Presence of <i>Giardia lamblia</i> in stools of six‐ to 18‐month old asymptomatic Malawians is associated with children's growth failure

Lehto, Kirsi‐Maarit; Fan, Yue‐Mei; Oikarinen, Sami; Nurminen, Noora; Hallamaa, Lotta; Juuti, Rosa; Mangani, Charles; Maleta, Kenneth; Hyöty, Heikki; Ashorn, Per

doi:10.1111/apa.14832

Cited by 15 publications

(12 citation statements)

References 29 publications

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“…If near real-time pathogen surveillance is a goal, sampling the most recently deposited material near or at the surface of pit contents in a dry pit latrine would be justified and has the advantage of being the easiest strategy for sampling. Though we lacked matched stools for comparison, the enteric pathogens we identified are known to be endemic in the study setting based on etiological studies of diarrheal disease [43][44][45][46]. For example, we frequently detected EAEC [45], norovirus [43,44,46], Giardia duodenalis [43,46], and Ascaris lumbricoides [47] in sludges and previous studies in Malawi also commonly detected these pathogens in children's stools.…”

Section: Discussionmentioning

confidence: 99%

“…Though we lacked matched stools for comparison, the enteric pathogens we identified are known to be endemic in the study setting based on etiological studies of diarrheal disease [ 43 – 46 ]. For example, we frequently detected EAEC [ 45 ], norovirus [ 43 , 44 , 46 ], Giardia duodenalis [ 43 , 46 ], and Ascaris lumbricoides [ 47 ] in sludges and previous studies in Malawi also commonly detected these pathogens in children’s stools. In addition, the individual pathogens we did not identify in fecal sludges aligned well with a study of 527 asymptomatic children in Blantyre, Malawi from 2013 to 2016 [ 45 ].…”

Section: Discussionmentioning

confidence: 99%

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Impact of sampling depth on pathogen detection in pit latrines

et al. 2021

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Wastewater based epidemiology (WBE) is increasingly used to provide decision makers with actionable data about community health. WBE efforts to date have primarily focused on sewer-transported wastewater in high-income countries, but at least 1.8 billion people in low- and middle-income countries (LMIC) use onsite sanitation systems such as pit latrines and septic tanks. Like wastewater, fecal sludges from such systems offer similar advantages in community pathogen monitoring and other epidemiological applications. To evaluate the distribution of enteric pathogens inside pit latrines–which could inform sampling methods for WBE in LMIC settings unserved by sewers–we collected fecal sludges from the surface, mid-point, and maximum-depth of 33 pit latrines in urban and peri-urban Malawi and analyzed the 99 samples for 20 common enteric pathogens via multiplex quantitative reverse transcription PCR. Using logistic regression adjusted for household population, latrine sharing, the presence of a concrete floor or slab, water source, and anal cleansing materials, we found no significant difference in the odds of detecting the 20 pathogens from the mid-point (adjusted odds ratio, aOR = 1.1; 95% confidence interval = 0.73, 1.6) and surface samples (aOR = 0.80, 95% CI = 0.54, 1.2) compared with those samples taken from the maximum depth. Our results suggest that, for the purposes of routine pathogen monitoring, pit latrine sampling depth does not strongly influence the odds of detecting enteric pathogens by molecular methods. A single sample from the pit latrines’ surface, or a composite of surface samples, may be preferred as the most recent material contributed to the pit and may be easiest to collect.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Impact of sampling depth on pathogen detection in pit latrines

et al. 2021

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“…In contrast, adults—especially those in areas where Giardia is not endemic—show a positive correlation between Giardia infection and diarrhea ( 51 , 78 ). Previous studies suggest that the association between growth stunting and Giardia infection is dependent on age ( 79 ), with some studies showing that asymptomatic Giardia infection is associated with growth stunting among children older than 18 months, but not infants or in children during their first 18 months ( 80 ), while others show an association between Giardia and growth stunting at 2 years of age ( 31 ). The effects of Giardia on gut microbiota may also be age dependent.…”

Section: Discussionmentioning

confidence: 99%

Natural Infection with Giardia Is Associated with Altered Community Structure of the Human and Canine Gut Microbiome

Berry

Johnson

Martins

et al. 2020

mSphere

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Enteric parasitic infections are among the most prevalent infections in lower- and middle-income countries (LMICs) and have a profound impact on global public health. While the microbiome is increasingly recognized as a key determinant of gut health and human development, the impact of naturally acquired parasite infections on microbial community structure in the gut, and the extent to which parasite-induced changes in the microbiome may contribute to gastrointestinal symptoms, is poorly understood. Enteric parasites are routinely identified in companion animals in the United States, presenting a unique opportunity to leverage this animal model to investigate the impact of naturally acquired parasite infections on the microbiome. Clinical, parasitological, and microbiome profiling of a cohort of 258 dogs revealed a significant correlation between parasite infection and composition of the bacterial community in the gut. Relative to other enteric parasites, Giardia was associated with a more pronounced perturbation of the microbiome. To compare our findings to large-scale epidemiological studies of enteric diseases in humans, a database mining approach was employed to integrate clinical and microbiome data. Substantial and consistent alterations to microbiome structure were observed in Giardia-infected children. Importantly, infection was associated with a reduction in the relative abundance of potential pathobionts, including Gammaproteobacteria, and an increase in Prevotella—a profile often associated with gut health. Taken together, these data show that widespread Giardia infection in young animals and humans is associated with significant remodeling of the gut microbiome and provide a possible explanation for the high prevalence of asymptomatic Giardia infections observed across host species. IMPORTANCE While enteric parasitic infections are among the most important infections in lower- and middle-income countries, their impact on gut microbiota is poorly understood. We reasoned that clinical symptoms associated with these infections may be influenced by alterations of the microbiome that occur during infection. To explore this notion, we took a two-pronged approach. First, we studied a cohort of dogs naturally infected with various enteric parasites and found a strong association between parasite infection and altered gut microbiota composition. Giardia, one of the most prevalent parasite infections globally, had a particularly large impact on the microbiome. Second, we took a database-driven strategy to integrate microbiome data with clinical data from large human field studies and found that Giardia infection is also associated with marked alteration of the gut microbiome of children, suggesting a possible explanation for why Giardia has been reported to be associated with protection from moderate to severe diarrhea.

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“…20 In a study conducted by Lehto et al on children aged 6 to 18 months, it was found that there was a significant relationship between giardiasis and children's growth failure, and it was better to be considered in our study. 21 Considering the influence of different factors on the prevalence of giardiasis, a study was conducted to examine the effect of seasons on the prevalence of infection and it was reported that it ranged from 8.29% in dry seasons to 12.10% in wet seasons. 22 Studies in Iran and other parts of the world suggest that due to increased health care services in communities, the prevalence of giardiasis has not decreased.…”

Section: Discussionmentioning

confidence: 99%

Survey of Giardiasis Symptoms in Patients Referred to Health Care Centers in Zahedan, South-Eastern Iran, 2017-2018

Raissi

Zibaei

Aliabadi

et al. 2019

Int J Enteric Pathog

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Background: There are many pathogenic intestinal parasites in humans, one of which is Giardia lamblia. This parasite has a variety of clinical symptoms in individuals. Poor health, weather conditions, and inappropriate lifestyle are all factors contributing to the high incidence of giardiasis. Objective: Based on factors influencing the prevalence of giardiasis in the region, this study was performed on subjects referred to Zahedan health care centers. Materials and Methods: A total of 671 stool specimens of subjects who referred between March 2017 and October 2018 were examined using direct and formalin ether concentration techniques. All demographic and clinical data in questionnaires were recorded. Data were analyzed using X2 test to determine any differences in the prevalence of giardiasis and clinical symptoms between different age groups. Results: Of 671 samples, 346 (51.1%) were positive. The most common complaint among participants was abdominal pain (64.1%), followed by diarrhea (53.7%), abdominal cramps (44.7%), nausea (32.6%), weight loss (30.9%), anorexia (26.8%), headache (22.2%), fatigue (14.1%), and fever (13.2%). Most of the clinical symptoms such as abdominal pain, abdominal cramp, weight loss, and headache were reported in females, and the results of chi-square test showed a significant difference (P<0.05). The age group of 1-12 years had the highest percentage of infection (49.42%). The data indicated that the highest rate of infection was observed in this group, showing a significant difference in comparison with other age groups (P<0.05). Conclusion: The results of this study showed that in addition to health education, preventing the transmission of parasites to children would also be necessary.

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Presence of Giardia lamblia in stools of six‐ to 18‐month old asymptomatic Malawians is associated with children's growth failure

Cited by 15 publications

References 29 publications

Impact of sampling depth on pathogen detection in pit latrines

Impact of sampling depth on pathogen detection in pit latrines

Natural Infection with Giardia Is Associated with Altered Community Structure of the Human and Canine Gut Microbiome

Survey of Giardiasis Symptoms in Patients Referred to Health Care Centers in Zahedan, South-Eastern Iran, 2017-2018

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