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• W1490478613 abstract "Food-borne trematodes, parasitizing the liver, lung and intestinal tract ofhumans, are an emerging public health problem in countries of tropical regions. Today,an estimated 40 million people are infected worldwide. More than half of those occurin Asia, particularly in Southeast Asian countries. Infection with food-borne trematodeis associated with divers and severe morbidity, i.e. a long-lasting infection withOpisthorchis viverrini gives rise to liver fibrosis, cholecystitis and cholangitis and mayinduce a malignant cholangiocarcinoma (CCA).In Lao People’s Democratic Republic (Lao PDR), particularly in the ruralsettings the habit of consumption of undercooked or insufficiently cooked food isfrequent and deeply culturally rooted. In addition access to clean water is low andadequate sanitary facilities are virtually absent, which reflects a socio-economicallydisadvantaged situation. These areas are at high risk for the transmission of food-bornetrematodiasis (FBT) and intestinal helminhiasis. The prevalence of these parasites hasan extensive geographical overlap; thus leading in a single person to an infection withseveral different species of parasites. The concurrent infection of multiple species, inturn, might aggravate the morbidity of the host. Five specific objectives were pursued in this Ph.D. thesis: (i) to investigatethe epidemiology of O. viverrini and assess the extent of co-infection with other intestinalparasites in a highly endemic setting, (ii) to describe the diversity of FBT with intestinaland hepato-biliar tropism in different eco-epidemiological settings and assess theircontribution to the overall morbidity, (iii) to assess the relationship between socioeconomicstatus and food-borne trematode infection, in particular O. viverrini in thedistinct eco-epidemiological settings, and (iv) to assess the concomitant infections ofintestinal parasites in the distinct eco-epidemiological settings and their inter-linking tothe environmental, socio-economic and behavioural risk factors. The data presented in this Ph.D. thesis was obtained from aseries of epidemiological studies. The data pertaining to the epidemiology of O. viverriniand other intestinal parasites were first obtained from a cross-sectional study carried outin February and March 2004 in the Saravane district, province of Saravane. Eligiblepersons were randomly selected from the district in two steps, i.e. study villages andhouseholds, based on the village register and household register available at the districthealth office (DHO) and at village. Two questionnaires were administrated to collect thedata at the individual level (demographic, behavioural and personal hygienic data) and atthe household level (food preparing method with fish, characteristics of household head).One single stool sample was obtained from each study participant and analysed by usingKato-Katz technique (KK-technique). Fish species from different local rivers werecollected and examined for the infection with metacercariae. A second cross-sectional study was carried out in March and May 2006 in threedistinct eco-epidemiological settings in Champasack province, i.e. islands in MekongRiver (Khong district), plain area bordering Mekong River (Mounlapamok district) andhighlands (Paksong district). A pre-tested individual questionnaire was used. All enrolledhousehold members were interviewed for demographic data (e.g. age, sex, educationalattainment and professional activity) and behavioural risks (e.g. food consumption habitsand personal hygiene), whereas a household questionnaire was administered to the headsof household to collect the socio-economic characteristics (e.g. building type and watersupply), asset ownership (e.g. farm engine and bicycle) and ownership of animals (e.g.buffalo cow and pig). From each participant three stool samples were collected onconsecutive days. Stool analysis was performed with KK-technique on each sample andsupplemented with formalin-ethyl-acetate concentration technique (FECT) on one of thesamples. The geographical coordinates of each household were registered, using a handheldglobal positioning system receiver (Garmin Ltd., Olathe, USA).The data on morbidity induced by O. viverrini infection and multiparasitism,especially morbidity related to a single infection with O. viverrini versus species anddouble infection with O. viverrini and S. mekongi were obtained from an in-depthhospital- and community-based study carried out in the year of 2005 and 2006 in the tworeferral hospitals (Mahosot and Savannakhet provincial hospital) and communities of three provinces in central and southern Lao PDR (Savannakhet, Saravane andChampasack). A purgative was added after praziquantel treatment (single oral dose: 40mg/kg). All diarrhoeal stools produced were collected and repeatedly washed until thesupernatant became clear. The sediment was examined for the presence of adult worms asfollows. First, adult Taenia spp., Echinostoma spp., and O. viverrini worms were visuallysearched. Second, the remaining sediment was examined with a stereo-microscope for thepresence of minute intestinal flukes (MIF). The number of each species of parasites wasrecorded. Species identification was confirmed under light microscope after specimenswere colored. The detailed clinical data (physical examination, ultrasound examination,liver function test and whole blood count) were obtained and were additionally associatedto the infection status. Our first study on the epidemiology of O. viverrini infection carried out inSaravane province showed a high O. viverrini prevalence rate of 58.5% among 814 studyparticipants. Infection occurred in all age-groups including pre-school children of lessthan 6 years (20.0%). The highest prevalence (> 80.0%) and infection intensity (mean200 epg) was observed among the adult people aged between 45 and 55 years, indicatingan accumulation of this food-borne trematode infection over time. Soil-transmittedhelminths were found at lower rates, e.g. hookworm at 46.1%, A. lumbricoides at 15.7%,and T. trichiura at 11.1%. Almost two-third of study participants harboured with two ormore parasite species. Examination of cyprinoid fish species in the local rivers showedthe high rates of infection with metacercariae. From 98 fish samples out of 23 cyprinoidspecies, almost two-third; the metacercariae were found.Our investigation in Champasack province revealed an overall prevalence ofO. viverrini infection of 64.3%. There were remarkable differences found between thesettings. High prevalence rates were observed in the low-lands of the Mekong plain (e.g.Khong district 92.0% and Mounlapamok district 90.9%). In Paksong district theprevalence was only 5.7%. The occurrence of soil-transmitted helminth infections wasdistinctly different. All three major soil-transmitted helminths were higher in themountainous Paksong district compared to the settings in the plain (e.g. hookworm94.8%, A. lumbricoides 85.9% and T. trichiura 55.7%). S. mekongi was highly prevalentin Kong district (68.0%: 153/225), while only 3.9% (9/232) was observed among study participants living in Mounlapamok. There was no S. mekongi infection in Paksongdistrict. Regarding multiparasitism, 4 out of 5 study participants harboured two or moreparasite species. Habit of raw food consumption, unavailability of sanitary facilities andsocio-economic disadvantages were identified as being the key underlying risk factors forO. viverrini infection and multiparasitism.The results from our in-depth study on morbidity showed that 83% of theexamined person harboured at least 2 parasite species. Six different species of smallintestinal trematodes and one of Echinostomatidae were identified in the purging process.The intensity of infection with O. viverrini worms varied in our patients. The wormburden was significantly associated with observed hepato-biliary pathologies, i.e. studyparticipants diagnosed with common bile duct dilatation, liver fibrosis and intrahepaticbile duct dilatation had 2.4 times, 3.1 times and 7.7 times higher worm burden than thosewithout such pathologies. Co-infections of O. viverrini and S. mekongi increasedconsistently the risk for liver pathologies. Study participants infected with later coinfectionswere at 2 and 6 times and 30 and 75 times higher risk of having the observedliver fibrosis and hepatomegaly compared to infection with O. viverrini alone and noninfectedindividuals, respectively in the ultrasound examination. The prevalence rates and intensity of infection with O. viverrini, andassociated multiparasitism with soil-transmitted helmints, food-borne trematodes andS. mekongi, and the hepto-biliar morbidity related to these infections call for concertedactions for control. Long-term and integrated efforts must improved access to preventiveand curative treatment courses in health facilities and the communities coupled withhealth education and improved access to clean water and adequate sanitation." @default.
• W1490478613 created "2016-06-24" @default.
• W1490478613 creator A5081748718 @default.
• W1490478613 date "2009-01-01" @default.
• W1490478613 modified "2023-09-24" @default.
• W1490478613 title "Epidemiology and morbidity of food-borne trematodiasis in Lao People's Democratic Republic with particular consideration to opisthorchiasis" @default.
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