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Chronic liver diseases (CLDs) represent an important health issue in developing countries andare commonly associated with impaired immunity. This increases the susceptibility to various infectiousagents including parasitic infections, which should be properly managed to avoid lifethreatening complications. This study assessed the feasibility of rapid, easy and applicablescreening test for Giardia and Cryptosporidium within 150 CLDs patients suitable for upper endoscopicexamination. Stool samples, duodenal aspirates and duodenal biopsies were examinedfor G. lamblia and C. parvum by different diagnostic techniques. The results showed stool microscopy(13.3% & 7.3%), duodenal aspirate microscopy (5.3% & 4.7%), rapid lateral flow immune-chromatographic assay (RLFIA) applied on duodenal aspirate samples (16.7% & 10%),duodenal biopsies histopathological examination (6.7% & 5.3%) and direct fluorescent antigendetection in stools (16.7% & 9.3%) for giardiasis and cryptosporidiosis respectively. The highsensitivity of lateral flow immune-chromatographic assay in detecting Giardia and Cryptosporidiumin duodenal fluid samples proved a good screening test for these patients.

Information on age-based Taenia solium taeniasis prevalence is crucial for control of cysticercosis. T. solium taeniasis prevalence was determined for a village in Liangshan Prefecture, Sichuan Province, China that was co-endemic for T. solium, Taenia saginata asiatica, and Taenia saginata. Individuals who were Taenia egg-positive by stool microscopy and/or expelled tapeworms or proglottids post-treatment were diagnosed as having taeniasis. Infecting species was identified via multiplex PCR on tapeworm specimens or coproPCR followed by sequencing. In addition, initial stool samples from 10 children with taeniasis suspected of having spontaneous expulsion of tapeworms within the period between diagnosis and treatment were subject to species confirmation via coproPCR and sequencing. Of the 389 study subjects, 194 (49.9%) were diagnosed with taeniasis. Children (< 16 years of age) had a higher T. solium taeniasis prevalence (8.8%) than older individuals (2.5%) (P = 0.0127). Molecular analysis of initial stool samples from 7 of 10 children suspected of spontaneously passing tapeworms indicated 6 infections due to T. solium and 1 infection due to T. saginata. This study found that young children had a higher T. solium taeniasis prevalence than older individuals, providing additional support for the belief that adult T. solium likely has a relatively short lifespan compared to other Taenia species with human definitive hosts.

Background Stool samples sent to the lab without an indication for screening was in the top 5 rejections in the hospital. Approximately 440 stool samples were rejected annually in the Microbiology lab for being sent for testing too frequently. A majority of these rejections were from wards with immunocompromised patients. Requisition/testing unnecessary samples leads to negative patient experience and unnecessary healthcare costs. A stool microscopy and culture costs £21.00. This is quite significant compared to the number of tests requested. Our aim was to investigate ward practices in sending stool samples for testing and the causes for high rejection rates of these. Method Current policies and practices for stool testing in wards and labs were studied, especially the weekly screen for neutropenic patients. Historic and live data were reviewed. Various teams were interviewed to understand the requirements for stool testing. Key groups involved: Infection Prevention and Control (IPC), Laboratory, Microbiologists, Specialty leads and nurses. Ethical clearance was not needed. Results We found mismatch in protocols held with different departments. We identified discrepancy of policy versus practices and lack of understanding between ward and the lab. We observed inconsistencies between wards. While many samples were rejected, we also found many were unnecessarily tested. Discussion Results indicated that a coherent update in departmental policies is required between IPC, Microbiology Laboratory and Nursing teams. Due to significant cultural implications, multiple approaches to educate staff in the updated practice will be required. A special focus is needed to the decision making at the point of requisition. Solutions such as simple flow charts, system updates to aid optimal test requisition on the electronic requesting system and education sessions will be explored in the next part of this study. Conclusion Differences in practices, guidance and its interpretation led to a significant number of unnecessary testing.

Reactive arthritis (ReA) is a syndrome of arthritis and tenosynovitis with defined extra-articular manifestations following certain infections. Despite being recognized a long time ago, debates still surrounds its definition. It is still unclear if the spectrum of the disease should include arthritis induced by other than the classical organisms. Here, we present an unusual cause of ReA. A young healthy female patient presented with acute polyarthritis and acute urticaria after 2 weeks of diarrheal illness. She was found to have blastocystis in the stool microscopy. Extensive evaluation ruled out other causes of her arthritis. She received metronidazole with a short course of NSAIDS and steroids with complete resolution of her skin and joint symptoms. She was followed for six months with no recurrence of arthritis or urticaria. Blastocystis sp. is a parasite that is prevalent in developing countries. It has been linked to isolated ReA or isolated urticaria among a few other case reports. This is the very first case to have blastocystis induced ReA that coexisted with acute urticaria. Upon review of the literature, we found that blastocystis induced ReA affects mainly young and middle-aged females such as in our case. The arthritis is usually settled with the parasite eradication. Finally, urticaria might be a distinguishing feature for blastocystis induced ReA that requires specific antimicrobial therapy.

Strongyloidiasis is a helminthic disease which is common in the tropics, subtropics and especially prevalent in far east. It is rarely reported in Bangladesh probably due to the low index of suspicion in common practice. We are reporting a case of strongyloidiasis that was found in a middle-aged patient presenting with diarrhoea, weight loss and generalized itching. He was treated in different hospitals and undergone extensive investigation. We diagnosed him as a case of strongyloidiasis on the basis of stool microscopy examination and treated with Ivermectin.J MEDICINE Jan 2018; 19 (1) : 54-57

Protozoal gastrointestinal infections predominantly affect people in lower income countries, with poor sanitation a significant contributing factor. In the developed world, outbreaks mainly affect identifiable high-risk groups and returning travellers. These infections carry a significant morbidity and mortality worldwide. The definitive diagnosis for these infections has traditionally relied upon stool microscopy, but this technique has a poor sensitivity in many infections, and newer technologies such as polymerase chain reaction and enzyme-linked immunoassay-based tests are becoming available. Identification of infection is particularly important in patients with HIV or those otherwise immunosuppressed, as they often suffer severe disease.

In high prevalence settings, cryptosporidiosis is commonly implicated as a cause of a gastroenteritis syndrome in the organ transplant population. Stool microscopy is predominant diagnostic modality. Therapeutic options in this group of patients are limited, making their management exceptionally challenging. We describe a case of a renal transplant recipient with cryptosporidiosis confirmed by the stool FilmArray gastrointestinal panel (GIP) nucleic acid-based assay and stool microscopy, describe our institutional experience in diagnosing cryptosporidiosis in a low-prevalence setting, and review the available literature on management of this condition in the organ transplant population. In a low-prevalence setting, the GIP can serve as a rapid screening tool in the diagnosis of cryptosporidiosis.

Intestinal parasitic infection (IPI) constitute a global health burden causing clinical morbidity in 450 million people. Many of these are women of reproductive age and children in developing countries. Mass deworming programmes with improvement in lifestyle are likely to reduce the intensity and prevalence of infection over the years. Hence, we aimed to assess the prevalence of intestinal parasitic infections among patients in a tertiary healthcare setting and to examine its time trends. A descriptive cross-sectional study was done using routinely collected data in a tertiary care hospital in South India. Details of examination of stool samples for the presence of intestinal helminth and protozoan ova/cysts, over the period of 5 years (2014–2019) were extracted from laboratory register and hospital information system. The presence of intestinal parasitic infection was determined by stool microscopy (direct wet mount and concentration techniques). Of the total 3267 stool samples, 303 (9.3%) had at least one parasite; 3.9% (93/3267) with helminths and 2.5% (81/3267) Entamoeba and multi-parasitism was seen in 0.14%. Stool samples from more than 18 years age had high positivity rate than others. Majority of the helminth infections were caused by Ascaris (57%) followed by hookworm (42%). Initially IPI which was 10.9% in 2014 declined to 10% in 2016 and attained a peak of 12.4% in 2017 then decreased to 6.7% in 2018. Nearly one out of ten patients had a parasitic infection. Prevalence surveys in the community followed by strengthening the deworming procedures will reduce the burden of IPIs.

Background A cross-sectional survey was performed to estimate the prevalence of periportal fibrosis in children based on ultrasound examination in the Marolambo district of the Atsinanana region of Madagascar. This is a remote area known to have a high prevalence of intestinal schistosomiasis. Methods School-aged children (5–14 y) were selected from six villages for parasitological and sonographic examination. Circulating cathodic antigen (CCA) tests and Kato Katz (KK) stool microscopy were performed. Video-clips of liver views were recorded with a SonoSite iViz and interpreted in the UK by comparison with standardised images (WHO protocol). Results The prevalence of schistosomiasis according to CCA testing was 97.8% (269/275) and 73.8% (203/275) by KK. Sonographic evidence of periportal fibrosis was observed in 11.3% (31/275). The youngest children with fibrosis were aged 6 y. Fibrosis was more common in older children (p=0.03) but was not associated with either infection intensity category (p=0.07) or gender (p=0.67). Conclusions Findings of periportal fibrosis among children in these hard-to-reach villages suggests chronic Schistosoma mansoni infection from a very young age. This may reflect other similarly remote schistosomiasis-endemic areas and reinforces the need to investigate morbidity in neglected communities to understand the true extent of disease burden in endemic countries.

Soil Transmitted Helmenthiasis (STH) is a major public health problem in the developing countries. Trichuriasis is one of the common prevalent parasitic infestations in the tropical and sub-tropical countries across the globe incuding India. However, there has been a steady decline of STH in the last five years where there has been success of albendazole with Mass Drug Administration (MDA) in National Filariasis Control Program and Kerala state has been one of them. We report a case of whipworm infection that was incidentally diagnosed by colonoscopy where repeated stool microscopy was uncontributory. The worm can be overlooked, particularly if colon preparation is not good.

The objective of this study was to evaluate the role of Blastocystis sp. in gastrointestinal symptoms reported by adult patients in a Peruvian hospital. A case-control 3:1 study was performed at the outpatient clinic. Direct stool examinations were done. One hundred sixty patients were included, 40 cases and 120 controls. Positivity to Blastocystis sp. was associated with dyspepsia (P

Intestinal parasite infections are frequent causes of diarrhea and malnutrition among children in the tropics. Transmission of helminths and intestinal protozoa is intimately connected with conditions of poverty, including inadequate sanitation and hygiene. Concurrent infections with several intestinal pathogens may lead to excess morbidity. Yet, there is a paucity of epidemiological data from Mali. In this study, stool samples from 56 individuals, aged 2&ndash, 63 years, from Bamako and Niono, south-central Mali were examined for intestinal parasites using stool microscopy. Additionally, stool samples were subjected to a rapid diagnostic test (RDT) and polymerase chain reaction (PCR) for the detection of Cryptosporidium spp. and Giardia intestinalis. The predominant pathogens were Schistosoma mansoni and G. intestinalis with prevalences of 41% and 38%, respectively. Hymenolepis nana was detected in 4% of the participants, while no eggs of soil-transmitted helminths were found. Concurrent infections with G. intestinalis and S. mansoni were diagnosed in 16% of the participants. For the detection of G. intestinalis, PCR was more sensitive (100%) than RDT (62%) and microscopy (48%). As helminth-protozoa coinfections might have important implications for morbidity control programs, future studies should employ diagnostic tools beyond stool microscopy to accurately assess the co-endemicity of giardiasis and schistosomiasis.

Background The parasite load within the sample and the amount of sample taken during examination greatly compromise the sensitivity of direct saline stool microscopy. Methods A cross-sectional study was conducted in March 2011 in Bahir Dar city among 778 fresh single stool samples to evaluate the performance of direct saline (DS), Kato Katz (KK) and Formol ether concentration (FEC) methods against the ‘Gold’ standard. Result Among 778 stool samples from school age children, the highest prevalence of intestinal parasites was recorded by FEC (55.1%). The sensitivity of DS, FEC and KK were 61.1%, 92.3% and 58.7%, respectively. Conclusion FEC is more sensitive than DS and KK. Hence, use of the latter is preferred.

Background Zoonotic schistosomiasis in Asia, caused by Schistosoma japonicum, remains a major public health concern in China and the Philippines. The developing epidemiological and socio-economic picture of the disease in endemic areas necessitates the development of affordable and highly accurate field diagnostics as an important component in evaluating ongoing integrated control and elimination efforts. Methods Three diagnostic methods, namely Kato-Katz (KK) stool microscopy, ELISA and droplet digital (dd) PCR assays, were compared by detecting infection in a total of 412 participants from an area moderately endemic for schistosomiasis in the Philippines. Results This comprehensive comparison further defined the diagnostic performance and features for each assay. Compared with the ddPCR assay analysing DNA from faeces (F_ddPCR), which exhibited the highest sensitivity, the SjSAP4 + Sj23-LHD-ELISA had the best accuracy (67.2%) among all five ELISA assays assessed. Schistosomiasis prevalence determined by the SjSAP4 + Sj23-LHD-ELISA and ddPCRs was similar and was at least 2.5 times higher than obtained with the KK method. However, the agreement between these assays was low. In terms of cost and logistical convenience, the SjSAP4 + Sj23-LHD-ELISA represents a cost-effective assay with considerable diagnostic merits. In contrast, although the ddPCR assays exhibited a high level of diagnostic performance, the high cost and the need for specialized equipment presents a major obstacle in their application in screening campaigns. Conclusion The SjSAP4 + Sj23-LHD-ELISA represents a cost-effective tool for the diagnosis of schistosomiasis that could prove an important component in the monitoring of integrated control measures as elimination draws closer, whereas the ddPCR assays, in addition to their high sensitivity and specificity, are capable of quantifying infection intensity. However, the high cost of ddPCR hinders its wider application in screening programs, although it could be a valuable reference in the development and improvement of other diagnostic assays., Author summary Schistosomiasis japonica remains prevalent in China and in the Philippines. The current changes in the epidemiological and socio-economic picture in the endemic areas makes it imperative that affordable and more sensitive field diagnostics are developed as an important component to evaluate ongoing integrated control and elimination efforts. Three diagnostic approaches, namely Kato-Katz stool microscopy, ELISA and droplet digital PCR assays, were compared by detecting infection in a cohort from schistosome-endemic areas in the Philippines. This comprehensive comparison further defined the diagnostic performance and features for each assay. Prevalence of schistosomiasis determined by the SjSAP4 + Sj23-LHD-ELISA and ddPCRs was at least 2.5 times higher than that by the KK method. The prevalence determined by the SjSAP4 + Sj23-LHD-ELISA and ddPCRs was similar, but low agreements between these assays were evident. The ddPCR assays showed considerable diagnostic performance but the high associated costs and the need for specialized equipment present major obstacles in their application in screening campaigns although they can serve as reference standards for evaluating other diagnostic assays. The SjSAP4 + Sj23-LHD-ELISA represents a cost-effective tool for the diagnosis of schistosomiasis japonica and this assay could prove an important monitoring tool to evaluate the impact of integrated control measures over time.

Background Intestinal trematodes are common parasites in man and many mammals. Infection is often asymptomatic and unrecognised. Case presentation A woman in her twenties presented with loose stools of variable intensity over six months. Additionally, she had experienced considerable fatigue during this period. There was no weight loss and initial blood tests were normal. Further testing at the second visit included stool microscopy, and small trematode eggs consistent with H. heterophyes infection were found. A more thorough anamnesis revealed the onset of symptoms on the day she returned from a week's holiday, and the probable exposure occurred from eating sushi twice during this holiday. After one day of treatment with praziquantel 40 mg/kg administered in three doses, the patient recovered completely within two to four weeks. Her asymptomatic partner had consumed the same food and had the same eggs in his stool sample. He was successfully treated with the same treatment dose. Interpretation A detailed travel history may provide important information relating to the diagnosis of diarrhoea and fatigue. Symptoms of H. heterophyes infection are variable. A single day's dose of 40 mg/kg of praziquantel was sufficient to eradicate infection in the two cases presented.

Background We evaluated the performance of stool microscopy, serology, and real time PCR (qPCR) for the diagnosis of strongyloidiasis at our reference laboratory. Methods Using a convenience sample of specimens submitted between April 1, 2014 and May 31, 2015, positivity rates and performance characteristics were calculated. Results During the enrolment period, 17,933 stool specimens were examined for O&P, 14 of which were positive for Strongyloides larvae. For stool specimens serially positive for larvae, mean duration of larval shedding was 12.7 days following the initial positive specimen, while for sputum and urine, it was 12 and 2 days, respectively. During the enrolment period, 3258 specimens were processed for Strongyloides serology, 200 of which were reactive (6.1%), 210 indeterminate (6.5%), and 2848 non-reactive (87.4%). qPCR was positive in 11 of 12 (91.7%) stool specimens containing larvae, and negative in all stool specimens without larvae by microscopy. There was no cross-reactivity of Strongyloides-specific qPCR to other stool protozoa or helminths. Conclusions In the absence of immunosuppression, larval burden in strongyloidiasis is low, limiting the utility of microscopy, and favoring serologic testing. However, false negative serology can occur in those with hyperinfection necessitating a combined diagnostic approach. qPCR was insufficiently sensitive to replace microscopy for detection of larvae.

Ürtiker insanların %15-25 inin yaşamlarını etkilemektedir. Parazitozların ürtikerle ilişkisi konusunda çoğunluğu olgu sunumlarından oluşan sınırlı sayıda araştırma bulunmaktadır. Yapılan çalışmalarda, ürtiker etyolojisinde diğer paraziter enfeksiyonlara daha sık rastlanırken Entamoeba histolitica görülme oranı düşüktür. Bu çalışmada ürtiker etyolojisinde rutin gayta mikroskopisi ile tanı koyduğumuz 4 Entomoeba histolitica olgusu sunulmaktadır. 3 hastada gastrointestinal semptom yoktu, 3 hastanın Entomoeba histolitica tedavisi ile ürtikeri geriledi, 1 hastada kronik böbrek yetmezliği olması nedeni ile enfeksiyon hastalıkları polikliniğine yönlendirildi., Urticaria affects 15-25% of people at least once in their life time. There is limited research about urticaria relations of parasitosis, the majority consisting of case reports. Current studies show that other parasitic infections are more frequently observed in the etiology of urticaria, whereas the incidence of Entamoeba histolytica is quite low. Here we present four recent cases of Entamoeba histolytica which its diagnosis was made in routine stool microscopy in urticaria. Three patients had no gastrointestinal symptoms, by the treatment of Entamoeba histolytica three patients’ urticaria have regressed, one patient was referred to the infectious diseases clinic because of chronic renal failure.

Background: Chronic Spontaneous Urticaria (CSU) has been found to have a negative impact on all aspects of patients’ lives - physical, mental, social and emotional. The ubiquitous and fascinating Giardia lamblia is primarily a gastrointestinal pathogen but it may present atypically (with or without gastroenterological manifestations). A link between Giardiasis and CSU was identified in the past. However, the possibility of this combination has been under-appreciated in clinical practice, even in developed world, resulting in inordinate delay in reaching correct diagnosis and instituting targeted pharmacotherapy. Such a situation adds to the miseries of the patients, both mental anguish and physical suffering. Objectives: -To determine the role of Giardia lamblia in the causation of CSU -To ratify the effects of eradication of Giardia lamblia on the course of CSU Methods: The present study was conducted on 63 referred cases of CSU (with insignificant improvement from the treatment already instituted). In view of the possibility of concomitant Giardial infection stool microscopy was advised and three fresh stool specimens, taken on alternate days, were collected from every case and examined for parasites. The two validated instruments employed for comparing Patient Related Outcome Measures (PROMs), before and after treatment, were UAS7 (Urticaria Activity Score of 7days) and CU-Q2oL (Chronic Urticaria Quality of Life Questionnaire). Results: Twenty two percent of those tested were found to have sole infection with Giardia lamblia. Secnidazole Sodium, as a single oral dose, resulted in complete parasitological and clinical cure in 93% of the cases. The results of the PROMs were compared and correlated with the clinical picture. Conclusion: The effects of eradication of Giardia lamblia on the course of the urticaria were excellent. Complete resolution of symptoms was seen in 93% of cases (and no recurrence in the follow up period of 16 weeks) with specific anti-giardial therapy alone proving that the causative agent was Giardia lamblia and that there was no role for any concomitant dermatological pathology. There is a dire need for meaningful cooperation between specialists of Dermatology and Tropical Medicine, in the management of otherwise unexplained urticaria.

Background Accurate determination of Schistosoma infection rates in low endemic regions to examine progress towards interruption of transmission and elimination requires highly sensitive diagnostic tools. An existing lateral flow (LF) based test demonstrating ongoing infections through detection of worm circulating anodic antigen (CAA), was improved for sensitivity through implementation of a protocol allowing increased sample input. Urine is the preferred sample as collection is non-invasive and sample volume is generally not a restriction. Methods Centrifugal filtration devices provided a method to concentrate supernatant of urine samples extracted with trichloroacetic acid (TCA). For field trials a practical sample volume of 2 mL urine allowed detection of CAA down to 0.3 pg/mL. The method was evaluated on a set of urine samples (n = 113) from an S. mansoni endemic region (Kisumu, Kenya) and compared to stool microscopy (Kato Katz, KK). In this analysis true positivity was defined as a sample with either a positive KK or UCAA test. Results Implementation of the concentration method increased clinical sensitivity (Sn) from 44 to 98% when moving from the standard 10 μL (UCAA10 assay) to 2000 μL (UCAA2000 assay) urine sample input. Sn for KK varied between 23 and 35% for a duplicate KK (single stool, two slides) to 52% for a six-fold KK (three consecutive day stools, two slides). The UCAA2000 assay indicated 47 positive samples with CAA concentration above 0.3 pg/mL. The six-fold KK detected 25 egg positives; 1 sample with 2 eggs detected in the 6-fold KK was not identified with the UCAA2000 assay. Conclusions Larger sample input increased Sn of the UCAA assay to a level indicating ‘true’ infection. Only a single 2 mL urine sample is needed, but analysing larger sample volumes could still increase test accuracy. The UCAA2000 test is an appropriate candidate for accurate identification of all infected individuals in low-endemic regions. Assay materials do not require refrigeration and collected urine samples may be stored and transported to central test laboratories without the need to be frozen.

Zusammenfassung Zusammenfassung Die klassische Stuhlmikroskopie zum Nachweis intestinaler Protozoen-Infektionen wird mehr und mehr ersetzt durch neue Detektionsverfahren wie Immunfluoreszenz, Antigen-ELISA oder PCR. Dies gilt insbesondere für die Diagnostik von Entamoeba histolytica, da dieser Parasit mikroskopisch nicht von anderen, apathogenen Amöbenspezies wie Entamoeba dispar oder Entamoeba moshkovskii unterschieden werden kann.

Background: Blastocystis was identified almost a century ago, yet its biology and pathogenicity status in humans is obscure. Studies on Blastocystis in India are scanty and are mostly microscopy based. This study compared three detection modalities to determine their efficiency in the identification of Blastocystis in human feces. Materials and Methods: A total of 279 stool samples were screened using microscopy, culture (Jones' medium), and polymerase chain reaction (PCR)-based methods. Among the three, PCR is considered the gold standard test for detection of Blastocystis, as it helps to authenticate the sensitivity, specificity, and kappa agreement obtained by the other two tests. The morphological features of Blastocystis were recorded at 24, 48, and 72 h. After positive morphological identification, ten samples were cultured on Lowenstein–Jensen (LJ) medium and Locke's egg slant medium. Results: The sensitivity and specificity determined on the basis of microscopy were 36.2% and 99.4%, respectively. On the other hand, Jones' medium showed 67.6% sensitivity and 100% specificity. Further, we documented various morphological and reproductive features of Blastocystis using various staining techniques on cultures positive in Jones' medium. In addition, we also found that LJ medium was not equally efficacious as Jones' medium in assisting the growth of Blastocystis. Conclusions: Although molecular diagnosis is a necessary tool for understanding the true epidemiology of Blastocystis, in laboratories devoid of molecular detection facilities, stool microscopy in conjunction with stool culture on Jones' medium could serve as the best alternative tool for the detection of Blastocystis.

Background A number of studies document the prevalence of Taenia solium infections in Nigeria, yet these studies do not cover porcine cysticercosis in private home slaughter slabs where there is no routine meat inspection and backyard pig keeping, slaughtering and sale are common practice. Methods An environmental and sanitary assessment was conducted within two unregistered home pig slaughter slabs in selected parts of the Kaduna metropolis in Nigeria. Slaughter premises were inspected for availability of basic facilities and questionnaires were used to elicit necessary informative data. Butchers were examined for taeniasis by stool microscopy and copro-antigen enzyme linked immunosorbent assay (copro-Ag ELISA) to ascertain T. solium – taeniasis. Pigs slaughtered at the premises were examined for cysticerci. Results Home slaughter conditions were substandard, unhygienic and lacked the basic facilities of a proper slaughterhouse. Prevalence of porcine cysticercosis was 9.3%. The butchers participating in the study had very poor knowledge of T. solium infections and 30% tested positive for taeniasis by copro-Ag ELISA at the time of the study. Conclusion Home slaughter of pigs in the areas studied should be considered and integrated as a component of prevention and control programmes – particularly through educational interventions – in order to equip individuals involved with a good understanding of the risks associated with animal husbandry and human practices. Electronic supplementary material The online version of this article (doi:10.1186/2049-9957-3-45) contains supplementary material, which is available to authorized users.

Microscopic stool examination can distinguishinflammatory from noninflammatory diarrheas. Themodified guaiac test was shown to have good correlationto stool microscopy. In a prospective study we evaluated the diagnostic accuracy of a modified guaiactest (ColoRectal-Test, Roche) and of an immunologicaltest for fecal haemoglobin (Colo-Immun-Test, Roche) inrelation to the diarrheal pathogens identified and compared it with the stool microscopy. In 304patients, clinical presentation, stool microscopy, stoolculture, and modified guaiac test were recorded.Sensitivity of the guaiac test was 69% as compared to 63-67% for the stool microscopy. Specificitycould be improved by 10-15% using an immunological testto exclude false-positive guaiac reactions. A modifiedguaiac test can replace microscopic stool examination to distinguish between inflammatoryand noninflammatory diarrhea. Immunological testing foroccult blood can improve the specificity of the guaiactest, but is too elaborate to serve as a screening test. The modified guaiac test can easily behandled by community health workers and could beimportant in the diagnostic work-up for acute infectiousdiarrhea.

Aging declining immune response, and often compromised gastrointestinal tract functions result in altered digestion and/or malabsorption. These problems are manifested by the presence of abnormally increased amount of yeast and vegetable cells in their stool revealed by the simple microscopy.

Background A key epidemiologic feature of schistosomiasis is its focal distribution, which has important implications for the spatial targeting of preventive chemotherapy programs. We evaluated the diagnostic accuracy of a urine pooling strategy using a point-of-care circulating cathodic antigen (POC-CCA) cassette test for detection of Schistosoma mansoni, and employed simulation modeling to test the classification accuracy and efficiency of this strategy in determining where preventive chemotherapy is needed in low-endemicity settings. Methodology We performed a cross-sectional study involving 114 children aged 6–15 years in six neighborhoods in Azaguié Ahoua, south Côte d’Ivoire to characterize the sensitivity and specificity of the POC-CCA cassette test with urine samples that were tested individually and in pools of 4, 8, and 12. We used a Bayesian latent class model to estimate test characteristics for individual POC-CCA and quadruplicate Kato-Katz thick smears on stool samples. We then developed a microsimulation model and used lot quality assurance sampling to test the performance, number of tests, and total cost per school for each pooled testing strategy to predict the binary need for school-based preventive chemotherapy using a 10% prevalence threshold for treatment. Principal Findings The sensitivity of the urine pooling strategy for S. mansoni diagnosis using pool sizes of 4, 8, and 12 was 85.9%, 79.5%, and 65.4%, respectively, when POC-CCA trace results were considered positive, and 61.5%, 47.4%, and 30.8% when POC-CCA trace results were considered negative. The modeled specificity ranged from 94.0–97.7% for the urine pooling strategies (when POC-CCA trace results were considered negative). The urine pooling strategy, regardless of the pool size, gave comparable and often superior classification performance to stool microscopy for the same number of tests. The urine pooling strategy with a pool size of 4 reduced the number of tests and total cost compared to classical stool microscopy. Conclusions/Significance This study introduces a method for rapid and efficient S. mansoni prevalence estimation through examining pooled urine samples with POC-CCA as an alternative to widely used stool microscopy., Author Summary Schistosomiasis is a disease caused by parasitic worms that affects over 250 million people. The global control strategy is regular deworming of school-aged children. Before deworming campaigns can be conducted, one must know where the disease is present. The current method requires collection of individual stool and urine samples that are examined under a microscope by trained laboratory technicians. We present an alternative method that can inform where schistosomiasis is present in above 10% of the population, which is the threshold at which school-based deworming is recommended. The proposed strategy involves pooling multiple urine samples and using a rapid diagnostic test. The goal is to reduce the number of tests, cost, time, and laboratory infrastructure to guide decision-making. We collected data in Côte d’Ivoire to evaluate this new diagnostic procedure of pooling urine, and used computer simulation to predict its performance in classification of communities above or below the 10% threshold. We found that the urine pooling strategy with a pool size of 4 reduced the number of tests and cost compared to the current standard method, while maintaining the same accuracy. Our findings suggest that this strategy may be an effective and cost-saving method compared to traditional microscopy.

Myiasis cases are often encountered in humans, especially in tropical and subtropical regions. Urogenital myiasis is one of the facultative myiasis cases that may be seen in humans. Psychoda albipennis is an insect species that causes urogential myiasis in humans Adults of this species, belongs to the Psychodidae subfamily, lives especially in humid toilets and domestic bathrooms. This case, presented as urogenital myiasis caused by P. albipennis in a fifteen year old male. The person, who was a student, was living in the city center reported to have passed five-six larvae for three months. The patient had normal urinalysis, stool microscopy and urine culture. Larvae were examined under a microscope and were identified as fourth period larvae of P. albipennis. Therefore, it should not be forgotten that P. albipennis may be an agent in urogenital myiasis.

Objective: To determine if use of basic laboratory tests improves diagnosis and treatment outcomes in outpatients attending rural primary health care facilities. Setting: Six rural health centres in Kenya. Design: Cross-sectional study to observe change in diagnosis and treatment made by clinical officers after laboratory testing in outpatients attending six rural health centres in Kenya. Subject: The diagnosis and treatment of 1134 patients attending outpatient services in six rural health centres were compared before and after basic laboratory testing. Essential clinical diagnostic equipment and laboratory tests were established at each health centre. Clinical officers and laboratory technicians received on-site refresher training in good diagnostic practices and laboratory procedures before the study began. Results: Laboratory tests were ordered on 704 (62.1%) patients. Diagnosis and treatment were changed in 45% of tested patients who returned with laboratory results (21% of all patients attending the clinics). 166 (23.5%) patients did not return to the clinician for a final diagnosis and management decision after laboratory testing. Blood slide examination for malaria parasites, wet preparations, urine microscopy and stool microscopy resulted in most changes to diagnosis. There was no significant change in drug costs after laboratory testing. The greatest changes in numbers of recorded diseases following laboratory testing was for intestinal worms (53%) and malaria (21%). Conclusion: Effective use of basic laboratory tests at primary health care level significantly improves diagnosis and patient treatment. Use of laboratory testing can be readily incorporated into routine clinical practice. On-site refresher training is an effective means of improving the quality of patient care and communication between clinical and laboratory staff.

This study analyzes the causes of neglect of stool microscopy by using cause- and-effect diagrams which are commonly used tools in personnel management in industry and hospitals. The lack of motivation among technicians in performing stool microscopy is the most important factor. Some possible factors responsible for this are non-recognition of their work by peers and inadequate skills due to lack of formal training and their attitude toward handling and examining stool specimens. The attitude of a laboratory senior staff member toward stool microscopy compounded the problem. Another key factor is the indifference of clinicians to the results of stool microscopy. Some detrimental factors seen are the lack of awareness on the importance of proper collection and transport of specimens and the need to examine adequate numbers. Motivation of senior laboratory experts change of attitude and effective supervision will cultivate a sense of confidence and importance among laboratory personnel doing the tests. Furthermore continuance of medical education is important to maintain the skills. Such approaches are believed to result in motivated competent laboratory personnel at the primary health care level.

Asymptomatic infestation with Strongyloides stercoralis, common in the tropics, may result in potentially fatal hyperinfection during treatment with immunosuppressive drugs used to treat patients with severe ulcerative colitis (UC). Hence, importance of early recognition and treatment of this nematode in patients with UC before starting immunosuppressive drugs can not be overemphasized. We report a 23-yrs old man with UC who presented with acute severe attack. Since his UC did not respond to intravenous hydrocortisone over 6 days, oral cyclosporine was started on 7th day after repeating stool microscopy, which revealed larvae of Strongyloides stercoralis. Duodenal aspirate also confirmed presence of multiple larvae. He responded to treatment for Strongyloides stercoralis , continuation of hydrocortisone and cyclosporine. Importance of early diagnosis of infestation with Strongyloides stercoralis while on treatment with immunosuppressive drugs for severe UC is emphasized. Difficulties in diagnosis and management of Strongyloides stercoralis infestation in patients with UC are discussed.

The aim of this study was to evaluate the performance of the CORIS Giardia-Strip test (CORIS Bioconcept, Gembloux, Belgium) as a rapid initial method for the routine diagnosis of giardiasis. Compared to a commercial ELISA-coproantigen test (ProSpect Giardia-ELISA-microplate assay; Remel, Lenexa, KS, USA), the commercial strip test had a sensitivity of 58%, a specificity of 99%, a positive predictive value of 93% and a negative predictive value of 93% (n=158). These results are comparable to those obtained using microscopy of direct wet-mounted stool. Since the CORIS Giardia-Strip test is simpler to perform, it can replace direct wet-mounted stool microscopy for the rapid diagnosis of giardiasis; however, its sensitivity is inferior to that of other immunochromatographic antigen detection tests and fresh stool samples are required for its use. Nevertheless, the results suggest that a positive CORIS Giardia-Strip test outcome does not need confirmation, while samples with negative results should be re-examined using another, more sensitive, test.

Rhabditiform larvae, transforming larvae from rhabditiform to filariform, and eggs of Strongyloides stercoralis were identified in the sputum of a Thai woman with acquired immunodeficiency syndrome (AIDS), and stool microscopy also showed a heavy load of rhabditiform larvae of S. stercoralis. She was treated with 12 mg ivermectin once a day for 2 days for the strongyloidiasis, with good therapeutic results being obtained. Strongyloidiasis may be a curable disease through the use of an appropriate therapy, even in a patient with AIDS.

Microscopic examination of a wet mount of the stool has been the standard practice for the laboratory diagnosis of intestinal parasitic infections. Here we describe a novel method of stool microscopy of 80 stool samples, 31 (38.75%) were positive by the new thick stool smear wet mount method, whereas the corresponding figure for the conventional method using lacto-phenol cotton blue was 16 (20%). The difference was found to be statistically significant ( P

M. tuberculosis can be grown from the stool of adults with pulmonary tuberculosis (PTB) and the advent of AIDS and its concomitant atypical infections has again focused attention on the diagnostic possibilities of this investigation. The suggestion has been made that stool culture and microscopy for M. tuberculosis might be of value in the diagnosis of childhood tuberculosis. Seventy-six children were investigated who were suspected of having respiratory tuberculosis. Two successive early morning gastric aspirates were collected and the radiometric Bactec® method was used for isolation of M. tuberculosis. Two stools from each child were combined and processed as previously described for the detection of mycobacteria. Positive cultures were tested for acid fastness by Ziehl-Neelsen staining and subcultured onto Lowenstein-Jensen medium for identification. Laboratory personnel were unaware of the clinical status of the children. (excerpt)

The provision of emergency medicine in Malawi is described and compared with that found in countries with more resources. Emergencies are as old as humanity. Specialised emergency care is relatively new. Emergency medicine in well resourced parts of the world has become increasingly complex, coordinated, and slick. Expectations of good practice from the public and from inpatient hospital colleagues are high. Experienced and specialised nursing and medical staff run excellent services with high patient turnover. Professional organisations representing emergency medicine make recommendations to government about staffing, training requirements, and back up services. But what of the universal picture? In most resource poor areas of the world it is very different. There are no prehospital general practice services and no regular ambulance services. Health centres provide primary care. These are staffed by one “clinical officer” (a paramedic trained in diagnosis and treatment) and one or two nurses who have available a few basic drugs. Self referred and health centre referred patients attend district or central hospitals. In these hospitals trauma cases are seen in a side room (called “casualty”) of the outpatients department. A clinical officer (CO) or medical assistant (MA) attends. Nominal supervision is given by the district medical officer, or in central hospitals by the orthopaedic or general surgical department. All other (medical) emergencies line up to see a CO or MA in outpatients. The queues are long and the staff are few. Laboratory investigations are minimal (perhaps a peripheral blood film for malaria parasites, a haemoglobin concentration, urine and stool microscopy). The World Health Organisation reports that the …

The original version of this article unfortunately contained a mistake. In Table 2 we calculated the percentages presented for the stool microscopy and culture of B. hominis row wise rather than vertically in the column. As this was aimed to determine the distribution of B.hominis in IBS-D versus control group, we should have calculated the percentage column wise. However, percentages calculated row wise will not change the P value when calculated column wise. There was an error on our part that percentages presented for the stool microscopy and culture of B. hominis in the Table 2 should have been reported column wise. Please see amended Table 2.

Parasitic gastrointestinal infections are a major cause of morbidity and mortality in the developing world, with stool microscopy being the mainstay of diagnostic practice. Both direct microscopy and concentration techniques can be utilized; direct microscopy may be time consuming and tedious; however clinical laboratories in developing countries lack trained staff who can effectively use concentration methods. In our practice we used the Parasep O and P filter concentrator tubes (manufactured by DiaSys Ltd, Berkshire, England. Product Code 146000) along with direct microscopic techniques and found that Parasep filters enhanced the ability to detect intestinal parasites that would have been missed on routine microscopy. We found the Parasep filter concentration method to be easy, cost-effective and reliable for routine stool examinations.

Ultrasound was used to diagnose periportal fibrosis (PPF) in a rural Zimbabwean community where Schistosoma mansoni is endemic. Ultrasound findings were compared with stool microscopy and abdominal palpation in 492 adults (305 females). 47 (9.6%) had definite PPF. The prevalence of PPF increased with age (P0.001), while S. mansoni egg counts decreased with age. Even within age groups, egg count did not correlate with PPF. No association was found between lifetime alcohol consumption and the presence of PPF. Splenomegaly and mid-line enlargement of the liver were specific (97% and 94%) but insensitive (21% and 28%) markers for PPF. Spleen size varied with S. mansoni egg count independently of the presence or degree of PPF. Endoscopy of 18 patients with PPF revealed oesophageal varices in two, both of whom had severe PPF.

We report a case of autoinfection due to Strongyloides stercoralis in a 27-year-old Ethiopian AIDS patient living in Germany for nearly 3 years. This case was diagnosed on the basis of a single-view field in microscopy of a freshly obtained formalin-fixed stool specimen showing both rhabditiform and filariform larvae. The diagnosis of autoinfection by microscopy is discussed in detail.

We compared the diagnostic accuracy of microscopical examination of multiple faecal specimens with duodenal juice examination in the diagnosis of giardiasis. Of 292 patients who had stool microscopy and duodenal aspirate, Giardia were identified in either stools or duodenal fluid from 73 patients (25%). Giardiasis was diagnosed in 62 (73%) with the first faecal specimen, but examination of 3 specimens increased the diagnostic yield to 85%. Giardia, however, were found in only 32 of 73 duodenal aspirates examined (44%). This finding is contrary to the widely held belief that duodenal fluid examination is superior to stool microscopy for the diagnosis of giardiasis. The 2 approaches are complementary, however, since Giardia was found in duodenal fluid, only, from 15% of patients.

Tutor’s Guide from the Schistosomiasis and Intestinal Parasites Unit, Division of Control of Tropical Diseases, World Health Organization, Geneva. (42 pages, 130 slides) WHO/CTD/SIP/98.2‘When is a book not a book?’ Answer: When it is an idealized set of slides of intestinal helminths and protozoans accompanied by a slim manual outlining the aims, uses, equipment and supplies, essential publications and an overview of medically relevant helminths and protozoa necessary to mount a workshop on the identification of parasites in stool samples.However, workshops are only as good as the tutor’s teaching ability and knowledge of the subject. Thus, although this package of slides and manual may provide the essential tools, the art lies in providing the appropriate environment in which to foster enthusiasm for the subject. Optimum conditions would be required, particularly with regard to projection facilities in mainly developing countries, to observe the fine nuances of helminth and protozoan morphology. Such training is clearly of major importance in tropical areas, and the success of enabling students to perform specific laboratory techniques such as direct faecal smears, the Kato–Katz faecal smear technique and various concentration and staining procedures, as well as identifying parasites by genus and species and by quantification of helminth eggs, will depend largely upon the skills of the trainer. A two-and-a-half-day workshop is suggested to cover the various areas outlined in the manual, and these clear photomicrographs will undoubtedly provide a superb visual display.The individual slides show close-up views of each ovum or protozoan, which often occupy most of the slide. It is a pity that common misleading artefacts found in stools, are not also illustrated, as the set of slides reflects the ideal rather than reality. In my experience, problems lie not so much with parasite identification as with false positives or the failure to find any organism at all.Intestinal parasites are clearly a major world health problem requiring both skills with the microscope and identification knowledge for diagnosis. The question remains how best to impart such knowledge in a lively and appealing way to laboratory technicians and health workers. The opportunity for interactive teaching that this manual and slides provide, should clearly help. Many of the slides are superfluous, there being often more than two or three of the same organism. However, each indicates slight and subtle variation, as well as allowing for damage or loss of any of the slides.The most difficult area in stool microscopy is the differentiation of the Entamoebae, Iodoamoebae, Diiodomoebae and other protozoans; in this respect, this set of slides is valuable, providing over 70 examples with clearly explained differentiating features. This volume goes hand in hand with Bench Aids for the Diagnosis of Intestinal Parasites (WHO 1997). The combination of manual and slides clearly represents a comprehensive set of basic teaching tools on this important subject.

In survey work, stool microscopy for cysts and serology are the only really practicable measures of amoebic infection. The diagnostic sensitivity of stool microscopy should be estimated. Using a simple deterministic mathematical model, the rates of gain and loss of infection and seropositivity may be estimated from survey data. The low value of the constants creates difficulties but they can be estimated from: (1) cumulative data from frequently sampled cohorts; (2) analysis of the curves of age prevalence; (3) analysis of curves of long-term follow-up studies. The second method is the simplest and normally gives valid results. Appropriate epidemiological studies can give useful information about protective immunity, incubation period, superinfection, and interactions between amoebic infection and various host factors, including other disease states. Knowledge of the rate constants of infection allows predictions to be made about the likely effect of control measures.

During 1918, the state of Queensland, Australia, the Australian Institute of Tropical Medicine, and the International Health Board conducted jointly a hookworm survey in the northern portion of the state of Queensland, and through stool microscopy found 21 per cent, of the total population to be infected. The parasite was harbored by two fifths of the schoolchildren, a great many of whom showed physical dwarfing and sexual retardation. In order to learn whether mental impairment might be due to hookworm disease, this investigation aimed to measure the mentality of a large number of children, and then to compare the results of the infected group with those of the noninfected group. The measures of intelligence employed were Goddard's 1911 Revision of the Binet-Simon scale,1and the Porteus mazes,2both of which were applied and scored according to the standard methods prescribed, excepting only the use of Australian copper and