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Background: Estimation of prevalence of Strongyloides stercoralis infection is required in endemic areas, in order to identify areas in need of control programmes. Data on prevalence of strongyloidiasis in Madagascar are scant. Aim of this work was to estimate prevalence of S. stercoralis in four districts of Madagascar. Methods: Fecal and serum samples collected in the context of a previous study on schistosomiasis were tested with S. stercoralis real-time PCR and serology, respectively. A multiplex real-time PCR for Ascaris lumbricoides, Ancylostoma duodenalis, Necator americanus, and Trichuris trichiura was done on fecal samples collected in the areas demonstrating higher prevalence of strongyloidiasis. Comparisons between proportions were made using Fisher exact test, with false discovery rate correction used for post-hoc comparisons. A multivariable Firth logistic regression model was used to assess potential risk factors for S. stercoralis infection. Results: Overall, 1775 serum samples were tested, of which 102 of 487 (20.9%) and 104 of 296 (35.2%) were serological-positive in Marovoay and in Vatomandry districts (both coastal areas), respectively, compared to 28 of 496 (5.6%) and 30 of 496 (6.1%) in Tsiroanomandidy and in Ambositra districts (both highlands), respectively (adj. p < 0.001). PCR for S. stercoralis was positive in 15 of 210 (7.1%) and in 11 of 296 (3.7%) samples from Marovoay from Vatomandry, respectively, while was negative for all samples tested in the other two districts. High prevalence of A. lumbricoides (45.9%), hookworm (44.6%) and T. trichiura (32.1%) was found in Vatomandry. In the multivariable analysis, strongyloidiasis was associated with hookworm infection. Hookworm infection was also associated with male sex and lower education level. Conclusions: S. stercoralis prevalence proved higher in coastal areas compared to highlands. Different climatic conditions may explain this distribution, along with previous rounds of anthelminthics distributed in the country, which may have reduced the parasite load in the population. The high prevalence of the other soil-transmitted helminths (STH) in Vatomandry was unexpected, given the good coverage with benzimidazole in control campaigns. Further studies are needed to explore the risk factors for STH and S. stercoralis infections in Madagascar, in order to align with the WHO recommendations. [ABSTRACT FROM AUTHOR]

Introduction: The soil-transmitted helminthiases (STH) are important neglected tropical diseases (NTD) as they are often ignored for their chronic disease outcome. However, they continue to be diseases of public health importance globally. Aim & Objectives: To analyze the epidemiology and distribution trend of STH infections from stool samples received in a tertiary care hospital in eastern India in the last decade. Material & Methods: A retrospective observational cross-sectional study was conducted based on stool examination findings from patients attending Calcutta School of Tropical Medicine which is a referral centre of excellence for HIV-AIDS between January 2012 and July 2022. These samples were subjected to direct microscopic examination following formol-ether concentration method, modified Ziehl-Neelsen and Trichrome staining techniques and were subsequently followed by culture by Harada-Mori technique.The data collected were subsequently analysed. Results: Out of 5821 stool samples, 736 (12.64%) revealed at least one STH and the most common STH detected was Trichuris trichiura (289 samples). The annual distribution revealed that 220 out of 811 (27.13%) samples obtained in 2012 had STH, while in 2021, 18 out of 1358 (1.33%) samples had STH, thereby reflecting a declining trend over the last decade. Conclusion: Trichuris trichiura was the most common STH infection in our study. There has been a sharp decline in STH infections in eastern India in the past decade, thereby reflecting successful therapeutic and preventive interventions. However, strict vigil through intensive laboratory diagnosis is needed to keep the prevalence of STH, a disease of public health importance, under control.

Simple Summary: Soil-transmitted worm infections, usually treated with benzimidazoles, can develop resistance due to genetic variations in a specific gene called β-tubulin isotype 1. This study aimed to create a new, quick, and accurate way to identify these genetic variations. We designed a test to spot changes in certain parts of the β-tubulin gene of Trichuris trichiura, the worm causing the infection. By using two different primers, we could distinguish between different genetic types at specific positions in the gene. We tested our method on samples from captive primates and found it to be reliable. Additionally, we explored whether the β-tubulin gene could be useful as a marker in genetic studies. Our tests worked well when we used them on samples from the field. However, we did not find any of the expected genetic variations in the worms or eggs we examined. Instead, all the samples showed the same genetic type. Despite this, our analysis of the β-tubulin gene confirmed the close relationship between T. trichiura and a related Trichuris suis species, which suggests that this gene could be valuable for understanding their evolutionary history. Soil-transmitted helminth (STH) infections, commonly treated with benzimidazoles, are linked to resistance through single nucleotide polymorphisms (SNPs) at position 167, 198, or 200 in the β-tubulin isotype 1 gene. The aim of this study was to establish a novel genotyping assay characterized by its rapidity and specificity. This assay was designed to detect the presence of SNPs within the partial β-tubulin gene of Trichuris trichiura. This was achieved through the biallelic discrimination at codons 167, 198, and 200 by employing the competitive binding of two allele-specific forward primers. The specificity and reliability of this assay were subsequently confirmed using Trichuris samples isolated from captive primates. Furthermore, a molecular study was conducted to substantiate the utility of the β-tubulin gene as a molecular marker. The assays showed high sensitivity and specificity when applied to field samples. Nevertheless, none of the SNPs within the β-tubulin gene were detected in any of the adult worms or eggs from the analyzed populations. All specimens consistently displayed an SS genotype. The examination of the β-tubulin gene further validated the established close relationships between the T. trichiura clade and Trichuris suis clade. This reaffirms its utility as a marker for phylogenetic analysis. [ABSTRACT FROM AUTHOR]

BACKGROUND Soil-transmitted helminth (STH) infection, frequently caused by Ascaris lumbricoides, Trichuris trichiura, and hookworms (Ancylostoma duodenale and Necator americanus), often gives rise to malabsorption of nutrients that form hemoglobin (Hb) thereby causing anemia. This study aimed to know the difference in erythrocyte profile in children with and without STH infections. METHODS This cross-sectional study involved 205 children from two Panimbang Jaya elementary schools in Pandeglang, Banten, Indonesia. Blood and stool samples were collected from a previous study conducted from November 2021 to May 2022. Erythrocyte parameters were Hb concentration, erythrocyte count, mean corpuscular volume (MCV), mean corpuscular Hb (MCH), and red cell distribution width (RDW). The iron profile included serum iron, total iron-biding capacity (TIBC), and ferritin. Worm infestation was detected by direct stool microscopical examination. Statistical analysis was performed using SPSS software version 20. RESULTS The prevalence of STH infection in Pandeglang was 44.4%, primarily characterized by mild intensity STH infection (79%). The identified STH species were A. lumbricoides, T. trichiura, and combination of both. The median differences between erythrocyte count, MCV, and MCH, and the mean differences of TIBC and serum iron were not statistically significant (p = 0.388, 0.098, and 0.057, and p = 0.304 and 0.455). However, children with STH infection had lower Hb (12.57 versus 12.95 g/dl) and ferritin (19.60 versus 30.57 µg/dl) levels but higher RDW (13.20 versus 13.10%). CONCLUSIONS A high prevalence of STH infection was identified among schoolchildren, but their erythrocyte profiles were similar regardless of STH infection status. [ABSTRACT FROM AUTHOR]

Trichuriasis is a neglected tropical disease caused by Trichuris trichiura that spreads through the ingestion of embryonated eggs in contaminated soil, water, or food. In nonendemic areas, T trichiura infestation is very rare and sporadic and is often diagnosed in immigrants from endemic countries such as the Philippines. Whipworms feed on human blood and also erode the colonic mucosa, thereby evoking an inflammatory response. In milder forms, trichuriasis can be asymptomatic and often an incidental diagnosis on screening colonoscopy. Heavily infested patients usually present with abdominal pain, nausea, vomiting, tenesmus, chronic diarrhea, iron deficiency anemia, or stunted growth. T trichiura worms can be removed with biopsy forceps during a colonoscopy; however, most patients require a course of albendazole, mebendazole, or ivermectin. We describe a unique case of T trichiura as an incidental finding during a screening colonoscopy. The whipworms were retrieved using biopsy forceps and the patient was treated with albendazole. At the time of the colonoscopy, the patient did not exhibit any specific symptoms related to the worm infestation. [ABSTRACT FROM AUTHOR]

Background: Soil-transmitted helminth (STH) infections are a public health concern in endemic areas. For efficient control, the epidemiology of the disease needs to be monitored. This report assesses the prevalence, incidence, post-treatment infection (PTI) rate, and risk factors for STH infections in two rural areas of Gabon. Method: In this longitudinal and prospective study, participants aged six to 30 years from the vicinity of Lambaréné and selected households using a simple randomization process were included and followed in two consecutive periods of six and nine months. Stool samples were obtained at the beginning and the end of each follow-up phase (FUP). The Kato-Katz technique was used for the detection of STH eggs, while the Harada-Mori technique and coproculture were used for the detection of larvae in stool processed within a maximum of four hours of collection. Prevalence was determined at the three main time points of the study, incidence was assessed during the two study phases, and PTI was defined as an infection detected nine months post-treatment. Results: A total of 262 participants were included. The overall prevalence of STH infections was 42% (95%CI: 34–50) and 44% (95%CI: 37–51) at baseline for the six and nine month FUPs, respectively. Trichuris trichiura was the most prevalent species at each time point of assessment. The cumulative incidence of STH at the 6- and 9-month follow-ups was 18% (95%CI: 12–27) and 35% (95%CI: 27–43), respectively, while the incidence rates were 41 (95%CI: 28–55) and 56 (95%CI: 46–67) per 100 person-years, respectively. The PTI rates at the 9-month follow-up for T. trichiura, hookworm, and Ascaris lumbricoides were 58% (95%CI: 41–74), 31% (95%CI: 11–59) and 18% (95%CI: 5–40), respectively. The STH infection intensity was generally light. Conclusion: The prevalence level of STH infection is moderate in the vicinity of Lambaréné, with T. trichiura being the most prevalent species. Our results reveal a rapid spread of the disease in the population mainly following intervention, particularly for trichuriasis, and therefore call for the full implementation of the World Health Organization's recommendations in the area. Trial registration clinicaltrials.gov Identifier NCT02769013. Registered 21 April 2016, https://clinicaltrials.gov/study/NCT02769013 [ABSTRACT FROM AUTHOR]

Geohelminthiasis is a public health problem in Nigeria. This study was aimed at determining the prevalence and risk factors involved in the transmission of geohelminthiasis. A total of 250 pupils from seven primary (three public, two private, and two mission) schools in Unubi, Anambra State, Nigeria participated in the study from June to November 2023. A total of 250 stool samples were collected from pupils and analyzed using wet mount preparation and formol-ether concentration technique to detect positive samples. Information on pupils’ risk factors for helminthiasis was elicited through questionnaires. Chi-square test was used to compare differences among variables at 95% confidence level. A total of 53 samples were positive for geohelminth eggs, giving an overall prevalence of 21.2% but only single infections with ova of Ascaris lumbricoides (12.8%), hookworm species 4.4%, and Trichuris trichiura 4.0% were encountered (P0.05). Males were more infected (22.5%) than females (19.6%) (P>0.05). Pupils from public schools had 30.6% prevalence and mission schools had 11.11% (P

In the paper, the results of an archaeoparasitological analysis of a population group from the ancient Greek city of Pantikapaion, located in the historical centre of the modern city of Kerch (Republic of Crimea), are presented. The aim of the study is to obtain information about the parasitic diseases, state of health, nutrition, and hygiene in a part of the population of the city. The materials for the study were soil samples obtained during the treatment of the human sacra from 31 burials of the necropolis, dated to the 2nd century AD. In the result of the conducted investigation, the parasitic spectrum of the studied population group was determined. Eggs of three species of helminths were found. The discovery of eggs of broad tapeworm (Dibothriocephalus latum) in the soil samples indicates the presence in the diet of the studied population group freshwater fish that were not sufficiently thermally treated. The archaeoparasitological data from archaeological sites of a chronologically close period in the territory of the Northern Black Sea region suggests that diphyllobothriasis was a decease far from being rare in this area. The presence of eggs of human roundworm (Ascaris lumbricoides) and whipworm (Trichuris trichiura) in the samples likely indicates the challenging sanitary-hygienic environment in the city and insufficient hygienic skills in the studied group. The analysis of the archaeoparasitological data within the historical context and utilisation of the archaeopathological material from the archaeological sites in the Northern Black Sea region permitted to identify the factors that had an influence on the wide spread of geohelminths. The humid and warm climate facilitated maturation of geohelminth eggs in the soil, while the human activities concerned with the irrigation of the territory, building public water collection points, and waste buildup in the streets, in combination with the high population density, were causing the rise of the infectious hazard. The relatively high incidence rates of Trichuris trichiura and Ascaris lumbricoides may indicate a high prevalence of certain bacterial intestinal infections transmitted by the identical route. The occurrence of geohelminths, alongside the archaeological data, can indicate a low social status of the studied population group.

From the safety inside vehicles, Knowsley Safari offers visitors a close-up encounter with captive olive baboons. As exiting vehicles may be contaminated with baboon stool, a comprehensive coprological inspection was conducted to address public health concerns. Baboon stools were obtained from vehicles, and sleeping areas, inclusive of video analysis of baboon–vehicle interactions. A purposely selected 4-day sampling period enabled comparative inspections of 2662 vehicles, with a total of 669 baboon stools examined (371 from vehicles and 298 from sleeping areas). As informed by our pilot study, front-line diagnostic methods were: QUIK-CHEK rapid diagnostic test (RDT) (Giardia and Cryptosporidium), Kato–Katz coproscopy (Trichuris) and charcoal culture (Strongyloides). Some 13.9% of vehicles were contaminated with baboon stool. Prevalence of giardiasis was 37.4% while cryptosporidiosis was

Background The currently recommended benzimidazole monotherapy is insufficiently effective to control infection with the soil-transmitted helminth Trichuris trichiura. Ivermectin-albendazole combination has shown promising, but setting-dependent efficacy, with therapeutic underperformance in Côte d'Ivoire. We evaluated whether moxidectin-albendazole could serve as an alternative to albendazole monotherapy in Côte d'Ivoire. Methods In this community-based, randomized, placebo-controlled, parallel-group superiority trial, individuals aged 12–60 years were screened for T. trichiura eggs in their stool using quadruplicate Kato-Katz thick smears. Diagnostically and clinically eligible participants were randomly assigned (1:1:1) to receive single oral doses of moxidectin (8 mg) and albendazole (400 mg), ivermectin (200 µg/kg) and albendazole (400 mg), or albendazole (400 mg) and placebo. The primary outcome was proportion cured, ie, cure rate (CR), assessed at 2–3 weeks post-treatment. Safety endpoints were assessed pre-treatment and at 3 and 24 hours post-treatment. Results For the 210 participants with primary outcome data, we observed CRs of 15.3% in the moxidectin-albendazole arm and 22.5% in the ivermectin-albendazole arm, which did not differ significantly from the CR of 13.4% in the albendazole arm (differences: 1.8%-points [95% confidence interval: −10.1 to 13.6] and 9.1%-points [−3.9 to 21.8], respectively). Most common adverse events were abdominal pain (range across arms: 11.9%–20.9%), headache (4.7%–14.3%), and itching (5.8%–13.1%), which were predominantly mild and transient. Conclusions All therapies showed similar low efficacy in treating trichuriasis in Côte d'Ivoire. Alternative treatment options need to be evaluated, and further analyses should be conducted to understand the lack of enhanced activity of the combination therapies in Côte d'Ivoire. Clinical Trials Registration NCT04726969. [ABSTRACT FROM AUTHOR]

Trichuris trichiura is a human parasite belonging to the nematode phylum. It has a genome of 75.2 Mb size that contains more than 9500 genes. Many of these are still uncharacterized proteins. Here, we have tried to annotate a protein bearing Uniprot accession id A0A077Z4I5 using various in silico tools. The amino acid sequence of this protein was subjected to various softwares which demonstrated it to be a Cysteine-knot protein. The motif search revealed the presence of this highly conserved domain, which is believed to be responsible for host parasite interaction and evasion of host immune system by the parasitic nematode. The report of this protein in human parasite T. trichiura is significant as it has not homolog in humans and can be a valid drug target. [ABSTRACT FROM AUTHOR]

Large intestine-dwelling helminths affect microbiome composition. In sub-Saharan Africa, where helminth infections are endemic, the use of chemotherapeutic drugs is the primary strategy for controlling soil-transmitted helminthiases (STHs). However, the emergence of anthelmintic resistance necessitates the urgent exploration of alternative and complementary treatments to achieve the World Health Organization’s goal of eliminating STHs. One promising avenue involves the manipulation of gut microbiota in at-risk populations. This study aimed to enhance the understanding of the interplay between Trichuris trichiura and the gut microbiome. In this study, we used the Mini-FLOTAC technique for parasitological analyses and a shotgun metagenomic sequencing approach to investigate the effect of T. trichiura on the gut microbiome by comparing infected and non-infected women of reproductive age (WRA) from Pemba. Structural and functional analyses of the gut microbiome revealed that T. trichiura infection shaped the host gut microbiome in WRA. Some taxa vary according to infection status. Prevotella genus was more abundant in healthy participants, whereas species such as Weissella cibaria, Leuconostoc citreum (new emergent probiotics), and Leuconostoc lactis (starter) decreased in infected individuals, suggesting the use of potential probiotic treatments to mitigate dysbiosis induced by STHs. Furthermore, the overall number of common fungi, irrespective of species, was significantly higher in the mycobiome of Trichuris infected participants. Functional analysis revealed significant differences in metabolic pathways (p < 0.05), with cholesterol metabolism and pathogenic infections being more abundant in the infected samples than in the non-infected samples. In conclusion, this study sheds light on the intricate interactions between helminth infections and the gut microbiome in the WRA, particularly in STH-endemic regions. The identified associations between specific gut microbial changes and T. trichiura infection may pave the way for innovative complementary treatments to effectively combat STHs.

Soil-transmitted helminth (STH) infections, commonly treated with benzimidazoles, are linked to resistance through single nucleotide polymorphisms (SNPs) at position 167, 198, or 200 in the β-tubulin isotype 1 gene. The aim of this study was to establish a novel genotyping assay characterized by its rapidity and specificity. This assay was designed to detect the presence of SNPs within the partial β-tubulin gene of Trichuris trichiura. This was achieved through the biallelic discrimination at codons 167, 198, and 200 by employing the competitive binding of two allele-specific forward primers. The specificity and reliability of this assay were subsequently confirmed using Trichuris samples isolated from captive primates. Furthermore, a molecular study was conducted to substantiate the utility of the β-tubulin gene as a molecular marker. The assays showed high sensitivity and specificity when applied to field samples. Nevertheless, none of the SNPs within the β-tubulin gene were detected in any of the adult worms or eggs from the analyzed populations. All specimens consistently displayed an SS genotype. The examination of the β-tubulin gene further validated the established close relationships between the T. trichiura clade and Trichuris suis clade. This reaffirms its utility as a marker for phylogenetic analysis.

Introduction: According to WHO, soil-transmitted helminth (STH) infections could infect up to 90% of children from deprived communities with unhygiene and improper sanitation lifestyle. In West Malaysia, commonly the aboriginal people (Orang Asli) is prone to be infected with STH infections. Albendazole (400mg) is an anthelminthic drug that has been used for more than 30 years to cure STH infections. Hence, the main objective of this project was to evaluate the efficacy of single-dose albendazole (400mg) against STH infections among Orang Asli. Methods: Stool samples were collected in Hulu Langat, Semenyih, Malaysia. Who had not previously undergone deworming treatment. The parasites were concentrated by floatation technique (using the standard salt-sugar solution) to extract the amount of helminths' egg before and after the albendazole treatment (400mg). Results: There were 44 participants after one-month post-treatment. The cure rate (CR) for Trichuris trichiura and Ascaris lumbricoides was 11.6% (n=5) and 35.0% (n=14), respectively. Moreover, there was no heavy infection for both STHs during the post-treatment of albendazole. Conclusion: The results indicated that the chosen anthelminthic showed higher cure rate efficacy in A.lumbricoides than T.trichiura. However, both species had decreased egg burden post-treatment with albendazole. [ABSTRACT FROM AUTHOR]

Standard- and large-sized eggs of Trichuris trichiura were found in the feces of schoolchildren in Yangon, Myanmar during epidemiological surveys and mass deworming with albendazole in 2017-2019. The standard-sized eggs were identified as those of T. trichiura, but it was necessary to exclude the possibility of the large-sized eggs belonging to Trichuris vulpis, a dog whipworm. We conducted morphological and molecular studies to determine the species of the 2 types of Trichuris eggs. Individual eggs of both sizes were isolated from Kato-Katz fecal smears (n=20) and mechanically destroyed using a 23G injection needle. Nuclear DNA was extracted, and the 18S rRNA region was sequenced in 15 standard-sized eggs and 15 large-sized eggs. The average size of standard-sized eggs (T. trichiura) was 55.2×26.1 μm (range: 51.7-57.6×21.3-28.0 μm; n=97), whereas the size of large-sized eggs was 69.3×32.0 μm (range: 65.1-76.4×30.1-34.5 μm; n=20), slightly smaller than the known size of T. vulpis. Regarding standard-sized eggs, the 18S rRNA nucleotide sequences exhibited 100% homology with T. trichiura deposited in GenBank and 88.6-90.5% homology with T. vulpis. Regarding large-sized eggs, the nucleotide sequences showed 99.8-100% homology with T. trichiura in GenBank and 89.6- 90.7% homology with T. vulpis. Both standard- and large-sized eggs of Trichuris spp. found in Myanmar schoolchildren during 2017-2019 were morphologically and molecularly confirmed to belong to T. trichiura. The conversion of eggs from smaller to large sizes might be due to anthelmintic treatments with albendazole [ABSTRACT FROM AUTHOR]

World Health Organization (WHO) reported that over 1.5 billion people are infected by soil-transmitted helminths (STH) worldwide in sub-Saharan Africa, the United States of America, China, and East Asia. Heavy infections and polyparasitism are associated with higher morbidity rates, and the patients are exposed to increased vulnerability to other diseases. Therefore, accurate diagnosis followed by mass treatment for morbidity control is necessary.STH diagnosis commonly involves the microscopic observation of the presence of the STH eggs and larvae in the faecal samples. Furthermore, molecular approaches are increasingly utilised in monitoring and surveillance as they show higher sensitivity. Their capability to differentiate hookworm species is an advantage over the Kato-Katz technique. This review discusses the advantages and limitations of microscopy and various molecular tools used for STH detection.

This meta-analysis was designed to assess the effect of the addition of a bead-beating (BB) step during DNA extraction to effectively isolate Trichuris trichiura DNA from stool samples for quantitative polymerase chain reaction (qPCR)-based diagnosis. qPCR-based molecular studies comparing the inclusion of a bead-beating step during the DNA extraction from stool samples with extraction without the step were included in the analysis. Studies using real patient samples in community settings were included. The PubMed database and Google search engine were searched in December 2019. Risk of bias and applicability were assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 checklist. Odds ratios (ORs) for individual studies were combined to estimate the random effects model OR. A total of six independent sub-studies were gathered from two published original articles. The division of the two major studies into six sub-studies was indispensable due to the nature of the study carried out. 128 of the total 192 samples (in all studies) were positive for T. trichiura when BB was used during DNA extraction compared to 108/192 when BB was excluded. The combined OR was 1.66 (95% confidence interval: 1.059 to 2.602). Though only two articles were included in the study, six exclusive individual sub-studies were analyzed. Inherent differences in the background prevalence of helminths in the study population could impact the sensitivity of qPCR. It was found that the inclusion of the BB step during DNA extraction significantly increased the sensitivity of the test. This study was not registered in any database. [ABSTRACT FROM AUTHOR]

Key Clinical Message Trichuris trichiura parasitizes only humans through fecal‐oral transmission. In non‐endemic areas, the frequency of endoscopic identification has been increasing due to the increasing number of immigrants from endemic countries. To prevent infection, it is important to pay attention to sanitary conditions such as soil and water sources.

Trichuris trichiura is a soil-transmitted helminth prevalent in developing countries with poor, inadequate sanitation and unsafe water sources. In Malaysia, the prevalence of trichuriasis is relatively high among the aboriginal community due to poverty and poor sanitation. However, there are few studies to determine the seasonal variation on the prevalence and risk factors to acquire Trichuris trichiura infection in Malaysia. The present study found higher Trichuris trichiura infection during the dry season (63.6%; 138/217) in comparison to the wet season (55.5%; 142/256). Low household income, low education level and practice of open defecation were significant risk factors to acquire Trichuris trichiura infection during the wet season. Usage of untreated water supplies for daily activities was a risk factor to acquire trichuriasis during the dry season. This study highlighted that poverty and poor sanitation practices as well as drinking untreated water put the aborigines at high risk to acquire trichuriasis. Therefore, health education, improved sanitation and provision of treated water supply are recommended for the prevention and control of Trichuris trichiura infections in the aboriginal community.

Case Summary: A 27 years old female presented to gynae OPD with foul smelling discharge per vaginum off and on for a year and was given treatment for PID (Pelvic inflammatory disease) and cervicitis. Pap smear was taken and was reported unsatisfactory due to inflammation. Colposcopy was planned later due to her bothersome complaints and suspicious looking cervix. A white worm popped out of cervix while doing colposcopy which turned out to be Trichuris trichiura. Deworming was done for the patient and her family members. Patient reported again with similar complaints and this time colposcopy and guided biopsy was done that showed Tubercular Granulomatous cervicitis hence, she was put on category I ATT (Anti-tubercular treatment) that relieved her symptoms and improved cervical findings. Conclusion: People living in tropical and subtropical areas are at highest risk of infection by T. trichiura. This is the first case of T. trichiura in ectopic location and first case of a live worm found in female genital tract. Previous studies have shown that helminthic infection can reactivate latent TB and aggravate the disease expression. [ABSTRACT FROM AUTHOR]

Abstract Background Achieving the elimination of soil-transmitted helminth (STH) infections requires a sufficient understanding of the current epidemiological status of STH endemicity. We aimed to examine the status of STH in Myanmar – a country with the eighth highest STH prevalence in the world, 10 years after instigation of the national deworming programme. Methods In August 2016 we screened for STH infections using Kato Katz (KK) microscopy and real-time PCR (qPCR) in schoolchildren from the Bago Region township of Phyu, a STH sentinel site in Myanmar. Ten schools were randomly selected, and one stool sample each from a total of 264 students was examined. Prevalence and intensity of infection were calculated for each STH. Results High prevalence of STH was identified in the study area with 78.8% of the schoolchildren infected with at least one STH by qPCR, and 33.3% by KK. The most prevalent STH was Trichuris trichiura, diagnosed by both KK (26.1%) and qPCR (67.1%), followed by Ascaris lumbricoides (15.5% KK; 54.9% qPCR). No hookworm infections were identified by KK; however, the qPCR analysis showed a high prevalence of Ancylostoma sp. infection (29.6%) with few Necator americanus (1.1%) infections. Conclusions Despite bi-annual deworming of schoolchildren in the fourth-grade and below, STH prevalence remains stubbornly high. These results informed the expansion of the Myanmar National STH control programme to include all school-aged children by the Ministry of Health and Sports in 2017, however further expansion to the whole community should be considered along with improving sanitation and hygiene measures. This would be augmented by rigorous monitoring and evaluation, including national prevalence surveys.

Eosinophilic leukocytosis can be attributed to a number of clinical conditions such as parasitic infection, allergies, and neoplasms. Parasitic infection is the main cause of eosinophilia; however, a marked leukocytosis with hypereosinophilia secondary to Trichuris trichiura in adults has not been previously reported. We describe a case of a 39-year-old man who presented with fever and diarrhea. The investigation revealed a white blood cell (WBC) count of 20.69 × 109/L with an absolute eosinophil count of 12.44 × 109/L. Fecal microscopic examination demonstrated T. trichuria eggs. The WBC count returned to normal following treatment with albendazole. The literature pertaining to hematological findings associated with Trichuris trichiura is explored in this report. This case highlights that a significant elevation of leukocyte count with hypereosinophilia can be one of the manifestations of trichuriasis infection in adults. Empirical treatment with anti-helminthic agents may play a role in suspected cases to avoid severe complications, such as Trichuris dysentery syndrome.

Key Clinical Message: Trichuris trichiura parasitizes only humans through fecal‐oral transmission. In non‐endemic areas, the frequency of endoscopic identification has been increasing due to the increasing number of immigrants from endemic countries. To prevent infection, it is important to pay attention to sanitary conditions such as soil and water sources. Colonoscopy revealed infection with male and female Trichuris trichiura. [ABSTRACT FROM AUTHOR]

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In tropical and subtropical regions, soil-transmitted helminth (STH) infections such as Ascaris lumbricoides, Trichuris trichiura, and hookworms have a significant impact on public health. Globally, A. lumbricoides infects approximately 0.8 billion people, while T. trichiura infects around 500 million. This study involved a comparison of three diagnostic methods, Kato-Katz and two flotation methods (concentration McMaster, and simple McMaster), for the detection of Ascaris and Trichuris in human faeces. We conducted a comparison of the number of eggs in faeces (or faecal egg counts (FECs)) obtained with these methods using freshly collected samples that were positive for T. trichiura and spiked with a known quantity of Ascaris sp. eggs. Additionally, for the concentration McMaster method we assessed FECs after storing the samples at 5°C for up to 21 days. The concentration McMaster method demonstrated superiority over the simple McMaster method in terms of higher detection levels for both helminths, while the Kato-Katz method yielded FEC values very close to the 'true' spiking values. Importantly, the concentration McMaster method was considerably easier to read compared with the Kato-Katz method, and it allowed for sample storage at 5°C for up to 14 days without affecting FEC results. Consequently, we conclude that the concentration McMaster method is an effective and user-friendly alternative for diagnosis of Ascaris and Trichuris infections in humans. Furthermore, it offers the advantage of sample storage before analysis, enhancing flexibility in the workflow., (Copyright © 2024. Published by Elsevier Ltd.)

Helminth parasites are endemic in rural communities in Nigeria that lack adequate water and sanitary facilities, so this study was focused on intestinal helminth infections and associated risks amongst pupils at Ebenebe in Anambra State Nigeria. This cross-sectional study was approved by Ministry of Basic Education Awka (Ref: MOBE/SCHD/1583/T9/8) while ethical permit (Ref: ASUBEB/ADM/14/VOL.III/232 of 21/11/2019) was granted by Anambra State Universal Basic Education Board. The 110 pupils enrolled in Umuji, Obuno, Umuoye, and Umuogbuefi public primary schools at Ebenebefor 2018/2019 school year constituted study population, while sample size of eighty (twenty pupils from each school) were systematically chosen. Pupils’ schools, age, gender, parents’ main occupation and toilet-use were obtained through visits, observations and oral interviews. Direct faecal smears and formalin-ether concentration techniques were used for stool samples analysis while parasitological keys were used for helminth parasites identifications. Data were summarized with bar charts using Microsoft Excel13Chart wizard, and standard error bars indicated significant differences (p

Soil transmitted helminths (STH) are major public health problem affecting the growth of children. 360 stool samples were collected and analyzed using Formol-ether concentration technique. Daksiri Primary School had the highest prevalence with 22(6.11 %), while the least was Uba Primary School with 13(3.61 %). There was no significant difference (p>0.05) in STH among schools. Ascaris lumbricoides had the highest prevalence with 52(14.44 %), followed by Trichuris trichiura with 28(7.78 %), while the least was hookworm 18(5.00 %). In relation to sex, males had the higher prevalence 56(15.56 %) than females with 42(11.67 %). There was no significant difference (p>0.05) between infection and sex. In relation to age group, the age groups 7 – 9 years had the highest prevalence of 42(11.67 %), while 3 – 6 years had the least prevalence with 23(6.39 %). There was no significant difference (p>0.05) in relation to STH by age groups. Those whose parents are civil servants had the least prevalence of 16(4.44 %), while those whose parents are farmers had the highest prevalence of 58(16.11 %). There was no significant difference on parents occupation at (p>0.05). Children, who used water closet system, had the least prevalence of 18(5.00 %), while those who used pit toilet recorded highest prevalence of 51(14.17 %). There was no significant difference (p>0.05) between infection and methods of stool disposal. There is need to promote child health, through health education, personal hygiene. Deworming should be sustained as control against outbreak of soil transmitted helminthes among school aged children. [ABSTRACT FROM AUTHOR]

Abstract Background Most of the studies conducted in Brazil assessing the relationship between water, sanitation and hygiene (WASH) and Soil-transmitted helminth (STH) infections, have focused on cases, reflecting the reality of small areas and not of a countrywide situation. In order to fill this gap, the current paper presents an epidemiological study exploring the association between water and sanitation and STHs prevalence in students from 7 to 17 years old, in all 27 Brazilian Federation Units. Methods Three ecological studies were carried out considering the prevalence of ascariasis, trichuriasis, and hookworm as outcome variables. The sample consisted of 197,567 students aged 7–17 years old living in 521 Brazilian municipalities. Data were retrieved from the National Survey on the Prevalence of Schistosomiasis mansoni and Soil-transmitted helminth infections (2011–2015). The Generalized Linear Model with the negative binomial distribution was used to evaluate the statistical association between outcomes and explanatory variables. Univariate and Multivariate analyses were conducted with 25 and 5 % significance levels, respectively. Data were aggregated considering municipalities as the geographical unit for analysis. Results Protective association was found between access to filtered water and adequate sanitation in schools with ascariasis (RR 0.989, CI 95 % 0.983–0.996; RR 0.988, CI 95 % 0.977–0.998), access to filtered water in schools with trichuriasis (RR 0.986, CI 95 % 0.979–0.993) and adequate sanitation at home with hookworm ((RR 0.989, CI 95 % 0.982–0.996). The percentage of population served with Bolsa Família Program, used as a proxy for poverty, was the only significant variable common to all models. Conclusions Our findings support that WASH, both in schools and homes, are essential to schoolchildren health with regard to STHs. However, sanitary interventions will not be fully effective in preventing STH infections without promoting access to quality public services, particularly for people living in poverty, the most vulnerable group.

Abstract Background Soil-transmitted helminth (STH) infections are highly prevalent in resource-limited countries. We assessed the effect of a combination intervention aiming to enhance handwashing with soap on STH reinfection following mass drug administration among primary school children in Kagera region, Northwestern Tanzania. Methods We conducted a cluster randomised trial in sixteen primary schools with known high STH prevalence. Schools were randomly assigned in a 1:1 ratio to either receive the intervention or continue with routine health education. The intervention included teacher-led classroom teaching, parental engagement sessions, environmental modifications and improved handwashing stations. The evaluation involved two cross-sectional surveys in a representative sample of students, with the end-line survey conducted 12 months after the baseline survey. The primary outcome was the combined prevalence of Ascaris lumbricoides and Trichuris trichiura infections at the end-line survey. Secondary outcomes included reported handwashing behaviour, the prevalence and intensity of individual STHs, and hand contamination with STH ova and coliform bacteria. End-line STH prevalence and intensity were adjusted for baseline differences of potential confounders. Results At the end-line survey, 3081 school children (1566 from intervention schools and 1515 from control schools) provided interview data and stool specimens. More school children in the intervention group reported the use of water and soap during handwashing compared to school children in the control group (58% vs. 35%; aOR=1.76, 95%CI 1.28–2.43, p=0.001). The combined prevalence of A. lumbricoides and T. trichiura infections was 39% in both trial arms (aOR = 1.19; 95%CI 0.74–1.91). The prevalence of A. lumbricoides was 15% in the intervention and 17% in the control arm (aOR =1.24, 95%CI 0.59–2.59) and that of T. trichiura was 31% in both arms (aOR=1.17, 95%CI 0.73–1.88). No significant differences were found for STH infection intensity in both the main study and the hand contamination sub-study. Conclusions The intervention was effective in increasing reported handwashing behaviour at school, but failed to show a similar effect in the home. The intervention had no effect on STH infection, possibly due to infection in the home environment, other transmission routes such as contaminated water or food or limited changes in school children’s handwashing behaviour. Trial registration The trial was registered on June 21, 2017, by the International Standard Randomised Controlled Trial Number ( ISRCTN45013173) .

Background and Aim: Trichuris trichiura and Hymenolepis diminuta are helminthic intestinal parasites that infect humans and other animals, including non-human primates. However, molecular detection of these parasites remains scarce in long-tailed macaques (Macaca fascicularis), which coexist with human communities in Thailand. Thus, this study aimed to molecularly confirm the occurrence of Trichuris spp. and Hymenolepis spp. infection and determine the species of both parasites that were found in long-tailed macaques. Materials and Methods: A total of 200 fecal samples were randomly collected from long-tailed macaques living in Lopburi, Thailand, and tested based on polymerase chain reaction (PCR) assays for Trichuris spp. and Hymenolepis spp. infections. The PCR products were submitted for DNA purification and sequencing. Phylogenetic analysis was performed using the maximum likelihood method. Results: Of 200 tested samples, three (1.5%) were positive for Trichuris spp. Sequence analysis of all positive samples revealed the presence of T. trichiura, while eight samples (8/200, 4%) positive for Hymenolepis spp. were classified as H. diminuta. No significant associations were found between parasite infection and sex of macaques. Conclusion: This study revealed that long-tailed macaques harbor T. trichiura and H. diminuta. These results suggested that local residents and tourists must pay attention to limiting contact with long-tailed macaques and take hygienic precautions to reduce the risk of zoonotic and anthroponotic transmission of these parasites between humans and long-tailed macaques.

Background: Soil-transmitted helminths (STH) are targeted for control through mass drug-administration campaigns to prevent morbidity affecting at-risk groups in endemic regions. Although broadly successful, the use of albendazole and mebendazole achieved variable progress, with deficiencies against Trichuris trichiura and a predictable low efficacy against Strongyloides stercoralis. Novel drug combinations offer a potential solution, providing they can be delivered safely and maintain efficacy against all STH species. Here we present the protocol of a clinical trial to evaluate a fixed-dose combination (FDC) tablet containing albendazole and ivermectin that will be compared against albendazole against STH. Methods: An adaptive phase II/III randomized controlled trial will be undertaken in STH endemic sites in Ethiopia, Kenya and Mozambique to evaluate an oral FDC of 400 mg albendazole and either 9- or 18 mg ivermectin. FDC will be administered as a single dose or single doses over three-consecutive days and assessed against a single dose of 400 mg albendazole. In the phase II trial, 126 T. trichiura-infected children weighting 15 to 45 kg will be treated in a dose-escalation manner to determine safety objectives. In the phase III trial, 1097 participants aged 5 to 18 years old infected with T. trichiura, hookworm and S. stercoralis will be recruited to determine safety and efficacy. The trial will be open-label with blinded outcome assessors. Cure rate measured 21-days after-treatment in duplicate Kato-Katz is the primary efficacy outcome. Secondary objectives include efficacy evaluation by quantitative polymerase chain reaction (PCR) as an outcome measurement, description of pharmacokinetic parameters, palatability and acceptability evaluations, and monitoring of anthelmintic resistance. Conclusions: This trial with registrational goals seeks to evaluate an innovative fixed-dose combination of albendazole and ivermectin co-formulated tablets, with the goal of providing an anthelmintic regimen with improved efficacy and spectrum of coverage against STH. ClinicalTrials.gov registration: NCT05124691 (18/11/2021).

Background: Achieving the elimination of soil-transmitted helminth (STH) infections requires a sufficient understanding of the current epidemiological status of STH endemicity. We aimed to examine the status of STH in Myanmar – a country with the eighth highest STH prevalence in the world, 10 years after instigation of the national deworming programme. Methods: In August 2016 we screened for STH infections using Kato Katz (KK) microscopy and real-time PCR (qPCR) in schoolchildren from the Bago Region township of Phyu, a STH sentinel site in Myanmar. Ten schools were randomly selected, and one stool sample each from a total of 264 students was examined. Prevalence and intensity of infection were calculated for each STH. Results: High prevalence of STH was identified in the study area with 78.8% of the schoolchildren infected with at least one STH by qPCR, and 33.3% by KK. The most prevalent STH was Trichuris trichiura, diagnosed by both KK (26.1%) and qPCR (67.1%), followed by Ascaris lumbricoides (15.5% KK; 54.9% qPCR). No hookworm infections were identified by KK; however, the qPCR analysis showed a high prevalence of Ancylostoma sp. infection (29.6%) with few Necator americanus (1.1%) infections. Conclusions: Despite bi-annual deworming of schoolchildren in the fourth-grade and below, STH prevalence remains stubbornly high. These results informed the expansion of the Myanmar National STH control programme to include all school-aged children by the Ministry of Health and Sports in 2017, however further expansion to the whole community should be considered along with improving sanitation and hygiene measures. This would be augmented by rigorous monitoring and evaluation, including national prevalence surveys. [ABSTRACT FROM AUTHOR]

Abstract Background Recent studies have reported the existence of a Trichuris species complex parasitizing primate. Nevertheless, the genetic and evolutionary relationship between Trichuris spp. parasitizing humans and Non-Human Primates (NHP) is poorly understood. The hypothesised existence of different species of Trichuris in primates opens the possibility to evaluate these primates as reservoir hosts of human trichuriasis and other putative new species of whipworms. Results In this paper, we carried out a morphological, biometrical and molecular study of Trichuris population parasitizing Macaca sylvanus from Spain based on traditional morpho-biometrical methods, PCA analysis and ribosomal (ITS2) and mitochondrial (cox1 and cob) DNA sequencing. Morphological results revealed that Trichuris sp. from M. sylvanus is Trichuris trichiura. Ribosomal datasets revealed that phylogenetic relationships of populations of Trichuris sp. from M. sylvanus were unresolved. The phylogeny inferred on mitochondrial datasets (partitioned and concatenated) revealed similar topologies; Thus, phylogenetic trees supported the existence of clear molecular differentiation between individuals of Trichuris sp. from M. sylvanus appearing in two different subclades. Conclusions Based on morphological parameters, biometrical measurements, and molecular sequence analysis, we conclude that the whipworms isolated from M. sylvanus were T. trichiura. Further, the evolutionary relationship showed that these worms belonged to two genotypes within the T. trichiura lineage. Since T. trichiura is of public health importance, it is important to carry out further studies to improve the understanding of its hosts range, evolution and phylogeography.

Abstract Background Trichuris trichiura (human whipworm) infects an estimated 477 million individuals worldwide. In addition to T. trichiura, other Trichuris species can cause an uncommon zoonosis and a number of human cases have been reported. The diagnosis of trichuriasis has relied traditionally on microscopy. Recently, there is an effort to use molecular diagnostic methods, mainly qPCR. LAMP technology could be an alternative for qPCR especially in low-income endemic areas. Trichuris muris, the causative agent of trichuriasis in mice, is of great importance as a model for human trichuriasis. Here, we evaluate the diagnostic utility of a new LAMP assay in an active experimental mouse trichuriasis in parallel with parasitological method by using stool and, for the first time, urine samples. Methods Stool and urine samples were collected from mice infected with eggs of T. muris. The dynamics of infection was determined by counting the number of eggs per gram of faeces. A LAMP based on the 18S rRNA gene from T. muris was designed. Sensitivity and specificity of LAMP was tested and compared with PCR. Stool and urine samples were analysed by both LAMP and PCR techniques. Results Trichuris muris eggs were detected for the first time in faeces 35 days post-infection. LAMP resulted specific and no cross-reactions were found when using 18 DNA samples from different parasites. The detection limit of the LAMP assay was 2 pg of T. muris DNA. When testing stool samples by LAMP we obtained positive results on day 35 p.i. and urine samples showed amplification results on day 20 p.i., i.e. 15 days before the onset of T. muris eggs in faeces. Conclusions To the best of our knowledge, we report, for the first time, a novel LAMP assay (Whip-LAMP) for sensitive detection of T. muris DNA in both stool and urine samples in a well-established mice experimental infection model. Considering the advantages of urine in molecular diagnosis in comparison to stool samples, should make us consider the possibility of starting the use urine specimens in molecular diagnosis and for field-based studies of human trichuriasis where possible. Further studies with clinical samples are still needed.

Abstract Background Accurate, scalable and sensitive diagnostic tools are crucial in determining prevalence of soil-transmitted helminths (STH), assessing infection intensities and monitoring treatment efficacy. However, assessments on treatment efficacy comparing traditional microscopic to newly emerging molecular approaches such as quantitative Polymerase Chain Reaction (qPCR) are scarce and hampered partly by lack of an established diagnostic gold standard. Methods We compared the performance of the copromicroscopic Kato-Katz method to qPCR in the framework of a randomized controlled trial on Pemba Island, Tanzania, evaluating treatment efficacy based on cure rates of albendazole monotherapy versus ivermectin-albendazole against Trichuris trichiura and concomitant STH infections. Day-to-day variability of both diagnostic methods was assessed to elucidate reproducibility of test results by analysing two stool samples before and two stool samples after treatment of 160 T. trichiura Kato-Katz positive participants, partially co-infected with Ascaris lumbricoides and hookworm, per treatment arm (n = 320). As negative controls, two faecal samples of 180 Kato-Katz helminth negative participants were analysed. Results Fair to moderate correlation between microscopic egg count and DNA copy number for the different STH species was observed at baseline and follow-up. Results indicated higher sensitivity of qPCR for all three STH species across all time points; however, we found lower test result reproducibility compared to Kato-Katz. When assessed with two samples from consecutive days by qPCR, cure rates were significantly lower for T. trichiura (23.2 vs 46.8%), A. lumbricoides (75.3 vs 100%) and hookworm (52.4 vs 78.3%) in the ivermectin-albendazole treatment arm, when compared to Kato-Katz. Conclusions qPCR diagnosis showed lower reproducibility of test results compared to Kato-Katz, hence multiple samples per participant should be analysed to achieve a reliable diagnosis of STH infection. Our study confirms that cure rates are overestimated using Kato-Katz alone. Our findings emphasize that standardized and accurate molecular diagnostic tools are urgently needed for future monitoring within STH control and/or elimination programmes.

Eosinophilic leukocytosis can be attributed to a number of clinical conditions such as parasitic infection, allergies, and neoplasms. Parasitic infection is the main cause of eosinophilia; however, a marked leukocytosis with hypereosinophilia secondary to Trichuris trichiura in adults has not been previously reported. We describe a case of a 39-year-old man who presented with fever and diarrhea. The investigation revealed a white blood cell (WBC) count of 20.69 × 109/L with an absolute eosinophil count of 12.44 × 109/L. Fecal microscopic examination demonstrated T. trichuria eggs. The WBC count returned to normal following treatment with albendazole. The literature pertaining to hematological findings associated with Trichuris trichiura is explored in this report. This case highlights that a significant elevation of leukocyte count with hypereosinophilia can be one of the manifestations of trichuriasis infection in adults. Empirical treatment with antihelminthic agents may play a role in suspected cases to avoid severe complications, such as Trichuris dysentery syndrome. [ABSTRACT FROM AUTHOR]

Soil-transmitted helminth (STH) infections are still a considerable challenge in Myanmar. We undertook a control program for STH infections (especially Trichuris trichiura) among schoolchildren in Myanmar using mass drug administration (MDA) and health education. Around 1,700 schoolchildren from 15 primary schools in 3 suburban districts (Shwe Pyi Thar, Twantay, and Kyauktan) of the Yangon Region were subjected in this study during 2017-2019. All of the schoolchildren in each school were orally administered albendazole (400 mg in a single dose) 2, 3, and 4 times a year in 2017, 2018, and 2019, respectively. The results revealed that the egg positive rate of any intestinal helminths (including STH) was reduced from 37.6% (649/1,724) in 2017 to 22.8% (352/1,542) in 2019. The egg positive rate of Ascaris lumbricoides was decreased remarkably from 23.3% (402/1,724) in 2017 to 3.6% (56/1,542) in 2019. However, that of T. trichiura was only slightly reduced from 26.9% (464/1,724) in 2017 to 20.2% (312/1,542) in 2019. The intensity of infection with A. lumbricoides and T. trichiura was both more or less reduced, and the proportion of light infection cases with A. lumbricoides and T. trichiura increased from 35.6% in 2017 to 64.3% in 2019 and from 70.3% in 2017 to 81.7% in 2019, respectively. The results indicated that repeated MDAs (2-4 times a year for 3 years) using albendazole on schoolchildren in Myanmar failed to control T. trichiura infection. For a successful control of trichuriasis in Myanmar, new MDA strategies, using a modified albendazole regimen (multiple daily doses for 2 or 3 days) or an alternative anthelmintic drug, such as oxantel pamoate, is strongly recommended. [ABSTRACT FROM AUTHOR]

Background The efficacy of currently available anthelminthics against Trichuris trichiura infections is significatively lower than for other soil-transmitted helminths. The combination of ivermectin (IVM) and albendazole (ALB) has shown significant improvements in efficacy. Methods Safety and efficacy randomized controlled clinical trial comparing 3 experimental regimens against ALB monotherapy for the treatment of T. trichiura infections in northern Honduras. Infected children were randomized to 4 treatment arms: arm 1, single-dose ALB (400 mg); arm 2, single-dose ALB (400 mg) plus IVM (600 μg/kg); arm 3, ALB (400 mg) for 3 consecutive days; or arm 4, ALB (400 mg) plus IVM (600 μg/kg) for 3 consecutive days. Efficacy was measured based on the egg reduction and cure rates, both assessed 14–21 days after treatment, using the Kato-Katz method. Safety was evaluated by analyzing the frequency and severity of adverse events. Results Of 176 children randomized to 1 of the 4 treatment arms, 117 completed treatment and follow-up. The egg reduction rates for arms 1, 2, 3, and 4 were 47.7%, 96.7%, 72.1%, and 100%, respectively; with P values <.001 for comparisons between IVM groups and ALB-only arms. The cure rates were 4.2%, 88.6%, 33.3%, and 100%, respectively. A total of 48 adverse events (85.4% mild) were reported in 36 children. Conclusions The combined use of ALB and high-dose IVM is a highly effective and well tolerated treatment for the treatment of T. trichiura infections, offering significantly improved treatment for the control of this infection. Clinical Trials Registration NCT04041453. [ABSTRACT FROM AUTHOR]

Abstract Background Japan is one of the few countries believed to have eliminated soil-transmitted helminths (STHs). In 1949, the national prevalence of Ascaris lumbricoides was 62.9%, which decreased to 0.6% in 1973 due to improvements in infrastructure, socioeconomic status, and the implementation of national STH control measures. The Parasitosis Prevention Law ended in 1994 and population-level screening ceased in Japan; therefore, current transmission status of STH in Japan is not well characterized. Sporadic cases of STH infections continue to be reported, raising the possibility of a larger-scale recrudescence of STH infections. Given that traditional microscopic detection methods are not sensitive to low-intensity STH infections, we conducted targeted prevalence surveys using sensitive PCR-based assays to evaluate the current STH-transmission status and to describe epidemiological characteristics of areas of Japan believed to have achieved historical elimination of STHs. Methods Stool samples were collected from 682 preschool- and school-aged children from six localities of Japan with previously high prevalence of STH. Caregivers of participants completed a questionnaire to ascertain access to water, sanitation and hygiene (WASH), and potential exposures to environmental contamination. For fecal testing, multi-parallel real-time PCR assays were used to detect infections of Ascaris lumbricoides, Necator americanus, Ancylostoma duodenale and Trichuris trichiura. Results Among the 682 children, no positive samples were identified, and participants reported high standards of WASH. Conclusions To our knowledge, this is the first STH-surveillance study in Japan to use sensitive molecular techniques for STH detection. The results suggest that recrudescence of STH infections has not occurred, and that declines in prevalence have been sustained in the sampled areas. These findings suggest that reductions in prevalence below the elimination thresholds, suggestive of transmission interruption, are possible. Additionally, this study provides circumstantial evidence that multi-parallel real-time PCR methods are applicable for evaluating elimination status in areas where STH prevalence is extremely low.

Helminthiasis remains a public health issue in endemic areas. Various drugs have been proposed to improve efficacy against helminths. The study aimed to assess the safety and efficacy of three different anthelmintic combinations to treat Trichuris trichiura infections. We conducted a randomized assessors-blind clinical trial involving children aged 2-17 years with T. trichiura . Participants were randomly assigned to one of three treatment arms. On the first and third days, all participants got albendazole 400 mg, and on the second day, albendazole (arm A), mebendazole 500 mg (arm B), or pyrantel 125 mg/kg (arm C). We assessed treatment efficacy using the cure rate (CR) and egg reduction rate (ERR) at 3 and 6 weeks post-treatment. At 3 weeks post-treatment, ERR and CR were highest in study arm A [ERR = 94%, 95% confidence interval (CI): 92-95; CR = 71%; 95% CI: 58-81] compared to the B and C arms. Decrease in ERR was significant only for arm B versus arm A ( P -value <0.001); decrease in ERR was significant for arms B and C ( P -value <0.001). No statistical difference was observed in CR when comparing arms A and B ( P -value =1.00) and C ( P -value =0.27). At 6 weeks, a decrease in ERR was observed in three arms, significant only for arm C, 81% (95% CI: 78-83). A significant increase in egg counts was observed between 3 and 6 weeks post-treatment. All treatments were safe with mild adverse events. Albendazole 400 mg/day (arm A) showed the highest efficacy against trichuriasis. Nonetheless, this treatment regimen was able to cure half of the treated individuals highlighting concerns about controlling the transmission of T. trichiura .CLINICAL TRIALRegistered at ClinicalTrials.gov (NCT04326868)., Competing Interests: The authors declare no conflict of interest.

Background: Childhood anaemia affects 1.8 billion people globally. Little is known about the long-term impact of mass drug administration (MDA) for the control of soil-transmitted helminthiases (STH) on the spatiotemporal variation of anaemia prevalence and severity. We describe the long-term spatiotemporal impact of a 5-year STH MDA programme (2007–2011) on the prevalence of anaemia and anaemia severity in school-aged children (SAC) in Burundi. Methodology/Principal Findings: We used annual haemoglobin concentration and STH data collected during 2007–2011 in 31 schools in Burundi. Spatial dependence in prevalence and severity of anaemia was assessed using semivariograms. Bayesian geostatistical models were developed to (a) quantify the role of STH (adjusted for other anaemia determinants) in the spatiotemporal distribution of anaemia prevalence/severity, and (b) predict the geographical variation of both outcomes across Burundi. Adjusted population data were used to estimate the geographical distribution of the number of SAC at risk of anaemia and with low and moderate/severe anaemia. Infections with Ascaris lumbricoides and Trichuris trichiura were positively and significantly associated with childhood anaemia; hookworm infections were not. A significant decrease in anaemia prevalence, from 40–50% (2008) to 10–20% (2011) was predicted in western areas. The predicted prevalence of low-severity anaemia decreased from 40–50% (2008) to

Although research conducted in East Asia has uncovered parasite eggs from ancient toilets or cesspits, data accumulated to date needs to be supplemented by more archaeoparasitological studies. We examined a total of 21 soil samples from a toilet-like structure at the Hwajisan site, a Baekje-period royal villa, in present-day Korea. At least 4 species of helminth eggs, i.e., Trichuris trichiura, Ascaris lumbricoides, Clonorchis sinensis, and Trichuris sp. (or Trichuris vulpis) were detected in 3 sediment samples of the structure that was likely a toilet used by Baekje nobles. The eggs of T. trichiura were found in all 3 samples (no. 1, 4, and 5); and A. lumbricoides eggs were detected in 2 samples (no. 4 and 5). C. sinensis and T. vulpis-like eggs were found in no. 5 sample. From the findings of this study, we can suppose that the soil-transmitted helminths were prevalent in ancient Korean people, including the nobles of Baekje Kingdom during the 5th to 7th century. [ABSTRACT FROM AUTHOR]

Soil-transmitted helminths (STHs) are widely distributed globally and India is a significant contributor to the overall global burden of the disease. Microscopic methods like Kato-Katz (K-K) thick smear and direct smear microscopy by wet mount (DSM) are widely used for STH diagnosis due to their ease in performance. Still, low sensitivity proves to be a significant limitation of these methods. This study explores the diagnostic performance of two and three consecutive-day stool samples compared to the common practice of single stool sample examination. We observed that the three consecutive-day stool examination technique increased overall helminth positivity from 12% to 16.3% in K-K and 11.5–15.9% in DSM, indicating that multiple sampling can diagnose intestinal helminthiasis more accurately. A significant increase in the intensities of hookworms (by 37.5%; p value: 0.001) and Trichuris trichiura (by 47.8%; p value: 0.037) (measured in terms of fecal egg count) was also observed. The methods undertaken in the current study are comparable in detecting the helminths as the marginal increase in positivity by K-K (16.32% vs. 15.86%) was statistically insignificant. [ABSTRACT FROM AUTHOR]

Background: Soil-transmitted helminth (STH) infections are highly prevalent in resource-limited countries. We assessed the effect of a combination intervention aiming to enhance handwashing with soap on STH reinfection following mass drug administration among primary school children in Kagera region, Northwestern Tanzania.Methods: We conducted a cluster randomised trial in sixteen primary schools with known high STH prevalence. Schools were randomly assigned in a 1:1 ratio to either receive the intervention or continue with routine health education. The intervention included teacher-led classroom teaching, parental engagement sessions, environmental modifications and improved handwashing stations. The evaluation involved two cross-sectional surveys in a representative sample of students, with the end-line survey conducted 12 months after the baseline survey. The primary outcome was the combined prevalence of Ascaris lumbricoides and Trichuris trichiura infections at the end-line survey. Secondary outcomes included reported handwashing behaviour, the prevalence and intensity of individual STHs, and hand contamination with STH ova and coliform bacteria. End-line STH prevalence and intensity were adjusted for baseline differences of potential confounders.Results: At the end-line survey, 3081 school children (1566 from intervention schools and 1515 from control schools) provided interview data and stool specimens. More school children in the intervention group reported the use of water and soap during handwashing compared to school children in the control group (58% vs. 35%; aOR=1.76, 95%CI 1.28-2.43, p=0.001). The combined prevalence of A. lumbricoides and T. trichiura infections was 39% in both trial arms (aOR = 1.19; 95%CI 0.74-1.91). The prevalence of A. lumbricoides was 15% in the intervention and 17% in the control arm (aOR =1.24, 95%CI 0.59-2.59) and that of T. trichiura was 31% in both arms (aOR=1.17, 95%CI 0.73-1.88). No significant differences were found for STH infection intensity in both the main study and the hand contamination sub-study.Conclusions: The intervention was effective in increasing reported handwashing behaviour at school, but failed to show a similar effect in the home. The intervention had no effect on STH infection, possibly due to infection in the home environment, other transmission routes such as contaminated water or food or limited changes in school children's handwashing behaviour.Trial Registration: The trial was registered on June 21, 2017, by the International Standard Randomised Controlled Trial Number ( ISRCTN45013173) . [ABSTRACT FROM AUTHOR]

Background: Most of the studies conducted in Brazil assessing the relationship between water, sanitation and hygiene (WASH) and Soil-transmitted helminth (STH) infections, have focused on cases, reflecting the reality of small areas and not of a countrywide situation. In order to fill this gap, the current paper presents an epidemiological study exploring the association between water and sanitation and STHs prevalence in students from 7 to 17 years old, in all 27 Brazilian Federation Units.Methods: Three ecological studies were carried out considering the prevalence of ascariasis, trichuriasis, and hookworm as outcome variables. The sample consisted of 197,567 students aged 7-17 years old living in 521 Brazilian municipalities. Data were retrieved from the National Survey on the Prevalence of Schistosomiasis mansoni and Soil-transmitted helminth infections (2011-2015). The Generalized Linear Model with the negative binomial distribution was used to evaluate the statistical association between outcomes and explanatory variables. Univariate and Multivariate analyses were conducted with 25 and 5 % significance levels, respectively. Data were aggregated considering municipalities as the geographical unit for analysis.Results: Protective association was found between access to filtered water and adequate sanitation in schools with ascariasis (RR 0.989, CI 95 % 0.983-0.996; RR 0.988, CI 95 % 0.977-0.998), access to filtered water in schools with trichuriasis (RR 0.986, CI 95 % 0.979-0.993) and adequate sanitation at home with hookworm ((RR 0.989, CI 95 % 0.982-0.996). The percentage of population served with Bolsa Família Program, used as a proxy for poverty, was the only significant variable common to all models.Conclusions: Our findings support that WASH, both in schools and homes, are essential to schoolchildren health with regard to STHs. However, sanitary interventions will not be fully effective in preventing STH infections without promoting access to quality public services, particularly for people living in poverty, the most vulnerable group. [ABSTRACT FROM AUTHOR]

Background and Aim: Trichuris trichiura and Hymenolepis diminuta are helminthic intestinal parasites that infect humans and other animals, including non-human primates. However, molecular detection of these parasites remains scarce in longtailed macaques (Macaca fascicularis), which coexist with human communities in Thailand. Thus, this study aimed to molecularly confirm the occurrence of Trichuris spp. and Hymenolepis spp. infection and determine the species of both parasites that were found in long-tailed macaques. Materials and Methods: A total of 200 fecal samples were randomly collected from long-tailed macaques living in Lopburi, Thailand, and tested based on polymerase chain reaction (PCR) assays for Trichuris spp. and Hymenolepis spp. infections. The PCR products were submitted for DNA purification and sequencing. Phylogenetic analysis was performed using the maximum likelihood method. Results: Of 200 tested samples, three (1.5%) were positive for Trichuris spp. Sequence analysis of all positive samples revealed the presence of T. trichiura, while eight samples (8/200, 4%) positive for Hymenolepis spp. were classified as H. diminuta. No significant associations were found between parasite infection and sex of macaques. Conclusion: This study revealed that long-tailed macaques harbor T. trichiura and H. diminuta. These results suggested that local residents and tourists must pay attention to limiting contact with long-tailed macaques and take hygienic precautions to reduce the risk of zoonotic and anthroponotic transmission of these parasites between humans and long-tailed macaques. [ABSTRACT FROM AUTHOR]

Our previous research on coprolite specimens from the mummies of Joseon Dynasty (1392-1910 CE) has revealed various species of parasite eggs. Herein, we added 2 new helminthic cases of human remains from Joseon-period graves in the Republic of Korea (Korea). The organic materials precipitated on the hip bones of 2 half-mummied cases (Goryeong and Gwangmyeong cases) were collected, rehydrated, and examined by a microscope. In the sample from Goryeong-gun (gun=County), ova of Trichuris trichiura, Clonorchis sinensis, and Metagonimus spp. were detected, and eggs of T. trichiura and A. lumbricoides were found from the sample of Gwangmyeong-si (si=City). By adding this outcome to the existing data pool, we confirm our previous estimates of Joseon-period parasite infection rates. The overall rates of A. lumbricoides, T. trichiura, and C. sinensis decreased dramatically from Joseon to the modern period. In Goryeong mummy specimen, we also found Metagonimus spp. eggs that has rarely been detected in archaeological samples so far. [ABSTRACT FROM AUTHOR]

Abstract Background Soil-transmitted helminthiasis affects almost 2 billion people worldwide in tropical climates. Preventive chemotherapy, using the benzimidazoles (albendazole and mebendazole) is the current main recommended control strategy. Nevertheless, there is limited efficacy of these drugs against hookworm infection and, to a greater extent, against trichuriasis. We describe a protocol for a trial investigating the efficacy and safety of the co-administration of ivermectin and albendazole against trichuriasis. Methods A double-blind, placebo-controlled randomized controlled trial will be conducted in three countries (Côte d’Ivoire, Tanzania and Lao PDR) with the aim to determine the efficacy, safety and extended effects of co-administered ivermectin and albendazole compared to standard albendazole monotherapy. We will enroll 600 participants aged 6–60 years in each setting. The primary outcome is cure rate (CR) against Trichuris trichiura infection as assessed by Kato-Katz 14–21 days after treatment. Secondary outcomes include CRs against concomitant soil-transmitted helminth (STH) infections (Ascaris lumbricoides, hookworm and Strongyloides stercoralis) and egg reduction rates (ERRs) against STH at 14–21 days, 180 days and 360 days. Tolerability of treatment, infection status assessed by polymerase chain reaction (PCR), and potential benefits of deworming on nutritional and morbidity indicators will be assessed. The primary analysis will include an available-case set and use logistic regression models adjusted for age, sex and weight. Discussion This trial will provide robust results on the efficacy and safety of co-administration of ivermectin and albendazole with the aim to better inform WHO recommendations on control of STHs. Furthermore, secondary and explanatory outcomes will provide direct evidence on the extended effects of combination therapy and insight on the relationship between nutrition and morbidity parameters and infection status and intensity. Trial registration NCT03527732 (date assigned: 17 May 2018).

A descriptive cross sectional study on intestinal parasitic infestation was earned out among children of three kindergartens (Methodist, Dharma Wanita and Aisyiah) in Medan. Of 162 samples of feces examined mixed infestations with Ascaris lumbricoides and Trichuris trichiura was found in 14,25%, single infestations of Trichuris trichiuria in 14,2%, AScaris lumbricoides in 13,0%, H. nana in 1,2% and G. Iamblia in 0,6%. Hookworm infestation was not found among preschool children in all of those three kindergartens.