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The prevalence of intestinal parasites and nasal S. aureus carriage among food handlers.


Food handlers play a major role in ensuring food safety throughout the chain of producing, processing, storage, and preparation. Mishandling food and disregarding hygiene by handlers may result in food contamination and its attendant consequences (OKojie, Wagbatsoma, & Ighoroge, 2005). The Centers for Disease Control and Prevention (CDC) have stated that poor personal hygiene is the third most commonly reported food preparation practice contributing to foodborne diseases. Contaminated hands may be the most significant means of transmission (Lillquist, McCabe, & Church, 2005).

Enterotoxin-producing S. aureus is a common cause of staphylococcal food poisoning, and nasal carriage of this microorganism, especially among food handlers, might pose significant risks. The infection of intestinal parasites usually occurs primarily via ingestion of eggs and cysts of parasites by a fecal-oral route or directly from human to human. Therefore, food handlers may play a significant role in disease transmission. The aim of our study was to determine the prevalence of intestinal parasites and nasal S. aureus carriage among food handlers in Manisa, Turkey.


The study was carried out between January 2005 and September 2006. Cooks, their helpers, and waitstaff working in restaurants and cafeterias were included in the study. In total, 8,895 people (aged 15-75) were investigated for nasal S. aureus carriage and intestinal parasites. Nasal swab materials were incubated in bloody agar and Eosin Methylene Blue agar (EMB) for 24 hours. The growing bacteria were evaluated according to the colony properties. Gram-positive, catalase-positive, and Staphytect-positive (Dry Spot Staphytect-Plus [Oxoid]) strains were accepted as S. aureus. The cellophone tape method was performed for Enterobius vermicularis and Taenia spp. eggs. Stool samples were first investigated by using the saline-Lugol method. The formol-ether concentration method was then performed to increase the possibility of finding eggs or cyst forms of protozoa. The prevalence of intestinal pathogens in food handlers was identified by stool cultures to check for Salmonella and Shigella, and microscopes were used to identify parasites. Informed consents from volunteers and approval From the local ethics committee were obtained prior to the start of the study in accordance with the Helsinki Declaration.


S. aureus was isolated in 69 (0.77%) samples. All S. aureus strains were oxacilline sensitive. Enteroparasites were found in 784 (8.8%) samples. The most common parasites were Entamoeba histolytica, 548 (69.9%), and Giardia intestinalis, 193 (24.6%). The detected parasites are shown in Table 1. None of the stool samples was observed to be positive for Salmonella or Shigella. Treatment was given to those who had a positive stool examination. An education program on the acquisition and prevention of pathogens was given by lecture and distribution of handouts.
Parasites Isolated from Stool Samples
 n %

Entamobea histolytica 548 69.9
Giardia intestinalis 193 24.6
E. vermicularis 27 3.5
H. nana 10 1.2
T. saginata 4 0.52
T. vaginalis 1 0.01
Ascaris lumbricoides 1 0.01
Total 784 100


The prevalence of intestinal pathogens among food handlers has been researched in various studies. Costa-Cruz and co-authors (1995) reported intestinal parasites in 47.1% of the food handlers in public elementary schools. Among the 49 infected food handlers, 32 (65.3%) carried one parasite and 17 (34.7%) carried two parasites. The most common intestinal parasites were Giardia lamblia (21.1%), Entamoeba coli (21.1%), and hookworms (9.6%). In another study that was carried out in public hospitals, 17.1% of food handlers had intestinal parasitism. The most frequent parasite was Entamoeba coli, detected in 48.5% of the samples with positive results (Laurenco, Uchoa, & Bastos, 2004). Al-Lahham and co-authors (1990) reported the most common parasites as Ascaris lumbricoides (4.9%), Giardia lamblia (3.9%), Schistosoma mansoni (2.8%), and hookworms (2.5%). In a medical college in North India, 41.1% of food handlers were infected with enteroparasites (Malhotra, Lal, Prakash, Daga, & Kishore, 2006). In an interesting study, an education program on the acquisition and prevention of pathogens was given to food handlers by lecture and distribution of handouts. After the education program, subsequent investigation showed a significant reduction in stool pathogens and parasites, but their knowledge and hygiene practices (e.g., hand washing) did not improve (Danchaivijitr et al., 2005).

Bacteriological investigations of the nose and throat have also been performed among food handlers. Hacibektasoglu and co-authors (1993) reported pathogen microorganisms in nose and throat cultures in 12% and 1.33% of the subjects, respectively. in nose cultures, the most common pathogen was S. aureus (85.2%), and in throat cultures, the most common pathogens were S. aureus (66.7%) and group A beta-hemolytic Streptococcus (50%). The nasal carriage of S. aureus was reported in 24% and 26.6% of subjects in two other studies (al Bustan, Udo, & Chugh, 1996; Oteri & Ekanem, 1989).

In our study, intestinal parasitism was found in 8.8% of subjects and pathogen microorganisms were isolated in 0.77% of nose cultures. When compared with studies in the literature, the rates are relatively low. This may be because Manisa is located in the western region of Turkey, with better socioeconomic conditions and a relatively high level of education. Nevertheless, the potential transmission risk of intestinal parasites by food handlers should always be kept in mind, and a periodic program of health education on food safety and hygiene should be presented. Hygienic behaviors, such as washing hands before handling food and changing clothes daily, should be encouraged. A risk of food contamination exists whenever a possibility of pathogen microorganism carriage exists; therefore, food handlers should be screened periodically via nose cultures.


al Bustan, M.A., Udo, E.E., & Chugh, T.D. (1996). Nasal carriage of enterotoxin-producing Staphylococcus aureus among restaurant workers in Kuwait City Epidemiology and Infection 116(3), 319-322.

al-Lahham, A.B., Abu-Saud, M., & Shehabi, A.A. (1990). Prevalence of salmonella, shigella and intestinal parasites in food handlers in Irbid, Jordan. Journal of Diarrhoeal Diseases Research, 8(4), 160-162.

Costa-Cruz, J.M., Cardoso, M.L., & Marques, D.E. (1995). Intestinal parasites in school food handlers in the city of Uberlandia, Mi-nas Gerais, Brazil. Revista do Instituto de Medicina Tropical de Sao Paulo, 37, 191-196.

Danchaivijitr, S., Rongrungruang, Y., Kachintorn, U., Techasathit, V, Pakaworavuthi, S., & Kachintorn, K. (2005). Prevalence and effectiveness of an education program on intestinal pathogens in food handlers. Journal of the Medical Association of Thailand 88(Suppl. 10), 31-35.

Hacibektasoglu,, A., Eyigun, C.P, & Ozsoy, M.F. (1993). Nose and throat carriage in food handlers. Mikrohiyoloji Bulteni, 27, 62-70.

Laurenco, A.E., Uchoa, C.M., & Bastos, O.M. (2004). Hospital food handlers in Niteroi, RJ, Brazil: intestinal parasitism. Archivos Latinoamericanos de Nutrition, 54(4), 395-401.

Lillquist, D.R., McCabe, M.L., & Church, K.H. (2005). A comparison of traditional hand washing training with active hand washing training in the food handler industry. Journal of Environmental Health, 67(6), 13-16.

Malhotra, R., Lal, P., Prakash, S.K., Daga, M.K., & Kishore, J. (2006). Study of hand hygiene and enteroparasite infestation among food handlers working in a medical college of North India. Indian Journal of Pathology & Microbiology, 49, 296-301.

Okojie, O.H., Wagbatsoma, V.A., & Ighoroge, A.D. (2005). An assessment of food hygiene among food handlers in a Nigerian university campus. Niger Postgrad Medical Journal 12, 93-96.

Oteri, T., & Ekanem, E.E. (1989). Food hygiene behavior among hospital food handlers. Public Health, 103, 153-159.

Although most of the information presented in the Journal refers to situations within the United States, environmental health and protection know no boundaries. The Journal periodically runs International Perspectives to ensure that issues relevant to our international constituency, representing over 60 countries worldwide, are addressed. Our goal is to raise diverse issues of interest to all our readers, irrespective of origin.

Turan Gunduz, M.D., Ph.D.

M.Emin Limoncu, M.D., Ph.D.

Sedat Cumen

Ali Ari

Serdag Etiz, M.D.

Ziya Tay, M.D.

Corresponding Author: Turan Gunduz, Assistant Professor, Department of Microbiology, Celal Bayar University, School of Vocational Health Services, Uncu Bozkoy Mah. Turunc Sokak. No: 25/5, Manisa, Turkey 45040. E-mail:
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Article Details
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Author:Gunduz, Turan; Limoncu, M.Emin; Cumen, Sedat; Ari, Ali; Etiz, Serdag; Tay, Ziya
Publication:Journal of Environmental Health
Article Type:Clinical report
Geographic Code:7TURK
Date:Jun 1, 2008
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