Helminthozoonoses in India – a resurgent problem

download Helminthozoonoses in India – a resurgent problem

of 46

Transcript of Helminthozoonoses in India – a resurgent problem

  • 8/7/2019 Helminthozoonoses in India a resurgent problem

    1/46

    Helminthozoonoses in India aresurgent problem

    M. B. Chhabra and K.M.L.Pathak

    Journal of parasitic diseases,December 2008, Vol. 32, No.2 77-86

  • 8/7/2019 Helminthozoonoses in India a resurgent problem

    2/46

    Introduction

    Parasitic zoonoses constitute an importantgroup of animal borne human diseases

    Transmissions associated with poverty, lack of sanitary practices and a proximity to animalsources

  • 8/7/2019 Helminthozoonoses in India a resurgent problem

    3/46

    Introduction

    Several factors have led to resurgence of parasitic zoonoses in the recent years

    Environmental changes Ecological disturbances Increased urbanization Lifestyle changes Increased travel Emergence of AIDS

  • 8/7/2019 Helminthozoonoses in India a resurgent problem

    4/46

    Trematode zoonoses

    Cercarial dermatitis

    FascioliasisFasciolopsiasisGastrodiscoidiasis

  • 8/7/2019 Helminthozoonoses in India a resurgent problem

    5/46

    Cercarial dermatitis

    Cercariae of several species of mammalian andavian schistosomes are responsible for causing

    dermatitis in man, during the act of skin penetrationAlso known as swimmers itch or paddy fielddermatitisCondition rampant in rural India

  • 8/7/2019 Helminthozoonoses in India a resurgent problem

    6/46

    M ost cases seem to involve cercariae of mammalian schistosomes, most commonly

    Schistosoma spindaleR ecent reports deal with cases from Assam,M adhya Pradesh and KarnatakaM uraleedharan et al reported case of a personwho collected snails with bare hands from anirrigation pond.

  • 8/7/2019 Helminthozoonoses in India a resurgent problem

    7/46

    M inutes after collecting the snails, heexperienced itching and erythema on thedorsum of hands which went on to becomemacules and then papules.Agarwal et al recorded Cercarian HullenR eaction positivity in 51% of humandermatitis cases not responding to benzyl

    benzoate as against 20% positivity in thoseresponding to the drug

  • 8/7/2019 Helminthozoonoses in India a resurgent problem

    8/46

    Fascioliasis

    Good example of an emerging/reemerging parasitic disease in many countries

    Caused by F asciola hepatica and F asciola gigantica.Definitive host range is very broad, includingmany herbivorous animals but occasionallyman

  • 8/7/2019 Helminthozoonoses in India a resurgent problem

    9/46

    Although human fascioliasis infection should be related to animal endemicity, reports of human fascioliasis in India have been veryrare.Case reports dealing with hepato biliarysymptoms and obstructive jaundice in childrenattributable to F .hepatica are on record fromUttar Pradesh

  • 8/7/2019 Helminthozoonoses in India a resurgent problem

    10/46

    Similar report from Assam was also of a childwith adult flukes in his gall bladder, whichwere detected by ultrasonography

  • 8/7/2019 Helminthozoonoses in India a resurgent problem

    11/46

    Fasciolopsiasis

    F asciolopsis buski is a large digenean whichinhabits the intestinal tract, particularly theduodenum and jejunum.Pigs are the main reservoir but rabbits werealso found susceptibleIn India a high infection rate has been recordedamong people in the north east, particularlyAssam.

  • 8/7/2019 Helminthozoonoses in India a resurgent problem

    12/46

    Infections in pigs and humans were reported inCalcutta whereas Bombay city had 29%

    presence in humans in the absence of F . buskiin pigs.Human foci were also detected in other partsof M aharashtraIn Assam, Segmentina spp were the snailintermediate hosts and Indoplanorbis exustuselsewhere

  • 8/7/2019 Helminthozoonoses in India a resurgent problem

    13/46

    In endemic areas the disease in underreportedand is most prevalent in remote rural placesand semi urban areas.Asthenia, pallor, malnutrition and protuberantabdomen in human infections were observed ina series in India.Therapeutic options found to be successfulinclude praziquantel, triclabendazole,rafoxanide

  • 8/7/2019 Helminthozoonoses in India a resurgent problem

    14/46

    There have been reports of a re-emergence of human fasciolopsiasis in Uttar Pradesh despite

    programs in the control of food bornetrematode infections

  • 8/7/2019 Helminthozoonoses in India a resurgent problem

    15/46

    Gastrodiscoidiasis

    G astrodiscoides hominis inhabits the caecumand colon of pigs and humans

    In India it has a large distribution in the northeastern and central states of Assam, Bengal,Orissa, Bihar, Uttar Pradesh and M adhyaPradesh.Follows a diheteroxenous life cycle, using anaquatic snail species as its intermediate host.

  • 8/7/2019 Helminthozoonoses in India a resurgent problem

    16/46

    J uvenile flukes released from metacercariaereach the cecum and colon where they matureand live attached to the mucosaPig is the main reservoir and prevalence in

    pigs is of epidemiological interestConcomitant infection with F . buski is high inIndia

  • 8/7/2019 Helminthozoonoses in India a resurgent problem

    17/46

    In Shillon ( M eghalaya) where rearing of pigsis a common household practice, G . hominisshowed a seasonal occurrence similar to that of F . buski .Owing to similarities in intermediate andreservoir hosts, as well as in transmission andcontamination characteristics, measures usefulagainst F . buski may also be applied against G .hominis

  • 8/7/2019 Helminthozoonoses in India a resurgent problem

    18/46

    Other trematodes

    Isolated foci of human paragonimiasis exist inM adras, bengal, Assam and M anipur

    FromM

    anipur 39 cases among young personsof 11-30yrs were reported die to eating of rawcrabs.R eports of a new focus of paragonimiasis fromArunachal Pradesh exist.ELISA using ES Ag of the parasite has beendeveloped.

  • 8/7/2019 Helminthozoonoses in India a resurgent problem

    19/46

    CESTODE ZOONOSES

    Cysticercosis

    Hydatidosis

    Sparganosis

  • 8/7/2019 Helminthozoonoses in India a resurgent problem

    20/46

    Cysticercosis

    Infection caused by metacestodes of T aenia solium.

    In India the incidence of human taeniasis,which averages 0.5-0.75% among general population, may go as high as 12-16% inselected groups such as backyard pig keepersand persons associated with pig slaughter

  • 8/7/2019 Helminthozoonoses in India a resurgent problem

    21/46

    Surveys in the past decade have indicated thatIndia is among the countries wherecysticercosis is a serious emerging problem

    Neurocysticercosis has been regarded as themost frequent parasitosis of the CNSA serological and MR I study in Lucknowfound existence of large number of asymptomatic cases, which indicated high

    prevalence.

  • 8/7/2019 Helminthozoonoses in India a resurgent problem

    22/46

    It is also the most common cause of epilepsyin India

    Accounted for 5-20% of all epilepsy casesSporadic cases of ocular cerebral and extracranial foci have been reported from all partsof the countryA study in Goa found eosinophilic granulomasin superficial muscles and subcutaneoustissues as a common presentation

  • 8/7/2019 Helminthozoonoses in India a resurgent problem

    23/46

    Swine cysticercosis, usually established at postmortem tissue inspection, has been recorded asranging from 2-28.8% in IndiaDetections by immunological tests, usuallycounterimmunoelectrophoresis or by ELISAand its variants have given higher positivityTreatment with Albendazole in experimentallyinfected pigs was highly effective in a study

  • 8/7/2019 Helminthozoonoses in India a resurgent problem

    24/46

    For implementing effective control,collaboration between medical and veterinaryservices at ground level, as well as acombination of rational control strategies, have

    been envisaged

  • 8/7/2019 Helminthozoonoses in India a resurgent problem

    25/46

    Hydatidosis

    E chinococcus multilocularis single reportfrom Chandigarh in 1978E

    . granulosus M

    ajor zoonosesWidespread prevalence, ranging from 2-30%in sheep, goat and pig, and a much higher 12-62% in cattle and buffalo, as reported fromseveral parts of India

  • 8/7/2019 Helminthozoonoses in India a resurgent problem

    26/46

    As regards fertility of cysts, it was recorded shigh as 90% in both sheep and goats whichindicated the suitability of these animals asintermediate hostsIt is also in accord with the observation that inIndia, it is mainly the sheep strain (and thecattle strain to a lesser extent) that is infectiousfor humans.

  • 8/7/2019 Helminthozoonoses in India a resurgent problem

    27/46

    Presentation highly variable as recorded inmany reportsM

    ost frequent

    hepatic and pulmonaryOthers cardiac, nephrotic, cerebral, spinal,mediastinal, ocular, bilateral ovarian and evenan unusual breast lump

  • 8/7/2019 Helminthozoonoses in India a resurgent problem

    28/46

    Detection of canine echinococcosis can befacilitated by finding coproantigens in faeces

    by sensitive assays such as ELISAOverall control would probably requiremeasures such as vaccination of intermediatehosts

  • 8/7/2019 Helminthozoonoses in India a resurgent problem

    29/46

    Sparganosis

    Infection my tapeworm larvae of the genusSpirometra which invade humans as accidentalhosts and persis as so called spargana for sometime in various tissuesFinal hosts are dogs, cats and other carnivoresIn India sparganosis has been reportedinvolving the subcutaneous tissues andmuscles of various parts of the body

  • 8/7/2019 Helminthozoonoses in India a resurgent problem

    30/46

    Uncommon presentations such as invasion of the anterior chamber of the eye, brain andspinal cord in two cases and cerebrum are alsoin recordBrain involvement was seen as a granuloma or abscess

  • 8/7/2019 Helminthozoonoses in India a resurgent problem

    31/46

    Nematode zoonoses

    Larva migrans Cutaneous larva migrans (creeping eruptions) Visceral larva migrans larvae of mainly the dog

    ascarid T oxocara canis

    In South Asian countries, due to rampantcontamination of soil and opportunities for itscontact with children as well as many kinds of workers, both these conditions are highly

    prevalent

  • 8/7/2019 Helminthozoonoses in India a resurgent problem

    32/46

    Screening for worm eggs detected in soil samplesand dog faeces at various centres in India hasfound positivity for A ncylostoma ranging from 3-93% and for T oxocara from 3.6 58.2%Stray dogs were found more likely to be infectedthan the pet dogs just as soil samples from

    playgrounds which were more likely to befrequented by stray dogs were found to havegreated positivity than soil around houses

  • 8/7/2019 Helminthozoonoses in India a resurgent problem

    33/46

    M agnitude of problem greater than detected byconventional methods of detection

    Using molecular epidemiological tools inaddition to the conventional ones in a remotecommunity in North East India, Traub et alfound 72% dogs harbouring A .caninum, 60% A . braziliense and 37% having mixedinfecetions with both hookworms

  • 8/7/2019 Helminthozoonoses in India a resurgent problem

    34/46

    Other nematode infections

    Gnathostomiasis caused by the migrating larvaeof G nathostoma spinigerum of which carnivorousanimals like cats and dogs are definitive hostsThe larvae may migrate in the skin or in visceralorgansTwo cases with intraocular parasites withresultant loss of vision and one case of intracranial invasion have been reported fromIndia

  • 8/7/2019 Helminthozoonoses in India a resurgent problem

    35/46

    Dirofilariasis there seems to be a focus of human dirofilariasis in Kerala with D irofilariarepens , normally a parasite of dogs and cats.Increased occurrence of the worms in thesubcutaneous tissues and subconjunctivalspace of humans in different parts of Keralawith incidence of microfilariae in dog bloodsmears, spells enhanced risk of humans whoacquire infection

  • 8/7/2019 Helminthozoonoses in India a resurgent problem

    36/46

    Thelaziasis also known as eye worminfection

    Two cases have been reported from India

    T richuris vulpis normally parasitic in dogs,

    its occurrence has been reported in an Indiantribal population

  • 8/7/2019 Helminthozoonoses in India a resurgent problem

    37/46

    Conclusion

    Global agencies have recommended continuedand greater surveillance of parasitic zoonosesin man and animalsCritical issues in implementation of controlwhere active transmission causes substantialmorbidity and mortality are the political will,social support, financing and organizationalframework.

  • 8/7/2019 Helminthozoonoses in India a resurgent problem

    38/46

    R edemption of professional

    ethicsJ. S. Bajaj

    Ann Natl Acad Med Sci (India)46(1): 1-3, 2010

  • 8/7/2019 Helminthozoonoses in India a resurgent problem

    39/46

    The editor describes the promulgation of theIndian M edical Council (professionalconduct, etiquette and ethics)(amendment)R egulations, 2009- part-I as an act of redemption of professional values.Over the last several decades growing impactof pharmaceutical industrys effort totransform physician behavior

  • 8/7/2019 Helminthozoonoses in India a resurgent problem

    40/46

    While physicians capacity of independentdecision making has declined, the retail pricesof drugs and products have shown a steepincreaseFrom 1997-2005, drug manufacturers have

    paid at least $57 million to doctors, nurses andother health care workers in M innesota alone

  • 8/7/2019 Helminthozoonoses in India a resurgent problem

    41/46

    In addition $40 million was provided to clinicsand research centers

    Apart from individual-centered approach, amore subtle way to produce a mass effect isthrough industrys endeavor to subsidizecontinuing medical education programmes

  • 8/7/2019 Helminthozoonoses in India a resurgent problem

    42/46

    Dissemination of appropriate informationthrough professional publications notably journalsupplements is another source of major expenditure

    Number of credit hours of accredited C M E programmes has become mandatory for the purpose of maintaining license to practice and thisis helping create a captive marketplace for industrys products as they usually subsidize such

    programmes

  • 8/7/2019 Helminthozoonoses in India a resurgent problem

    43/46

    Strong and consistent evidence that industrysponsored research tends to favour pro-industryinferencesBias in drug trials is common and generally favorsthe sponsors productCompounding these aberrations is the fact that peer reviewers may themselves show bias in so far asthey may approve or reject an rticle simply becauseit favours or contradicts their own interests

  • 8/7/2019 Helminthozoonoses in India a resurgent problem

    44/46

    Example of misconduct

    An internationally acclaimed diabetesinvestigator, while reviewing a confidentialstudy for the NE JM , sent a copy of themanuscript by fax to GlaxoSmithKline (themanufacturer of the drug under study), thustipping the company to the imminent

    publication of safety concerns in relation toantidiabetes drug R osiglitazone

  • 8/7/2019 Helminthozoonoses in India a resurgent problem

    45/46

    The same expert acknowledged havingreceived $75000 in consulting and speakingfees from the company since 1999

  • 8/7/2019 Helminthozoonoses in India a resurgent problem

    46/46

    High time that nefarious activities of such physicians who travel luxuriously to promotespecific drugs or biomedical devicesmanufactured by their sponsors, whoenthusiastically join advisory boards of

    pharma companies and who create industry

    supported clinical practice guidelines becurbed by imposing laws like M CI amendmentand also penalties