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8/19/2019 Dacca Report
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INTESTINAL PROTOZOA AND HELMINTHS IN SCHOOL CHILDREN OF DACCA,
EAST PAKISTAN (EAST BENGAL)*
ROB ERT E . KUNTZ
N aval M edical Research U nit No. 2, Taipei, Taiwan
The subcontinent of India has frequently ex
p erie nc ed th e ra va ge s o f c ommun ic ab le a nd o th er
diseases on an epidemic scale. In the spring of
1958 the Provincial G overnm ent of East Paid
stan, as a result of extensive occurrences of
cholera and smallpox, made a plea for outside
assistance. M edical supp lies and tech nical help
wer e o ff er ed b y s ev er al n at io ns . The Commandi ng
Officer of U . S. Naval M edical Research U nit
N o. 2 provided technical assistance by offering
the services of a group of investigators and
technicians from the U nit at T aipei, T aiw an. T he
a uth or , ser vin g in th e ca pa city o f p ara sito lo gist,
accom panied this group which was designated as
the U. S. Naval M edical M ission to East Paid
stan
T he present report concerns people in an area
where there have been few surveys giving the
in cid en ce o f p ara sites a nd o th er in testin al m icr o
fauna. D ata and inform ation w ere obtained from
a stu dy of s to ol sp ec im en s c ollec te d in th e v icin ity
of Dacca, the capital. East Pakistan possesses
peo ple sithvar iedult ure snd bac kgr oun dsnd
the recent partitioning of India and the Pakistans
has resu lted in a co ntin ual tw o-w ay m ig ratio n of
refugees. D acca, w ith a population of approxi
mate ly o ne -th ir d m illio n, is lo ca te d o n th e Bur hi
Ganga River in the vast alluvial plain formed by
the silt desposits from the G anges, B rahm aputra
an d M egh ana R ivers. T he clim ate is w arm and
hum id and the average rainfall is reported as
80+ inches p er year.
M ATERIALS AND M ETHODS
Most of the fecal samples were obtained from
school children 6 to 18 years of age w ith the
majority in the 10 to 16 years age group. Al
th ough the w ork of the N aval M ission w as con
c er ne d p rimar ily w ith c ho le ra whic h w as p re va
lent in Dacca at the tim e, study m aterials for
* The opinions or assertions contained herein
a re th e p riva te o ne s o f th e a uth or a nd a re n ot to
b e c on str ue d a s o ffic ia l o r r efle ctin g th e v iews o f
the D ep artm en t of the N avi.
Ma il a dd re ss : APO 63, S an F ra nc is co , Ca li fo rn ia
th is re po rt w ere o btain ed o nly fro m in div id uals
apparently in a normal state of health. Stools
were taken from three areas representing s li ghtl y
d if fe re nt s oc io lo gi c a nd e co lo gi c h ab it at s.
M irpur C olony H igh School, a school w ith an
enrollm ent of approxim ately 1100 students lo
cated a few miles north of Dacca in an area in
w hich a g ood p art of th e po pu latio n w as en gage d
in f arm ing, marketi ng and a llie d o ccupa ti on s. A s
a result of an influx of numerous refugees from
India and other parts of Pakistan, a num ber of
p eo ple w ere u nemp lo ye d. M irp ur is lo ca te d n ea r a
branch of the Burhi Ganga River and the popu
lation makes generous use of its waters. As in
most villages in this part of the world, the people
were crowded into lim ited living space thus en
co ura ging the spread an d p ro pa gatio n o f c ertain
diseases. The m ajority of the population w as
Muslim , th e rem ain der H in du . Q uestio nin g o n
the spot and m acroscopic examination of stools
rev ea led th e lo ca l d ie t to co nsist m ain ly o f rice
a nd v eg eta ble s. Wa te r fo r th e v illa ge w as a va il
able from tube wells but it is likely that water
was taken from small ponds and rivers for house
hol d u se .
Te ij gaon Poly techn ic H igh Schoo l, a spec ia li zed ,
s em i-priv at e in st it ut ion w ith approxima te ly 500
s tu de nts is lo ca te d in D ac ca p ro pe r. T he s tu de nt
body was primarily Muslim and most of the
children came from homes in the urban com
m unity. The m ajority of parents were shop
keepers, m erch ants an d civil servants. Sin ce
attendance at this school required tuition, it is
r ea sonab le t o a ssume tha t th e s tuden ts c ame f rom
a s li ghtl y d if ferent economic l eve l than charact er
istic of m ost people of East Pakistan. This as
sump tio n w as fu rth er su pp orted b y th e gen era l
co nd itio ns a nd a pp eara nce o f th e sch oo l a s w ell
as of th e students.
D em ra Secondary School is a sm all inadequate
s chool crowded with approx imate ly 300 s tudents .
Stools were obtained from some parents and
y ou ng er ch ild re n a s w ell as from th e stu de nts.
S in ce th is series in clu ded seve ral ch ild ren a nd
16 8
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16 9
NTESTINAL PARASITES IN DACCA CHILDREN
parents, the ages ranged from 2 to 55 years.
H ow ever, the m ajority fell w ithin the 10 to 20
years age group. M ost of the children w ere from
fam ilies in w hich p aren ts an d o ld er c hildren w ere
laborers at the nearby jute m ills. The general
la xnes s in s an it at ion, mode o f liv ing and a pro li fi c
fly p op ula tion in th e v illa ge su gg ested a n id eal
h ab ita t f or e ff ec tiv e p ro pa ga tio n a nd tr an sm i ss io n
of p ara sites. V illa gers h ad d ire ct acc ess to th e
nearby Burhi G anga R iver. A s in other villages
in thisgener alrea tubewe llswerep resen tut
th e n ea rb y r iv er a ppar en tly se rv ed a s a s ou rc e o f
wa te r f or g eneral u se .
Even with the aid of a well-trained and ex
perienced interpreter only a very cursory back
ground history (age, occupation of parents, etc.,)
could be obtained. A s in previous surveys, fecal
sam ples w ere fixed by the “ MIF-vial―method1
which facilitates collection of study materials
und er a dv er se c onditio ns a nd g av e a ssu ra nc e o f
immediate and proper fixation of the included
m icrofauna. The m ajority of specim ens w as re
moved from sputum cups and fixed within 2 to
4 hours after passage.
For coll ec tion in t he fi eld 15-m i c apac ity s cr ew
cap vials w ere em ployed and 9.4 m l of M F (m er
thiolate-form alin) solution w as added prior to
departure from Taipei. Lugol's solution (0.6 in )
w as added to M F a few seconds before addition
of fecal sample to vial. W hen volume of stool
perm itted, three samples totaling about 1 m l
were taken from different areas of the stool.
A fter placing in M W fixative the fecal sam ples
were s tir red v igorou sly w it h t he a id o f an app lic a
t or s tic k. Upon r et urn t o t he laborat or y a t Taipei,
the stools were exam ined as opportunity per
m itted . T wo d irect sm ea r p rep ara tio ns (2 2 x 2 2
mm coverslip) of several drops each were ex
amin ed c are fu lly . T he se samp le s w ere w ith drawn
b y p ip ette from th e u pp erm ost la yer o f p articu
la te sed im en t. A t th e tim e o f seco nd p roc essin g,
on e h alf of the rem ainin g vialed specim en w as
s ub jec te d to M L FC co nce ntration .2
SU RV EY F IN DIN GS
S in ce th e p er io d fo r o bs er va tio n o f th e p eo ple
under study w as lim ited, it is difficult to correlate
th e p resen ce an d in cid en ce o f in testin al fau na
w ith d ue re ga rd to e co lo gic fa cto rs a nd th e g en era l
habits of the population. O n the site, there w as a
very definite im pression that all areas in w hich
studies were made provided ideal conditions for
th e w elfa re o f p ara sites o f m an a nd lower v erte
b rates. T able 1 lists th e sp ecies an d inciden ce fo r
intestinal protozoa and helm intha detected in a
single fecal sam ple obtained from people in the
Dacca area. No attempt has been made to cate
gorize data by precise age groups, by occupation
o f f am ilie s r epre sent ed , e tc ., s in ce th e numbers o f
p erson s fro m each o f three localities is n ot g reat.
M ost o f t he in testin al p ro to zo a com m on to m an
a re re pre se nte d b ut th e in cid en ce fo r s ome s pe cie s
is low er than exp ected for th is area. T he total
ra te s fo r E nIa nZOeb a h ie to ly tic a a re mo de ra te ly
h ig h an d su rp ass th ose fo r E ntamo eb a co li a nd
End olim ax n an a, u su ally th e p re domiw in t s pe cie s
in su rveys of this typ e. Sin ce it is believed that
th e i nc id ence o f pat hogenic E . h ie to ly tic a i s ove r
estim ate d in some stu dies, th e la rg er an d sm all
races of E. histolytica have been recognized as
d is tin ct ent it ie s, and t he re fo re lis te d s epara te ly .
The sm all, supposedly non-pathogenic race of
E. histolytica is much more common than the
large form of E . histolytica and the ratios of the
sm all to th e large race fall in th e sam e range as
recorded in sim ilar surveys in E gypt.3
The to ta l r ate s fo r E niamo eb a h is to ly tic a a nd
the o ther amebae , a lone , i nd ic ate t ha t v er y s at is
f ac to ry cond it ions f or tr an sm is sion o f paras it es
exist in the general population of D acca. D irect
person-to-person transm ission, perhaps as a rsult
of very low household sanitation practices and
grossly contam inated food, is suggested by the
incid encefDienia moeba fragi lishe generalse
o f w ate r fr om h ig hly c on tamin ate d p onds in a nd
around the city may well account for prevalence
of cyst -forming protozoans .
In Pak is ta n, a s in o th er c ountr ie s o f th e A sia n
In dian area, it is difficult to estim ate th e tru e
s ig ni fi ca nc e o f ameb ia sis s in ce t he re is a t en de nc y
in statistica l re po rts to in dica te m orb id ity a nd
m ortality due to all types of dysentery and diar
rheas in a single category. A visit to several
hospitals and health institutions in the D acca
area revealed that inform ation on am ebiasis was
essentially lacking and frequently no attem pt
w as m ad e to d ifferen tiate th is d ise ase from o th er
sim ilar co nd itio ns. W he n d ifferen tiatio n is co n
s id er ed , d et ermi na tio ns a re b as ed a lmo st e nt ir ely
on c lini ca l evidence .
Giardia lamblia is well represented but no
higher than expected in a population sample con
sistin g p rim arily of scho ol age child ren . T here is
no ade quate e xp la na tio n fe r th e low in cid en ce o r
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MirpurTeijgaonDemraDirect
@Direc t
smear M IFCDirect smearIFCProtozoaEntamoeba
h is to ly tic a ( LR onl y)@...
E ntamo eb a h is to lytic a (S R o nly )
Ent amo eb a h is to ly tic a ( LR and SR) ...
To ta l E . h is to ly tic a
Ent amoe ba c oli
E ndolim ax nana
lodamoeba bü ts ch li i
Dien tamoeba frag il is
Giardia l amb li a
Ch il oma st ix me sn il i
T ri ch omon as h om in is
En te romonas homini s
B alan tidium c oli
Isospora
6
24
7
37
37
23
18
9
16
—
1
—
1
15
19
4
25
34
14
17
3
8
—
—
—
—
—11
20
4
35
16
25
13
10
21
—
—
â
—
—6
20
5
31
20
20
6
15
20
—
1
â
—
11 0
25
4
39
20
10
19
4
14
2
3
2
—
—9
25
4
38
23
9
17
4
17
2
1
—
—HelminthsHookworm
Asca ri s lumb ri co id es
Enterob ius vermicularis
Heterodera
T ri chur is t ri ch iu ra
Acanthocephalan
Diphyflobothrium
Hym eno lep is n an a
Taenia
Fasc io lops is bus ki
Haplor ch is t ai chui
T yr og ly ph oid m ite
44
62
3
—
55
—
1
—
1
—
—
52 9
75
1
—
84
2
—
—
1
—
1
—52
36
6
1
39
—
—
—
—
—
1
124
40
3
1
56
—
—
—
—
—
1
—47
82
1
1
67
—
—
1
—
1
1
—13
83
1
1
87
—
—
1
—
1
—
2Negative
for protozoa
N eg ativ e fo r h elm in th s
N egative for both
19
7
02 2
3
034
26
03 9
19
03 5
6
03 6
6
0No.
of s tools exam ined 11711780809898
17 0
ROBER T E . K UN TZ
TABLE I
Incidence per cent)* of intestinal protozoa and helm inths in school children in the vicinity of D acca, East
Pakistan
* Given as nearest whole number.
t M IF C (m erthio la te -io dine -form alin co nc en tra tio n).
@ LR = large race E. histolytica with cysts measuring more than lOp; SR small race with cysts less
th an lOp .
absence o f o ther f lagel la te s. Chil omas ti x, a cosmo
po litan pro to zo an rep orted in m ost su rve ys, w as
d etected in o nly tw o p erso ns; b oth w ere m em bers
of the sam e fam ily. A sin gle stool contained cysts
o f Ba lant id ium coli wh ich is v er y preva lent in the
pigs of East Pakistan, and Isospora w as recog
n iz ed in a no th er sample .
Surveys for intestinal fauna of man in East
P ak istan are few o r lack in g. T herefo re, th ere a re
no fig ur es fo r c ompar iso n o f fin din gs fo r p eo ple
in th e D acca a rea w ith th ose in o th er p arts o f th e
country. Recently Dutt and Ghosh4 reported an
incidence of 11.3 and 7.5 r espectively for
E . h istolytica a nd G . lamb lia in a su rvey in W est
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17 1
NTESTINAL PARASITES IN DACCA CHILDREN
Bengal. They also stated that G upta, vi aL., in
1 95 4, h ad re po rte d a n in cid en ce o f 1 1.1 a nd 1 4.7
o f B . histo ly tic a and G . la mblia resp ective ly in a
study of hospital patients at C alcutta w hich lies
150 m iles southw est of D acca.
A ltho ug h g ov ern men t h ealth reco rd s p resen t
in s ome deta il t he s ta tis tic s r el at ing t o morb id it y
and m ortality due to snake bites, attacks by w ild
anim als and the m ore im portant com municable
diseases, no m ention is m ade of helm inth para
sites. T his, probably, is to be expected in a land
w here the significance of the latter is overshad
ow ed by the m ore devastating diseases su ch as
m alaria, c ho lera, an d sm allp ox. U po n qu estio n
ing officials and technicians at hospitals and
schools it w as learned that helm inth infections
are co nsidered as †œaart o f da ily liv in g―an d
that “everybodyhas worms― .Figures presented
in Table 1 tend to support this thesis.
It is d ou btfu l th at th ere h ave b een a ny ex ten
s iv e improvemen ts f or t he c on tr ol o r r educ ti on o f
helm inth diseases since Chandler's work in this
area 30 years ago. Ascaris and Trichuris are
found in the m ajority of persons exam ined and
hookworm is also com mon. It is assum ed that
Necat or amer ic anus is th e p re va ilin g s pe cie s in th e
D acca re gion b ut ex ten siv e m ig ratio ns of p eop le
i n recent years have probably int roduced Ancylos
toma duodenale. It is likely that multiple stool
sp ec im e ns wou ld h av e d emo nstra te d e ve n g re ate r
num bers of infections by worm s. As with certain
o f th e p ro toz oa , th e rates for in cid en ce of h oo k
w orm , A scaris, and w hipw orm corroborate obser
v atio ns r ev ea lin g a v er y low s ta nd ar d o f sa nita
tion in the majority of homes. In view of the
latter, the very low incidence (1 person) for H y
men ole pis n an a is pu zzlin g. H ow ev er, C ha nd le r s5
survey of India showed H. nana to be erratic in
o cc ur re nc e a nd p ra ctic all y a bs en t in s ome r eg io ns .
Although it may be argued that the nem atodes
h av e mu ch mo re re sista nt e gg s th an Hymen ole pis,
it is not believed that this is the lim iting factor
for infection by this parasite in Dacca where
most environments appear to be optimal for
p ro pa ga ti on a nd t ra nsm is sio n.
B oth Stronqyloides stercoralis and Tricho
stro nq ylu s w ere a bsen t altho ug h the ha bits of th e
people along w ith their close association with
c erta in a nim ldR wo uld s eem to a llow in fe ctio n b y
these worms. Dutt and Ghosh4 reported a low
rate of infection for Stronqyloides in W est B engal,
i.e., 0.4 , and did not list Trichostrongylus.
Earlier, Chandler found Trichostrongylus to be
rare in the area now know n as E ast P akistan, and
S tron gylo id es to b e very erra tic in d istribu tion
w ith a v ery low in cid en ce in some p la ces.
S in ce t he se s tud ie s we re bas ed ent ir el y upon an
e xamin ati on o f f ec al s amp le s th e r at es o f in fe ctio n
f or Enterob iusprobably are much lower than they
would have been had the scotch tape method
been em ployed. In view of the closeness of the
p eop le to th e so il an d th e fac t th at th ey ea t m an y
f re sh veg et ab le s, th e pauci ty o f He te rode ra is no t
re ad ily u nd ers to od . Howev er, C ha nd le r lik ew is e
reco rd ed lo w ra tes fo r th is h elm in th in certa in
lo ca litie s. E gg s o f a n a ca nth oc ep ha la n were fo un d
in 2 fecal sam ples. T hese possessed the general
char ac te ri st ic s o f Mac racan tho rhynchus h ir ud ina
ceus but have not been listed as such since the
mea su reme nts w ere c on sid era bly le ss th an g iv en
for this parasite. The specific identity of the
D iphyliobothrium is also questionable since m eas
urements do not agree w ith those given for
diphyllobothriids reported for man. Possibly
th ese represent instances in w hich th e eggs of
animal parasites have been consumed with con
tam in ated fo od s in an en virom en t w here rats an d
dom estic animals have access to food intended
for h um an use.
F asC iO lO pa is a nd H ap lo rc his ta ich ui a re th e o nly
representatives of the trem atoda, although the
domestic animals of East Pakistan are heavily
infected w ith F asciola an d o th er h elm in th s. C er
tainly, the consum ption of num erous brackish
an d fresh water fishes in the D acca area offers
oppor tun ity for grea ter inf ec ti on wi th t rematodes
than indicated in the present survey.
C oncen tration of p arasites b y th e use of th e
M IFC m eth od d id n ot g rea tly alter th e fin din gs
for m ost sp ecies. A s a m atter o f fa ct th e ra tes for
a number o f p ro to zo a a nd h elm in th s w er e h ig he r
b y th e d ir ec t sme ar e xamin atio n. T his is a n in di
ca tion of th e effica cy o f th e M IF v ia l a nd d irect
sm ear tech nic by w hich gradual sedim entation is
re sp on sib le fo r c on sid era ble c on ce ntra tio n o f th e
in clu ded o rg an ism s an d eg gs. T here a re ex cep
tio ns . In s amp le s fr om a ll th re e s ch oo ls th e r ate s
fo r A sc ar is a nd T ric hu ris w er e e le va te d a nd th e
eggs of an unidentified acanthocephalan w ere
found as a result of em ploym ent of the M IFC
technic.
T he in cid en ce o f in testin al fa un a is g iv en fo r
each of three schools from w hich stool sam ples
wer e o bta in ed . H ow ev er , s in ce th e liv in g c ondi
tio ns in th e differen t areas w ere c om parab le an d
the overall pictu re of parasitism sim ilar, it is
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172
ROBERT E. KUNTZ
u nn ec es sa ry fo r a dd itio na l d isc us sio n re ga rd in g
th e fin din gs fo r ea ch sch ool. It is q uite o bv io us
th at p ar as ite s a nd r ela te d i nt es ti na l f au na f lo uri sh
in th e pop ulations stu died and their presen ce
reflects the low sanitary standards of people
living in an environment where transm ission for
c erta in p ara site s is o ptim al. A ll s to ols c on ta in ed
a t le ast o ne sp ec ie s o f in te stin al fa un a and only a
few escaped infection by helminths. Although
h elm in th d ise ase s e lic it little a tte ntio n, it sh ou ld
be noted that in a cholera ward visited by the
a uth or, tw o ch ild ren su ffered n oticea bly w ith
in te stin al o cc lu sio n by As ca ris a nd o th er p atie nts
were anem ic as a result of heavy hookworm
infection.
SUMMARY
A survey based upon a study of single stool
specim en s from 300 stu den ts in th e vicin ity of
Dacca, East Pakistan, indicates the occurrence
of parasites and intestinal fauna in this general
a re a. En t amoeb a h is to ly tic a, B . c oli a nd Endo limax
n an a w ere p re va le nt, s up po rtin g o bse rv atio ns in
dicating that the people, in general, live in an
envi ronmen t wh ich pe rmi ts e ff ec ti ve t ran smi ss ion
o f c er ta in p ar as ite s. T he sma ll, n on -p ath og en ic
race of E. histolytica was m uch m ore com mon
than the larger race. B alantidium coii and Iso
spora were uncom mon with a single infection
d ete cte d fo r e ac h. Hoo kworm , A sc aris a nd T ric hu
ne occurred in a high percentage of the popula
tio n a nd eg gs of H ym en ok pis n an a w ere fo un d in
a s in gle sto ol. A n u nid en tifie d a ca nth oc ep ha la n
w s re orded s well s singleinfe tionith
Fasc io lopsi s and Diphyl lobothn ium , and three w it h
H apiorchis taichui. All persons studied possessed
a t le as t one spe cie s o f paras ite .
ACKNOWLEDGEMENTS
The author is indebted to Dr. Thomas A .
Cockburn, ICA, Dacca and to the M inistry of
Health of East Pakistan for the use of laboratory
and o ther f ac ilit ie s during the fi eld phas es o f t his
study. D r. Raymond H. Watten, LCDR, MC,
USN, Charles Knight, HM C, USN and James
E . R eese Jr., HM1, U SN , assisted in ob tain in g
inform ation and specim ens. G . M . M alakatis,
H M1, U SN and Jam es E. R eese, Jr., H M1, U SN ,
p ro cessed the fecal sp ecim en s. M r. Jalal-U dd in
A hm ed, D epartm ent of H ealth served in the ca
pacity of interpreter and as liaison officer for
th e M is sio n.
REFERENCES
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M IF stain-preservation technic for the
i denti fic ati on o f in te st inal p ro to zoa. Am . J .
Trop. M ed. H yg., 2: 613-619.
2 . B r@ao W ., SCHLOEGEL,. L ., MANSOUR ,. S .,
AND kn4u@ F, G. I., 1955. A new concentration
technic for the dem onstration of protozoa
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