title: Intestinal parasite screening in internationally adopted children: importance of multiple stool specimens.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: 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. mary.staat@cchmc.org
authors.forename: Mary Allen
authors.initials: MA
authors.lastname: Staat
authors.forename: Marilyn
authors.initials: M
authors.lastname: Rice
authors.forename: Stephanie
authors.initials: S
authors.lastname: Donauer
authors.forename: Sheena
authors.initials: S
authors.lastname: Mukkada
authors.forename: Michol
authors.initials: M
authors.lastname: Holloway
authors.forename: Amy
authors.initials: A
authors.lastname: Cassedy
authors.forename: Jennifer
authors.initials: J
authors.lastname: Kelley
authors.forename: Shelia
authors.initials: S
authors.lastname: Salisbury
mesh_terms: D000300:Adoption; D000367:Age Factors; D016845:Blastocystis hominis / Q000302:isolation & purification*; D002648:Child; D002675:Child, Preschool; D005243:Feces / Q000469:parasitology*; D005260:Female; D016829:Giardia lamblia / Q000302:isolation & purification*; D014943:Global Health; D006801:Humans; D007223:Infant; D007411:Intestinal Diseases, Parasitic / Q000453:epidemiology*; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D009752:Nutritional Status; D015995:Prevalence