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    Seasonal proportion of parasites in cases and controls in Sangkhlaburi during study period of October 2001–October 2002.

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    Provinces of Thailand relevant to the discussion and Table 5.

  • 1

    Thapar N, Sanderson IR, 2004. Diarrhoea in children: an interface between developing and developed countries. Lancet 363 :641–653.

  • 2

    Stephenson LS, Latham MC, Ottesen EA, 2000. Malnutrition and parasitic helminth infections. Parasitology 121 :S23–S38.

  • 3

    Ezeamama AE, Friedman JF, Olveda RM, Acosta LP, Kurtis JD, Mor V, McGarvey ST, 2005. Functional significance of low-intensity polyparasite helminth infections in anemia. J Infect Dis 192 :2160–2170.

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  • 4

    Raso G, Luginbühl A, Adjoua CA, Tian-Bi NT, Silué KD, Matthys B, Vounatsou P, Wang Y, Dumas M-E, Holmes E, Singer BH, Tanner M, N’Goran EK, Utzinger J, 2004. Multiple parasite infections and their relationship to self-reported morbidity in a community of rural Côte d’Ivoire. Int J Epidemiol 33 :1092–1102.

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  • 5

    Kanchanaburi Basic Information, 2004. Location. Transp 20 Available at: http://www.thai.net/oard5/agro/kanchanaburi/general.html. Accessed September 20, 2004.

  • 6

    Kellogg JA, Elder CJ, 1999. Justification for use of a single trichrome stain as the sole means for routine detection of intestinal parasites in concentrated stool specimens. J Clin Microbiol 37 :835–837.

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  • 7

    Bronsdon MA, 1984. Rapid dimethyl sulfoxide-modified acid-fast stain of Cryptosporidium oocysts in stool specimens. J Clin Microbiol 19 :952–953.

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  • 8

    National Committee for Clinical Laboratory Standards, 1997. Procedures for the recovery and identification of parasites from the intestinal tract, Vol 17, No 23. M28-A. National Committee for Clinical Laboratory Standards, Wayne, PA.

  • 9

    Srijan A, Wongstitwilairoong B, Pitarangsi C, Serichantalergs O, Fukuda CD, Bodhidatta L, Mason CJ, 2005. Re-evaluation of commercially available enzyme-linked immunosorbent assay for the detection of Giardia lamblia and Cryptosporidium spp from stool specimens. Southeast Asian J Trop Med Public Health 36 (Suppl 4):26–29.

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  • 10

    Janoff EN, Mead PS, Mead JR, Echeverria P, Bodhidatta L, Bhaibulaya M, Sterling CR, Taylor DN, 1990. Endemic Cryptosporidium and Giardia lamblia infections in a Thai orphanage. Am J Trop Med Hyg 43 :248–256.

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  • 11

    Termmathurapoj S, Engkanun K, Naaglor T, Taamsri P, Areekul W, Leelayoova S, Mungthin M, 2000. Cross-sectional study of intestinal protozoan infections in orphans and childcare workers at the Phayathai babies’ home, Bangkok, Thailand. J Trop Med Parasitol 23 :21–27.

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  • 12

    Mungthin M, Suwannasaeng R, Naaglor T, Areekul W, Leelayoova S, 2001. Asymptomatic intestinal microsporidiosis in Thai orphans and child-care workers. Trans R Soc Trop Med Hyg 95 :304–306.

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  • 13

    Saksirisampant W, Nuchprayoon S, Wiwanitkit V, Yenthakam S, Ampavasiri A, 2003. Intestinal parasitic infestations among children in an orphanage in Pathum Thani Province. J Med Assoc Thai 86 (Suppl 2):S263–S270.

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  • 14

    Echeverria P, Taylor DN, Lexsomboon U, Bhaibulaya M, Black-low NR, Tamura K, Sakazaki R, 1989. Case-control study of endemic diarrheal disease in Thai children. J Infect Dis 159 :543–548.

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  • 15

    Chavalittamrong B, Charoenvidhya S, Tuchinda P, Suntornpoch V, Chearskul S, 1978. Prevalence of Giardia lamblia in children attending an out-patient department of Siriraj Hospital. Southeast Asian J Trop Med Public Health 9 :51–54.

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  • 16

    Istre GR, Dunlop TS, Gaspard GB, Hopkins RS, 1984. Waterborne giardiasis at a mountain resort: evidence for acquired immunity. Am J Public Health 74 :602–604.

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  • 17

    Gilman RH, Marquis GS, Miranda E, Vestegui M, Martinez H, 1988. Rapid reinfection by Giardia lamblia after treatment in a hyperendemic third world community. Lancet 13 :343–345.

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  • 18

    Jongwutiwes S, Kraivichian P, Kulkumthorn M, Sitthichareonchai P, Jaroenkorn M, 1990. Cryptosporidiosis among orphanage children in Thailand: a one year prospective study. Southeast Asian J Trop Med Public Health 21 :458–464.

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  • 19

    Chavalittamrong B, Jirapinyo P, 1984. Intestinal parasites in pediatric patients with diarrhoeal diseases in Bangkok. Southeast Asian J Trop Med Public Health 15 :385–388.

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  • 20

    Gilman RH, Brown KH, Visvesvara GS, Mondal G, Greenberg B, Sack RB, Brandt F, Khan MU, 1985. Epidemiology and serology of Giardia lamblia in a developing country: Bangladesh. Trans R Soc Trop Med Hyg 79 :469–473.

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  • 21

    Bunnag T, Klongkamnuankarn K, Thirachandra S, Impand P, Sornmani S, 1982. Seroepidemiology of amoebiasis in the villagers in Phichit Province and urban slum dwellers in Bangkok, Thailand. Southeast Asian J Trop Med Public Health 13 :541–546.

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  • 22

    Sornmani S, Vivatanasesth P, Bunnag T, Intarakhao C, Harinasuta C, 1973. A study on the pattern of socioeconomic and health status in relation to parasitic diseases in the inhabitants around Ubolratana dam in northeast Thailand. Southeast Asian J Trop Public Health 4 :421–434.

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  • 23

    Jongsuksuntigul P. Soil-transmitted helminthiasis control in Thailand. Lecture note presented at ACIPAC international training course on school-based malaria and soil-transmitted helminthiases control for programme managers at the Faculty of Tropical Medicine. Mahidol University, Bangkok, Thailand: October 5, 2001.

  • 24

    Kasuya S, Khamboonruang C, Amano K, Murase T, Araki H, Kato Y, Kumada Y, Koyama A, Higuchi M, Nakamura J, Tomida K, Makino S, 1989. Intestinal parasitic infections among schoolchildren in Chiang Mai, northern Thailand: an analysis of the present situation. J Trop Med Hyg 92 :360–364.

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  • 25

    Waikagul J, Krudsood S, Radomyos P, Radomyos B, Chalemrut K, Jonsuksuntigul P, Kojima S, Looareesuwan S, Thaineau W, 2002. A cross-sectional study of intestinal parasitic infections among schoolchildren in Nan Province, northern Thailand. Southeast Asian J Trop Med Public Health 33 :218–223.

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  • 26

    World Health Organization, 2004. Cambodia protects 75% of children against parasites. Wkly Epidemiol Rec 79 :263–264.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

INTESTINAL PARASITIC INFECTIONS AMONG PRE-SCHOOL CHILDREN IN SANGKHLABURI, THAILAND

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  • 1 Armed Forces Research Institute of Medical Sciences (AFRIMS), Department of Enteric Diseases, Bangkok, Thailand; Kwai River Christian Hospital (KRCH), Sangkhlaburi, Thailand

This study was conducted to investigate the presence of intestinal parasites among pre-school children (aged 3 months to 5 years) in Sangkhlaburi, a rural district in the west of Thailand along the Thai-Myanmar border. Stool specimens were collected from October 2001 through October 2002. A total of 472 pre-school children, 233 males and 239 females, 236 children with diarrhea and 236 asymptomatic children were recruited for the study. Each specimen was processed and examined by direct wet smear, modified acid fast stain, formalin-ethylacetate sedimentation concentration technique, and trichrome stain. In detecting Giardia lamblia and Cryptosporidium species ProSpecT Microplate assays (Alexon-Trend, Lenexa, KS) were performed. There were 107 individuals (22.7%), 41 diarrheal and 66 asymptomatic children, infected with intestinal parasites. The most frequent parasites identified in cases and controls were G. lamblia and Cryptosporidium spp. Eighteen specimens (3.8%) showed mixed parasite infections. Highest proportion of intestinal parasites occurred during the rainy season (June–October).

INTRODUCTION

Three factors that separate the developing world from the developed world are access to safe drinking water, sanitation, and nutrition.1 The most prevalent nutritional deficiency worldwide, and hence a cause of morbidity, is iron-deficiency anemia.2 In a helminth endemic region, a rice-farming village in the Philippines, 507 children, 18 years old and younger, were studied to determine that low-intensity infections, increased severity of polyparasitism infections, and increased number of parasites causing infection all resulted in a greater risk of developing anemia.3 In another rural, helminth endemic region, Côte d’Ivoire, West Africa, researchers identified 500 age diverse study participants to learn the extent of polyparasitism and determine the significance between polyparasitism and self-reported morbidity indicators. Only 10% of this single village population were not infected with any of the intestinal parasites (Schistosoma mansoni, soil-transmitted helminths, and intestinal protozoa—probably under-reported because only single formol-ether processed stool samples were done), 10% had mono-infections (infants and young children mostly), and 75% harbored three or more parasite species concurrently. The authors speculate that polyparasitism is likely the norm rather than the exception in other parts of the developing world also, and proved that increasing numbers of parasites harbored in any one person results in an increase in morbidity indicators.4

Since intestinal parasitic infections are associated with poor socioeconomic class and unsanitary environments, people living in such conditions in rural Thailand are at risk for developing parasitism. Previous intestinal parasite studies undertaken in Thailand have focused on school-age children and older or pre-school orphans living in crowded conditions. Hence, we sought to assess and quantify the extent of parasitic infections and polyparasitism in a symptomatic and asymptomatic pre-school child population. Additionally, we evaluate seasonal prevalence over a year’s time.

MATERIALS AND METHODS

Study area.

Sangkhlaburi, a district in Kanchanaburi province, is about 450 km northwest of Bangkok. Bordering Thailand and Myanmar, Sangkhlaburi averages an annual rainfall of 2359 mm. Most precipitation occurs during the rainy season (June–October). Temperatures range from daily averages of 29°C during the hot season (March–May) to 24°C during the cool months (November–February). During this study period the district’s population was 26,484. The major nationalities living in Sangkhlaburi from highest population to lowest are Karen, Thai, Mon, and Burmese.5

Study site.

This investigation was conducted from October 2001 through October 2002. The center for the study was AFRIMS-Kwai River Christian Clinical Center (AKCC) housed in the Kwai River Christian Hospital (KRCH). The hospital is in Sangkhlaburi district, Nongloo subdistrict, and services six villages. The villages are located within a 9-km radius of AKCC and in addition to the hospital, share a market, three health care centers, and schools.

Enrollment and specimen collection.

A diarrheal stool specimen was collected from 236 children, aged 3 months–5 years, who came to the hospital or one of three nearby health care centers with complaints of diarrhea. All children who met the age criteria and had diarrhea were enrolled as cases. Control specimens matched by the patients’ age (± 3 months) were collected from children who came to the hospital or health care centers for reasons other than diarrhea on the same day or not more than one week after the age-matched case was enrolled. Controls had not experienced diarrhea, vomiting, food poisoning, or gastrointestinal disease for at least 2 weeks and reported no use of antiprotozoal or anti-helminth medications. A total of 472 fresh stool specimens were collected and examined for intestinal parasitic pathogens. With each specimen a consent form was completed by a parent or guardian. Demographics gathered included age, sex, nationality (278 Karen, 113 Thai, 60 Mon, 14 Burmese, 4 Lao, and 3 other), and village name.

Specimen processing and examination.

Stool specimens were processed by mixing one portion stool with three portions preservatives, both 10% buffered formalin and Zinc PVA.6 Saline and iodine wet mount smears of fresh stool were prepared, fixed in absolute methanol for 10 minutes, and air dried before performing DMSO-mAFB staining as described by Bronsdon for the detection of Cryptosporidium and Cyclospora oocysts.7 Iodine wet mounts and DMSO-mAFB smears were prepared from 345 formalin-preserved specimens after performing a formalin-ethylacetate sedimentation concentration; not all 472 specimens were of a quantity sufficient to concentrate. Trichrome stains were performed on stool specimens preserved in Zinc PVA.8 Microscopic examination was performed by a seasoned medical parasitologist with 10 years experience. Two hundred to three hundred oil immersion fields were examined for the presence of ameba, protozoan cysts and trophozoites of flagellates (to include G. lamblia, B. hominis), and soil-transmitted helminth eggs and larvae (to include Ascaris lumbricoides and Trichuris trichiura—both round worms). A portion of 434 stool specimens was kept in a cryogenic vial at −20°C before weekly shipment on dry ice to AFRIMS; not all 472 specimens were available for freezing and further testing due to insufficient quantity. At AFRIMS the 434 samples were thawed and tested for the presence of G. lamblia and Cryptosporidium specific antigens by ProSpecT Giardia/Cryptosporidium Microplate assay, an enzyme immunoassay. All positive samples were then tested by single antigen assays, ProSpecT Giardia Microplate and ProSpecT Cryptosporidium Microplate assays (Alexon-Trend, now Remel, Inc., Lenexa, KS). The previously reported sensitivities of ProSpecT Giardia/Cryptosporidium, Giardia, and Cryptosporidium Microplate assays were 95.5%, 94.9%, and 100%, respectively.9

Statistical methods.

Statistical analysis was performed by using a two-tailed χ2 test. A P value of < 0.05 was considered significant.

RESULTS

From October 2001 through October 2002, stool specimens from a total of 472 pre-school children, 233 males and 239 females, 236 children with diarrhea (cases) and 236 asymptomatic children (controls), were examined for the presence of intestinal parasites by the described methods. There were 107 individuals, 41 cases and 66 controls, infected with intestinal parasites. A statistically significant (P < 0.01) higher proportion was found in control children (27.9%) compared with case children (17.4%). The proportion between males (18.5% and 25.7%) and females (16.1% and 29.9%) was similar in both cases and controls (p = NS), respectively. Children between 2 and 3 years of age had the highest proportion of intestinal parasites compared with the other four age groups in cases; children between 4 and 5 years of age led the control group in highest percentage of intestinal parasites. The youngest age group included in this study, children between 3 months and 1 year of age, showed a statistically significant lower parasitism compared with the other four age groups. The Karen, Thai, Mon, and Burmese children had fractions of 22.5% and 32.2%, 11.9% and 15.2%, 12.1% and 29.6%, and 0 and 25%, in cases and controls, respectively (Table 1). Karen people had a statistically significant higher proportion of intestinal parasites compared with Thai pre-schoolers (P < 0.05) in controls, but not in cases. Amongst the other nationalities, significant differences in parasitism were not observed in controls or cases.

Further analysis of the parasites revealed two species of round worm and four species of protozoan. The parasite detected most frequently in cases and controls was G. lamblia, followed by Cryptosporidium spp. In cases, Cyclospora spp. was the next most frequently identified parasite followed by Ascaris lumbricoides and Blastocystis hominis, whereas in controls, Ascaris lumbricoides identification was followed by Cyclospora spp., Blastocystis hominis, and Trichuris trichiura (Table 2). Eighteen specimens (3.8%) showed mixed parasitic infections (Table 3). Fraction of infection in cases and controls was lowest in the hot season (8.3% and 20%, respectively) and peaked during the rainy season (30.5% and 32.2%, respectively) (Figure 1).

The number of both G. lamblia and Cryptosporidium spp. detected increased significantly with the addition of an enzyme immunoassay technique (three ProSpecT Microplate assays). Of 434 stool specimens screened using ProSpecT Giardia/Cryptosporidium Microplate assay, 99 were positive and hence tested further using the single antigen assays for Giardia and Cryptosporidium. Of 73 tests positive for G. lamblia, 34 were simple smear positive, 40 were microscopy positive after concentration, and 71 (97.3%) were positive by ProSpecT Giardia Microplate assay. Of 16 tests positive for Cryptosporidium spp., 4 were simple smear positive (DMSO-mAFB stain), 5 were microscopy positive after concentration, and 16 (100%) were positive by ProSpecT Cryptosporidium Microplate assay (Table 4). The EIA tests incorporated in this study were easy to use, improved sensitivity of detecting both G. lamblia and Cryptosporidium spp. compared with traditional microscopy, showed no signs of cross-reactivity with other parasites, and reduced labor and capital expenditure costs.

DISCUSSION

Other intestinal parasite studies have been conducted in at least these seven provinces in Thailand–Bangkok, Nonthaburi, Pathum Thani, Phichit, Nan, Khon Kaen, and Chiang Mai—all north of Bangkok (Figure 2 and Table 5). We are unaware of another seasonal study of intestinal parasites taking place in Kanchanaburi province, northwest of Bangkok. The limitation in comparing studies lies in differing study designs, number of stool samples examined, and ova and parasite examination techniques, but factors influencing the prevalence of intestinal parasites are constant. Climate, food and water supplies, personal and community hygiene, sanitation, proximity to domestic and wild animals, and socioeconomic class all play into the likelihood of exposure to intestinal parasites.1

In this study of pre-school children living in Sangkhlaburi, Thailand, we found that 27.9% of asymptomatic controls and 17.4% of symptomatic cases had intestinal parasites (Table 1). We were unable to find another study of asymptomatic and symptomatic age-matched pre-school children living in rural communities in Thailand to compare our overall intestinal parasites detected. Janoff and colleagues found that 17% of asymptomatic pre-school orphans living in an urban Bangkok home had intestinal parasites compared with 15% of symptomatic cases.10 Other studies in Thailand of only institutionalized, asymptomatic children show prevalence of intestinal parasites ranging from 30.8% in an urban setting up to 81.1% in a rural setting.1113 The possibility of a dilutional effect masking the number or presence of parasites detected in children with diarrhea in our study is worthy of consideration.

In the 472 pre-school children studied in our investigation, G. lamblia was the most frequent parasite detected in 87 of 472 (18.4%) cases and controls with significantly greater proportion in asymptomatic controls compared with symptomatic cases, 55 of 236 (23.3%) versus 32 of 236 (13.6%) (P < 0.01) (Table 2). This finding is consistent with results from a study of urban, institutionalized pre-schoolers in which G. lamblia was detected in 18% of asymptomatic controls, and only 2% of symptomatic cases (Table 5).10 By contrast, two other studies conducted in Bangkok found little difference in detection of G. lamblia between children with diarrhea and those without gastrointestinal symptoms. G. lamblia was detected in 2% of symptomatic pre-schoolers and 1.3% of age-matched asymptomatic controls, whereas in another study, G. lamblia was detected in 18.6% of symptomatic children and 18.2% of asymptomatic children.14,15 It is hypothesized that chronic exposure to G. lamblia in places with an unreliable water supply protects persons against parasite-associated symptoms.16 However, evidence suggests that children do not acquire immunity to re-colonization with G. lamblia in highly endemic areas.17

The second most frequently identified intestinal parasite amongst our study population was Cryptosporidium. Cryptosporidium oocysts were detected in 12 asymptomatic controls (2.5%) yet only in four symptomatic children (0.8%). Janoff and colleagues found a similar division between institutionalized, asymptomatic pre-school children with Cryptosporidium (6%) versus symptomatic pre-school children with Cryptosporidium living in the same institution (2%).10 Frequent exposure may have resulted from both water and fecal–oral transmission, and was intensified by crowded living quarters.10 Two groups of investigators in Thailand have reported the reverse—a statistically significant higher percentage of symptomatic children with Cryptosporidium (1.8% and 7.3%, respectively) versus age-matched, asymptomatic children with Cryptosporidium detected in stools (0.3% and none, respectively).14,18

In our study population of children less than 5 years of age, we found the proportion of G. lamblia to be highest in 2–3 year olds in cases and controls. Amongst cases, Cryptosporidium was detected only in 1–2 year olds, whereas in controls the proportion was highest in 4–5 year olds. Other studies designed to detect proportion of intestinal parasites and group participants by age in Thailand have also shown that children are typically infected with G. lamblia and/or Cryptosporidium at 1 year of age and older.1315,19 Although Termmathurapoj and colleagues agree that G. lamblia is more often detected in children older than 1 year of age, they found that the risk of acquiring Cryptosporidium in children living in an orphanage was 2.4 times higher for those younger than 1 year.11 Janoff and colleagues found both Cryptosporidium and G. lamblia were significantly more common in children 2 years or older; the children were living in close quarters.10 While exposure to G. lamblia and Cryptosporidium begins early in life in these communities in Thailand, there are subtle differences in age of infectivity.

No association has been found between positive antibody titers to G. lamblia and Cryptosporidium and positive stool samples, infection, or symptomatic disease in areas where exposure is elevated compared with more developed countries.10,20 Studies in G. lamblia and Cryptosporidium endemic areas, Bangladesh and Thailand, describe serum antibody titers to G. lamblia and Cryptosporidium being acquired at early ages and remaining high across all age groups, but not reliable in determining disease.10,20

Two parasitological studies of age diverse populations in rural Thailand report high percentages of parasites detected, 63% and 69.1%, respectively. Helminths were detected more often than protozoa with Opisthorchis viverrini and hookworm most frequently identified.21,22 In a 2001 national survey of parasitic infections in children and adults conducted by the Department of Communicable Disease Control, Ministry of Public Health/Thailand, helminths ranked 22.3% in prevalence. Hookworm, the most common helminth detected, accounted for 11.3% of the parasitic infections.23 Investigators in northern Thailand reported hookworm as the most frequent parasite detected (26.3%) in a study of primary school children in which the overall percentage of parasites detected was 48.7%.24 We did not identify hookworm in any of the 472 stool samples analyzed, and suspect that decreased exposure in pre-school age children is one explanation.

Mixed parasitic infections are not uncommon amongst children of developing countries. In our study population, G. lamblia was mixed with another parasite in 18 pre-school children, 3.8% of cases and controls. In Nan province where the rate of parasitic infections in school children exceeded the national average, mixed parasitic infections accounted for 33% of all parasitic infections.25 Additionally, Chavalittamrong and colleagues concluded that parasitic infections may increase one’s susceptibility to infection with other intestinal pathogens, bacterial and viral.15,19

We have shown that high temperatures in combination with high rainfall are conducive to acquiring intestinal parasites. The percentage of infected cases and controls peaked during the rainy season, 30.5% and 32.5%, respectively. Jongwutiwes and colleagues made the same observation of Cryptosporidium infection.18 In our study, the lowest percentage of infected cases and controls occurred during the hot season, 8.3% and 20% respectively.

The effects of an intervention can be seen in Cambodia, a neighboring country. As a result of clinical investigations, prevalence plotting, and a committed Ministry of Health, the need to treat Cambodian school-age children against intestinal parasites was identified. The World Health Organization reports that as recent as 5 years ago in 1999, 70% of Cambodian children were infected with intestinal helminths. The impact of these infections could be seen on school attendance, children’s performance in reasoning, reading comprehension, memory, and general health. Improvement was seen in all of these areas when 75% of Cambodian’s nearly three million school age children were treated prophylactically with inexpensive, antihelmintic drugs, such as albendazole, between 2001 and 2004.26 Similarly, a series of parasitologic surveys in Chiang Mai conducted between 1969 and 1989 identified a dramatic decrease in the number of Ascaris cases following improvements in sanitary conditions and introduction of elimination projects to include a Helminthiasis Control Project, a public health education campaign, and easy access to antihelmintics.25

We have identified an at-risk population who could benefit from health education, promotion of good personal hygiene, improvement in sanitation, provision of safe drinking water, and possibly mass treatment. The study of parasitic infections in different populations is necessary to develop effective prevention and control strategies. There continues to be a pressing need for parasitological studies of protozoan and helminth parasites in endemic areas.

Table 1

Number of intestinal parasites for cases and controls grouped by sex, age, and nationality in Sangkhlaburi

No. infected/No. investigated
GroupCasesControls
Sex
    Male23/12428/109
    Female18/11238/127
Age (years)
    3 months–14/849/99
    1–215/9233/82
    2–314/3316/31
    3–44/142/13
    4–54/136/11
Nationality
    Karen29/12948/149
    Thai8/677/46
    Mon4/338/27
    Burmese0/23/12
    Lao0/20/2
    Other0/30/0
Total41/236 (17.4%)66/236 (27.9%)
Table 2

Proportion of intestinal parasites among 472 pre-school children in Sangkhlaburi

No. infected
Intestinal parasitesCases (N = 236)Controls (N = 236)
G. lamblia32 (13.6%)55 (23.3%)
B. hominis21
Cryptosporidium4 (0.8%)12 (2.5%)
Cyclospora35
A. lumbricoides211
T. trichiura01
Total4385
Table 3

Occurrence of mixed intestinal parasite infections in 18 pre-school children in Sangkhlaburi

Intestinal parasites detectedNo. of infections from cases and controls
G. lamblia + B. hominus2
G. lamblia + Cyclospora1
G. lamblia + Cryptosporidium9
G. lamblia + A. lumbricoides5
G. lamblia + A. lumbricoides + T. trichiura1
18 (3.8%)
Table 4

Detection of G. lamblia and Cryptosporidium spp. by simple smear, concentration technique, and EIA Microplate assays (n = 345)

Simple smearConcentration techniqueEIA Microplate assaysTotal detected
G. lamblia34407173
Cryptosporidium451616
Table 5

Summary of intestinal parasite studies in Thailand

StudyProvincePopulationG. lamblia detectedCryptosporidium detected
G. Giardia; E. Entamoeba; B. Blastocystis; BH Babies’ Home; N/A not applicable.
Chavalittamrong et al., 197815Bangkok/urbanChildren in low socioeconomicsAsymptomatic18.18%N/A
Symptomatic18.58%
Chavalittamrong and Jirapinyo, 198419Bangkok/urbanChildren in low socioeconomicsSymptomatic6.1%N/A
Saksirisampant et al., 200313Pathum Thani/ruralPre-school orphansAsymptomatic37.7%None
Mungthin et al., 200112Bangkok/urbanChildren/orphans Phayathai BHAsymptomaticNone7.8%
Childcare workersAsymptomaticNoneNone
Termmathurapoj et al., 200011Bangkok/urbanPre-school children/orphans Phayathai BHAsymptomaticNone12%
Childcare workersAsymptomaticNoneNone
Janoff et al. 199010Bangkok/urbanPre-school children/orphansAsymptomatic18%6%
Symptomatic2%2%
Jongwitiwes et al., 199018Nonthaburi/urbanChildren/orphansAsymptomatic6.4% overallNone
Symptomatic7.3%
Bunnag et al., 198221Phichit/ruralVillage dwellers7%N/A
Bangkok/urbanSlum dwellers10%N/A
Sornmani et al., 197322Khon Kaen/ruralVillage dwellers on periphery of a lake7.2%N/A
Waikagul et al., 200225Nan/ruralSchool children5.3%N/A
Kasuya et al., 198924Chiang Mai/ruralPrimary school children7.7%N/A
Echeverria et al., 198914Bangkok/urbanPre-school childrenAsymptomatic1.3%0.3%
Symptomatic2%1.8%
Boonchai et al., this studyKanchanaburi/ruralPre-school childrenAsymptomatic23.3%2.5%
Symptomatic13.6%0.8%
Figure 1.
Figure 1.

Seasonal proportion of parasites in cases and controls in Sangkhlaburi during study period of October 2001–October 2002.

Citation: The American Journal of Tropical Medicine and Hygiene Am J Trop Med Hyg 76, 2; 10.4269/ajtmh.2007.76.345

Figure 2.
Figure 2.

Provinces of Thailand relevant to the discussion and Table 5.

Citation: The American Journal of Tropical Medicine and Hygiene Am J Trop Med Hyg 76, 2; 10.4269/ajtmh.2007.76.345

*

Address correspondence to Boonchai Wongstitwilairoong, Department of Enteric Diseases, AFRIMS, 315/6 Rajavithi Road, Phyathai, Bangkok 10400 Thailand. E-mail: boonchaiw@afrims.org

Authors’ addresses: Boonchai Wongstitwilairoong, Apichai Srijan, Oralak Serichantalergs, Caroline D. Fukuda, Ladaporn Bodhidatta, and Carl J. Mason, Department of Enteric Diseases, Armed Forces Research Institute of Medical Sciences (AFRIMS), 315/6 Rajavithi Road, Phyathai, Bangkok 10400 Thailand, E-mail: boonchaiw@afrims.org. Philip McDaniel, 275 SW 130th Avenue, Beaverton, OR 97005, E-mail: philmcd@concentric.net.

Acknowledgments: The authors thank the staff at Kwai River Christian Hospital (KRCH) and Armed Forces Research Institute of Medical Sciences (AFRIMS) Department of Enteric Diseases.

Financial support: United States Department of Defense Global Emerging Infections System (GEIS), Washington, DC.

Disclaimer: The opinions, interpretations, conclusions, and recommendations expressed here are those of the authors and not necessarily endorsed by the U.S. Army.

REFERENCES

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    Thapar N, Sanderson IR, 2004. Diarrhoea in children: an interface between developing and developed countries. Lancet 363 :641–653.

  • 2

    Stephenson LS, Latham MC, Ottesen EA, 2000. Malnutrition and parasitic helminth infections. Parasitology 121 :S23–S38.

  • 3

    Ezeamama AE, Friedman JF, Olveda RM, Acosta LP, Kurtis JD, Mor V, McGarvey ST, 2005. Functional significance of low-intensity polyparasite helminth infections in anemia. J Infect Dis 192 :2160–2170.

    • Search Google Scholar
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Author Notes

Reprint requests: Boonchai Wongstitwilairoong, Department of Enteric Diseases, AFRIMS, 315/6 Rajavithi Road, Phyathai, Bangkok 10400 Thailand, Telephone: 66-2-644-4888 extension 2580-1, Fax: 66-2-644-4980, E-mail: boonchaiw@afrims.org.
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