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.

Estrongiloidiasis gastrointestinal en paciente inmunocompetente: a propósito de un caso / Gastrointestinal strongyloidosis in an immunocompetent patient: a case report

Intestinal parasitic infections cause a not insignificant number of chronic diarrhea in children, however, with the sociodemographic change that our country has experienced, the number of cases and new parasites (immigration from tropical endemic areas) could increase. We report the case of an immunocompetent patient who presents with chronic diarrhea associated with Strongyloides stercoralis infection. The patient migrated two years ago from an endemic area for this helminth. The diagnosis is challenging, and the chances of a successful outcome depend on the administration of the antiparasitic.

Las infecciones parasitarias intestinales provocan un número no despreciable de causas de diarrea crónica en niños, sin embargo, con el cambio sociodemográfico que ha vivido nuestro país se podría incrementar el número de casos y de nuevos parásitos (inmigración de áreas endémicas tropicales). Reportamos el caso de un paciente inmunocompetente, que presenta cuadro de diarrea crónica asociada a infección por Strongyloides stercoralis. El paciente habría migrado hace dos años desde zona endémica para este helminto. El diagnóstico es desafiante y las posibilidades de un resultado exitoso dependen de la administración del antiparasitario.

Parasitismo intestinal en niños de círculos infantiles de un Consejo popular. Matanzas. 2014-2015 / Intestinal parasitism in children assisting day care centers of one popular council. Matanzas. 2014-2015

RESUMEN Introducción: la prevalencia de las infecciones parasitarias intestinales en niños no ha variado mucho en Cuba en los últimos años. Objetivo: determinar la prevalencia de las infecciones parasitarias intestinales e identificar los factores asociados en los círculos infantiles de un Consejo popular de Matanzas. Materiales y métodos: se realizó un estudio analítico, transversal, entre octubre de 2014 y abril de 2015 en el cual se incluyeron niños que asistían a esos círculos infantiles. Se utilizó un muestreo sistemático para la selección. La información se recogió a través de una entrevista estructurada y sé colectaron dos muestras fecales, en días alternos. Cada muestra fue procesada con dos métodos coproparasitológicos. Se estudiaron variables sociodemográficas y factores higiénicos sanitarios. En el procesamiento estadístico se calcularon las frecuencias absolutas, relativas y el Odds Ratio. Se realizó un análisis bivariado y se controlaron los posibles factores de confusión utilizando la regresión logística del programa SPSS. Resultados: 93 niños estaban infectados por algún parásito o comensal. Blastocystis sp., Giardia lamblia y E. histolytica/ E. dispar resultaron los parásitos más frecuentes. La calidad del agua de consumo, comerse las uñas o chuparse el dedo, así como el no lavado de las manos fueron identificados como factores asociados al parasitismo, el resto de los factores resultaron de confusión. Conclusiones: la mitad de los niños se encontraban parasitados, lo que demuestra que las condiciones higiénicas y la educación sanitaria en estas instituciones están aún por debajo del nivel deseado por el sistema nacional de salud (AU).

ABSTRACT Introduction: the prevalence of intestinal parasitic infections in children has not changed in Cuba in the last years in spite of the efforts made by the National Public Health System. Objective: to determine the prevalence of the intestinal parasitic infections and to identify the factors associated to them in the day care centers of the Popular Council Matanzas. Material and methods: a cross-sectional, analytical study was carried out in the period from October 2014 till April 2015 in children assisting those day care centers. The sample was chosen by a systematic sampling. Information was gathered through a structured interview and two stool samples were collected after a day. Each stool sample was processed using two different stool parasitological methods. Socio-demographic variables and hygienic-sanitary factors were studied. Odds ratio, relative and absolute frequencies were calculated during statistic processing. A bivariate analysis was made and the main possible confusion variants were controlled using the SPSS program logistic regression. Results: 93 children were infected by any parasite or commensal, predominating monoparasitism. Blastocystis sp., Giardia lamblia and E. histolytica /E. dispar were the most frequent parasites. Drinking water quality, nails biting or fingers sucking, as well as no hand washing were identified as factors associated to parasitism; the rest of the factors were confusing. Conclusions: half of the patients were found parasite carriers, showing that hygienic conditions and sanitary education in these institutions are still under the level desired by the National Health System (AU).

Impact on prevalence of intestinal helminth infection in school children administered with seven annual rounds of diethyl carbamazine (DEC) with albendazole.

Background & objectives: One third of the world’s population is infected with one or more of the most common soil-transmitted helminths (STH). Albendazole (ALB) is being administered with diethyl carbamazine (DEC) in filariasis endemic areas to eliminate lymphatic filariasis (LF) and helminth infections. In this study, the cumulative impact of seven annual rounds of mass drug administrations (MDA) of DEC and ALB on STH infection in school children in selected villages in southern India was determined. Methods: During 2001-2010, seven MDAs were implemented by the Tamil Nadu state health department, India. LF and STH infections were monitored in school children from 18 villages of the two treatment arms (viz, DEC alone and DEC+ALB). Kato-Katz cellophane quantitative thick smear technique was employed to estimate STH infections at three weeks, six months and one year post MDA. Results: Prior to treatment, an overall STH prevalence was 60 per cent. After each MDA, infection markedly reduced at three weeks post-treatment in both the arms. The prevalence increased at six months period, which was maintained up to one year. After seven rounds of MDA, the infection reduced from 60.44 to 12.48 per cent in DEC+ALB arm; while the reduction was negligible in DEC alone arm (58.77 to 52.70%). Interpretation & conclusions: Seven rounds of MDA with DEC+ALB reduced the infection load significantly, and further sustained low level of infection for 10 years. However, complete parasite elimination could not be achieved. To curtail STH infection in the community, MDA should be regularized and environmental sanitation measures need to be improved by effective community-based campaigns.

Prevalence of Schistosomes and Soil-Transmitted Helminths among Schoolchildren in Lake Victoria Basin, Tanzania

The objectives of this study was to conduct a survey on schistosomiasis and soil-transmitted helminth (STH) infections in order to come up with feasible control strategies in Lake Victoria basin, Tanzania. Depending on the size of the school, 150-200 schoolchildren were recruited for the study. Duplicate Kato-Katz stool smears were prepared from each child and microscopically examined for Schistosoma mansoni and STHs. Urine specimens were examined for Schistosoma haematobium eggs using the filtration technique. After the survey, mass drug administration was done using praziquantel and albendazole for schistosomiasis and STHs infections, respectively. A total of 5,952 schoolchildren from 36 schools were recruited for the study and had their stool and urine specimens examined. Out of 5,952 schoolchildren, 898 (15.1%) were positive for S. mansoni, 754 (12.6%) for hookworms, 188 (3.2%) for Ascaris lumblicoides, and 5 (0.008%) for Trichuris trichiura. Out of 5,826 schoolchildren who provided urine samples, 519 (8.9%) were positive for S. haematobium eggs. The results revealed that intestinal schistosomiasis, urogenital schistosomiasis, and STH infections are highly prevalent throughought the lake basin. The high prevalence of intestinal and urogenital schistosomisiasis in the study area was a function of the distance from Lake Victoria, the former being more prevalent at localities close to the lake, whilst the latter is more so away from it. Control of schistosomiasis and STHs in the study area requires an integrated strategy that involves provision of health education to communities, regular treatments, and provision of adequate safe water supply and sanitation facilities.

Prevalence of Schistosomes and Soil-Transmitted Helminths and Morbidity Associated with Schistosomiasis among Adult Population in Lake Victoria Basin, Tanzania

The objective of this study was to carry out a community survey on schistosomiais and soil-transmitted helminth (STH) infections in order to suggest feasible and effective intervention strategies in Lake Victoria basin, Tanzania. A total of 37 communities selected from 23 districts of the 4 regions in the Lake Victoria basin of Tanzania were involved in the study. From each of the selected locality, 50 adult community members, 25 males and 25 females, were recruited for the study. Each study participant was requested to submit stool and urine specimens. From each stool specimen, duplicate Kato-Katz thick smears were prepared and microscopically examined for Schistosoma mansoni and STH eggs. Urine specimens were processed by the filtration technique and microscopically examined for Schistosoma haematobium eggs. Ultrasound examination for morbidity due to schistosomiasis was performed. Mass treatment was done using praziquantel and albendazole for schistosome and STHs infections, respectively. Out of 1,606 adults who provided stool specimens, 199 (12.4%) were positive for S. mansoni, 349 (21.7%) for hookworms, 133 (8.3%) for Ascaris lumbricoides, and 33 (2.0%) for Trichuris trichiura. Out of 1,400 participants who provided urine specimens, 25 (1.8%) were positive for S. haematobium eggs. Because of the co-endemicity of these afflictions and their impact on vulnerable population groups, the helminthiasis could be simultaneously treated with 2 drugs, praziquantel for schistosomiasis and albendazole for STHs.

Improved Socio-Economic Status of a Community Population Following Schistosomiasis and Intestinal Worm Control Interventions on Kome Island, North-Western Tanzania

Research on micro-level assessment of the changes of socio-economic status following health interventions is very scarce. The use of household asset data to determine wealth indices is a common procedure for estimating socio-economic position in resource poor settings. In such settings information about income is usually lacking, and the collection of individual consumption or expenditure data would require in-depth interviews, posing a considerable risk of bias. In this study, we determined the socio-economic status of 213 households in a community population in an island in the north-western Tanzania before and 3 year after implementation of a participatory hygiene and sanitation transformation (PHAST) intervention to control schistosomiasis and intestinal worm infections. We constructed a household 'wealth index' based housing construction features (e.g., type of roof, walls, and floor) and durable assets ownership (e.g., bicycle, radio, etc.). We employed principal components analysis and classified households into wealth quintiles. The study revealed that asset variables with positive factor scores were associated with higher socio-economic status, whereas asset variables with negative factor scores were associated with lower socio-economic status. Overall, households which were rated as the poorest and very poor were on the decrease, whereas those rated as poor, less poor, and the least poor were on the increase after PHAST intervention. This decrease/increase was significant. The median shifted from -0.4376677 to 0.5001073, and the mean from -0.2605787 (SD; 2.005688) to 0.2605787 (SD; 1.831199). The difference in socio-economic status of the people between the 2 phases was highly statistically significant (P<0.001). We argue that finding of this study should be treated with caution as there were other interventions to control schistosomiasis and intestinal worm infections which were running concurrently on Kome Island apart from PHAST intervention.

Development of cognitive abilities of children infected with helminths through health education / Desenvolvimento de habilidades cognitivas de crianças infectadas por helmintos através da Educação em Saúde

INTRODUCTION: The aim of this study was to evaluate the effect of health education in learning and cognitive development of children infected, previously treated in an endemic area for helminthiasis. METHODS: It is a longitudinal, experimental, with random allocation of participants. The study included 87 children of both sexes enrolled in the school hall of Maranhão, State of Minas Gerais, Brazil, and divided into two groups: intervention and control. Initially the children were submitted to the parasitological fecal examination for infection diagnosis and, when positive, they were treated. For the data collection, a structured questionnaire and the psychological tests Raven, Wisc-III and DAP III were applied, before and after the educational intervention. For the group comparison, the Mann Whitney test was used, and established significance level of 5%. RESULTS: It was found that previously infected children who received the educational intervention, children showed higher performance than the control group in strutured questionnaire (p<0.05). CONCLUSIONS: It is acceptable to suppose the positive influence and the importance in the use of educational interventions in the cognitive recovery and learning of children previously treated with anthelmintics.

INTRODUÇÃO: O objetivo do estudo foi avaliar o efeito da educação em saúde na aprendizagem e desenvolvimento cognitivo de crianças infectadas, previamente tratadas, em área endêmica para helmintoses. MÉTODOS: Trata-se de um estudo longitudinal, experimental e com distribuição aleatória dos participantes. Participaram do estudo 87 crianças, de ambos os sexos, matriculadas na escola municipal de Maranhão, Minas Gerais, Brasil, e distribuídas em dois grupos: intervenção e controle. Inicialmente, as crianças foram submetidas ao exame parasitológico de fezes para diagnóstico de infecção e, em caso positivo, foram tratadas. Para a coleta de dados, foi aplicado um questionário estruturado e os testes psicológicos Raven, Wisc-III e DFH III, antes e após intervenção educativa. Para a comparação entre os grupos foi utilizado o teste Mann Whitney e estabelecido nível de significância de 5%. RESULTADOS: Verificou-se que as crianças previamente infectadas, que receberam a intervenção educativa, apresentaram desempenho superior as crianças do grupo controle no questionário estruturado (p<0,05). CONCLUSÕES: É aceitável supor a influencia positiva e a importância da utilização de intervenções educativas na recuperação cognitiva e aprendizagem das crianças previamente tratadas com antihelmínticos.

An Indigenous Case of Intestinal Capillariasis with Protein-Losing Enteropathy in Korea

We encountered an indigenous case of intestinal capillariasis with protein-losing enteropathy in the Republic of Korea. A 37-year-old man, residing in Sacheon-si, Gyeongsangnam-do, admitted to the Gyeongsang National University Hospital (GNUH) due to long-lasting diarrhea, abdominal pain, anasarca, and weight loss. He recalled that he frequently ate raw fish, especially the common blackish goby (Acanthogobius flavimanus) and has never been abroad. Under the suspicion of protein-losing enteropathy, he received various kinds of medical examinations, and was diagnosed as intestinal capillariasis based on characteristic sectional findings of nematode worms in the biopsied small intestine. Adults, juvenile worms, and eggs were also detected in the diarrheic stools collected before and after medication. The clinical symptoms became much better after treatment with albendazole 400 mg daily for 3 days, and all findings were in normal range in laboratory examinations performed after 1 month. The present study is the 6th Korean case of intestinal capillariasis and the 3rd indigenous one in the Republic of Korea.

Evaluation of reduction in egg shedding of gastrointestinal nematodes in cattle following administration of anthelmintics / Avaliação na redução de ovos de nematódeos gastrintestinais em bovinos após a administração de anti-helmínticos

To evaluate the necessary time and to identify the differences among anthelmintics for the reduction of parasite eggs shed in feces, five groups of cattle were treated with moxidectin, ivermectin, levamisole phosphate, and albendazole sulphoxide. Levamisole promoted a reduction in egg count per gram (EPG-R) of 97.4 percent after 24 hours, moxidectin 98.3 percent after 36 hours, and albendazole sulphoxide 95.9 percent after 36 hours post- treatment. Cooperia spp. and Haemonchus spp. showed resistance to ivermectin. The results demonstrated that the diagnosis of parasite resistance in cattle can be based on a count of eggs per gram (EPG) carried out as soon as seven days after the treatment.

No intuito de avaliar o tempo necessário para redução dos valores de OPG visando identificar o início de atuação dos anti-helmínticos, cinco grupos de novilhos, naturalmente infectados por nematódeos gastrintestinais foram tratados com moxidectina, ivermectina, fosfato de levamisol e sulfóxido de albendazol. O levamisol promoveu redução no número de ovos de nematódeos eliminados nas fezes (R-OPG) de 97,4 por cento 24 horas após a aplicação, a moxidectina de 98,3 por cento após 36 horas, e o sulfóxido de albendazol de 95,9 por cento após 36 horas. Foi registrada a presença de Cooperia spp. e Haemonchus spp. com resistência a ivermectina. A contagem de OPG realizada aos sete dias pós-tratamento apresentou resultados similares aos obtidos nas contagens realizadas 10 e 14 dias após a aplicação dos anti-helmínticos avaliados, demonstrando que o intervalo adequado entre o tratamento anti-helmíntico e o exame para verificar a redução do OPG pode ser de 7 dias.

Ivermectina: sus múltiple usos, seguridad y toxicidad / Ivermectin: its multiple uses, safety and toxicity

La Ivermectina, con más de 30 años de uso en humanos, es una droga que aún sigue siendo estudiada en otras indicaciones. Su seguridad es alta; se han dado casi 2.000 millones de dosis en humanos con efectos colaterales mínimos. Se excreta por las heces, no es nefrotóxica ni hepatotóxica. Es el tratamiento de elección en pacientes con SIDA, recibiendo terapia HAART para estrongiloidiasis sistémica y sarna noruega. Es empleada en niños mayores de dos años de edad o con más de 15 kilos de peso. La dosis es de 200 microgramos/kg en forma oral, al 0,6 por ciento en gotas (1 gota/kg de peso) y de 400 microgramos/kg en forma tópica al 0,1 por ciento (0,4 cc/kg de peso). Logró erradicar la oncocercosis que produce la “ceguera del río” y fue considerada como el triunfo de la humanidad sobre la adversidad por la OMS en 2009.

Ivermectin has been used during more than 30 years and yet it is an old drug in search for additional indications. Ivermectin has high safety profile, and more than 2 billion doses have been administered with mild side effects. Ivermectin is metabolized in the liver, and the drug or its metabolites are excreted almost exclusively in the feces over an estimated 12 days, with less than 1percent of the oral dose excreted in the urine. The plasma half-life of ivermectin in humans is approximately 18 hours following oral administration. Ivermectin is primarily metabolized by CYP3A4, and does not provoke hepato /nephrotoxicicty. This molecule is the gold standard treatment for strongyloidiasis and crusted scabies in patients with AIDS during treatment with HAART therapy. Ivermectin is used in children older than 2 years or more than 15 kg weight. Oral ivermectin 0.6 percent dose is 200 micrograms/kg (1 drop per kg) and topical ivermectin 0.1 percent dose is 400 micrograms/kg (0.4 cc per kg). Ivermectin was able to eliminate human river blindness (onchocerciasis) and “represent one of the most triumphant public health campaigns ever waged in the developing world” by WHO in 2009.

Prevalence of Giardia intestinalis and other zoonotic intestinal parasites in private household dogs of the Hachinohe area in Aomori prefecture, Japan in 1997, 2002 and 2007

An epidemiological study on canine intestinal parasites was undertaken to evaluate changes in the prevalence among private household dogs from the Hachinohe region of Aomori prefecture, Japan, in 1997, 2002 and 2007, using the formalin-ethyl acetate sedimentation technique. The risk of zoonotic transmission from household dogs to humans was also discussed. All intestinal parasites detected in the present study (Giardia intestinalis, Isospora spp., Toxocara canis, Ancylostoma caninum, Trichuris vulpis and Strongyloides stercoralis) showed no changes in prevalence over the past 10 years based on analysis considering canine epidemiological profiles. In particular, prevalence of Giardia intestinalis in dogs under 1 year old, derived from pet shops/breeding kennels and kept indoors was unchanged, remaining at a high level of >15.0% at each time point. Toxocara canis also showed no changes in the group of dogs under 1 year old, bred by private owners and kept outdoors, and the prevalence was >10.0% every year. The present results indicate that the prevalence of Giardia intestinalis and other intestinal parasites in private household dogs has not always decreased, and the potential for direct parasitic zoonotic transmission from dogs to humans may be relatively high level, than from the environment (indoors and outdoors). We recommend careful surveillance of intestinal parasites and aggressive use of anthelminthic in private household dogs under considering the epidemiological factors.

Actualizacion del tratamiento de las parasitosis intestinales y de algunas enfermedades parasitarias de la sangre, de los tejidos y de la piel / Updating the treatment of intestinal parasites and parasitic diseases of blood, tissue and skin

En los últimos veinticinco años han surgido una serie de fármacos antihelmínticos, pero muy pocos medicamentos antiprotozoarios intestinales del hombre. Dentro de los primeros tenemos a la ivermectina, droga de elección en strongiloidiasis, filariasis y en algunas infestaciones por artrópodos: pediculosis y sarna. Otro fármaco es la combinación de pirantel oxantel de gran rendimiento en tricocefaliasis y en terapias masivas o comunitarias que no tiene por objeto la cura parasitológica, sino una disminución de la carga parasitaria. Dentro de los medicamentos antiprotozoarios está la nitaxozanida, fármaco útil en la criptosporidiasis y la diarrea crónica por G.intestinalis. La FDA de USA considera a este medicamento como el de elección para estas dos parasitosis El secnidazol derivado nitroimidazólico, de administración única por un solo día y de vida media larga, es otro de los fármacos eficientes para la amebiasis y giardiasis intestinales. Las dicloroacetamidas: Teclozan, etofamida, clefamida y diloxanida son fármacos útiles en la amebiasis crónica y portadores, igual efecto tiene la quinfamida. En Tablas Terapéuticas se describen los principales medicamentos antihelmínticos y antiprotozoarios intestinales del hombre.

In the last twenty five years new antihelminthic drugs have been developed, but very few humans intestinal antiprotozoan medicaments. Between the firsts we have ivermectin the election drug in strongyloidiasis, filariasis and infestations by arthropods: pediculosis and scabies. Another drug is the combination of pyrantel-oxantel which has high compliance in trichuriasis and in mass or communities treatments which has'nt as target a parasitological cure but a diminishing of the parasitological burden. Nitazoxanide is ahuman antiprotozoan drug usefull in cryptosporidiasis and chronic diarrhea by Glardia intestinalis. FDA of USA consider this medicament of choice in this two parasitosis. Secnidazole a nitroimidazole deriva te with a large half-life, single administration for one day, is another efficient drug for intestinal amebiasis and giardiasis. The dichloroacetamides: teclozan, etofamide, clefamide and diloxanide are usefull drugs in chronic amebiasis and carriers, the same effect has quinfamide. In the Therapeutic Tables the main intestinal human antihelminthic and antiprotozoan drugs are described.

Enteric parasitic infections in HIV/AIDS patients before and after the highly active antiretroviral therapy

Enteroparasites are related to gastrointestinal alterations among patients with HIV/AIDS, some causing severe manifestations in the period before the institution of the highly active antiretroviral therapy (HAART). The prevalence of enteroparasitoses in patients with HIV/AIDS seen at two hospitals in Ceará , Brazil, was compared in the pre-HAART (Group 1; n = 482) and HAART (Group 2; n = 100) eras. Fecal parasitologic examinations (FPE) were performed using the direct, Lutz, Baermann-Moraes and modified Ziehl-Neelsen methods. The following parasites were detected in Groups 1 and 2, respectively: Strongyloides stercoralis - 30.1 percent and 11 percent (p<0.0001), Ascaris lumbricoides - 15.6 percent and 2 percent (p<0.0001), hookworms - 13.7 percent and 2 percent (p<0.0001), Trichuris trichiura - 13.1 percent and 1 percent (p<0.0001), Hymenolepis nana - 0 and 1 percent (p = 0.1718), Giardia duodenalis - 7.9 percent and 1 percent (p = 0.0076), Entamoeba histolytica/dispar - 3.3 percent and 1 percent (p = 0.3301), Isospora belli - 4.8 percent and 1 percent (p = 0.0993), Cryptosporidium sp. - 8.1 percent and 0 (p = 0.0007), and non-pathogenic protozoans as well. There was a significant reduction in the prevalence of enteroparasites between the eras (63.9 percent to 24 percent; p<0.0001). In the HAART era, the following observations were made: greater frequency of enteroparasites in patients without antiretroviral therapy (p = 0.0575), as in those with AIDS (p = 0.08), and diarrhea (36 percent of the patients); lack of association with positive FPE (p = 0.626); and non-detection of Cryptosporidium sp. Strongyloides stercoralis showed an elevated prevalence in the two eras and was more frequent in men (32.41 percent) than women (19.04 percent) of Group 1 (p = 0.018), a finding suggesting the transmission of the helminth through sodomy. The advent of the HAART modified the profile of opportunistic infections, including parasites, probably due...

MONRATE: A descriptive tool for calculation and prediction of re-infection of Ascaris lumbricoides (Ascaridida: Ascarididae)

The study presents an interactive descriptive tool (MONRATE) for calculating and predicting reinfection rates and time of Ascaris lumbricoides following mass chemotherapy. The implementation was based on the theoretical equation published by Hayashi in 1977, for time-prevalence: Y=G [1-(1-X)N-R] as modified by Jong-Yil in 1983. Using the Psuedo-Code of the MONRATE tool, the calculated monthly reinfection rates (X) for the LGAs are (names are locations in Nigeria in a region predominately populated by the Yoruba speaking tribes of Nigeria whose traditional occupations are agriculture and commerce): Ewekoro (1.6 %), Odeda (2.3 %), Ado-odo/Otta (2.3 %), Ogun Waterside (3.8 %) and Obafemi/Owode (4.2 %). The mathematical mean of ‘X’ values in the study areas for Ogun State was 2.84. The calculated reinfection time (N months) for the LGAs are varied such as Ado-odo/Otta (12.7), Ogun Waterside (21.8), Obafemi/Owode (22.92), Odeda (25.45), and Ewekoro (25.9). The mean value for N in Ogun State was 21.75. The results obtained from MONRATE were compared with those obtained using the mathematical equation and found to be the same. Rev. Biol. Trop. 55 (3-4): 755-760. Epub 2007 December, 28.

Se presenta una herramienta descriptiva e interactiva (MONRATE) para calcular y predecir las tasas y tiempo de reinfección con Ascaris lumbricoides tras un tratamiento de quimioterapia. Nos basamos en la ecuación propuesta por Hayashi en 1977 para el tiempo de prevalencia: Y=G [1- (1-X)N-R], según la modificó Jong-Yil en 1983. Utilizando el código Psuedo de la herramienta de MONRATE, las tasas de reinfección mensuales (X) para varios sitios de Nigeria, África, son: Ewekoro (1.6 %), Odeda (2.3 %), Ado-odo/Otta (2.3 %), Ogun Waterside (3.8 %) y Obafemi/ Owode (4.2 %). El promedio matemático de los valores de "X" en el área de estudio del Estado de Ogun fue 2.84. El tiempo de reinfección calculado (N meses) para LGAs es variado: Ado-odo/Otta (12.7), Ogun Waterside (21.8), Obafemi/Owode (22.92), Odeda (25.45) y Ewekoro (25.9). El valor promedio para N en el Estado de Ogun fue 21.75. Los resultados del programa MONRATE son iguales a los producidos por la ecuación.

High prevalence of liver and intestinal fluke infections among residents of Savannakhet Province in Laos

The prevalence of liver and intestinal fluke infections was surveyed on residents of Savannakhet Province, Laos. Fecal specimens were collected from a total of 981 residents in 4 Mekong riverside villages and examined by the Kato-Katz thick smear technique. The results revealed that the overall helminth egg positive rate was 84.2%, and the positive rate for small trematode eggs, including Opisthorchis viverrini, heterophyids, or lecithodendriids, was 67.1%. To obtain adult flukes, 38 small trematode egg positive cases were treated with a 20-30 mg/kg single dose of praziquantel and purged. Diarrheic stools were then collected from 29 people and searched for helminth parasites using stereomicroscopes. Mixed infections with O. viverrini and 6 kinds of intestinal flukes were found, namely, Haplorchis taichui, Haplorchis pumilio, Haplorchis yokogawai, Prosthodendrium molenkampi, Phaneropsolus bonnei, and echinostomes. The total number of flukes collected was 7,693 specimens (av. no. per treated person; 265.3). The most common species was O. viverrini, followed by H. taichui, P. molenkampi, echinostomes, H. pumilio, P. bonnei, and H. yokogawai. The results indicate that foodborne liver and intestinal fluke infections are prevalent among residents of Savannakhet Province, Laos.

Current status of anti-diarrheal and anti-secretory drugs in the management of acute childhood diarrhea.

Each year 1.8 million children die due to diarrheal diseases. Indiscriminate use of antibiotics has resulted in increasing resistance to commonly used antibiotics. Moreover the recent outbreaks of shigella and cholera have revealed multi-drug resistance strains. There is a need for review of recommended antibiotics for shigellosis. From recent data it emerges that fluoroquinolones should be the first line of therapy and cephalosporins to be used as the second line. Among the anti-cholera antibiotics, tetracyclines which were the drug of choice for adults, has the advantage of high sensitivity and low cost. Single dose doxycycline would have minimal side effects, hence can be the drug of choice even in children. We should not allow the business pressures to force usage of probiotics and racecadotril as their role in the management of acute diarrhea is yet to be established. Nitazoxanide has high efficacy against Cryptosporodial diarrhea only. Strict adherence to the recommendations for the management of acute childhood diarrhea is needed or else we dilute the effect of standard management.

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.

The first confirmed case of Diphyllobothrium latum in Brazil

Diphyllobothriasis is an infection of the small intestine by the broad tapeworm Diphyllobothrium sp. The associated symptomatology is nonspecific, but megaloblastic anemia is a well-described complication. Although the infection is common in temperate regions, descriptions in South America have so far been limited to Chile, Peru, and a few cases in Argentina. This paper presents the first confirmed Brazilian case of diphyllobothriasis. A 29-years-old woman living in Salvador (state of Bahia) apparently acquired the infection from eating sushi. The diagnosis was based on fecal examination that revealed a large quantity of operculated eggs. A single dose of praziquantel (600 mg) was sufficient to cure the infection.