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

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

Neurocysticercosis (NCC), a leading global cause of severe progressive headache and epilepsy, in developed or affluent countries is mostly diagnosed among immigrants from poor or developing Taenia solium taeniasis-endemic countries. Taeniasis carriers in Kuwait are routinely screened by insensitive stool microscopy. In this study, enzyme-linked immunoelectrotransfer blot (EITB) was used as a confirmatory test for NCC. Screening was performed on 970 patients referred for suspected NCC on the basis of relevant history and/or ring-enhancing lesions on computed tomography and/or magnetic resonance imaging during a 14-year period in Kuwait. Demographic data and clinical details were retrieved from laboratory or hospital records. EITB was positive in 150 subjects (15.5%), including 98 expatriates mostly originating from taeniasis-endemic countries and, surprisingly, 52 Kuwaiti nationals. The clinical details of 48 of 50 NCC cases diagnosed during 2014–2019 were available. Most common symptoms included seizures, persistent headache with/without fever, and fits or loss of consciousness. Cysticercal lesions were located at various brain regions in 39 of 48 patients. Multiple members of 3 families with NCC were identified, infection was linked to domestic workers from taeniasis-endemic countries and confirmed in at least 1 family. Our data show that NCC is predominantly imported in Kuwait by expatriates originating from taeniasis-endemic countries who transmit the infection to Kuwaiti citizens.

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

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

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

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

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

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

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

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

The areas endemic for schistosomiasis in the Lao People’s Democratic Republic and in Cambodia were first reported 50 and 60 years ago, respectively. However, the causative parasite Schistosoma mekongi was not recognized as a separate species until 1978. The infection is distributed along a limited part of the Mekong River, regulated by the focal distribution of the intermediate snail host Neotricula aperta. Although more sensitive diagnostics imply a higher figure, the current use of stool examinations suggests that only about 1500 people are presently infected. This well-characterized setting should offer an exemplary potential for the elimination of the disease from its endemic areas; yet, the local topography, reservoir animals, and a dearth of safe water sources make transmission control a challenge. Control activities based on mass drug administration resulted in strong advances, and prevalence was reduced to less than 5% according to stool microscopy. Even so, transmission continues unabated, and the true number of infected people could be as much as 10 times higher than reported. On-going control activities are discussed together with plans for the future.

Entamoeba histolytica is a rare but feared pathogen owing to its related morbidity and mortality. Physicians in an ambulatory clinic in Cusco noted frequent reports of E. histolytica diagnosed by microscopy. Other non-pathogenic species of Entamoeba have an identical microscopic appearance. To determine whether the organisms were actually E. histolytica, faecal specimens from children aged six months to three years with diarrhoea were tested by a species-specific ELISA for E. histolytica antigen. Although 19/73 patients (26.0%) were presumptively diagnosed with amoebiasis based on microscopy, none were confirmed by ELISA. Most cases diagnosed as E. histolytic by microscopy in Peru are not infected by the pathogenic species and are probably colonised by non-pathogenic amoeba such as Entamoeba dispar.

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

Studies of the role of Schistosoma co-infections on plasma HIV-1 RNA (HIV-1 viral load) have yielded incongruent results. The role of duration of HIV-1 infection on the link between Schistosoma and HIV-1 viral load has not been previously investigated. We aimed to assess the impact of HIV-1/Schistosoma co-infections on viral load in Antiretroviral Treatment (ART)-naive HIV-1 infected people taking into account the duration of HIV-1 infection. We describe 79 HIV-infected outpatients greater than 18 years of age who had never used ART in Mwanza, Tanzania. Schistosomiasis testing was done by urine and stool microscopy and by serum Schistosoma circulating anodic antigen (CAA) testing. Schistosoma positivity was defined as having either test positive. We conducted univariable and multivariable linear regressions to assess the relationship between Schistosoma infection and the log10 of viral load. Duration of HIV infection was calculated using the first measured CD4+ T-cell (CD4) count as a function of normal CD4 count decay per calendar year in drug naive individuals. An active Schistosoma infection was demonstrated in 46.8% of the patients. The median log10 viral load was 4.5[3.4-4.9] log10 copies/mL in Schistosoma uninfected patients and 4.3[3.7-4.6] log10 copies/mL in Schistosoma infected patients. Schistosoma co-infection was negatively associated with the log10 of viral load after adjustment for Schistosoma intensity as measured by CAA, CD4 counts at time of testing, and duration of HIV-1 infection (β = -0.7[-1.3;-0.1], p = 0.022). Schistosoma co-infection was not associated with viral load in univariable analysis. There was also no interaction between Schistosoma positivity and duration of HIV-1 infection. Our study is the first, to our knowledge, to report adjustment for duration of HIV-1 infection when analyzing the relationship between HIV-1 viral load and Schistosoma spp. We found that time infected with HIV-1 has a major effect on the relationship between HIV-1 viral load and Schistosoma infection and may be a critical explanatory factor in the disparate findings of studies on HIV-1 viral load and schistosomiasis. The log10 viral load difference found indicates that Schistosoma co-infection does not make HIV progression worse, and could possibly lead to slower HIV disease progression.

Background: Ancillary health services are those supplemental services other than room, board, and medical/nursing services provided to hospital patients in the course of care. Ancillary department staff forms an integral part in the smooth functioning of a hospital. There is a need to focus on the health of these individuals to ensure their well-being and in turn, productivity at the workplace. Objective: To study the morbidity profile of the staff working at ancillary departments of a tertiary care hospital in Bengaluru, Karnataka, India. Materials and Methods: We conducted our study in a 1,200-bedded tertiary care hospital in Bengaluru, Karnataka, India. Annual medical checkup (AMC) for all the staff working at the ancillary departments has been started in recent years and is provided free of cost and during working hours. A total of 150 employees from ancillary departments underwent AMC in the year 2013. Data were analyzed using Statistical Package for the Social Sciences (SPSS) version 20.0. Spearman's correlation and Chi-square test were used. Results: Of the 150 employees, the majority was male (72%); the mean age was 38 ± 11 years. The most common morbidities were diabetes mellitus (11%), hypertension (10.6%), musculoskeletal disorders (9.3%), surgical problems (8.6%, hemorrhoids, varicose veins), and dental caries (6.6%). On stool microscopy, 12% of the dietary workers showed ova/cyst. There was a significant positive correlation between age and the number of chronic morbidities (P < 0.01). Conclusion: Lifestyle disorders such as diabetes mellitus and hypertension were the major morbidities among the staff in the ancillary departments of the hospital. We ensured regular follow-up, adherence to medication, and lifestyle modifications in terms of diet and exercise.

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

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

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

For the assessment of fat malabsorption, the standard method of measuring faecal fat excretion using a 5 day stool collection has been compared with the alternative methods: stool microscopy, a lipid tolerance test and a continuous marker technique for the estimation of fat content on a single stool sample. The lipid test, using an emulsion of arachis oil (Prosparol), was less reliable than had been expected with a sensitivity of 33% and a specificity of 45.4%. Stool microscopy using Oil Red O to stain fat globules had a sensitivity of 72.2% and a specificity of 95.4%. Fat estimation of a single stool sample using copper (1) thiocyanate showed a high correlation with that determined on a 5 day stool collection (p less than 0.001). It is concluded that lipid tolerance tests have little place in the estimation of fat absorption. In laboratories where faecal fats are not measured, microscopic examination of stool for fat globules provides a specific and relatively sensitive method for detecting steatorrhoea. The use of a continuous marker provides a method for assessing the degree of steatorrhoea on a single stool sample without the disadvantages of the conventional method of faecal fat analysis.

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

International audience; OBJECTIVE:the aim of this study is to evaluate the performance of stool microscopy and culture in the diagnosis of pulmonary tuberculosis (PTB).MATERIAL AND METHOD:In resource-limited settings, PTB is mainly diagnosed in sputum by microscopy methods. In patients unable to provide sputum, invasive procedures are necessary to obtain alternative respiratory tract specimens. Because Mycobacterium tuberculosis complex (MTC) organisms are known to survive in gastric fluid, we hypothesized that swallowed MTC organisms would be detectable in stool samples. We compared the presence of MTC organisms in sputum and stool specimens collected at the same time from the same patients.RESULTS:We included samples routinely submitted to our laboratory of microbiological diagnosis from patients with suspected PTB. In addition, a stool specimen was collected within 24 h of the sputum collection or gastric aspirate. In the 57 patients included, sputum microcopy and culture confirmed respectively 9 (21%) and 15 (26%) cases. Stool samples made it possible to confirm 9 cases by microscopy and 5 cases by culture. The sensitivity of microscopy was 60% and that of culture 33%. Sputum analysis was negative for one HIV-infected patient, but the stool sample was positive and permitted the diagnosis of PTB.CONCLUSION:This study proves that despite the low sensitivity of stool cultures it can be an alternative or additional interesting sample for the diagnosis of PTB in patients who have difficulty expectorating.

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

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

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

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

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

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

Background: The appendix is a vestigial organ which is infiltrated by faecal material, microbes and parasites. The most important aetio-pathology of appendicitis is obstruction of its lumen, by a faecolith. This results from accumulation and inspissation of faecal matter around vegetable fibres. The cause for appendicitis is numerous and one among them is parasitic infestation. Aims: To analyze the faecolith present in the appendectomy specimen for parasites and to compare the results in fresh and preserved specimens. Materials and Methods: Patients with acute/chronic appendicitis were subjected for surgery and the appendectomy specimens were collected in saline and formalin suspensions, for preservation purposes. The lumen was washed with normal saline and contents were collected and wet mount preparations were examined under low and high power microscopy. Results: Among 100 specimens 48 faecolith analyses proved to be positive for parasitic association, giving 48% positivity, which is quite high. The commonest isolate was followed by mixed infection. In our study we observed that saline preparations were easy for handling and we were also able to demonstrate the undistorted morphology of parasite better than formalin preserved specimens. Conclusion: This study reveals the importance of analyzing the appendectomy specimen for understanding the etiopathogenisis of appendicitis in spite of having a negative stool microscopy. A post surgical analysis of appendectomy specimen may surprise you with different etiological agents as confirmed by our study.

We have tried a new approach to routine stool microscopy by using a combination of methylene blue and glycerol in wet mount preparation of fresh faecal samples for the demonstration of medically important intestinal parasites. This combination was evaluated for finding differences in the details and clarity of morphology and internal structures of parasites under low- and high-power microscopy as compared to iodine and saline mount. It was further evaluated to estimate the time taken by methylene blue-glycerol mount to dry up as compared to iodine and saline wet mount.

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

Beginning in 2005, the Centers for Disease Control and Prevention (CDC) expanded the overseas presump- tive treatment of intestinal parasites with albendazole to include refugees from the Middle East. We surveyed the prevalence of helminths and protozoa in recent Middle Eastern refugees (2008-2010) in comparison with refugees from other geographical regions and from a previous survey (2001-2004) in Santa Clara County, California. Based on stool microscopy, helminth infections decreased, particularly in Middle Eastern refugees (0.1% versus 2.3% 2001-2004, P = 0.01). Among all refugees, Giardia intestinalis was the most common protozoan found. Protozoa infections also decreased somewhat in Middle Eastern refugees (7.2%, 2008-2010 versus 12.9%, 2001-2004, P = 0.08). Serology for Strongyloides stercoralis and Schistosoma spp. identified more infected individuals than stool exams. Helminth infections are increasingly rare in refugees to Northern California. Routine screening stool microscopy may be unnecessary in all refugees.

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

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

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

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

Objetivos. Evaluar la eficacia de la técnica de electroinmunotransferencia (EITB) o Western blot utilizando antígenos de excreción-secreción de las formas adultas de Fasciola hepatica (Fh E/S Ag) para el diagnóstico de la fasciolosis humana. Materiales y métodos. Los antígenos fueron obtenidos a las 18 horas de incubación en medio Minimum Essential Eagle y preparados a la concentración proteica de 0,15 ug/uL; los cuales, al ser enfrentados con un pool de sueros de pacientes con fasciolosis confirmada por el hallazgo de huevos del parásito en las heces, se detectaron los antígenos de 10, 12, 17, 23, 27, 30, 36, 43, 66 y 136 KDa, con los cuales se desarrolló la técnica de Western blot. La sensibilidad se evaluó empleando sueros de 67 pacientes con fasciolosis, y la especificidad con sueros de 57 pacientes con otras parasitosis y diez sueros de personas no parasitadas. Resultados. De los 67 sueros, 64 reaccionaron con la banda de 23 KDa y 61 con la banda de 17KDa. Estas dos bandas no fueron detectadas por ninguno de los sueros de pacientes con otras parasitosis, ni de personas no parasitadas, siendo por ello consideradas como específicas y diagnósticas. Conclusiones. La sensibilidad de la prueba, utilizando las bandas de 17 y 23 KDa, fue de 95,5 % cuando se presenta reacción positiva en una o en las dos bandas, siendo la especificidad para estos dos antígenos de 100 % con un valor predictivo positivo de 100 % y un valor predictivo negativo de 95,71 %. Objectives. To evaluate the performance of the enzyme-linked immunoelectrotransfer blot assay (EITB, Western blot) using excretory/secretory antigens from adult forms of Fasciola hepatica (Fh E/S Ag) for the diagnosis of human fasciolosis. Materials and methods. Antigens were obtained after 18 hours of incubation in culture medium Minimum Essential Eagle, prepared at a protein concentration of 0.15 ug/uL and run against a pool of sera of patients with proven fasciolosis (confirmed by the finding of parasite eggs in the stool microscopy). Antigens of 10, 12, 17, 23, 27, 30, 36, 43, 66 and 136 kDa were detected and used to develop the Western blot technique. The sensitivity was evaluated using sera from 67 fasciolosis patients, and the specificity using sera from 57 patients with other parasitic diseases, and 10 from healthy individuals. Results. Out of the 67 sera, 64 reacted with the 23 kDa band and 61 with the one of 17 kDa. These two bands were not detected in sera from patients with other parasitic diseases or in those from healthy volunteers and thus could be considered specific and diagnostic. Conclusions. The sensitivity of the test, using the bands of 17 and 23 kDa, was 95.5% for positive reactions to at least one of these two bands, being its specificity 100% with a positive predictive value of 100% and negative predictive value of 95.71%.

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

In order to study the effect of hookworm infection on haematological values, a total of 80 hookworn-infected patients and 100 apparently healthy subjects within the age range of 20-70 years were recruited at the Ahmadu Bello University Teaching Hospital, Zaria in Kaduna State between September 2000 and August 2001. Standard manual methods were used in carrying out haematological studies for packed cell volume (PCV), haemoglobin concentration, total and differential leucocyte counts. Stool samples from the participants were analysed for parasites by macroscopy, microscopy and quantitative hookworm ova counts. Result showed that hookworm-infected male patients with egg counts >10,000 per gram of faeces had significantly decreased values of PCV, haemoglobin concentration, total leucocyte counts, neutrophil, lymphocyte and eosinophil counts, when compared with the controls (P 0.05). In female subjects there were significant differences in all parameters (P 0.05). It is therefore concluded that stool microscopy should also be included when full blood counts are requested by the physician for a proper interpretation of anaemia in endemic areas, since hookworm infection can affect haematological values significantly. Keywords : Anaemia, hookworm infection, haematological values. Journal of Medical Laboratory Sciences Vol. 14 (1) 2005: pp. 14-18

Background Intestinal helminthiasis is a major cause of morbidity and mortality in infants and children particularly in the tropics and subtropics. This report highlights the possibility of hookworm infestation in infancy. Method A case report of hookworm infestation in a three-month old infant who was managed in the University of Port Harcourt Teaching Hospital, Port Harcourt in May 2001 for failure to thrive and recurrent severe anaemia. Result The patient was admitted in the children's emergency ward with passage of dark watery stools, fever, excessive crying and severe anemia and was transfused twice. Stool microscopy revealed numerous ova of hookworm and she was treated with albendazole. Three days after administration of anti-helminthic, stools became formed with normal colour and temperature was normal. She gained weight before discharge home. Conclusion Hookworm infestation should be suspected as a cause of severe anaemia in infants in communities with a high risk of infestation such as fishing port communities. To the best of my knowledge, symptomatic hookworm infestation in the first year of life has not been previously documented in Nigeria.