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研究生:楊文森
研究生(外文):VINCENT PAM GYANG
論文名稱:奈及利亞拉哥斯市Makoko社區學童之侵神經性寄生蟲感染流行病學與MIF技術偵測腸道寄生蟲之評估
論文名稱(外文):Epidemiology of neurophilic parasitic infections among schoolchildren in Lagos, Nigeria and the evaluation of MIF technique for the detection of intestinal helminthes
指導教授:范家堃范家堃引用關係
指導教授(外文):Chia-Kwung Fan
學位類別:博士
校院名稱:臺北醫學大學
系所名稱:醫學科學研究所
學門:醫藥衛生學門
學類:醫學學類
論文種類:學術論文
論文出版年:2015
畢業學年度:103
語文別:英文
論文頁數:142
中文關鍵詞:犬蛔蟲弓形蟲腸道寄生蟲感染血清陽性率疾病認知危險因子小學學童奈及利亞
外文關鍵詞:Toxocara canisToxoplasma gondiiIntestinal parasitic infectionsSeroprevalenceDisease awarenessRisk factorsPrimary school childrenNigeria
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Neurophilic parasitic infections (like Toxocariasis and Toxoplasmosis) and intestinal parasites are serious public health problems in many developed and developing countries. Children are particularly at risk due to their attraction to pets (especially dogs and cats), their play habits, poor level of hygiene and in some cases pica. In Nigeria many studies have indicated the existence of Toxocara canis in dogs, but investigations in humans is very scanty and none exist exclusively on children, and in southern Nigeria. With regards to Toxoplasmosis, most of the studies, if not all, in the country are on pregnant women. Hence, there is also paucity of information on the prevalence in children. Intestinal parasitic infections continue to prevail in Nigeria, hence the need for accurate diagnosis. Most studies in the country were done using the Kato-Katz, probably due to cheaper cost, though the technique is believed to be less sensitive compared to the Merthiolate-Iodine-Formaldehyde (MIF) technique. Blood samples were collected (3-5mls) for the detection of both Toxocara canis and Toxoplasma gondii. The larval excretory-secretory antigens, from the third stage larva, were used to test sera for toxocara specific IgG by western blotting. A kit based on latex agglutination (Toxo Test-MT: Eiken Tokyo) was used to test sera for T. gondii and a titre of 1:32 or higher was considered positive. Intestinal helminthes were investigated using stool samples. About 1g of stool sample was put in special containers for the MIF procedure and mixed with 5mls of MIF solution, then passed through a 100 mesh sieve. It was then allowed to stand overnight after which about 50ul was aspirated onto microscope slides and viewed. For the Kato-Katz technique, about 1g of stool was also used. The stool was placed on a filter paper and pressed through a 100 mesh sieve. The sieved stool was then scraped off the sieve surface and placed to fill a hole on a template on a microscope slide. The fecal material was then covered with pre-soaked cellophane strips in malachite green, inverted and pressed for an even spread, then viewed. Out of the 384 samples (blood and stool) examined, results showed that 86.1%, 24% and 86.2% of the children were infected with Toxocara canis, Toxoplasma gondii and intestinal parasites respectively. The MIF technique showed superiority to Kato-Katz in detection of intestinal parasites (p < 0.0001), and it was also able to detect protozoan parasites like Entamoeba hystolytica/E. dispar (27%), Entamoeba coli (10%), Giardia lamblia (13%), Endolimax nana (11%) and Blastocystis hominis (3%), which were not detected by Kata-Katz. With the results of Toxocariasis and Toxoplasmosis infections, we have generated baseline data on these neglected tropical diseases among schoolchildren in Nigeria, while enriching the data on intestinal parasitic infections. There is therefore need for community education on personal hygiene, proper sanitation, and drinking of safe water. Government intervention in these aspects is also urgently required.

TABLE OF CONTENT
LIST OF ABBREVIATIONS…………………………………………………..……1
SUMMARY…………………………………………………………….……………..2
PART 1. Seroprevalence, disease awareness, and risk factors for Toxocara canis
infection among primary schoolchildren in Makoko, an urban slum community
in Nigeria……………………………………………………………………..……....4
1.1 Abstract……………………………………………………………...….……4
1.2 Introduction…………………………………………………………………..6
1.3 Background on Toxocariasis…………………………………………………9
1.4 Life cycle of Toxocara canis…………………………………………………9
1.5 World-wide prevalence of Toxocara canis…………………..……………..11
1.6 Global seroprevalence of Toxocara canis infection …...………………..…11
1.7 In Nigeria……………………………………………………………………12
1.8 Clinical classification of Toxocariasis…………………………...…………12
1.9 Visceral larva migrans (VLM)……………………………....……………..13
1.10 Ocular larva migrans (OLM)……………………………….....……………13
1.11 Neurotoxocariasis (NT)………………………………………….…………14
1.12 Covert or common toxocariasis………………………………….…………14
1.13 Diagnosis…………………………………………………………...………15
1.14 Treatment……………………………………………………………………16
1.15 Control………………………………………………………………………16
1.16 World Health Organization strategies to combat Neglected Tropical
Diseases……………………………………………………………………..17
1.17 Materials and Methods……………………………………...………………19
1.17a Study area……………………………………………………………19

1.17b Preliminary investigation of study site……………….……….……...19
1.17c Study population, sample size, and sampling strategy….……………20
1.17d Ethical consideration/Mobilization and Advocacy Visits….………...20
1.17e Blood collection………………………………………….……….…..21
1.17f Toxocara egg culture……………………….………………………....21
1.17g Preparation of Toxocara canis larval excretory-secretory antigens
(TcES)………………………………………………………………………21
1.17h Western blot analysis…………………….…………………………...22
1.17i Knowledge about toxocariasis, generalized symptoms and risk
factors ………………………………………………………………………23
1.17j Statistical analysis…………………….………………………………23
1.18 Results………………………………………………………………………23
1.19 Discussion………………………………………………………………….24
PART 2. Toxoplasma gondii infection: seroprevalence and associated risk factors
among primary schoolchildren in Lagos City, Southern Nigeria. …..…….…….31
2.1 Abstract………………………………………………………………………31
2.2 Introduction………………………………………………………………….32
2.3 Background on Toxoplasmosis………………………………………………34
2.4 Morphology…………………………………………………………………..35
2.5 Life cycle……………………………………………………………………..35
2.5a Definitive host cycle……………………………………...………………35
2.5b Intermediate host cycle…………………………………...………………36
2.6 Clinical disease……………………………………………….………………37
2.6a Congenital Toxoplasmosis……………………………….………..……..37
2.6b Ocular Toxoplasmosis……………………………………...…………….38

2.6c Acquired Toxoplasmosis…………………………………………..……..38
2.6d Recrudescent Toxoplasmosis…………………………...………………..38
2.7 Diagnosis……………………………………………………..………………39
2.8 Treatment…………………………………………………..…………………40
2.9 Prevention and control………………………………………..………………40
2.10 Materials and methods………………………………………..……..………41
2.10a Study area …………….……………………………………………...…41
2.10b Study design……….……………………………………………………41
2.10c Sample collection and analysis…….……………………………………42
2.10d Knowledge about toxoplasmosis and prevalence of generalized
symptoms……………………..…….……….……………………………42
2.10e Statistical analysis……………………………………………….……...42
2.11 Results……………………………………………..………………..………43
2.12 Discussion………………………………………….………………….……44
2.13 Conclusion……………………………………………..……………………47
PART 3. Intestinal parasitic infections: current status and associated risk factors
among schoolchildren in an archetypal African urban slum in Nigeria……...…48
3.1 Abstract……………………………………………………………......……..48
3.2 Introduction………………………………………………...………….……..49
3.3 Background on IPIs encountered in the study……………..…………………51
3.3a Ascaris lumbricoides……………………….....………………….……...51
3.3a,a Life cycle………………………………………………………...…..51
3.3a,b Clinical diseases………………………………………………….…52
3.3a,c Hepatobiliary Ascariasis (HPA)…………………………….………53
3.3a,d Neonatal Ascariasis…………………………………………...…….53

3.3a,e Treatment…………………………………………….……..……….53
3.3a,f Prevention and control………………………………………………53
3.3b The Hookworms………………………………………………………….54
3.3b,a Life cycle……………………………………………………………54
3.3b,b Clinical disease……………………………………...………………54
3.3b,c Treatment……………………………………………...………….…55
3.3b,d Prevention and control………………………………...………….…55
3.3c Trichuris trichiura…………………………………………..……..…….55
3.3c,a Life cycle………………………………………………...………….55
3.3c,b Clinical disease……………………………………………….……..56
3.3c,c Treatment……………………………………………………………56
3.3c,d Prevention and control………………………………………………56
3.3d Entamoeba histolytica/E. dispar……………………………...…………57
3.3d,a Life cycle……………………………………………...…….………57
3.3d,b Clinical diseases………………………………………….…………58
3.3d,c Treatment……………………………………………………………59
3.3d,d Prevention and control………………………………………………59
3.3e Giardia duodenalis………………………………………………..……..59
3.3e,a Life cycle………………………………………………...………….60
3.3e,b Clinical disease……………………………………………..………60
3.3e,c Treatment…………………………………………………..….……61
3.3e,d Prevention and control……………………………………...………61
3.3f Blastocystis hominis………………..…………………………..…………61
3.3f,a Life cycle………………………………………………….…………61
3.3f,b Clinical disease…………………………………………….…….….61

3.3f,c Treatment……………………………………………………………62
3.3f,d Prevention and control……………………………….……..……….62
3.3g Commensal amoebae……………………………………………………62
3.3g,a Entamoeba coli………………………………………….……..……62
3.3g,b Endolimax nana…………………………………………..…………63
3.4 Diagnosis techniques used in the study………………………………………63
3.4a Kato-katz technique……………………………………………..…….…63
3.4b Merthiolate-Iodine-Formaldehyde (MIF) technique…………….………63
3.5 Materials and methods…………….…………………………………….……64
3.5a The geography of Makoko …….……………………………………...…64
3.5b Study population and subject selection ….……………………….……...65
3.5c Sample collection………………………….……………………..………66
3.5d Kata-Katz procedure…………………….…………………….…….……66
3.5e Merthiolate-Iodine-Formaldehyde (MIF) procedure………….….………66
3.5f Statistical analysis…………………….……………………………..……67
3.6 Results……………………………………………………………….….……67
3.7 Discussion…………………………………………………………..….…….68
PART 4. SUMMARY AND DISCUSSION………………………..………………75
REFERENCES…………………………………………………………….………..77
TABLES…………………………………………………………………...……….105
FIGURE LEGENDS……………………………………...……………………….119
APPENDIX…………………………………………………………………...……127

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