Division of Infectious Diseases, MLC 7013, International Adoption Center, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, ML 7036, Cincinnati, OH 45229-3039, USA.
Pediatrics. 2011 Sep;128(3):e613-22. doi: 10.1542/peds.2010-3032. Epub 2011 Aug 8.
Our goal was to determine the prevalence of intestinal parasites in internationally adopted children, to examine factors associated with infection, and to determine if evaluating multiple stool specimens increases the yield of parasite identification.
We evaluated internationally adopted children with at least 1 stool specimen submitted for ova and parasite testing within 120 days after arrival to the United States. In children submitting 3 stool specimens, in which at least 1 specimen was positive for the pathogen studied, we examined whether multiple stool specimens increased the likelihood of pathogen identification.
Of the 1042 children studied, 27% had at least 1 pathogen identified; with pathogen-specific prevalence of Giardia intestinalis (19%), Blastocystis hominis (10%), Dientamoeba fragilis (5%), Entamoeba histolytica (1%), Ascaris lumbricoides (1%), and Hymenolepsis species (1%). The lowest prevalence occurred in South Korean (0%), Guatemalan (9%), and Chinese (13%) children, and the highest prevalence occurred in Ethiopian (55%) and Ukrainian (74%) children. Increasing age was significantly associated with parasite identification, whereas malnutrition and gastrointestinal symptoms were not. Overall, the yield of 1 stool specimen was 79% with pathogen recovery significantly increasing for 2 (92%) and 3 (100%) specimens, respectively (P < .0001). Pathogen identification also significantly increased with evaluation of additional stool specimens for children with and without gastrointestinal symptoms.
We provide data for evidence-based guidelines for intestinal parasite screening in internationally adopted children. Gastrointestinal symptoms were not predictive of pathogen recovery, and multiple stool specimens increased pathogen identification in this high-risk group of children.
我们的目标是确定国际收养儿童中肠道寄生虫的流行率，研究与感染相关的因素，并确定评估多个粪便标本是否会提高寄生虫鉴定的检出率。
我们评估了至少有 1 份粪便标本在抵达美国后 120 天内提交用于卵和寄生虫检测的国际收养儿童。在提交了 3 份粪便标本的儿童中，至少有 1 份标本检测到研究病原体阳性，我们研究了多个粪便标本是否会增加病原体鉴定的可能性。
在所研究的 1042 名儿童中，27%至少有 1 种病原体被鉴定；具体病原体的流行率为肠贾第鞭毛虫（19%）、人芽囊原虫（10%）、脆弱双核阿米巴（5%）、溶组织内阿米巴（1%）、蛔虫（1%）和膜壳绦虫属（1%）。韩国（0%）、危地马拉（9%）和中国（13%）儿童的最低流行率，埃塞俄比亚（55%）和乌克兰（74%）儿童的最高流行率。年龄增长与寄生虫鉴定显著相关，而营养不良和胃肠道症状则没有。总体而言，1 份粪便标本的检出率为 79%，2 份（92%）和 3 份（100%）标本的病原体回收率显著增加（P<0.0001）。对于有和没有胃肠道症状的儿童，评估额外的粪便标本也显著增加了病原体的鉴定。
我们为国际收养儿童肠道寄生虫筛查提供了循证指南的数据。胃肠道症状不能预测病原体的恢复，在这个高风险儿童群体中，多个粪便标本增加了病原体的鉴定。
