In order to investigate the epidemiological situation of intestinal parasite infections in Laos, parasitological surveys were carried out on a national scale including 17 provinces and the Vientiane Municipality. A total of 29,846 stool specimens were collected from primary schoolchildren from May 2000 to June 2002 and examined once with the cellophane thick smear technique. The cumulative egg positive rate for intestinal helminths was 61.9%. By species, the rate for Ascaris lumbricoides was 34.9%, hookworm 19.1%, Trichuris trichiura 25.8%, Opisthorchis viverrini 10.9%, Taenia spp. 0.6% and Hymenolepis spp. 0.2%. The northern mountainous regions such as Phongsaly, Huaphan or Saysomboune Province showed a higher prevalence (over 70%) of soil- transmitted helminths. The regions along the Mekong River such as Khammuane, Saravane or Savannakhet Province showed a higher prevalence (over 20%) of fish-borne parasites. On the other hand, Schistosoma mansoni eggs were detected in 1.7% of schoolchildren only in Champassak Province, a previously endemic area. The highest prevalence was noted in Phongsaly Province (96.0%) and the lowest in Bolikhamxay Province (27.5%). An additional small-scale survey by cellophane anal swab detected Enterobius vermicularis eggs in 35.7% of 451 schoolchildren aged 6-8 years in Khammuane, Vientiane, Champassak Province and the Vientiane Municipality. Meanwhile, the mean blood haemoglobin level of hookworm-infected children was not lower than that of children not infected with hookworm, suggesting that nutritional factors are more important than parasite infection per se. Nevertheless, the above results indicate that a nationwide parasite control project is necessary to reduce possible morbidity due to parasitic diseases in the country.
Neurocysticercosis (NCC), which is caused by infection with the larval stage of the pork tapeworm (Taenia solium), is now recognized as a major cause of neurologic diseases in countries where the infection is endemic. Migration of persons from these countries is resulting in diagnosis and local transmission in nonendemic countries at increasing rates. In the present study, immunoblotting and an ELISA were carried out using antigens of T. solium cysticerci fractionated by isoelectric focusing and serum samples from patients with NCC, alveolar (AE) or cystic echinococcosis (CE), and other diseases. Immunoblot analysis revealed antigens fractionated by isoelectric focusing (pH 9.2-9.6) either from cyst fluid of T. solium cysticerci or from intact cysts had unique components (glycoproteins) highly specific and sensitive for detection of NCC exclusively. All confirmed NCC serum samples (53 of 53) recognized at least three major bands of 10-26-kD of fractions with pH 9.2-9.6 from either intact cysts or cyst fluid. These bands were not recognized by sera from patients with other parasitic diseases including AE (0 of 34), CE (0 of 36), or other heterologous parasitoses (0 of 77), patients with hepatoma (0 of 19) or sarcoidosis (0 of 11), or sera from healthy controls (0 of 29). The ELISA using the antigens showed the same sensitivity and specificity for differentiation of NCC (53 of 53) from other diseases (0 of 107) or healthy individuals (0 of 29). Both immunoblotting and the ELISA using the fractionated antigens readily differentiated all NCC from AE or CE in a blind test of 29 serum samples of persons with NCC, CE, and AE. Antigens fractionated from cyst fluid of T. solium cysticerci by a simple, single-step isoelectric focusing (pH 9.2-9.6) are highly specific and sensitive for differential serodiagnosis of NCC in immunoblotting and/or an ELISA.
Two outbreaks of acute toxoplasmosis involving 8 adult patients in Korea were linked to eating uncooked pork. In the first outbreak, 3 patients developed unilateral chorioretinitis within 3 months of eating a meal consisting of raw spleen and liver of a wild pig. In the second outbreak, 5 of 11 soldiers who ate a meal consisting of raw liver of a domestic pig developed lymphadenopathy. All 8 patients had high levels of IgG Toxoplasma gondii antibodies (> or = 1:1024) in the Sabin-Feldman dye test, modified agglutination test incorporating mercaptoethanol, and latex agglutination test. T. gondii IgM antibodies persisted in these patients for several months. Most patients had a favorable response to anti-T. gondii chemotherapy with pyrimethamine and sulfanomides.
Human sparganosis in Korea was discussed on the bases of five human cases experienced by the present authors and 58 case records already reported by many previous authors, in aspects of epidemiology and clinical features. Sparganosis is not infrequent tissue helminthiasis now in Korea and the incidence has been evidently increased during past 10 years. It might be interpreted that improved medical delivery system and health care exposed the hidden but prevalent disease. The distribution of sparganosis in Korea is apparently subdivided into three major endemic areas; Kyunggi Do, Kyungsang Do and Hamkyung Nam Do. Although scanty in other areas of Korea, the distribution of this disease is presumably throughout the whole peninsula of Korea except Cheju Do. The majority of human cases of sparganosis in Korea has revealed raw consuming of snakes for treatment of tuberculosis, syphilis and joint pain, for tonics and for the belief of special nutrition among very limited group of Korean population. Because of this kinds of mode of infection, comprising four fifths of all cases, the majority of cases detected were male adult consisting of about 70% of total cases. And drinking of untreated water in rural area where no protective, sanitary measures for water sources were provided in the past, seems another important causes of infection especially in women and children in Korea. Thus it may be concluded that sparganosis in Korea is concluded by eating of infective stages per os voluntarily or involuntarily, but not through the direct invasion. Clinically, subcutaneous mass or lump was the most frequent problem in those patients and those masses were associated with inflammatory signs. By the anatomical location of the lesion, some peculiar manifestations could be developed as in orbital, abdominal, urethral, ureteral and vertebral cases. And the lesions could be complicated by haemorrhage or abscess formations. The larval worms hitherto collected in Korea has been identified tentatively as Sparganum mansoni because neither branched larvae nor Sparganum proliferum were ever reported.
A study was carried out to figure the cases and to observe the endemic status of clonorchiasis and metagonimiasis in endemic areas in Korea. Total 13,373 inhabitants living in 40 villages along 7 main rivers and 9 small streams were subjected to stool examination. They were selected randomly among the riverside population. Their specimens were examined both by cellphane thick smear method and Stoll's egg countung technique. This study was performed during the period from May 1979 to April 1980. The results obtained are as follows: 1. The egg positive rate of any kind of helminths was 58.7% out of 13,373 examned cases, and the egg positive rates by each helminth were; Clonorchis sinensis 21.5%, Metagonimus yokogaqai 4.8%, large type Metagonimus eggs 0.4%, Ascaris lumbricoides 22.9%, Trichuris trichiura 35.2%, hookworm 0.2%, Taenia sp. 0.5%, Hymenolepis nana 0.07%, Paragonimus westermani 2 cases, Fasciola sp. 4 cases, Echinostoma sp. 1 case and Hymenolepis diminuta 1 case respectively. 2. Many endemic foci of clonorchiasis were revealed along the 7 major rivers. The egg positive rates of each river basin differed from each other significantly; Nagdonggang 40.2%, Yeongsangang 30.8%, Seomjingang 17.3%, Hangang 15.7%, Tamjingang 15.9%, Geumgang 12.0% and Mangyeonggang 8.0%. The cases of clonorchiasis were estimated in range 830,000 to 890,000 in riverside areas of the 7 rivers. By grading the infection intensity, 64.7% was in Grade I(EPG 0-900), 28.6% in Grade II (EPG 1000-9,900), 5.5% in Grade III (EPG 10,000-29,900) and 1.3% in Grade IV (EPG over 30,000). The proportion of the cases in Grade III and IV was 6.8% among positive cases. Therefore 60,000 cases at least were regarded to suffer from it clinically. Males of 30-60 years of age showed higher positive rate and heavier burden of infection. This makes clonorchiasis more important socially because the patients lose their social productivity. 3. A few endemic foci of metagonimiasis were detected newly by egg detection; Samcheong 28.5% egg positive rate, Uljin 21.3%, Yeuongdeog 46.3%, Milyang 6.7%, Yeongil 9.2% and Geoje 18.2%. The mean EPG values were in range of 320-7, 120 by the focus. The egg positive rate and proportion of EPG Grade varied greatly by the area, and mean proportion of the positive cases were 69.7% in Grade I, 24.1% in Grade II, 5.0% in Grade III and 1.2% in Grade IV. Males of 30-60 years were infected in higher rate also. The large sized eggs of Metagonimus were found also in upper basin of Hangang and Geumgang mainly. They were regarded as eggs of M. takahashii which is mediated by the cyprinid fishes. Its significance should be studied further. Clonorchiasis and metagonimiasis should be realized as important public health problems in Korea by their wide distribution, high prevalence rate and heavy infection intensity. Comprehensive measures against them are needed urgently.
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