How Many Stool Examinations are Necessary to Detect Pathogenic Intestinal Protozoa?

Hiatt, Robert A.; Markell, Edward K.; Ng, Ernest Hung Yu

doi:10.4269/ajtmh.1995.53.36

Cited by 136 publications

(67 citation statements)

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“…Additional examinations could increase prevalence detection rates, as reported by other investigators. 19 Three Schistosoma species have been detected in Equatorial Guinea: S. mansoni, S. haematobium, and S. intercalatum. 20 All schistosomiasis cases (S. intercalatum) in this survey were found in members of the Fang ethnic group from the mainland region, the focus of this disease in Equatorial Guinea.…”

Section: Discussionmentioning

confidence: 99%

Prevalence of intestinal parasite infections with special reference to Entamoeba histolytica on the island of Bioko (Equatorial Guinea).

Roche¹,

Benito²

1999

The American Journal of Tropical Medicine and Hygiene

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Abstract. The prevalence of intestinal parasitic infections was assessed (1993 through 1995) among two different groups of persons on the island of Bioko, Equatorial Guinea. In the first group, parasitologic examinations were performed on stool specimens from a household-based sample of 557 dwellers from the rural area of the island. In the second group, 1,633 inpatients and outpatients at the General Hospital of Malabo (the capital of the country) were studied. All age groups were represented in both groups. The average prevalence of the most common protozoan and helminthic intestinal infections in rural and urban areas, respectively, was as follows: Entamoeba histolytica/E. dispar (14.9% and 32.7%, respectively), Giardia lamblia (7.2% and 8.6%), Ascaris lumbricoides (45.8% and 31.4%), and Trichuris trichiura (25.7% and 36.4%). Seventy-nine sera from patients with amebic liver abscess (suspected by ultrasonography) were studied by an immunohemagglutination assay, with 44 (56%) showing anti-E. histolytica titers Ն 1:32. Of these 79 sera, 71 were studied by an enzyme immunoassay, 86% of which were positive with titers Ն 1: 64. This study showed that parasitic infections in Equatorial Guinea represent a major health problem.One of the principal factors contributing to child morbidity and mortality in tropical countries is the high frequency of diarrheal episodes due to intestinal infections, which also contributes to childhood growth retardation. Diarrheal diseases are a major cause of mortality in developing countries; their control and prevention are one of the main objectives of the World Health Organization (WHO) within the Division of Diarrheal and Acute Respiratory Disease Control programs in developing countries.

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Section: Discussionmentioning

confidence: 99%

Prevalence of intestinal parasite infections with special reference to Entamoeba histolytica on the island of Bioko (Equatorial Guinea).

Roche¹,

Benito²

1999

The American Journal of Tropical Medicine and Hygiene

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“…We could have missed some infections with this and other parasites by testing insufficient numbers of specimens during some illness episodes (13); by collecting routine stool specimens monthly rather than more often, which would have been impractical; and by using techniques that by present standards are suboptimally sensitive for detection of particular parasites. For example, UV fluorescence microscopy is now known to be more sensitive than examination of acid-fast-stained slides for detection of Cyclospora cayetanensis (12).…”

Section: Discussionmentioning

confidence: 99%

Multiyear Prospective Study of Intestinal Parasitism in a Cohort of Peace Corps Volunteers in Guatemala

et al. 2001

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We conducted a prospective, longitudinal study in a cohort of 36 Peace Corps volunteers (PCVs) in Guatemala to study the incidence and natural history of intestinal parasitic infections during the PCVs' >2-year overseas stay. PCVs collected stool specimens at least monthly and when ill with gastrointestinal symptoms. Of the 1,168 specimens tested, 453 (38.8%) were positive for at least one parasite and 48 (4.1%) were positive for a pathogenic parasite. A median interval of 187 days (range, 14 to 752 days) elapsed before the first documented parasitic infection, and the median intervals from arrival until subsequent infections (e.g., second or third) were >300 days. The PCVs had 116 episodes of infection with 11 parasites, including up to 4 episodes per PCV with specific nonpathogens and Blastocystis hominis. The incidence, in episodes per 100 person-years, was highest for B. hominis (65), followed by Entamoeba coli (31), Cryptosporidium parvum (17), and Entamoeba hartmanni (17). The PCVs' B. hominis episodes lasted 6,809 person-days (28.7% of the 23,689 person-days in the study), the E. coli episodes lasted 2,055 person-days (8.7%), and each of the other types of episodes lasted <2% of the person-days in the study. Gastrointestinal symptoms were somewhat more common and more persistent, but not significantly so, in association with pathogen episodes than with B. hominis and nonpathogen episodes. Although infections with pathogenic parasites could account for only a minority of the PCVs' diarrheal episodes, the continued acquisition of parasitic infections throughout the PCVs' >2-year stay in Guatemala suggests that PCVs repeatedly had fecal exposures and thus were at risk for infections with both parasitic and nonparasitic pathogens throughout their overseas service.The most common medical disorder among travelers from developed countries to developing countries is diarrheal illness (28, 29), which also is the most common reason that Peace Corps volunteers (PCVs) seek medical care (4, 7). Various bacterial enteropathogens, such as enterotoxigenic Escherichia coli, are the most commonly identified etiologic agents of travelers' diarrhea (5, 18, 21). However, surveillance data from 1990 suggested that intestinal parasitism was prevalent among PCVs and that infection with Entamoeba histolytica was particularly common among PCVs in Guatemala (7,10). In that context, we conducted studies among PCVs in Guatemala to identify risk factors for diarrheal illness in general and to determine how common various parasitic infections are in this setting. We first conducted a clinic-based, case-control study, which included 48 case (diarrheal) episodes, 26 control episodes, and 115 stool specimens obtained during these episodes (10). Six (12.5%) of the case episodes could be accounted for by protozoal pathogens, specifically, Cyclospora cayetanensis (three episodes), Cryptosporidium parvum (one), Giardia lamblia (one), and E. histolytica-Entamoeba dispar (one). Infection with Blastocystis hominis was equally prevalent among cas...

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“…23 In Cuba, microscopic faecal examination remains the mainstay of diagnostic proceeding for giardiasis and, due to its limitations, 24 it is recommended the examination of up to three faecal samples collected over alternative days. 25 Presumably, all health workers in Havana know this rule, but stricter adherence to it seems to be necessary. Alternatively, the diagnosis efforts for patients with gastrointestinal symptoms and suspected giardiasis were mainly concentrated on microscopy of duodenal aspirate, which has become the main diagnostic tool for it in APHCH.…”

Section: Discussionmentioning

confidence: 99%

“…22 It is necessary the examination of at least three faecal samples collected over alternate days and in this way, several days often pass between the initial suspicion of giardiasis and the final parasitological confirmation. 25 During this time, an untreated patient's condition may improve or will worsen. In our study, the median time between the first presentation to a health unit till the start of treatment of giardiasis was 6 days.…”

Section: Discussionmentioning

confidence: 99%

Care-seeking behaviour and diagnostic processes for symptomatic giardiasis in children attending an academic paediatric hospital

Escobedo¹,

Almirall²,

Ávila

et al. 2014

Pathogens and Global Health

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Giardiasis is one of the commonest intestinal parasitic infections in Cuba. In order to determine careseeking behaviour and diagnostic processes in paediatric in-patients with giardiasis, structured questionnaires were administered by interview mothers of children with giardiasis during January to December 2010. During the study period, 97 children were diagnosed with giardiasis, of whom 86 (88.6%) caregivers were interviewed. The median number of days from symptoms onset to the first presentation in a health unit was 2 days (range: 0-15 days). The pattern of care-seeking behaviour was variable; 41 (47.7%) of children initially visited the emergency unit in a paediatric hospital. Sixty-six children had, at least, one further contact for help before diagnosis of giardiasis was made (range: 1-5 contacts) and of the 128 contact visits, 94 (73.4%) were also targeted more to hospitals. There was a median time of 6 days between the first presentation to a health unit until diagnosis, which was mainly made by microscopic examination of duodenal aspiration. Among factors investigated in mothers, only knowing other person with giardiasis had significant association with their ability to suspect giardiasis [odds ratio (OR): 29.8, 95% confidence interval (CI): 3.71-239.4, P50.001]. Requesting a faecal specimen or ordering duodenal aspiration for microscopic examination during the first visit appeared associated with correct diagnosis (OR: 3.84, 95% CI: 1.57-9.40, P50.003). Efforts should be made to increase doctors' awareness of-and diagnostic skills for childhood giardiasis. At the same time, it is necessary to improve caregivers' awareness about giardiasis.

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How Many Stool Examinations are Necessary to Detect Pathogenic Intestinal Protozoa?

Cited by 136 publications

References 0 publications

Prevalence of intestinal parasite infections with special reference to Entamoeba histolytica on the island of Bioko (Equatorial Guinea).

Prevalence of intestinal parasite infections with special reference to Entamoeba histolytica on the island of Bioko (Equatorial Guinea).

Multiyear Prospective Study of Intestinal Parasitism in a Cohort of Peace Corps Volunteers in Guatemala

Care-seeking behaviour and diagnostic processes for symptomatic giardiasis in children attending an academic paediatric hospital

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