Giardiasis in Varna district - prevalence and risk assessment

Гиардиазата е космополитна чревна протозооза, която се среща както в тропическите, така и в страните с умерен климат. На регионално ниво заболяването е изучавано в миналото, но в настоящия момент не съществува систематизирана информация относно разпространението на G. duodenalis сред различните части от населението. Целта на настоящото изследване е да установим екстензинвазията на гиардиазата в област Варна за периода 2007-2016 г. и да анализираме ефекта на различни фактори - възраст, пол, местоживеене, професия и др., върху вероятността за опаразитяване. Материал и методи: Обхванати са 55 856 лица, изследвани чрез фекална намазка, оцветена с луголов разтвор. Явленията в различните групи са представени като относителен дял. Анализът на риска е осъществен чрез χ2-тест за асоциация на Pearson, a величината на ефекта - чрез отношението на шансовете (odds ratio). Резултати и обсъждане: Сред изследвания контингент открихме 327 лица, инвазирани с G. duodenalis, a общият екстензитет от 0.58% поставя гиардиазата на второ място от всички чревни паразитози в областта. Заболяемостта по години варира между 95.93%000 за 2007 г. до 48.98%000 за 2016 г. и ако демонстрираната тенденция запази своя ход, прогнозните предвиждания посочват, че показателят ще достигне 17.36%000 за 2026 г. Гиардиазата е по-честа в детската възраст, но съотношението де-ца-възрастни е едва 2:1, a висок риск откриваме в младата активна възраст от 20-35 г. и като цяло сред възрастните мъже. В малките градове от областта вероятността за заразяване с G. duodenalis е 3,5 пъти по-висока, отколкото в гр. Варна, a в селата рискът се покачва 6-кратно. Най-висок професионален риск отчитаме при мъжете и жените, ангажирани с производството на хранителни продукти и работещите в детските заведения на областта. Въпреки сравнително високата честота, открита сред различните групи от Варненския регион, гиардиазата остава слабо познато заболяване и рядко се включва в диференциално диагностичните планове при лицата с гастроинтестинални симптоми, особено в зрялата възраст.Introduction: Giardiasis is a worldwide intestinal protozoal disease that occurs both in tropical and temperate climates. The distribution in the region has been studied in the past, but there is no current in-formation regarding the prevalence of G. duodenalis among distinct risk groups of the population. Aim: The aim of the present study is to establish the prevalence of giardiasis in Varna region in the period 2007 - 2016 and to evaluate the effect of various indicators - age, sex, place of residence, occupation, etc., on the risk of infection. Materials and Methods: For the 10-year period, a total of 55 856 individuals were tested for G. duodenalis with wet mount preparation stained with Lugol`s iodine solution. The prevalence of the disease was estimated in the separate risk groups, the risk differences were evaluated by Pearson`s χ2-test for association and the effect size was measured by the odds ratio. Results and Discussion: Three hundred twenty-seven infected with G. duodenalis persons were found in the investigated population from Varna region. The overall prevalence of 0.58% makes giardiasis the second most frequent intestinal parasitosis in the region. The established incidence ranges from 95.93 %000 in 2007 to 48.98%000 in 2016. If this negative trend is sustained, the estimated magnitude will reach 17.36%000 in 2026. Giardiasis is more common in childhood, but the children to adults ratio is barely 2:1.Even more, elevated risk is found in the young population (20-35 years) and in adult males. In small towns of the area the odds for infection with G. duodenalis are 3.5 higher than in Varna city, while in the rural areas the risk increases 6-fold. Raised prevalence and occupational risk are observed amongst workers in the food production industry and employees in childcare facilities in the region. Regardless of the relatively high frequency found among the different groups of Varna region, giardiasis remains a little-known disease and is rarely included in the differential diagnosis of gastrointestinal dysfunction especially in adult patients

RARE CASE OF ASCARIASIS DETECTED BY COLONOSCOPY ON THE BACKGROUND OF ELEVATED LEVELS OF FECAL CALPROTECTIN

Introduction: The causative agents of ascariasis in humans are two species: Ascaris lumbricoides and Ascaris suum. For diagnosis, a fecal sample is most often examined. In some cases, the parasite can be identified when coming out with the intestinal passage, and very rarely up on colonoscopy. Aim to present a rare case of ascariasis where the diagnosis was made by colonoscopy on the background of elevated levels of fecal calprotectin (f-CP). Case presentation: A colonoscopy was performed on a 52-year-old female patient due to elevated f-CP. The patient had no complaints. The colonoscopy did not detect pathological changes of the intestinal mucosa, but documented larval stages of Ascaris spp. freely moving in the lumen of the large intestine. The patient was treated with albendazole. Subsequent parasitological examinations of fecal samples were negative. Discussion: In developed countries, the transmission of Ascaris lumbricoides is greatly reduced. On the background of a very limited transmission of Ascaris lumbricoides, many authors consider that most of the sporadic cases of ascariasis are due to Ascaris suum. In the case described by us, the f-CP levels normalized after the treatment, and for this reason, we cannot categorically reject the relationship between Ascaris infection and elevated f-CP levels. Conclusion: The presented clinical case is of interest due to the unusual way of diagnosi ascariasis. In the absence of clinical symptoms, and pathological changes of blood and biochemical parameters, except for elevated fecal calprotectin, inflammatory colon disease was suspected and was colonoscopy performed on this occasion

Molecular characterization of Echinococcus granulosus isolates from Bulgarian human cystic echinococcosis patients

Although cystic echinococcosis (CE) is highly endemic in Bulgaria, there is still scarce information about species and/or genotypes of the Echinococcus granulosus complex that infect humans. Our study tackled the genetic diversity of E. granulosus complex in a cohort of 30 Bulgarian CE patients. Ten animal E. granulosus isolates from neighboring Greece were additionally included. Specimens were comparatively analyzed for partial sequences of five mitochondrial (mt) (cox I, nad I, rrnS, rrnL, and atp6) and three nuclear (nc) genes (act II, hbx 2, and ef-1α) using a PCR-sequencing approach. All 30 Bulgarian isolates were identified as E. granulosus sensu stricto (s.s.) and were showing identical sequences for each of the three examined partial nc gene markers. Based upon concatenated sequences from partial mtDNA markers, we detected 10 haplotypes: 6 haplotypes (H1-H6) clustering with E. granulosus s.s. (G1) and 4 haplotypes (H9-H13) grouping with E. granulosus s.s. (G3), with H1 and H10 being the most frequent in Bulgarian patients. The haplotypes H1, H4, and H11 were also present in Greek hydatid cyst samples of animal origin. In conclusion, E. granulosus s.s. (G1 and G3 genotypes) is the only causative agent found so far to cause human CE in Bulgaria. However, further studies including larger sample sizes and other additional geographic regions in Bulgaria will have to be performed to confirm our results

Human Parasitic Diseases in Bulgaria in Between 2013-2014

Parasitic diseases are a significant part of the overall pathology registered in Bulgaria. It is essential to constantly improve the efficiency of the public health system in order to deal with autochthonous parasitic disease

Scientific opinion on ethology and spread of trichinosis in animals and humans in Bulgaria

Subject to presentation is the updated information on the species structure of the agents causing trichinosis in humans and in animals. The major points of the epizootology, epidemiology, diagnostics and prophylaxis of the diseases have been outlined, together with the life cycle of the causative agents. Based on the results of studies carried out in Bulgaria, it was identified that trichinosis is more wide-spread among wild boars than domestic pig, the situation with the first ones being of rising trend each year. It is noted that trichinosis in animals in Bulgaria is caused by two species, T. britovi and T. spiralis, the first one being more frequent. There are notifications referred to saying about the capsuleless type of the disease (T. pseudospiralis) found in humans and animals. Special attention is focused on the fact that T. britovi is the major ethologic agent resulting in the salvatic cycle of trichinellosis in Bulgaria, while T. spiralis is more likely to be a factor more for the synanthropic than for the salvatic cycle. It is also noted that in domestic pigs more frequent are the invasions observed in animals reared in small personal farms (backyards), while consumption of meat yielded through uncontrolled slaughtering (i.e. out of the regulated slaughterhouses or under domestic conditions) or in case of illegal hunting of wild boars are the major factors still posing serious risk of outbreaks in humans. Feeding domestic pigs with kitchen wastes and insufficient pest (rodents) controls are considered to be the major risks of invading domestic pigs

Imported malaria in Bulgaria, status and prognosis after eradication in 1965

Background: This retrospective analysis assessed all recorded malaria cases in Bulgaria after 1965, when the country was certified as malaria-free by the World Health Organization (WHO), and evaluated the readiness of the public health system to interrupt an outbreak of local transmission in case of infection importation. Methods: The cases were analyzed according to causative species; geographic origin of the imported case; and the citizenship, age, and gender of the infected individuals. Results: In the 50-year study period (1966–2015), there were a total of 3011 cases of malaria imported to Bulgaria from different regions of the world. The majority of the cases originating in Africa were caused by Plasmodium falciparum (65.5%), while most of these originating in Asia were caused by P. vivax (80.9%). The potential season for malaria transmission in Bulgaria is from April to October, and 58.5% of the malaria cases were imported during that time of the year. Conclusions: The increasing movement of people to and from areas endemic for malaria requires the health authorities of countries with appropriate conditions for reintroduction to conduct enhanced measures for surveillance and control of this potentially deadly disease. Keywords: Local transmission, Reintroduction, Surveillance, Contro