Report about the most common parasite

In

Gaza Strip

 

Prepared by:

Mohammed Adnan Qazzaz

Gaza Strip is a narrow zone of land (360 km2) situated on the southeastern corner of the Mediterranean Sea. It is bordered on the south by Egypt, on the west by the Mediterranean, on the east by Negev desert and on the north by the green line. Over one million inhabitants live in Gaza Strip.

In order to monitor changes in the frequency of intestinal parasites, the records of 8,417 stool specimens of patients attending the Ahli Arab Hospital in the Gaza city in the period 1995-2000 were reviewed and analyzed. Of these 2,506 (29.77%) were positive.

Although 9 different parasites were encountered, the most common pathogenic parasites identified were: Entamoeba histolytica (70.19%), Ascaris lumbricoides (14.64%), and Giardia lamblia (10.34%). The other parasites present were: Trichuris trichiura , Hymenolepis nana , Enterobius vermicularis, Strongyloides , stercolaris, Taenia saginata , and Echinococcus granulosus. The overall monthly

incidence of parasites did not show clear seasonal patterns.The prevalence of intestinal parasites has dropped significantly over the reviewed years from 36.35% in 1995 to 21.20% in 2000. This decline in prevalence reflects the continuing efforts of the public health authorities to improve primary health care, water supply services and sanitation conditions. .

The hospital records of 8,417 stool specimens were analyzed. The annual distribution of the specimens and the percentage of specimens containing parasites are presented in Table 1. The overall prevalence of parasites was 29.77%. As can be seen from the table the overall frequency of parasites has decreased from 36.35% in the year 1995 to 21.20% in the year 2000

Table 1. Overall distribution of tested stool specimens and positive cases of intestinal parasites at the Ahli Arab hospital

The numbers and types of parasites seen over the six years are shown in Table 2. The most common parasites identified were; E. histolytica , A. lumbricoides and G. lamblia . The same table also shows that changes have occurred in the types of parasites over the reviewed years. In general, E.histolytica was the most commonly isolated parasite and represented around three quarters of all parasites throughout the investigated years. Moreover, E. histolytica was the only parasite that showed consistent and significant annual increase.

Most of the remaining identified parasites, however, showed a significant decrease. For instance, A. lumbricoides and G. lamblia which were respectively responsible for 14.56% and 12.30% of parasitosis in the year 1995 became numerically less in the year 2000 and represented only 9.22% and 8.53% of the positive specimens, respectively. T. saginata and E. garanulosus remained uncommon parasites in Gaza and only 2 cases of each were recorded in the whole study period.

distribution of the recovered parasites over the six years is illustrated in the figure below :Generally the percentage of positive specimens per month did not deviate from the yearly overall percentage. Additionally, there was no apparent seasonal variation for any of the recorded parasites. The monthly

The most commone parasite in Gaza Strip : Gardia lamblia Entamoeba hostolyticaOientamoeba fragilis Blastocystic hominis Entamoeba coliEndolimax nana Ascaris lumbricoidesEntrobius vermicularis Chilomastix mesuiniTrichuris trichiuraCryptosporidium parvum Strongyloides stercoralis Taenia saginataHymenolopis nana

Entamoeba hostolytica and Entamoeba coli:

Most physicians in Gaza prescribe medicaments for patient's suffering from Entamoeba histolytica/dispar without parasitologic diagnosis. Additionally, stool analysis performed by the routine methods usually reports the species as E. histolytica without con-firmation. In this study, 92 stool specimens were collected and analyzed by wet mount, iron haematoxylin staining, antigen detection of E. histolytica and polymerase chain reaction (PCR). The total number of E. histolytica identified by PCR was 64

(69.6%) that of E. dispar was 21 (22.8%). Mixed infection with both E. histolytica and E. dispar was evident in 7 specimens (7.6%). In the light of these results approximately 30% of suspected clinical amoebiasis cases were negative for E. histolytica. It is recommended to use PCR for diagnosis of stool specimens from patients with E. histolytica/dispar and that treatment should be prescribed for only patients positive for E.

Gardia lamblia :Giardia lamblia (synonymous with Lamblia intestinalis and Giardia duodenalis) is a flagellated protozoan parasite that colonises and reproduces in the small intestine, causing giardiasis its most common in Khan Yuins City and it cause 12.30% of parasitic infection in Gaza strip .

Dientamoeba fragilis :Some cases are reported in Gaza strip but it's not so common .

Blastocystic hominis :Some cases are reported in Gaza strip but it's not so common . this protozoa is not always pathogen .

Endolimax nana :

Its intestinal protozoa . Originally thought to be non-pathogenic, studies suggest it can cause intermittent or chronic diarrhea.Additionally, it is very significant in medicine because it can provide false positives for other tests, notably the similar species Entamoeba histolytica, the pathogenresponsible for amoebic dysentery, and because its presence indicates the host has consumed fecal material. It forms cysts with four nuclei which excyst in the body and become trophozoites. Endolimax nana nuclei have a large endosome somewhat off-center and small amounts of visible chromatin or none at all.

Ascaris lumbricoides :

Ascaris lumbricoides is the giant roundworm of humans, belonging to the phylumNematoda. An ascarid nematode, it is responsible for the disease ascariasis in humans, and it is the largest and most common parasitic worm in humans. A quarter of the human population is estimated to be infected by this parasite. Ascariasis is prevalent worldwide and more so in tropical and subtropical countries.Here in Gaza it cause 9.5% of protozoal infestation and its common in children more than the adult and its reported in almost all the cites in Gaza Strip .

Entrobius vermicularis :It’s the most common helminthes that infect child in Gaza Strip and its very easy to be diagnosed . any itching in the anus region of a child in Gaza strip is referred to Entrobius worms . and its cause 38.6%, of the parasite infestation in Gaza .

Trichuris trichiura :Its common in Gaza valley region and it cause 7.3% of the helminthal infestation in Gaza Strip .

Strongyloides stercoralis :It cause 11.0% of helminthal infestation in Gaza strip

A study in Gaza valley region shows that :

in Gaza Valley, out of 352 children surveyed, 265 (75.28%) were positive for intestinal helminths. Prevalence of Ascaris lumbricoides was 71.87%, followed byTrichuris trichiura (26.42%), Enterobius vermicularis (13.92%) and . Single species infection was seen in 38.63% of the infected children, whereas 36.64% were infected with multiple species of helminth parasites. The prevalence of infection peaked in the age group of 11-15 years (84.91%) followed by the age group of 6-10 years (81.70%) and age group of 0-5 years (50.54%) .The differences in prevalence rates between male, female and rural urban children was insignificant .Water source, defecation site, personal hygiene and maternal education were significant risk factors in predicting the intestinal helminth infection.

Conclusion : The present study reveals that intestinal helminths are abundant among schoolchildren of Gaza valley. This situation strongly calls for the institution of control measures, including treatment of infected individuals, improvement of sanitation practices, provision of clean water and further studies on the abundance of intestinal protozoan infections in the children of Gaza valley. The impact of each measure would be maximized through a health education program directed at schoolchildren and their mothers in particular, and to communities in general.

Taenia saginata :

This is the beef tape worm and it is not so common in Gaza but some cases were reported . produces only mild abdominal symptoms .

Hymenolopis nana :

Dwarf tapeworm it cause 4.1% of helminthal infestation .

Cryptosporidium parvum :This one most of the infections is asymptomatic . however In some people "often immuniocompromised " can cause sever diarrhea . And 6.6% of tested people were positive for it .

Final Conclusion :

The highest incidence rate in proportion to the total number of investigated samples was recorded in Jabalia area 17.0% followed by Deir el balaharea 16.6%, Beit hanoun 15.6% and Gaza town 14.0%. The infection rate was higher in younger age group (6->9 years) in which several of pupils reported variable symptoms like abdominal pain, cramps, weight loss, diarrhea, and anorexia. The rate of infection was higher in children from overcrowded areas, rural areas, low income families and it was reported more in male than female pupils.

The worst parasite in Gaza and in whole Palestine is the Israeli occupation

Freedom for Gaza . Freedom For whole Palestine

Treatment of some protozoa and helminthesDrugs for treatment of protozoal infection

Organism Drug Of Choice Other Drugs

Dientamoeba fragilis Iodoquinol, 650mg 3time daily for 20 days

Tetracycline,500mg 4 times daily for 10 days

Paromoycin,500 mg 3 times daily for 7 days

Trypanosome CruziNifurtimox

Orbenznidizol

Trypanosome BruceiHemolymphatic Suramin Pentamidine Or Eflonithine

Advanced CNS disease Melarsoprol Eflonithine

Gardia Lamblia

Metronidazol, 250mg3 times

Ordailyfor 5 days Tinidazole

Furazolidone, 100 mg 4 times daily for 7 days

OrAlbendazole ,400 mg daily

for 5 days

Blantidium coli Tetracycline , 500 mg 4 times daily for 10 daily

Metronidazol 750,mg 3 times daily for 5 days

Cryptosporidium species Paromoycin,500-750 mg 3 times daily for 10 days

Azithromycin, 500 mg daily for 21day

Trichomonas vaginalis

Metronidazol, 2 gonce or 250 mg 3 times daily for 7days

OrTinidazole , 2 g once

Lishmaniasis

Visceral

Sodium stibogluconate , 20 mg IV or IM for 28 day

Meglumine antimoniteOr

PentamidineOr

Amphotericine BMucosal

Ctaneous Sodium stibogluconate , 20 mg IV or IM for 20 day

Meglumine antimoniteOr

PentamidineOr

Ketoconazole

Drugs For Treatment TrematodesOrganism Drug Of Choice Other Drugs

Schistosoma

Haematobium

praziquantel metrifonatemansoni

japonicum

Fasciola hepatica Bithionol triclabendazole

Fasciolopsis buski Praziquantel or niclosamide

Clonorchis sinensis praziquantel Albendazole

Paragonimus westermani praziquantel Bithionol

Drugs for treatment of helminthic infection :

Drugs For Treatment cestodes

Other Drugs Drug Of Choice Organism

Praziquantel or niclosamide Diphyllobothrium latem

Praziquantel or niclosamide Taenia solium

mebandazole Praziquantel or niclosamide Taenia saginata

niclosamide Praziquantel Hymenolepis nana

Albendazole Echinococcus granulosus

Drugs For Treatment Nematodes

Organism Drug Of Choice Other Drugs

Entrobius vermocularis Mebandazole . pyrantel pamoate Albendazole

Nactor amiericanus. ancyostoma pyrantel pamoateAlbendazole

Mebandazole

Wuchereria bancrofti diethylcabamazine invermectin

Loa loa diethylcabamazine invermectin

Brugia malayi diethylcabamazine invermectin

Trichuris trichiura AlbendazoleMebandazole

oxantel/pyrantel pamoate

Strongyloides stercoralis invermectin Albendazolethiabendazole

Ascaris lumbricoides Albendazole pyrantel pamoate

Mebandazole

piperazine

Treatment of Amebiasis

Asymptomatic intestinal infection :Drug of choice : Lumina agent :Diloxanide Furoate 500 mg 3 times daily for 10 days .Iodoquinol , 650 mg 3 times daily for 21 days . Promomycine , 10 mg /kg 3 times daily for 7 days .

Mild to moderate intestinal infection : Drug of choice :Metronidazol, 750mg 3 times daily (or 500 mg IV every 6 hours) for 10 days Tinidazole . 2g daily for 3 days .Other drugs :Lumina agent :Diloxanide Furoate 500 mg 3 times daily for 10 days .Tetracycline,250mg 3 times daily for 10 days

Severe intestinal infection : Drug of choice :Metronidazol, 750mg 3 times daily (or 500 mg IV every 6 hours) for 10 days Tinidazole . 2g daily for 3 days .Other drugs :Lumina agent :Diloxanide Furoate 500 mg 3 times daily for 10 days .Tetracycline,250mg 3 times daily for 10 days

Hepatic abscess . ameboma and lung abscess : Drug of choice :Metronidazol, 750mg 3 times daily (or 500 mg IV every 6 hours) for 10 days Tinidazole . 2g daily for 3 days .Other drugs :Dehydrometine or emerine ,1 mg /kg SC or IM for 8-10 days , followed by ( liver abscess only ) chloroquine , 500 mg twice daily then 500 mg daily for 21 Lumina agent :Diloxanide Furoate 500 mg 3 times daily for 10 days .Tetracycline,250mg 3 times daily for 10 days

Thanks