Oesophagostomum bifurcum-induced nodular pathology in a highly endemic area of Northern Ghana

Abstract

Human infection with Oesophagostomum bifurcum is rare globally, but focally endemic and common in Ghana and Togo. Two clinical presentations are identified: uni-nodular disease, which may be recognized as a 'Dapaong Tumour', and multi-nodular disease. Here, we describe the prevalence of O. bifurcum infection and the association with nodular pathology in northern Ghana. The study was performed in October 2002. Out of a well-defined population of approximately 18000, 928 subjects of all ages were randomly selected for parasitological and ultrasound examination. In stool cultures, 44% had detectable third-stage O. bifurcum larvae present. Females were more often infected than males (P<0.05). In 34% of the samples, nodules were detected along the colon wall, with the ascending and the transverse colon being the most affected regions. Significant correlations existed between the intensity of infection and the presence of nodules, both at the village and the individual level (P<0.001 for both). Patients with multi-nodular pathology had significantly higher larval counts than patients with uni-nodular pathology. The present data suggest that nodular pathology, and probably the severity of the disease, are directly related to intensity of the infection.

Clinical and pathologic manifestation of oesophagostomosis in African great apes: does self‐medication in wild apes influence disease progression?

“…Recent studies in humans where nodular pathology and larvae occurred together showed that the chance of developing nodules increased with increasing intensity of infection. Among 928 subjects in a recent study in an endemic zone [41], 44% had O. bifurcum eggs in their stools and 34% had nodular pathology mostly in ascending and transverse colon. Half of them had a multiple nodular pathology detected by ultrasound technique.…”

“…in wild apes and those of sanctuaries, however, parasite loads are rarely determined and data obtained by using comparable methods are not available. If a correlation occurs between parasite burden and risk of nodular pathology (as demonstrated in humans [41]), we can suggest that association of mechanical and chemical properties of plants ingested may be used to maintain subclinical level of infection in great apes. Regular ingestion of plants with antihelmintic properties may decrease the number of L3 and adult nematodes in intestine.…”

“…At that time, it was suggested that Oesophagostomum worms rarely develop beyond the encysted stage and it was believed that humans were infected through contact with primates and that infection did not maintain in our species. Recent reports show that infection is rare in man, except in focally endemic areas as in Ghana and Togo where a high prevalence has been reported [1, 32, 33, 34, 35, 40, 41]. In these regions, a quarter of a million of people were recently estimated as infected by Oesophagostomum bifurcum and one million are at risk.…”

Ecology and Epidemiology of Nematode Infection in Japanese Macaques:

“…For example, Oesophagostomum spp. can be associated with significant pathology because juvenile stages of these parasites encyst during development and cause nodules in the intestinal mucosa, which eventually burst open to release adult forms of the parasite (Huffman et al 1997;Anderson 2000;Huffman & Caton 2001;Storey et al 2001;Acha & Szyfres 2003;Ziem et al 2005;Krief et al 2008). Strongyloides spp.…”

Polymorphisms in TLR4 and TLR2 genes, cytokine production and survival in rural Ghana

“…14,15 Inhabitants belong to different ethnic groups such as Bimoba, Fulani, Busanga, Kusasi and Maprusi. Surveys on demographics were held annually from June to August, starting from 2002, 16 in which population information including births, deaths and migration was updated. Each year, mouth swabs for DNA analyses were obtained from a subset of adults and newborns.…”