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Status of Intestinal Parasitic Infections in a Tertiary Care Center

Article in Journal of Nepal Health Research Council · December 2022

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 Original Article
J Nepal Health Res Counc 2022 Apr-Jun;20(55):505-9

Status of Intestinal Parasitic Infections in a Tertiary

Care Center
Ajaya Basnet,1 Arun Bahadur Chand,2 Nayanum Pokhrel,3 Parbati Gurung,1 Junu Richhinbung Rai,4 Sohani
Bajracharya,5 Sadiksha Acharya,1 Lok Bahadur Shrestha6
1
Department of Medical Microbiology, Shi-Gan International College of Science and Technology, Tribhuvan
University, Kathmandu, Bagmati, Nepal, 2Department of Microbiology, KIST Medical College and Teaching
Hospital, Lalitpur, Nepal, 3Research Section, Nepal Health Research Council, Kathmandu, Bagmati, Nepal,
4
Department of Microbiology, Maharajgunj Medical Campus, Tribhuvan University Teaching Hospital,
Institute Of Medicine, Kathmandu, Nepal, 5Department of Clinical Microbiology, Kanti Children’s’ Hospital,
Kathmandu, Bagmati, Nepal, 6School of Medical Sciences and The Kirby Institute, University of New South
Wales, Sydney, Australia.

ABSTRACT

Background: Intestinal parasitic infections (IPIs) are diseases of serious public health concern in low- and middle-
income countries, including Nepal. Such infections can cause growth retardation and increased susceptibility to other
parasitic infections. Hence, this study aims to assess the prevalence of IPIs among the patients attending a tertiary care
hospital in central Nepal.

Methods: Clinical and laboratory records of patients, whose stool samples were collected and transported to the
Department of Clinical Microbiology, KIST Medical College and Teaching Hospital, during 2 years (January 2019 and
December 2020) were examined for parasitological findings, by conventional microscopy using normal saline and
iodine preparation.

Results: Out of 3,146 patients included in the study, 411 (13.1%) patients (median age[IQR]: 27[12-45]) were
infected with the intestinal parasites. Patients of different age groups, such as 20-30 years (16.1%), 10-20 years
(14.1%), and 30-40 years (13.3%) were mostly infected. Infection was more common in females (221/1572, 14.1%)
than males (190/1574, 12.1%). There were 373 (90.8%) cases of IPIs due to Entamoeba histolytica, 34 (8.3%) cases due
to Giardia lamblia, and 4 (0.9%) cases due to helminths. The prevalence of IPI in the first and second years was
14.5% (260/1794) and 11.2% (151/1352), respectively. IPIs were more common in summer (n=87, 12.8%) and
spring(n=81, 10.8%).

Conclusions: Present study showed a declined prevalence of helminth infection. However, a higher rate of protozoan
infection indicated the water source contamination with fecal matters and therefore urgencies for awareness among
the public about hygienic practices.

Keywords: Hospital visiting patients; intestinal parasitic infections; Nepal

INTRODUCTION malnutrition (due to increased nutrient loss, iron

deficiency), wasting, stunted linear growth, and
Intestinal parasitic infections (IPIs) has been a major decreased cognitive development.4 The synergism
public health problem in developing countries, including between IPIs and malnutrition is responsible for the
Nepal.1 As of 2020, WHO estimates more than 1.5 billion increased tendency of other microbial infections as
people to be infected globally with IPIs, primarily from well as higher mortality among children in developing
sub-Saharan Africa, China, and East Asia.2 Several factors countries.5
such as poor socio-economic conditions, high population
density, and unhygienic lifestyle attribute to IPIs.3 Though several field-based cross-sectional studies
The infected individual is often predisposed to portraying the prevalence of IPIs in school-aged children
Correspondence: Arun Bahadur Chand, Department of Clinical Microbiology, KIST
Medical College and Teaching Hospital, Lalitpur, Nepal. Email: arunbchand@gmail.com,
Phone: +977 9851216148.

JNHRC Vol. 20 No. 2 Issue 55 Apr - Jun 2022 505

 Status of Intestinal Parasitic Infections in a Tertiary Care Center

have been reported from Nepal, this hospital-based study 190 (12.1%) were males. Among the infected patients,
presents the actual scenario of parasitic infestation in there were 91 (16.1%) patients of age group 20-30 years,
patients visiting a tertiary care hospital in central Nepal. 41 (14.1%) of 10-20 years, 58 (13.3%) of 30-40 years,
44 (13.2%) of 40-50 years, 49 (12.1%) of ≥ 60 years,
METHODS 95(11.5%) of <10 years, and 33 (11.4%) of 50-60 years
(Table1).Concerning the seasons, there were 164 (15.8%)
A hospital-based retrospective study was conducted incidences of IPIs in the summer season, 87 (12.8%) in
in the Department of Clinical Microbiology of Kist the spring season, 79 (11.6%) in the autumn season, and
Medical College and Teaching Hospital (KISTMCTH), 81 (10.8%) in the winter season (Table 1).
Gwarko, Lalitpur. The study was approved by the
Institutional Review Committee (Reference number: Table 1. Incidence of intestinal parasitic infection based
20787952) of KISTMCTH. Patients with gastrointestinal upon age, gender, and season.
symptoms attending in Outpatient department and
Total Patients infected
Inpatient department of the hospital from January
patients
2019 to December 2020 were traced and analyzed for Variables Total Protozoan Helminth
(n=3,
parasitological findings.   146) n % n % n %

Using a wooden scoop, 5-10 grams of stool samples were Age

27 years
(median 27 years [12-45]
collected from the patients in wide-mouthed, clean, [8-46]
[IQR])
dry, screw-capped, leak-proof plastic containers. Each
container was labeled carefully and transported to Age group (years)
the Department of Clinical Microbiology for analysis. < 10 826 95 11.5 95 11.5 0 0
Macroscopic examination of the stool specimens
10-20 290 41 14.1 41 14.1 0 0
for the color, consistency, and presence of mucous,
blood, adult worms, or any other abnormalities was 20-30 566 91 16.1 90 15.9 1 0.2
done. Additionally, the microscopic examination was 30-40 436 58 13.3 57 13.1 1 0.2
performed by conventional microscopy using direct
40-50 334 44 13.2 43 12.9 1 0.3
normal saline and iodine wet mounts of the specimens.
Direct saline wet mounts with approximately 2mg of 50-60 289 33 11.4 33 11.4 0 0
stool specimens were prepared in a drop of normal saline ≥ 60 405 49 12.1 48 11.9 1 0.2
(0.9%) to observe pus cells, ova, cyst, and trophozoites
Gender
of parasites. Iodine wet mount preparations using
approximately 2mg of stool specimens were prepared in Male 1,574 190 12.1 190 12.1 0 0
5 times diluted Lugol’s iodine. Both preparations were Female 1,572 221 14.1 217 13.8 4 0.3
covered with coverslips and examined under the low
Season
power field(400×)of the microscope.6
Summer 1,037 164 15.8 164 15.8 0 0
Data analysis was performed using the Statistical Spring 680 87 12.8 86 12.6 1 0.2
Package for the Social Sciences software version 17.0.
Autumn 680 79 11.6 78 11.5 1 0.1
Patients’ demographics and prevalence of IPIs based
on age, gender, season and year were calculated and Winter 749 81 10.8 79 10.5 2 0.3
presented in tables accordingly.
Out of 411 infected patients, there were 407 (99.1%)
RESULTS incidencesof protozoan infection and 4 (0.9%)of
helminth infection (Table 2). There were 373 (90.8%)
Out of 3,146 patients investigated for parasitological cases of IPIs due to E. histolytica, 34 (8.3%) due to G.
findings, 411 patients were infected with intestinal lamblia, 2 (0.5%) due to Ascaris lumbricoides, and 1
parasites. The overall prevalence of IPIs among the (0.2%) due to Ancylostoma duodenaleand Strongyloides
patients was 13.1% (411/3146). . stercoralis each (Fig 1). Helminth infection due to A.
lumbricoides (0.9%, 2/221), A. duodenale(0.5%, 1/221),
The patients with IPIs had a median age (IQR) of 27 and S. stercoralis (0.5%, 1/221) were observed only in
years (12-45). Among them,221 (14.1%) werefemalesand infected female patients (Table 2).

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Table 2. Frequency of intestinal parasites on yearly basis. without using shoes/slippers or due to improper hygiene
or unhealthy habit of eating junk foods.16
Year
Parasites 2019 (n=1,794) 2020 (n=1,352) Total The prevalence of IPIs in the duration of two years, from
Male Female Male Female January 2019 to December 2020, was declined from
Protozoa (n=407) the first year (14.5%) to the successive year (11.2%).
Entamoeba Such a declining trends in the prevalence of IPIs in
108 125 61 79 373
histolytica the successive years was in agreement with the trend
Giardia reported by Kunwaret al.17In this study, the prevalence
14 9 7 4 34
lamblia of IPIs was highest in the summer season (15.8%) and
Helminths (n=4) lowest in the winter season (10.8%). The occurrence
Ascaris of IPIs due to protozoa(12.9%) was more common than
0 2 0 0 2
lumbricoides the helminths (0.1%), which is in agreement with the
Hookworm 0 1 0 0 1 previous findings from Nepal.18 The high prevalence of E.
Strongyloides histolytica (90.8%) followed by G. lamblia (8.3%) in this
0 1 0 0 1
stercoralis study is consistent with findings of various studies from
Total 122 138 68 83 411 Nepal and several other parts of the world.19,20 Contrary to
our findings, a study by Chandrashekhar et al.21reported
DISCUSSION a higher prevalence of G. lamblia (13.2%) and a low
prevalence of E. histolytica (1.7%). Nonetheless, such
The findings of the current study documented an a surge in the prevalence of protozoan indicates a
overall prevalence of intestinal parasites in 13.1% high level of contamination of food and water source
among the patients. The prevalence rate of the current by human feces,which could have occurred due to the
study concords with the findings reported from other proximity of broken drainage pipes left unattended that
southeastern countries, including China (14.9%)7 and eventually contaminated the drinking water and other
India (13.3%).8 However, prevalence seems much lower water bodies.22,23
than studies conducted in other parts of Nepal, including
Biratnagar (15.17%),9 Dang (21.4%),10 and in different Regarding the nematodes infection, the current study
countries like Sudan (64.4%)11, Yemen (58.7%)12, revealed a low prevalence for A. lumbricoides, A.
Iraq (22.0%)13, and Brazil (57.8%).14 The remarkably duodenale, and S. stercoralis. This finding was lower
lower prevalence of IPIs in our study could be due to than several other studies reported from Nepal,21 and
the differences in the method employed for stool other parts of the world, including Ethiopia (11.3%)24 and
examination, improved economical status, and level of China (0.5%).7 The significant decrease in the prevalence
awareness about IPIs amongst the dwellers. Additionally, of helminth infection in this study could be due to
the governmental policies of general improvement in commendable use of sanitary latrines, improvements
health services, sanitary conditions, and deworming in iron status, and deworming programs.3,7 The
programs could be other reasons for the low prevalence periodic campaign of anti-helminthic drug, especially
of IPIs.15 albendazole administration, governed by the ministry
of health to the school-aged children could explain the
The higher incidence of IPIs in females (14.1%) as lower prevalence of helminthic infections seen in this
compared to males (12.1%) in this study was similar study.25-27 Some of the limitations of this study include
to the findings of Li et al.7 Increased incidence of IPIs the examination of stool specimens by saline/iodine
in females could be due to differences in occupational wet mount technique, which may affect the accuracy of
exposure, low literacy rate, and poor hygienic and the parasite/egg count. In addition, this technique may
sanitation practices in different communities.9 The fail to detect some parasites that need concentration
patients of the age group 20-30 years (16.1%) were techniques for identification.
mostly affected by intestinal parasites followed by those
of <10 years (11.5%). This finding is juxtaposed to the CONCLUSIONS
study done by Khanal et al.,10 who reported the highest
IPIs rate in the age group of < 10 years, followed by 20-30 The low prevalence of IPIs due to helminth as observed in
years. The higher infection rates in adults in this study this study indicates the improvement in living conditions
could be attributed to the close contact of individuals and hygiene of people besides the combined efforts of
to the fecal contaminated environment while farming the healthcare authorities in the district. However, the
higher dissemination of protozoa strongly calls for the

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provision of safe drinking water, both at the household infection in primary school children in Elengaz area,
and community levels. Khartoum, Sudan. Academic Research International.
2014;5(2):86.[Full Text]
Conflict of interest
12. Al-Haddad AM, Baswaid SH. Frequency of intestinal
None.
parasitic infection among children in Hadhramout
governorate (Yemen). J. Egypt. Soc. Parasitol.
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