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1. Report about the most common
parasite
In
Gaza Strip
Prepared by :
Mohammed Adnan Qazzaz

2. Gaza Strip is a narrow
zone of land (360 km2)
situated on the
southeastern corner of
the Mediterranean
Sea. It is bordered on
the south by Egypt, on
the west by the
Mediterranean, on the
east by Negev desert
and on the north by
the green line. Over
one million inhabitants
live in Gaza Strip.

3. In order to monitor changes in the frequency of
intestinal parasites, the records of 8,417 stool
specimens of patients attending the Ahli Arab
Hospital in the Gaza city in the period 1995-2000
were reviewed and analyzed. Of these 2,506
(29.77%) were positive.

4. Although 9 different parasites were encountered, the
most common pathogenic parasites identified were:
Entamoeba histolytica (70.19%), Ascaris lumbricoides
(14.64%)
, and Giardia lamblia (10.34%). The other parasites
present were: Trichuris trichiura , Hymenolepis nana
, Enterobius vermicularis, Strongyloides
, stercolaris, Taenia saginata , and Echinococcus
granulosus. The overall monthly

5. incidence of parasites did not show clear seasonal
patterns.
The prevalence of intestinal parasites has dropped
significantly over the reviewed years from 36.35% in
1995 to 21.20% in 2000. This decline in prevalence
reflects the continuing efforts of the public health
authorities to improve primary health care, water supply
services and sanitation conditions.
.

6. The hospital records of 8,417 stool specimens were
analyzed. The annual distribution of the specimens and
the percentage of specimens containing parasites are
presented in Table 1. The overall prevalence of parasites
was 29.77%. As can be seen from the table the overall
frequency of parasites has decreased from 36.35% in
the year 1995 to 21.20% in the year 2000

7. Table 1. Overall distribution of tested stool specimens and
positive cases of intestinal parasites at the Ahli Arab hospital

8. The numbers and types of parasites seen over the six
years are shown in Table 2. The most common parasites
identified were; E. histolytica , A. lumbricoides and
G. lamblia . The same table also shows that changes
have occurred in the types of parasites over the
reviewed years. In general, E.histolytica was the most
commonly isolated parasite and represented around
three quarters of all parasites throughout the
investigated years. Moreover, E. histolytica was the only
parasite that showed consistent and significant annual
increase.

9. Most of the remaining identified
parasites, however, showed a significant decrease. For
instance, A. lumbricoides and G. lamblia which were
respectively responsible for 14.56% and 12.30% of
parasitosis in the year 1995 became numerically less in
the year 2000 and represented only 9.22% and 8.53% of
the positive specimens, respectively. T. saginata and E.
garanulosus remained uncommon parasites in Gaza and
only 2 cases of each were recorded in the whole study
period.

10. distribution of the recovered parasites over the six years is
illustrated in the figure below :
Generally the percentage of positive specimens per month did
not deviate from the yearly overall percentage. Additionally,
there was no apparent seasonal variation for any of the recorded
parasites. The monthly

11. The most commone parasite in Gaza Strip :
Gardia lamblia
Entamoeba hostolytica
Oientamoeba fragilis
Blastocystic hominis
Entamoeba coli
Endolimax nana
Ascaris lumbricoides
Entrobius vermicularis
Chilomastix mesuini
Trichuris trichiura
Cryptosporidium parvum
Strongyloides stercoralis
Taenia saginata
Hymenolopis nana

12. Entamoeba hostolytica and Entamoeba coli:
Most physicians in Gaza prescribe medicaments for patient's
suffering from Entamoeba histolytica/dispar without parasitologic
diagnosis. Additionally, stool analysis performed by the routine
methods usually reports the species as E. histolytica without con-
firmation. In this study, 92 stool specimens were collected and
analyzed by wet mount, iron haematoxylin staining, antigen
detection of E. histolytica and polymerase chain reaction (PCR).
The total number of E. histolytica identified by PCR was 64

13. (69.6%) that of E. dispar was 21 (22.8%). Mixed infection with
both E. histolytica and E. dispar was evident in 7 specimens
(7.6%). In the light of these results approximately 30% of
suspected clinical amoebiasis cases were negative for E.
histolytica. It is recommended to use PCR for diagnosis of stool
specimens from patients with E. histolytica/dispar and that
treatment should be prescribed for only patients positive for E.

14. Gardia lamblia :
Giardia lamblia (synonymous with Lamblia
intestinalis and Giardia duodenalis) is a flagellated
protozoan parasite that colonises and reproduces in the small
intestine, causing giardiasis its most common in Khan Yuins City
and it cause 12.30% of parasitic infection in Gaza strip .

15. Dientamoeba fragilis :
Some cases are reported in Gaza strip but it's not so common .
Blastocystic hominis :
Some cases are reported in Gaza strip but it's not so common .
this protozoa is not always pathogen .

16. Endolimax nana :
Its intestinal protozoa . Originally thought to be non-pathogenic,
studies suggest it can cause intermittent or chronic
diarrhea.Additionally, it is very significant in medicine because it
can provide false positives for other tests, notably the similar
species Entamoeba histolytica, the pathogenresponsible for
amoebic dysentery, and because its presence indicates the host
has consumed fecal material. It forms cysts with four nuclei
which excyst in the body and become trophozoites. Endolimax
nana nuclei have a large endosome somewhat off-center and
small amounts of visible chromatin or none at all.

17. Ascaris lumbricoides :
Ascaris lumbricoides is the giant roundworm of
humans, belonging to the phylumNematoda.
An ascarid nematode, it is responsible for the
disease ascariasis in humans, and it is the largest and
most common parasitic worm in humans. A quarter of
the human population is estimated to be infected by
this parasite. Ascariasis is prevalent worldwide and
more so in tropical and subtropical countries.
Here in Gaza it cause 9.5% of protozoal infestation and
its common in children more than the adult and its
reported in almost all the cites in Gaza Strip .

19. Entrobius vermicularis :
It’s the most common helminthes that infect child in
Gaza Strip and its very easy to be diagnosed . any itching
in the anus region of a child in Gaza strip is referred to
Entrobius worms . and its cause 38.6%, of the parasite
infestation in Gaza .

20. Trichuris trichiura :
Its common in Gaza valley region and it cause 7.3% of
the helminthal infestation in Gaza Strip .

21. Strongyloides stercoralis :
It cause 11.0% of helminthal infestation in Gaza strip

22. A study in Gaza valley region shows that :
in Gaza Valley, out of 352 children surveyed, 265 (75.28%) were positive for
intestinal helminths. Prevalence of Ascaris lumbricoides was 71.87%, followed
byTrichuris trichiura (26.42%), Enterobius vermicularis (13.92%) and . Single
species infection was seen in 38.63% of the infected children, whereas 36.64%
were infected with multiple species of helminth parasites. The prevalence of
infection peaked in the age group of 11-15 years (84.91%) followed by the age
group of 6-10 years (81.70%) and age group of 0-5 years (50.54%) .The
differences in prevalence rates between male, female and rural urban children
was insignificant .Water source, defecation site, personal hygiene and maternal
education were significant risk factors in predicting the intestinal helminth
infection.

23. Conclusion :
The present study reveals that intestinal helminths are
abundant among schoolchildren of Gaza valley. This
situation strongly calls for the institution of control
measures, including treatment of infected
individuals, improvement of sanitation
practices, provision of clean water and further studies
on the abundance of intestinal protozoan infections in
the children of Gaza valley. The impact of each
measure would be maximized through a health
education program directed at schoolchildren and
their mothers in particular, and to communities in
general.

24. Taenia saginata :
This is the beef tape worm and it is not so common in Gaza but
some cases were reported . produces only mild abdominal
symptoms .

25. Hymenolopis nana :
Dwarf tapeworm it cause 4.1% of helminthal infestation .

26. Cryptosporidium parvum :
This one most of the infections is asymptomatic . however In
some people "often immuniocompromised " can cause sever
diarrhea . And 6.6% of tested people were positive for it .

27. Final Conclusion :
The highest incidence rate in proportion to the total
number of investigated samples was recorded in Jabalia
area 17.0% followed by Deir el balaharea 16.6%, Beit
hanoun 15.6% and Gaza town 14.0%. The infection rate
was higher in younger age group (6- 9 years) in which
several of pupils reported variable symptoms like
abdominal pain, cramps, weight loss, diarrhea, and
anorexia. The rate of infection was higher in children
from overcrowded areas, rural areas, low income
families and it was reported more in male than female
pupils.

28. The worst parasite in Gaza and in whole Palestine is the Israeli occupation
Freedom for Gaza . Freedom For whole Palestine

29. Treatment of some protozoa and helminthes
Drugs for treatment of protozoal infection
Organism Drug Of Choice Other Drugs
Tetracycline,500mg 4 times
Iodoquinol, 650mg 3time daily for 10 days
Dientamoeba fragilis
daily for 20 days Paromoycin,500 mg 3
times daily for 7 days
Nifurtimox
Trypanosome Cruzi Or
benznidizol
Hemolymphatic Suramin Pentamidine Or Eflonithine
Trypanosome Brucei
Advanced CNS
Melarsoprol Eflonithine
disease
Furazolidone, 100 mg 4
Metronidazol, 250mg3
times daily for 7 days
times
Gardia Lamblia Or
Or
Albendazole ,400 mg daily
dailyfor 5 days Tinidazole
for 5 days
Tetracycline , 500 mg 4 Metronidazol 750,mg 3
Blantidium coli
times daily for 10 daily times daily for 5 days

30. Paromoycin,500-750 mg 3 times Azithromycin, 500 mg daily for
Cryptosporidium species
daily for 10 days 21day
Metronidazol, 2 gonce or 250 mg 3
times daily for 7days
Trichomonas vaginalis
Or
Tinidazole , 2 g once
Visceral
Meglumine antimonite
Or
Sodium stibogluconate , 20 mg IV
Pentamidine
Mucosal or IM for 28 day
Or
Amphotericine B
Lishmaniasis
Meglumine antimonite
Or
Sodium stibogluconate , 20 mg IV
Ctaneous Pentamidine
or IM for 20 day
Or
Ketoconazole

31. Drugs for treatment of helminthic infection :
Drugs For Treatment Trematodes
Organism Drug Of Choice Other Drugs
Haematobium
Schistosoma mansoni praziquantel metrifonate
japonicum
Bithionol
Fasciola hepatica
triclabendazole
Praziquantel or
Fasciolopsis buski
niclosamide
Clonorchis sinensis praziquantel Albendazole
Paragonimus westermani praziquantel Bithionol

32. Drugs For Treatment cestodes
Organism Drug Of Choice Other Drugs
Diphyllobothrium latem Praziquantel or niclosamide
Taenia solium Praziquantel or niclosamide
Taenia saginata Praziquantel or niclosamide mebandazole
Hymenolepis nana Praziquantel niclosamide
Echinococcus granulosus Albendazole

33. Drugs For Treatment Nematodes
Organism Drug Of Choice Other Drugs
Entrobius vermocularis Mebandazole . pyrantel pamoate Albendazole
Nactor amiericanus. ancyostoma pyrantel pamoate
Albendazole
Mebandazole
Wuchereria bancrofti diethylcabamazine invermectin
Loa loa diethylcabamazine invermectin
Brugia malayi diethylcabamazine invermectin
Trichuris trichiura Albendazole oxantel/pyrantel pamoate
Mebandazole
Strongyloides stercoralis invermectin Albendazole
thiabendazole
Ascaris lumbricoides Albendazole piperazine
pyrantel pamoate
Mebandazole

34. Treatment of Amebiasis
Asymptomatic intestinal infection :
Drug of choice :
Lumina agent :Diloxanide Furoate 500 mg 3 times daily for 10 days .
Iodoquinol , 650 mg 3 times daily for 21 days .
Promomycine , 10 mg /kg 3 times daily for 7 days .
Mild to moderate intestinal infection :
Drug of choice :
Metronidazol, 750mg 3 times daily (or 500 mg IV every 6 hours) for 10 days
Tinidazole . 2g daily for 3 days .
Other drugs :
Lumina agent :Diloxanide Furoate 500 mg 3 times daily for 10 days .
Tetracycline,250mg 3 times daily for 10 days

35. Severe intestinal infection :
Drug of choice :
Metronidazol, 750mg 3 times daily (or 500 mg IV every 6 hours) for 10 days
Tinidazole . 2g daily for 3 days .
Other drugs :
Lumina agent :Diloxanide Furoate 500 mg 3 times daily for 10 days .
Tetracycline,250mg 3 times daily for 10 days
Hepatic abscess . ameboma and lung abscess :
Drug of choice :
Metronidazol, 750mg 3 times daily (or 500 mg IV every 6 hours) for 10 days
Tinidazole . 2g daily for 3 days .
Other drugs :
Dehydrometine or emerine ,1 mg /kg SC or IM for 8-10 days , followed by ( liver abscess
only ) chloroquine , 500 mg twice daily then 500 mg daily for 21
Lumina agent :Diloxanide Furoate 500 mg 3 times daily for 10 days .
Tetracycline,250mg 3 times daily for 10 days