09 August 2023: Articles
Unknown etiology, Unusual setting of medical care, Rare disease, Educational Purpose (only if useful for a systematic review or synthesis)Roberto Darwin Coello Peralta 1ABCDEFG*, Sandra Gabriela Parra-Guayasamin 1E, Carmen A. Yancha Moreta 2DFG, Gilma Esperanza Guerrero Lapo2DFG, Diego Martín Cushicóndor Collaguazo 1BCF, Natali Estefanía Ortega Tinajero3BCF, Betty Judith Pazmiño Gómez 2E, Eduardo Alfredo Gómez Landires4AE, Geraldine Ramallo5ABCDEF
Am J Case Rep 2023; 24:e939583
BACKGROUND: Worldwide, there are few cases of Urbanorum spp. in humans; however, it is associated with gastrointestinal pathologies, where humans probably acquire the disease by fecal-oral transmission, by ingesting food or water with infective cysts. The main symptoms of the patients who have this presumed parasite are fever, vomiting, colic, dyspepsia, and watery diarrhea. Since the first case of Urbanorum spp. was reported in 1994 in Colombia, cases have subsequently been reported in Peru, Ecuador, Colombia, Brazil, and Mexico. In Ecuador, a prevalence of 1.16% has been reported, and the objective of this study was to record another case of Urbanorum spp. infection in Ecuador.
CASE REPORT: A female patient (mixed race; 40 years old; and thin, weighing 57 to 62 kg) requested help from the FCI Project approved and financed by the University of Guayaquil (Ecuador). She underwent routine tests, such as direct parasitology and sedimentation with centrifugation using saline solution. Samples were observed under an optical microscope with 10x and 40x objectives and stained with and without Lugol’s solution. We detected a rounded structure with several filaments similar to light yellow pseudopods.
CONCLUSIONS: Herein, a case of Urbanorum spp. infection in Ecuador, where current environmental and sanitary conditions have contributed to new cases, is reported, indicating that the community was exposed to this probable parasite with importance in public health. Further studies are recommended to confirm its etiology, life cycle, and epidemiology, in order to create a national registry, in case it is defined as a protozoan.
Keywords: Ecuador, Environment and Public Health, Clinical Laboratory Techniques, Parasitology
Protozoa and helminths (enteroparasites) are very prevalent and persistent worldwide. It is estimated that 3.5 billion people around the world are affected, constituting a serious public health problem due to the epidemiological triangle of parasitic diseases, that is, the relationship between the condition of the host, the parasite, and the environment [1,2]. Helminths are highly prevalent in developing countries, and their frequency is an indicator of socioeconomic and health deficiency in a region. Parasite occurrence is prevalent among hosts exposed to poor basic sanitary conditions and with low levels of education (schooling) and inadequate hygiene habits, which allows the appearance of parasites, affecting the health of local populations . Parasites can cause various gastrointestinal pathologies, malnutrition, cognitive and physiological delays, and even death, independent of age .
In 1991, Dr. Francisco Tirado Santamaría reported the first cases of
Similar to other intestinal parasites, the transmission of
Ecuador has high rates of intestinal parasites [9,10], and this report presents a case of natural infection by
This case report was part of the FCI-029 Project (Fund Competitive of Research) approved and was financed by the University of Guayaquil (Ecuador), called: “Ecoepidemiology of neglected intestinal helminthiasis in urban-marginal and rural areas of the Guayas province”.
A thin, 40-year-old woman who weighed between 57 and 60 kg was a resident of the urban-marginal sector of the “Balerio Estacio” Cooperative of the city of Guayaquil, Ecuador; she had a history of diarrhea, low body weight, abdominal discomfort, and fever of 2 days of evolution. She consulted researchers from the FCI-029 Project of the University of Guayaquil (“Ecoepidemiology of Neglected Intestinal Helminthiases in Urban-Marginal and Rural Areas of the Province of Guayas,” on November 24, 2022. That same day the patient was seen in the Private Ecomedical Center, the symptoms were considered, and the infection was confirmed with the results obtained from the laboratory.
The physical evaluation carried out showed that the ocular and oral mucosa, cardiac and pulmonary auscultation, and abdominal palpation and percussion were normal.
The place where the patient resides did not have adequate sanitation, which had a large epidemiological impact, and was a research site of the aforementioned project. Informed consent was requested from the patient before a sample was obtained. The method for obtaining the sample was explained to the patient, who was provided a sterile container. Fecal samples were transported on the day of collection in refrigerated boxes (4–8°C) to the “Pazmiño” Clinical and Microbiological Laboratory in the city of Milagro.
The samples obtained were semi-liquid, common to diarrhea. Later, they were analyzed using coproparasitic methods: direct parasitological and sedimentation with centrifugation using saline solution. The sample was stained with Lugol’s solution and examined the same day using 10× and 40× objectives.
The analyzed sample lacked red blood cells, leukocytes, and mucus, but contained a round structure and several filaments, similar to those described by Rodrigues and Gonçalves (2022) and Sousa and Alves (2018) [2,6] (Figure 1). In addition, the microscopic analysis of the presumed parasite was indicative of
The patient was treated with metronidazole administered in doses of 500–750 mg PO every 8 hours for 10 days. Fourteen days after treatment, the team from Project FCI-029 of the University of Guayaquil reported that the patient’s health had improved.
The blood tests performed presented normal values. In addition, a differential diagnosis was made in a private laboratory through fecal parasitology and stool cultures of Amebiasis, Giardiasis, Cystoisosporiasis, Colibacillosis, and Salmonellosis, but none were registered.
A limitation of the present report is that the patient could not be followed up after treatment since she did not repeat the parasitological tests after she felt better. However, the identification of
The environmental conditions in Ecuador are favorable for the appearance of cases of intestinal parasites. In Latin America,
In South America,
Tirado Santamaría carried out several studies that serve as an epidemiological record of this infectious agent in Colombia. In 1991, he observed
In Peru, during 2006, of a total of 96 children 3–14 years of age, 20.8% were infected with
In Ecuador in 2016, in a study on the prevalence of protozoa and helminths in 3 different regions of Ecuador, out of a total of 295 fecal samples, various types of parasites were identified. Furthermore, the presence of
In Brazil, the first report of
In a study carried out in 2020 in cities of the Vale do Paraíba metropolitan region, of a total of 2777 samples analyzed using the Hoffman, Pons, and Janner technique, 252 samples (9.07%) were positive for
In 2019 in Veracruz (Mexico), Bonilla et al found the first case of
Although previous studies have performed several different parasitological techniques, the techniques used in the present study (direct method and sedimentation method) effectively identified
The reports of
This study was based on the identification of morphological characteristics of
Despite the limitations of this study, control and prevention of
Our report presents relevant points regarding
In this article we report another case of
FiguresFigure 1.. Microscopic identification of Urbanorum spp., determined in feces of an investigated woman, highlighting their shape, light yellow color, and morphology, using the direct coproparasitic method, as viewed under a light microscope using 40× objective and stained with Lugol’s solution.
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