Fecal occult blood testing on Trichuris-infected primary school children in northeastern peninsular Malaysia.

Abstract

Abstract. Stool specimens of 104 primary schoolchildren (mean Ϯ SD age ϭ 8.2 Ϯ 0.3 years) were examined for helminth eggs and for occult blood to investigate the possibility that trichuriasis causes occult intestinal bleeding in the absence of the overt Trichuris dysentery syndrome. A commercially available guaiac test was used to detect fecal occult blood. Sixty-one children had Trichuris infection, 11 of whom had heavy infections (Ͼ 10,000 eggs per gram of feces [epg]), and 53 had Ascaris infections. No hookworm infection was detected. Baseline screening yielded only one weakly positive occult blood test result in a child with a light (800 epg) Trichuris infection. Serial stool occult blood testing on the 11 subjects with heavy trichuriasis and 8 uninfected controls yielded a single weakly positive result in the control group. The results provide no evidence that trichuriasis predisposes to significant occult gastrointestinal bleeding in children in the absence of the dysenteric syndrome.Intense infection with Trichuris trichiura, a nematode that inhabits the colon causes a chronic dysenteric illness in children. 1 However, this is a relatively uncommon event, Considering that the global prevalence of Trichuris infection is approximately 800 million, 2 there is a remarkable dearth of data on whether the infection predisposes to occult gastrointestinal bleeding in the absence of the overt Trichuris dysentery syndrome. There is evidence of an association between heavy Trichuris infection and anemia even when the dysenteric illness is not present. 3,4 Earlier studies that addressed the question of gastrointestinal bleeding and trichuriasis were conducted on small numbers of selected patients who may not be representative of the community. 1-7 A larger, more recent study was community-based but conducted on a population with a high prevalence of concomitant hookworm infection that could have obscured the role of trichuriasis in causing intestinal bleeding. 8 The aim of the present study was to determine if trichuriasis predisposed to occult colonic bleeding among early primary school children in northeastern peninsular Malaysia, a population with a relatively high prevalence of trichuriasis but a low prevalence of hookworm infection. MATERIALS AND METHODSStool specimens from 104 children attending a single school on the outskirts of the town of Kota Bharu in northeastern peninsular Malaysia were collected and examined for helminth eggs. All 117 children in the second grade were targeted for the study but stool specimens were obtained from only 104 subjects. Egg counts were determined using a modification of Stoll's method and expressed as eggs per gram of feces (epg). 9 Parasitologic examinations were generally performed on the day of stool collection. The stools were then stored at Ϫ20ЊC for up to 48 hr before being tested for occult blood using a commercially available slide test kit. This test consisted of guaiac-impregnated paper upon which a thin smear of stool was made (Coloscreen; Helena Laboratories, Beaum...

Trichuris dysentery syndrome: a common cause of chronic iron deficiency anemia in adults in an endemic area (with videos)

“…This was caused by occult blood loss from colonic lesions. 17 This blood loss presumably was caused by mucosal petechial lesions, and blotchy mucosal hemorrhages were caused by burrowing of the anterior end of the worm into the mucosa. As expected, there was no effect on the nutritional status of our patients.…”

Fecal Occult Blood Test and Gastrointestinal Parasitic Infection

“…Previous studies illustrated that occult blood is not correlated with T. trichiura infection, unless there is a Trichuris dysentery syndrome (TDS) [6, 7, 10]. Similarly for hookworms, they do not lead to a significant occult gastrointestinal bleeding unless high-burden infection occurs [11–13].…”

Iron Deficiency Anemia: Focus on Infectious Diseases in Lesser Developed Countries

“…Potential mechanisms of trichuris-related anemia include worm consumption of blood in the context of heavy infections, colonic lesions with associated bleeding, or chronic reduction in food and micronutrient intake due to the anorexia inducing effects of TNF-alpha released in response to infection [86, 89]. Of note, one study assessing occult blood loss with T. trichiura found that trichuriasis does not lead to significant occult gastrointestinal bleeding in the absence of TDS [90]. …”