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EDITORIAL  
Year : 2012  |  Volume : 5  |  Issue : 4  |  Page : 279-281
Intestinal parasitic infections: An overview


Department of Microbiology, Prathima Institution of Medical Sciences, Nagunur, Karimnagar, India

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Date of Web Publication8-Oct-2012
 

How to cite this article:
Ramana K V. Intestinal parasitic infections: An overview. Ann Trop Med Public Health 2012;5:279-81

How to cite this URL:
Ramana K V. Intestinal parasitic infections: An overview. Ann Trop Med Public Health [serial online] 2012 [cited 2014 Oct 21];5:279-81. Available from: http://www.atmph.org/text.asp?2012/5/4/279/101988
Intestinal parasitic infections are responsible for considerable morbidity and occasional mortality among the infected population throughout the world. It is estimated that around 2 billion people are infected with intestinal parasites globally. [1] More than half of the infected individuals include school going age children. About 39 million disability adjusted life years (DALY's) are linked to IPI's which are responsible for huge financial burden. [2] Most of the parasitic infections are spread by faeco-oral route by consumption of contaminated food or water. Many parasitic infections are zoonotic, transmitted from domestic animals including cattle, sheep, cats, dog and rodents which act as reservoir. [3] Protozoan parasitic infections and intestinal helminthic infections are a common cause of parasitic manifestation in infants, children, adolescent, reproductive age and pregnant woman. Intestinal parasitic infections are a symbol of low socioeconomic status predominantly affecting poor people in underdeveloped and developing nations. The most important drawback of IPI's is that about 90% of infected individuals remain asymptomatic. [4] The prevalence of intestinal parasitic infections varies with different geographical regions. An Indian study recently done, found higher prevalence rates (81.2%) of protozoan parasites compared to helminthes (18.8%) in contrast to studies in other parts of the world. [5],[6] Recent studies have reported Giardia lamblia to be the most prevalent protozoan followed by Entamoeba histolytica and Blastocystis hominis.[7] Among the helminthic parasites, the soil transmitted helminthes that include Ascaris lumbricoides, Trichuris trichuria and Ancylostoma duodenale are the most common. [8]Hymenolepis nana is considered the most frequent cause of tape worm infection. [7]

Poverty, illiteracy, lack of safe drinking water, poor hygiene, and malnutrition is responsible for repeated intestinal parasitic infections which lead to severe morbidity. [9] Environmental factors also play a role in the incidence of IPI as hot and humid tropical climate favor increased parasite prevalence. [10] Though age is not a factor, children are observed to be most affected by parasitic infestation. Micro and macronutrient deficiency, low birth weight, underweight can predispose to frequent IPI's. [6] Parasitic infestation in pregnant and reproductive age population can be responsible for intrauterine growth retardation. IPI's can be responsible for nausea, vomiting, diarrhea, malabsorption, malaise, fatigue, depression, weight loss, fever and gastrointestinal obstruction. Others including hypoprotenemia, wasting, pica and edema are observed in IPI. [7] Complications of intestinal parasitic infections include intestinal ulceration, abscesses, peritonitis and reactive arthritis or asymptomatic synovitis usually involving lower extremities. Hypersensitivity reactions seen as rashes and utricaria are common in parasitic manifestations. Parasite specific manifestations are seen in case of Ancylostoma duodenale, the hook worm aided by an organic anticoagulant can consume or suck about 0.25 mL of blood each day and be responsible for microcytic hypochromic anaemia. [11] Giardiasis can be responsible for severe malabsorption syndrome and Entamoeba histolytica infection if not treated can be responsible for intestinal and extra intestinal manifestations including amoeboma, toxic megacolon, pneumatosis coli (intramural air), peritonitis and liver abscess. [12] Large helminthic parasites can precipitate intestinal obstruction, intussusceptions and other related complications. [13] Lack of knowledge of prevalence of parasites in a particular geographical area may lead to misdiagnosis of IPI's as appendicitis, and other inflammatory bowel diseases. [14] Treatment with steroids can exacerbate parasitic infestation. [15] Previous studies have observed the relation between micronutrient deficiencies and IPI's in relation to Vitamin A, C, E, Riboflavin and Folic acid. [16]

Diagnosis plays an important role in IPI's as suggested by the World Health Organization (WHO)'s 4 part strategy to control IPI's in Diarrheal diseases control (CDD) programme. [17] Stool examination for parasitic ova, cysts, trophozoite and larvae remains the gold standard for the laboratory diagnosis for IPI's. [18] Studies previously done have observed increased detection rates of parasites after use of concentration techniques. [19],[20] Others recommend screening of at least three stool samples for correct diagnosis. [21] Though serological tests including ELISA for the detection of antigen in stool, as well as antibody in blood/serum are available, their useful has been found to be limited except in case of extra intestinal manifestations. Usefulness of PCR in the diagnosis of parasitic infections is limited due to cost affordability in low income countries. [22]

The need of the hour is that we should have enough studies related to the epidemiology of various IPI's in pediatric age group in different parts of the world. [23],[24],[25],[26],[27],[28],[29] Recent reports of infection with Diphyllobothrium spp and Dipylidium caninum from India highlights the need for pediatricians to make a thorough clinical evaluation taking in to consideration the prevalent parasitic infection in the particular geographical region, hygiene status, recent travel to endemic areas and other associated predisposing factors as suggested by the World Health Organization (WHO). [30] Clinical microbiologists must follow standard laboratory procedures when screening the stool samples and increase the chances of finding the parasites. The social and preventive medicine personnel should conduct visits to communities, evaluate their nutrition status (especially children and pregnant women), encourage hygiene practices, recommend consumption of safe drinking water, sensitize about the infections transmitted by domestic animals, disadvantages of illiteracy and defecation in open areas and prioritize primary health care and emphasize oral rehydration as the key and relatively inexpensive intervention for reduction of diarrhoeal disease mortality. Spread of IPI's can be controlled by deworming and treating asymptomatic carriers. Prevention strategies include use of proper sewage disposal methods, consumption of clean and treated safe drinking water and proper hygiene (hand washing, cleaning fruits and vegetables before consumption). [31] In conclusion we reemphasize the need for a multifaceted approach considering role of epidemiological surveillance (parasitic prevalence in slum, rural and urban environments), evaluation of various factors associated with parasitic infections in respective geographical areas, formulating standard laboratory investigations to identify parasites and initiate control programmes in minimizing the morbidity and mortality caused by IPI's.

 
   References Top

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2.Stephenson LS, Latham MC, Ottesen EA. Malnutrition and parasitic helminth infections. Parasitology 2000;121 Suppl: S23-38.  Back to cited text no. 2
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3.Ramana KV, Rao SD, Rao R, Mohanty SK, Wilson CG. Human dipylidiasis: A case report of Dipylidium caninum infection in teaching hospital at Karimnagar. Online J Health Allied Scs 2011;10:28.   Back to cited text no. 3
    
4.Reed SL. Amoebiasis and infection with free-living amoebas. In: Harrison TR, Fauci AS, Braunwald E, et al., editors. Harrison's Principles of Internal Medicine. 15 th ed. New York: McGraw-Hill; 2001.p. 1199-202.  Back to cited text no. 4
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5.Sehgal R, Reddy GV, Verweij JJ, Rao AV. Prevalence of intestinal parasitic infections among school children and pregnant women in a low socio-economic area, Chandigarh, North India. RIF 2010;1:100- 3.   Back to cited text no. 5
    
6.Kucik CJ, Martin GL, Sortor BV. Common intestinal parasites. Am Fam Physician 2004;69:1161-8.  Back to cited text no. 6
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7.Steiger U, Weber M. [Unusual etiology of erythema nodosum, pleural effusion and reactive arthritis: Giardia lamblia]. Praxis (Bern 1994) 2002;91:1091-2.  Back to cited text no. 7
    
8.Steketee RW. Pregnancy, nutrition and parasitic diseases. J Nutr 2003;133:1661S-7.  Back to cited text no. 8
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9.Pillai DR, Kain KC. Common Intestinal parasites. Curr Treat Opt Infect Dis 2003;5:207-17.  Back to cited text no. 9
    
10.Bethony J, Brooker S, Albonico M, Geiger SM, Loukas A, Diemert D, et al. Soil-transmitted helminth infections: Ascariasis, trichuriasis, and hookworm. Lancet 2006;367:1521-32.  Back to cited text no. 10
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11.Nematian J, Nematian E, Gholamrezanezhad A, Asgari AA. Prevalence of intestinal parasitic infections and their relation with socio-economic factors and hygienic habits in Tehran primary school students. Acta Trop 2004;92:179-86.  Back to cited text no. 11
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12.WHO. Geographical distribution and usefull facts and stats. Geneva; WHO; 2006.   Back to cited text no. 12
    
13.Quihui L, Valencia ME, Crompton DW, Phillips S, Hagan P, Morales G, et al. Role of the employment status and education of mothers in the prevalence of intestinal parasitic infections in Mexican rural schoolchildren. BMC Public Health 2006;6:225.  Back to cited text no. 13
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14.Dickson R, Awasthi S, Demellweek C, Williamson P. Anthelmintic drugs for treating worms in children: effects on growth and cognitive performance. Cochrane Database Syst Rev 2003:CD000371.  Back to cited text no. 14
    
15.Feachem RG, Hogan RC, Merson MH. Diarrhoeal disease control: reviews of potential interventions. Bull World Health Organ 1983;61:637-40.  Back to cited text no. 15
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16.Scrimshaw NS, SanGiovanni JP. Synergism of nutrition, infection, and immunity: an overview. Am J Clin Nutr 1997;66:464S-77.  Back to cited text no. 16
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17.World Health Organization (WHO). Monitoring helminthic control programmes (WHO/CDS/CPC/SIP/99.3). Geneva, Switzerland: WHO; 1999.  Back to cited text no. 17
    
18.WHO. Basic laboratory methods in medical parasitology. Geneva: WHO; 1991.  Back to cited text no. 18
    
19.Marti H, Koella JC. Multiple stool examinations for ova and parasites and rate of false-negative results. J Clin Microbiol 1993;31:3044-5.  Back to cited text no. 19
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27.Naish S, McCarthy J, Williams GM. Prevalence, intensity and risk factors for soil-transmitted helminth infection in a South Indian fishing village. Acta Trop 2004;91:177-87.  Back to cited text no. 27
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28.Wani SA, Ahmad F, Zargar SA, Dar PA, Dar ZA, Jan TR. Intestinal helminths in a population of children from the Kashmir valley, India. J Helminthol 2008;82:313-7.  Back to cited text no. 28
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29.Khurana S, Aggarwal A, Malla N. Comparative analysis of intestinal parasitic infections in slum, rural and urban populations in and around union Territory, Chandigarh. J Commun Dis 2005;37:239-43.  Back to cited text no. 29
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30.Ramana K, Rao S, Vinaykumar M, Krishnappa M, Reddy R, Sarfaraz M, et al. Diphyllobothriasis in a nine-year-old child in India: A case report. J Med Case Rep 2011;5:332.  Back to cited text no. 30
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Correspondence Address:
K V Ramana
Department of Microbiology, Prathima Institution of Medical Sciences, Nagunur, Karimnagar-505 417
India
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DOI: 10.4103/1755-6783.101988

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1 Opportunistic intestinal parasitic infections
Annals of Tropical Medicine and Public Health
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