragilis...
Dientamoeba fragilis is an intestinal protozoan, an inhabitant of the human gastrointestinal tract, with a worldwide distribution. The reported prevalence of D. fragilis varies worldwide in different populations between 0.3% and 82.9%, and its role as a pathogen is still unclear. The parasite has been identified in the faeces of asymptomatic patients and with different acute and chronic symptoms, like abdominal pain, diarrhoea, flatulence, nausea and vomiting. The aims of this study were to evaluate the prevalence of D. fragilis in the North-East of Italy, and the clinical improvement of symptoms after recommended treatment with paromomycin or metronidazole. Furthermore, a literature review of D. fragilis prevalence studies in Italy was carried out to show the Italian situation. Of 575 enrolled people, 85 (14.8%) were positive for D. fragilis. The most prevalent symptoms were abdominal pain 28.2%, anal itching 27.1%, watery diarrhoea 18.8%, meteorism 16.5% and nausea/lack of appetite 14.1%. The high rate of anal itching was unexpected, because it wasn't a common symptom. 32 patients were co-infected with B. hominis (37.7%) and three with G. lamblia (3.5%). Our study showed paromomycin had a high efficacy for treatment of D. fragilis infections 100.0% (45/45), while caution must be used when using metronidazole 53.3% (24/40). We recommend paromomycin for empirical treatment, given its great effectiveness in our population.
Topics: Adolescent; Adult; Aged; Antiprotozoal Agents; Child; Child, Preschool; Cross-Sectional Studies; Dientamoeba; Dientamoebiasis; Female; Humans; Infant; Italy; Male; Metronidazole; Middle Aged; Paromomycin; Prevalence; Young Adult
PubMed: 33137500
DOI: 10.1016/j.parint.2020.102227 -
Acta Parasitologica Mar 2019Dientamoeba fragilis is a protozoan parasite of the human gastrointestinal tract and still controversial in association with gastrointestinal symptoms.
BACKGROUND
Dientamoeba fragilis is a protozoan parasite of the human gastrointestinal tract and still controversial in association with gastrointestinal symptoms.
PURPOSE
We present cross-sectional study of the prevalence of D. fragilis, and sociodemographic and clinical features in the patients with gastrointestinal symptoms.
METHODS
A total of 490 fecal specimens were collected from outpatients with gastrointestinal symptoms in the Department of Parasitology, Faculty of Medicine, Ege University and Celal Bayar University, Turkey. Fecal specimens were examined with microscopy and inoculated in Robinson medium. D. fragilis-positive samples were examined for the presence of other intestinal parasites using enzyme immunoassay. Real-time PCR analysis was performed on all samples.
RESULTS
Of the 490 stool specimens examined by real-time PCR, 59 patients were positive for D. fragilis infection with prevalence rate of 12.04%. Forty-four of positive patients (74.5%) were found to be infected with only D. fragilis, while 23.7% were co-infected with Blastocystis and 1.7% were co-infected with Rotavirus. No statistically significant difference was found in all the examined patients in terms of D. fragilis positivity for all sociodemographic parameters. Loose stool consistency was associated with the presence of D. fragilis, with 18.3% (P = 0.001). When the clinical symptoms of all the patients participating in this study were examined, diarrhea was statistically more significant in patients with the presence of D. fragilis (16.3%; P = 0.001). The rate of diarrhea in D. fragilis-positive patients (84.09%; P = 0.0005) was higher than that of D. fragilis-negative patients and it was statistically significant.
CONCLUSION
This study is important for assessing the prevalence of D. fragilis and its association with other factors in symptomatic patients in a large sample group in Turkey, as well as investigating the relationship of identified symptoms with the D. fragilis pathogenicity. It is suggested that D. fragilis in this case is not a commensal parasite but a pathogenic parasite and that the most common clinical symptom is diarrhea.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Blastocystis Infections; Child; Child, Preschool; Cross-Sectional Studies; Dientamoeba; Dientamoebiasis; Enzyme-Linked Immunosorbent Assay; Feces; Female; Gastrointestinal Diseases; Humans; Infant; Infant, Newborn; Male; Microscopy; Middle Aged; Outpatients; Parasitology; Prevalence; Real-Time Polymerase Chain Reaction; Rotavirus Infections; Socioeconomic Factors; Turkey; Young Adult
PubMed: 30645736
DOI: 10.2478/s11686-018-00017-5 -
Journal of Medical Microbiology Sep 2021The identification of enteropathogens is critical for the clinical management of patients with suspected gastrointestinal infection. The FLOW multiplex PCR system...
The identification of enteropathogens is critical for the clinical management of patients with suspected gastrointestinal infection. The FLOW multiplex PCR system (FMPS) is a semi-automated platform (FLOW System, Roche) for multiplex real-time PCR analysis. FMPS has greater sensitivity for the detection of enteric pathogens than standard methods such as culture, biochemical identification, immunochromatography or microscopic examination.The diagnostic performance of the FMPS was evaluated and compared to that of traditional microbiological procedures. A total of 10 659 samples were collected and analysed over a period of 7 years. From 2013 to 2018 (every July to September), samples were processed using standard microbiological culture methods. In 2019, the FMPS was implemented using real-time PCR to detect the following enteropathogens: spp. spp. spp., spp., adenovirus, norovirus and rotavirus. Standard microbiological culture methods (2013-2018) included stool culture, microscopy and immunochromatography. A total of 1078 stool samples were analysed prospectively using the FMPS from July to September (2019): bacterial, parasitic and viral pathogens were identified in 15.3, 9.71 and 5.29 % of cases, respectively. During the same period of 6 years (2013-2018), the proportion of positive identifications using standard microbiological methods from 2013 to 2018 was significantly lower. A major significant recovery improvement was observed for all bacteria species tested: spp./enteroinvasive (EIEC) ( <0.05), spp. ( <0.05) and spp. ( <0.05). Marked differences were also observed for the parasites , spp. and . These results support the value of multiplex real-time PCR analysis for the detection of enteric pathogens in laboratory diagnosis with outstanding performance in identifying labile micro-organisms. The identification of unsuspected micro-organisms for less specific clinical presentations may also impact on clinical practice and help optimize patient management.
Topics: Adenoviridae; Blastocystis hominis; Campylobacter; Cryptosporidium; Dientamoeba; Entamoeba histolytica; Feces; Gastroenteritis; Giardia lamblia; Humans; Multiplex Polymerase Chain Reaction; Norovirus; Real-Time Polymerase Chain Reaction; Rotavirus; Salmonella; Shigella
PubMed: 34516365
DOI: 10.1099/jmm.0.001367 -
Journal of Pediatric Gastroenterology... Dec 2021This survey was undertaken to obtain insight in the attitude of Dutch physicians towards pathogenicity, diagnostic- and therapeutic approach towards Dientamoeba fragilis...
This survey was undertaken to obtain insight in the attitude of Dutch physicians towards pathogenicity, diagnostic- and therapeutic approach towards Dientamoeba fragilis in children. Physicians were invited by e-mail for a questionnaire. A total of 211 of 450 physicians (46.9%) completed the questionnaire, including 67 general practitioners (GPs) and 144 pediatricians. Of all respondents, 175 of 211 (82.9%) considered D fragilis a "potential pathogen", when other causes of gastro-intestinal complaints are ruled out. Only 16 of 211 (7.6%) performed diagnostic tests regularly. Diagnostic tests were performed by 162 of 211 (77%) of respondents in children with diarrhea and abdominal pain in consideration of duration of symptoms. Fecal polymerase chain reaction (PCR) was diagnostic modality of preference. Eighty-nine of 142 (62.7%) prescribed metronidazole as antibiotic of first choice. This study shows heterogeneity in clinical practice amongst Dutch physicians regarding diagnostic- and therapeutic approach of D fragilis in children. Different attitude towards pathogenicity and inconsistent guidelines could be causative factors.
Topics: Child; Dientamoeba; Dientamoebiasis; Feces; General Practitioners; Humans; Netherlands; Pediatricians; Surveys and Questionnaires
PubMed: 34520404
DOI: 10.1097/MPG.0000000000003297 -
World Journal of Gastroenterology Jul 2020() and () are two protozoan parasites of human bowel that are found throughout the world. There is still debate about the pathogenicity of these protozoans, despite...
BACKGROUND
() and () are two protozoan parasites of human bowel that are found throughout the world. There is still debate about the pathogenicity of these protozoans, despite them being commonly associated with gastrointestinal symptoms and can cause health issue in both children and adults. These parasites are usually transmitted through faecal-oral contact particularly under poor hygiene conditions or food/water contamination. Once a person is infected, the parasites live in the large intestine and are passed in the faeces.
AIM
To investigate the effect of triple antibiotic therapy using enema infusion in the treatment of and infections.
METHODS
This retrospective longitudinal study was conducted in a single medical centre, which included fifty-four patients (≥ 18 years) who were positive for , or both between 2017 and 2018. The treatment consisted of triple antibiotics that were infused over two consecutive days through rectal enema. Faecal samples were collected from participants pre- and post-treatment and were tested for parasites using microscopy and polymerase chain reaction. Patients' symptoms were recorded prior and after the treatment as well as patient demographic data.
RESULTS
Patients ( = 54), were either positive for (37%), (35%) or both (28%). All patients completed the two-day treatment and no serious adverse effect was reported. The most common side effect experienced by the patients during the treatment was urine discolouration which was cleared by six weeks of follow-up. Common symptoms reported prior to treatment were diarrhoea, abdominal pain, constipation and fatigue. Other symptoms included abdominal discomfort, dizziness and blood in the stool. Eighty-nine percent of patients completed a final stool test post-treatment. At six weeks post-treatment, 79% of patients cleared the parasites from their faeces. Symptoms such as abdominal discomfort, dizziness and blood in the stool decreased significantly at both seven days and six weeks post-treatment ( < 0.040). The enema retention time, bowel preparation, previous antibiotic treatment or previous gastrointestinal problems had no significant effect on parasite eradication.
CONCLUSION
Overall, eradication of parasites and improvement of clinical outcomes were observed in treated patients, showing the efficacy of this combination to eradicate the parasites and provide positive clinical outcome.
Topics: Adult; Animals; Anti-Bacterial Agents; Child; Enema; Feces; Female; Humans; Longitudinal Studies; Male; Parasites; Parasitic Diseases; Retrospective Studies
PubMed: 32774058
DOI: 10.3748/wjg.v26.i26.3792