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Humans can be infected with anthroponotic (Ancylostoma duodenale and Necator americanus) and with zoonotic (Ancylostoma ceylanicum, A. caninum, A. braziliense, and Uncinaria stenocephala) hookworms from dogs. Anthroponotic species are usually thought not to infect dogs. We used the internal transcribed spacer–1 (ITS1) gene in a quantitative PCR to detect anthroponotic and zoonotic hookworm species in fecal samples from 54 children and 79 dogs living in an indigenous community in tropical Northwestern Ecuador. Hookworm DNA was detected in 59.3% of children and 92.4% of dogs. Among samples from children, zoonotic hookworms were detected in 24.1% (A. ceylanicum 14.8%, A. caninum 11.1%, and A. braziliense 1.9%), whilst in dog samples, anthroponotic species were detected in 19.0% (N. americanus 12.4% and A. duodenale 6.3%). Sanger sequencing was performed successfully on 60 qPCR-positive samples (16 from children and 44 from dogs), and consensus sequences were obtained with >98% homology to GenBank references for hookworm spp. Phylogenetic analysis showed a close relationship between anthroponotic and zoonotic Ancylostoma species and no heterogeneity between A. duodenale and A. caninum; in human samples, we found A. ceylanicum but not A. braziliense sequences and we were unable to identify N. americanus in the dog samples. No infections with U. stenocephala were detected. Our data provide evidence for high rates of hookworm infections in indigenous children and dogs in a marginalized rural setting in coastal Ecuador. We also found evidence for potential cross-transmission of hookworm spp. between humans and dogs that represent a potential domestic reservoir for zoonotic and anthroponotic hookworms. [ABSTRACT FROM AUTHOR]

Hookworm, a parasitic infection, retains a considerable burden of disease, affecting the most underprivileged segments of the general population in endemic countries and remains one of the leading causes of mild to severe anemia in Low and Middle Income Countries (LMICs), particularly in pregnancy and children under 5. Despite repeated large scale Preventive Chemotherapy (PC) interventions since more than 3 decades, there is broad consensus among scholars that elimination targets set in the newly launched NTD roadmap will require additional tools and interventions. Development of a vaccine could constitute a promising expansion of the existing arsenal against hookworm. Therefore, we have evaluated the biological and implementation feasibility of the vaccine development as well as the added value of such a novel tool. Based on pipeline landscaping and the current knowledge on key biological aspects of the pathogen and its interactions with the host, we found biological feasibility of development of a hookworm vaccine to be moderate. Also, our analysis on manufacturing and regulatory issues as well as potential uptake yielded moderate implementation feasibility. Modelling studies suggest a that introduction of a vaccine in parallel with ongoing integrated interventions (PC, WASH, shoe campaigns), could substantially reduce burden of disease in a cost – saving mode. Finally a set of actions are recommended that might impact positively the likelihood of timely development and introduction of a hookworm vaccine. [ABSTRACT FROM AUTHOR]

Controlled Human Infection Models (CHIS) involve administering human pathogens to healthy participants in controlled medical settings, which can elicit complex bioethical issues. Understanding how the community perceives such studies can significantly increase the participant's sense of cooperation and increases the researcher's and the participant's transparency. The current study describes the development of an educational intervention to achieve these ends as it aims to (1) analyze perceptions of the Controlled Human Infection Studies (CHIS), and (2) evaluate the participants' comprehension of the CHIS. Methods: This is a qualitative action research that includes the development of an educational intervention with residents of a rural area in Minas Gerais, Brazil, where there is continuous natural transmission of the human pathogen Necator americanus ("hookworm"). In this area, it is intended to carry out a proposed phase 3 vaccine clinical trial in the future to test the efficacy of hookworm vaccines using controlled human infection. Two data collection strategies were used: an educational intervention and a focus group. Results: The participants' perceptions showed distinct perspectives on CHIS. On one side, they recognized that the investigation is essential for the community, but on the other side, they thought that there would be resistance to its conduct by fear of infection. The idea that the study would generate a benefit for the greater good, contributing to the prevention of hookworm infection, was clearly stated. The participants perceived that the study offered concrete risks that could be reduced by constant monitoring by the researchers. They also mentioned the importance of access to information and the positive influence those who express interest in participating in the study can exert in the community. In relation to comprehension the participants memorized the information, mobilized it to explain everyday situations and created strategies to disseminate the study and engage the community in its development. By repeating and making sense of the information, the participant not only assimilates the knowledge transmitted, but also creates new knowledge. Conclusion: We concluded that an educational process of discussion and dialogue around participants' perceptions about the CHIS, promotes understanding and allows ways to disseminate information about the research to be collectively created. [ABSTRACT FROM AUTHOR]

Aims: This study aimed to characterize feline hookworms from stray cats living in Bangkok. Methods and Results: A total of 56 hookworm‐positive faecal samples were identified for hookworm species by using PCR targeting the ITS1, 5.8S, and ITS2 fragment and qPCR targeting ITS2. Of 56 samples, 96.4% (54/56) were identified as Ancylostoma ceylanicum and 1.8% (1/56) as Ancylostoma caninum. With qPCR, 89.3% (50/56) were identified as single A. ceylanicum infection and 5.4% (3/56) as coinfection of A. ceylanicum and A. caninum. For genetic characterization of A. ceylanicum, 10 samples were pooled, and the partial COI gene was amplified, followed by deep amplicon sequencing. Five pooled samples were analysed, and 99.73% were identified with A. ceylanicum sequences, which were allocated into 19 haplotypes (AC01‐AC19). Genetic diversity findings for A. ceylanicum in Asia revealed that three of eight haplotypes considered of zoonotic significance occurred in humans, dogs, and cats, including haplotypes H01, H20, and H21. The predominant haplotype in this study, AC01, was clustered with H01‐a zoonotic haplotype. Conclusions: The diversity obtained by deep amplicon sequencing supported that the A. ceylanicum community had high genetic variation. Deep amplicon sequencing was a useful method to determine source, zoonotic potential, and host–parasite relationship. [ABSTRACT FROM AUTHOR]

Background: Infections caused by soil-transmitted helminths (STHs) are the most prevalent neglected tropical diseases and result in a major disease burden in low- and middle-income countries, especially in school-aged children. Improved diagnostic methods, especially for light intensity infections, are needed for efficient, control and elimination of STHs as a public health problem, as well as STH management. Image-based artificial intelligence (AI) has shown promise for STH detection in digitized stool samples. However, the diagnostic accuracy of AI-based analysis of entire microscope slides, so called whole-slide images (WSI), has previously not been evaluated on a sample-level in primary healthcare settings in STH endemic countries. Methodology/Principal findings: Stool samples (n = 1,335) were collected during 2020 from children attending primary schools in Kwale County, Kenya, prepared according to the Kato-Katz method at a local primary healthcare laboratory and digitized with a portable whole-slide microscopy scanner and uploaded via mobile networks to a cloud environment. The digital samples of adequate quality (n = 1,180) were split into a training (n = 388) and test set (n = 792) and a deep-learning system (DLS) developed for detection of STHs. The DLS findings were compared with expert manual microscopy and additional visual assessment of the digital samples in slides with discordant results between the methods. Manual microscopy detected 15 (1.9%) Ascaris lumbricoides, 172 (21.7%) Tricuris trichiura and 140 (17.7%) hookworm (Ancylostoma duodenale or Necator americanus) infections in the test set. Importantly, more than 90% of all STH positive cases represented light intensity infections. With manual microscopy as the reference standard, the sensitivity of the DLS as the index test for detection of A. lumbricoides, T. trichiura and hookworm was 80%, 92% and 76%, respectively. The corresponding specificity was 98%, 90% and 95%. Notably, in 79 samples (10%) classified as negative by manual microscopy for a specific species, STH eggs were detected by the DLS and confirmed correct by visual inspection of the digital samples. Conclusions/Significance: Analysis of digitally scanned stool samples with the DLS provided high diagnostic accuracy for detection of STHs. Importantly, a substantial number of light intensity infections were missed by manual microscopy but detected by the DLS. Thus, analysis of WSIs with image-based AI may provide a future tool for improved detection of STHs in a primary healthcare setting, which in turn could facilitate monitoring and evaluation of control programs. Author summary: In this school survey conducted within a primary healthcare setting in rural Kenya, a deep-learning system (DLS) was developed for detection of eggs secreted in human stool from intestinal worms, so called soil-transmitted helminths (STHs). Infections caused by STHs are the most common neglected tropical diseases and a major cause of health impairment in low- and middle-income countries. Novel diagnostic methods are needed to improve disease control. In the current study, stool samples were collected from children attending local primary schools and digitized using a portable slide scanner and uploaded via mobile networks to a cloud repository. Using the digital samples, a DLS was trained and tested for the detection of eggs of the most common STHs (Ascaris lumbricoides, Tricuris trichiura and hookworms) and compared to conventional manual microscopy analysis of the samples. The results showed that the DLS was able to accurately detect STHs in the digital samples. Although the DLS detected some false positive parasites, it was able to detect a significant number of parasites that had been missed with conventional microscopy analysis. The study concludes that digital microscopy, supported by image-based artificial intelligence, can be implemented in a primary health care setting and may provide a future tool for improved STH detection and, thereby, better monitoring and evaluation of control programs. The digital method is especially promising in light intensity infections, with only a few parasite eggs per sample. [ABSTRACT FROM AUTHOR]

Zoonotic hookworm infections remain a significant public health problem, causing nearly 500 million cases globally and approximately four million disability-adjusted life years lost annually. More than one-fifth of these cases are attributed to Ancylostoma ceylanicum, an emerging zoonotic health issue in the Asia-Pacific region. This review presents key research gaps regarding the epidemiology, diagnosis, control, prevention and elimination of A. ceylanicum and other canine zoonotic hookworms as neglected health threats. A. ceylanicum is the second most prevalent human hookworm in the region; it is the most common hookworm among dogs and cats-reservoirs of zoonotic infections. Previous population genetic and phylogenetic analyses revealed that A. ceylanicum has three possible transmission dynamics: zoonotic, animal-only, and human-only pathways. The actual burden of zoonotic ancylostomiasis in most endemic countries remains unknown due to the use of parasitological techniques (e.g., Kato-Katz thick smear and floatation techniques) that have reduced diagnostic performance and do not allow accurate species identification in helminth surveys. The emergence of benzimidazole resistance in soil-transmitted helminths (STHs), including hookworms, is a concern due to the protracted implementation of mass drug administration (MDA). Resistance is conferred by single nucleotide polymorphisms (SNPs) that occur in the β-tubulin isotype 1 gene. These mutations have been reported in drug-resistant A. caninum but have not been found in A. ceylanicum in the field. A. ceylanicum remains understudied in the Asia-Pacific region. The zoonotic nature of the parasite warrants investigation of its occurrence in human and animal reservoir hosts to understand the dynamics of zoonotic transmission in different endemic foci. The detection of benzimidazole resistance-associated SNPs in zoonotic hookworms from Asia-Pacific countries has yet to be thoroughly explored. Considering the high level of hookworm endemicity in the region, the circulation of resistant isolates between humans and animals potentially presents a significant One Health threat that can undermine current MDA and proposed animal deworming-based control efforts. [ABSTRACT FROM AUTHOR]

Background: The World Health Organization emphasizes the importance of integrated monitoring and evaluation in neglected tropical disease (NTD) control programs. Serological assays offer a potential solution for integrated diagnosis of NTDs, particularly for those requiring mass drug administration (MDA) as primary control and elimination strategy. This scoping review aims (i) to provide an overview of assays using serum or plasma to detect infections with soil-transmitted helminths (STHs) in both humans and animals, (ii) to examine the methodologies used in this research field and (iii) to discuss advancements in serological diagnosis of STHs to guide prevention and control programs in veterinary and human medicine. Methodology: We conducted a systematic search in the Ovid MEDLINE, Embase and Cochrane Library databases, supplemented by a Google search using predefined keywords to identify commercially available serological assays. Additionally, we performed a patent search through Espacenet. Principal findings: We identified 85 relevant literature records spanning over 50 years, with a notable increased interest in serological assay development in recent years. Most of the research efforts concentrated on diagnosing Ascaris infections in both humans and pigs, primarily using ELISA and western blot technologies. Almost all records targeted antibodies as analytes, employing proteins and peptides as analyte detection agents. Approximately 60% of sample sets described pertained to human samples. No commercially available tests for Trichuris or hookworms were identified, while for Ascaris, there are at least seven different ELISAs on the market. Conclusions: While a substantial number of assays are employed in epidemiological research, the current state of serological diagnosis for guiding STH prevention and control programs is limited. Only two assays designed for pigs are used to inform efficient deworming practices in pig populations. Regarding human diagnosis, none of the existing assays has undergone extensive large-scale validation or integration into routine diagnostics for MDA programs. Author summary: To further integrate the monitoring and evaluation of public health control programs against neglected tropical diseases (NTDs), the diagnostic platforms used should ideally be able to screen multiple NTDs in one and the same sample. A stepping stone for more synergies across these programs are blood-based diagnostic assays. Although they have been both developed and implemented to inform public health programs for a number of NTDs, little is known about the progress towards a blood-based diagnostic assays to follow-up on public health programs against intestinal worms. Therefore, we conducted an extensive review of blood-based tests for intestinal worm infections in humans and animals, analysing their progress from assay-development towards routine use in both public and animal health control programs. Our results indicated that, despite many tests are used in research, the use of blood-based assays for guiding control programs against intestinal worms is limited. Only two tests for pigs are currently used to inform deworming programs in pig herds. For human diagnosis, none of the current assays has been extensively evaluated or used for routine diagnosis in control programs. [ABSTRACT FROM AUTHOR]

Cutaneous larva migrans (CLM) results from hookworm larvae infestation, mainly Ancylostoma braziliense or Ancylostoma caninum. It is common in Sub-Saharan Africa, often acquired through soil contact, especially in sandy beaches, manifesting as serpiginous, erythematous and intensely pruritic tracts within the epidermis, and presenting with diverse clinical appearances. Diagnosis is mostly clinical; however, dermoscopy can enhance diagnostic accuracy and distinction from mimics. The current body of literature is deficient in its representation of dermoscopic data for CLM in Black patients. This study explores dermoscopy in nine dark-skinned patients with 16 CLM lesions. Distinctive serpiginous structureless areas displaying a range of colours, peripheral scales surrounding brown areas and brown dots were predominant features, whereas vascular characteristics were less evident. This article highlights the presence of distinct reaction patterns, including brown dots, scales, and accentuated, often disrupted brown reticular lines in addition to the characteristic winding tracts in darker skin. [ABSTRACT FROM AUTHOR]

Introduction. This study determines the incidence of common viral and helminth coinfections with malaria in the tertiary care hospital set up in southern Khyber Pakhtunkhwa, Pakistan. Materials and Methods. The multidimensional research included malaria patients admitted to different hospitals of district Kohat during January and December 2021. Stool samples and blood were assembled from the patients. Giemsa-stained microscopy-positive samples were processed by the immunochromatography technique (ICT) to identify Plasmodium species. Common viral infections such as viral hepatitis (A, B, and C), HIV, and dengue (DENV) were analyzed by ICT kits while SARS-CoV-2 was confirmed through real-time PCR. Furthermore, the intestinal helminths were identified using the Kato-Katz thick smear method. Results. Among 1278 patients, 548 were diagnosed with malaria, 412 (75.2%) were positive for P. vivax infection, 115 (21%) for P. falciparum, and 21 (3.8%) for mixed malaria infection (P. vivax/P. falciparum), with a higher incidence among males (65.2%) than females (34.8%). Coinfection with helminths was positive in 215 (39.3%) malaria patients. The most common infections were caused by the Ascaris lumbricoides species (42.6%) followed by Enterobius vermicularis (31.7%) and hookworm. A total of 24.6% of malaria-positive cases were also coinfected with different viruses with higher frequencies of confection for HAV (8.2%) and DENV (6.2%), respectively. The patients revealed higher incidence of coinfections with P. falciparum (57%) as compared with P. vivax (39.2%) and mixed infections (3.7%). Conclusion. This study demonstrated that the study population exhibited a significant incidence of coinfections with intestinal helminth and viral malaria. [ABSTRACT FROM AUTHOR]

Background: Control efforts of soil-transmitted helminthiases rely primarily on large scale administration with anthelminthic drugs. The assessment of drug efficacies and understanding of drug behavior is pivotal to the evaluation of treatment successes, both in preventive chemotherapy programs as well as in research of novel treatment options. The current WHO guidelines recommend an interval of 14–21 days between the treatment and follow-up, yet no in-depth analysis of egg excretion patterns of Trichuris trichiura after treatment has been conducted to date. Methods: Within the framework of a multi-country trial to assess the efficacy and safety of ivermectin-albendazole combination therapy vs albendazole monotherapy against T. trichiura infections, we conducted a study collecting daily stool samples over the period of 28 days post-treatment in 87 participants in Pak Khan, Lao PDR. Egg counts were derived by duplicate Kato-Katz on-site for T. trichiura, hookworm and Ascaris lumbricoides and stool sample aliquots were subsequently analyzed by qPCR for the detection of T. trichiura infections. Sensitivity and specificity was calculated for each day separately using data derived by Kato-Katz to determine the optimal timepoint at which to assess drug efficacy. Results: Egg excretion patterns varied across treatment arms. For T. trichiura, only the ivermectin-albendazole treatment led to a considerable reduction in mean egg counts, whereas both treatments reduced hookworm egg counts and A. lumbricoides were cleared in all participants after day 7. For T. trichiura, we found sensitivity to be highest at days 18 and 22 when using egg counts as outcome and days 19 and 24 when using qPCR. Specificity was high (>0.9) from day 14 onwards. For hookworm, the highest sensitivity and specificity rates were found at days 17 and 25, respectively. Conclusions: Based on our study the ideal time period to assess drug efficacy for soil-transmitted helminth infections would be between day 18 and 24. The current WHO recommendation of 14 to 21 days is likely to yield acceptable outcome measures for soil-transmitted helminth infections. Trial registration: NCT03527732. Author summary: Whipworm (T. trichiura), hookworm and roundworm (A. lumbricoides) infections are highly common worldwide. To reduce the morbidity caused by these infections, hundreds of million deworming drugs are given to children every year. To assess how good deworming drugs work it is recommended to microscopically analyze stool samples 14–21 days after treatment, however the evidence base for this recommendation is scarce. In Lao PDR we conducted a study collecting daily stool samples from 87 participants for 28 days post-treatment with two deworming drugs, single albendazole and co-administered albendazole-ivermectin. We counted the eggs of T. trichiura, hookworm and A. lumbricoides of each sample by microscopy and calculated the daily proportions of correctly classified negative or positive individuals according to considered real negatives and positives. We used these measures to find the optimal timepoint at which drug efficacy should be assessed. We found that only albendazole-ivermectin reduced the egg counts of whipworm infection whereas both treatments reduced hookworm egg counts and A. lumbricoides worms were absent in all participants after day 7. The best time points to evaluate the activity of the deworming drugs were found at days 18 and 22 for whipworm, and at days 17 and 25 for hookworm, respectively. [ABSTRACT FROM AUTHOR]

BACKGROUND Soil-transmitted helminth (STH) infection, frequently caused by Ascaris lumbricoides, Trichuris trichiura, and hookworms (Ancylostoma duodenale and Necator americanus), often gives rise to malabsorption of nutrients that form hemoglobin (Hb) thereby causing anemia. This study aimed to know the difference in erythrocyte profile in children with and without STH infections. METHODS This cross-sectional study involved 205 children from two Panimbang Jaya elementary schools in Pandeglang, Banten, Indonesia. Blood and stool samples were collected from a previous study conducted from November 2021 to May 2022. Erythrocyte parameters were Hb concentration, erythrocyte count, mean corpuscular volume (MCV), mean corpuscular Hb (MCH), and red cell distribution width (RDW). The iron profile included serum iron, total iron-biding capacity (TIBC), and ferritin. Worm infestation was detected by direct stool microscopical examination. Statistical analysis was performed using SPSS software version 20. RESULTS The prevalence of STH infection in Pandeglang was 44.4%, primarily characterized by mild intensity STH infection (79%). The identified STH species were A. lumbricoides, T. trichiura, and combination of both. The median differences between erythrocyte count, MCV, and MCH, and the mean differences of TIBC and serum iron were not statistically significant (p = 0.388, 0.098, and 0.057, and p = 0.304 and 0.455). However, children with STH infection had lower Hb (12.57 versus 12.95 g/dl) and ferritin (19.60 versus 30.57 µg/dl) levels but higher RDW (13.20 versus 13.10%). CONCLUSIONS A high prevalence of STH infection was identified among schoolchildren, but their erythrocyte profiles were similar regardless of STH infection status. [ABSTRACT FROM AUTHOR]

The impact of the Global Programme to Eliminate Lymphatic Filariasis (GPELF) (initiated in 2000 in Ghana and ran for 12 years) in mitigating soil-transmitted helminth (STH) infections in LF-endemic areas is unknown. During a 1-year hiatus which ensued between 2011 and 2012, a longitudinal study was conducted to determine GPELF effect on hookworm infections in selected communities involved in the programme since its inception, while measuring the effectiveness of biannual ALB treatments on schoolchildren living in such communities. A total of 399 school children aged 3 to 18 years were randomly selected from four communities in the Kpandai district of northern Ghana. Each presented a single stool sample at baseline, 21 days post-treatment, at the 3rd and 6th months, 21 days post-second intervention (i.e. following sample collection and treatment with ALB in the 6th month), and in the ninth month of the study period. Haemoglobin (hb) levels were also measured at all time points using finger prick blood samples and a URIT digital test kit. Each participant submitting a sample, was treated with a single-dose ALB (400mg) at baseline and in the sixth month. Stool samples were processed by preparing duplicate Kato-Katz slides per sample, and examined by microscopy. The Body Mass Index-for-age z-scores (BAZ) of participants were assessed following the determination of BMIs at each time point by measuring their height and weight with a stadiometer and weighing scale. Overall hookworm prevalences were 25.68% (95% CI = 20.51–31.75) at baseline, 11.18% (95% CI = 7.87–15.41) 21 days post-treatment, 11.78% (95% CI = 8.38–16.11) and 6.95% (95% CI = 4.41–10.43) in the 3rd and 6th months, 0.91% (95% CI = 0.19–2.65) 21 days post-second intervention, and 8.46% (95% CI = 5.62–12.23) in the ninth month. Observed overall faecal egg count reduction rates (ERRs) were 94.21% (95% CI = 81.50%– 100.00%) 21 days after baseline treatment, 97.70% (95% CI = 85.08–100.00) and 96.95% (95% CI = 84.18%– 100.00%) in the 3rd and 6th months, 99.98% (95% CI = 86.42%– 100.00%) 21 days post-second intervention, and 17.18% (95% CI = 14.07%– 20.67%) in the 9th month. Respective cure rates (CRs) were 62.35% (95% CI = 46.71–81.56%), 85.88% (95% CI = 67.32–100.00%), 87.06% (95% CI = 68.36%– 100.00%), 98.82% (95% CI = 78.83%– 100.00%), and 36.36% (95% CI = 9.91%– 93.11%). Additionally, increases in the percent frequency of 'normal hb' (p < 0.01) were observed across the study time points, whilst 'normal BAZ' cases remained high (from 94.87% to 98.87%) throughout the study period. These findings primarily indicate satisfactory effectiveness of ALB which may be maintainable in mass drug administration programmes by the modification of treatment strategies from annual to bi-annual regimes. This could minimize the likelihood of emerging poorly-responding hookworm phenotypes in Ghana. Additionally, a positive impact of bi-annual treatment on participant anaemia status is herein indicated with particular regard to the school children in our cohort. [ABSTRACT FROM AUTHOR]

A 4 yr old castrated male greyhound presented with a history of chronic (>3 wk) intermittent diarrhea. Initial fecal analysis identified infection with Ancylostoma caninum. Despite treatment with routine anthelmintics, the dog remained persistently A caninum positive for several months. A novel fecal gastrointestinal real-time polymerase chain reaction (qPCR) parasite panel detected A caninum and the genetic benzimidazole (BZ) F167Y resistance marker in multiple samplings over 48 hr. This finding, together with the dog's clinical signs (diarrhea) and lack of response to routine anthelmintics, prompted treatment with cyclooctadepsipeptide emodepside, a drug currently not registered for dogs in the United States. The dog's clinical signs resolved and post-treatment fecal qPCR testing was negative. However, 5 mo later, retesting with fecal qPCR detected A caninum and concurrent BZ resistance marker, as well as Giardia. A presumptive diagnosis of re-infection was made and the emodepside treatment was continued. The dog again reverted to undetected (A caninum and the 167 resistance marker) on reassessment fecal qPCR. This case report describes the use of a novel fecal qPCR panel for gastrointestinal parasites, persistent hookworm and BZ F167Y resistance marker detection in a dog, and highlights the importance of a stepwise approach to clinical management, treatment, and retesting. [ABSTRACT FROM AUTHOR]

This article discusses a case of human ocular dirofilariasis in Poland. Dirofilariasis is a zoonotic disease caused by filarial parasites, with dogs being the main reservoir. The disease is transmitted by mosquitoes, and humans are accidental hosts. The patient in this case presented with symptoms in the right eye and a subconjunctival infestation was discovered. The worm was surgically removed, and the patient underwent follow-up examinations. The article also provides information on the lifecycle of the parasite, other potential vectors, and the diagnosis and treatment of dirofilariasis. [Extracted from the article]

The article discusses two cases of zoonotic diseases presenting as head and neck swellings in children. The first case involves a two-year-old boy with a swelling on the left cheek, which was diagnosed as Dirofilaria. The second case involves a six-year-old boy with a submental swelling and a history of recurrent fever, which was diagnosed as toxoplasmosis. The article emphasizes the importance of evaluating children with unexplained fever and subcutaneous swelling for zoonotic diseases and highlights the need for preventive strategies such as controlling stray animals and mosquitoes. [Extracted from the article]

Infection with the soil-transmitted helminth Strongyloides stercoralis affects up to 600 million people globally, most of whom live in rural areas with poor sanitation. If untreated, infection leads to long-lasting morbidity and might even be life-threatening. Moxidectin might be a promising alternative to ivermectin, the only currently recommended single-dose treatment. We aimed to assess whether moxidectin is non-inferior in terms of efficacy and safety compared with ivermectin. In this randomised, double-blind, parallel-group, non-inferiority, phase 2b/3 trial in communities in Laos and Cambodia, adults aged 18–65 years were screened for the presence of S stercoralis larvae in their stool via sextuplicate quantitative Baermann assays. Using computer-generated group allocation (block randomisation stratified by infection intensity), parasitologically (two or more positive Baermann assays) and clinically eligible participants were randomly assigned (1:1) to receive single oral doses of either moxidectin (8 mg) and ivermectin-matched placebo, or ivermectin (200 μg/kg bodyweight) and moxidectin-matched placebo. The primary endpoint was cure rate assessed at 14–21 days after treatment, using the available-case population analysed according to intention-to-treat principles. Moxidectin was considered non-inferior to ivermectin if the lower limit of the two-sided 95% CI of the difference was greater than the non-inferiority margin of –10 percentage points. Safety endpoints were assessed before treatment, and at 2–3 h, 24 h, and 14–21 days after treatment. This trial is registered at ClinicalTrials.gov , NCT04056325 and NCT04848688. Between Dec 6, 2020, and May 21, 2022, 4291 participants were screened, 726 of whom were enrolled and randomly assigned to moxidectin (n=363) or ivermectin (n=363). For the participants with primary outcome data, we observed a cure rate of 93·6% (95% CI 90·5 to 96·0; 324 of 346 participants) in the moxidectin group and 95·7% (93·0 to 97·6; 335 of 350 participants) in the ivermectin group, resulting in a between-group difference of –2·1 percentage points (95% CI –5·5 to 1·3). The most common adverse events were abdominal pain (32 [9%] of 363 with moxidectin vs 34 [9%] of 363 with ivermectin) and headache (25 [7%] vs 30 [8%]), which were predominantly mild and transient. Moxidectin was non-inferior to ivermectin in terms of efficacy in the treatment of strongyloidiasis. Additionally, both drugs had a similar safety profile. The fixed dose and lower cost of moxidectin compared with ivermectin make it a valuable alternative for people with strongyloidiasis. Swiss National Science Foundation. [ABSTRACT FROM AUTHOR]

Background: Gastrointestinal parasite (GIP) infections are a major cause of global morbidity, infecting hundreds of millions of people each year and potentially leading to lifelong infection and serious complications. Few data exist on screening for GIP infections in migrants entering the UK or on the current performance of different traditional diagnostic approaches. This study aimed to describe the prevalence of GIP infections in Nepalese Gurkha recruits screened on arrival in the UK. Methodology/Principal findings: We present a retrospective analysis of data from screening male adults (18–21 years) who arrived in the UK from Nepal between 2012 and 2020. Three separate faecal samples were obtained from participants at weekly intervals and processed for formalin-ethyl acetate (FEA) concentration/light microscopy and charcoal culture. Serum samples were analysed for IgG antibodies to Strongyloides stercoralis by ELISA. Results were available from 2,263 participants, of whom 463 (20.5%, 95% CI 18.8%-22.2%) had a positive diagnostic test for at least one GIP infection. A total of 525 potential infections were identified. Giardia duodenalis was most common (231/2263, 10.2%), followed by S. stercoralis (102/2263, 4.5%), and hookworm species (86/2263, 3.8%). Analysis (microscopy and culture) of the initial stool sample diagnosed only 244/427 (57.1%) faecally identified pathogens, including 41/86 (47.7%) hookworm infections. The proportion of participants infected with any GIP showed a downward trend over the study period. Log-binomial regression showed risk of infection decreasing by 6.1% year-on-year (95% CI 3.2% - 9.0%). This was driven predominantly by a fall in hookworm, S. stercoralis and Trichuris trichiura prevalence. Conclusions/Significance: The level of potentially pathogenic GIP infection in young Nepalese men migrating to the UK is high (20.5%) and requires a combined diagnostic approach including serology and analysis of multiple stool samples incorporating specialised parasitological methods. Advances in molecular approaches may optimise and simplify the intensive screening strategy required. Author summary: Gastrointestinal parasite (GIP) infections caused by protozoa and helminths affect hundreds of millions of people worldwide, resulting in significant morbidity, but remain neglected in terms of diagnosis and management. Migrant and refugee populations are rarely offered screening for GIP infection in the UK, but providing this can create opportunities for treatment, as well as to gather valuable epidemiological data. We present a retrospective analysis of screening for gastrointestinal parasites in 2,263 young Nepalese men arriving in the UK as military Gurkha recruits, using a range of conventional diagnostic methods. The presented study is one of the largest reported and most complete approach to GIP screening in a homogeneous migrant population, finding high rates of GIP infection. When conventional diagnostic methods of light microscopy and charcoal culture are used, we found serial stool collection in combination with serological assessment for Strongyloides sp. is required to achieve satisfactory results, as opposed to a single stool examination. [ABSTRACT FROM AUTHOR]

Background: Loa loa filariasis (loiasis) is still considered a relatively benign disease. However, recent epidemiologic data suggest increased mortality and morbidity in L. loa infected individuals. We aimed to examine whether the density of L. loa microfilariae (mfs) in the blood is associated with cardiovascular disease. Methodology: Using a point-of-care device (pOpmètre), we conducted a cross-sectional study to assess arterial stiffness and peripheral arterial disease (PAD) in 991 individuals living in a loiasis-endemic rural area in the Republic of the Congo. Microfilaremic individuals were matched for age, sex and village of residence with 2 amicrofilaremic subjects. We analyzed markers of arterial stiffness (Pulse-Wave Velocity, PWV), PAD (Ankle-Brachial Index, ABI) and cardiovascular health (Pulse Pressure, PP). The analysis considered parasitological results (L. loa microfilarial density [MFD], soil-transmitted helminths infection, asymptomatic malaria and onchocerciasis), sociodemographic characteristics and known cardiovascular risk factors (body mass index, smoking status, creatininemia, blood pressure). Principal findings: Among the individuals included in the analysis, 192/982 (19.5%) and 137/976 (14.0%) had a PWV or an ABI considered out of range, respectively. Out of range PWV was associated with younger age, high mean arterial pressure and high L. loa MFD. Compared to amicrofilaremic subjects, those with more than 10,000 mfs/mL were 2.17 times more likely to have an out of range PWV (p = 0.00). Factors significantly associated with PAD were older age, low pulse rate, low body mass index, smoking, and L. loa microfilaremia. Factors significantly associated with an elevation of PP were older age, female sex, high average blood pressure, low pulse rate and L. loa microfilaremia. Conclusion: A potential link between high L. loa microfilaremia and cardiovascular health deterioration is suggested. Further studies are required to confirm and explore this association. Author summary: Recent epidemiologic data suggested an increased mortality and morbidity in individuals harboring high densities of Loa loa microfilariae in the blood, underscoring the importance of studies on the possible reasons for this excess mortality. This cross-sectional study assessed arterial stiffness and cardiovascular health markers using a point-of-care device (pOpmètre) among 991 sex-, age- and residency-matched individuals living in rural forested areas of Congo. Analyses included known cardiovascular risk factors (body mass index, smoking, blood pressure, creatininemia) and parasitological covariates (onchocerciasis, asymptomatic malaria, soil-transmitted helminths and Loa loa microfilaremia). People with microfilaremia were more likely to have levels of cardiovascular markers indicating arterial stiffness and deteriorated cardiovascular health, compared with those without microfilaremia. [ABSTRACT FROM AUTHOR]

Background and Aim: According to the World Health Organization, close to 21% of India's population may be affected by intestinal parasites, accounting for 39 million disability-adjusted life years, which may likely be due to substandard sanitation practices and insufficient personal hygiene standards. This research was conducted with the aim of determining the prevalence of helminthic infections among school-aged children in the South Canara district of India. Materials and Methods: We conducted a cross-sectional study involving school children from nursery to the 8th Grade in the South Canara district of Karnataka, India. The presence of various intestinal parasites in different age groups was determined by performing routine stool microscopy. Modified acid-fast staining was performed for stool samples collected from children <5 years of age for the detection of intestinal coccidian parasites. Statistical analysis was carried out to analyze age-related trends in relation to the prevalence of commonly detected intestinal parasites. Results: Intestinal parasites were identified in 10 of the 253 students (3.9%), with the highest incidence observed in the age group of 7-10 years (1.9%). The most prevalent parasite identified was the cysts of Giardia lamblia, with a prevalence of 7.54%, followed by Ascaris lumbricoides and hookworm, each having a prevalence of 5.66%. Of the 253 students, 92.2% practiced handwashing with soap after defecation, while 7.8% did not use soap. The handwashing practices did not significantly vary across different age groups. Clinically, pallor was observed in 64.2% of the individuals. Conclusion: Giardiasis was the most common parasitic infection, followed by soil-transmitted helminths such as Ascariasis and hookworm. The level of hygiene practices among children exceeded the prevailing national and state standards. [ABSTRACT FROM AUTHOR]

Background: Preventive chemotherapy with a single dose of praziquantel given to an all-at-risk population through mass drug administration is the cornerstone intervention to control and eliminate schistosomiasis as a public health problem. This intervention mainly targets school age children, and pre-school age children (pre-SAC) are excluded from receiving preventive chemotherapy, partly due to scarcity of data on praziquantel treatment outcomes. Methods: We conducted active efficacy and safety surveillance of praziquantel treatment among 240 Schistosoma mansoni-infected pre-SAC who received a single dose of praziquantel (40 mg/kg) in southern Ethiopia. The study outcomes were egg reduction rates (ERR) and cure rates (CRs) four weeks after treatment using the Kato–Katz technique and treatment-associated adverse events (AEs) that occurred within 8 days post-treatment. Results: The overall ERR was 93.3% (WHO reference threshold ≥ 90%), while the CR was 85.2% (95% CI = 80.0–89.5%). Baseline S. mansoni infection intensity was significantly associated with CRs, 100% among light infected than moderate (83.4%) or heavy (29.4%) infected children. An increase of 100 in baseline S. mansoni egg count per gram of stool resulted in a 26% (95% CI: 17%, 34%) reduction in the odds of cure. The incidence of experiencing at least one type of AE was 23.1% (95% CI: 18.0%, 29.0%). Stomachache, diarrhea, and nausea were the most common AEs. AEs were mild-to-moderate grade and transient. Pre-treatment moderate (ARR = 3.2, 95% CI: 1.69, 6.14) or heavy infection intensity (ARR = 6.5, 95% CI: 3.62, 11.52) was a significant predictor of AEs (p < 0.001). Sex, age, or soil-transmitted helminth coinfections were not significant predictors of CR or AEs. Conclusions: Single-dose praziquantel is tolerable and effective against S. mansoni infection among pre-SAC, and associated AEs are mostly mild-to-moderate and transient. However, the reduced CR in heavily infected and AEs in one-fourth of S. mansoni-infected pre-SAC underscores the need for safety and efficacy monitoring, especially in moderate-to-high infection settings. Integrating pre-SACs in the national deworming programs is recommended to accelerate the elimination of schistosomiasis as a public health problem. [ABSTRACT FROM AUTHOR]

This document is a list of references cited in an article about the prevalence and impact of zoonotic parasites Ancylostoma ceylanicum and Ancylostoma caninum. The references include studies conducted in various countries, including the Philippines, that investigate these parasites' effects on humans and animals. The article emphasizes the need for further research, including studying drug resistance. The references provide a comprehensive overview of the current knowledge and future directions of research on these neglected parasites. [Extracted from the article]

Despite the existence of a powerful theoretical foundation for the development of multiscale models of infectious disease dynamics in the form of the replication–transmission relativity theory, the majority of current modelling studies focus more on single-scale modelling. The explicit aim of this study is to change the current predominantly single-scale modelling landscape in the design of planning frameworks for the control, elimination and even eradication of infectious disease systems through the exploitation of multiscale modelling methods based on the application of the replication–transmission relativity theory. We first present a structured roadmap for the development of multiscale models of infectious disease systems. The roadmap is tested on hookworm infection. The testing of the feasibility of the roadmap established a fundamental result which can be generalized to confirm that the complexity of an infectious disease system is encapsulated with a level of organization spanning a microscale and a macroscale. [ABSTRACT FROM AUTHOR]

Hookworm infection is an important cause of iron deficiency anemia, especially in heavily infected high-risk populations residing in underdeveloped tropical countries. Stool examination is the main method used for hookworm diagnosis; however, its sensitivity is relatively low. Hookworm infections have been incidentally diagnosed during routine upper gastrointestinal endoscopies. We present the case of a 60-year-old Ethiopian farmer who had severe iron deficiency anemia and positive occult blood in the stool. Repeated stool examinations revealed no ova or parasites. Esophagogastroduodenoscopy revealed the presence of hookworms in the duodenum. The patient was treated with albendazole and ferrous sulfate. Careful endoscopic examination of the duodenum is crucial for identifying unsuspected hookworm infection responsible for chronic gastrointestinal bleeding and iron deficiency anemia. [ABSTRACT FROM AUTHOR]

"Exhibiting Health: Public Health Displays in the Progressive Era" by Jennifer Lisa Koslow explores the use of exhibitions as a means of public health education and social reform in early 20th-century America. The book examines the efficacy of these exhibitions in achieving their goals and highlights the influence of World's Fairs on the development of public health exhibits. Koslow also discusses the role of museum professionals in the creation of these exhibits and the importance of understanding the audience and setting clear educational goals. The book sheds light on a lesser-known episode in public health, social reform, and museum practice. [Extracted from the article]

Background: There are limited longitudinal data on the acquisition of Giardia lamblia infections in childhood using molecular assays to detect and type assemblages, and measure effects of infections on diarrhea risk and childhood growth. Methods: We analysed stool samples from a surveillance sample within a birth cohort in a rural district in tropical Ecuador. The cohort was followed to 8 years of age for the presence of G. lamblia in stools by quantitative PCR and A and B assemblages by Taqman assay or Sanger sequencing. We explored risk factors associated with infection using generalized estimating equations applied to longitudinal binary outcomes, and longitudinal panel data analysis to estimate effects of infection on diarrhea and growth trajectories. Results: 2,812 stool samples collected between 1 month and 8 years of age from 498 children were analyzed and showed high rates of infection: 79.7% were infected at least once with peak prevalence (53.9%) at 5 years. Assemblage B was accounted for 56.8% of genotyped infections. Risk factors for infection included male sex (P = 0.001), daycare attendance (P<0.001), having a household latrine (P = 0.04), childhood (P<0.001) and maternal soil-transmitted helminth (P = 0.029) infections, and exposures to donkeys (age interaction P = 0.034). G. lamblia was associated with increased risk of diarrhea (per episode, RR 1.03, 95% CI 1.01–1.06, P = 0.011) during the first 3 years of life and a transient impairment of weight (age interaction P = 0.017) and height-for-age (age interaction P = 0.025) trajectories between 1 and 4 years of age. There was no increased risk of either assemblage being associated with outcomes. Conclusion: Our data show a relatively high edemicity of G. lamblia transmission during childhood in coastal Ecuador, and evidence that infection is associated with a transiently increased risk of diarrhea during the first 3 years of life and impairment of weight and height between 1 and 4 years. Author summary: Giardia lamblia is an intestinal protozoal pathogen that is estimated to infect annually over 200 million people worldwide. The infection typically causes a self-limiting diarrheal illness, but which occasionally may be severe and persistent. The infection is most common in children living in poor regions of the tropics in conditions of inadequate access to clean water and sanitation. In endemic settings, associations of infections with diarrhea in children are variable and there is evidence that subclinical infections may cause growth stunting. Here, we analyzed stool samples collected for a surveillance cohort of children followed up from birth to 8 years of age in a rural district of tropical coastal Ecuador. Stool samples were analyzed for the presence of G. lamblia infections using a highly sensitive molecular test (quantitative PCR) and positive samples were genotyped for G. lamblia assemblages. G. lamblia was detected in almost 80% of children during follow-up and about half the cohort was infected by 5 years of age. Assemblages A and B were detected with B being the most frequent assemblage. Risk factors for infection included male sex and factors associated with increased early contacts with other children (i.e., daycare attendance), poor sanitation (having a household latrine and infections with other enteric parasites), and exposures to donkeys as a potential source of zoonotic infections. There was evidence that early G. lamblia infections were associated transient effects of increased diarrheal risk up to 3 years and reduced linear and ponderal growth between 1 and 4 years of age. We did not see any relative effect of assemblage (i.e., B vs. A) on disease. Our data, from a longitudinal birth cohort showed a relatively high prevalence of infection in this rural tropical setting that was associated with the possible onset of adaptive immunity against (diarrheal) disease and transient effects on growth trajectories. [ABSTRACT FROM AUTHOR]

Background: Intestinal helminth infections are among the most common infections worldwide and have a negative impact on the health, education, nutrition and economic development of affected populations. This study aimed to estimate the prevalence of intestinal helminthiasis, including T. solium taeniasis, using a large-scale community-based study in Chiparamba area of Chipata District in the Eastern province of Zambia. Methods/Principal findings: A cross-sectional study was conducted between June 2019 and December 2022 in a rural community of 25 randomly selected villages known to be at risk for T. solium infection. Stool samples were examined for intestinal helminths using the formol-ether concentration technique and further tested for taeniasis by copro antigen-ELISA (copro Ag-ELISA). Descriptive statistical analyses were conducted, and associations between the disease prevalence of active infections and individual- and village-level variables were determined using the chi-square or Fisher's exact test. Predictors of an individual being positive for either taeniasis or other soil-transmitted helminths were determined using binary logistic regression. A total of 2762 stool samples were examined. One hundred ninety-five (7.1%) tested positive for at least one helminthic parasite on microscopy, with hookworm being the most frequent 84 (3.0%), followed by S. mansoni, 66 (2.4%). For taeniasis, 11 (0.4%) participants were positive for Taenia spp. microscopically, while 241 (8.7%) tested positive via copro Ag-ELISA. On bivariate analysis, male sex was significantly associated with the prevalence of intestinal parasites (p = 0.012) but not with that of taeniasis based on copro Ag-ELISA results. Village level differences were significant for infection with intestinal helminths as well as for taeniasis positivity on copro Ag-ELISA (p <0.001). Conclusion: Intestinal helminths, including T. solium taeniasis, are prevalent in Chiparamba area of Chipata district in the eastern province of Zambia, supporting the clear need for further targeted public health interventions for surveillance and control. Author summary: Intestinal helminth infections including schistosomiasis and T. solium are among the major neglected tropical diseases affecting communities with poor access to clean water, sanitation and hygiene. T. solium taeniasis is also associated with communities practicing free range pig management. These infections are common in Sub-Saharan Africa, South America, and Asia, where they negatively impact on the health, education, nutrition and economic development of the affected population. Our study aimed to estimate the prevalence of intestinal helminthiasis, including T. solium taeniasis in Chiparamba area of Chipata district in the Eastern province of Zambia. We found that 7.1% of the stool samples examined microscopically, were infected with at least one intestinal parasite. The most common parasites found were hookworm (3.0%) and S. mansoni (2.4%) while 0.4% were Taenia spp. We also found that 8.7% of the stool samples examined were positive for Taenia spp. antigens. Males were more associated with having intestinal parasites. Village level differences for infection with intestinal helminths as well as being positive for Taenia spp. antigens were also observed. The study shows that intestinal helminths including T. solium are present in our study community and require public health interventions for surveillance and control. [ABSTRACT FROM AUTHOR]

Background: Neglected tropical diseases (NTDs) affect most impoverished communities in developing countries, like Myanmar in Southeast Asia. NTDs have been understudied and underreported in Myanmar. Methods: A systematic review of published and grey literature (1900–2023) on neglected tropical diseases (NTDs) in Myanmar was conducted. The literature search included five international databases: PubMed, EMBASE, Ovid Global Health, and Web of Science Core Collection and one national database: the Myanmar Central Biomedical Library (locally published papers and grey literature). The selection criteria included articles with all types of study designs of current or previous infections conducted in humans, that reported NTDs, recognised by WHO, US CDC, and listed in PLoS NTDs. We included melioidosis and rickettsioses which we consider also meet the definition of an NTD. Results: A total of 5941 records were retrieved and screened, of which, 672 (11%) met the selection criteria and were included in this review. Of the included articles, 449 (65%) were published after 2000 and 369 (55%) were from two regions (Yangon and Mandalay) of Myanmar. Of the included articles, 238 (35%) reported bacterial NTDs, 212 (32%) viral NTDs, 153 (23%) helminth NTDs, 25 (4%) protozoal NTDs and 39 (6%) reported more than one aetiology. Based on reported frequency in descending order, the bacterial NTDs were leprosy, Escherichia coli enteritis, salmonellosis, cholera, shigellosis, melioidosis, leptospirosis and rickettsioses; the viral NTDs were dengue, chikungunya and Japanese encephalitis virus (JEV) infection; the protozoal NTDs were amoebiasis, giardiasis and leishmaniasis, and the helminth NTDs were ascariasis, trichuriasis, hookworm disease, filariasis and strongyloidiasis. Conclusion: This review summarises NTDs reported in Myanmar over the past 100 years. The findings suggest that most NTDs are likely to be under reported, especially from the majority of the country which is far from academic centres. Research capacity building together with strengthening of laboratory systems would lead to better understanding of the true burden of NTDs in Myanmar. Trial registration: PROSPERO registration ID: CRD42018092627. Author summary: Neglected tropical diseases (NTDs) are a group of preventable and treatable diseases common in tropical countries primarily affecting poor rural communities. Myanmar is a tropical country in Southeast Asia in which 70% of the population live in rural areas. It is one of the top ten countries with a high burden of NTDs in term of incidence and prevalence. We conducted a systematic review of all available literature on infectious NTDs in Myanmar to collate all reported NTDs published in international as well as local journals including theses and dissertations. Our review found bacterial and viral NTDs being the most commonly reported NTDs followed by helminthiasis and protozoal NTDs. More than half of the studies were located in two out of fifteen states and regions of Myanmar. This review summarises reported NTDs in Myanmar over 100 years and indicates gaps in knowledge about certain diseases to inform future research directions related to NTDs in Myanmar. [ABSTRACT FROM AUTHOR]

Cutaneous larva migrans (CLM) is a dermatosis caused by accidental infestation with animal hookworms and is widely distributed in tropical and subtropical regions. Humans become infected when their skin comes into contact with soil contaminated with dog faeces. The filariform larvae penetrate and burrow into human skin, causing a condition known as "creeping eruption". We describe a case, well-documented by photos, of CLM infection in a family of three who returned from Thailand. [ABSTRACT FROM AUTHOR]

Human mobility contributes to the spatial dynamics of many infectious diseases, and understanding these dynamics helps us to determine the most effective ways to intervene and plan surveillance. In this paper, we describe a novel transmission model for the spatial dynamics of hookworm, a parasitic worm which is a common infection across sub-Saharan Africa, East Asia and the Pacific islands. We fit our model, with and without mobility, to data obtained from a sub-county in Kenya, and validate the model's predictions against the decline in prevalence observed over the course of a clustered randomized control trial evaluating methods of administering mass chemotherapy. We find that our model which incorporates human mobility is able to reproduce the observed patterns in decline of prevalence during the TUMIKIA trial, and additionally, that the widespread bounce-back of infection may be possible over many years, depending on the rates of people movement between villages. The results have important implications for the design of mass chemotherapy programmes for the elimination of human helminth transmission. This article is part of the theme issue 'Challenges and opportunities in the fight against neglected tropical diseases: a decade from the London Declaration on NTDs'. [ABSTRACT FROM AUTHOR]

Copyright of HiSTOReLo: Revista de Historia Regional y Local is the property of Universidad Nacional de Colombia, Centro Editorial Facultad de Ciencias Humanas y Economicas and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

An introduction is presented in which editor discusses various articles within the issue on topics including sociocultural aspects of the exanthematous typhus epidemic in Santiago of Chile in the 1930s; tropical anemia as hookworm disease and hygienic policies and intensity of smallpox epidemics.

Copyright of Saudi Medical Journal is the property of Saudi Medical Journal and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The article describes a case study of a 48-year-old man with a foot lesion following snorkeling, focusing on the differential diagnosis of coral dermatitis and its management. Topics include distinguishing between coral dermatitis and other conditions like cutaneous larva migrans and seabather's eruption based on clinical presentation and response to treatment.

Rapid increases in human populations and environmental changes of past decades have led to changes in rates of contact and spatial overlap with wildlife. Together with other historical, social and environmental processes, this has significantly contributed to pathogen transmission in both directions, especially between humans and non-human primates, whose close phylogenetic relationship facilitates cross-infections. Using high-throughput amplicon sequencing, we studied strongylid communities in sympatric western lowland gorillas, central chimpanzees and humans co-occurring in an unprotected area in the northern periphery of the Dja Faunal Reserve, Cameroon. At the genus level, we classified 65 strongylid ITS-2 amplicon sequencing variants (ASVs) in humans and great apes. Great apes exhibited higher strongylid diversity than humans. Necator and Oesophagostomum were the most prevalent genera, and we commonly observed mixed infections of more than one strongylid species. Human strongylid communities were dominated by the human hookworm N. americanus, while great apes were mainly infected with N. gorillae, O. stephanostomum and trichostrongylids. We were also able to detect rare strongylid taxa (such as Ancylostoma and Ternidens). We detected eight ASVs shared between humans and great apes (four N. americanus variants, two N. gorillae variants, one O. stephanostomum type I and one Trichostrongylus sp. type II variant). Our results show that knowledge of strongylid communities in primates, including humans, is still limited. Sharing the same habitat, especially outside protected areas (where access to the forest is not restricted), can enable mutual parasite exchange and can even override host phylogeny or conserved patterns. Such studies are critical for assessing the threats posed to all hosts by increasing human-wildlife spatial overlap. In this study, the term "contact" refers to physical contact, while "spatial overlap" refers to environmental contact. Author summary: Strongylid nematodes are common intestinal parasites, infecting a wide range of mammalian taxa, including humans and non-human primates (NHPs). They have evolved to live in vertebrate hosts for months or years and form complex communities within these hosts. Heavy strongylid infections can cause severe intestinal inflammation, intestinal lesions, respiratory difficulties, iron deficiency anemia, weight loss, childhood stunting, and adverse birth outcomes. As human population and human settlements have grown rapidly in recent decades, people often live in close proximity to wildlife, allowing for cross-transmission of soil-transmitted helminths. Because humans and NHPs (especially great apes) are closely related to one another evolutionarily, it is easy for strongylids infecting one primate species to jump to a different primate hosts. This evolutionary relationship can result in overlap and reciprocal exchange of pathogens and can have a damaging effect both on humans and NHP endangered species populations. As DNA-based diagnosis has become a routine part of modern parasitology, we employed a modern high-throughput sequencing approach to describe complex communities and zoonotic patterns of parasitic strongylid nematodes infecting humans and great apes in Cameroon. [ABSTRACT FROM AUTHOR]

The reduced prevalence of insulin resistance and type 2 diabetes in countries with endemic parasitic worm infections suggests a protective role for worms against metabolic disorders, however clinical evidence has been non-existent. This 2-year randomised, double-blinded clinical trial in Australia of hookworm infection in 40 male and female adults at risk of type 2 diabetes assessed the safety and potential metabolic benefits of treatment with either 20 (n = 14) or 40 (n = 13) Necator americanus larvae (L3) or Placebo (n = 13) (Registration ACTRN12617000818336). Primary outcome was safety defined by adverse events and completion rate. Homoeostatic model assessment of insulin resistance, fasting blood glucose and body mass were key secondary outcomes. Adverse events were more frequent in hookworm-treated participants, where 44% experienced expected gastrointestinal symptoms, but completion rates were comparable to Placebo. Fasting glucose and insulin resistance were lowered in both hookworm-treated groups at 1 year, and body mass was reduced after L3-20 treatment at 2 years. This study suggests hookworm infection is safe in people at risk of type 2 diabetes and associated with improved insulin resistance, warranting further exploration of the benefits of hookworms on metabolic health. A beneficial effect of parasitic worms on metabolic health has been postulated based on epidemiological and animal studies. Here, the authors show in a phase I clinical trial that treatment of people at risk of type 2 diabetes with hookworms is safe and may improve key measures of metabolic health. [ABSTRACT FROM AUTHOR]

Background: Schistosomiasis and hookworm infection remain public health problems in large parts of sub-Saharan Africa. The epidemiology of schistosomiasis and hookworm was studied in seasonal transmission settings in the northern part of Côte d'Ivoire. Methodology: In August 2018, a cross-sectional study was conducted. Urine and stool samples were collected from 742 individuals aged 6–96 years in 16 localities from four departments in northern Côte d'Ivoire. Urine samples were examined by a filtration method for quantification of Schistosoma haematobium eggs. Stool samples were subjected to duplicate Kato-Katz thick smears and eggs of Schistosoma mansoni and soil-transmitted helminths (STHs) were counted. Additionally, a questionnaire was administered to determine demographic characteristics and to identify risk factors of schistosomiasis and STHs. Malacologic surveys were carried out at water points that are contacted by humans and animals. Principal findings: The prevalence of schistosomiasis was very low. Only two cases of S. mansoni were found (0.3%, 95% confidence interval [CI]: 0.1–1.0%). The distribution of S. haematobium was focal, with cases found only in two departments; Ferkessédougou (5.4%, 95% CI: 2.5–9.9%) and Ouangolodougou (2.7%, 95% CI: 0.9–6.3%). Hookworm was the only STH species observed with a prevalence of 1.5% (95% CI: 0.8–2.8%). A higher risk of S. haematobium infection was observed in males compared to females, but the difference was not statistically significant (2.3% versus 1.3%, odds ratio [OR]: 1.5, 95% CI: 0.8–2.7). Participants aged 16–20 years showed the highest prevalence of S. haematobium. A total of 111 human- and animal-water contact points were identified at 47 water sources. Three potential intermediate host snails of schistosomes were collected; namely, Bulinus forskalii (n = 761), Bulinus truncatus (n = 205), and Biomphalaria pfeifferi (n = 1). Yet, only one specimen of Bu. truncatus was found to be shedding schistosome cercariae. Conclusions/Significance: This study confirms very low transmission of schistosomiasis and hookworm in northern Côte d'Ivoire. The establishment and rigorous implementation of integrated surveillance-response systems could lead to the elimination of schistosomiasis and hookworm in this part of Côte d'Ivoire. Author summary: Schistosomiasis and soil-transmitted helminthiasis, the latter including, hookworms, roundworms, and whipworms, are the most widespread parasitic neglected tropical diseases. As is the case in many sub-Saharan African countries, schistosomiasis and soil-transmitted helminthiasis are endemic in Côte d'Ivoire. Mass drug administration is the mainstay of the global control strategy against schistosomiasis and soil-transmitted helminthiasis and has been implemented in Côte d'Ivoire since 2013. The new road map put forward by the World Health Organization (WHO) for the control of neglected tropical diseases aims to eliminate schistosomiasis and soil-transmitted helminthiasis as a public health problem by 2030. In light of WHO's goals, this study updates prevalence data for schistosomiasis and soil-transmitted helminthiasis and provides a deeper understanding of risk factors that drive transmission in the northern part of Côte d'Ivoire. The findings showed very low prevalence and transmission of schistosomiasis and hookworm. Participants aged 16–20 years and fishermen had the highest prevalence of urogenital schistosomiasis, with both males (2.3%) and females (1.3%) at risk of infection. The results corroborate findings from other investigations in sub-Saharan Africa, which confirm that current efforts to control schistosomiasis and soil-transmitted helminthiasis are successful. Nevertheless, further investment is still needed to reach elimination. In particular, a surveillance-response system would be a valuable tool in a low-prevalence context such as northern Côte d'Ivoire. [ABSTRACT FROM AUTHOR]

Background. Toxocariasis is an important zoonotic infection, especially in tropical areas. One of the significant challenges in the serodiagnosis of human toxocariasis is the cross-reaction of Toxocara antigens with other parasites due to their relatively similar glycan structures. Removing the glycan structure from Toxocara excretory-secretory (TES) antigens may increase the efficacy of these antigens in the diagnosis of toxocariasis. The current study aimed to assess the efficacy of deglycosylated Toxocara cati excretory-secretory (dTES) antigens for the serodiagnosis of human toxocariasis. Methods. Toxocara ES antigens were prepared from T. cati second-stage larvae and deglycosylated using sodium hydroxide (NaOH). The TES antigens, along with the dTES antigens, were used in an ELISA as well as a western blotting system for the detection of anti-Toxocara antibodies. Sera samples collected from 30 confirmed cases of toxocariasis, 30 patients with other diseases, and 30 healthy subjects were evaluated by both systems. Results. The sensitivity of TES and dTES ELISA for the diagnosis of human toxocariasis was 96.67% (95% CI = 82.78–99.92) and 93.33% (95% CI = 77.93–99.18), respectively, while the specificity of dTES (88.33%; 95% CI = 77.43–95.18) increased significantly compared to the TES (80.00%; 95% CI = 67.67–89.22). The sensitivity of both antigens was 100% (95% CI = 88.43–100) by the western blotting system. Moreover, the specificity of TES and dTES antigens was 95% (95% CI = 86.08–98.96) and 98.33% (95% CI = 91.06–99.96), respectively, when using the western blotting system. Conclusion. Results of the current study indicate that the chemical removal of the glycan epitopes of T. cati ES antigens significantly reduces cross-reactivity rates with other parasitic infections. Considering the findings of the present study, the dTES antigens seem to be suitable antigens for the serodiagnosis of human toxocariasis. [ABSTRACT FROM AUTHOR]

Background: Intestinal parasitic infections (IPIs) can cause illness, morbidity, and occasional mortality in children. Agro-pastoralist and pastoralist children in the Somali Regional State of Ethiopia (ESRS) are especially at risk for IPIs, as access to safe water, sanitation, and health services is lacking. Minimal data on the prevalence of IPIs and associated risk factors exists in this region. Methodology: We assessed the prevalence of IPIs and associated risk factors during the wet season from May-June 2021 in 366 children aged 2 to 5 years in four agro-pastoralist and four pastoralist kebeles (wards) in Adadle woreda (district) of the Shebelle zone, ESRS. Household information, anthropometric measurements, and stool samples were obtained from included children. Parasites were identified microscopically using Kato-Katz and direct smear methods. Risk factors were assessed using general estimating equation models accounting for clustering. Principal findings: Overall prevalence of IPIs was 35%: 30.6% for single infections and 4.4% for poly-parasitic infections. Intestinal protozoan prevalence was 24.9%: 21.9% Giardia intestinalis, and 3.0% Entamoeba spp.. Intestinal helminth prevalence was 14.5%: 12.8% Ascaris lumbricoides, 1.4% hookworm (Ancylostoma duodenale /Necator americanus.), and 0.3% Hymenolepis nana. G. intestinalis infection was associated with drinking water sourced from the river (aOR 15.6, 95%CI 6.84, 35.4) and from collected rainwater (aOR 9.48, 95%CI 3.39, 26.5), with toilet sharing (aOR 2.93, 95%CI 1.36, 6.31) and with household ownership of cattle (1–5 cattle: aOR 1.65, 95%CI 1.13, 2.41; 6+ cattle: aOR 2.07, 95%CI 1.33, 3.21) and chickens (aOR 3.80, 95%CI 1.77, 8.17). A. lumbricoides infection was associated with children 36 to 47 months old (aOR 1.92, 95%CI 1.03, 3.58). Conclusions/Significance: Improving access to safe water, sanitation, and hygiene services in Adadle and employing a One Health approach would likely improve the health of children living in (agro-) pastoralist communities in Adadle and the ESRS; however, further studies are required. Author summary: Intestinal parasitic infections remain a silent threat to the health and life-trajectories of children living in areas with inadequate access to clean water, proper sanitation, and hygiene facilities, including the Somali region of Ethiopia. A large majority in this region live as pastoralists (semi-mobile animal herders), in close contact with their animals and nature, at risk for climate-related threats like drought and flooding, and at risk for infectious agents like intestinal parasites. We assessed the prevalence of intestinal parasitic infections in pastoralist children in the Adadle district of the Somali region of Ethiopia (ESRS), and the individual and household-level factors associated with these infections. We found that locally collected water, shared toilets, along with ownership of cows and chickens increased the risk for having an intestinal parasitic infection with Giardia intestinalis, which can cause diarrhea and is transmitted through water, food, and soil that have been contaminated by the feces of infected humans and animals. If access to clean water, sanitation, and hygiene infrastructure is not improved, these infections remain recurrent in these communities and their animals, continually affecting the health of children. This study is one of few involving pastoralists in this region, hopefully lending guidance to regional public health policies. [ABSTRACT FROM AUTHOR]

Background: Soil-transmitted helminth (STH) infection is driven by a complex interaction of demographic, socioeconomic and behavioural factors, including those related to water, sanitation and hygiene (WASH). Epidemiological studies that measure both infection and potential risk factors associated with infection help to understand the drivers of transmission in a population and therefore can provide information to optimise STH control programmes. Methods: During October and November 2019, we conducted a cross-sectional survey of the prevalence and intensity of STH infection and associated risk factors among 7710 primary-school-age children from 64 primary schools across 13 districts in Dak Lak province, Vietnam. Quantitative PCR (qPCR) was used to detect and quantify STH infections. Results: The predominant STH species was the hookworm Necator americanus (overall cluster-adjusted prevalence of 13.7%), and its prevalence was heterogeneously distributed across surveyed schools (0% to 56.3%). All other STH species had a prevalence of less than 1%. Using mixed-effects logistic regression, we found that the adjusted odds ratio (aOR) was significantly higher for both infection and moderate-to-heavy-intensity infection with N. americanus among children from multiple ethnic minority groups, compared to children from the majority group (Kinh). Adjusted odds of infection with N. americanus were also higher in children who reported practising open defecation at school (aOR 1.42, 95% CI 1.05, 1.93, P = 0.02) and in those who had an unimproved household water supply (aOR 1.28, 95% CI 1.04, 1.57, P = 0.02). Conversely, children with a flushing household toilet had a reduced risk of infection (aOR 0.58, 95% CI 0.47, 0.70, P < 0.01), as did those whose primary female carer attended secondary (aOR 0.65, 95% CI 0.51, 0.84, P < 0.01) or tertiary education (aOR 0.39, 95% CI 0.24, 0.63, P < 0.01). Conclusions: This study is the largest reported prevalence survey of STH infections conducted using qPCR as a diagnostic technique. The findings of higher adjusted odds of infection amongst ethnic minority children highlight that STH control programmes may not be reaching certain population groups and that additional culturally appropriate approaches may be required. Additionally, the associations between specific WASH factors and infection indicate potential programmatic targets to complement preventive chemotherapy programmes. [ABSTRACT FROM AUTHOR]

Background. Soil-transmitted helminths are parasitic nematodes found in the intestine. They are more prevalent in the tropics and subtropics, including Ethiopia. However, low-sensitive direct wet mount microscopy fails to detect soil-transmitted helminths among infected cases. Therefore, more sensitive and cost-effective diagnostic methods are urgently needed to minimize soil-transmitted helminthiasis morbidity. Objective. This study aimed to compare and evaluate the performance of diagnostic methods for soil-transmitted helminths against the "gold" standard. Methods. An institution-based cross-sectional study was conducted among 421 schoolchildren from May to July, 2022 in the Amhara Region. Study participants were selected using a systematic random sampling technique. Stool samples were processed via Kato–Katz, McMaster, and spontaneous tube sedimentation techniques. Data were entered into epi-data version 3.1 and analyzed using SPSS version 25. The sensitivity, specificity, positive predictive value, and negative predictive value were calculated against the combined result as a "gold" standard. The strength of agreement between the diagnostic methods was determined by the Kappa value. Results. The overall prevalence of soil-transmitted helminths was 32.8% (95% CI: 28.2–37.8%) using a combination of methods. The detection rates of Kato–Katz, McMaster, and spontaneous tube sedimentation were 28.5% (95% CI: 24.2–33.2%), 30% (95% CI: 25.6–34.8%), and 30.5% (95% CI: 26.1–35.3%), respectively. Sensitivity and negative predictive values were 87.1% (95% CI: 80.2–92.3%) and 95.1% (95% CI: 92.6–96.8%) for Kato–Katz; 91.7% (95% CI: 85.6–95.6%) and 96.5% (95% CI: 94.1–98.0%) for McMaster; and 93.2% (95% CI: 87.5–96.8%) and 97.1% (95% CI: 94.7–98.4%) for spontaneous tube sedimentation. Kappa values of Kato–Katz, McMaster, and spontaneous tube sedimentation for the diagnosis of soil-transmitted helminths were 0.901, 0.937, and 0.948, respectively. Conclusion. Kato–Katz, McMaster, and spontaneous tube sedimentation techniques had comparable sensitivity with almost perfect agreement for the detection of soil-transmitted helminths. Therefore, the spontaneous tube sedimentation technique can be used as an alternative diagnostic method for soil-transmitted helminth infections in endemic countries. [ABSTRACT FROM AUTHOR]

Assessments of disease burden are important to inform national, regional, and global strategies and to guide investment. We aimed to estimate the drinking water, sanitation, and hygiene (WASH)-attributable burden of disease for diarrhoea, acute respiratory infections, undernutrition, and soil-transmitted helminthiasis, using the WASH service levels used to monitor the UN Sustainable Development Goals (SDGs) as counterfactual minimum risk-exposure levels. We assessed the WASH-attributable disease burden of the four health outcomes overall and disaggregated by region, age, and sex for the year 2019. We calculated WASH-attributable fractions of diarrhoea and acute respiratory infections by country using modelled WASH exposures and exposure–response relationships from two updated meta-analyses. We used the WHO and UNICEF Joint Monitoring Programme for Water Supply, Sanitation and Hygiene public database to estimate population exposure to different WASH service levels. WASH-attributable undernutrition was estimated by combining the population attributable fractions (PAF) of diarrhoea caused by unsafe WASH and the PAF of undernutrition caused by diarrhoea. Soil-transmitted helminthiasis was fully attributed to unsafe WASH. We estimate that 1·4 (95% CI 1·3–1·5) million deaths and 74 (68–80) million disability-adjusted life-years (DALYs) could have been prevented by safe WASH in 2019 across the four designated outcomes, representing 2·5% of global deaths and 2·9% of global DALYs from all causes. The proportion of diarrhoea that is attributable to unsafe WASH is 0·69 (0·65–0·72), 0·14 (0·13–0·17) for acute respiratory infections, and 0·10 (0·09–0·10) for undernutrition, and we assume that the entire disease burden from soil-transmitted helminthiasis was attributable to unsafe WASH. WASH-attributable burden of disease estimates based on the levels of service established under the SDG framework show that progress towards the internationally agreed goal of safely managed WASH services for all would yield major public-health returns. WHO and Foreign, Commonwealth & Development Office. [ABSTRACT FROM AUTHOR]

Background: Schistosomiasis and soil-transmitted helminth infections are among the neglected tropical diseases (NTDs) affecting primarily marginalized communities in low- and middle-income countries. Surveillance data for NTDs are typically sparse, and hence, geospatial predictive modeling based on remotely sensed (RS) environmental data is widely used to characterize disease transmission and treatment needs. However, as large-scale preventive chemotherapy has become a widespread practice, resulting in reduced prevalence and intensity of infection, the validity and relevance of these models should be re-assessed. Methodology: We employed two nationally representative school-based prevalence surveys of Schistosoma haematobium and hookworm infections from Ghana conducted before (2008) and after (2015) the introduction of large-scale preventive chemotherapy. We derived environmental variables from fine-resolution RS data (Landsat 8) and examined a variable distance radius (1–5 km) for aggregating these variables around point-prevalence locations in a non-parametric random forest modeling approach. We used partial dependence and individual conditional expectation plots to improve interpretability. Principal findings: The average school-level S. haematobium prevalence decreased from 23.8% to 3.6% and that of hookworm from 8.6% to 3.1% between 2008 and 2015. However, hotspots of high-prevalence locations persisted for both diseases. The models with environmental data extracted from a buffer radius of 2–3 km around the school location where prevalence was measured had the best performance. Model performance (according to the R2 value) was already low and declined further from approximately 0.4 in 2008 to 0.1 in 2015 for S. haematobium and from approximately 0.3 to 0.2 for hookworm. According to the 2008 models, land surface temperature (LST), modified normalized difference water index (MNDWI), elevation, slope, and streams variables were associated with S. haematobium prevalence. LST, slope, and improved water coverage were associated with hookworm prevalence. Associations with the environment in 2015 could not be evaluated due to low model performance. Conclusions/significance: Our study showed that in the era of preventive chemotherapy, associations between S. haematobium and hookworm infections and the environment weakened, and thus predictive power of environmental models declined. In light of these observations, it is timely to develop new cost-effective passive surveillance methods for NTDs as an alternative to costly surveys, and to focus on persisting hotspots of infection with additional interventions to reduce reinfection. We further question the broad application of RS-based modeling for environmental diseases for which large-scale pharmaceutical interventions are in place. Author summary: Parasitic worm infections, such as schistosomiasis and soil-transmitted helminthiasis, belong to a group of diseases collectively known as neglected tropical diseases (NTDs) that affect primarily marginalized communities. Transmission of both parasitic worms is affected by behavioral, environmental, and socioeconomic factors. In the absence of reliable surveillance data, sophisticated geostatistical models that rely on environmental predictors are commonly used to predict transmission and treatment needs. We used two nationally representative surveys conducted in Ghana and employed a relatively simple and interpretable modeling approach to predict the risk of Schistosoma haematobium and hookworm infections among school-age children before (2008) and after (2015) deworming became a widespread practice. We found that as the proportion of infected children declined, model performance decreased, but hotspots of high-prevalence locations persisted. This suggests that the models may still be useful in spatial targeting of interventions, but the broad application of the approach should be re-evaluated. [ABSTRACT FROM AUTHOR]

The article describes the case of a 58-year-old woman who experienced fatigue, abdominal bloating, and eosinophilia and had been in her usual state of health until eight months before the current evaluation. Topics discussed include medical history of the patient, differential diagnosis, and nonifectious and infectious causes of eosinophilia.

Background: Soil-transmitted helminth (STH) control programs currently lack evidence-based recommendations for cost-efficient survey designs for monitoring and evaluation. Here, we present a framework to provide evidence-based recommendations, using a case study of therapeutic drug efficacy monitoring based on the examination of helminth eggs in stool. Methods: We performed an in-depth analysis of the operational costs to process one stool sample for three diagnostic methods (Kato-Katz, Mini-FLOTAC and FECPAKG2). Next, we performed simulations to determine the probability of detecting a truly reduced therapeutic efficacy for different scenarios of STH species (Ascaris lumbricoides, Trichuris trichiura and hookworms), pre-treatment infection levels, survey design (screen and select (SS); screen, select and retest (SSR) and no selection (NS)) and number of subjects enrolled (100–5,000). Finally, we integrated the outcome of the cost assessment into the simulation study to estimate the total survey costs and determined the most cost-efficient survey design. Principal findings: Kato-Katz allowed for both the highest sample throughput and the lowest cost per test, while FECPAKG2 required both the most laboratory time and was the most expensive. Counting of eggs accounted for 23% (FECPAKG2) or ≥80% (Kato-Katz and Mini-FLOTAC) of the total time-to-result. NS survey designs in combination with Kato-Katz were the most cost-efficient to assess therapeutic drug efficacy in all scenarios of STH species and endemicity. Conclusions/significance: We confirm that Kato-Katz is the fecal egg counting method of choice for monitoring therapeutic drug efficacy, but that the survey design currently recommended by WHO (SS) should be updated. Our generic framework, which captures laboratory time and material costs, can be used to further support cost-efficient choices for other important surveys informing STH control programs. In addition, it can be used to explore the value of alternative diagnostic techniques, like automated egg counting, which may further reduce operational costs. Trial Registration: ClinicalTrials.gov NCT03465488 Author summary: Large-scale deworming programs are implemented worldwide to reduce morbidity caused by intestinal worms. As these programs operate in resource-poor-settings, it is important that their operational costs are minimized without jeopardizing the quality of decision-making. We present a framework for evidence-based recommendations for cost-efficient decision-making in deworming programs, using monitoring of therapeutic drug efficacy via stool examination as a case study. To this end, we first assessed the time and the cost of processing stool samples in a laboratory according to different diagnostic methods. Then for each diagnostic method, survey design, and a range of settings (pre-dominant worm species and pre-treatment infection levels), we calculated the probability of correctly detecting a truly reduced therapeutic drug efficacy and the associated operational costs. Generally, the estimated operational costs varied across diagnostic method, survey design, worm species and disease endemicity. Based on our findings, we conclude that the use of the current diagnostic standard, the Kato-Katz method, is justified to assess drug efficacy, but that a change in survey design is warranted. Our methodology, which leverages detailed data on laboratory time and material costs, can also be used to provide evidence-based recommendations for other types of decisions in large-scale deworming programs. [ABSTRACT FROM AUTHOR]

Background: Soil transmitted Helminths (STH) infections remain a public health concern worldwide, particularly in tropical and subtropical areas where these diseases are highly endemic. Knowing the prevalence and risk factors of the disease is crucial for efficient STH control strategies in endemic areas. The scarcity of epidemiological data on STH for Equatorial Guinea has motivated the decision to perform the present study. Methods: A cluster-based cross-sectional study was carried out in Bata district from November 2020 to January 2021. Stool samples were collected for the diagnostic of STH infections using Kato-Katz technique. Descriptive statistics was performed for determination of STH prevalence and intensity, while logistic regression models were used to assess the risk factors associated with STH infections. Results: A total of 340 participants were included in the study with a mean age of 24 years (SD = 23.7) and 1.2 female-to-male sex-ratio. The overall prevalence of any STH was 60% (95%CI: 55–65). The most prevalent species were Ascaris lumbricoides (43%, 95%CI: 37–48) and Trichuris trichiura (40%, 95%CI: 35–46). Intensity of infection were mainly light to moderate. A trend of association was observed between age and any STH infection (overall p-value = 0.07), with a significant difference observed between children aged 5–14 years as compared to those aged 1–4 (aOR 2.12; 95%CI: 1.02–4.43, p-value = 0.04), while locality was significantly associated with STH infection (overall p-value<0.001) with a higher odds observed for peri-urban area as compared to urban area (aOR 4.57; 95%CI: 2.27–9.60, p-value<0.001). Conclusion: Bata district is a high STH transmission area, where school-aged children and peri-urban areas are associated with a higher risk of any STH infection. This situation calls for a full implementation of the WHO recommendations for STH control; mass drug administration of anthelminthic twice a year to the whole population with great attention to school age children, and prioritizing peri-urban areas where safe water, improve sanitation, and hygiene education should be implemented to achieve a better control. Author summary: Soil-transmitted helminths (STH) remain a public health problem in endemic areas even though they are among the five preventive chemotherapy controlled neglected tropical diseases which benefit from regular mass distributions of antiparasitic drugs. Equatorial Guinea is known to be endemic for STH. However, epidemiological data on these infections needed for an effective control program are scarce or inexistent. For deworming implementation, passive strategies consisting of deworming of young children during vaccination campaigns and systematic treatment of children consulting at hospital for helminth-like symptoms are being implemented, as well as distribution of albendazole during lymphatic filariasis community mass treatment. In the present work, we provide current epidemiological data on STH infection in Bata district, which is the largest and most populated among the nineteen districts of Equatorial Guinea. We reported a high prevalence of STH infections of low to moderate intensity in the study areas, where school age children are more at-risk age group, and peri–urban area the more at-risk area. Our findings highlight the need to implement the WHO recommendations for control of STH infections in the country, such as mass drug administration of anthelminthic twice a year with great attention to pre-school-age children and school aged children. Health Education and other preventive measures such as WASH should be taken in consideration. [ABSTRACT FROM AUTHOR]

Background: As the climate crisis grows, so does the global burden of displacement. Displacement, whether a direct or indirect consequence of natural disaster, can lead to dire health sequelae. Skin health is no exception to this, with dermatologic disease being a leading concern reported by those who care for displaced persons. Health professionals who provide dermatologic care for displaced persons benefit from understanding how climate change impacts the global profile of infectious agents. Methods: This review was performed using PubMed and Google Scholar. Search terms included climate change, displaced person, internally displaced person, and refugee, as well as searches of infectious disease dermatology and the specific diseases of interest. Case reports, case series, reviews, and original research articles were included in this review. Non‐English studies were not included. Results: In this manuscript several key infectious agents were identified, and we discuss the skin manifestations and impact of climate change on cutaneous leishmaniasis, dengue, chikungunya, zika, malaria, pediculosis, cutaneous larva migrans, cholera, and varicella zoster. Conclusions: Climate change plays a significant role in the challenges faced by displaced persons, including their skin health. Among the many consequences of climate change is its altering of the ecological profile of infectious agents and vectors that impact displaced persons. Being familiar with this impact can improve dermatologic care for this vulnerable population. [ABSTRACT FROM AUTHOR]

Strongyloides stercoralis, a pathogenic roundworm, is considered endemic in several tropical and subtropical areas worldwide. Indigenous populations have the highest soil-transmitted helminthiases-related mortality rates, but the prevalence and risk factors associated with S. stercoralis in Brazilian indigenous populations have not been established. Thus, the present study aimed to assess the seroprevalence and associated risk factors for S. stercoralis in indigenous communities and the healthcare professionals serving them in Brazil. Indigenous populations living in nine communities and healthcare professionals were tested for anti- S. stercoralis antibodies by ELISA. A questionnaire was used to assess socio-epidemiological information. Associated risk factors for seropositivity were tested by chi-square or Fisher's exact tests, using bivariate analyses and multivariate logistic regression. Overall, 174/463 (37.6%; CI 95%: 33.3–42.1) indigenous persons and 77/147 (52.4%; 95% CI: 44.3–60.3) healthcare professionals were seropositive for anti- S. stercoralis antibodies. Seropositivity among the two groups was statistically significant (p = 0.0016; OR = 0.547; 95% CI: 0.376–0.796) and revealed that healthcare professionals were 1.83 times more likely to be seropositive. The multivariate analysis showed that being male or being adult were also risk factors, while having a septic tank as a sanitary facility represented a protective factor for S. stercoralis exposure in indigenous persons. None of the variables evaluated were associated with S. stercoralis exposure in the professional group. The study herein has reported a high seroprevalence to Strongyloides stercoralis in indigenous communities of Brazil and healthcare professionals, warning for potential public health concerns of strongyloidiasis in such populations. Author summary: Human strongyloidiasis, caused mainly by nematoda Strongyloides stercoralis, with estimate of infecting around 613.9 million people worldwide, and may play a pivotal role in causing morbidity in aboriginals and indigenous populations worldwide. Nevertheless, prevalence and risk factors for Strongyloides stercoralis in Brazilian indigenous populations remains to be fully established. The present study was the first comparative report of S. stercoralis seroprevalence in indigenous population and healthcare professionals. A high seroprevalence to Strongyloides stercoralis in indigenous communities of Brazil along with even higher exposure of healthcare professionals was reported and should be considered as vulnerability and health worker exposure. Male and adult indigenous persons were more likely seropositive as associated risk factors, while having septic tank as a sanitary facility represented a protective factor for S. stercoralis exposure. Thus, the present study has alerted for the public health concerns of strongyloidiasis in such vulnerable populations, particularly when lacking sanitation conditions. Finally, a further One Health approach may contribute for better understanding the strongyloidiasis exposure including the environmental, animal, and human components to battle this important parasitic neglected disease in indigenous communities. [ABSTRACT FROM AUTHOR]

We describe a 39-year-old woman with a 1-month-old linear erythema diagnosed with cutaneous larva migrans by reflectance confocal microscopy (RCM). This case reveals that the great significance of diagnosing and treating cutaneous larva migrans (CLM) by RCM and dermoscopy, which might provide novel insights into dermatological clinical practice. [ABSTRACT FROM AUTHOR]