Report about the most common parasite In Gaza StripPrepared by :Mohammed Adnan Qazzaz
Gaza Strip is a narrowzone of land (360 km2)situated on thesoutheastern corner ofthe MediterraneanSea. It is bordered onthe south by Egypt, onthe west by theMediterranean, on theeast by Negev desertand on the north bythe green line. Overone million inhabitantslive in Gaza Strip.
In order to monitor changes in the frequency ofintestinal parasites, the records of 8,417 stoolspecimens of patients attending the Ahli ArabHospital in the Gaza city in the period 1995-2000were reviewed and analyzed. Of these 2,506(29.77%) were positive.
Although 9 different parasites were encountered, themost common pathogenic parasites identified were:Entamoeba histolytica (70.19%), Ascaris lumbricoides(14.64%), and Giardia lamblia (10.34%). The other parasitespresent were: Trichuris trichiura , Hymenolepis nana, Enterobius vermicularis, Strongyloides, stercolaris, Taenia saginata , and Echinococcusgranulosus. The overall monthly
incidence of parasites did not show clear seasonalpatterns.The prevalence of intestinal parasites has droppedsignificantly over the reviewed years from 36.35% in1995 to 21.20% in 2000. This decline in prevalencereflects the continuing efforts of the public healthauthorities to improve primary health care, water supplyservices and sanitation conditions..
The hospital records of 8,417 stool specimens wereanalyzed. The annual distribution of the specimens andthe percentage of specimens containing parasites arepresented in Table 1. The overall prevalence of parasiteswas 29.77%. As can be seen from the table the overallfrequency of parasites has decreased from 36.35% inthe year 1995 to 21.20% in the year 2000
Table 1. Overall distribution of tested stool specimens andpositive cases of intestinal parasites at the Ahli Arab hospital
The numbers and types of parasites seen over the sixyears are shown in Table 2. The most common parasitesidentified were; E. histolytica , A. lumbricoides andG. lamblia . The same table also shows that changeshave occurred in the types of parasites over thereviewed years. In general, E.histolytica was the mostcommonly isolated parasite and represented aroundthree quarters of all parasites throughout theinvestigated years. Moreover, E. histolytica was the onlyparasite that showed consistent and significant annualincrease.
Most of the remaining identifiedparasites, however, showed a significant decrease. Forinstance, A. lumbricoides and G. lamblia which wererespectively responsible for 14.56% and 12.30% ofparasitosis in the year 1995 became numerically less inthe year 2000 and represented only 9.22% and 8.53% ofthe positive specimens, respectively. T. saginata and E.garanulosus remained uncommon parasites in Gaza andonly 2 cases of each were recorded in the whole studyperiod.
distribution of the recovered parasites over the six years isillustrated in the figure below :Generally the percentage of positive specimens per month didnot deviate from the yearly overall percentage. Additionally,there was no apparent seasonal variation for any of the recordedparasites. The monthly
The most commone parasite in Gaza Strip :Gardia lambliaEntamoeba hostolyticaOientamoeba fragilisBlastocystic hominisEntamoeba coliEndolimax nanaAscaris lumbricoidesEntrobius vermicularisChilomastix mesuiniTrichuris trichiuraCryptosporidium parvumStrongyloides stercoralisTaenia saginataHymenolopis nana
Entamoeba hostolytica and Entamoeba coli:Most physicians in Gaza prescribe medicaments for patientssuffering from Entamoeba histolytica/dispar without parasitologicdiagnosis. Additionally, stool analysis performed by the routinemethods usually reports the species as E. histolytica without con-firmation. In this study, 92 stool specimens were collected andanalyzed by wet mount, iron haematoxylin staining, antigendetection of E. histolytica and polymerase chain reaction (PCR).The total number of E. histolytica identified by PCR was 64
(69.6%) that of E. dispar was 21 (22.8%). Mixed infection withboth E. histolytica and E. dispar was evident in 7 specimens(7.6%). In the light of these results approximately 30% ofsuspected clinical amoebiasis cases were negative for E.histolytica. It is recommended to use PCR for diagnosis of stoolspecimens from patients with E. histolytica/dispar and thattreatment should be prescribed for only patients positive for E.
Gardia lamblia :Giardia lamblia (synonymous with Lambliaintestinalis and Giardia duodenalis) is a flagellatedprotozoan parasite that colonises and reproduces in the smallintestine, causing giardiasis its most common in Khan Yuins Cityand it cause 12.30% of parasitic infection in Gaza strip .
Dientamoeba fragilis :Some cases are reported in Gaza strip but its not so common .Blastocystic hominis :Some cases are reported in Gaza strip but its not so common .this protozoa is not always pathogen .
Endolimax nana :Its intestinal protozoa . Originally thought to be non-pathogenic,studies suggest it can cause intermittent or chronicdiarrhea.Additionally, it is very significant in medicine because itcan provide false positives for other tests, notably the similarspecies Entamoeba histolytica, the pathogenresponsible foramoebic dysentery, and because its presence indicates the hosthas consumed fecal material. It forms cysts with four nucleiwhich excyst in the body and become trophozoites. Endolimaxnana nuclei have a large endosome somewhat off-center andsmall amounts of visible chromatin or none at all.
Ascaris lumbricoides :Ascaris lumbricoides is the giant roundworm ofhumans, belonging to the phylumNematoda. An ascarid nematode, it is responsible for thedisease ascariasis in humans, and it is the largest andmost common parasitic worm in humans. A quarter ofthe human population is estimated to be infected bythis parasite. Ascariasis is prevalent worldwide andmore so in tropical and subtropical countries.Here in Gaza it cause 9.5% of protozoal infestation andits common in children more than the adult and itsreported in almost all the cites in Gaza Strip .
Entrobius vermicularis :It’s the most common helminthes that infect child inGaza Strip and its very easy to be diagnosed . any itchingin the anus region of a child in Gaza strip is referred toEntrobius worms . and its cause 38.6%, of the parasiteinfestation in Gaza .
Trichuris trichiura :Its common in Gaza valley region and it cause 7.3% ofthe helminthal infestation in Gaza Strip .
Strongyloides stercoralis :It cause 11.0% of helminthal infestation in Gaza strip
A study in Gaza valley region shows that :in Gaza Valley, out of 352 children surveyed, 265 (75.28%) were positive forintestinal helminths. Prevalence of Ascaris lumbricoides was 71.87%, followedbyTrichuris trichiura (26.42%), Enterobius vermicularis (13.92%) and . Singlespecies infection was seen in 38.63% of the infected children, whereas 36.64%were infected with multiple species of helminth parasites. The prevalence ofinfection peaked in the age group of 11-15 years (84.91%) followed by the agegroup of 6-10 years (81.70%) and age group of 0-5 years (50.54%) .Thedifferences in prevalence rates between male, female and rural urban childrenwas insignificant .Water source, defecation site, personal hygiene and maternaleducation were significant risk factors in predicting the intestinal helminthinfection.
Conclusion :The present study reveals that intestinal helminths areabundant among schoolchildren of Gaza valley. Thissituation strongly calls for the institution of controlmeasures, including treatment of infectedindividuals, improvement of sanitationpractices, provision of clean water and further studieson the abundance of intestinal protozoan infections inthe children of Gaza valley. The impact of eachmeasure would be maximized through a healtheducation program directed at schoolchildren andtheir mothers in particular, and to communities ingeneral.
Taenia saginata :This is the beef tape worm and it is not so common in Gaza butsome cases were reported . produces only mild abdominalsymptoms .
Hymenolopis nana :Dwarf tapeworm it cause 4.1% of helminthal infestation .
Cryptosporidium parvum :This one most of the infections is asymptomatic . however Insome people "often immuniocompromised " can cause severdiarrhea . And 6.6% of tested people were positive for it .
Final Conclusion :The highest incidence rate in proportion to the totalnumber of investigated samples was recorded in Jabaliaarea 17.0% followed by Deir el balaharea 16.6%, Beithanoun 15.6% and Gaza town 14.0%. The infection ratewas higher in younger age group (6- 9 years) in whichseveral of pupils reported variable symptoms likeabdominal pain, cramps, weight loss, diarrhea, andanorexia. The rate of infection was higher in childrenfrom overcrowded areas, rural areas, low incomefamilies and it was reported more in male than femalepupils.
The worst parasite in Gaza and in whole Palestine is the Israeli occupation Freedom for Gaza . Freedom For whole Palestine
Treatment of some protozoa and helminthes Drugs for treatment of protozoal infection Organism Drug Of Choice Other Drugs Tetracycline,500mg 4 times Iodoquinol, 650mg 3time daily for 10 days Dientamoeba fragilis daily for 20 days Paromoycin,500 mg 3 times daily for 7 days Nifurtimox Trypanosome Cruzi Or benznidizol Hemolymphatic Suramin Pentamidine Or EflonithineTrypanosome Brucei Advanced CNS Melarsoprol Eflonithine disease Furazolidone, 100 mg 4 Metronidazol, 250mg3 times daily for 7 days times Gardia Lamblia Or Or Albendazole ,400 mg daily dailyfor 5 days Tinidazole for 5 days Tetracycline , 500 mg 4 Metronidazol 750,mg 3 Blantidium coli times daily for 10 daily times daily for 5 days
Paromoycin,500-750 mg 3 times Azithromycin, 500 mg daily for Cryptosporidium species daily for 10 days 21day Metronidazol, 2 gonce or 250 mg 3 times daily for 7days Trichomonas vaginalis Or Tinidazole , 2 g once Visceral Meglumine antimonite Or Sodium stibogluconate , 20 mg IV Pentamidine Mucosal or IM for 28 day Or Amphotericine BLishmaniasis Meglumine antimonite Or Sodium stibogluconate , 20 mg IV Ctaneous Pentamidine or IM for 20 day Or Ketoconazole
Drugs for treatment of helminthic infection : Drugs For Treatment Trematodes Organism Drug Of Choice Other Drugs Haematobium Schistosoma mansoni praziquantel metrifonate japonicum Bithionol Fasciola hepatica triclabendazole Praziquantel or Fasciolopsis buski niclosamide Clonorchis sinensis praziquantel Albendazole Paragonimus westermani praziquantel Bithionol
Drugs For Treatment cestodes Organism Drug Of Choice Other DrugsDiphyllobothrium latem Praziquantel or niclosamide Taenia solium Praziquantel or niclosamide Taenia saginata Praziquantel or niclosamide mebandazole Hymenolepis nana Praziquantel niclosamideEchinococcus granulosus Albendazole
Drugs For Treatment Nematodes Organism Drug Of Choice Other Drugs Entrobius vermocularis Mebandazole . pyrantel pamoate AlbendazoleNactor amiericanus. ancyostoma pyrantel pamoate Albendazole Mebandazole Wuchereria bancrofti diethylcabamazine invermectin Loa loa diethylcabamazine invermectin Brugia malayi diethylcabamazine invermectin Trichuris trichiura Albendazole oxantel/pyrantel pamoate Mebandazole Strongyloides stercoralis invermectin Albendazole thiabendazole Ascaris lumbricoides Albendazole piperazine pyrantel pamoate Mebandazole
Treatment of AmebiasisAsymptomatic intestinal infection :Drug of choice :Lumina agent :Diloxanide Furoate 500 mg 3 times daily for 10 days .Iodoquinol , 650 mg 3 times daily for 21 days .Promomycine , 10 mg /kg 3 times daily for 7 days .Mild to moderate intestinal infection : Drug of choice :Metronidazol, 750mg 3 times daily (or 500 mg IV every 6 hours) for 10 daysTinidazole . 2g daily for 3 days .Other drugs :Lumina agent :Diloxanide Furoate 500 mg 3 times daily for 10 days .Tetracycline,250mg 3 times daily for 10 days
Severe intestinal infection : Drug of choice :Metronidazol, 750mg 3 times daily (or 500 mg IV every 6 hours) for 10 daysTinidazole . 2g daily for 3 days .Other drugs :Lumina agent :Diloxanide Furoate 500 mg 3 times daily for 10 days .Tetracycline,250mg 3 times daily for 10 daysHepatic abscess . ameboma and lung abscess : Drug of choice :Metronidazol, 750mg 3 times daily (or 500 mg IV every 6 hours) for 10 daysTinidazole . 2g daily for 3 days .Other drugs :Dehydrometine or emerine ,1 mg /kg SC or IM for 8-10 days , followed by ( liver abscessonly ) chloroquine , 500 mg twice daily then 500 mg daily for 21Lumina agent :Diloxanide Furoate 500 mg 3 times daily for 10 days .Tetracycline,250mg 3 times daily for 10 days