Hyperreactive malarious splenomegaly and aids: a case report

Malaria is endemic in the North of Brazil. However, Hyperreactive Malarious Splenomegaly (HMS) has been rarely described. Splenomegaly in HIV/Aids infection has a large differential diagnosis, but malaria is a cause of gross splenomegaly, regardless of the HIV status. In this paper, we report the case of a 50-year-old man, HIV positive, with massive splenomegaly and multiple malaria infections in the past. He fulfilled the criteria for HMS, received a short course of anti-malarial treatment and weekly quimioprofilatic Chloroquine. In 9 months, he had great clinical and laboratorial improvement confirming the HMS, a rare diagnosis in Brazil.

Congenital toxoplasmosis in a reference center of Paraná, Southern Brazil

This study describes the characteristics of 31 children with congenital toxoplasmosis children admitted to the University Hospital of Londrina, Southern Brazil, from 2000 to 2010. In total, 23 (85.2%) of the mothers received prenatal care but only four (13.0%) were treated for toxoplasmosis. Birth weight was <2500 g in 37.9% of the infants. During the first month of life, physical examination was normal in 34.5%, and for those with clinical signs and symptoms, the main manifestations were hepatomegaly and/or splenomegaly (62.1%), jaundice (13.8%), and microcephaly (6.9%). During ophthalmic examination, 74.2% of the children exhibited injuries, 58.1% chorioretinitis, 32.3% strabismus, 19.4% microphthalmia, and 16.2% vitreitis. Anti-Toxoplasma gondii IgM antibodies were detected in 48.3% of the children. Imaging brain evaluation was normal in 44.8%; brain calcifications, hydrocephaly, or both conditions were observed in 27.6%, 10.3%, and 17.2%, respectively, of the patients. Patients with cerebrospinal fluid protein > 200 mg/dL presented more brain calcifications (p = 0.0325). Other sequelae were visual impairment (55.2% of the cases), developmental delay (31.0%), motor deficit (13.8%), convulsion (27.5%), and attention deficit (10.3%). All patients were treated with sulfadiazine, pyrimethamine, and folinic acid, and 55.2% of them exhibited adverse effects. The results demonstrate the significance of the early diagnosis and treatment of toxoplasmosis during pregnancy to reduce congenital toxoplasmosis and its consequences.

Toxoplasmosis: an examination of knowledge among health professionals and pregnant women in a municipality of the State of Paraná

Introduction The aim of this study was to investigate the knowledge of toxoplasmosis among professionals and pregnant women in the public health services in Paraná, Brazil. Methods A cross-sectional observational and transversal study of 80 health professionals (44 nurses and 36 physicians) and 330 pregnant women [111 immunoglobulin M (IgM)- and IgG-non-reactive and 219 IgG-reactive] was conducted in 2010. An epidemiological data questionnaire was administered to the professionals and to the pregnant women, and a questionnaire about the clinical aspects and laboratory diagnosis of toxoplasmosis was administered to the professionals. Results The participants frequently provided correct responses about prophylactic measures. Regarding the clinical and laboratory aspects, the physicians provided more correct responses and discussed toxoplasmosis with the pregnant women. The professionals had difficulty interpreting the avidity test results, and the physicians stated that they referred pregnant women with high-risk pregnancies to a county reference center. Of the professionals, 53 (91.4%) reported that they instructed women during prenatal care, but only 54 (48.6%) at-risk pregnant women and 99 (45.2%) women who were not at risk reported receiving information about preventive measures. The physicians provided verbal instructions to 120 (78.4%) women, although instructional materials were available in the county. The pregnant women generally lacked knowledge about preventive measures for congenital toxoplasmosis, but the at-risk pregnant women tended to respond correctly. Conclusions This study provides data to direct public health policies regarding the importance of updating the knowledge of primary care professionals. Mechanisms should be developed to increase public knowledge because prophylactic strategies are important for preventing congenital toxoplasmosis. .

Ocorrência de enteroparasitoses em escolares do município de Jataizinho, Estado do Paraná, Brasil / Occurrence of enteroparasitosis in schoolchildren of the municipal district of Jataizinho, State of Paraná, Brazil

As enteroparasitoses são responsáveis por altos índices de morbidade principalmente nos países em desenvolvimento, onde o crescimento populacional não é acompanhado de melhoria das condições de vida da população. O objetivo deste estudo foi determinar a ocorrência e os fatores associados às enteroparasitoses em escolares de Jataizinho, Estado do Paraná, Brasil. Foram avaliadas 264 amostras de fezes pelos métodos de sedimentação espontânea, método direto e Kato-Katz. A prevalência geral de enteroparasitoses foi de 68,2% (180/264). Os protozoários de maior prevalência foram a Endolimax nana (47,5%) e a Entamoeba coli (23,5%). Já entre os helmintos foram o Ascaris lumbricoides (10,2%) e o Trichuris trichiura (6,1%). Houve predominância de casos de poliparasitismo (50,5%) em relação aos de monoparasitismo (49,5%). Ovos de Schistosoma mansoni foram encontrados em quatro (1,5%) amostras analisadas. O principal fator associado às parasitoses intestinais foi o hábito de freqüentar rio, riacho ou lagoa (OR = 2,78; IC 95%; 1,32 ? 5,92). De acordo com os resultados encontrados, medidas de educação sanitária devem ser implantadas com urgência, enfatizando o risco de freqüentar rios ou lagos, melhores hábitos de higiene pessoal e higienização dos alimentos

The enteroparasitoses are responsible for high death rates, mainly in developing countries where population growth is not followed by improvement in the population?s standard of living. The aim of this study was to determine the occurrence of and the factors associated with enteroparasitosis in schoolchildren from Jataizinho, State of Paraná, Brazil. 264 fecal samples were analyzed by sedimentation in water, direct technique and Kato-Katz methods. The general prevalence of enteroparasitosis was of 68.2% (180/264). The most frequent protozoans were Endolimax nana (47.5%) and Entamoeba coli (23.1%). Already among the helminthes were Ascaris lumbricoides (10.2%) and Trichuris trichiura (6.1%). There was a predominance of poliparasitism cases (50.5%) in relation to the monoparasitism (49.5%). Schistosoma mansoni eggs were found in four (1.5%) of the analyzed samples. The main factor associated with intestinal parasitosis was related to the habit of bathing in rivers, streams or lakes (OR = 2.78; IC 95%; 1.32 ? 5.92). According to the results obtained, sanitary education measures should be urgently implemented, emphasizing the risk of the habit of bathing in rivers and lakes, better personal hygiene habits and hygiene procedures for food