USA - Human Intestinal Parasite Burden and Poor Sanitation in Rural Alabama - Hookworm

[Gert van der Hoek]

05 september 2017

[FONT=&quot]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. [/FONT][FONT=&quot]Necator americanus[/FONT][FONT=&quot] 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 [/FONT][FONT=&quot]N. americanus[/FONT][FONT=&quot], four (7.3%) for [/FONT][FONT=&quot]Strongyloides stercoralis[/FONT][FONT=&quot], and one (1.8%) for [/FONT][FONT=&quot]Entamoeba histolytica[/FONT][FONT=&quot]. Stool tested positive for [/FONT][FONT=&quot]N. americanus[/FONT][FONT=&quot] contained low levels of parasite DNA (geometric mean 0.0302 fg/?L). Soil studies detected one (2.9%) [/FONT][FONT=&quot]Cryptosporidium[/FONT][FONT=&quot] species, and [/FONT][FONT=&quot]Toxocara[/FONT][FONT=&quot] 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 [/FONT][FONT=&quot]N. americanus[/FONT][FONT=&quot]. 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.[/FONT]

 

[Gert van der Hoek]

Hookworm, a disease of extreme poverty, is is thriving in the US south. Why?

sept 5, 2017

[FONT=&quot]Children playing feet away from open pools of raw sewage; drinking water pumped beside cracked pipes of untreated waste; human faeces flushed back into kitchen sinks and bathtubs whenever the rains come; people testing positive for hookworm, an intestinal parasite that thrives on extreme poverty.[/FONT]

[FONT=&quot]These are the findings of a new study into endemic tropical diseases, not in places usually associated with them in the developing world of sub-Saharan Africa and Asia, but in a corner of the richest nation on earth: Alabama.[/FONT]

[FONT=&quot]Scientists in Houston, Texas, have lifted the lid on one of America?s darkest and deepest secrets: that hidden beneath fabulous wealth, the US tolerates poverty-related illness at levels comparable to the world?s poorest countries. More than one in three people sampled in a poor area of Alabama tested positive for traces of hookworm, a gastrointestinal parasite that was thought to have been eradicated from the US decades ago.[/FONT]

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