Avaliação da abordagem sindrômica do corrimento vaginal para o diagnóstico de tricomoníase / Evaluation of syndromic approach of vaginal discharge flowchart to diagnosis of trichomoniasis

A infecção por Trichomonas vaginalis é a doença sexualmente transmissível não viral mais prevalente no mundo. Entre os diferentes métodos para seu diagnóstico, estão os fluxogramas previstos pela abordagem sindrômica. Objetivo: Avaliar o fluxograma de corrimento vaginal para o diagnóstico de tricomoníase em mulheres atendidas em equipe de saúde da família. Métodos: Estudo transversal feito com amostra consecutiva de população ambulatorial, composta por mulheres em idade fértil, exceto gestantes e menores de idade. As participantes responderam a um questionário onde foram registradas as queixas ocorridas nas últimas quatro semanas. Também foram examinadas e submetidas à medição do pH vaginal e teste das aminas. A cultura em meio específico foi considerada como padrão-ouro. Resultados: Dez por cento das mulheres infectadas pela T. vaginalis estavam assintomáticas; entre as infectadas, a dispareunia foi significativamente maior do que entre as mulheres negativas. O esquema proposto pela abordagem sindrômica tem baixa especificidade e acurácia. Conclusão: O diagnóstico de tricomoníase embasado apenas na queixa de corrimento tem baixa acurácia; o resultado do teste das aminas melhora a especificidade do diagnóstico da infecção por Trichomonas vaginalis, independentemente do valor do pH vaginal.

Trichomonas vaginalis infection is the most prevalent non-viral sexually transmitted disease in the world. Among the different methods for diagnosis, the World Health Organization and Ministry of Health of Brazil proposes the use of flowcharts in the syndromic approach. Objective: To evaluate the syndromic approach of vaginal discharge to diagnosis of T. vaginalis infection. Methods: Transversal study with sample of outpatient population consisting of women in reproductive age. After exclusion of pregnant women and minor girls, the final sample consisted of women between 18 and 49 years old. The participants answered a questionnaire where the complaints were registered. They were examined, had the vaginal pH assessed and sample tested with 10% KOH solution to verify the exhalation of amine odor (whiff test). After this proceeding, a vaginal secretion sample was inoculated in a specific T. vaginalis culture medium. The culture results were used as the gold standard to evaluate the syndromic approach flowchart. The algorithm was evaluated according sensitivity, specificity, accuracy, and predictive values. Results: Among women with T. vaginalis infection, 10% were asymptomatic; among them, dyspareunia was significantly higher, if compared to women with no infection. Flowchart proposed by the syndromic approach had low specificity and accuracy, leading to unnecessary treatment in two-third of women. Conclusion: The diagnosis of trichomoniasis based only on the discharge complaint had low accuracy; the whiff test result improves the specificity of diagnosis of T. vaginalis infection, regardless of the vaginal pH value

Intestinal parasites in two indigenous ethnic groups in northwestern Amazonia / Parasitos intestinais em dois grupos indígenas no noroeste da Amazônia

Approximately 90% of the population in the northwestern Amazonia is composed of indigenous people and their healthcare is still a challenge. The objective of this study was to determine the frequency of parasites in two indigenous ethnic groups (Baré and Baniwa) in northwestern Amazonia. Stool samples from 270 individuals (199 Baniwa and 71 Baré) were analyzed using Richie's method and the spontaneous sedimentation method. Statistical differences among the proportions of infected individuals based on gender, age, and ethnicity were determined. All individuals were infected by protozoans or helminths. The most frequent parasites in the indigenous people were Ascaris lumbricoides (73%), Entamoeba spp. (53%), and Giardia intestinalis (48%). Protozoan parasites were more common among children aged 0-12 years; however, the frequency of helminths, such as hookworms and A. lumbricoides, was higher in adults. There were no significant differences in parasite frequencies between different genders or ethnic groups. Mixed infections by two or more protozoan and/or helminth species were detected in 96% of individuals. One individual was infected by 14 species. A high frequency of intestinal parasites was found in Baré and Baniwa ethnic groups. Improvements to infrastructure and health education programs are required to reduce risk of infection by intestinal parasites.

Aproximadamente 90% da população no noroeste da Amazônia é composta de grupos indígenas e o acesso deles aos serviços de saúde ainda é um desafio. O objetivo deste estudo foi determinar a frequência de parasitos em dois grupos indígenas (Baré e Baniwa) no noroeste da Amazônia. Amostras de fezes de 270 indivíduos (199 Baniwa e 71 Baré) foram analisadas pelos métodos de Richie e sedimentação espontânea. Foram determinadas diferenças estatísticas entre as proporções de indivíduos infectados com base no sexo, idade e etnia. Todos os indivíduos estavam infectados por protozoários ou helmintos. Os parasitos mais frequentes nos índios foram Ascaris lumbricoides (73%), Entamoeba spp. (53%), e Giardia intestinalis (48%). Protozoários parasitos foram mais comuns entre as crianças com idade entre 0-12 anos; no entanto, a frequência de ancilostomídeos e A. lumbricoides foi maior em adultos. Não houve diferenças significativas nas frequências de parasitos entre os diferentes sexos ou grupos étnicos. Infecções mistas por duas ou mais espécies de protozoários e/ou helmintos foram detectadas em 96% dos indivíduos. Um indivíduo estava infectado por 14 espécies. Uma alta frequência de parasitos intestinais foi encontrada em indígenas dos grupos Baré e Baniwa. Melhorias dos programas de infra-estrutura e educação em saúde são necessárias para reduzir o risco de infecção por parasitos intestinais.

Frequency of intestinal parasites and commensals in street waste pickers from two cooperatives in the Brazilian Federal District

This study describes the occurrence of intestinal parasites and commensals among street waste pickers (SWPs) of two cooperatives of recyclable materials in the Federal District, Brazil. Stool samples from 75 individuals were analyzed using the Rugai method and spontaneous sedimentation. A questionnaire was applied to assess the awareness of SWPs regarding diseases caused by garbage handling and their prevention methods. Sixty SWPs (80%) were diagnosed with intestinal helminths or protozoa. The most frequent protozoa found were Entamoeba coli (43%), Endolimax nana (28%), and Entamoeba hartmanni (15%), and helminths such as Ascaris lumbricoides (12%), hookworms (8%), and Strongyloides stercoralis (8%) were also found. Other species identified in the workers were E. histolytica/dispar (8%), Giardia lamblia (7%), Hymenolepis diminuta (3%), and Hymenolepis nana (3%). Thirty nine SWPs (65%) had mixed infections. Most (80%) SWPs reported having parasitic diseases in the past, and 72% reported having undergone a stool test. All individuals considered important to use personal protective equipment but only 40% wore gloves. The adoption of healthy hygiene habits and the proper use of personal protective equipment should decrease the occurrence of intestinal parasites in these individuals

Secondary syphilis and acute pelvic inflammatory disease in primary health care: a case report

We present the case of a young woman who was attended to in a family health clinic. The patienthad genital lesions and lower abdominal pain, and was diagnosed with syphilis and acute pelvicinflammatory disease. Our aim is to share this experience, which occurred in a basic health unit.

Relatamos o caso de uma jovem atendida em equipe de saúde da família. Ela apresentavalesões genitais e dor no baixo ventre, tendo sido estabelecidos os diagnósticos de sífilis e doençainflamatória pélvica aguda. Nosso objetivo é compartilhar a experiência ocorrida em uma unidadede atenção primária à saúde.

Factors associated with the occurrence of intestinal parasites in children living in the federal district of Brazil

This study aimed to describe factors associated with the occurrence of intestinal parasites in children living in the Federal District of Brazil (FD). Between 2012 and 2013 fecal samples from 193 children of Riacho Fundo II (RF, n=73) and Ceilândia (CE, n=120) were examined using Rugai and Lutz’s methods. Socioeconomic and health variables were obtained through interviews with the children’s parents. The association between these variables and the occurrence of parasites was analyzed by chi-squared or Fisher’s exact tests. The occurrence of parasites in RF (79 percent) was higher than in CE (54 percent). The most frequent parasites were Giardia intestinalis (RF=15 percent, CE=9 percent), Hymenolepis nana (RF=44 percent, CE=0 percent) and Ascaris lumbricoides (RF=30 percent, CE=2 percent). In CE, a higher frequency of parasites was found in children living in crowded houses and also in houses with domestic animals present. In RF, a higher frequency of parasites was found in children whose families did not wash fruit and vegetables hygienically. A relevant occurrence of intestinal parasites in children was found in the FD, where there is a treated water supply and sewage system. We concluded that poor hygiene habits are the key factors in the transmission of intestinal parasites in FD.

O objetivo do estudo foi descrever fatores associados à ocorrência de enteroparasitos em crianças no Distrito Federal (DF). Entre 2012 e 2013, foram examinadas amostras de fezes de 193 crianças das regiões administrativas de Riacho Fundo II (RF, n=73) e Ceilândia (CE, n=120) pelos métodos Rugai e Lutz. As variáveis socioeconômicas e sanitárias foram obtidas por meio de questionários aplicados às famílias e a associação com a ocorrência de enteroparasitos foi analisada pelo teste qui-quadrado. A ocorrência de enteroparasitos em RF (79 porcento) foi maior que em CE (54 porcento) e os mais frequentes foram: Giardia intestinalis (RF=15 porcento, CE=9 porcento), Hymenolepis nana (RF=44 porcento, CE=0 porcento) e Ascaris lumbricoides (RF=30 porcento, CE=2 porcento). Verificou-se frequência mais elevada de parasitos entre crianças de CE que viviam em casas com maior número de moradores e nas quais havia a presença de animais domésticos. Também foi encontrada frequência mais elevada de parasitos entre crianças de RF cujas famílias não higienizavam frutas e verduras. Uma relevante ocorrência de parasitos intestinais em crianças foi constatada no DF onde existem boas condições de saneamento básico. Conclui-se que, precários hábitos de higiene são fatores fundamentais para a transmissão de enteroparasitos no DF.

Ocorrência de parasitos intestinais em hortaliças comercializadas em feiras no Distrito Federal, Brasil / Intestinal parsites in vegetables commercialized in markets from Federal District, Brazil

Infecções parasitárias ocorrem em decorrência de precárias condições sanitárias e maus hábitos de higienização. Hortaliças comercializadas em feiras livres podem representar risco para a saúde pública por serem consumidas cruas pela população e, eventualmente, estarem contaminadas com cistos de protozoários, ovos e/ou larvas de helmintos parasitos. Com o objetivo de descrever a ocorrência desses organismos em hortaliças comercializadas em feiras, foram analisadas amostras de agrião (Nasturtium officinale R. Br), alface-crespa (Lactuca sativa L.) e rúcula (Eruca sativa Mill) em dez Regiões Administrativas do Distrito Federal, no período de fevereiro a abril de 2013, pelo método de sedimentação espontânea. Observou-se que todas as feiras comercializavam hortaliças contaminadas por algum organismo (protozoários, helmintos e/ou artrópodes). Os parasitos intestinais detectados foram Entamoeba sp., E. coli, Strongyloides sp., Ascaris sp, Enterobius vermicularis e Ancylostomidae. Concluiu-se que as hortaliças comercializadas nas feiras públicas do DF podem veicular parasitos intestinais caso não sejam devidamente higienizadas.

Parasitic infections occur due to poor sanitary conditions and hygiene habits. Vegetables sold in open markets may pose a risk to public health because they are eaten raw by the population and eventually be contaminated with protozoan cysts, eggs and/or larvae of helminthes parasites. In order to describe the occurrence of these parasites in vegetables sold in open markets, samples of watercress (Nasturtium officinale R. Br), lettuce (Lactuca sativa L.) and arugula (Eruca sativa Mill) collected in ten administrative regions of the Federal District of Brazil were analyzed between February and April 2013, using the method of sedimentation. It was observed that all open markets sold vegetables contaminated by some organism (protozoans, helminthes and/or arthropods). The intestinal parasites detected were Entamoeba sp., E. coli, Strongyloides sp. Ascaris sp, Enterobius vermicularis and Ancylostomidae. It is concluded that vegetables sold in the open markets of the Federal District of Brazil may facilitate the transmission of intestinal parasites if not properly sanitized.

Enteroparasites and commensals among children in four peripheral districts of Uberlândia, State of Minas Gerais / Enteroparasitas e comensais em crianças de quatro bairros da periferia de Uberlândia, Estado de Minas Gerais

The aim of this study was to determine the occurrence of intestinal parasites and commensals among children in four peripheral districts located in the northern, southern, eastern and western sectors of Uberlândia, Minas Gerais, using the Baermann methods as modified by Moraes and Lutz. Out of 160 individuals studied, 93 (58.1 percent CI: 50.4-65.7) were infected, distributed among the sectors as follows: northern (72.5 percent), southern (47.5 percent), eastern (57.5 percent) and western (55 percent). The positive findings according to age groups were: 0-5 years (26.9 percent), 5-10 years (21.2 percent) and 10-15 years (10 percent). Male children presented 2.7 times higher risk of infection than females did (OR: 2.7; CI: 1052-7001). The parasites and commensals identified were: Giardia lamblia (27.5 percent), Entamoeba coli (20.6 percent), Ascaris lumbricoides (14.4 percent), Enterobius vermicularis (8.8 percent), Hymenolepis nana (7.5 percent), Hymenolepis diminuta (5 percent), hookworms (3.1 percent), Trichuris trichiura (2.5 percent), Endolimax nana (2.5 percent), Entamoeba hartmanni (2.5 percent), Strongyloides stercoralis (1.3 percent), Iodamoeba butschlii (1.3 percent) and Capillaria hepatica (0.6 percent). The infection rate in these children was high and showed the need to implement prophylactic education programs in the community.

O objetivo deste estudo foi determinar a ocorrência de parasitas e comensais intestinais em crianças de quatro bairros periféricos, localizados nos setores norte, sul, leste e oeste em Uberlândia, Minas Gerais, utilizando os métodos de Baermann modificado por Moraes, e de Lutz. Dos 160 indivíduos estudados, 93 (58,1 por cento, IC: 50,4-65,7) estavam infectados, assim distribuídos: setor norte (72,5 por cento), sul (47,5 por cento), leste (57,5 por cento) e oeste (55 por cento). A positividade por faixa etária foi: 0 - 5 anos (26,9 por cento), 5 - 10 (21,2 por cento) e 10 - 15 anos (10 por cento). As crianças do sexo masculino mostraram 2,7 maior risco de infecção (OR: 2,7, IC: 1052-7001). Os agentes identificados foram: Giardia lamblia (27,5 por cento), Entamoeba coli (20,6 por cento), Ascaris lumbricoides (14,4 por cento), Enterobius vermicularis (8,8 por cento), Hymenolepis nana (7,5 por cento), Hymenolepis diminuta (5 por cento), ancilostomídeos (3,1 por cento), Trichuris trichiura (2,5 por cento), Endolimax nana (2,5 por cento), Entamoeba hartmanni (2,5 por cento), Strongyloides stercoralis (1,3 por cento), Iodamoeba butschlii (1,3 por cento) e Capillaria hepatica (0,6 por cento). A porcentagem de infecção nas crianças foi alta e mostrou a necessidade de implantação de programas de educação profilática na comunidade.

Strongyloides venezuelensis alkaline extract for the diagnosis of human strongyloidiasis by enzyme-linked immunosorbent assay

The present study was conducted to detected IgG antibodies using Strongyloides venezuelensis alkaline extract for the diagnosis of human strongyloidiasis by the enzyme-linked immunosorbent assay (ELISA). Sera from 90 subjects were analyzed (30 with strongyloidiasis, 30 with other parasites and 30 healthy individuals). Results were expressed in antibody titers, which were considered as positive when titer was > 80. Sensibility and specificity of the assay were 100 percent and 96.7 percent, respectively. It can be concluded that the heterologous alkaline extract could be employed in ELISA as a diagnostic aid in human strongyloidiasis, due to its advantages as easiness of obtaining, practicability in preparing, and high indexes of sensitivity and specificity

Anti-Taenia solium metacestodes antibodies in serum from blood donors from four cities of Triângulo Mineiro area, Minas Gerais, Brazil, 1995

Serological survey was performed to detect IgG antibodies anti-Taenia solium metacestodes in blood donors of Hemocentro Regional de Uberlândia, Minas Gerais, Brazil. A total of 1133 sera from blood donors coming from four cities of Triângulo Mineiro area were analyzed by the indirect fluorescence antibody test (IFAT) and the enzyme linked immunosorbent assay (ELISA). Specific IgG antibodies were found in 5.6 percent of the studied population, showing differences in the positive rates according to their origin: Araguari (13.5 percent), Tupaciguara (5.0 percent), Monte Alegre de Minas (4.8 percent) and Uberlândia (4.7 percent). The results indicate the probable endemicity of cysticercosis in this population

Strongyloides stercoralis and other enteroparasites in children at Uberlândia City, State of Minas Gerais, Brazil

To evaluate the rate of infection by Strongyloides stercoralis and other enteroparasites a survey was conducted in the city of Uberlândia, State of Minas Gerais, Brazil. A total of 900 stool samples from 300 children aging from four months to seven years, randomly selected in ten nursery schools from September 1994 to December 1995, were examined, both by the Baermann-Moraes and Lutz methods. Thirty nine children (13 per cent) were found to be infected by S. stercoralis, 64 per cent were boys and 35.9 per cent were girls. Taking all the enteroparasites as a whole the results of the survey pointed out that 265 (88.4 per cent) of the 300 children were infected by the following: Giardia lamblia, 78,3 per cent; Ascaris lumbricoides, 15.3 per cent; S. stercoralis, 13 per cent; Hymenolepis nana, 6.7 per cent; hookworms, 6 per cent; Enterobius vermicularis, 4 per cent; Hymenolepis diminuta, 4 per cent and Trichuris trichiura, 0.7 per cent. From 265 infected children 64.5 per cent were mono-infected, 27.2 per cent were infected by two parasites and 8.3 per cent had a poly-specific parasite burden. It was concluded that strongyloidiasis is hyperendemic in this area.