Iron-Deficiency Anemia Related to Ancylostoma duodenale Infection in 67 Years Old Female Patient

Background. Ancylostomiasis is an infection caused by hookworms. It is estimated that hookworms infect 1.2 billion people worldwide and cause higher morbidity than other types, mainly due to iron deficiency anemia. Hookworm infection increases with age. The main clinical manifestations are abdominal pain, features of iron deficiency anemia and hypoproteinemia. Diagnosis is based on the finding of characteristic eggs in the stool. Case presentation. A 67-year-old female patient had been administered into the Internal Medicine Ward of Dr. M. Djamil Padang Hospital with the main complaint of weakness, fatigue, and lethargy which had increased since 3 days before being admitted to the hospital. The patient also had complaints of pale skin, fever, heartburn, decreased appetite and weight loss. The patient was admitted to the hospital with awareness of compost mentis, cooperative, and his general condition appeared to be moderately ill, blood pressure 130/90 mmHg, pulse rate 104 x/minute, regular pulse, adequate filling, respiratory rate 22 x/minute, temperature 37.8 C. On physical examination, the conjunctiva of the pantient’s eyes were anemic. Laboratory examination revealed Hemoglobin 4 g/dl, Hematocrit 16%, MCV/MCH/MCHC 62fl/15pg/25g/dL, Reticulocytes 0.5%, SI/TIBC 22/315 mg/dL, Ferritin 8.5 ng/mL, and peripheral blood smear showing severe hypochromic microcytic anemia and relative eosinofilia. Ancylostoma duodenale worm eggs were found on routine stool examination. Final diagnosis was Severe microcytic hypochromic anemia caused by an iron deficiency and Ancylostomiasis. Severe microcytic hypochromic anemia caused by iron deficiency and ancylostomiasis was established based on the patient’s history, physical examination and laboratory investigations. Conclusions. Hookworms infect many people worldwide and cause high morbidity, mainly due to iron deficiency anemia. The highest prevalence is found in the tropics and subtropics, including Indonesia. The main clinical manifestations are abdominal pain, features of iron deficiency anemia and hypoproteinemia. Diagnosis is based on the finding of characteristic eggs in the stool. Albendazole 400 mg single dose resulted in 80% cure and a dose of 200 mg/day for 3 days gave 100% cure. Treatment of anemia is by administering ferrous sulfate or ferrous gluconate orally 200 mg three times a day and continued for up to 3 months after normal hemoglobin levels are achieved to maintain iron stores.

Prevalence of cestodes infection among school children of urban parts of Lower Dir district, Pakistan

Tapeworms of zoonotic importance have been described as a leading public health problem. Current research was aim to assess the prevalence of tapeworms among 5-12years school children residing in district Lower Dir, Pakistan from January 2019-December 2019. The wet mount preparation in saline/iodine/methods were used for stool examination. Data was analyzed using appropriate descriptive, static methods. Of the 400 children studied 71.7% were infected with one or more species of intestinal parasites. Single infection of cestode species was found in 69 individuals with 17.2% prevalence and multiple parasitic infections were identified in 19.7% (n=79/400) individuals. The multiple infection were comprised as 10% (n=40) double, 6.75% (n=27) triple and 3% (n=12) quadruple. A total of 9 species of helminths and one species of protozoan infection. Among the helminths Ascaris lumbricoides was the most prevalent 33.1% (n=95), Taenia saginata 22.6% (n=65), hookworm 19.8% (n=57), Hymenolepis nana 18.8% (n=54), Enterobius vermicularis and Hymenolepis diminuta 1.39% (n=4each), Trichuris trichura 1.04% (n=3), Toxocara spp 0.69% (n=2) and Schistosoma japonicum 0.34% (n=1) were reported. One protozoan species was Cryptosporidium spp 0.69% (n=2) in current study. In case of A.lumbricoides, hookworm, E.vermicularis, T.trichura, T.saginata, H.nana and H.diminuta the male children of below 8 years of age were highly infected. Other infections are reported in the same prevalence with slight difference if any. We conclude that there is a need for mass scale campaigns to create awareness regarding health and hygiene in children and the need for development of effective poverty control programs because deworming alone is not adequate to control parasitic infections.

Prenatal and Postnatal Manifestations of Congenital Chloride Diarrhea Due to a Heterozygote Variant of the SLC26A3 Gene: A Case Report

Congenital chloride diarrhea (CCD) is caused by a recessive mutation in the SLC26A3 gene and characterized mainly by watery diarrhea, hypochloremia and metabolic alkalosis. Various different mutations in SLC26A3 are responsible for the disease. In the prenatal period, the symptoms of CCD may include polyhydramnios, preterm labor and abdominal distension. The main feature of CCD is chloride-rich diarrhea, which leads to excessive loss of fluid and salt immediately after birth and is followed by weight loss and dehydration. Hyponatremia and hypochloremia are soon accompanied by hypokalemia and metabolic alkalosis. Untreated CCD is fatal even in the first weeks of life. Diagnosis is made by high fecal chloride concentrations in patients with serum electrolytes corrected by salt substitution and confirmed using genetic testing of peripheral blood samples. Here, we detail prenatal and postnatal manifestations of a preterm infant, born via Caesarian section, who was suspected to suffer intrauterine bowel obstruction. Upper median laparotomy was performed and no intestinal abnormalities found. The course of the neonatal period was complicated by severe diarrhea with hypochloremia, hyponatremia and metabolic alkalosis. Based on the patient's clinical picture and stool examination, a diagnosis of CCD was established. Mutation of the SLC26A3 gene was confirmed using genetic testing.

Efficiency of the Stool-PCR Test Targeting NADH Dehydrogenase (Nad) Subunits for Detection of Opisthorchis viverrini Eggs

Opisthorchis viverrini infection is the major parasitic infection problem in Southeast Asian countries, and long-term infection will lead to cholangiocarcinoma (CCA), the bile duct cancer. The early diagnosis of O. viverrini infection may interrupt the progression of the opisthorchiasis and other related illnesses, especially CCA. The current diagnostic procedure is stool examination by microscope-based methods such as direct smear and concentration techniques but it is limited by low parasite egg numbers. The molecular diagnosis prompts the chance to evaluate the light infection with low number of parasite eggs but is currently inconvenient for routine use due to special equipment requirement and unstable sensitivities. Our present study aims to establish the efficiency of OvNad subunits, the mitochondrial gene, for introducing as a potential diagnostic target by conventional PCR, the cheapest and easiest molecular procedure. A total of 166 stool samples were investigated microscopically by the PBS-ethyl acetate concentration technique (PECT); 75 samples were O. viverrini positive with 28 samples that were positive with single parasite (hookworm, A. lumbricoides, S. stercoralis, Taenia spp., and T. trichiura), 11 samples were with mixed infection, and 52 samples were without parasite detection. The detection limits of OvNad subunits were evaluated in artificially spiked samples containing 0, 1, 5, 10, 20, 50, and 100 Ov-eggs. The result suggested that the best detection efficacy was of OvNad5 that had exact detection limits at only 5 eggs. In the PCR amplification of OvNad subunits, there exist 100% specificities with varied sensitivities from 64%, 88%, 80%, and 100% of OvNad1, OvNad2, OvNad4, and OvNad5, respectively. OvNad subunits were amplified specifically without cross reactivity with the other collected parasites. Our study established that OvNad subunits, especially OvNad5, are the potent candidates for PCR amplification of stool containing Ov-eggs with high confidential sensitivity, specificity, PPV, and NPV even in the light infection that would be a benefit for developing as a routine diagnosis of O. viverrini infection.

Evaluation of Paromomycin Loaded Chitosan Nanoparticles and Oxidative Stress Activities against Entamoeba Histolytica

This investigation was carried out to estimate the antiparasitic potential of chitosan nanoparticles loaded with paromomycin against Entamoeba histolytica infected. After rats inoculated orally in a dose 103 viable cysts for acute infection; then treated with paromomycin, chitosan nanoparticles as a single or combined therapy given for seven days. Stool examination revealed a significant decrease in the number of Entamoeba histolytica cysts in all treated infected rats compared with infected non-treated. Combined treatment provided better results than single treatment. The best effect was observed in the group of rats treated with chitosan nanoparticles loaded with paromomycin. Also, the oxidative stress markers Glutathione (GSH) and Lipid Peroxide (Malondialdehyde) (MDA) were assessed in liver tissue homogenate. The current work is the first time of using chitosan nanoparticles loaded with paromomycin as therapeutic agents against experimental amoebiasis. It was shown that the highest degree of effectiveness attained by the synergistic action of paromomycin and chitosan nanoparticles as was indicated by lower parasite count and GSH, MDA concentration.

Amoebic liver abscess in a COVID-19 patient: a case report

Background Amoebiasis is a parasitic disease caused by Entamoeba histolytica, which affects people living in low- and middle-income countries and has intestinal and extraintestinal manifestations. To date, knowledge on coronavirus disease 2019 (COVID-19) coinfection with enteric parasites is limited, and E. histolytica coinfection has not been previously described. Here we present the case of a patient with COVID-19 who, during hospitalisation, presented a clinical picture consistent with an amoebic liver abscess (ALA). Case presentation A 54-year-old man, admitted as a suspected case of COVID-19, presented to our hospital with dyspnoea, malaise, fever and hypoxaemia. A nasopharyngeal swab was positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) by reverse-transcription polymerase chain reaction. After 7 days, he developed diarrhoea, choluria and dysentery. An abdominal ultrasound showed a lesion compatible with a liver abscess; stool examination revealed E. histolytica trophozoites, and additional serology for E. histolytica was positive. After 12 days of treatment with metronidazole, ceftazidime and nitazoxanide, the patient reported acute abdominal pain, and an ultrasound examination revealed free liquid in the abdominal cavity. An emergency exploratory laparotomy was performed, finding 3000 mL of a thick fluid described as “anchovy paste”. Computed tomography scan revealed a second abscess. He ended up receiving 21 days of antibiotic treatment and was discharged with satisfactory improvement. Conclusion Here we present, to the best of our knowledge, the first report of ALA and COVID-19 co-presenting. Based on their pathophysiological similarities, coinfection with SARS-CoV-2 and E. histolytica could change the patient’s clinical course; however, larger studies are needed to fully understand the interaction between these pathogens.

Development and Efficacy of Droplet Digital PCR for Detection of Strongyloides stercoralis in Stool

Human strongyloidiasis is one of the neglected tropical diseases caused by infection with soil-transmitted helminth Strongyloides stercoralis. Conventional stool examination, a method commonly used for diagnosis of S. stercoralis, has low sensitivity, especially in the case of light infections. Herein, we developed the droplet digital polymerase chain reaction (ddPCR) assay to detect S. stercoralis larvae in stool and compared its performance with real-time PCR and stool examination techniques (formalin ethyl-acetate concentration technique [FECT] and agar plate culture [APC]). The ddPCR results showed 98% sensitivity and 90% specificity, and real-time PCR showed 82% sensitivity and 76.7% specificity when compared with the microscopic methods. Moreover, ddPCR could detect a single S. stercoralis larva in feces, and cross-reactions with other parasites were not observed. In conclusion, a novel ddPCR method exhibited high sensitivity and specificity for detection of S. stercoralis in stool samples. This technique may help to improve diagnosis, particularly in cases with light infection. In addition, ddPCR technique might be useful for screening patients before starting immunosuppressive drug therapy, and follow-up after treatment of strongyloidiasis.

Helminthiasis Prevalence Based on GIS along Thai-Cambodian Border in Phusing District, Sisaket Province, Thailand

Helminthiasis has been a major public health problem in Southeast Asia, especially in rural areas significant along the Thai national borderline. This research within provincial public health working standard aimed to identify the situation and influent factors along 3 sequential purposes within 3 steps as 1)To explore 5 years situation to get the specific study area, 2)To find out the prevalence of the area, and 3)To excrete the influent factors. The target area of the first step comprised 2 subdistricts, Donrak and Phrai Phattana within 9873 parents who participated in the stool examination program in 2015-2019 under the provincial Public Health Office, of primary school pupils. In the second step specific area were selected via the criteria of 30 percentile of the high border length line which were 2 subdistricts. 469 parents in those did re-examine their stool in the last 3 months in 2019 to compare the 2 sets of the prevalence. In both steps of the analysis, basic data were gender and 6 age ranges (Min = 20 years old, Max > 60 years old).In the final step, influent factors based on the documents and congruence among 6 responsible staffs with an equal number in each, The stool examination was FECT and helminthiasis simple smear in the first 2 steps was in the same standard. In the third one, the excreted factors were supported by theories and 100 percent of the congruence. The results were as 1)In the first step, 15.96% among 9873 subjects were infected. Male (n=893)was statistically significant higher (P<=.05) than female(n=682).The age range mode was 41-50 years old. 2)In the second step, 21 % among 496 subjects were infected. Male(n=37)was statistically significant higher than female(n=13) at .05 level. Age range mode was in 40-50 years old in both subdistricts. 3)In the final step, 3 influent factors were delivered out as the number of water resources and geographical patient location, and fish consuming behavior. The beyond results besides the purposes revealed prevalence of helminthiasis comprised; Opisthorchis viverrini (47.08%), hookworm (28.17%), and Taenia spp (6.91%). This was crucial for further investigation in each type to be able to link into both the public health and helminth professional area.

Recurrent Abdominal Pain in School Age Children

Background Abdominal pain defined as any type of pain or discomfort that occurs in any area from the lower chest to the groin. Abdominal pain is symptom of a wide variety of mild to serious diseases, disorders, conditions. Abdominal pain can result from infection, malignancy, inflammation, obstruction and other abnormal processes. Aim of the Work To define the causes of recurrent abdominal pain among a sample of school age children. Subjects and Methods This cross sectional study was carried out to evaluate those children who presented to the Pediatric Outpatient Clinic, Children Hospital, Ain Shams University because of recurrent abdominal pain they were diagnosed in the pediatric Gastroenterology unit between June 2016 and July 2017. History taking included full analysis of abdominal pain, associated gastrointestinal symptoms and associated systemic manifestations. Examination included anthropometric measurements, general and local abdominal examination. Routine investigations included complete blood counts, urine analysis and culture, microscopic stool examination and pelviabdominal US. Other specific investigations were selected according to clinical manifestations to reach an organic cause. After reaching the definitive diagnosis, patients were classified into 2 groups organic causes and functional abdominal pain. Results During the study period, 100 children presented with recurrent abdominal pain. Results revealed that only 28% of the recurrent abdominal pain causes were attributed to organic factors; the most commonly encountered organic causes of recurrent abdominal pain were urinary tract infection (12%) while 72% of children presented with functional recurrent abdominal pain. The most common causes of function recurrent abdominal pain in our study was irritable bowel syndrome. Conclusion Most of the cases of RAP among school age children are due to functional abdominal pain (72%).

Detection of Goat Digestive Tract Protozoa Through Feces Examination in Kwanyar Sub-District, Bangkalan District

This study aims to determine the prevalence and species of protozoa that infect the digestive tract of goats in Kwanyar Sub-District, Bangkalan District. This study was conducted in June-July 2019 with 100 samples of stool examination in the laboratory of the Division of Parasitology, Faculty of Veterinary Medicine, Airlangga University. On examination found two types of protozoa, which were: Eimeria sp and Blastocystis sp. The results of this study showed the prevalence of 48% digestive tract protozoa. The results of statistical analysis using the Chi-Square test showed significant differences in age under one year and over one year in goats (p <0.05).