J. G. Esteban

The Northern Bolivian Altiplano: a region highly endemic for human fascioliasis.

SummaryThe worldwide importance of human infection by Fasciola hepatica has been recognized in recent years. The endemic region between Lake Titicaca and the valley of La Paz, Bolivia, at 3800–4100 m altitude, presents the highest prevalences and intensities recorded. Large geographical studies involving Lymnaea truncatula snails (malacological, physico‐chemical, and botanic studies of 59, 28 and 30 water bodies, respectively, inhabited by lymnaeids; environmental mean temperature studies covering a 40‐year period), livestock (5491 cattle) and human coprological surveys (2723 subjects, 2521 of whom were school children) were conducted during 1991–97 to establish the boundaries and distributional characteristics of this endemic Northern Altiplano region. The endemic area covers part of the Los Andes, Ingavi, Omasuyos and Murillo provinces of the La Paz Department. The human endemic zone is stable, isolated and apparently fixed in its present outline, the boundaries being marked by geographical, climatic and soil‐water chemical characteristics. The parasite distribution is irregular in the endemic area, the transmission foci being patchily distributed and linked to the presence of appropriate water bodies. Prevalences in school children are related to snail population distribution and extent. Altiplanic lymnaeids mainly inhabit permanent water bodies, which enables parasite transmission during the whole year. A confluence of several factors mitigates the negative effects of the high altitude.

High endemicity of human fascioliasis between Lake Titicaca and La Paz valley, Bolivia

Over a 6-year period, an epidemiological study of human infection by Fasciola hepatica in the Northern Bolivian Altiplano was carried out. Prevalences and intensities were analysed from coprological results obtained in 31 surveys performed in 24 localities and proved to be the highest known so far. The global prevalence was 15.4%, with local prevalences ranging from 0% to 68.2%. Significant differences between prevalence rates were detected and the highest prevalences were in subjects aged < 20 years. However, prevalences showed no gender difference. The global intensity (eggs per gram of faeces, epg) ranged from 24 to 5064 epg and showed arithmetic and geometric means respectively of 446 and 191 epg, with highest local arithmetic and geometric means of 1345 and 678 epg. Significant differences in mean egg output were detected between localities. The significantly higher F. hepatica egg counts shown by girls in school surveys is worth mentioning. Although the distributions of intensities according to age-groups did not show any significant difference, a decrease of egg output counts with an increase of age was detected. It is concluded that fascioliasis is a very important human health problem in this region.

Presence of very high prevalence and intensity of infection with Fasciola hepatica among Aymara children from the Northern Bolivian Altiplano

Coprological studies of school children from four communities in the Northern Bolivian Altiplano were carried out in order to estimate the prevalences and intensities of Fasciola hepatica infection. Single stool specimens were collected at random from 558 school children (308 boys and 250 girls) aged 5-19 years old. Nineteen different parasite species (13 protozoan and six helminths) were detected. Of the children examined, 98.7% (96.5-100%) presented infection with at least one parasite species. The mean prevalence of 27.6% by Fasciola hepatica (range, 5.9-38.2%) was the highest not only with respect to the helminth species found in the Northern Bolivian Altiplano but also among the fasciolosis prevalences reported in children in other parts of the world to date. Prevalences were significantly different among the communities surveyed and was significantly higher in the 9-12 years age group. There were, however, no significant differences between sexes. Among the 154 children presenting F. hepatica eggs in stools, intensities ranged from 24-5064 eggs per gram of faeces (epg), with arithmetic and geometric means of 474 and 201 epg, respectively. Significant differences in mean egg output were detected between communities, sexes and age groups. Individual fasciolosis infections coexisting with other pathogenic parasite species (Entamoeba histolytica and/or E. dispar, Giardia intestinalis, Balantidium coli, Dientamoeba fragilis, Cryptosporidium sp., Hymenolepis nana, Taenia spp., Trichuris trichiura, Ascaris lumbricoides and Enterobius vermicularis) were detected. A significant positive association with F. hepatica was only found in the case of G. intestinalis. This coprological study not only verifies the existence of high prevalences of F. hepatica among humans in the Northern Bolivian Altiplano, but also demonstrates the need to expand the Southern boundaries of this high endemic zone to include the Southeastern region of Lake Titicaca.

A population‐based coprological study of human fascioliasis in a hyperendemic area of the Bolivian Altiplano

The community of Chijipata Alta, at an altitude of 3850 m, near the southern coast of Lake Titicaca in the Northern Altiplano of Bolivia, was surveyed for human fascioliasis. The global prevalence (66.7%) and intensity (eggs per gram of faeces – epg: range: 24–4440; arithmetic mean: 1001; geometric mean: 390) proved to be the highest known in the world by means of coprological techniques. These results suggest the existence of highly hyperendemic subzones among the large human fascioliasis‐endemic zone of the Bolivian Northern Altiplano. Despite the decrease in prevalence and intensity from children (75.0%, 24–4440 epg) to adults (41.7%, 144–864 epg), our findings show that in an hyperendemic zone adult subjects either maintain the parasites acquired when young or are newly infected as the consequence of inhabiting a zone of high infection risk.

Immunology and pathology of intestinal trematodes in their definitive hosts.

This review examines the significant literature on the immunology and pathology of intestinal trematodes in their definitive hosts. We emphasize information on selected species in six families for which the literature on these topics is extensive. The families are Brachylaimidae, Diplostomidae, Echinostomatidae, Gymnophallidae, Heterophyidae, and Paramphistomidae. For most of these families, coverage is considered under the following headings: (i) background; (ii) pathology of the infection; (iii) immunology of the infection; (iv) immunodiagnosis; and (v) human infection. Some of these heading have been subdivided further, based on the literature available on a particular topic. Following this coverage, we include a final section on the important topical literature on selected trematodes in families other than the six mentioned above.

Analysis of climatic data and forecast indices for human fascioliasis at very high altitude

Human infection with Fasciola hepatica has recently been recognized as an important health problem worldwide, and particularly at very high altitudes in South America. The highest prevalences and intensities of human fascioliasis known are those of the northern Bolivian Altiplano, where infected Lymnaea truncatula occur at altitudes of 3800-4100 m. In the present study, the climatic data for this area of the Altiplano, which differ markedly from those of endemic areas in the lowlands, were analysed. There is no marked seasonality in temperature but there are large variations in temperature within a daily, 24-h period. Rainfall is seasonal, with a long dry season, coinciding with the lowest minimum temperatures, and a long wet season. The rate of evapotranspiration is very high, and temporary water bodies dry out very quickly. Solar radiation at ground level is intense, not only because of the altitude but also because of the lack of trees and shrubs. Two climatic indices for forecasting fascioliasis, Mt and Wb-bs, were calculated. Modifications in these forecast indices are proposed, to reflect the environment at high altitude and low latitude. Estimates, based on climadiagrammes, of the durations of the wet and dry seasons were greatly effected by the inclusion of an aridity-index modification. The usefulness of the modified indices was examined using prevalence data for human and cattle fascioliasis collected in the neighbourhoods of the stations providing the meteorological data. Values for both indices indicated that conditions were optimum for transmission between December and March. The results were statistically significant for the modified Wb-bs index when the data for a meteorological station in which no lymnaeids were found were excluded. The modified Mt index did not appear sufficiently accurate to be useful. The values for the modified Wb-bs index permitted the study areas to be designated low-, moderate- or high-risk areas for the transmission of fascioliasis to man and domestic animals.

Leucine Aminopeptidase Is an Immunodominant Antigen of Fasciola hepatica Excretory and Secretory Products in Human Infections

ABSTRACT The liver fluke Fasciola hepatica parasitizes humans and ruminant livestock worldwide, and it is now being considered a reemerging zoonotic disease, especially in areas in which it is endemic, such as South America. This study investigates the immune response to excretory and secretory products produced by F. hepatica in a group of patients from the Peruvian Altiplano, where the disease is highly endemic. Using a proteomic approach and immunoblotting techniques, we have identified the enzymes leucine aminopeptidase (LAP) and phosphoenolpyruvate carboxykinase as immunodominant antigens recognized by sera from fasciolosis patients. An indirect enzyme-linked immunosorbent assay using recombinant LAP as the antigen was developed to check sera from individuals of this region. Our results demonstrate that LAP produces a specific and strong reaction, suggesting its potential use in the serologic diagnosis of F. hepatica infections in humans.

The comparative development of Echinostoma caproni (Trematoda: Echinostomatidae) adults in experimentally infected hamsters and rats

The aim of the present study was to compare the development of Echinostoma caproni (Trematoda: Echinostomatidae) adults in two host species displaying different degrees of compatibility with this parasite. For this purpose, the variability in the worm recovery, egg output, and morphology of E. caproni adults during the course of experimental infections in hamsters and rats was analyzed. Student’s t-tests and two-factor ANOVA analysis with the time post-infection and the host species as independent variables, and Bonferroni t-tests as post hoc analysis were used for the study. Worm recovery and egg output were host species dependent. The values were significantly higher in the worms established in hamsters than those in rats. The oral sucker area, pre-pharynx length, and pharynx area were the most conservative features, and no significant variability related to the host species was detected. In contrast, body area, collar width, esophagus length, cirrus sac area, ventral sucker area, ovarian area and anterior and posterior testicular areas were significantly higher in those worms collected from hamsters. Moreover, significant worm age-host species interactions were found for body area, ovarian area, ventral sucker area, and anterior and posterior testicular areas.

Chapter 3. Recent advances in the biology of echinostomes.

This chapter examines the significant literature on the biology of echinostomes. The members of the family Echinostomatidae are medically and veterinary-important parasitic flatworms that invade humans, domestic animals and wildlife and also parasitize in their larval stages numerous invertebrate and cold-blooded vertebrate hosts. All echinostomes possess a complicated lifecycle expressed by: (i) alternation of seven generations known as the adult, egg, miracidium, sporocyst, redia, cercaria and metacercaria, and (ii) inclusion of three host categories known as the definitive host and first and second intermediate hosts. Moreover, echinostomes have served as experimental models in parasitology at all levels of organization. We discuss recent advances in several areas of the biological sciences that feature studies on echinostomes. Initially, we consider aspects of the lifecycle, development and systematics of selected members of the Echinostomatidae. We then highlight host-parasite interactions between echinostomes and their intermediate and definitive hosts with emphasis on the application of novel techniques to these topics.

An experimental study of the reproductive success of Echinostoma friedi (Trematoda : Echinostomatidae) in the golden hamster.

Viable eggs produced weekly per infective stage was used as a measure of the reproductive success of Echinostoma friedi during the first 12 weeks of infection in hamsters. The weekly reproductive success was not constant during the experiment in relation to the egg output and the proportion of viable eggs produced. The egg release started during week 2 post-inoculation, attaining a maximum during week 3. A decline in egg output was observed from week 9. Viable eggs were only produced from week 3 post-inoculation and a maximum was attained at week 4 of the experiment. A decline in egg viability was observed from week 9. Considering together the egg output and the egg viability, the maximum weekly reproductive success was obtained during week 4 post-inoculation. The changes in the weekly reproductive success were not reflected in variations in worm numbers and body sizes during the course of the infection. The humoral immune response of golden hamsters during the infection with E. friedi was determined. Increases of IgG levels against somatic and excretory/secretory products of E. friedi were detected coinciding with the reduction in the reproductive success.