Detection of Giardia intestinalis infections in Polish soldiers deployed to Afghanistan
Abstract
Background: Members of the Polish Military Contingent (PMC) have been stationed in Afghanistan since 2002. They typically serve in areas characterised by low standards of sanitation which often leads to the development of food- and waterborne diseases. The aim of the study was to evaluate the prevalence of Giardia intestinalis infections among Polish soldiers deployed to Afghanistan. The research study was conducted as part of a programme for prevention of parasitic diseases of the gastrointestinal tract run by the Polish Armed Forces.
Materials and methods: The study was carried out in August 2011; it involved 630 asymptomatic Polish soldiers serving in the Forward Operational Base (FOB) Ghazni in eastern Afghanistan. Stool specimens obtained from members of the PMC were first tested in FOB Ghazni (detection of Giardia intestinalis by Rida Quick Giardia immunochromatographic tests and Ridascreen Giardia immunoenzymatic tests — single samples). Next, the same biological material and two other faecal specimens fixed in 10% formalin were transported to the Military Institute of Medicine in Poland, where they were tested for Giardia intestinalis under light microscopy (direct smear, decantation in distilled water).
Results: Parasitological tests performed under light microscopy showed that 2.7% (17/630) of the study group were infected with Giardia intestinalis. Some of these results were confirmed by immunochromatographic tests (6/630). In contrast, immunoenzymatic tests (ELISA) demonstrated a significantly higher detection rate reaching 18.1% (114/630). Immunoenzymatic tests confirmed all the positive results given by light microscopy and by immunochromatographic tests.
Conclusions: The prevalence rate of Giardia intestinalis infections in Polish soldiers deployed to Afghanistan was found to be high. Microscopic methods exhibit low sensitivity and therefore may result in the underestimation of the true parasite prevalence. Immunoenzymatic tests (ELISA) showing a much higher sensitivity in comparison to light microscopy and immunochromatographic tests ought to be applied in screening for intestinal protozoan infections in areas characterised by harsh environmental conditions.
Keywords: Giardia intestinalisPolish soldiersAfghanistandiagnostics
References
- Sommer MF, Beck R, Ionita M, et al. Multilocus sequence typing of canine Giardia duodenalis from South Eastern European countries. Parasitol Res. 2015; 114(6): 2165–2174.
- Cacciò SM, Thompson RC, McLauchlin J, et al. Unravelling Cryptosporidium and Giardia epidemiology. Trends Parasitol. 2005; 21(9): 430–437.
- Oberhuber G, Kastner N, Stolte M. Giardiasis: a histologic analysis of 567 cases. Scand J Gastroenterol. 1997; 32(1): 48–51.
- Ballweber LR, Xiao L, Bowman DD, et al. Giardiasis in dogs and cats: update on epidemiology and public health significance. Trends Parasitol. 2010; 26(4): 180–189.
- Adam RD. The biology of Giardia spp. Microbiol Rev. 1991; 55(4): 706–732.
- Feng Y, Xiao L. Zoonotic potential and molecular epidemiology of Giardia species and giardiasis. Clin Microbiol Rev. 2011; 24(1): 110–140.
- Thompson RC. The zoonotic significance and molecular epidemiology of Giardia and giardiasis. Vet Parasitol. 2004; 126(1-2): 15–35.
- Yakoob J, Jafri W, Abid S, et al. Giardiasis in patients with dyspeptic symptoms. World J Gastroenterol. 2005; 11(42): 6667–6670.
- Myjak P, Głowniak C, Gołąb E, et al. Standardy w zakresie laboratoryjnych czynności w parazytologii medycznej, oceny ich jakości i wartości diagnostycznej oraz laboratoryjnej interpretacji i autoryzacji wyników badań (propozycje). Diagnostyka Laboratoryjna. 2011; 47: 341–351.
- Júlio C, Vilares A, Oleastro M, et al. Prevalence and risk factors for Giardia duodenalis infection among children: a case study in Portugal. Parasit Vectors. 2012; 5: 22.
- Al-Saeed AT, Issa SH. Detection of Giardia lamblia antigen in stool specimens using enzyme-linked immunosorbent assay. East Mediterr Health J. 2010; 16(4): 362–364.
- Savioli L, Smith H, Thompson A. Giardia and Cryptosporidium join the 'Neglected Diseases Initiative'. Trends Parasitol. 2006; 22(5): 203–208.
- El-Sherbini GT, Abosdera MM. Risk factors associated with intestinal parasitic infections among children. J Egypt Soc Parasitol. 2013; 43(1): 287–294.
- Ziegelbauer K, Speich B, Mäusezahl D, et al. Effect of sanitation on soil-transmitted helminth infection: systematic review and meta-analysis. PLoS Med. 2012; 9(1): e1001162.
- Schär F, Inpankaew T, Traub RJ, et al. The prevalence and diversity of intestinal parasitic infections in humans and domestic animals in a rural Cambodian village. Parasitol Int. 2014; 63(4): 597–603.
- Korzeniewski K, Augustynowicz A, Lass A. Prevalence of intestinal parasites in Afghan community on the example of patients treated in Ghazni Provincial Hospital. Int Marit Health. 2014; 65(2): 68–72.
- United Nations Environment Programme. Afghanistan’s Environment 2008. National Environmental Protection Agency of the Islamic Republic of Afghanistan Kabul, 2009.
- World Health Organization. Country Cooperation Strategy 2005 to 2009. Islamic Republic of Afghanistan. 03.08.2005.
- Korzeniewski K. Examinations regarding the prevalence of intestinal parasitic diseases in Polish soldiers contingents assigned to missions abroad. Int Marit Health. 2011; 62(1): 31–36.
- Frickmann H, Schwarz NG, Wiemer DF, et al. Food and drinking water hygiene and intestinal protozoa in deployed German soldiers. Eur J Microbiol Immunol (Bp). 2013; 3(1): 53–60.
- Korzeniewski K, Skórczewski K. Health problems of peacekeepers carrying out mandatory tasks in Chad, Central Africa. Int Marit Health. 2011; 62(1): 37–40.
- El-Nahas HA, Salem DA, El-Henawy AA, et al. Giardia diagnostic methods in human fecal samples: a comparative study. Cytometry B Clin Cytom. 2013; 84(1): 44–49.
- Gutiérrez-Cisneros MJ, Martínez-Ruiz R, Subirats M, et al. [Assessment of two commercially available immunochromatographic assays for a rapid diagnosis of Giardia duodenalis and Cryptosporidium spp. in human fecal specimens]. Enferm Infecc Microbiol Clin. 2011; 29(3): 201–203.
- Clinical and Laboratory Standards Institute (LSI). Procedures for the Recovery and Identification of Parasites from the Intestinal Tract: Approved Guideline. CLSI Document M28-A2. 2 nd Ed. Clinical Laboratory Standards Institute Wayne,.
- Hawash Y. Evaluation of an immunoassay-based algorithm for screening and identification of giardia and cryptosporidium antigens in human faecal specimens from saudi arabia. J Parasitol Res. 2014; 2014: 213745.
- Jahan N, Khatoon R, Ahmad S. A Comparison of Microscopy and Enzyme Linked Immunosorbent Assay for Diagnosis of Giardia lamblia in Human Faecal Specimens. J Clin Diagn Res. 2014; 8(11): DC04–DC06.
- Hanson KL, Cartwright CP. Use of an enzyme immunoassay does not eliminate the need to analyze multiple stool specimens for sensitive detection of Giardia lamblia. J Clin Microbiol. 2001; 39(2): 474–477.
- Weitzel T, Dittrich S, Möhl I, et al. Evaluation of seven commercial antigen detection tests for Giardia and Cryptosporidium in stool samples. Clin Microbiol Infect. 2006; 12(7): 656–659.
- Barazesh A, Majidi J, Fallah E, et al. Designing of enzyme linked immunosorbent assay (ELISA) kit for diagnosis copro-antigens of Giardia lamblia. Afri J Biotechnol. 2010; 9: 5025–5027.
- Vidal AM, Catapani WR. Enzyme-linked immunosorbent assay (ELISA) immunoassaying versus microscopy: advantages and drawbacks for diagnosing giardiasis. Sao Paulo Med J. 2005; 123(6): 282–285.
- Soares R, Tasca T. Giardiasis: an update review on sensitivity and specificity of methods for laboratorial diagnosis. J Microbiol Methods. 2016; 129: 98–102.
- Korzeniewski K. Prevalence of intestinal parasitic infections in the population of Central Asia on the example of inhabitants of Eastern Afghanistan. Przegl Epidemiol. 2016; 70(4): 563–573.
- Guidetti C, Ricci L, Vecchi L. Prevalenza delle parassitosi intestinali a Reggio Emilia e Provincia nel corso del 2009. Infez Med. 2010; 3: 154–161.
- Davies AP, Campbell B, Evans MR, et al. Asymptomatic carriage of protozoan parasites in children in day care centers in the United kingdom. Pediatr Infect Dis J. 2009; 28(9): 838–840.
- Sagebiel D, Weitzel T, Stark K, et al. Giardiasis in kindergartens: prevalence study in Berlin, Germany, 2006. Parasitol Res. 2009; 105(3): 681–687.
- National Institute of Public Health. Infectious diseases and poisonings in Poland in 2015 [in Polish]. Department of Epidemiology, NIPH Warsaw, 2016.
- Bajer A. Cryptosporidium and Giardia spp. infections in humans, animals and the environment in Poland. Parasitol Res. 2008; 104(1): 1–17.
