Endoparasitic infections of gastrointestinal tract in people often run as opportunistic infections, coinciding with other contagious diseases (TB, HIV), and they are a common cause of morbidity as well as mortality of patients and globally belong among the most common infections in the human population.
The occurrence of intestinal parasitic infections is influenced by a lot of factors, such as environmental, socio-economic, labour, health and other (Kumar
Globally, more than 1.5 billion people (24 % of the world’s population) are infected with parasitic infections caused by soil-borne helminths, including
A fairly good indicator of the population load with endoparasitoses is the data on the contamination of urban waste water in the region observed. Examination of urban waste water and sludge from five monitored wastewater treatment plants (WWTP) in the eastern Slovakia, revealed the total positivity of samples P = 35.87 %. In 11.09 % of the samples the oo(cysts) protozoa, and helminth eggs in 20.87 % were recorded. In the raw municipal wastewater only germs of
Giardiasis was recorded in Europe in paediatric and adult populations in Albania (P = 11 %) and Turkey (P = 8 %) and in children in Poland (P = 1 %). In the southern Europe vector-borne zoonoses including leishmaniasis and Chagas’ disease appeared. The risk populations include the Roma population, some groups of immigrants. The main group of helminthic infections in Europe includes soil-transmitted helminthiases as well as alimentary helminthiases and cestodes. Most of these infections occur in the eastern Europe and Turkey. The most common soil-transmitted infections include ascariasis and trichuriasis with prevailing occurrence in children and adults living in the southeastern Europe, Albania (ascariasis P = 1 %, trichuriasis P = 12 %), Armenia (ascariasis P = 4 %, trichuriasis P = 1 %), and in the paediatric population in Poland (ascariasis P = 1 – 15 %, trichuriasis P < 1 – 8 %). The highest prevalence of ascariasis (P = 69 %) and trichuriasis (P = 65 %) was published in Turkey in paediatric and adult populations. Enterobiasis incidence was recorded in the eastern Europe (reported in Poland P = 2 – 40 % in adults and children), Turkey (P= 5-10 % in children) and it is present in Italy (P = 13 % in children) (Hotez & Gurwith, 2011). Slovakia, with its population of 5,423,800.5 is divided into three areas. The west Slovakia including Bratislava, Trnava, Trenčín and Nitra regions has 2,462,723 residents, the middle Slovakia Žilina, Banská Bystrica regions 1,344,633 inhabitants and the eastern Slovakia Prešov and Košice 1,616,444.5 inhabitants. The Epidemiological Information System (EPIS) of the Public Health Authority in Slovak Republic serving for monitoring of the current epide-miological situation of infectious diseases in the human population in Slovakia does not include official information on the incidence of endoparasitic diseases with exception of toxoplasmosis and taeniosis, and annual maps of regional incidence of helminthiasis and taeniosis (Statistical Office, 2015).
The presented epidemiological study on the prevalence of endoparasitic infections belongs among the largest within the last decade that have been carried out in the territory of Slovakia.
In total, the presence of endoparasites was examined in 2,760 people – 1,173 male and 1,587 female from the three regions of Slovakia (Western, Central and Eastern Slovakia). The set analysed was divided into three age groups, the first group (age 1 month – 7 years), the second group (age 8 – 18 years), and the third group (age 19 – 88 years). The formalin-ether sedimentation method was used for the examination of stool samples for the presence of protozoan cysts and oocysts (Ritchie, 1948, modified). Detection of helminth eggs was carried out by the concentration ovoscopic method using the diagnostic sets Paraprep L-Faecal Parasite Concentrator (Diamondal, France). Subsequently, the samples were examined microscopically. For comparison of age, regions, sex groups and statistical evaluation of the results, the chi-square test (χ2) was used employing the SPSS programme.
By the examination of 2,760 stool samples in the human population investigated, we found the total prevalence of gastrointestinal parasitoses P = 6.81 %. The prevalence of protozoan infections was P = 2.64 %, and helminthic infections, P = 4.17 % (Table 1). Out of the protozoa the species
Prevalence (P) of gastrointestinal parasitoses In the populations from selected regions of Slovakia
Parasites | n/2760 | P (%) |
---|---|---|
Protozoa | 73 | 2.64 |
Helminths | 115 | 4.17 |
Negative finding | 2572 | 0 |
n – number of positive samples; P – prevalence
Species representation of endoparasites in positive samples of stool
Parasites | n/2760 | P (%) |
---|---|---|
22 | 0.79 | |
20 | 0.72 | |
18 | 0.65 | |
16 | 0.58 | |
103 | 3.73 | |
22 | 0.79 | |
6 | 0.22 |
n – number of positive samples; P – prevalence
In six cases we recorded co-infection with
Occurrence of co-infections of endoparasitic species
Co-infections | n/2760 | P (%) |
---|---|---|
6 | 0.22 | |
1 | 0.04 | |
1 | 0.04 | |
5 | 0.18 | |
2 | 0.07 | |
1 | 0.04 | |
5 | 0.18 | |
2 | 0.07 | |
1 | 0.04 | |
6 | 0.22 | |
1 | 0.04 |
n – number of positive samples; P – prevalence
The prevalence of protozoan infections was higher in females (P = 2.90 %) than that in males (P = 2.30 %), with the highest incidence of
Prevalence (P) of gastrointestinal parasitoses according to sex, age categories and region
Sex | Protozoa | Helminths | ||||
---|---|---|---|---|---|---|
n/2760 | P (%) | X2 | n/2760 | P (%) | X2 | |
Male (N=1173) | 27 | 2.30 | 58 | 4.94 | ||
Female (N=1587) | 46 | 2.90 | p=0.33408 | 57 | 3.59 | p=0.07872 |
1 m–7 years (N=1267) | 31 | 2.45 | 74 | 5.84 | ||
8–18 years (N=733) | 24 | 3.27 | p=0.46157 | 34 | 4.64 | p≤0.0001 p ≤ 0.001 |
19–88 years (N=760) | 18 | 2.37 | 7 | 0.92 | ||
Western Slovakia (N=529) | 5 | 0.95 | 3 | 0.57 | ||
Central Slovakia (N=70) | 1 | 1.43 | p=0.01760 p ≤ 0.01 | 0 | - | p≤0.0001 p ≤ 0.001 |
Eastern Slovakia (N=2161) | 67 | 3.10 | 112 | 5.18 |
n – number of examined samples; n – number of positive samples; P – prevalence; X2- chi square test, p – value; Significance level: * p ≤ 0.05
The highest prevalence of protozoan infections (P = 3.27 %) was found in the age group 8 – 18 yearly and helminthic infections (P = 5.84 %) in the lowest age group of children at the age of 1 month to 7 years. In 8 – 18 years old, the most common types of the protozoa were confirmed
The lowest prevalence of protozoan infections (P = 2.37 %) and helminthiasis (P = 0.92 %) was recorded in the age category of 19 – 88 years old, with the most frequently confirmed species
The highest positivity for the presence of gastrointestinal parasite germs was found in the population living in the eastern Slovakia (n = 179 /N = 2760) (Fig. 4). According to number of samples examined, we can compare the real locations in eastern and western Slovakia, but the results from Central Slovakia is rather an indicative, due to the low number of samples examined. The statistical significance of differences was found in the incidence protozoan infections (χ2, p< 0.01) and also helminthiases (χ2, p< 0.0001) between the compared regions of Slovakia.
Endoparasitic infections of gastrointestinal tract have a worldwide distribution. The most frequent outbreaks of protozoan infections are associated with the infections with
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In the human population examined by us the prevalence of protozoan infections P = 2.64 % was found, with the highest prevalence of
The stool examination in this study revealed the prevalence of helminthic infections P = 4.17 %. The identified species were
The incidence of infection with
Slight infection runs often asymptomatically, while serious infections tend to lead to acute abdominal pain and ileus from the small bowel mechanical obstruction, especially in children (Bundy & Brooker, 2014). In endemic countries, intestinal ascariasis is also a common cause of the diseases of liver, biliary tract, and pancreas, including possible acute pancreatitis and cholecystitis that result from larval migration through tissues. Abdominal ultrasonography, tomography, and magnetic resonance imaging can identify the cause of the difficulties (Das, 2014). In endemic countries, ascariasis is a common cause of malabsorption syndrome, malnutrition, and lack of trace elements can lead to the failure of growth, cognitive disorders as well as to the defective immune regulations and increased risk of other infections (Lamberton and Jourdan, 2015). The prevalence of ascariasis is directly proportional to the density of population in the region, the level of education, health protection measures with regard to wastewater management, droppings as fertilizer use, personal hygiene, available health care, socio-economic status of the country (Das, 2014). Mortality due to the diseases caused by soil-borne helminths, including ascariasis, trichuriasis is most reported due to severe infections with
Within the developmental cycle of
Of the helminthic infections our evaluation revealed the presence of eggs of
Enterobiosis is equally widespread global disease, especially in the countries in temperate zones. The most commonly infected are children. The estimated prevalence in the paediatric population in the various regions of the world is from 4 to 28 % (Dori
By the comparison of the three regions of Slovakia (western, middle and eastern Slovakia), we found that the prevalence of endoparasitoses was significantly higher in the eastern Slovakia, despite the imbalance in the number of examined samples. Transmission and dissemination of the endoparasitoses is the result of poor hygiene and lack of water infrastructure. The rural communities are particularly endangered whose water resources are extracted from surface water that may be contaminated also with germs of endoparasites. The periods of heavy rain may be particularly important in terms of contamination of water resources by faeces due to lacking of sewerage system of households. Parasitic infections ongoing also in chronic form, weakening the organism as well as related bacterial, fungal, and viral infections affect hundreds of millions of people living in low- and middle-in-come countries. In Europe, these diseases occur especially in the eastern and southern Europe and in Turkey, where the standard of living and economic level is the lowest (Hotez and Gurwith, 2011). Up to 165 million people in Europe (more than 20 % of the population) live below the poverty line and about 2 % of the European population lives in absolute poverty. This has a significant impact on the incidence and prevalence of parasitic diseases. It is especially a case of the countries located in the southeastern Europe, including the Balkan nations, Albania, Bosnia and Herzegovina, Bulgaria, Croatia, Kosovo, Macedonia, Montenegro, Serbia, Romania as well as Turkey that in Europe are considered to be the poorest nations. The second group of nations characterised by extreme poverty includes some of the former Soviet bloc countries in Europe, i.e Belarus, Azerbaijan, Ukraine, Georgia and Moldova (Stuckler
In Europe some populations require attention because of their susceptibility to high rates of infection. One of them is the Roma population in which it is estimated that 7 – 9,000,000 Roma currently live in the central and eastern Europe, with the largest number in Romania, Bulgaria, then in Macedonia and Slovakia, where they represent over 8 % of the population. 70 % to 80 % of Roma in Bulgaria and Romania live in poverty, where they survive in conditions of non-standard housing, poor hygiene and suffer from malnutrition. Their exposure to intestinal parasitic diseases, bacterial and viral diseases is very high. The high incidence of giardiasis, shigellosis, salmonellosis and hepatitis, as well as respiratory and ectoparasitic diseases, in particular of pediculosis was recorded (Rechel
Similar situation is in Slovakia, there are over 1,000 Roma Settlements. Around 150,000 Roma live in segregated places which are unfit for living. Particularly access to safe drinking water have a negative impact on the incidence of infectious diseases (Rimárová, 2010). In Europe the next population at risk is immigrant populations, including migrants from Africa, in which to a high degree occur so-called “neglected infections “, as well as orphans intended for international adoption (Norman
Stool examination of hospitalised paediatric patients with respiratory diseases in Slovakia (recurrent and chronic bronchitis, bronchial asthma, contact TBC, active TBC, rhinopharyngitis, bronchitis, pneumonitis, cystic fibrosis, fluidothorax, pleuropneumonia) revealed overall prevalence endoparasitoses P = 19.85 %; the prevalence of helminthic infections was P = 7.35 %. There were represented
Similarly, in cancer patients has been recorded incidence of opportunistic endoparasitic infections. The National Cancer Institute in Bratislava, for the last ten years recorded a continuous increase in cancer both in pediatric and adult population in Slovakia. From the above, it is important to monitor the interaction between the primary disease (e.g. respiratory, infectious, oncologic) and endoparasitoses (protozoan infections and helminthoses) which attack the immune system (Communication from Jurišová, 2016 and National Cancer Registry of the Slovak Republic, 2016).
Examinations of 2,760 faecal samples revealed the current epidemiological situation in the incidence of gastrointestinal parasitoses in the population in Slovakia. The total prevalence of gastrointestinal parasitoses P = 6.81 % was found, the prevalence of protozoan infections was P = 2.64 %, and helminthic infections P = 4.17 %. To reduce the risk of endoparasitosis spreading in the human population it is necessary to improve the personal hygiene, including environmental hygiene, sanitation, proper disposal and manipulation with urban waste water. Epidemiologically important is the protection of drinking water sources, health education and health care. This must also include proper diagnosis and subsequent effective therapy of endoparasitic infections in order to reduce the load (contamination) of the environment with the germs of these diseases, and prevent their transmission and spreading especially in the risk economically and socially underdeveloped regions, particularly of the eastern Slovakia.