Yussely Tatiana Cobos-Leon

Acute diarrheal disease (ADD) caused by parasites and Tuberculosis (TB) remain major public health concerns in vulnerable indigenous communities with limited access to sanitation, safe water, and healthcare, and where humans, animals and the environment interact closely. Using a One Health framework, this study investigated TB and Intestinal parasites in human, animal and environmental samples from 15 Wayuu indigenous communities in Manaure, La Guajira. A total of 190 samples, including human sputum and feces, animal milk and feces, soil and drinking water, were analyzed according to sample type, preservation suitability, and availability using parasitological concentration techniques, qPCR for helminth detection, metatranscriptomic sequencing, Xpert ^® MTB/RIF assay, and mycobacterial culture. Mycobacterium tuberculosis was detected in 8.3% of human sputum samples, with no evidence of rifampicin resistance, whereas Mycobacterium bovis was not detected in animal milk. Human fecal samples analyzed by microscopy showed Blastocystis sp. and the Entamoeba histolytica/Entamoeba dispar complex (38.8% each), followed by Giardia (19.4%), Hymenolepis nana and Trichuris trichiura (5.1% each) and Hymenolepis diminuta (1%). Commensal parasites were also identified, with Entamoeba coli (46.9%) being the most frequent species, indicating inadequate sanitary conditions and poor hygiene practices. Co-infections were common in humans (60.2%). In animal fecal samples, strongylids (66.7%), amoebas (16.7%) and Giardia (8.3%) were observed. Giardia sp. was detected in 2.38% of soil samples by microscopy, supporting environmental circulation, whereas no parasites were detected in water sediments. Multiplex qPCR detected Trichuris trichiura DNA in human feces and Trichuris spp. DNA in soil and sheep fecal samples. Metatranscriptomic analysis of 22 human fecal samples revealed a high diversity and frequency of parasitic protozoa (90.9%), with Blastocystis spp. being the most frequent (81.8%). Additionally, reads of free-living amoebae, including Acanthamoeba spp. (10%) and Naegleria spp. (5%) were detected in community drinking water sources. These findings suggest active transmission of TB and parasitic-associated ADD in Wayuu communities and highlight the need for integrated surveillance and culturally appropriate interventions focused on sanitation, hygiene, veterinary services and community health education to improve the living and health conditions of these vulnerable populations.

Acute diarrheal disease (ADD) caused by parasites and TB represent a significant public health burden worldwide and in Colombia, particularly affecting indigenous populations who are at high risk of contracting these diseases due to the social, environmental, and cultural conditions in which they live. Materials: Fifteen Wayuu indigenous communities in four areas of Manaure, in La Guajira, were subject to intervention; with prior informed consent, environmental samples and samples from individuals with clinical symptoms were collected. A total of 156 samples of human and animal feces, soil, and sediment from drinking water were analyzed for microscopic using the Kato–Katz and formalin–ether concentration techniques, 109 samples were analyzed by qPCR for the detection of helminths and 23 for metatranscriptomics targeting protozoan parasites and helminths. Additionally, 36 sputum samples from patients with respiratory symptoms were tested using Xpert/MTB Rif, and 37 milk samples were tested for M. bovis. Results: Among the samples tested for tuberculosis, a positivity rate of 8.3% was found, in all cases with sensitivity to rifampicin; M. bovis was not found in animal milk. Microscopic analysis of human samples revealed pathogenic parasites, the most common being Blastocystis spp. and the Entamoeba hystolitica/Entamoeba dispar complexeach with 38.8% (n=38), Giardia spp. with 19.4%, Hymenolepis nanaand Trichuris trichiura each with 5.1%. Commensal parasites were also identified as indicator of poor sanitary conditions. Co-infection with intestinal parasites was common in humans at 60.2%. In microscopic analysis of animals fecal samples, revealed a high incidence of Uncinaria spp. with 58.3%, amoebas 16.7% and Giardia 8.3%; this latter is also found in soil. Metatranscriptomics showed a high frequency of intestinal parasites in fecal samples (90.9%), with Blastocystis spp. being the most frequent (81.8%) with notable intra-species diversity, followed by Entamoeba histolytica (54.5%) and Giardia duodenalis (31.8%), and detected free-living amoebae in community water sources, highlighting potential health risks associated with exposure to untreated water in low-sanitation settings. Conclusions: The Wayuu communities studied show a significant burden of tuberculosis and intestinal parasitic infections, likely associated with poor sanitary conditions and environmental factors that facilitate their transmission. Although TB prevalence was moderate, with no evidence of rifampicin resistance or the circulation of M. bovis in milk, the high prevalence of intestinal parasites, including co-infections and their detection in humans, animals, and the environment suggest active transmission in the region. These findings highlight the need to implement comprehensive interventions in water, sanitation, and hygiene, along with surveillance and health education strategies with an intercultural approach, aimed at improving the conditions of these vulnerable populations.