Persistent damage to Enterocytozoon bieneusi, with persistent symptomatic relief, after combined furazolidone and albendazole in AIDS patients. (1/790)

AIM: To investigate morphological changes in Enterocytozoon bieneusi and the duration of symptomatic relief after combination treatment with furazolidone and albendazole in AIDS patients. METHODS: Four severely immunocompromised AIDS patients with symptomatic E bieneusi infection of the gut received an 18 day course of combined furazolidone and albendazole (500 + 800 mg daily). All patients were monitored for parasite shedding in stool by light microscopy at the end of treatment and monthly during follow up. At the end of treatment, duodenal biopsy specimens obtained from three patients were studied by transmission electron microscopy by two pathologists blind to the patients' treatment or clinical outcome. Duodenal biopsy specimens obtained from one of the patients two months after completion of treatment were also studied electronmicroscopically. RESULTS: All patients had long lasting symptomatic relief, with a major decrease--or transient absence--of spore shedding in stools from completion of treatment. After treatment, changes in faecal spores were persistently found by light microscopy in all cases, and there was evidence of both a substantial decrease in the parasite load and ultrastructural damage in the parasite in all biopsy specimens. The treatment was well tolerated, and no patient had clinical or parasitological relapse during follow up (up to 15 months). CONCLUSIONS: The long lasting symptomatic relief observed in all four treated patients correlated with the persistent decrease in parasite load both in tissue and in stool, and with the morphological changes observed in the life cycle of the protozoan. These data suggest that combined treatment with furazolidone and albendazole is active against E bieneusi and may result in lasting remission even in severely immunocompromised patients.  (+info)

A powerful DNA extraction method and PCR for detection of microsporidia in clinical stool specimens. (2/790)

The diagnosis of intestinal microsporidiosis has traditionally depended on direct visualization of the parasite in stool specimens or intestinal biopsy samples by light and/or electron microscopy. Limited information about the specificity and sensitivity of PCR for the detection microsporidia in clinical stool specimens is available. To establish a sensitive and specific method for the detection of microsporidia in clinical samples, we studied clinical stool specimens of 104 randomly selected human immunodeficiency virus-infected patients with diarrhea to compare light microscopy and PCR. Fluorochrome Uvitex 2B staining was used for light microscopy. To raise the sensitivity of PCR, we used a powerful and fast DNA extraction method including stool sedimentation, glass bead disruption, and proteinase K and chitinase digestion. PCR was performed with primer pairs V1-PMP2, V1-EB450, and V1-SI500, and the nature of the PCR products was confirmed by Southern blot hybridization. Microsporidiosis was diagnosed by light microscopy in eight patients. Ten patients tested positive for microsporidiosis by PCR. Enterocytozoon bieneusi was found in seven cases, and Encephalitozoon intestinalis was found in four cases. In one case a double infection with E. bieneusi and E. intestinalis was diagnosed by PCR, whereas light microscopy showed only E. bieneusi infection. PCR testing of stool specimens is useful for diagnosis and species differentiation of intestinal microsporidiosis in HIV patients.  (+info)

Prevalence of intestinal parasite infections with special reference to Entamoeba histolytica on the island of Bioko (Equatorial Guinea). (3/790)

The prevalence of intestinal parasitic infections was assessed (1993 through 1995) among two different groups of persons on the island of Bioko, Equatorial Guinea. In the first group, parasitologic examinations were performed on stool specimens from a household-based sample of 557 dwellers from the rural area of the island. In the second group, 1,633 inpatients and outpatients at the General Hospital of Malabo (the capital of the country) were studied. All age groups were represented in both groups. The average prevalence of the most common protozoan and helminthic intestinal infections in rural and urban areas, respectively, was as follows: Entamoeba histolytica/E. dispar (14.9% and 32.7%, respectively), Giardia lamblia (7.2% and 8.6%), Ascaris lumbricoides (45.8% and 31.4%), and Trichuris trichiura (25.7% and 36.4%). Seventy-nine sera from patients with amebic liver abscess (suspected by ultrasonography) were studied by an immunohemagglutination assay, with 44 (56%) showing anti-E. histolytica titers > or = 1:32. Of these 79 sera, 71 were studied by an enzyme immunoassay, 86% of which were positive with titers > or = 1:64. This study showed that parasitic infections in Equatorial Guinea represent a major health problem.  (+info)

The cost effectiveness of strategies for the treatment of intestinal parasites in immigrants. (4/790)

BACKGROUND: Currently, more than 600,000 immigrants enter the United States each year from countries where intestinal parasites are endemic. At entry persons with parasitic infections may be asymptomatic, and stool examinations are not a sensitive method of screening for parasitosis. Albendazole is a new, broad-spectrum antiparasitic drug, which was approved recently by the Food and Drug Administration. International trials have shown albendazole to be safe and effective in eradicating many parasites. In the United States there is now disagreement about whether to screen all immigrants for parasites, treat all immigrants presumptively, or do nothing unless they have symptoms. METHODS: We compared the costs and benefits of no preventive intervention (watchful waiting) with those of universal screening or presumptive treatment with 400 mg of albendazole per day for five days. Those at risk were defined as immigrants to the United States from Asia, the Middle East, sub-Saharan Africa, Eastern Europe, and Latin America and the Caribbean. Cost effectiveness was expressed both in terms of the cost of treatment per disability-adjusted life-year (DALY) averted (one DALY is defined as the loss of one year of healthy life to disease) and in terms of the cost per hospitalization averted. RESULTS: As compared with watchful waiting, presumptive treatment of all immigrants at risk for parasitosis would avert at least 870 DALYs, prevent at least 33 deaths and 374 hospitalizations, and save at least $4.2 million per year. As compared with watchful waiting, screening would cost $159,236 per DALY averted. CONCLUSIONS: Presumptive administration of albendazole to all immigrants at risk for parasitosis would save lives and money. Universal screening, with treatment of persons with positive stool examinations, would save lives but is less cost effective than presumptive treatment.  (+info)

Suppression of giardiasis during the intestinal phase of trichinosis in the mouse. (5/790)

The interaction of the intestinal phases of Giardia muris and Trichinella spiralis was investigated in Swiss albino mice. Intraoesophageal inoculation of G. muris cysts seven days before, or seven days after, similar inoculation of T. spiralis larvae resulted in significant reduction in the numbers of Giardia trophozoites in small bowel and Giardia cysts in stools. This effect was not observed when G. muris cysts were administered after resolution of the intestinal phase of trichinosis. Giardiasis had no effect on trichinosis as assessed by numbers of adult worms in small bowel and larvae in skeletal muscles. Studies of small bowel morphology showed that the intestinal phase of trichinosis was associated with increased numbers of inflammatory cells in the lamina propria, a significant increase in Paneth cells in crypts, and a marked reduction in the villus:crypt ratio of jejunum. These observations suggest that the intestinal phase of trichinosis induced environmental changes in small bowel, perhaps related to inflammation, which resulted in suppression of proliferation of Giardia trophozoites.  (+info)

A case of gastric pseudoterranoviasis in a 43-year-old man in Korea. (6/790)

A case of Pseudoterranova decipiens infection was found in a 43-year-old man by gastroendoscopic examination on August 20, 1996. On August 6, 1996, he visited a local clinic, complaining of epigastric pain two days after eating raw marine fishes. Although the symptoms were relieved soon, endoscopic examination was done for differential diagnosis. A white, live nematode larva was removed from the fundus of the stomach. The larva was 38.3 x 1.0 mm in size and had a cecum reaching to the mid-level of the ventriculus. A lot of transverse striations were regularly arranged on the cuticle of its body surface, but the boring tooth and mucron were not observed at both ends of the worm. The worm was identified as the 4th stage larva of P. decipiens.  (+info)

Nematode intestinal parasites of children in rural Guinea, Africa: prevalence and relationship to geophagia. (7/790)

BACKGROUND: Intestinal parasitism is common among children in developing countries, but the risk factors for infection are not well characterized. METHODS: A stool examination was performed on 286 randomly selected children aged 1-18 years from three rural villages in Guinea, Africa. Information collected by questionnaire was used to examine the relationship between geophagia and infection with intestinal nematodes acquired by ingestion versus skin penetration. RESULTS: Fifty-three per cent of children were infected by at least one type of soil-transmitted nematode. Geophagia was reported by parents to occur in 57%, 53%, and 43%, of children ages 1-5, 6-10, and 11-18 years, respectively. The pattern of geophagia by age and gender of the children more closely resembled the infection pattern for the two orally acquired and soil-transmitted nematodes (Ascaris lumbricoides, Trichuris trichiura) than it did the infection pattern for the two soil-transmitted nematodes that infect by skin penetration (hookworm, Strongyloides stercoralis). CONCLUSIONS: These findings demonstrate that geophagia is an important risk factor for orally acquired nematode infections in African children. Education regarding geophagia prevention should be an integral component of any soil-transmitted parasite control programme.  (+info)

Development of a polymerase chain reaction diagnostic assay for Ceratomyxa shasta, a myxosporean parasite of salmonid fish. (8/790)

A diagnostic procedure based on the polymerase chain reaction (PCR) was developed for the myxosporean parasite Ceratomyxa shasta. Three sets of oligonucleotide primers were designed to specifically amplify C. shasta ribosomal RNA genes and several parameters of the assay were tested and optimised. A simple protocol for the processing of fish tissue samples was also developed. In a single round, 20 microliters volume reaction the optimised procedure allows the detection of 50 fg of purified C. shasta genomic DNA, or 0.01 spore from a seeded fish intestine sample. This protocol is considerably faster, cheaper and more reliable than any previous diagnostic procedure for a myxosporean parasite, and can be an invaluable tool for the monitoring of early and/or subclinical C. shasta infections in wild and cultured salmon populations.  (+info)