RESUMEN
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.
Asunto(s)
Antihelmínticos , Trichuris , Albendazol/efectos adversos , Animales , Antihelmínticos/efectos adversos , Niño , Honduras , Humanos , Ivermectina/efectos adversos , Instituciones AcadémicasRESUMEN
To determine whether the presence of Blastocystis is associated with other gastrointestinal parasite infections, stool samples from 95 Honduran rural children were analyzed using multi-parallel quantitative real-time polymerase chain reaction (PCR) and Kato-Katz. Combined results detected the following prevalence: Blastocystis, 71.6%; Trichuris trichiura, 63.2%; Giardia lamblia, 40.0%; Ascaris lumbricoides, 15.8%; and Necator americanus, 4.2%. Age was found associated with the quantity of both Blastocystis DNA (r s = 0.524, P < 0.001) and T. trichiura DNA in the stool (fg/µL) by quantitative PCR (r s = 0.272, P < 0.001). In addition, there was an association with T. trichiura and Blastocystis infection (odds ratio [OR] = 4.72; 95% CI = 1.83, 12.20; P < 0.001). These findings demonstrate a high prevalence of Blastocystis and other intestinal parasites in a rural location in Honduras.
Asunto(s)
Infecciones por Blastocystis/parasitología , Blastocystis , Coinfección , Parasitosis Intestinales/parasitología , Reacción en Cadena en Tiempo Real de la Polimerasa/métodos , Población Rural , Infecciones por Blastocystis/epidemiología , Honduras/epidemiología , Humanos , Parasitosis Intestinales/epidemiología , Prevalencia , Sensibilidad y EspecificidadRESUMEN
BACKGROUND: Soil-transmitted helminths (STH) establish chronic infections in the human intestine. The host reacts to these infections with a dominant T-helper type 2 cell (Th2) response that while attempting to control the worm population, can also provide an anti-inflammatory environment favourable for parasite survival. Regulatory cytokine interleukin 10 (IL-10) has been proposed as a key molecule involved in the attenuation of chronic inflammation and the ensuing tolerance for these helminth parasites. The objective of this study was to determine whether STH-infected children from an endemic community had increased circulating IL-10 levels when compared to non-infected children. RESULTS: A total of 39 children (25 boys and 14 girls, 7-15 years of age) were enrolled in study. Utilizing the Kato-Katz method to detect intestinal helminthiases, 10 children were non-infected and 29 were harbouring STH infections by Ascaris lumbricoides, Trichuris trichiura and/or hookworms. Of the 29 infected children, 11 had single-species infections and 18 were polyparasitized with two or three STH species. Serum samples from all 39 children were tested for IL-10 serum concentrations, out of which 12 had undetectable levels while 27 had levels ranging from 0.4-105 pg/mL. Excluding extreme outlying values, 25 samples had IL-10 concentration values ranging from 0.4 -7.2 pg/mL. Differences in IL-10 levels among non-parasitized, monoparasitized, and polyparasitized groups were not statistically significant. However, children infected with any of the three STH species investigated had higher IL-10 levels than non-parasitized children (geometric means: 0.89 pg/mL vs. 0.74 pg/mL, p = 0.428). Similarly, polyparasitized children had higher IL-10 levels than both monoparasitized and non-parasitized children (1.04 pg/mL, 0.69 pg/mL, and 0.74 pg/mL, respectively, p = 0.481). A significant moderate negative correlation between IL-10 levels and children's age was found, but no correlations were observed between IL-10 levels and intensity of infection by any of the parasite species investigated. CONCLUSIONS: We found no strong evidence for an association between STH infection and serum IL-10 concentration levels. However, the trends identified here warrant further investigation. Additional research is needed to expand the current understanding of the immune response elicited by STH infections in children living in endemic communities.
Asunto(s)
Helmintiasis/parasitología , Helmintiasis/transmisión , Interleucina-10/sangre , Suelo/parasitología , Adolescente , Niño , Femenino , Helmintiasis/sangre , Helmintiasis/inmunología , Honduras , Humanos , MasculinoRESUMEN
BACKGROUND: Among many neglected tropical diseases endemic in Honduras, soil-transmitted helminth (STH) infections are of particular importance. However, knowledge gaps remain in terms of risk factors involved in infection transmission. The aim of this study was to investigate risk factors associated with STH infections in schoolchildren living in rural Honduras. METHODS: A cross-sectional study was conducted among Honduran rural schoolchildren in 2011. Demographic, socio-economic, and epidemiological data were obtained through a standardized questionnaire and STH infections were determined by the Kato-Katz method. Logistic regression models accounting for school clustering were used to assess putative risk factors for infection. RESULTS: A total of 320 children completed the study. Prevalences for any STH and for Ascaris lumbricoides, Trichuris trichiura and hookworms were: 72.5%, 30.3%, 66.9% and 15.9%, respectively. A number of risk factors were identified at the individual, household, and school level. Boys were at increased odds of infection with hookworms (OR 2.33, 95% CI = 1.23-4.42). Higher socio-economic status in the family had a protective effect against infections by A. lumbricoides (OR 0.80, 95% CI = 0.65-0.99) and T. trichiura (OR 0.77, 95% CI = 0.63-0.94).Low school hygiene conditions significantly increased the odds for ascariasis (OR 14.85, 95% CI = 7.29-30.24), trichuriasis (OR 7.32, 95% CI = 3.71-14.45), mixed infections (OR 9.02, 95% CI = 4.66-17.46), and ascariasis intensity of infection (OR 3.32, 95% CI = 1.05 -10.52).Children attending schools not providing deworming treatment or that had provided it only once a year were at increased odds of ascariasis (OR 10.40, 95% CI = 4.39-24.65), hookworm (OR 2.92, 95% CI = 1.09-7.85) and mixed infections (OR 10.57, 95% CI = 4.53-24.66). CONCLUSIONS: Poverty-reduction strategies will ultimately lead to sustainable control of STH infections in Honduras, but as shorter-term measures, uninterrupted bi-annual deworming treatment paired with improvements in school sanitary conditions may result in significant reductions of STH prevalence among Honduran schoolchildren.
Asunto(s)
Albendazol/uso terapéutico , Helmintiasis/prevención & control , Helmintiasis/transmisión , Saneamiento , Instituciones Académicas , Suelo/parasitología , Antihelmínticos/uso terapéutico , Niño , Estudios Transversales , Femenino , Honduras/epidemiología , Humanos , Masculino , Oportunidad Relativa , Factores de RiesgoRESUMEN
BACKGROUND: Honduras is endemic for soil-transmitted helminth (STH) infections, but critical information gaps still remain on the prevalence and intensity of these infections as well as on their spatial distribution at subnational levels. OBJECTIVES: Firstly, to review the research activity on STH infections in Honduras and secondly, to carry out a national prevalence analysis and map the geographical distribution of these infections in children. METHODS: A systematic search was conducted of the published and grey literature to identify scientific work on the impact and prevalence of STH infections done between May 1930 and June 30, 2012. International databases and Honduran journals were searched. Grey literature was gleaned from local libraries and key informants. Select studies conducted between 2001 and 2012 were used to produce prevalence maps and to investigate association between STH prevalence and socio-economic and environmental factors. RESULTS: Of 257 identified studies, 211 (21.4% peer-reviewed) were retained for analysis and categorized as clinical research (10.9%), treatment efficacy studies (8.1%) or epidemiological studies (81%). Prevalence analysis and geographical mapping included 36 epidemiological studies from Honduras's 18 departments and 23% of its municipalities. Overall STH prevalence was >50% in 40.6% of municipalities. Prevalences above 20% for each trichuriasis, ascariasis, and hookworm infection were found in 68%, 47.8%, and 7.2% of studied municipalities, respectively. Municipalities with lower human development index, less access to of potable water, and with higher annual precipitation showed higher STH prevalences. CONCLUSIONS: This is the first study to provide a comprehensive historic review of STH research activity and prevalence in Honduras, revealing important knowledge gaps related to infection risk factors, disease burden, and anti-parasitic drug efficacy, among others. Our decade-long prevalence analysis reveals geographical differences in STH prevalence and these findings suggest that differential intervention strategies might be necessary in Honduras for the control of these infections.
Asunto(s)
Helmintiasis/epidemiología , Helmintos/clasificación , Helmintos/aislamiento & purificación , Enfermedades Intestinales/epidemiología , Animales , Investigación Biomédica/tendencias , Helmintiasis/transmisión , Honduras/epidemiología , Humanos , Parasitosis Intestinales , Parasitología/tendencias , Prevalencia , Topografía MédicaRESUMEN
BACKGROUND: Soil-transmitted helminth (STH) infections are endemic in Honduras and efforts are underway to decrease their transmission. However, current evidence is lacking in regards to their prevalence, intensity and their impact on children's health. OBJECTIVES: To evaluate the prevalence and intensity of STH infections and their association with nutritional status in a sample of Honduran children. METHODOLOGY: A cross-sectional study was done among school-age children residing in rural communities in Honduras, in 2011. Demographic data was obtained, hemoglobin and protein concentrations were determined in blood samples and STH infections investigated in single-stool samples by Kato-Katz. Anthropometric measurements were taken to calculate height-for-age (HAZ), BMI-for-age (BAZ) and weight-for-age (WAZ) to determine stunting, thinness and underweight, respectively. RESULTS: Among 320 children studied (48% girls, aged 7-14 years, mean 9.76 ± 1.4) an overall STH prevalence of 72.5% was found. Children >10 years of age were generally more infected than 7-10 year-olds (p = 0.015). Prevalence was 30%, 67% and 16% for Ascaris, Trichuris and hookworms, respectively. Moderate-to-heavy infections as well as polyparasitism were common among the infected children (36% and 44%, respectively). Polyparasitism was four times more likely to occur in children attending schools with absent or annual deworming schedules than in pupils attending schools deworming twice a year (p<0.001). Stunting was observed in 5.6% of children and it was associated with increasing age. Also, 2.2% of studied children were thin, 1.3% underweight and 2.2% had anemia. Moderate-to-heavy infections and polyparasitism were significantly associated with decreased values in WAZ and marginally associated with decreased values in HAZ. CONCLUSIONS: STH infections remain a public health concern in Honduras and despite current efforts were highly prevalent in the studied community. The role of multiparasite STH infections in undermining children's nutritional status warrants more research.
Asunto(s)
Helmintiasis/epidemiología , Helmintos/aislamiento & purificación , Estado Nutricional , Adolescente , Animales , Antropometría , Proteínas Sanguíneas/análisis , Niño , Coinfección/epidemiología , Coinfección/parasitología , Estudios Transversales , Heces/parasitología , Femenino , Helmintiasis/parasitología , Helmintos/clasificación , Hemoglobinas/análisis , Honduras/epidemiología , Humanos , Masculino , Prevalencia , Población RuralRESUMEN
Antecedentes. El método Kato-Katz se utiliza para determinar infecciones por helmintos transmitidos por el suelo. A pesar de ser un método de concentración sencillo, robusto y relativamente sensible, la calidad de los resultados del Kato-Katz está sujeta a su apropiada estandarización en cada laboratorio. Objetivo. Describir el efecto negativo del aclaramiento excesivo de las muestras en la detección de uncinariasis utilizando el método de Kato-Katz en una encuesta coproparasitológica realizada en comunidades rurales Hondureñas en el año 2011. Materiales y Métodos. Se realizó un estudio epidemiológico sobre infecciones por uncinarias utilizando el método Kato-Katz en 351 niños de varias comunidades de Olancho, entre febrero y abril de 2011, encontrándose prevalencia de uncinariasis de 6.0%. La revisión del procedimiento determinó que en 228 muestras el tiempo de aclaramiento excedió dos horas. Se procedió a un segundo muestreo y se recolectaron 195 muestras de la misma población. Resultados. Las nuevas muestras se examinaron entre 60-90 minutos después de su preparación obteniéndose una prevalencia de uncinariasis de 15.9%. Conclusiones. El exceso de aclaramiento de las heces con el método Kato-Katz produjo la subestimación inicial de uncinariasis. Debido a que Kato-Katz es un método importante para la evaluación de los programas de desparasitación, su implementación en el laboratorio debe hacerse bajo supervisión...