Diagnosis Of Hookworm Infestation By Using Modified Kato-Katz Thick Smear
Diagnosis Of Hookworm Infestation
By Using Modified Kato-Katz Thick Smear
Syahril Pasaribu
Chairuddin P. Lubis
Department of Pediatrics
Faculty of Medicine
University of North Sumatera
INTRODUCTION
Intestinal nematode infections constitute a major health problem in the third
world, particularly in tropical countries where optimal conditions exist for propagation of
these helminths1,2,3,4,5,6,7,8.
High prevalence of the most important soil transmitted helminthiasis, Ascaris
lumbricoides, Trichuris trichiura and Hookworm as well as their occurrance in multiple
infections are commonly found in several areas in Indonesia9,10,11,12,13 and the infection
are prominent among school children14,15.
The morbidity of hookworm infections in endemic areas is sustained primarily by
children. In one study half of the children were infected before age 5; 90% were infected
by 9 yr of age. Intensity of the infection increases up to age 6-7, then stabilizes for a few
years16.
The diagnostic methods for hookworms and related nematode infections by the
recovery of larvae from faecal samples have various advantage over the conventional
diagnostic methods of the examine of parasite eggs in faeces. The culture methods are
more snsitive and efficient for detection of the infection than direct examination of eggs
in faeces, because the amount of faecal samples being examined is much larger; in
routine faecal examinations, some 10 mg or less is examined in direct faecal smear
method, some 50 mg in thick faecal smear method, but some 500 mg of faecal samples
can be examined by using the test tube method and much more samples can be cultured
in the polyethylene tube method17,18.
MATERIALS AND METHODS
This study had been done as a double blind study from January - March 1996.
Stool samples of 541 children from two primary school in the rural areas of North
Sumatera Province were examined to determine the infection rates of soil transmitted
helminthiasis.
Every stool samples were examined by using a modified Kato-Katz thick smear
and a modified Harada-Mori technique.
Data analysis comprises: gender, age, nutritional status, occupation of the father,
educational level of the parents.
In general, diagnostic tests are evaluated by calculating sensitivity and specificity,
predictive value and accuracy of the test.
1
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RESULTS AND DISCUSSIONS
From 541 stool samples, we found that 469 of them were positive (86.7%). with
eggs or larvae. Mixed infestations were 374 (79.7%) and 95 (20.3%) was single
infestation.(Table 1).
Table 1. Stool examination of the pupils
Number of
Infestation
Positive
Single
%
Mixed
469
95
20.3
374
%
79.7
In this study we found that the prevalence of A.lumbricoides 22.7% ; Trichuris
trichiura 68.2% and Hookworm 47.5% (Table 2).
Table 2. Prevalence of soil transmitted helminthiasis
Number of
A. Lumnricoides
T. Trichiura
Hookworm
examined
No. (+)
%
No. (+)
%
No. (+)
%
541
123
22.7
369
68.2
257
47.5
Table 3. Occupational status of the father
Occupation
Number
Persentage
Laborer/Farmer
297
55
Enterpreneur
128
24
Civil Servant
43
8
Others
73
13
Total
541
100
This table shown us the occupation of father was laborer/farmer 55% and 24%
was entrepreneur. Government employee only 8% (table 3)
Table 4. Education of the parents
Education Level
Mother
Percent
Fsather
Illiterate
19
3
26
Primary school
368
68
260
Junior High School
109
20
150
Senior High School
41
8
103
University
4
1
2
Total
541
100
541
Percent
5
48
27
19
1
100
The education of the parents mostly primary school (68% mother and 48% father). Senior
high school only 8% mother and 19% father (Table 4).
2
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Table 5. Relation between nutritional status and parasitic infestation
Nutritional Status
Parasitic
Infestation
Percent
No. (+)
%
No.(-)
%
Wellnourished
345
86.3
55
13.7
400
Mild/Moderate Malnutr
124
88.6
16
11.4
140
Severe Malnutrition
0.0
1
100.0
1
Total
469
72
541
Parasitic infestations in the wellnourished children and mild/moderate
malnutrition didn't differ, that is 86.3% dan 88.6% (Table 5).
Table 6. Relation between gender and parasitic infestations
Gender
Parasitic infestations
Total
Number (+) Number (-)
Boys
230
38
268
Girls
239
34
273
Total
469
72
541
X = 0.35
DF = 1
p = 0.56
No relationship between gender and parasitic infestation (p>0.05).(Table 6)
Table 7. Relation between age and parastic infestations
Age (yr)
Parasitic infestations
Total
Number (+) Number (-)
69
183
35
218
- 12
219
30
249
- 15
67
7
74
Total
49
72
541
X = 2.72
DF = 2
p = 0.26
No significant difference between age and parasitic infestation in this study
(p>0.05). (Table 7)
Table 6. Diagnostic test of hookworm by using Kato-Katz
Harada Mori
Total
Number (+) Number (-)
Positif
109
38
147
Kato - Katz
Negatif
148
246
394
Total
257
284
541
-
Sensitivity
Specificity
PV(+)
PV(-)
Accuracy
= 109/257
= 246/284
= 109/147
= 246/394
= 355/541
= 42.2%
= 86.6%
= 74.2%
= 62.4%
= 65.6%
3
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Marwi MA (1979) have been found that the sensititivy of Harada-Mori's technic
was 85.57% and Kobayashi et al in 1966 was 79.6%19. It means that the sensitivity of
HardMori's technic more better than Kato-Katz's technic.
CONCLUSIONS
Modified Harada-Mori technique is still better than modified Kato-Katz thick
smear, as a diagnostic tool for hookworm infestations.
REFERENCES
Coulad JP. Traitment des nematodoses. Ann Soc Belge Med Trop, 1983;63:5-20.
Fain A. Les maladies parasitaires en Europe. Ann Sac Belge Med Trop, 1980;60:3-26.
Gatti F., Vanderick K., Parent M., Bulihereme J., et Vendepitte J. Treatment of
roundworm infestation in African children with a single dose of tetramisole
(R.8299). Ann Sac Belge Med Trop, 1969; 49 :51-62.
Kaba AS., Luvwezo M., Nzuzi K et Thiepont D. Le traitment anti-helminthique d'enfants
d'age scolaire au Zaire. Ann Soc Belge Med Trop, 1978 ; 58 : 241-249.
Kadio A., Moreau J., Gazin J et Caudet H. L'albendazole (Zentel) dans le Traitment de
l'ankylostomiase en Cote d'Ivoire.
Krubwa F., Gatti F., Lontie M., Nguete K., Vendepitte Jet Thiepont D. Administration
trimestrielle de mebendazole en milIeu scolaire suburbain. Med Trop, 1975;34:679687.
Nwosu ABC. Intestinal helminthiases in Nigeria : Epidemiology, Infection dynamics and
control strategies. Med Afr noire, 1982 ; 29 : 4449 - 53.
Vendepitte J. Helminthologie mediale. P.U.Z.Kinsha sa, 1973:45
Clarke MD., Cross JH., Carney WP., Bechnee WM., Sri Oemijati., Partono F., Hudojo.,
Arbain J. and Noerhayati S. A parasitological survey in the Jogyakarta area of
central Java. Indonesia. SEA J Trop Med Pub Hlth, 1973 ; 4 : 195.
Carney WP., Atmosoedjono S., Sajidiman Hand Arbain J. Intestinal parasites and malaria
in Sukamenanti Pasaman Regency West Sumatera. Bull Hlth Studies
Indonesia,1974;2:61.
Cross JH., Clarke MD., Durfee PT., Irving GS., Taylor J., Partono F., Arbain J., Hudojo
and Sri oemijati. Parasitological survey and seroepidemiology of amoebiasis in
South Kalimntan (Borneo), Indonesia. SEA J Trop Med Pub Hlth,1975;6:52.
Margono SS., Rasidi R. Simanjuntak GM., Sukarya A., Sarumpaet S and Endardjo S.
Intestinal parasites in Obano, Irian Jaya, Indonesia. Maj Kedokt Indon, 1979; 29:56.
4
e-USU Repository © 2004 Universitas Sumatera Utara
Rasidi R., Margono SS., Simanjuntak GM and Koesharjono C. Intestinal parasites in
villages of Bali. Maj Kedokt Indon; 1979;29:3.
Abadi K., Tjowandi F., Sasabone P., Rambulangi J, Djajakusli L and Haerani T. Survey
on insidence the anthelmintic in a mass treatment. Department of Parasitology,
Faculty of Medicine, Hasanuddin university , Ujung Pandang, Sulawesi (in
Indonesian), 197
Abidin SAN. and Rased R. Treatment of intestinal nematodes using single dose 500 mg
mebendazole, Medika, 1990;33 :192-197.
Kazura JW and Mahmoud ADF. Helminths in Nelson Textbook of Pediatrics. Edited by
Behrman RE, Vaughan VC, Nelson WE. 13th Eds. WB.Sauders Company,
1987:739-743.
Sasa M. Diagnosis of hookworm and Strongyloides infections by Faecal culture method.
Gilles HM. Hookworm infection and anemia in Clinical Tropical Diseases, edited by
Maegraith B, 8th Eds. Blackwell Scientific publications, 1984:178-188.
Department of Helminthology Faculty of Tropical Medicine. Culture technique for
diagnosis of hookworm & related species, 1987.
5
e-USU Repository © 2004 Universitas Sumatera Utara
By Using Modified Kato-Katz Thick Smear
Syahril Pasaribu
Chairuddin P. Lubis
Department of Pediatrics
Faculty of Medicine
University of North Sumatera
INTRODUCTION
Intestinal nematode infections constitute a major health problem in the third
world, particularly in tropical countries where optimal conditions exist for propagation of
these helminths1,2,3,4,5,6,7,8.
High prevalence of the most important soil transmitted helminthiasis, Ascaris
lumbricoides, Trichuris trichiura and Hookworm as well as their occurrance in multiple
infections are commonly found in several areas in Indonesia9,10,11,12,13 and the infection
are prominent among school children14,15.
The morbidity of hookworm infections in endemic areas is sustained primarily by
children. In one study half of the children were infected before age 5; 90% were infected
by 9 yr of age. Intensity of the infection increases up to age 6-7, then stabilizes for a few
years16.
The diagnostic methods for hookworms and related nematode infections by the
recovery of larvae from faecal samples have various advantage over the conventional
diagnostic methods of the examine of parasite eggs in faeces. The culture methods are
more snsitive and efficient for detection of the infection than direct examination of eggs
in faeces, because the amount of faecal samples being examined is much larger; in
routine faecal examinations, some 10 mg or less is examined in direct faecal smear
method, some 50 mg in thick faecal smear method, but some 500 mg of faecal samples
can be examined by using the test tube method and much more samples can be cultured
in the polyethylene tube method17,18.
MATERIALS AND METHODS
This study had been done as a double blind study from January - March 1996.
Stool samples of 541 children from two primary school in the rural areas of North
Sumatera Province were examined to determine the infection rates of soil transmitted
helminthiasis.
Every stool samples were examined by using a modified Kato-Katz thick smear
and a modified Harada-Mori technique.
Data analysis comprises: gender, age, nutritional status, occupation of the father,
educational level of the parents.
In general, diagnostic tests are evaluated by calculating sensitivity and specificity,
predictive value and accuracy of the test.
1
e-USU Repository © 2004 Universitas Sumatera Utara
RESULTS AND DISCUSSIONS
From 541 stool samples, we found that 469 of them were positive (86.7%). with
eggs or larvae. Mixed infestations were 374 (79.7%) and 95 (20.3%) was single
infestation.(Table 1).
Table 1. Stool examination of the pupils
Number of
Infestation
Positive
Single
%
Mixed
469
95
20.3
374
%
79.7
In this study we found that the prevalence of A.lumbricoides 22.7% ; Trichuris
trichiura 68.2% and Hookworm 47.5% (Table 2).
Table 2. Prevalence of soil transmitted helminthiasis
Number of
A. Lumnricoides
T. Trichiura
Hookworm
examined
No. (+)
%
No. (+)
%
No. (+)
%
541
123
22.7
369
68.2
257
47.5
Table 3. Occupational status of the father
Occupation
Number
Persentage
Laborer/Farmer
297
55
Enterpreneur
128
24
Civil Servant
43
8
Others
73
13
Total
541
100
This table shown us the occupation of father was laborer/farmer 55% and 24%
was entrepreneur. Government employee only 8% (table 3)
Table 4. Education of the parents
Education Level
Mother
Percent
Fsather
Illiterate
19
3
26
Primary school
368
68
260
Junior High School
109
20
150
Senior High School
41
8
103
University
4
1
2
Total
541
100
541
Percent
5
48
27
19
1
100
The education of the parents mostly primary school (68% mother and 48% father). Senior
high school only 8% mother and 19% father (Table 4).
2
e-USU Repository © 2004 Universitas Sumatera Utara
Table 5. Relation between nutritional status and parasitic infestation
Nutritional Status
Parasitic
Infestation
Percent
No. (+)
%
No.(-)
%
Wellnourished
345
86.3
55
13.7
400
Mild/Moderate Malnutr
124
88.6
16
11.4
140
Severe Malnutrition
0.0
1
100.0
1
Total
469
72
541
Parasitic infestations in the wellnourished children and mild/moderate
malnutrition didn't differ, that is 86.3% dan 88.6% (Table 5).
Table 6. Relation between gender and parasitic infestations
Gender
Parasitic infestations
Total
Number (+) Number (-)
Boys
230
38
268
Girls
239
34
273
Total
469
72
541
X = 0.35
DF = 1
p = 0.56
No relationship between gender and parasitic infestation (p>0.05).(Table 6)
Table 7. Relation between age and parastic infestations
Age (yr)
Parasitic infestations
Total
Number (+) Number (-)
69
183
35
218
- 12
219
30
249
- 15
67
7
74
Total
49
72
541
X = 2.72
DF = 2
p = 0.26
No significant difference between age and parasitic infestation in this study
(p>0.05). (Table 7)
Table 6. Diagnostic test of hookworm by using Kato-Katz
Harada Mori
Total
Number (+) Number (-)
Positif
109
38
147
Kato - Katz
Negatif
148
246
394
Total
257
284
541
-
Sensitivity
Specificity
PV(+)
PV(-)
Accuracy
= 109/257
= 246/284
= 109/147
= 246/394
= 355/541
= 42.2%
= 86.6%
= 74.2%
= 62.4%
= 65.6%
3
e-USU Repository © 2004 Universitas Sumatera Utara
Marwi MA (1979) have been found that the sensititivy of Harada-Mori's technic
was 85.57% and Kobayashi et al in 1966 was 79.6%19. It means that the sensitivity of
HardMori's technic more better than Kato-Katz's technic.
CONCLUSIONS
Modified Harada-Mori technique is still better than modified Kato-Katz thick
smear, as a diagnostic tool for hookworm infestations.
REFERENCES
Coulad JP. Traitment des nematodoses. Ann Soc Belge Med Trop, 1983;63:5-20.
Fain A. Les maladies parasitaires en Europe. Ann Sac Belge Med Trop, 1980;60:3-26.
Gatti F., Vanderick K., Parent M., Bulihereme J., et Vendepitte J. Treatment of
roundworm infestation in African children with a single dose of tetramisole
(R.8299). Ann Sac Belge Med Trop, 1969; 49 :51-62.
Kaba AS., Luvwezo M., Nzuzi K et Thiepont D. Le traitment anti-helminthique d'enfants
d'age scolaire au Zaire. Ann Soc Belge Med Trop, 1978 ; 58 : 241-249.
Kadio A., Moreau J., Gazin J et Caudet H. L'albendazole (Zentel) dans le Traitment de
l'ankylostomiase en Cote d'Ivoire.
Krubwa F., Gatti F., Lontie M., Nguete K., Vendepitte Jet Thiepont D. Administration
trimestrielle de mebendazole en milIeu scolaire suburbain. Med Trop, 1975;34:679687.
Nwosu ABC. Intestinal helminthiases in Nigeria : Epidemiology, Infection dynamics and
control strategies. Med Afr noire, 1982 ; 29 : 4449 - 53.
Vendepitte J. Helminthologie mediale. P.U.Z.Kinsha sa, 1973:45
Clarke MD., Cross JH., Carney WP., Bechnee WM., Sri Oemijati., Partono F., Hudojo.,
Arbain J. and Noerhayati S. A parasitological survey in the Jogyakarta area of
central Java. Indonesia. SEA J Trop Med Pub Hlth, 1973 ; 4 : 195.
Carney WP., Atmosoedjono S., Sajidiman Hand Arbain J. Intestinal parasites and malaria
in Sukamenanti Pasaman Regency West Sumatera. Bull Hlth Studies
Indonesia,1974;2:61.
Cross JH., Clarke MD., Durfee PT., Irving GS., Taylor J., Partono F., Arbain J., Hudojo
and Sri oemijati. Parasitological survey and seroepidemiology of amoebiasis in
South Kalimntan (Borneo), Indonesia. SEA J Trop Med Pub Hlth,1975;6:52.
Margono SS., Rasidi R. Simanjuntak GM., Sukarya A., Sarumpaet S and Endardjo S.
Intestinal parasites in Obano, Irian Jaya, Indonesia. Maj Kedokt Indon, 1979; 29:56.
4
e-USU Repository © 2004 Universitas Sumatera Utara
Rasidi R., Margono SS., Simanjuntak GM and Koesharjono C. Intestinal parasites in
villages of Bali. Maj Kedokt Indon; 1979;29:3.
Abadi K., Tjowandi F., Sasabone P., Rambulangi J, Djajakusli L and Haerani T. Survey
on insidence the anthelmintic in a mass treatment. Department of Parasitology,
Faculty of Medicine, Hasanuddin university , Ujung Pandang, Sulawesi (in
Indonesian), 197
Abidin SAN. and Rased R. Treatment of intestinal nematodes using single dose 500 mg
mebendazole, Medika, 1990;33 :192-197.
Kazura JW and Mahmoud ADF. Helminths in Nelson Textbook of Pediatrics. Edited by
Behrman RE, Vaughan VC, Nelson WE. 13th Eds. WB.Sauders Company,
1987:739-743.
Sasa M. Diagnosis of hookworm and Strongyloides infections by Faecal culture method.
Gilles HM. Hookworm infection and anemia in Clinical Tropical Diseases, edited by
Maegraith B, 8th Eds. Blackwell Scientific publications, 1984:178-188.
Department of Helminthology Faculty of Tropical Medicine. Culture technique for
diagnosis of hookworm & related species, 1987.
5
e-USU Repository © 2004 Universitas Sumatera Utara