Epidemiologic and clinical characteristics of acute diarrhea with emphasis on Entamoeba histolytica infections in preschool children in an urban slum of Dhaka, Bangladesh

Centre for Health and Population Research, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh.
The American journal of tropical medicine and hygiene (Impact Factor: 2.74). 10/2003; 69(4):398-405.
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ABSTRACT The epidemiology, clinical features, nutritional status, and causative agents of diarrhea were studied in 289 Bangladeshi children (147 boys and 142 girls) 2-5 years old. The use of improved diagnostic tests for amebiasis enabled for the first time analysis of the contribution of Entamoeba histolytica to total diarrheal illness in this community setting. The average incidence rate of diarrhea was 1.8/child-year, and the average number of diarrheal days was 3.7 days/child-year over an average observation period of 2.8 years/child. Seventy-five percent of the diarrheal episodes were < or = 2 days in duration. Persistent diarrhea was relatively uncommon (0.2% of the children) and chronic diarrhea was observed in only one episode. Compared with malnourished and/or stunted children, better-nourished children experienced significantly fewer diarrheal episodes. The diarrheal incidence rate for children with blood group A was significantly less that that of the children with blood groups O and AB. The most frequent bacterial enteropathogens isolated from diarrheal stool specimens were enterotoxigenic Escherichia coli (9%) and Aeromonas species (9%), followed by Plesimonas shigelloides (4%) and Shigella flexneri (3.8%). Rotavirus was the most common viral agent isolated from diarrheal stool samples (5%). Giardia lamblia, Cryptosporidium parvum, and E. histolytica were identified in 11%, 8.4%, and 8%, respectively, of the diarrheal stool specimens. Dysentery was observed in 7.7% of all diarrheal episodes. The most common pathogens isolated from dysenteric stool were S. flexneri (11.6%), Aeromonas sp. (10%), E. histolytica (8.7%), Campylobacter jejunii (5.8%), P. shigelloides (4.3%), and A. caviae (4.3%). The overall incidence rate of E. histolytica-associated diarrhea was 0.08/child-year. Visible blood and hemoccult test-detected blood loss was found in 7% and 25%, respectively, of cases of E. histolytica-associated diarrhea. Children who had recovered from a diarrheal episode with E. histolytica, but not E. dispar, had half the chance of developing subsequent E. histolytica-associated diarrhea, consistent with the development of species-specific acquired immunity. In conclusion, the use of modern diagnostic tests demonstrated that E. histolytica contributed to overall morbidity from diarrheal illness. Understanding the etiology, frequency, and consequences of acute diarrhea in children from a developing country should aid in the design of interventions to improve child health.

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Available from: Rashidul Haque, Mar 19, 2014
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    • "e l s e v i e r . c o m / l o c a t e / i j p a r a Although these conditions could be particularly relevant in regions where amoebiasis is endemic and it is common to find mixed intestinal infections of enteropathogenic bacteria and E. histolytica (Lara et al., 1974; Flores-Abuxapqui et al., 1993; Valdespino-Gomez et al., 1994; Haque et al., 2003; Paniagua et al., 2007), it is not yet clear how the pathogen interplay could modulate and/or modify the expression of virulence of trophozoites and of bacteria. It has been reported that the Gal/GalNAc lectin and the lipophospho-peptidoglycan (LPPG) in the surface of trophozoites are recognised by Toll-like receptors (TLRs) of murine monocytes and macrophages, stimulating production of inflammatory cytokines (Seguin et al., 1995; Kammanadiminti et al., 2004; Maldonado-Bernal et al., 2005). "
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    ABSTRACT: In mixed intestinal infections with Entamoeba histolytica trophozoites and enteropathogenic bacteria, which are wide-spread in areas of endemic amoebiasis, interaction between the pathogens could be an important factor in the occurrence of invasive disease. It has been reported that exposure of human colonic cells to enteropathogenic bacteria increased trophozoite adherence to the cells and their subsequent damage. We report here that the Carbohydrate Recognition Domain (CRD) of the amoebic Gal/GalNAc lectin binds to Toll-like receptors TLR-2 and TLR-4 in human colonic cells, activating the "classic" signalling pathway of these receptors. Activation induced expression of TLR-2 and TLR-4 mRNAs and the mRNAs of pro-inflammatory cytokines, as well as an increase in the corresponding proteins. Direct correlation was observed between the increased expression of TLRs and pro-inflammatory cytokines, the enhanced adhesion of trophozoites to the cells and the inflicted cell damage. When cells were exposed to pathogenic bacteria Staphylococcus aureus (Gram⁺) or Shigella dysenteriae (Gram⁻), elements of an innate immune response were induced. CRD by itself elicited a similar cell response, while exposure to a commensal Escherichia coli had a null effect. Pre-exposure of the cells to pathogenic bacteria and then to CRD rendered an inflammatory-like microenvironment that after addition of trophozoites facilitated greater cell destruction. Our results suggest that CRD is recognised by human colonic cells as a pathogen-associated-molecular-pattern-like molecule and as such can induce the expression of elements of an innate immune response. In the human host, an exacerbated inflammatory environment, derived from pathogen interplay, may be an important factor for development of invasive disease.
    International journal for parasitology 08/2011; 41(10):1101-12. DOI:10.1016/j.ijpara.2011.06.003 · 3.40 Impact Factor
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    • "Haque et al. (2003) reported 11.08% Giardia lamblia infection in 2–5 years old group in Mirpur, an urban slum area in Dhaka. In Bangladesh several studies has been performed to determine the prevalence of Giardia lamblia (Haque et al., 2003; Alam et al., 2011) by direct microscopic examination. Very few researches have been conducted by modern diagnostic techniques like immunofluorescence assay, enzyme-linked immunosorbent assay (ELISA) or polymerase chain reaction (PCR). "
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    ABSTRACT: Giardia lamblia is highly infectious protozoan parasite capable of causing gastrointestinal illness in both humans and animals. The objective of this study was to determine the prevalence of Giardia lamblia infection in children < 5 years old and calves. Enzyme Linked Immunosorbent Assay (ELISA) has been used for the detection of Giardia lamblia. A total of 266 children and 15 calves diarrheic fecal samples were tested for Giardia lamblia during January 2011 to May 2012. The prevalence of Giardia lamblia infection among children was 3.8% while 13.3% in calves. Giardia lamblia was highest in children between 24 and 60 months of age (8.7%). Giardia lamblia infection was higher in male (4.7%) than in female (2.0%). Male calves (14.3%) have slightly higher prevalence than female calves (12.5%). The highest prevalence (33.3%) of Giardia lamblia infection in calves was between the ages 6 and 9 months. This is the first study to determine the prevalence of Giardia lamblia infection in calves using ELISA method in Bangladesh. A larger scale study is needed for accurate estimates of prevalence of Giardia lamblia to undertake an appropriate control strategy in future.
    01/2011; 9:177-182. DOI:10.3329/bjvm.v9i2.13474
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    • "Also, in other endemic areas such as Bangladesh, the intestinal invasive form of amebiasis (dysentery) is more prevalent and the risk group is preschool children (2.2%). In the same age group, bacterial dysentery (shigellosis) is 5.3% (Haque et al., 2003). There are differences in morbidity due to intestinal invasive amebiasis and amebic liver abscess in different endemic areas. "
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    ABSTRACT: The epidemiology of amebiasis has dramatically changed since the separation of Entamoeba histolytica and Entamoeba dispar species, and the worldwide prevalence of these species has not been estimated until recently. The most cited data regarding prevalence, morbidity, or mortality due to amebiasis is the 1986 Walsh report, in which 100,000 deaths are reported to occur worldwide each year due to medical complications of invasive amebiasis. However, the prevalence values of Entamoeba histolytica infection could be completely erroneous since the estimations were performed prior to the molecular characterization of E. histolytica and E. dispar species. Moreover, Entamoeba moshkovskii, another morphologically indistinguishable human parasitic Entamoeba, was not mentioned or considered as a contributor to the prevalence figures in endemic areas. However, recent available prevalence and morbidity data obtained through molecular techniques allow the construction of a more reliable map of endemic regions of amebiasis all over the world [the Asian subcontinent (India, Bangladesh), Africa, Asian Pacific Countries (Thailand, Japan), South and Central America (Mexico, Colombia)]. The epidemiology of infectious diseases focuses on identification of factors that determine disease distribution in time and space, transmission factors responsible for the disease, clinical manifestations, and progression in the host, with the goal being the design of realistic intervention and prevention strategies in a reasonable period of time. In the present review, we will describe how molecular tools have made actual knowledge regarding the epidemiology of amebiasis possible. We will also analyze the most relevant available data on prevalence, morbidity, geographic distribution, patterns of transmission, exposure, and risk factors for infection in the human host. Our intention is to emphasize the recent molecular typing methods applied in genotyping Entamoeba species and strains, and to assess their value and limitations. Finally, we will discuss those areas of the host-parasite relationship that are still not fully understood, and the scientific challenges to approach this important public health problem in the future.
    Infection, genetics and evolution: journal of molecular epidemiology and evolutionary genetics in infectious diseases 07/2009; 9(6):1023-32. DOI:10.1016/j.meegid.2009.06.008 · 3.26 Impact Factor
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