Acondicionamento e coleta de resíduos sólidos domiciliares e impactos na saúde de crianças residentes em assentamentos periurbanos de Salvador, Bahia, Brasil / Household solid waste bagging and collection and their health implications for children living in outlying urban settlements in Salvador, Bahia State, Brazil

O artigo apresenta estudo do acondicionamento e coleta de resíduos sólidos domiciliares e o impacto na saúde de crianças, por meio de pesquisa realizada em nove assentamentos humanos localizados em área periurbana da cidade de Salvador, Bahia, Brasil. Como indicadores epidemiológicos foram utilizados, em 1.893 crianças entre 5 e 14 anos, a infecção por nematóides intestinais, expressa pela prevalência de Ascaris lumbricoides, Trichuris trichiura e ancilostomídeos, e em 1.204 crianças menores de cinco anos, a incidência de diarréia e o estado nutricional, este expresso por indicadores antropométricos. Os resultados apresentam a maior prevalência dos três nematóides nas crianças dos domicílios que não dispõem de acondicionamento adequado e de coleta de resíduos sólidos que naquelas de domicílios com acondicionamento adequado e coleta regular, sendo a diferença encontrada estatisticamente significante, mesmo quando outros fatores de risco sócio-econômicos, culturais, demográficos e ambientais são considerados. Resultado semelhante é também observado com relação aos indicadores epidemiológicos, incidência de diarréia e estado nutricional.

This paper presents a study on the bagging and collection of household solid waste and the health implications for children. The research was conducted in nine human settlements on the outskirts of Salvador, Bahia State, Brazil. Intestinal nematode infection, predominantly involving Ascaris lumbricoides, Trichuris trichiura, and hookworms, was used as an epidemiological indicator in 1,893 children from 5 to 14 years of age. The study also included diarrhea incidence and nutritional status as shown by anthropometric indicators in 1,204 children less than 5 years of age. There was a higher prevalence of the three nematodes in children living in households without proper bagging/isolation and collection of household solid waste as compared to those in areas with regular garbage collection and adequate isolation of solid waste. The differences were statistically significant when other socioeconomic, cultural, demographic, and environmental risks factors were considered in the analysis. Similar results were also observed for epidemiological indicators, diarrhea incidence, and nutritional status.

Intestinal nematodes and pulmonary tuberculosis

We report a significantly higher prevalence of intestinal nematodes in patients with pulmonary tuberculosis (TB) compared to a matched control group: 33/57 (57.8 percent) in patients with TB and 18/86 (20.9 percent) in the control group; OR=5.19; 95 percent CI= 2.33-11.69; p=0.000). When TB patients eosinophilia was also significantly higher among those with intestinal parasites (69.8 percent) compared to those without this condition (45.6 percent). We hypothesized that the immune modulation induced by nematodes is a factor that enhances TB infection/progression and that eosinophilia seen in TB patients is a consequence of helminth infection

The prevalence of malnutrition and geo-helminth infections among primary schoolchildren in rural Kelantan.

A cross-sectional study of the nutritional status of schoolchildren aged 7-10 years from the Kuala Betis Resettlement Scheme in Gua Musang, Kelantan was done. A total of 291 schoolchildren were examined but only 183 (62.9%) fecal samples were returned for geo-helminth infection analysis. The prevalence of stunting was 40.4% and underweight was 28.4%. A total of 127 schoolchildren (69.4%) were positive for at least one of the 3 geo-helminth infections. The most common geo-helminth was Ascaris lumbricoides (62.8%), followed by Trichuris trichiura (38.9%), and hookworm infection was relatively low (12.6%). All the anthropometric indices measured were lower in the geo-helminth infected children compared to the uninfected childen, except for the weight-for-height z-score. However the differences were insignificant Geo-helminth infections may not be a significant factor in malnutrition of these schoolchildren. However, with the availability of safe, efficacious and cheap broad spectrum anthelmintics, regular mass treatment should be given in selected areas where the prevalence of geo-helminth infections is still high, so that these schoolchildren will be able to achieve their growth potential during their school years.

Hiperinfección por Strongyloides stercolaris en portadores del virus linfotrófico humano tipo I (HTLV-I)

Se presenta una serie de siete pacientes portadores del virus linfotrófico humano tipo I (HTLV-I) con hiperinfección por S. stercolaris. Ninguno de elllos presentaba paraparesia espástica tropical/mielopatíaasociada con el HTLV-I (TSP-HAM) o leucemia/linfoma de células T del adulto (ATL). Ninguno había recibido glucocorticoides ni tenía antecedentes de transfusiones sanguíneas. Todos eran HIV (-). El diagnóstico serológico de infección por HTLV-I se realizó por los métodos de ELISA y PA, y fueron confirmados por Western Blot. El diagnóstico de estrongiloidiasis fue hecho por la prueba de Baerman en materia fecal en seis de siete pacientes, y en todos los casos por biopsia gástrica y/o duodenal. Seis pacientes provenían de la costa pacífica y el caso restante de Bucaramanga, Santander. Todos los pacientes presentaban cuadro de dolor abdominal progresivo, anorexia, náusea, vómito y diarrea. Al momento de la consulta presentaron gastritis y duodenitis crónica (por endoscopia y bipsia); cuatro de ellos presentaron infiltración gástrica y seis compromiso severo del estado nutricional. Ninguno presentó eosinofilia. Como complicaciones hubo un caso de meningitis bacteriana, uno de absceso cerebral y una septicemia por E. coli. Como conclusión se sugiere que los portadores del virus HTLV-1 pueden cursar con una pérdida selectiva de la inmunidad contra S. stercolaris. Por otro lado, se debe estudiar la posible coinfección con HTLV-I en pacientes con hiperinfección por S. stercolaris.

Capillaria hepatica: a cause of septal fibrosis of the liver

Fine, long, fibrous septa were observed as a late change developing in the acinar zone III of the liver of rats experimentally infected with the helminth Capillaria hepatica. Hepatic septal fibrosis begun 30 days after inoculation of embryonated eggs into the stomach of rats and became clearly evident from the 40th day onwards. Experimental observation was undertaken for 170 days. Septal fibrosis increased progressively with time and was most marked when the parasitic nodules formed around larvae, disintegrating worms and eggs were involving. Septal fibrosis of the liver has not been previously recognized as a manifestation of hepatic capillariasis. The presence of sequestered parasite antigens, probably being slowly released within the liver, appears to be a major factor in the pathogenesis of hepatic septal fibrosis observed in rats with C. hepatica infection

Clinical studies on angiostrongyliasis cantonensis among children in Taiwan.

Angiostrongyliasis cantonensis is a disease commonly seen in Taiwan, especially in children during the summer rainy season. Most of the cases reported in other countries were adults and their clinical manifestations were different from children. Studies on special clinical characteristics of angiostrongyliasis cantonensis among 82 children in Taiwan were performed. Thirty-eight (46.3%) were male and 44 (53.7%) females, and 87% could be traced to a history of contact with the intermediate host, the giant African snail, Achatina fulica, which plays a major role in transmission. The incubation period (average: 13.2 days) was shorter in children than in adults (average: 16.5 days). In about one-third (30.5%) of the total cases, the clinical form was meningoencephalitis, which was higher than in adult cases seen in Thailand (5%). The most common clinical symptom was fever (91.5%), followed by vomiting and headache. The percentages of sixth and seventh cranial neuropathy associated with the disease were 19.5% and 11.0% respectively. Ophthalmologic fundoscopy showed that 25.0% with papilledema which was significantly higher than seen in adults (12%) in Thailand. Most of the cases in this study had peripheral leukocytosis (above 10,000/mm3) and eosinophilia (above 10%); the percentages were 82.9% and 84.1%, respectively. The worm recovery rate from cerebrospinal fluid by lumbar puncture of 82 cases was 41.5%; 141 worms were collected from one female patient using a pumping method. In the recent 2 years, albendazole and levamisole were used clinically with good result.

Abdome agudo na infância por angiostrongilíase intestinal: relato de um caso / Acute abdomen due to intestinal angiostrongylus infections: a case report

É apresentado o caso de uma criança de um ano de idade portadora de abdome agudo causado pelo Angiostrongylus costaricensis. O diagnóstico da angiostrongilíase intetinal é feito apenas através de biópsia e identificaçäo de formas do verme na parede intestinal e/ou mesentério. Ovos e larvas do verme ainda näo säo encontrados nas fezes humanas. Até o momento, a única terapêutica comprovadamente eficaz é a ressecçäo cirúrgica das áreas comprometidas. Devido às limitaçöes diagnósticas, esta enfermidade, provavelmente, tem sua prevalência subestimada. O objetivo do presente artigo é chamar a atençäo para est apossibilidade, em nosso meio, no diagnóstico diferencial do abdome agudo na infância

Albendazole in the treatment of opisthorchiasis and concomitant intestinal helminthic infections.

A total of 52 adult patients with opisthorchiasis with or without concomitant intestinal helminthic infections were treated with albendazole at dosage regimens of 400 mg twice daily for 3 days (group I with 25 patients) and 7 days (group II 27 patients). By concentration method with four examinations from two faecal specimens of each patient the cure rates and percentage egg reduction on day 30 in group I and group II were 12% and 33%, 94 and 95 respectively; by Stoll method the cure rates and percentage egg reduction were 40% and 63%, 92 and 92 in group I and group II, respectively. There were no statistically significant differences between the results of the two regimens. Twenty six patients with hookworm and 9 patients with S. stercolaris infections were cured. Opisthorchis viverrini, N. americanus, A. duodenale, A. ceylanicum, E. malayanum, E. ilocanum, S. stercolaris, E. vermicularis, and T. saginata segments were expelled in stools, mostly on days 1 to 4. Most of the patients felt relieved from symptoms of pain in the right hypochondrium and epigastrium. The side effects were mild and transient. There were no evidence of toxic effects on the bone marrow, heart, liver or kidneys. Albendazole was shown to be effective against Opisthorchis viverrini infection as well as other concomitant intestinal helminthic infections; but the optimal dosage and duration of treatment have not yet been achieved.

ELISA for the detection of angiostrongylus cantonensis antibodies in patients with eosinophilic meningitis.

The enzyme-linked immunosorbent assay (ELISA) was used to examine sera from twelve Taiwanese children with eosinophilic meningitis suspected to be induced by infection with Angiostrongylus cantonensis. Polystyrene tubes were coated with Angiostrongylus cantonensis antigens (5 micrograms/ml protein) prepared from fourth-stage larvae recovered from the brains of experimentally infected rats. Alkaline phosphatase labelled goat antihuman IgG conjugate was used in a dilution of 1 to 500; sera were diluted 1 to 1000. Positive control sera were from patients with parasitologically confirmed infections; the negative control sera from healthy persons. The ELISA values for sera from suspected cases of angiostrongyliasis ranged from 4.5 to 23.1; the positive control sera, 12.7 to 34.4 and the negative control sera 1.3 and 2.2. The assay shows promise and with the use of more purified antigens, micromethods and automated ELISA readers it should become valuable in the presumptive diagnosis of angiostrongyliasis in endemic areas.