Intestinal Parasitic Infections in Internationally Adopted Children: A 10-Year Retrospective Study

Abstract

Background: Intestinal parasitic infections (IPIs) represent one of the leading causes of morbidity in the world. Children involved in international adoptions constitute a special group of subjects with specific problems and specific healthcare needs. Nevertheless, in current literature there are insufficient data on IPI in this subset of children. This study aims to evaluate the prevalence of IPI in a cohort of internationally adopted children and to investigate epidemiologic factors and clinical features related to IPIs. Methods: A retrospective study involving internationally adopted children <18 years old for which results from 3 fecal parasitologic tests were available, evaluated between September 1, 2008 and April 31, 2018 at a tertiary level university hospital in Rome. Univariate and multivariate logistic regression analyses were carried out to identify demographic factors and clinical features associated with IPIs. Two comparisons were performed, the first one according to the positivity of the parasitologic examination of the feces and the second one according to the pathogenicity of the identified strains. Results: Of 584 children evaluated, 346 (59.3%) had a positive parasitologic examination (143 pathogenic parasites and 203 nonpathogenic parasites) and 238 (40.8%) had a negative parasitologic examination. About 28.9% of children were positive for 2 or more parasites. A statistically significant positive association was found between IPIs and age, macroarea of origin (Africa and Latin America), living in institutions before adoption and vitamin D deficiency (P < 0.05). Conclusions: Intestinal parasites represent a widespread infection among internationally adopted children, especially in school-age children and those from Latin America and Africa. Importantly, the parasites found in adopted children were not pathogenic in most cases and did not cause significant alterations in growth, major micronutrient deficits or malnutrition.

Intestinal parasites may be associated with later behavioral problems in internationally adopted children

“…The continent of origin of the adopted children was associated with the prevalence of parasites on arrival (Table 1). Similar to already reported data [3,4,6,[9][10][11][12][13][14][15]48], the most prevalent pathogenic intestinal parasite detected among the adopted children was Giardia lamblia, but the parents were unable to specify the species of the parasites or worms in 35% of the cases. Not all intestinal parasites have the same pathology or effect on their hosts.…”

“…The prevalence of intestinal parasites among internationally adopted children on arrival in Finland was 15.6%, which is comparable to the prevalence in adopted children in earlier studies in the other countries [3,[9][10][11]48] but lower than the reported in some recent works [6,[12][13][14][15]. This difference may be attributed to the development of better stool screening technologies, such as DNA-based methods, or reporting biases.…”

“…Although many psychological explanations exist for growth and developmental delays also more physiological explanations are plausible. Intestinal parasite infections are common on arrival among internationally adopted children, especially among adoptees from countries with poor living conditions and subpar sanitation [3,4,6,[9][10][11][12][13][14][15][16]. Intestinal parasites in children are associated with growth and developmental delays [17][18][19] as well as micronutrient deficiencies [20].…”

Ascariasis, Amebiasis and Giardiasis in Mexican children: distribution and geographical, environmental and socioeconomic risk factors

“…This study has limitations that need to be addressed for proper interpretation of the results. There are other factors that are known to affect the incidence of intestinal parasites and were not measured, such as malnutrition and migration (Buonsenso et al 2019 ). SINAVE data is based on diagnostic results of children for whom the parents were seeking health care, the real incidence of the studied parasites is most likely underestimated.…”

“…Intestinal parasitic infections are a public health problem in Mexico (Gutiérrez-Jiménez et al 2017 ). While infection can occur at any age, school age children (5–9 years) are most at risk for intestinal parasitic infection, due to their behaviour and increased exposure (Zavala et al 2017 ), and they are at the highest risk of morbidity among all age groups(Buonsenso et al 2019 ). Intestinal parasites can be divided into soil transmitted helminths (STHs) and intestinal protozoa.…”