Urbanorum spp novo parasita no Brasil / Urbanorum spp new parasite in Brazil / Urbanorum spp nuevo parásito en Brasil

Introdução: As enteroparasitoses são foco de investigações científicas no mundo todo. Urbanorumspp. foi reconhecido como parasita em 1994 no Peru, expandindo-se pela América do Sul. Relatado pela primeira vez no Brasil em 2018, Maranhão. Este relato apresenta o segundo caso no estado do Paraná. Relato de caso: Paciente masculino, 56 anos, 75kg, diabético, habitante de São José dos Pinhais, área urbana. Procura atenção primária por dor ao evacuar, tenesmo e cólica abdominal. Nega diarréia, febre, sangue nas fezes e viagem recente. Exame físico abdominal, hemograma e parcial de urina sem alterações. Parasitológico de fezes: Urbanorum spp. Prescrito Nitazoxanida 500mg 12/12h por 3 dias. Paciente retorna com melhora da sintomatologia e parasitológico de controle negativo. Conclusão: Atualmente a escassez de estudos primários prospectivos dificultam o delineamento clínico-epidemiológico e tratamento da parasitose. A disseminação do parasita entre extremos do país em curto intervalo de tempo, aliada à carência de saneamento básico criam um alerta para seu grande potencial epidêmico. Por isso, as políticas de saúde pública devem priorizar ações informativas e preventivas a fim de evitar surtos e complicações. A atenção primária à saúde é fundamental nesse contexto, justamente pela longitudinalidade e abrangência do cuidado.

Background: Enteroparasitosis are the focus of scientific research worldwide. Urbanorum spp. was recognized as a parasite in Peru in 1994, expanding throughout South America. Reported for the first time in Brazil, state of Maranhão, in 2018. This report presents the second case in the state of Paraná. Case report: Male patient, 56 years old, 75kg, diabetic, inhabitant of São José dos Pinhais, urban area, seeks primary care for pain on bowel movement, tenesmus and abdominal cramps. Denies diarrhea, fever, bloody stools, recent trip. Abdominal examination, blood count and partial urine without changes. Stool parasitology: urbanorum spp. Prescribed Nitazoxanide 500mg 12/12h for 3 days. Patient returns with improvement of symptomatology and parasitological negative control. Conclusion:Currently, the scarcity of prospective studies and meta-analyzes make clinical-epidemiological design and treatment of parasitosis difficult. The spread of the parasite between extremes of the country in a short period of time, coupled with the lack of basic sanitation create a warning for its great epidemic potential. Therefore, public health policies should prioritize informative and preventive actions in order to avoid outbreaks and complications. Primary health care is fundamental in this context, precisely because of the longitudinally and comprehensiveness of care.

Introducción: Las enteroparasitosis el punto de enfoque de investigaciones científicas en todo el mundo. Urbanorum spp fue reconocido cómo parásito en 1994 en el Peru, expandiéndose en América do Sul. Relatado por primera vez en Brasil, Maranhão, 2018. Este informe se encuentra en segundo lugar en el estado de Paraná. Relato del caso: Paciente masculino, 56 años, 75 kg, diabético, habitante de São José dos Pinhais, área urbana. Búsqueda atención primaria por dolor al defecar, tenesmo, y dolor abdominal. Nega diarrea, fiebre, sangre en heces o viaje reciente. Examen físico abdominal, hemograma e tests de orina sin modificaciones. Análisis parasitología: urbanorum spp. Prescripto Nitazoxanide 500mg 12/12h durante 3 días. Paciente volvió con alivio sintomático e materia fecal negativo. Conclusión: En la actualidad la escasez de estudios prospectivos y metanálisis dificultan la delineación clínico-epidemiológica y el tratamiento de la parasitosis. La diseminación del parásito entre los extremos del país en un corto período de tiempo, junto con la falta de saneamiento básico, crea una alerta por su gran potencial epidémico. Por lo tanto, las políticas de salud pública deben priorizar las acciones informativas y preventivas para evitar brotes y complicaciones. La atención primaria de salud es fundamental en este contexto, precisamente por la longitudinalidad y la amplitud de la atención.

Schistosomiasis mansoni in families of fishing workers of endemic area of Alagoas / Esquistosomiasis mansónica en familias de trabajadores de la pesca de área endémica de Alagoas / Esquistossomose mansônica em famílias de trabalhadores da pesca de área endêmica de Alagoas

Abstract Objective: To analyze the epidemiological and clinical aspects involved in the transmission and manifestation of schistosomiasis in a community of fishermen from the endemic area of Alagoas. Methods: Epidemiological, transversal, prospective, descriptive, quantitative study. The coproparasitological survey included 275 family units of fish workers and the epidemiological and clinical ones, those with a positive diagnosis for S. mansoni. Results: The prevalence of schistosomiasis was 13.9% (fishermen), 2.1% (shellfish) and 2.1% (family members). The occurrence of the infection varied according to gender, age, ethnicity and socioeconomic status. Exposure occurred near the home. Autochthonous and predominant low parasite burden, intestinal clinical presentation, abdominal pain and diarrhea were observed. There were no nutritional and pressure changes associated with parasitosis. Adherence to drug therapy and use of the schistosomicidal drug was feared. Conclusion: Fish workers are at high risk for contracting the disease with clinical hepatointestinal manifestation, which requires more intense health actions.

Resumen Objetivo: Analizar los aspectos epidemiológicos y clínicos involucrados en la transmisión y manifestación de la esquistosomiasis en una comunidad de pescadores de área endémica de Alagoas. Métodos: Estudio epidemiológico, transversal, prospectivo, descriptivo, cuantitativo. La encuesta coproparasitológica contempló 275 unidades familiares de los trabajadores de la pesca y el epidemiológico y clínico, aquellos con diagnóstico positivo para S. mansoni. Resultados: La prevalencia de la esquistosomiasis fue 13,9% (pescadores), 2,1% (marisqueras) y 2,1% (familiares). La ocurrencia de la infección varió según el género, edad, etnia y condición socioeconómica. La exposición ocurrió cerca del domicilio. Se observó autoctonía y predominio de carga parasitaria baja, presentación clínica intestinal, dolor abdominal y diarrea. No hubo alteraciones nutricionales y presión arterial asociadas a la parasitosis. Existia el temor de la adhesión a la terapia medicamentosa y al uso de la droga esquistomicida. Conclusión: Los trabajadores de la pesca presentan alto riesgo para contraer la enfermedad con manifestación clínica hepatointestinal, lo que requiere acciones de salud más intensas.

Resumo Objetivo: Analisar os aspectos epidemiológicos e clínicos envolvidos na transmissão e manifestação da esquistossomose em uma comunidade de pescadores de área endêmica de Alagoas. Métodos: Estudo epidemiológico, transversal, prospectivo, descritivo, quantitativo. O inquérito coproparasitólogico contemplou 275 unidades familiares de trabalhadores da pesca e o epidemiológico e clínico, àqueles com diagnóstico positivo para S. mansoni. Resultados: A prevalência da esquistossomose foi 13,9% (pescadores), 2,1% (marisqueiras) e 2,1% (familiares). A ocorrência da infecção variou conforme gênero, idade, etnia e condição socioeconômica. A exposição ocorreu próxima ao domicílio. Observou-se autoctonia e predominância de carga parasitária baixa, apresentação clínica intestinal, dor abdominal e diarreia. Não ocorreram alterações nutricionais e pressóricas associadas à parasitose. Houve receio na adesão à terapêutica medicamentosa e ao uso do fármaco esquistossomicida. Conclusão: Os trabalhadores da pesca apresentam alto risco para contrair a doença com manifestação clínica hepatointestinal, o que requer ações de saúde mais fortalecidas.

Infección experimental de aislados humanos de Blastocystis sp. en ratones inmunosuprimidos con dexamentasona / Experimental infection using human isolates of Blastocystis sp. in dexamethasone immunosurpressed mice

Blastocystis sp. es un protozoario controversial en cuanto a su papel patogénico, asociado a enfermedad gastrointestinal, con alta prevalencia. A fin de evaluar signos, síntomas y hallazgos de laboratorio producidos por Blastocystis sp., ratones inmunosuprimidos con dexametasona fueron infectados con morfologías del parásito obtenidos de pacientes sintomáticos y asintomáticos. Los parásitos se aislaron empleando gradiente de densidad con lymphoprep™, se realizó semicuantificación de las morfologías presentes en las muestra de heces, y se inocularon 1,6 × 105 parásitos en ratones Balb/c, vía intragástrica. En heces de pacientes sintomáticos se encontraron seis veces más vacuolares que granulares, mientras que en asintomáticos la relación fue apenas dos veces mayor. Los síntomas más frecuentes en los pacientes fueron: flatulencia (85%), dolor de cabeza(62%), dolor abdominal (55%), fiebre (30%) y estreñimiento (8%). La semicuantificación de parásitos por campo en humanos no encontró relación directa entre carga parasitaria y sintomatología gastrointestinal, mientras que en la cuantificación de parásitos por gramo de heces si existió. Los ratones presentaron signos variables luego de la infección, todos aquellos infectados con muestras de pacientes sintomáticos presentaron signos, mientras que solo algunos de los infectados con muestras de pacientes asintomáticos los desarrollaron. Se demostró que no existe relación estadísticamente significativa (p= 0,8) entre la morfología del parásito y los signos manifestados por el ratón; sin embargo hubo una relación estadísticamente significativa (p=0,02) entre las formas vacuolares del parásito y la aparición de síntomas en los pacientes. Se concluye que Blastocystis sp. tiene capacidad de producir signos sugestivos de patología en ratones.

Blastocystis sp. is a controversial protozoan in terms of its pathogenic role associated with high-prevalence gastrointestinal disease. To evaluate signs, symptoms and laboratory findings produced by Blastocystis sp., dexamethasone immunosuppressed mice were infected with parasite morphologies obtained from symptomatic and asymptomatic patients. The parasites were isolated using density gradient with lymphoprep™, semi-quantification of the morphologies present in the stool sample was performed and 1.6 × 105 parasites were inoculated into Balb/c mice, intragastrically. In the faeces of symptomatic patients, vacuolar morphology was six times greater than granular morphology, whereas the ratio in asymptomatic patients was only two times greater. The most common symptoms in patients were flatulence (85%), headache (62%), abdominal pain (55%), fever (30%) and constipation (8%). The semi-quantification of parasites per field in humans evidenced no direct relationship between parasite burden and gastrointestinal symptoms, while in parasite quantification per gram of feces, a direct relationship was found. The mice showed variable signs after infection; all those infected with samples from symptomatic patients showed signs, while only some of those infected with samples from asymptomatic patients developed them. It was demonstrated that no statistically significant (p = 0.8) relationship exists between the morphology of the parasite and the signs manifested by the mouse; nevertheless, there was a statistically significant (p = 0.02) relationship between the vacuolar forms of the parasite and onset of symptoms in patients. Conclusions are that Blastocystis sp. is capable of producing signs suggestive of pathology in mice.

Frequency of intestinal parasitic infection among children in Hadhramout governorate [Yemen]

Six hundred children from urban and rural regions of Hadhramout governorate were examined targeted for the detection of intestinal parasites during the year 2009. The main infective parasites prevailed in children were Gardia lamblia [19.17%], Entamoeba histolytica [16.83%], Ascaris lumbricoides [15.83%], Trichuris trichiura [2.33%], Hymenolepis nana [2.33%], Taenia saginata [1.50%] and Schistosoma mansoni [0.67%]. Besides, infections were accompanied by different symptoms as diarrhea [43.5%], abdominal pain [23.3%], abdominal distention [17.3%], constipation [9.1%], nausea and vomiting [8.02%] and fever [5.1%]. The parasitosis reflected the hygienic problems and their influence on public health of Hadhramout

Recurrent abdominal pain in children

To determine the causes of recurrent abdominal pain [RAP] in children and suggest general management guidelines. It is a descriptive observational study conducted from August 2000 to July 2003.One hundred fifty two children of 2- 15-Years age with recurrent abdominal pain were enrolled in this study. A pre-designed proforma was filled and investigations like Complete Blood Count [CBC], urine and fresh stool analysis was performed in all cases. Patients presenting with upper abdominal pain with or without dyspeptic symptoms were evaluated for H. Pylon by serology. Helicobacter pylon antibody serology [value >50 i.u Elisa method] positive patients were offered endoscopy examination and endoscopic antral biopsies were done. Other tests like x-ray chest and or abdomen, barium meal study, ultrasonography of abdomen, EEG examination and tuberculin test were done as indicated. Patients were followed at 2-week interval for three months and specific treatment prescribed as per etiology identified. Out of 152 children, a female to male ratio was 2:1, age range was 2-15 years and mean age was 8.9 years. Mean duration of symptoms was 16 months. Patients presented with epigastric localization of pain 65%, 25% presented with 'whole' abdominal pain while 5% patients presented with pain in loins and 5% had pain in tower abdomen. Protozoal infections which included giardiasis and amoebiasis [33%] were the commonest association followed by Helicobacter pylon [31%]. Endoscopy was performed in 15 cases; biopsy was positive for H.Pylori in all [100%] cases. Thirteen percent had worms in addition to giardia and entamoeba histolytica and 10% had gastro-esophageal reflux. Among other causes urinary tract infection was 5%, constipation was 3% a peptic ulcer diseases was 02%. Abdominal epilepsy, abdominal migraine, cholilithiasis, ovarian cyst, ulcerative colitis and gastnic-trichobizoar all were less than 1%. Recurrent abdominal pain is frequent and challenging pediatric problem. High index of suspicion and careful thorough clinical evaluation supported by stepwise laboratory work-up according to it's clinical presentation and consideration of common treatable causes will be a cost effective approach. Balanced diet with higher fiber content, environmental cleanliness, better quality of water and good personal hygiene practices can reduce common infections with causative factors

Prevalence, risk factors and clinical features associated with intestinal parasitic infections in children from San Juan y Martínez, Pinar del Río, Cuba / Prevalencia, factores de riesgo, y aspectos clínicos asociados con las infecciones parasitarias intestinales en niños de San Juan y Martínez, Pinar del Río, Cuba

A cross-sectional study was carried out in 200 children aged 5-15 years, to examine the presence of intestinal parasitic infections (IPIs) and to assess the risk factors and clinical features associated with them in children in San Juan y Martinez (SJM), Cuba. Three fresh faecal samples were collected from each child and were examined by direct wet mount, brine flotation, formalin-ether and Kato-Katz techniques. Data relating to demography, source of drinking water, personal hygiene habits and clinical features were also collected. Living in the rural area was significantly associated with the highest infection rates (p < 0.01). According to clinical features and laboratory examinations, children with abdominal pain were about four times more likely to have IPIs (OR 4.05, CI, 1.11, 13.18) especially soil-transmitted helminths (STH). We suggest that IPIs, especially STH, in SJM should be strongly suspected in children with abdominal pain from rural areas. Targeted and frequent interventions to control these infections are needed in this municipality.

Se llevó a cabo un estudio transversal en 200 niños de 5-15 años para examinar la presencia de infecciones parasitarias intestinales (IPI) y evaluar los factores de riesgo y los aspectos clínicos asociados con ellas, en niños de San Juan y Martinez (SJM), Cuba. Tres muestras fecales frescas de cada niño fueron recogidas y examinadas mediante preparación fresca directa, flotación en salmuera, éter-formalina y técnicas de Kato-Katz. También se recogieron datos en relación con la demografía, fuentes de abastecimiento de agua potable, hábitos de higiene personal y características clínicas. El vivir en el área rural estaba significativamente asociado con las más altas tasas de infección (p < 0.01). De acuerdo con las características clínicas y los exámenes de laboratorio, los niños con dolor abdominal tenían una probabilidad cuatro veces mayor de tener IPI (OR 4.05, CI, 1.11, 13.18) especialmente helmintos transmitidos por el suelo (HTS). Sugerimos sospechar fuertemente la presencia de IPIs, especialmente de HTS en SJM, en niños con dolor abdominal, provenientes de las áreas rurales. Se necesitan intervenciones frecuentes, dirigidas a controlar estas infecciones en esta municipalidad.

Enclavamiento de Ascaris lumbricoides en vía biliar: presentación de un caso / Bolts of ascaris lumbricoides in via biliary: presentation of a case

La ascariasis es una parasitosis cosmopolita, frecuente en la población infantil a nivel mundial, dado que no requiere factores climáticos o ambientales especiales. Ingresa al organismo por ingesta de huevos, cumpliendo un ciclo hístico-tisular trans-alveolocapilar en su desarrollo para retomar al yeyuno como parásito adulto, etapa en la cual tiene una movilidad exagerada cuando se altera la homeostasis (sobre todo fiebre en los niños), pudiendo migrar a diferentes sitios originando diversas complicaciones entre las que destaca la migración a vía biliar y su enclavamiento. Presentamos el caso de una escolar de 8 años de edad, procedente de Beni, que consulta por dolor abdominal severisimo en flanco derecho de diez días de evolución, irradiado a epigastrio. Se interna en el Hospital de San Borja y al no ser controlado el cuadro, es remitido al Hospital del Niño de la ciudad de La Paz , donde se encuentran dos Ascaris móviles en interior de vesícula y colédoco en la ecografía. Se administra pamoato de pirantel, sin disminución inicial del dolor, mismo que por su intensidad, tiempo de evolución, se decide programarla para cirugía; ante ls atenuación del dolor se solicita control ecográfico en el que se evidencia la salida espontánea de los parásitos, por lo que se continua con una conducta conservadora, con buena evaluación.

The Ascaris is a cosmopolitan parasite, frequent in children inthe whole world, since it does not need any special climatic orenvironmental factors for its growth and development.It enters the organism by intake of eggs, completing a histicaltissuetransalveolar capillary cycle in its development returning tothe jejunum as adult parasite. In this stage it has an exaggeratedmobility when the homoeostasis is altered (principally fever inchildren), being able to migrate to different locations causing diversecomplications, among which the migration to bilious conducts standsout with the ascaris´ enclosure.We present the case of an 8 year-old school boy, who came from theBeni with extremely severe abdominal pain on the right side with anevolution of 10 days and irradiation to the epigastrium. The boy hadbeen admitted to the hospital of San Borja, and since his problemwas not solved, he was transferred to the Hospital del Niño in la Paz,where two mobile ascaris were found inside the gall bladder and thecholedoco in the echography. Pamoato of pirantel was administered,without initial decrease of the pain. Due to the intensity, and the timeof evolution of the pain, surgery was considered. When the pain wasattenuated an echographic control was made that showed thespontaneous exit of the parasites. For this reason, the conservativetreatment was continued with a positive evolution.

Frequency of intestinal parasites in children presenting with diarrhea and/or abdominal pain to Sam hospital, Sana'a, Republic of Yemen

To detect the frequency of intestinal parasites in children presenting with diarrhea and/or abdominal pain to Sam Hospital, Sana'a, Republic of Yemen. A record-based study was performed during a one year period from January 1, 2003 to December 31, 2003. The total number of patients seen for differnt causes through that period was 24100. The charts of those children with diarrhea and/or abdominal pain or discomfort who were referred to the laboratory unit for stool examination were analyzed. A normal saline sedimentation technique was adopted for stool examination. Normal ethyl acetate sedimentation or direct smear methods were also used when necessary. Data about age and sex were collected. The ages of the patients ranged from 2 months to 15 years. Stool examination was carried out in 2824 patients; 1703 [60.3%] of them were males and 1121 [39.7%] were females. Six hundred sixty [23.4%] specimens were parasite positive. Of these, 286 [10.1%] were Entamoeba histolytica, 266 [9.4%] Giardia lamblia, 52 [[1.8%] Hymenolepis nana, 27 [1%] Schistsoma mansoni, 20 [0.7%] Ascaris, 5 [0.2%] Enterobius, and 4 [0.1%] Trichuris trichiura. The majority of the patients were males. The most frequently found found intestinal parasites in children were Entamoeba histolytica followed by Giardia, H. nana, Schistosoma mansoni, and Ascaris

First report of Escherichia coli O157 among Iraqi children

We determined the prevalence of enterohaemorrhagic Escherichia coli, especially E. coli O157, and other enteropathogens among 200 children with bloody diarrhoea and 100 age-matched controls at two Baghdad hospitals. Bacterial and parasitic agents were found in 39.5% and 28.5% of cases, respectively; no pathogen was detected in 32%. E. coli O157 was identified in 11.5% and more than one pathogen was found in 15.5% of cases. The most common pathogens were enteropathogenic E. coli [EPEC] [5%]; E. coli other than E. coli O157 or EPEC [15%]; Entamoeba histolytica [25%] and Giardia lamblia [3.5%]. All isolates of E. coli O157:H7 were sensitive to cephalexin, ciprofloxacin, gentamicin and nalidixic acid and resistant to erythromycin, polymyxin B and vancomycin. Resistance to 6 or more antimicrobial agents was common [50% of isolates]

The endoscopic diagnosis of intestinal capillariasis in a child: a case report.

A 13-year-old boy was diagnosed as having intestinal capillariasis by gastroduodenoscopy. He presented with a 10-month history of chronic abdominal pain and diarrhea. The boy had stayed in central Thailand and had eaten uncooked fish and raw shellfish. Gastroduodenoscopy showed normal jejunal mucosa although histology revealed flattened villi, crypt proliferation, acute inflammation, and eosinophilic granulomata. An egg of Capillaria philippinensis was also seen. The child was treated with mebendazole for 30 days. He had gained six kilograms by the time of his last follow-up.

Biliary ascariasis.

Biliary ascariasis is a less frequent, but important complication of ascaris infestation, because it may cause biliary colic, pyogenic cholangitis, and septicemia. Early diagnosis and treatment is important to prevent these complications. We present here a five-year-old girl with biliary ascariasis, whose main complaint was abdominal pain. After giving piperazin salt, multiple ascaris worms were seen in the stool within 10 days. She is at the follow-up without any complication.

Oral expulsion of Taenia saginata.

We report a 25-year-old woman who presented with abdominal pain, vomiting and fever, and had an epigastric lump on examination. At laparotomy she was diagnosed to have acute segmental jejunitis. Three days postoperative, she vomited a 2-meter-long tapeworm (Taenia saginata), a rare route of expulsion.

Aspirado duodenal directo transendoscópico: estudio de 50 casos / Direct transendoscopic duodenal aspirate: study of 50 cases

Se estudian 50 niños con antecedentes de dolor abdominal recurrente de localización alta, tuvieran o no diarreas, y en los cuales los exámenes habituales de heces fecales en serie y la intubación duodenal convencional habían dado resultados negativos. A todos se les realizó un estudio endoscópico gastroduodenal, y se aprovechó la ocasión para obtener una muestra del jugo duodenal por aspiración directa durante la propia endosopía. Se encontró duodenitis crónica en el 66 % de los niños examinados y gastritis crónica en el 20 % de los mismos. Se demostró la presenciaa de parasitismo duodenal en el 52 % de los pacientes a los cuales se les realizó el estudio y predominaron los trofozoitos de giardias (28 %) y los quistes de ameba histolítica (22 %) en los 50 pacientes examinados. El aspirado duodenal directo transendoscópico es un medio de diagnóstico útil en el estudio de los niños con dolor abdominal recurrente de localización alta, y proponemos su uso también en adultos. Debe estudiarse el posible papel de la ameba histolítica en la causa de la duodenitis crónica de algunos pacientes