The present study has been designed as a basic study on laboratory diagnosis of giardiasis and to demonstrate a more effective method for the detection of Giardia lamblia cyst with the inherent advantages of minimizing both the number of stool examinations required and the interval of stool collections for estimating the real state of prevalence in the shortest time possible. There were 3 subject groups of 75 children each currently residing in an orphanage in Gunsan city, Jeonbuk province from which stool specimens were collected every day, every other day, and every 3 days. The procedure is as follows: Resuspend the fixed sample after fixation with SAF solution. Centrifuge the sediment for 1 min. at 2,000 rpm after straining through gauze into a tube. Divide the sediment into 3 parts and use them for direct fecal smear, formalin-ether concentration (MGL) and zinc sulfate (ZnSO(4)) floatation techniques. The results are summarized as follows: Overall infection rate after 10 trials showed a 60 percent positive indication. The positive rate among children under 4 years old was significantly higher than the rate in children over 4 years old. No significant difference in rate by sex was observed. The results of examinations by direct fecal smear and MGL techniques appeared more accurate than that obtained by ZnSO(4) floatation method as indicated by a higher positive rate. Of all three methods concerned, combinations of two demonstrated a higher positive rate than that shown by any one alone. In three consecutive examinations under varying conditions such as different days, the cyst detection rate by MGL technique indicated 83 percent. In 5 examinations under the same varying conditions, the indicated rate was 94 percent. The interval of stool collection proved to be insignificant for the cyst detection rate. In conclusion, both MGL method and modified fecal direct smear can provide a good cyst detection rate of G. lamblia provided that more than 3 consecutive examinations of stool under varying conditions are carried out.
parasitology-protozoa ; Giardia lamblia ; diagnosis ; ormalin ; ether ; zinc sulfate

Conventional formalin-ether concentration method is a gold standard for the diagnosis of parasite infection. However, it may be time-consuming and laborious. We aimed to reveal the clinical usefulness of a modified formalin-ether concentration method using the Para Tube (KS Corporation, Korea) compared with the conventional method. A total of 117 fresh, unpreserved fecal samples composed to 90 negative controls and 27 positive controls with ova of Diphyllobothrium latum/D. nihonkaiense, ova of Clonorchis sinensis and cysts of Giardia lamblia were used in this study. Both methods showed comparable correct identification rate (87.2% for the Para Tube vs. 86.3% for the conventional method).When five samples were examined at once, the Para Tube method reduced the procedure time compared with the conventional method (19 min 58 sec vs. 23 min 18 sec, P=0.0286). We concluded that the modified formalin-ether concentration method using the Para Tube is a rapid, simple, and reliable fecal concentration method for clinical use.
Clonorchis sinensis ; Diagnosis ; Diphyllobothrium ; Giardia lamblia ; Ovum ; Parasites

As many Koreans now travel abroad, they are at increased risk for a variety of infectious diseases that are endemic to developing countries in the tropics and subtropics. We report two cases of co-infection with Giardia lamblia and Salmonella species not susceptible to nalidixic acid, after travel abroad.
Coinfection ; Communicable Diseases ; Developing Countries ; Giardia ; Giardia lamblia ; Nalidixic Acid ; Salmonella

Giardia lamblia, a gastrointestinal protozoan, is one of the most common disease-causing parasites in the world. Giardiasis is primarily encountered in areas with poor sanitation, but it is also seen in more developed countries. A possible sequela of Giardia infections of the bowel is reactive arthritis or synovitis. Few reports of synovitis secondary to giardiasis exist in the literature. Arthropathy secondary to giardiasis is uncommon, but may be underdiagnosed. We present a 23 year-old woman who had polyarthritis after Giardia lamblia infestation. The synovitis subsided with treatment of the giardiasis with metronidazole. The diagnosis of Giardia synovitis should be suspected by the presence of Giardia cysts in the stool. Although uncommon, giardiasis can cause severe synovitis that may be confused with a septic joint.
Arthritis* ; Arthritis, Reactive ; Developed Countries ; Diagnosis ; Female ; Giardia lamblia ; Giardia* ; Giardiasis ; Humans ; Joints ; Metronidazole ; Parasites ; Sanitation ; Synovitis ; Young Adult*

Cryptosporidium parvum and Giardia duodenalis are the main diarrhea-causing parasitic pathogens; however, their prevalence in Korea is unknown. Here, we conducted a survey to determine the prevalence and genotype distribution of these 2 pathogens causing acute diarrhea in 8,571 patients hospitalized in 17 Regional Institute of Health Environment sites in Korea, during 2013–2016. C. parvum and G. duodenalis were detected and genotyped by nested PCR, and the isolate were molecularly characterized by sequencing the glycoprotein 60 (Gp60) and β-giardin genes, respectively. The overall prevalence of C. parvum and G. duodenalis was 0.37% (n=32) and 0.55% (n=47), respectively, and both pathogens were more prevalent in children under 9 years old. Molecular epidemiological analysis showed that the C. parvum isolates belonged to the IIa family and were subtyped as IIaA13G2R1, IIaA14G2R1, IIaA15G2R1, and IIaA18G3R1. Analysis of the β-giardin gene fragment from G. duodenalis showed that all positive strains belong to assemblage A. This is the first report on the molecular epidemiology and subtyping of C. parvum and G. duodenalis in such a large number of diarrheal patients in Korea. These results highlight the need for continuous monitoring of these zoonotic pathogens and provide a basis for implementing control and prevention strategies. Further, the results might be useful for epidemiological investigation of the source of outbreak.
Child ; Cryptosporidium parvum ; Cryptosporidium ; Diarrhea ; Genotype ; Giardia lamblia ; Giardia ; Glycoproteins ; Humans ; Korea ; Molecular Epidemiology ; Polymerase Chain Reaction ; Prevalence

This study was undertaken in order to elucidate the prevalences of the intestinal protozoan infection according to localities and the mode of the infestation in the mountainous area of Chollapuk-do, Korea during the year 1970-1971. 8,508 of fecal samples were collected among the inhabitants of the mountainous area, which covered 18 Myens(=Township) from 6 Guns(=County) in the eastern part of Chollapuk-do. Most of the inhabitants of this area were engaged in farming and living under lower economic and poor sanitary conditions. The samples were examined twice repeatedly by iodine stained direct fecal smear method. For the study on the mode of infestation, with the exception of drinking water, the zinc sulfate floatation technic was applied for the examinations of hog-feces, manure heap, garden soil, sewage, dishtowel, dust in room and floor, house fly and house rat. The results were summarized as follows: Among total 8,508 fecal specimens examined, 3,152(37.6 percent) were positive for the intestinal protozoa: E. histolytica 9.8 percent, E. coli 25.6 percent, E. nana 7.2 percent, G lamblia 6.8 percent, I. butschlii 0.6 percent, and C. mensnili 0.7 percent. A single infection of the intestinal protozoa was the highest(68.3 percent), and double infection(22.3 percent) triple, quadruple and quintuple infections were in decreasing order. The highest distribution (39.8 percent) was observed in the group aging 41-50, and the lowest (27.3 percent) in the group above 61. The groups under 10 years showed a relatively high positive rate among all age groups. Sexual distribution of protozoan infection showed slightly higher rate (38.6 percent) in male than that (35.4 percent) of female. Jangsoo-gun showed the highest positive rate (42.9 percent) and Namwon-gun was the lowest (32.5 percent). The prevalence of E. histolytica showed the highest (11.6 percent) in Imsil-gun and the lowest (6.9 percent) in Jangsoo-gun. E. histolytica cysts were found 9.1 percent among total 99 samples of hog feces, 4.8 percent among 78 samples of manure heap, 0.6 percent among 164 samples of fingernail dirt, 5.3 percent among 57 samples of drinking water, 15.8 percent among 19 samples of sewage, 7.1 percent among 42 samples of dishtowel, 0.1 percent among 780 samples of house fly and 5.0 percent among 40 samples of house rat.
parasitology-protozoa ; Entamoeba coli ; Entamoeba histolytica ; Giardia lamblia ; Endolimax nana ; Iodamoeba butschlii ; Chilomastix mesnili ; epidemiology

A survey on the prevalence of intestinal protozoan cysts was conductcd in Jeonlanam Do (Province), Korea in 1981. A total of 4,116 specimens was collected from 2,035 male and 2,086 female inhabitants in 4 urban and 7 rural areas. Each case was selected randomly to represent 1,000 inhabitants referred to the census in 1980. Formalin-Ether sedimentation technique was employed to concentrate the cysts and one Lugol's iodine stained smear was examined for each case. The results were summarized as follows: The cases who passed out protozoan cysts of any kind were 9.1 percent out of total 4,116 examined, and cumulative positive rate was 11.0 percent. Among the positive cases, 16.5 percent were infected by two or more species of protozoa. Total 5 species of cysts were detected and the positive rates were as follows; Entamoeba histolytica 1.4 percent, E. Coli, 4.9 percent, Endolimax nana 2.5 percent, Iodamoeba butschlii 0.4 percent and Giardia lamblia 1.9 percent. The cyst positive rates varied greatly by the surveyed area. The positive rate in rural area was 11.6 percent compared with 5.7 percent in urban area. The highest rate was found 14.5 percent in Gurye Gun (County) and the lowest 3.6 percent in Mogpo Si (City). Female showed much higher positive rate than male as 11.8 percent compared with 6.4 percent and the cumulative rate 14.2 percent and 7.6 percent respectively. By age group, the rate was highest as 13.9 percent in 40-49 years and next 12.5 percent in over 60 years group. The cyst prevalence rate diminished remarkably in Jeonlanam Do compared to previous records. However, the finding that 20.2 percent of females of 40 years were the carrier of protozoan cysts was an important information in public health point of view.
parasitology-protozoa ; Entamoeba histolytica ; Entamoeba coli ; Endolimax nana ; Iodamoeba butschlii ; Giardia lamblia ; epidemiology ; intestine

To evaluate the status of intestinal protozoan infections in inhabitants of Gangweon-Do, Korea, a total of 1,310 stool specimens (male 669, female 641) was collected from 2 cities and 3 counties. They were examined routinely 1 time by the method of formalin-ether sedimentation technique. The results were as follows: The positive rate for any kind of the intestinal protozoan cysts was 8.9 percent. A total of 6 kinds of the intestinal protozoan cysts were detected. The prevalence rate of each protozoa were; E. histolytica 0.8 percent, E. coli 7.6 percent, E. nana 1.4 percent, I. butschlii 0.2 percent, G. lamblia 0.5 percent and C. mesnili 0.5 percent. Sogcho-city showed the highest positive rate as 15.2 percent, Myeongju county was the next as 11.3 percent and Weonju-city showed the lowest positive rate as low as 3.9 percent. By age, the highest positive rate was found in 20-29 age group(12.4 percent). Female (9.5 percent) showed a slight higher positive rate than male (8.4 percent).
parasitology-protozoa ; Entamoeba histolytica ; Entamoeba coli ; Endolimax nana ; Iodamoeba butschlii ; Giardia lamblia ; Chilomastix mesnili ; epidemiology ; intestine

The present study was designed to elucidate the recent prevalence of the intestinal protozoa and to demonstrate the relationship on prevalence of the surveyed population with their academic career and living conditions. During the period from May to July 1981, total 2,735 fecal specimens were collected from the inhabitants of 11 areas in Gyeong-gi Do (province) near by Seoul City, and 6 areas in Jeonra Bug Do, southwestern part of Korea. The samples were fixed with SAF solution and were examined by formalin-ether sedimentation technique. The results are summarized as follows: Overall positive rate of intestinal protozoa was 11.1 percent: Gyeong-gi Do, 10.7 percent; Jeonra Bug Do, 11.7 percent. Five species of intestinal protozoa were detected: Entamoeba histolytica 0.69 percent, Entamoeba coli 5.52 percent, Endolimax nana 2.71 percent, Giardia lamblia 2.23 percent, Iodamoeba butschlii 0.l8 percent. Highest positive rates among the examined areas were recognized: Incheon City of Gyeong-gi Do, 26.7 percent; Im-sil Gun(county) of Jeonra Bug Do, 19.9 percent. By species, E. nana showed the highest prevalence rate (13.74 percent) in Incheon City, and E. histolytica (2.37 percent) and E. coli (9.95 percent) in Im-sil Gun. Prevalence of E. histolytica in rural areas was higher than in urban areas. No significant difference in the prevalence rate by sex and age was recognized, although the group under 10 years and over 60 years were lower than in other age groups. The highest positive rate of E. histolytica was observed in pauper group and significant linearity of prevalence rate of E. histolytica by monthly income was observed. The inhabitants who used conventional latrine showed higher prevalence, 11.5 percent, than the group of inhabitants who used modified privy. Although no significant difference of positive rate was recognized by academic career, but the lowest prevalence rate was observed in college graduates. Over half of the surveyed population, 64.8 percent has no experience on anthelmintic practice. Number of anthelmintic application resulted no difference in prevalence. In conclusion, prevalences of intestinal protozoa in Gyeong-gi Do and Jeonra Bug Do decreased remarkably in comparison with those of one decade before. However, economic level, academic career and anthelmintic administration seemed no essential reasons for such declination.
parasitology-protozoa ; epidemiology ; Entamoeba histolytica ; Entamoeba coli ; Endolimax nana ; Giardia lamblia ; Iodamoeba butschlii

BACKGROUND: Because of a lack of quality control (QC) materials, stool examination has not been standardised. This study examined intestinal parasites in diarrhea specimens to manufacture and evaluate the performance stability of QC materials for stool examination. METHODS: This study examined diarrhea specimens submitted for stool culture. Microscopic examination was performed using the direct smear and formalin-ether concentration method (Military General Laboratory, MGL). Enzyme-linked immunosorbent assay (ELISA) kits (R-Biopharm AG, Germany) and xTAG Gastrointestinal Pathogen Panel (Luminex Corp., USA) were used for the three major protozoa: Cryptosporidium parvum, Giardia lamblia, and Entamoeba histolytica. Polymerase chain reaction (PCR) was performed for Dientamoeba fragilis and Blastocystis hominis. The QC materials for stool examination were generated using Diphyllobothrium nihonkaiense ova. The manufactured QC materials were evaluated under different storage conditions, with varying preservatives, temperatures, and storage times. RESULTS: From November 2015 to April 2016, 82 diarrhea specimens were collected and tested. All results from microscopy and ELISA were negative; C. parvum (n=2) and G. lamblia (n=1) were detected by xTAG, while D. fragilis (n=10) and B. hominis (n=2) were detected by PCR. High- and low-concentration QC materials were manufactured. Using the high-concentration QC material, ova were observed in all storage conditions using MGL. Using the low-concentration QC material, the ova were observed until 14 days, but not after 3 weeks. CONCLUSIONS: It should be considered for making QC materials for stool examinations that focus on D. fragilis and B. hominis frequently found in Korea and with the caution to the low-concentration of QC materials could be unstable.
Blastocystis hominis ; Cryptosporidium parvum ; Diarrhea* ; Dientamoeba ; Diphyllobothrium ; Entamoeba histolytica ; Enzyme-Linked Immunosorbent Assay ; Giardia ; Giardia lamblia ; Korea ; Methods* ; Microscopy ; Ovum ; Parasites* ; Polymerase Chain Reaction ; Quality Control*