Human Intestinal Parasite Burden and Poor Sanitation in Rural Alabama
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Open Access
- 8 November 2017
- journal article
- Published by American Society of Tropical Medicine and Hygiene in The American Journal of Tropical Medicine and Hygiene
- Vol. 97 (5), 1623-1628
- https://doi.org/10.4269/ajtmh.17-0396
Abstract
Hookworm infection affects 430 million people worldwide, causing iron deficiency, impaired cognitive development, and stunting in children. Because of the environmental conditions needed for the hookworm life-cycle, this parasite is endemic to resource-limited countries. Necator americanus was endemic in the southern United States before improvement of sewage disposal systems and eradication programs. With continued poverty, poor sanitation, and an environment suitable for the hookworm life-cycle in some regions of the southern United States, a current prevalence study using modern molecular diagnostics is warranted. Lowndes County, Alabama, was chosen as the study site given previous high hookworm burdens, degree of poverty, and use of open-sewage systems. Participants were interviewed, and stool, serum, and soil samples were tested for nine intestinal parasites using a multiparallel quantitative real-time PCR (qPCR) and enzyme-linked immunosorbent assays. We found that, among 24 households, 42.4% reported exposure to raw sewage within their home, and from 55 stool samples, 19 (34.5%) tested positive for N. americanus, four (7.3%) for Strongyloides stercoralis, and one (1.8%) for Entamoeba histolytica. Stool tested positive for N. americanus contained low levels of parasite DNA (geometric mean 0.0302 fg/μL). Soil studies detected one (2.9%) Cryptosporidium species, and Toxocara serology assay detected one (5.2%) positive in this population. Individuals living in this high-risk environment within the United States continue to have stool samples positive for N. americanus. Gastrointestinal parasites known to be endemic to developing countries are identifiable in American poverty regions, and areas with lower disease burden are more likely to be identified by using qPCR.Keywords
This publication has 26 references indexed in Scilit:
- NTDs V.2.0: “Blue Marble Health”—Neglected Tropical Disease Control and Elimination in a Shifting Health Policy LandscapePLoS Neglected Tropical Diseases, 2013
- A Novel, Multi-Parallel, Real-Time Polymerase Chain Reaction Approach for Eight Gastrointestinal Parasites Provides Improved Diagnostic Capabilities to Resource-Limited At-Risk PopulationsThe American Journal of Tropical Medicine and Hygiene, 2013
- Nonutility of routine testing of stool for ova and parasites in a tertiary care Canadian centreCanadian Journal of Microbiology, 2012
- Soil-Transmitted Helminthiasis in the United States: A Systematic Review—1940–2010The American Journal of Tropical Medicine and Hygiene, 2011
- Impact of hookworm infection and deworming on anaemia in non‐pregnant populations: a systematic reviewTropical Medicine & International Health, 2010
- How Four Once Common Diseases Were Eliminated From The American SouthHealth Affairs, 2009
- Hookworm-Related Anaemia among Pregnant Women: A Systematic ReviewPLoS Neglected Tropical Diseases, 2008
- Neglected Infections of Poverty in the United States of AmericaPLoS Neglected Tropical Diseases, 2008
- Multi-country analysis of the effects of diarrhoea on childhood stuntingInternational Journal of Epidemiology, 2008
- Disease and Development: Evidence from Hookworm Eradication in the American SouthThe Quarterly Journal of Economics, 2007