A molecular and morphological study of Ascaris suum in a human-pig contact scenario in northeastern Brazil / Estudo molecular e morfológico de Ascaris suum em um cenário de contato entre suínos e humanos no nordeste brasileiro

The aim of the present study was to assess morphologic and genetic data on ascariasis in swine (Sus scrofa domesticus) and humans in low-resource rural and periurban communities in the state of Piauí, Brazil. Our cross-sectional survey included 100 fecal samples obtained from swine and 682 samples from humans. Fifteen pigs were necropsied. Human and porcine fecal samples were examined to identify Ascaris eggs. Parasites obtained in the swine necropsies were studied using scanning electron microscopy (SEM), and the mitochondrial gene encoding the cytochrome oxidase 1 (cox1) enzyme was partially amplified and sequenced for molecular taxonomy and phylogenetic analyses. The overall prevalence of Ascaris eggs in the swine fecal samples was 16/100 (16%). No Ascaris eggs were identified in the human fecal samples. SEM of six worms recovered from pigs demonstrated morphological characteristics of A. suum. Cox1 sequences were compatible with A. suum reference sequences. Original and reference (GenBank) nucleotide sequences were organized into clusters that did not segregate the parasites by host species or and region. The largest haplogroups were dominated by haplotypes H01, H02 and H31. In the communities studied, there was no epidemiological evidence of the zoonotic transmission of ascariasis at the human-swine interface.(AU)

O presente estudo teve como objetivo acessar dados morfológicos e genéticos sobre a ascaridíase em suínos (Sus scrofa domesticus) e humanos, em comunidades rurais e periurbanas no estado do Piauí. O estudo transversal incluiu 100 amostras fecais de suínos e 682 amostras obtidas de humanos. Quinze suínos foram necropsiados. Amostras fecais suínas e humanas foram examinadas para detecção de ovos de Ascaris. Os parasitas adultos, obtidos nas necropsias, foram estudados através de microscopia eletrônica de varredura (MEV), e o gene mitocondrial codificante da enzima citocromo oxidase 1 (cox1) foi parcialmente amplificado e sequenciado para análises filogenéticas e de taxonomia molecular. A prevalência de Ascaris em amostras fecais de suínos foi 16/100 (16%), não sendo identificado nenhum caso de infecção por este parasita em humanos. A análise por MEV de parasitas recuperados de suínos demonstrou características morfológicas de Ascaris suum. As sequências nucleotídicas de cox1 foram compatíveis com A. suum. As sequências originais e de referência (obtidas no GeneBank) foram organizadas em clusters que não segregaram os parasitas por hospedeiro ou região geográfica. Os maiores haplogrupos foram dominados pelos haplótipos H01, H02 e H31. Nas comunidades estudadas, não foi evidenciada transmissão zoonótica de A. suum na interface suíno-humana.(AU)

Giardia lamblia-infected preschoolers present growth delays independent of the assemblage A, B or E

BACKGROUND Intestinal parasite Giardia can affect children's physical development mainly stunting even in asymptomatic cases. The protozoa G. lamblia is divided into assemblages A-H. However, it is still unclear whether clinical manifestations and pathogenesis may vary according to the infecting assemblage. OBJECTIVES To investigate whether G. lamblia assemblages influence differently the physical development of preschoolers from a community of Rio de Janeiro, Brazil. METHODS Anthropometric parameters were analysed from children attending a daycare centre and stool samples were obtained for the G. lamblia diagnosis. G. lamblia isolates from positive samples were genotyped. Data were analysed in order to verify whether there is a relationship between G. lamblia infection and the physical development of children according to the assemblage. FINDINGS Herein we demonstrated that although eutrophic, G. lamblia-infected daycare preschoolers from a low-income community presented growth delay compared to non-infected ones. This effect was observed for the three assemblages (A, B or E) found infecting humans. MAIN CONCLUSION G. lamblia causes growth delays on children independent of infecting assemblage (A, B or E).

Factors associated with mucosal involvement in tegumentary leishmaniasis: a nation-based study using surveillance data from Brazil

ABSTRACT This study aimed to assess the factors associated with mucosal leishmaniasis (ML) within the scope of tegumentary leishmaniasis (TL) cases reported in Brazil. Surveillance data were assessed, and comparisons were made between ML and cutaneous leishmaniasis (CL) cases. Additionally, ML incidence rates for municipalities were depicted through a geographic information system. From 2007 to 2017, 235,489 TL cases were reported, of which 235,232 were classified as follows: 14,204 (6%) were ML cases and 221,028 (94%) were CL cases. Multivariate analysis showed that the proportion of ML cases reached 16.8% among individuals >75 years (adjusted OR = 2.77; 95% CI = 2.41-3.19; p < 0.001), and ML was also more frequent among males (aOR = 1.28; 95% CI = 1.20-1.38; p < 0.001), HIV-positive patients (aOR = 2.15; 95% CI = 1.80-2.56; p < 0.001), patients residing in urban areas (aOR = 1.52; 95% CI = 1.43-1.62; p < 0.001), and imported cases (with respect to county) when compared to autochthonous cases (aOR = 1.84; 95% CI = 1.71-1.98; p < 0.001). A lower proportion of positive results in direct parasitological examinations was observed in ML cases (32.6% vs. 60.8%; p < 0.001). The leishmanin skin test results were more often positive in ML cases (41.7% vs. 25.9%; p < 0.001). In ML, compatible changes in histopathology were more frequent (14.6% vs. 3.9%; p < 0.001). A greater proportion of ML cases were treated with amphotericin B (6.9% vs. 0.9%; p < 0.001). The case-fatality rate was higher in ML (0.6% vs. 0.1%; p < 0.001). A higher incidence of ML was observed in a geographical band extending across the Amazon region from the southern Para State to the Acre State. ML exhibited varying frequencies within specific populations. The definition of predictable factors predisposing Leishmania-infected subjects to develop ML is important for defining strategies to mitigate the mucosal damage caused by leishmaniasis.

Clinical and epidemiological aspects of microcephaly in the state of Piauí, northeastern Brazil, 2015-20166 / Aspectos clínicos e epidemiológicos da microcefalia no Estado do Piauí, Nordeste do Brasil, 2015-2016

Abstract Objectives: To describe aspects of the microcephaly epidemic in the state of Piauí. Methods: All cases of congenital microcephaly confirmed in the state between 2015 and 2016 were included (n = 100). Investigation forms of the Regional Reference Center for Microcephaly were reviewed. Discarded cases (n = 63) were used as a comparison group. Results: In October, November, and December 2015 incidence rates reached 4.46, 6.33 and 3.86/1000 live births, respectively; 44 cases were reported in the state capital. Among the mothers of confirmed and discarded cases, the frequency of skin rash during pregnancy was 50/97 (51.5%) and 8/51 (15.7%), respectively (p < 0.001); 33 confirmed cases (35.9%) had a head circumference z-score between −2 and −3, 23 (25%) between −3 and −4, and 8 (8.7%) had a z-score of less than −4. Head computer tomography scans revealed calcifications in 78/95 (82.1%) cases. Lissencephaly, hydrocephalus and agenesis of the corpus callosum were also frequently observed. Ophthalmic findings included retinal pigment epithelium rarefaction and atrophy. Absence of otoacoustic emissions was observed in 21/70 cases. One newborn also presented lower limb muscle atrophy. There were no significant differences in vaccination rates for influenza, diphtheria-tetanus-acellular pertussis, and hepatitis B in either group. Conclusions: The state of Piauí, like others in the northeastern region, faced an epidemic of congenital microcephaly between 2015 and 2016, presumably related to congenital Zika virus infection, more intense in the capital. Current challenges include the improvement of vector control, basic research, scaling-up of diagnostic tools for pre-natal screening of Zika virus, vaccines, and health care for affected children.

Resumo Objetivos: Descrever os aspectos da epidemia de microcefalia no Estado do Piauí. Métodos: Foram incluídos todos os casos de microcefalia congênita confirmados no estado entre 2015-2016 (n = 100). Os formulários de investigação do Centro Regional de Referência em Microcefalia foram analisados. Os casos descartados (n = 63) foram usados como grupo de comparação. Resultados: Em outubro, novembro e dezembro de 2015, as taxas de incidência atingiram 4,46, 6,33 e 3,86/1.000 nascidos vivos, respectivamente; 44 casos foram relatados na capital do estado. Entre as mães de casos confirmados e descartados, a frequência de erupção cutânea durante a gravidez foi 50/97 (51,5%) e 8/51 (15,7%), respectivamente (p < 0,001); 33 casos confirmados (35,9%) apresentaram um escore z de perímetro cefálico entre -2 e -3, 23 (25%) entre -3 e -4 e 8 (8,7%) apresentaram escore z inferior a -4. As tomografias computadorizadas cerebrais revelaram calcificações em 78/95 (82,1%) dos casos. Lisencefalia, hidrocefalia e agenesia do corpo caloso também foram observadas com mais frequência. Os achados oftalmológicos incluíram rarefação e atrofia do epitélio pigmentar da retina. Foram observadas ausência de emissões otoacústicas em 21/70 casos. Um recém-nascido também apresentou atrofia muscular dos membros inferiores. Não houve diferenças significativas nas taxas de vacinação para gripe, vacina difteria tétano e coqueluche acelular e hepatite B em qualquer grupo. Conclusões: O Estado do Piauí, como outros na região Nordeste, enfrentou, entre 2015 e 2016, uma epidemia de microcefalia congênita, supostamente relacionada à infecção congênita pelo vírus Zika, mais intensa na capital. Os desafios atuais incluem melhora do controle de vetores, pesquisa básica, ampliação de ferramentas de diagnóstico para exame pré-natal do vírus Zika, vacinas e cuidados de saúde para crianças afetadas.

Entomological survey in the state of Piauí, Northeastern Brazil, reveals intradomiciliary colonization of Triatoma brasiliensis macromelasoma

ABSTRACT This survey aimed to assess the presence of triatomine vectors of Chagas disease within the rural communities of São João do Piauí, Northeast Brazil. Intradomiciliary and peridomiciliary collection strategies were implemented wherein 279 specimens of Triatoma brasiliensis macromelasoma, both nymph and adult were found in 15 (50%) of the studied homes. Of the intradomiciliary insects, 73 (67.6%) were identified as nymph instars (1st instar [N1]= 6, N2= 14, N3= 28, N4= 7 and N5= 18). In the studied communities, a continuous interaction between triatomine bugs and humans could be shown. It is therefore urgent that suitable strategies for the control of the triatomine vector are implemented in this area.

Varicella zoster virus related deaths and hospitalizations before the introduction of universal vaccination with the tetraviral vaccine / Óbitos e internações relacionados ao vírus varicela-zoster antes da introdução da vacinação universal com a vacina tetravalente

Abstract Objective: To characterize varicella zoster virus-related deaths and hospitalizations in Brazil before universal vaccination with the tetravalent (measles, mumps, rubella, and varicella) vaccine, attempting to collect baseline data on varicella morbidity and mortality in order to evaluate the impact of the varicella vaccination program. Methods: Varicella-associated mortality data were evaluated between 1996 and 2011 and varicella zoster virus-associated hospitalizations between 1998 and 2013. Data were gathered from the Informatics Department of the Unified Health System, considering the International Classification of Diseases, 10th Revision, code B01. All age groups were assessed. Varicella-specific mortality rates were calculated and seasonality of varicella-zoster virus-associated hospitalizations was described. Results: There were 2334 varicella deaths between 1996 and 2011, 19.3% in infants aged less than 1 year and 36% in children from 1 to 4 years. In infants under 1 year, varicella mortality rates reached 3.2/100,000/year. In children aged 1–4 years, varicella mortality rates reach 1.64/100,000/year. Average annual mortality rates for varicella in Brazil are 0.88/100,000 in infants under 1 year and 0.40/100,000 in children aged 1–4 years. The total number of hospitalizations associated with varicella zoster virus was 62,246 from 2008 to 2013. Varicella-associated hospitalizations have a seasonal distribution in children, peaking in November. In the elderly, monthly averages of herpes zoster-associated hospitalizations present no significant seasonal variation. Conclusions: Varicella is associated, in the pre-vaccine period, to significant morbidity and mortality in Brazil. The universal vaccination program is expected to decrease the disease burden from varicella.

Resumo Objetivo: Caracterizar os óbitos e internações relacionados ao vírus varicela-zoster no Brasil antes da vacinação universal com a vacina tetravalente (sarampo, caxumba, rubéola e varicela), tentando coletar dados de referência sobre a morbidez e mortalidade por varicela, para avaliar o impacto do programa de vacinação contra a varicela. Métodos: Os dados de mortalidade associada à varicela foram avaliados entre 1996 e 2011 e as internações associadas ao vírus varicela-zoster, entre 1998 e 2013. Os dados foram coletados do Departamento de Informática do Sistema Unificado de Saúde, considerando a Classificação Internacional de Doenças, 10ª Revisão, código B01. Todas as faixas etárias foram avaliadas. Foram calculadas as taxas de mortalidade específicas por varicela e foi descrita a sazonalidade das internações associadas ao vírus varicela-zoster. Resultados: Houve 2.334 óbitos por varicela entre 1996 e 2011, 19,3% em neonatos com menos de 1 ano e 36% em crianças de 1 a 4 anos. Em neonatos com menos de 1 ano, as taxas de mortalidade por varicela atingiram 3,2/100.000/ano. Em crianças de 1–4 anos de idade, as taxas de mortalidade por varicela atingem 1,64/100.000/ano. As taxas de mortalidade anuais médias por varicela no Brasil são de 0,88/100.000 em neonatos com menos de 1 ano de idade e 0,40/100.000 em crianças de 1 a 4 anos de idade. O número total de internações associadas ao vírus varicela-zoster foi de 62.246 de 2008 a 2013. As internações relacionadas à varicela apresentaram distribuição sazonal em crianças, com pico em novembro. Em idosos, as médias mensais de internações associadas ao herpes zoster não apresentam variação sazonal significativa. Conclusões: A varicela está associada a morbidez e mortalidade significativas no período pré-vacinação no Brasil. O programa de vacinação universal deve diminuir a carga de doença da varicela.

A non-enteric adenovirus A12 gastroenteritis outbreak in Rio de Janeiro, Brazil

A gastroenteritis outbreak that occurred in 2013 in a low-income community in Rio de Janeiro was investigated for the presence of enteric viruses, including species A rotavirus (RVA), norovirus (NoV), astrovirus (HAstV), bocavirus (HBoV), aichivirus (AiV), and adenovirus (HAdV). Five of nine stool samples (83%) from patients were positive for HAdV, and no other enteric viruses were detected. Polymerase chain reaction products were sequenced and subjected to phylogenetic analysis, which revealed four strains and one strain of non-enteric HAdV-A12 and HAdV-F41, respectively. The HAdV-A12 nucleotide sequences shared 100% nucleotide similarity. Viral load was assessed using a TaqMan real-time PCR assay. Stool samples that were positive for HAdV-A12 had high viral loads (mean 1.9 X 107 DNA copies/g stool). All four patients with HAdV-A12 were < 25 months of age and had symptoms of fever and diarrhoea. Evaluation of enteric virus outbreaks allows the characterisation of novel or unique diarrhoea-associated viruses in regions where RVA vaccination is routinely performed.

Frequency and molecular characterisation of Entamoeba histolytica, Entamoeba dispar, Entamoeba moshkovskii, and Entamoeba hartmanni in the context of water scarcity in northeastern Brazil

This study aimed to estimate the frequency, associated factors, and molecular characterisation of Entamoeba histolytica, Entamoeba dispar, Entamoeba moshkovskii, andEntamoeba hartmanni infections. We performed a survey (n = 213 subjects) to obtain parasitological, sanitation, and sociodemographic data. Faecal samples were processed through flotation and centrifugation methods.E. histolytica, E. dispar, E. moshkovskii, and E. hartmanni were identified by nested-polymerase chain reaction (PCR). The overall prevalence of infection was 22/213 (10.3%). The infection rate among subjects who drink rainwater collected from roofs in tanks was higher than the rate in subjects who drink desalinated water pumped from wells; similarly, the infection rate among subjects who practice open defecation was significantly higher than that of subjects with latrines. Out of the 22 samples positive for morphologically indistinguishableEntamoeba species, the differentiation by PCR was successful for 21. The species distribution was as follows: 57.1% to E. dispar, 23.8% to E. histolytica, 14.3% toE. histolytica and E. dispar, and 4.8% E. dispar and E. hartmanni. These data suggest a high prevalence of asymptomatic infection by the group of morphologically indistinguishable Entamoeba histolytica/dispar/moshkovskiicomplex and E. hartmanni species. In this context of water scarcity, the sanitary and socioenvironmental characteristics of the region appear to favour transmission.

Clinical conditions associated withintestinal strongyloidiasis in Rio de Janeiro, Brazil

INTRODUCTION: Strongyloides stercoralis is a soil-transmitted helminth that produces an infection that can persist for decades. The relationships between certain clinical conditions and strongyloidiasis remains controversial. This study aims to identify the clinical conditions associated with intestinal strongyloidiasis at a reference center for infectious diseases in Rio de Janeiro, Brazil. METHODS: The clinical conditions that were assessed included HIV/AIDS, HTLV infection, cardiovascular diseases, diabetes, obstructive respiratory diseases, viral hepatitis, tuberculosis, cancer, chronic renal disease, nutritional/metabolic disorders, psychiatric conditions, rheumatic diseases and dermatologic diseases. We compared 167 S. stercoralis-positive and 133 S. stercoralis-negative patients. RESULTS: After controlling for sex (male/female OR = 2.29; 95% (CI): (1.42 - 3.70), rheumatic diseases remained significantly associated with intestinal strongyloidiasis (OR: 4.96; 95% CI: 1.34-18.37) in a multiple logistic regression model. With respect to leukocyte counts, patients with strongyloidiasis presented with significantly higher relative eosinophil (10.32% ± 7.2 vs. 4.23% ± 2.92) and monocyte (8.49% ± 7.25 vs. 5.39% ± 4.31) counts and lower segmented neutrophil (52.85% ± 15.31 vs. 61.32% ± 11.4) and lymphocyte counts (28.11% ± 9.72 vs. 30.90% ± 9.51) than S. stercoralis-negative patients. CONCLUSIONS: Strongyloidiasis should be routinely investigated in hospitalized patients with complex conditions facilitate the treatment of patients who will undergo immunosuppressive therapy. Diagnoses should be determined through the use of appropriate parasitological methods, such as the Baermann-Moraes technique. .

The effect of hookworm infection and urinary scistosomiasis on blood hemoglobiin concentration of schoolchildren living in northern Mozambique / Infecções por ancilostomídeos e Schistosoma haematobium e sua correlação com a concentração sanguínea de hemoglobina em crianças moçambicanas

This study aims to assess the association between schistosomiasis and hookworm infection with hemoglobin levels of schoolchildren in northern Mozambique. Through a cross-sectional survey, 1,015 children from five to 12 years old in the provinces of Nampula, Cabo Delgado and Niassa were studied. Hookworm infection and urinary schistosomiasis were diagnosed, through Ritchie and filtration methods, with a prevalence of 31.3% and 59.1%, respectively. Hemoglobin levels were obtained with a portable photometer (Hemocue®). The average hemoglobin concentration was 10.8 ± 1.42 g/dL, and 62.1% of the children presented levels below 11.5 g/dL, of which 11.8% of the total number of children had hemoglobin levels below 9 g/dL. A multiple linear regression analysis demonstrated negative interactions between hemoglobin levels and ancylostomiasis, this being restricted to the province of Cabo Delgado (β = -0.55; p < 0.001) where an independent interaction between hemoglobin levels and urinary schistosomiasis was also observed (β = -0.35; p = 0.016). The logistical regression model indicated that hookworm infection represents a predictor of mild (OR = 1.87; 95% CI = 1.17-3.00) and moderate/severe anemia (OR = 2.71; 95% CI = 1.50 - 4.89). We concluded that, in the province of Cabo Delgado, hookworm and Schistosoma haematobium infections negatively influence hemoglobin levels in schoolchildren. Periodical deworming should be considered in the region. Health education and improvements in sanitary infrastructure could achieve long-term and sustainable reductions in soil-transmitted helminthiases and schistosomiasis prevalence rates.

Este estudo tem como objetivo avaliar a relação entre a ancilostomíase e a esquistossomíase urinária com as concentrações sanguíneas de hemoglobina em crianças escolares no norte de Moçambique. Em estudo transversal, 1.015 crianças com idade entre cinco e 12 anos foram incluídas, nas Províncias de Nampula, Cabo Delgado e Niassa. A ancilostomíase e a esquistossomíase urinária foram diagnosticadas através das técnicas de Ritchie e de filtração da urina, respectivamente; prevalências de 31,3% e 59,1% foram observadas. As concentrações sanguíneas de hemoglobina foram obtidas com um fotômetro portátil (Hemocue). A concentração média de hemoglobina foi 10,8 ± 1.42 g/dL, 62,1% das crianças apresentaram concentração abaixo de 11,5 g/dL e 11,8% apresentaram nível abaixo de 9 g/dL. A regressão linear múltipla demonstrou interações negativas entre os níveis de hemoglobina e i) a infecção por ancilostomídeos (β = -0,55; p < 0,001) e ii) a esquistossomíase urinária (β = -0,35; p = 0,016), ambas associações restritas à Província de Cabo Delgado. Também em Cabo Delgado, o modelo de regressão logística demonstrou que a infecção por ancilostomídeos representa um preditor de anemia leve (OR = 1,87; 95% CI = 1,17-3,00) e anemia moderada/grave (OR = 2,71; 95% CI = 1,50 - 4,89). O estudo conclui que em Cabo Delgado, Moçambique, as infecções por ancilostomídeos e Schistosoma haematobium estão significativamente associadas a uma menor concentração sanguínea de hemoglobina em crianças em idade escolar. A administração periódica de anti-helmínticos deve ser feita regularmente. Melhorias na infraestrutura sanitária das regiões estudadas são as medidas mais eficazes para controle destas parasitoses.

Active surveillance of American tegumentary leishmaniasis in endemic areas in rural Bolivia / Vigilância ativa da leishmaniose tegumentar americana em áreas endêmicas na Bolívia

INTRODUCTION: American tegumentary leishmaniasis (ATL), including mucocutaneous leishmaniasis (MCL) and localized cutaneous leishmaniasis (LCL), is endemic in Bolivia. We describe the results of active surveillance of ATL from 2001 to 2006 and assess demographic data related to ATL epidemiology in the Yungas valleys. METHODS: Community-based active ATL surveillance was performed by the institutions SERVIR, CÁRITAS, and the Health Services Department of La Paz, whose files were reviewed retrospectively. A cross-sectional survey was carried out to assess demographic data in two communities. RESULTS: Two thousand nine hundred nine cases of ATL were detected from 2001 to 2006: 2,488 (85.5 percent) corresponded to LCL and 421 (14.5 percent) to MCL. A reduction in the proportion of mucosal cases was observed between 2001 and 2006. The proportion of MCL cases increased with age and was higher among males (15.5 percent versus 12.1 percent, p=0.018). The rate of positivity via direct observation of the parasite in dermal scrapings and in parasite cultivation was significantly higher for LCL than for MCL (p<0.001 and p=0.009, respectively). The rate of reactivity in the leishmanin skin test was higher in the group with mucosal lesions (p=0.012). The cross-sectional survey showed that 40 percent of the families had emigrated from the Altiplano. CONCLUSIONS: It is necessary to undertake continuous case detection of ATL in the area, where the disease presents a high rate of mucosal cases. Increasing incidence seems to be associated with immigration and continuous deforestation to expand the crop-growing areas.

INTRODUÇÃO: A leishmaniose tegumentar americana (LTA), incluindo a leishmaniose mucocutânea (LMC) e a leishmaniose cutânea (LC), é endêmica em várias regiões da Bolívia. Descreve-se um sistema de vigilância da LTA conduzido entre 2001 e 2006 e avaliando-se dados demográficos relacionados à epidemiologia da doença. MÉTODOS: O sistema de busca ativa foi realizado conjuntamente pelas instituições SERVIR e CÁRITAS e pelo Servicio de Salud de La Paz (SEDES), cujos arquivos foram revisados, retrospectivamente. Um estudo transversal foi realizado em duas comunidades para aquisição de dados sócio-demográficos. RESULTADOS: Dois mil novecentos e nove casos de LTA, sendo 2.488 (85,5 por cento) de LC e 421 (14,5 por cento) de LMC foram diagnosticados de 2001 a 2006. Foi observada redução na proporção de casos mucosos ao longo do período. A proporção de LMC aumentou proporcionalmente à idade dos pacientes, sendo mais frequente entre pessoas do sexo masculino (15,5 por cento versus 12,1 por cento, p = 0,018). A taxa de detecção do parasita nos raspados cutâneos e no cultivo foram significativamente maiores em pacientes com LC do que em pessoas com LMC (p < 0,001 e p = 0,009 respectivamente). A reatividade à reação de Montenegro foi mais frequente em pessoas com LMC (p = 0.012). O estudo transversal mostrou que 40 por cento das famílias nas comunidades estudadas emigraram do Altiplano. CONCLUSÕES: Faz-se necessária uma contínua busca ativa de casos de LTA na região, onde a doença é hiperendêmica. As elevadas taxas de incidência parecem estar relacionadas à imigração e ao desflorestamento para expansão das áreas cultivadas.

Influence of blood meal and mating in reproduction patterns of Triatoma brasiliensis females (Hemiptera: Reduviidae) under laboratory conditions

The influence of blood meal and mating on Triatoma brasiliensis (Neiva) female fecundity, fertility, life-span and the preoviposition period were investigated under laboratory conditions. Nourishment increased fecundity, fertility and adult lifespan, whereas mating increased fecundity, fertility and decreased the preoviposition period. Females also required more than one mating to reach their full reproductive potential. Results indicate that both nourishment and mating are important in T. brasiliensis proliferation. Such information will help towards developing effective control strategies of this vector of Chagas disease.

Reassessing the entomological investigation around the first autochthonous case of Chagas disease in Western Brazilian Amazon

In 1979, the first autochthonous case of Chagas disease in the Western Brazilian Amazon was reported and an entomological survey was carried out around it. Specimens of Rhodnius pictipes and Rhodnius robustus were collected in intradomicile and sylvatic ecotopes. Adult bugs were infected with trypanosomatids. Invasion of houses by triatomines was demonstrated and the presence of infected bugs inside dwellings was associated with the possibility of vector-borne Chagas disease. Continuous entomological surveillance employing additional taxonomic tools is needed in the Brazilian Amazon in order to better understand the dynamics of house invasion by sylvatic triatomines and the risk of Trypanosoma cruzi infection transmission.

Tuberculose e parasitismo intestinal em população indígena na Amazônia brasileira / Tuberculosis y parasitismo intestinal en población indígena en el Amazonas Brasilero / Tuberculosis and intestinal parasitism among indigenous people in the Brazilian Amazon region

O objetivo do estudo foi estimar as freqüências de tuberculose e parasitoses intestinais na em comunidades indígenas da localidade de Iauareté (AM), em 2001. Estudo transversal (n=333) visando à obtenção de dados demográficos e amostras biológicas para exames de escarro e fezes. Dentre os 43 sintomáticos respiratórios, seis foram positivos na pesquisa de bacilos álcool-ácido resistentes no escarro. As parasitoses intestinais apresentaram freqüência significativamente maior entre a população Hüpda do que entre os índios que habitam os demais bairros (37,5 por cento vs. 19,3 por cento para Ascaris lumbricoides, 32,4 por cento vs. 16,3 por cento para Trichuris trichiura, 75 por cento vs. 19,3 por cento para ancilostomídeos, 75 por cento vs. 35,4 por cento para Entamoeba histolyticaD dispar e 33,3 por cento vs. 10,7 por cento para Giardia lamblia). Conclui-se que a tuberculose e o parasitismo intestinal são freqüentes nessas comunidades, exigindo medidas de controle e melhorias na assistência à saúde.

The objective of the survey was to estimate the frequencies of tuberculosis and intestinal parasitosis in indigenous communities at the locality of Iauareté, Northern Brazil, in 2001. This was a cross-sectional survey (n=333) aimed at obtaining demographic data and biological samples for sputum and feces examinations. Among the 43 individuals with respiratory symptoms, six presented alcohol/acid-fast bacilli in sputum. Intestinal parasitosis was significantly more frequent among the Hüpda population than among the Indians living in other districts (37.5 percent vs. 19.3 percent for Ascaris lumbricoides, 32.4 percent vs. 16.3 percent for Trichuris trichiura, 75 percent vs. 19.3 percent for hookworms, 75 percent vs. 35.4 percent for Entamoeba histolyticaD dispar and 33.3 percent vs. 10.7 percent for Giardia lamblia). It is concluded that tuberculosis and intestinal parasitism are frequent in these communities, thus requiring control measures and better medical care.

El objetivo del estudio fue estimar las frecuencias de tuberculosis y parasitosis intestinales en las comunidades indígenas de la localidad de Iauareté (Norte de Brasil), en 2001. Estudio transversal (n=333) intentando obtener datos demográficos y muestras biológicas para examenes de esputo y heces. Entre los 43 sintomáticos respiratorios, seis fueron positivos en la pesquisa de bacilos alcohol-ácido resistentes en el esputo. Las parasitosis intestinales presentaron frecuencia significativamente mayor entre la población Hüpda que entre los indios que habitan las demás localidades (37,5 por ciento vs. 19,3 por ciento para Ascaris lumbricoides, 32,4 por ciento vs. 16,3 por ciento para Trichuris trichiura, 75 por ciento vs. 19,3 por ciento para ancilostomídeos, 75 por ciento vs. 35,4 por ciento para Entamoeba histolytica/dispar y 33,3 por ciento vs. 10,7 por ciento para Giardia lamblia). Se concluyó que la tuberculosis y el parasitismo intestinal son frecuentes en esas comunidades, exigiendo medidas de control y mejorías en la asistencia a la salud.

Group A rotavirus genotypes and the ongoing Brazilian experience: a review

Brazil was the first Latin American country to introduce universal group A rotavirus (RV-A) vaccination in March 2006, resulting in a unique epidemiological scenario. Since RV-A first identification in Brazil, 2,691 RV-A-positive stool samples, collected between 1982- 2007, were typed by independent research groups throughout the country. In the pre-vaccination era, 2,492 RV-A-positive samples collected from 1982-2005 were successfully typed, while 199 samples were analyzed from 2006-2007. According to the reviewed studies, there were two important times in the pre-vaccination era: (i) the period from 1982-1995, during which the detection of G5P[8] RV-A, in addition to the classical genotypes G1-4, challenged vaccine development programs; and (ii) the period from 1996-2005, during which genotype G9P[8] emerged, following a global trend. The rate of G2P[4] RV-A detection decreased from 26 percent (173/653) during 1982-1995 to 2 percent (43/1,839) during 1996-2005. The overall detection rate of RV-A genotypes from 1982-2005 was as follows: 43 percent (n = 1,079) G1P[8]/G1P[not typed (NT)]; 20 percent (n = 488) G9P[8]/G9P[NT]; 9 percent (n = 216) G2P[4]/G2P[NT]; 6 percent (n = 151) G3P[8]/G3P[NT]; 4 percent (n = 103) G4P[8]/G4P[NT]; and 4 percent (n = 94) G5P[8]/G5P[NT]. Mixed infections accounted for 189 (7 percent) of the positive samples, while atypical G/P combinations or other genotypes, including G6, G8, G10 and G12, were identified in 172 (7 percent) samples. The initial surveillance studies carried out in several Brazilian states with RV-A-positive samples collected in 2006 and 2007 show a predominance of G2P[4] strains (148/199 or 74 percent). Herein, we review RV-A typing studies carried out since the 1980s in Brazil, highlighting the dynamics of RV-A strain circulation profiles before and early after universal use of RV-A vaccine in Brazil.

Seroprevalence of Toxoplasma gondii infection among indian people living in Iauareté, São Gabriel da Cachoeira, Amazonas, Brazil / Soroprevalência da infecção por Toxoplasma gondii em populações indígenas de Iauareté, São Gabriel da Cachoeira, Amazonas, Brasil

The goal of this survey was to estimate the seroprevalence of Toxoplasma gondii infection in Iauareté, a multiethnic Indian community in the upper Rio Negro basin. We carried out a cross-sectional survey (n = 260), in order to obtain serum samples and demographic data. The sample was randomly selected, by family conglomerate analysis. Serodiagnosis was performed by an enzyme-linked immunosorbent assay and indirect immunofluorescence. Prevalence of reactivity was 73.5 percent (191/260), being higher in the older-age groups, reaching 95.7 percent (44/46) in the group aged 50 years or more. The majority of seropositive subjects had titers equal to or less than 1:64. Seroprevalence was greater in Indians belonging to the Hupda ethnic group (p = 0.03). According to the present survey, Indian people living in Iauareté have a high prevalence of antibodies to T. gondii. Demographic concentration and urbanization within low sanitation and poor hygiene backgrounds, as well as unfiltered water consumption, may be related to the high frequency of T. gondii seroprevalence observed in the studied area.

Este estudo objetivou estimar a soroprevalência da infecção por Toxoplasma gondii em Iauareté, uma comunidade indígena multiétnica situada na bacia do Alto Rio Negro. Foi realizado um estudo seccional (n = 260), obtendo-se amostras de soro e dados demográficos, através de amostragem sistemática por conglomerado. Os testes sorológicos foram realizados através de ensaio imunoenzimático e imunofluorescência indireta. A prevalência da reatividade foi de 73,5 por cento (191/260), aumentando com a faixa etária e atingindo 95,7 por cento (44/46) em maiores de 50 anos. A maioria das amostras reativas apresentou títulos iguais ou inferiores a 1:64. Observou-se maior freqüência de reatividade entre os índios da etnia Maku Hupda. De acordo com o presente estudo, a população indígena de Iauareté apresenta alta prevalência da presença de anticorpos contra T. gondii. A concentração demográfica e a urbanização, conduzidas sem infra-estrutura sanitária, levadas a cabo na região no ultimo século, podem estar relacionadas à alta freqüência de detecção de anticorpos contra T. gondii na área estudada.

Giardia lamblia and other intestinal parasitic infections and their relationships with nutritional status in children in Brazilian Amazon

The objective of this survey was to assess the relationships between intestinal parasitism, nutritional status and hemoglobin level in children with Indian ascendancy living in an urban area in Brazilian Amazon. We carried out a cross-sectional survey obtaining anthropometric, parasitological and socioeconomic data, and hemoglobin measurements of children aged six to 84 months. Anthropometric data were expressed as z-scores for weight for age (WAZ), height for age (HAZ), weight for height (WHZ) and mid upper circumference for age (MUACZ) parameters. Parasitological examinations were performed through Ritchie (n = 307), Kato-Katz (n = 278), Baermann-Moraes (n = 238) and Safranin-methylene blue methods (n = 307). Hemoglobin measurements were obtained with a Hemocue® photometer (n = 282). Socioeconomic data were used in order to classify children in three family income strata (n = 242). Multiple linear regression analysis showed independent interactions between Giardia lamblia and WAZ (beta = -0.195, SE = 0.138, p = 0.003), WHZ (beta = -0.161, SE = 0.133, p = 0.018) and MUACZ (beta = -0.197, SE = 0.143, p = 0.011), controlling for age, sex, family income, Ascaris lumbricoides, and hookworm infection. Also, the multivariate model showed that the only variable associated with hemoglobin levels was age. Intestinal parasitism control should increase children's possibilities of full development in the studied area.

O presente estudo objetivou avaliar a relação entre as parasitoses intestinais, o status nutricional e os níveis de hemoglobina em crianças vivendo em uma área urbana na Amazônia Brasileira. Foi realizado um estudo seccional, obtendo-se dados antropométricos, parasitológicos e socioeconômicos, além de dosagens de hemoglobina através do fotômetro Hemocue®, de crianças com idade entre seis e 84 meses. Os dados da antropometria foram expressos como escores de desvio-padrão (escores z) para os parâmetros peso-idade (PI), altura-idade (AI), peso-altura (PA) e perímetro braquial-idade (PBI). Os exames parasitológicos foram realizados através dos métodos de Ritchie (n = 307), Kato-Katz (n = 278), Baermann-Moraes (n = 238) e Safranina-Azul-de-Metileno (n = 307). A regressão linear múltipla demonstrou interações independentes entre Giardia lamblia e PI (beta = -0.195, p = 0.003), PA (beta = -0.161, p = 0.018) e PBI (beta = -0.197, p = 0.011), após controle para idade, sexo, renda familiar e infecções por Ascaris lumbricoides e ancilostomídeos. O modelo multivariado demonstrou ainda que a única variável associada aos níveis de hemoglobina foi a idade. O estudo concluiu que a giardíase está associada, nos sujeitos pesquisados, a menores médias para os parâmetros antropométricos estudados e que um controle efetivo das parasitoses intestinais poderia contribuir para o pleno desenvolvimento das crianças na área estudada.

Detection of Cryptosporidium spp and other intestinal parasites in children with acute diarrhea and severe dehydration in Rio de Janeiro

The objective of the present study was to estimate the frequency of infection by Cryptosporidium spp and other intestinal parasites in dehydrated children with gastroenteritis who were admitted to a pediatric hospital. Stool examinations from 218 children were performed. Cryptosporidium spp was identified in eighteen out of 193 stool samples (9.3 percent) subjected to safranin-methylene blue staining. Giardia lamblia was detected in ten out of 213 (4.7 percent) samples examined via the direct or Ritchie methods. Other parasites identified were Ascaris lumbricoides (4.2 percent), Blastocystis hominis (1.4 percent), Entamoeba coli (0.9 percent), Entamoeba histolytica/Entamoeba dispar (0.5 percent), Endolimax nana (0.5 percent), Trichuris trichiura (0.5 percent) and Enterobius vermicularis (0.5 percent).

O objetivo do presente estudo foi estimar a freqüência das infecções por Cryptosporidium spp e outros parasitas intestinais em crianças desidratadas com gastroenterite, internadas em um hospital pediátrico. Exames de fezes de 218 crianças foram realizados. Cryptosporidium spp foi detectado em 18 de 193 (9,3 por cento) amostras fecais submetidas à coloração pela safranina/azul-de-metileno. Giardia lamblia foi detectada em dez de 213 (4,7 por cento) amostras submetidas ao exame direto ou ao método de Ritchie. Também foram identificados Ascaris lumbricoides (4,2 por cento), Blastocystis hominis (1,4 por cento), Entamoeba coli (0,9 por cento), Entamoeba histolytica/Entamoeba dispar (0,5 por cento), Endolimax nana (0,5 por cento), Trichuris trichiura (0,5 por cento) and Enterobius vermicularis (0,5 por cento).

Estudo das gastroenterites por rotavírus em hospital pediátrico no Rio de Janeiro / Study of the gastroenteritis for rotavirus in pediatric hospital in Rio de Janeiro

A vacina Rotarix, composta por rotavírus humano genotipo G1P[8] (cepa RIX 4414) ativo, atenuado, foi introduzida no programa brasileiro de imunizações em março de 2006. O presente estudo objetivou: i) determinar a freqüência e a distribuição temporal das hospitalizações por doença diarréica aguda (DDA) em crianças com até cinco anos de idade em um hospital pediátrico da rede municipal de saúde do Rio de Janeiro, ii) estimar a freqüência de infecção pelos diferentes genotipos de rotavírus em crianças hospitalizadascom DDA, iii) detectar diferenças na exposição à vacina contra rotavírus em crianças com DDA positivas e negativas para rotavírus, iv) comparar as freqüências de algumasmanifestações clínicas em crianças positivas e negativas para rotavírus e v) descrever os eventos adversos associados à vacina Rotarix no Rio de Janeiro. Reviram-se os diagnósticos de 6.338 internações ocorridas entre junho de 2001 e junho de 2007, construindo-se curvas epidêmicas relativas aos casos de DDA. Prospectivamente, entre fevereiro de 2005 e junho de 2007, realizou-se uma vigilância sentinela com coleta de amostras fecais de 431 crianças admitidas com DDA, analisando-se mensalmente a freqüência de infecção pelos diferentes genotipos de rotavírus. Os rotavírus do grupo A foram detectados através de ensaio imunoenzimático e eletroforese em gel de poliacrilamida. A genotipagem foi realizada por reação polimerásica em cadeia. Realizou-se um estudo de caso-controle com 70 crianças hospitalizadas com DDA, sendo 14 casos positivos para rotavírus e 56 controles negativos. Avaliou-se a presença de sintomas (n=337) e distúrbios eletrolíticos (n=182) em um grupo de crianças incluídas na vigilância prospectiva. Descreveram-se os eventos adversos associados à administração da vacina Rotarix a partir de dados fornecidos pela Coordenação de Epidemiologia da Secretaria Municipal de Saúde do Rio de Janeiro. A DDA foi a causa de 1.294 (20,4por cento) das 6.338 internações nas...rotavírus.

Mass treatment for intestinal helminthisis control in an Amazonian endemic area in Brazil / Tratamento em massa para controle das helmintíases intestinais em área endêmica na Amazônia Brasileira

The objective of the present study was to estimate the prevalence of soil-transmitted helminthiasis and evaluate the sanitary conditions and the role of a mass treatment campaign for control of these infections in Santa Isabel do Rio Negro. A cross-sectional survey was carried out in 2002, to obtain data related to the sanitary conditions of the population and fecal samples for parasitological examination in 308 individuals, followed by a mass treatment with albendazole or mebendazole with coverage of 83 percent of the city population in 2003. A new survey was carried out in 2004, involving 214 individuals, for comparison of the prevalences of intestinal parasitosis before and after the mass treatment. The prevalences of ascariasis, trichuriasis and hookworm infection were 48 percent; 27 percent and 21 percent respectively in 2002. There was a significant decrease for the frequency of infections by Ascaris lumbricoides (p < 0.05; OR / 95 percent CI = 0.44 / 0.30 - 0.65), Trichuris trichiura (p < 0.05; OR / 95 percent CI = 0.37 / 0.22 - 0.62), hookworm (p < 0.05; OR / 95 percent CI = 0.03 / 0.01 - 0.15) and helminth poliparasitism (p < 0.05; OR / 95 percent CI = 0.16 / 0.08 - 0.32). It was also noticed a decrease of prevalence of infection by Entamoeba histolytica / dispar (p < 0.05; OR / 95 percent CI = 0.30 / 0.19 - 0.49) and non-pathogenic amoebas. It was inferred that a mass treatment can contribute to the control of soil-transmitted helminthiasis as a practicable short-dated measure. However, governmental plans for public health, education and urban infrastructure are essential for the sustained reduction of prevalences of those infections.

O presente trabalho objetivou avaliar a prevalência e o papel de um tratamento em massa das helmintíases intestinais em Santa Isabel do Rio Negro, Estado do Amazonas, Brasil. Foi realizado em 2002 um estudo seccional, incluindo inquérito copro-parasitológico, objetivando a obtenção das prevalências das parasitoses intestinais e dados sobre as condições sanitárias do local, estudando-se uma amostra de 308 indivíduos. Em 2003 foi realizada intervenção para tratamento em massa das helmintíases intestinais com administração de albendazol (ou mebendazol para crianças entre 12 e 24 meses) na sede do município, alcançando-se 83 por cento de cobertura. Novo inquérito copro-parasitológico foi realizado em 2004, para comparação das prevalências antes a após o tratamento. As prevalências das infecções por Ascaris lumbricoides, Trichuris trichiura e ancilostomídeos foram 48 por cento, 27 por cento e 21 por cento, respectivamente em 2002. Em 2004 observou-se redução significativa das infecções por Ascaris lumbricoides (p < 0,05; OR / 95 por cento IC = 0,44 / 0,30 - 0,65), Trichuris trichiura (p < 0,05; OR / 95 por cento IC = 0,37 / 0,22 - 0,62), ancilostomídeos (p < 0,05; OR / 95 por cento IC = 0,03 / 0,01 - 0,15) e poliparasitismo por helmintos intestinais (p < 0,05; OR / 95 por cento IC = 0,16 / 0,08 - 0,32). Foi também observada redução da prevalência de infecção por Entamoeba histolytica/dispar (p < 0,05; OR / 95 por cento CI = 0,30 / 0,19 - 0,49). Concluiu-se que o tratamento em massa pode auxiliar o controle das helmintíases intestinais, porém ações governamentais em infraestrutura urbana e educação são essenciais para uma redução sustentada das prevalências destas infecções.