Implementation of an organized colorectal cancer screening program through quantitative fecal immunochemical test followed by colonoscopy in an urban low-income community: Guidance and strategies.

Fecal Immunochemical Test (FIT) followed by a colonoscopy is an efficacious strategy to improve the adenoma detection rate and Colorectal Cancer (CRC). There is no organized national screening program for CRC in Brazil. The aim of this research was to describe the implementation of an organized screening program for CRC through FIT followed by colonoscopy, in an urban low-income community of São Paulo city. The endpoints of the study were: FIT participation rate, FIT positivity rate, colonoscopy compliance rate, Positive Predictive Values (PPV) for adenoma and CRC, and the rate of complications. From May 2016 to October 2019, asymptomatic individuals, 50-75 years old, received a free kit to perform the FIT. Positive FIT (≥ 50 ng/mL) individuals were referred to colonoscopy. 10,057 individuals returned the stool sample for analysis, of which (98.2%) 9,881 were valid. Women represented 64.8% of the participants. 55.3% of individuals did not complete elementary school. Positive FIT was 7.8% (776/9881). The colonoscopy compliance rate was 68.9% (535/776). There were no major colonoscopy complications. Adenoma were detected in 63.2% (332/525) of individuals. Advanced adenomatous lesions were found in 31.4% (165/525). CRC was diagnosed in 5.9% (31/525), characterized as adenocarcinoma: in situ in 3.2% (1/31), intramucosal in 29% (9/31), and invasive in 67.7% (21/31). Endoscopic treatment with curative intent for CRC was performed in 45.2% (14/31) of the cases. Therefore, in an urban low-income community, an organized CRC screening using FIT followed by colonoscopy ensued a high participation rate, and high predictive positive value for both, adenoma and CRC.

Implementation of an organized colorectal cancer screening program through quantitative fecal immunochemical test followed by colonoscopy in an urban low-income community: Guidance and strategies

Abstract Fecal Immunochemical Test (FIT) followed by a colonoscopy is an efficacious strategy to improve the adenoma detection rate and Colorectal Cancer (CRC). There is no organized national screening program for CRC in Brazil. The aim of this research was to describe the implementation of an organized screening program for CRC through FIT followed by colonoscopy, in an urban low-income community of São Paulo city. The endpoints of the study were: FIT participation rate, FIT positivity rate, colonoscopy compliance rate, Positive Predictive Values (PPV) for adenoma and CRC, and the rate of complications. From May 2016 to October 2019, asymptomatic individuals, 50-75 years old, received a free kit to perform the FIT. Positive FIT (≥ 50 ng/mL) individuals were referred to colonoscopy. 10,057 individuals returned the stool sample for analysis, of which (98.2%) 9,881 were valid. Women represented 64.8% of the participants. 55.3% of individuals did not complete elementary school. Positive FIT was 7.8% (776/9881). The colonoscopy compliance rate was 68.9% (535/776). There were no major colonoscopy complications. Adenoma were detected in 63.2% (332/525) of individuals. Advanced adenomatous lesions were found in 31.4% (165/525). CRC was diagnosed in 5.9% (31/525), characterized as adenocarcinoma: in situ in 3.2% (1/31), intramucosal in 29% (9/31), and invasive in 67.7% (21/31). Endoscopic treatment with curative intent for CRC was performed in 45.2% (14/31) of the cases. Therefore, in an urban low-income community, an organized CRC screening using FIT followed by colonoscopy ensued a high participation rate, and high predictive positive value for both, adenoma and CRC.

Infection by intestinal parasites in disabled patients and their guardians / Infecção por parasitos intestinais em pacientes com necessidades especiais e seus tutores

Introduction: intestinal parasitic infections are common major problem closely related to poverty, inadequate sanitation, insufficient health care and overcrowding. They cause significant morbidity among institutionalized patients, however, there are few studies that analyze the frequency of intestinal parasites in disabled patients that are not institutionalized. Objective: the aim of the present study was to determine the prevalence of intestinal parasitic infection in disabled patients and their guardians. Methodology: a total of 336 fecal samples were collected from 53 disabled patients and history of diarrhea during the study period and 31 guardians, parents and professional staff of Institution. Parasite research was carried out using zinc sulphate centrifugal-flotation technique, Lutz/Hoffman Pons and Janer method, Rugai method and Gram-Chromotrope, Leishman, Kinyoun, Kato-Katz and Trichrome stains were used. Results: we found 15.5% of positive sample for enteroparasites in all analyzed individuals (13/84), with 11.3% (6/53) of prevalence in disabled patients and 22.5% (7/31) for guardians, with significant difference. There was no difference between gender, but there was a higher number of positives in patients between 6 and 11 years of age. Monoparasitism and the presence of protozoa, especially Blastocystis hominis, were the most prevalent conditions. Conclusions: despite the aforementioned intrinsic susceptibility of patients with special needs, the prevalence of intestinal parasites was low. In guardians, the prevalence was higher, suggesting extreme attention to the care process, which may have prevented the transmission to their disabled patients contact.

Introdução: as infecções parasitárias intestinais são um problema comum, intimamente relacionado à pobreza, saneamento inadequado, assistência médica insuficiente e superpopulação. Essas infecções causam morbidade significativa em pacientes institucionalizados, no entanto, existem poucos estudos que analisam a frequência de parasitas intestinais em pacientes com necessidades especiais não institucionalizados. Objetivo: o presente estudo teve como propósito determinar a prevalência de infecção parasitária intestinal em pacientes com necessidades especiais e seus responsáveis/tutores. Metodologia: foram coletadas 336 amostras fecais de 53 pacientes com necessidades especiais e histórico de diarréia durante o período do estudo e 31 responsáveis/ tutores, pais e equipe profissional relacionada. As técnicas de centrífugo-flutuação em sulfato de zinco, método Lutz/Hoffman Pons e Janer, método Rugai e Gram-Cromotrópico, Leishman, Kinyoun, Kato-Katz e Tricrômica foram utilizadas para a pesquisa de helmintos e protozoários. Resultados: foi encontrado 15,5% (13/84) de prevalência de enteroparasitos em todos os indivíduos analisados, sendo 11,3% (6/53) de prevalência em pacientes com necessidades especiais e 22,5% (7/31) de responsáveis/tutores, com diferença significativa. Não houve diferença entre os sexos, mas encontrou-se maior número de positivos em pacientes com 6 a 11 anos de idade. O monoparasitismo e a presença de protozoários, especialmente Blastocystis hominis, foram as condições mais prevalentes. Conclusões: apesar da suscetibilidade intrínseca dos pacientes com necessidades especiais, a prevalência de parasitas intestinais foi baixa. Nos responsáveis, a prevalência foi maior, sugerindo extrema atenção ao processo de cuidar, o que pode ter evitado a transmissão para os seus pacientes com necessidades especiais contactantes.

Culture isolation and molecular identification of Blastocystis sp. in Brazilian human isolates: preliminary results.

Blastocystis sp. is a protist commonly found in stool samples of humans and animals. Biological and genetic factors of this organism remain controversial. The present study aimed to develop and implement the Blastocystis in vitro culture of Brazilian human isolates for routine use. The fecal isolates (n = 20) were maintained in our laboratory by several passages in Pavlova's medium. Cultures were monitored every 72 h by light microscopy. Genomic DNA was extracted to identify the subtypes (STs). In most isolates, the vacuolar form was prevalent. The amoeboid, granular and cystic forms were observed during in vitro cultivation. STs 1, 2, 3, 4 and 7 were identified. Our preliminary results show the generation time and forms present in the in vitro culture of Blastocystis subtypes isolated from Brazilian human isolates. Therefore, we emphasize the use of in vitro culture as a tool in future studies for the better understanding of the biological aspects of Blastocystis sp.

Characterization of subtypes of Blastocystis sp. isolated from patients with urticaria, São Paulo, Brazil.

Blastocystis sp. is described as an enteric protist prevalent in fecal samples from humans and animals; its pathogenicity and epidemiology are still controversial. Currently, it has been associated with intestinal diseases such as irritable bowel syndrome and clinical manifestations of allergic skin, such as chronic urticaria. In the context of urticaria, it is still uncertain whether this organism is directly related to the allergic manifestation or just a common component of the intestinal microbiota. This study aimed to evaluate the occurrence and molecular diversity of Blastocystis sp. in individuals with urticaria from a dermatology outpatient clinic, São Paulo, Brazil. Fecal samples of 58 patients with urticaria were examined using parasitological methods; and subsequently tested by polymerase chain reaction using Blastocystis-specific primers. The subtypes (STs) and alleles (a) were determined using BLASTn and MLST tools. ST1, ST2, ST3, ST4, ST6 and mixed infection (ST1 + ST3) were identified in the patients with urticaria; ST1 (a4), ST3 (a34 and a36) and ST4 (a42) were the most prevalent. Our molecular analyses allowed an initial description of Blastocystis subtypes in patients with urticaria from São Paulo city, Brazil.

Hemorragia digestiva ocasional em criança por estrongiloidíase: importância do exame parasitológico / Occasional digestive hemorrhage in children due to strongyloidiasis: importance of parasitologic testing

RESUMO Objetivo: Descrever um caso incomum de infecção por Strongyloides stercoralis (S. stercoralis) em paciente de quatro meses de idade e ressaltar a importância do diagnóstico precoce. Descrição do caso: Paciente masculino, procedente e residente de Videira, Santa Catarina, Brasil, nasceu pré-termo, parto cesárea, peso de nascimento 1.655 g, e permaneceu na Unidade de Terapia Intensiva neonatal e intermediária por 20 dias. Aos quatro meses de idade, começou a evacuar fezes sanguinolentas e foi feita hipótese de alergia à proteína do leite de vaca, em razão da sintomatologia e do uso da fórmula infantil para o primeiro semestre, para o qual foi indicada a substituição por fórmula infantil com proteína hidrolisada. Foram solicitados a pesquisa de leucócitos e o exame parasitológico das fezes). Ambos se mostraram positivos e o parasitológico revelou a presença de larva rabditoide de S. stercoralis. O clínico manteve a hipótese inicial e a dieta, mas solicitou a coleta de três amostras de fezes, que resultaram em uma amostra para larvas rabditoide, em muda, de S. stercoralis. Como a criança apresentava dor abdominal, vômito e as fezes permaneciam sanguinolentas, foi iniciado o tratamento com tiabendazol - duas vezes/dia por dois dias -, repetido após sete dias, e, em seguida, realizado o exame parasitológico de fezes, tendo sido negativo. Comentários: A estrongiloidíase, apesar de ser uma infecção parasitária frequentemente leve, em pacientes imunocomprometidos pode se apresentar de forma grave e disseminada. Deve-se suspeitar desse agente em pacientes que vivem em áreas endêmicas, sendo o diagnóstico estabelecido por meio da pesquisa das larvas do S. stercoralis na secreção traqueal e nas fezes.

ABSTRACT Objective: To describe an uncommon case of infection by Strongyloides stercoralis (S. stercoralis) in a 4-month-old child and to highlight the importance of early diagnosis. Case description: The patient was a male child from the city of Videira, State of Santa Catarina, Southern Brazil, who was born preterm by Cesarean-section, weighing 1,655 g, and stayed in the neonatal intensive care unit for 20 days. At four months of age, the child started presenting blood in stools and the possibility of cow's milk protein allergy was considered, given the symptoms and the use of infant formula in his 1st semester of life, which was then replaced by infant formula with hydrolyzed protein. White blood cell count and a parasitological stool sample were requested. Both tested positive and the stool ova and parasite examination showed a rhabditoid larva of S. stercoralis. The clinician maintained the initial hypothesis and diet, but requested three new stool samples, which tested positive for rhabditoid larvae of S. stercoralis. Since the child presented abdominal pain and vomiting, and there was still blood in stools, treatment with thiabendazole was initiated twice a day for two days. Treatment was repeated after seven days along with a new parasitological examination, which was then negative. Comments: Although strongyloidiasis is usually a mild parasitic infection, it may be severe and disseminated in immunocompromised patients. This agent must be considered in patients who live in endemic areas, and the diagnosis should be established by searching S. stercoralis larvae in tracheal secretions and in stools.

OCCASIONAL DIGESTIVE HEMORRHAGE IN CHILDREN DUE TO STRONGYLOIDIASIS: IMPORTANCE OF PARASITOLOGIC TESTING. / HEMORRAGIA DIGESTIVA OCASIONAL EM CRIANÇA POR ESTRONGILOIDÍASE: IMPORTÂNCIA DO EXAME PARASITOLÓGICO.

OBJECTIVE: To describe an uncommon case of infection by Strongyloides stercoralis (S. stercoralis) in a 4-month-old child and to highlight the importance of early diagnosis. CASE DESCRIPTION: The patient was a male child from the city of Videira, State of Santa Catarina, Southern Brazil, who was born preterm by Cesarean-section, weighing 1,655 g, and stayed in the neonatal intensive care unit for 20 days. At four months of age, the child started presenting blood in stools and the possibility of cow's milk protein allergy was considered, given the symptoms and the use of infant formula in his 1st semester of life, which was then replaced by infant formula with hydrolyzed protein. White blood cell count and a parasitological stool sample were requested. Both tested positive and the stool ova and parasite examination showed a rhabditoid larva of S. stercoralis. The clinician maintained the initial hypothesis and diet, but requested three new stool samples, which tested positive for rhabditoid larvae of S. stercoralis. Since the child presented abdominal pain and vomiting, and there was still blood in stools, treatment with thiabendazole was initiated twice a day for two days. Treatment was repeated after seven days along with a new parasitological examination, which was then negative. COMMENTS: Although strongyloidiasis is usually a mild parasitic infection, it may be severe and disseminated in immunocompromised patients. This agent must be considered in patients who live in endemic areas, and the diagnosis should be established by searching S. stercoralis larvae in tracheal secretions and in stools.

OBJETIVO: Descrever um caso incomum de infecção por Strongyloides stercoralis (S. stercoralis) em paciente de quatro meses de idade e ressaltar a importância do diagnóstico precoce. DESCRIÇÃO DO CASO: Paciente masculino, procedente e residente de Videira, Santa Catarina, Brasil, nasceu pré-termo, parto cesárea, peso de nascimento 1.655 g, e permaneceu na Unidade de Terapia Intensiva neonatal e intermediária por 20 dias. Aos quatro meses de idade, começou a evacuar fezes sanguinolentas e foi feita hipótese de alergia à proteína do leite de vaca, em razão da sintomatologia e do uso da fórmula infantil para o primeiro semestre, para o qual foi indicada a substituição por fórmula infantil com proteína hidrolisada. Foram solicitados a pesquisa de leucócitos e o exame parasitológico das fezes). Ambos se mostraram positivos e o parasitológico revelou a presença de larva rabditoide de S. stercoralis. O clínico manteve a hipótese inicial e a dieta, mas solicitou a coleta de três amostras de fezes, que resultaram em uma amostra para larvas rabditoide, em muda, de S. stercoralis. Como a criança apresentava dor abdominal, vômito e as fezes permaneciam sanguinolentas, foi iniciado o tratamento com tiabendazol - duas vezes/dia por dois dias -, repetido após sete dias, e, em seguida, realizado o exame parasitológico de fezes, tendo sido negativo. COMENTÁRIOS: A estrongiloidíase, apesar de ser uma infecção parasitária frequentemente leve, em pacientes imunocomprometidos pode se apresentar de forma grave e disseminada. Deve-se suspeitar desse agente em pacientes que vivem em áreas endêmicas, sendo o diagnóstico estabelecido por meio da pesquisa das larvas do S. stercoralis na secreção traqueal e nas fezes.

IgG reactivity with 40-35 kDa soluble and membrane antigen of Strongyloides venezuelensis in immunocompromised patients.

Immunocompromised patients constitute a risk group for the development of severe clinical forms of human strongyloidiasis. The diagnosis of this infection is primarily performed by parasitological techniques, but with low sensitivity. Serological techniques appear as an alternative, especially with heterologous antigens use. The aim of this study was to perform the Western blot technique by using S. venezuelensis infective third stage larva (iL3) soluble (TS) and membrane (TM) saline antigens to reveal immunoreactive bands in immunocompromised patients with strongyloidiasis. Serum samples from 117 parasitologically well-characterized patients were divided into four groups: S. stercoralis positive and immunocompetent (S + IC); S. stercoralis positive and immunocompromised (S + IP); negative and immunocompetent (S-IC); negative and immunocompromised (S-IP). A 40-35 kDa band was recognized by 100% of patients in the S + IC group in both antigenic fractions, and by 62.5% and 50% in the S + IP group using the TS and TM fractions, respectively. A 29 kDa band was recognized by 86.3% and 72.7% (for TS and TM, respectively) of patients in the S + IC group, and only by 12.5% of patients in the S + IP group on the TM antigen. Regardless of the patients' immunological condition, the 40-35 kDa band from S. venezuelensis was detected more frequently and can be used as an important marker to the immunodiagnosis of human strongyloidiasis.

DIAGNOSIS OF Strongyloides stercoralis INFECTION IN IMMUNOCOMPROMISED PATIENTS BY SEROLOGICAL AND MOLECULAR METHODS.

Strongyloidiasis is a potentially serious infection in immunocompromised patients. Thus, the availability of sensitive and specific diagnostic methods is desirable, especially in the context of immunosuppressed patients in whom the diagnosis and treatment of strongyloidiasis is of utmost importance. In this study, serological and molecular tools were used to diagnose Strongyloides stercoralis infections in immunosuppressed patients. Serum and stool samples were obtained from 52 patients. Stool samples were first analyzed by Lutz, Rugai, and Agar plate culture methods, and then by a quantitative real time polymerase chain reaction (qPCR). Serum samples were evaluated by an enzyme-linked immunosorbent assay (ELISA) using a soluble (AS) or a membrane fractions antigen (AM) obtained from alkaline solutions of the filariform larvae of Strongyloides venezuelensis. Of the 52 immunosuppressed patients, three (5.8%) were positive for S. stercoralis by parasitological methods, compared to two patients (3.8%) and one patient (1.9%) who were detected by ELISA using the AS and the AM antigens, respectively. S. stercoralis DNA was amplified in seven (13.5%) stool samples by qPCR. These results suggest the utility of qPCR as an alternative diagnostic tool for the diagnosis of S. stercoralis infection in immunocompromised patients, considering the possible severity of this helminthiasis in this group of patients.

IMMUNODIAGNOSIS OF HUMAN STRONGYLOIDIASIS: USE OF SIX DIFFERENT ANTIGENIC FRACTIONS FROM Strongyloides venezuelensis PARASITIC FEMALES.

The aim of this study was to evaluate six different antigenic fractions from Strongyloides venezuelensis parasitic females for the immunodiagnosis of human strongyloidiasis. Soluble and membrane fractions from S. venezuelensis parasitic females were prepared in phosphate-buffered saline (SSF and SMF, respectively), Tris-HCl (TSF and TMF, respectively), and an alkaline buffer (ASF and AMF, respectively). Serum samples obtained from patients with strongyloidiasis or, other parasitic diseases, and healthy individuals were analyzed by enzyme-linked immunosorbent assay (ELISA). Soluble fractions SSF, TSF, and ASF showed 85.0%, 75.0%, and 80.0% sensitivity and 93.1%, 93.1%, and 87.5% specificity, respectively. Membrane fractions SMF, TMF, and AMF showed 80.0%, 75.0%, and 85.0% sensitivity, and 95.8%, 90.3%, and 91.7% specificity, respectively. In conclusion, the present results suggest that the fractions obtained from parasitic females, especially the SSF and SMF, could be used as alternative antigen sources in the serodiagnosis of human strongyloidiasis.

Comparative Study of the Accuracy of Different Techniques for the Laboratory Diagnosis of Schistosomiasis Mansoni in Areas of Low Endemicity in Barra Mansa City, Rio de Janeiro State, Brazil.

Schistosomiasis constitutes a major public health problem, with an estimated 200 million people infected worldwide. Many areas of Brazil show low endemicity of schistosomiasis, and the current standard parasitological techniques are not sufficiently sensitive to detect the low-level helminth infections common in areas of low endemicity (ALEs). This study compared the Kato-Katz (KK); Hoffman, Pons, and Janer (HH); enzyme-linked immunosorbent assay- (ELISA-) IgG and ELISA-IgM; indirect immunofluorescence technique (IFT-IgM); and qPCR techniques for schistosomiasis detection in serum and fecal samples, using the circumoval precipitin test (COPT) as reference. An epidemiological survey was conducted in a randomized sample of residents from five neighborhoods of Barra Mansa, RJ, with 610 fecal and 612 serum samples. ELISA-IgM (21.4%) showed the highest positivity and HH and KK techniques were the least sensitive (0.8%). All techniques except qPCR-serum showed high accuracy (82-95.5%), differed significantly from COPT in positivity (P < 0.05), and showed poor agreement with COPT. Medium agreement was seen with ELISA-IgG (Kappa = 0.377) and IFA (Kappa = 0.347). Parasitological techniques showed much lower positivity rates than those by other techniques. We suggest the possibility of using a combination of laboratory tools for the diagnosis of schistosomiasis in ALEs.

Evaluation of real-time PCR assay to detect Schistosoma mansoni infections in a low endemic setting.

BACKGROUND: Schistosomiasis constitutes a major public health problem, and 200 million people are estimated to be infected with schistosomiasis worldwide. In Brazil, schistosomiasis has been reported in 19 states, showing areas of high and medium endemicity and a wide range of areas of low endemicity (ALE). Barra Mansa in Rio de Janeiro state has an estimated prevalence of 1%. ALE represent a new challenge for the helminth control because about 75% of infected individuals are asymptomatic and infections occur with a low parasite load (<100 eggs per gram of feces), causing a decrease in sensitivity of stool parasitological techniques, which are a reference for the laboratory diagnosis of this helminth. The objective of this study was to evaluate the performance of a TaqMan quantitative polymerase chain reaction (qPCR) technique in serum and feces DNA samples using the techniques of Kato-Katz (KK), Hoffman, Pons and Janer (HH) as references, during an epidemiological survey using fecal samples and sera from randomized residents from an ALE. METHODS: A cross-sectional study conducted from April to December 2011 using a probabilistic sampling that collected 572 fecal and serum samples. The laboratory diagnostic techniques used were: KK, HH and qPCR (feces and serum). RESULTS: We obtained the following results using the different diagnostic techniques: KK and HH, 0.9% (n =5); qPCR-feces, 9.6% (n =55); and qPCR-serum, 1.4% (n =8). The qPCR-feces presented the highest positivity, whereas the techniques of HH and KK were the least sensitive to detect infections (0.8%). Compared to HH and KK, qPCR-feces showed a statistically significant difference in positivity (p <0.05), although with poor agreement. CONCLUSION: The positivity rate presented by the qPCR approach was far higher than that obtained by parasitological techniques. The lack of adequate surveillance in ALE of schistosomiasis indicates a high possibility of these areas being actually of medium and high endemicity. This study presents a control perspective, pointing to the possibility of using combined laboratory tools in the diagnosis of schistosomiasis in ALE.

Detection of Schistosoma mansoni antibodies in a low-endemicity area using indirect immunofluorescence and circumoval precipitin test.

Parasitological diagnostic methods for schistosomiasis lack sensitivity, especially in regions of low endemicity. The objective of this study was to determine the prevalence of Schistosoma mansoni infections by antibody detection using the indirect immunofluorescence assay (IFA-IgM) and circumoval precipitin test (COPT). Serum samples of 572 individuals were randomly selected. The IFA-IgM and COPT were used to detect anti-S. mansoni antibodies. Of the patients studied, 15.9% (N = 91) were IFA-IgM positive and 5.1% (N = 29) had COPT reactions (P < 0.001 by McNemar's test). Immunodiagnostic techniques showed higher infection prevalence than had been previously estimated. This study suggests that combined use of these diagnostic tools could be useful for the diagnosis of schistosomiasis in epidemiological studies in areas of low endemicity.

Microsporidiosis in a Brazilian University Hospital: case report

This is the report on a patient with chronic diarrhea caused by microsporidia. He is married, infected with HIV and has low CD4 cell count. The diagnosis was established through stool parasite search using concentration methods and Gram - chromotrope staining technique. Ileum biopsy was also performed in this case. The etiological diagnosis may be established in a clinical laboratory, by chromotrope staining technique in routine microscopic examination of stool specimens.

Este é o relato de caso de doente com diarréia crônica causada por Microsporidia. O doente era homem, casado, infectado com HIV e tinha baixa taxa de linfócitos CD4+. O diagnóstico foi feito em exame de fezes utilizando métodos de concentração e técnica de coloração de Gram-Chromotrope. Biópsia de íleo também foi realizada neste caso. O diagnóstico etiológico pode ser feito em laboratório clínico, por técnicas de coloração baseada em cromotrope na rotina da observação microscópica direta.

Microsporidiosis in a Brazilian University Hospital: case report.

This is the report on a patient with chronic diarrhea caused by microsporidia. He is married, infected with HIV and has low CD4 cell count. The diagnosis was established through stool parasite search using concentration methods and Gram-chromotrope staining technique. Ileum biopsy was also performed in this case. The etiological diagnosis may be established in a clinical laboratory, by chromotrope staining technique in routine microscopic examination of stool specimens.

Retrospective study of the occurrence of Cyclospora cayetanensis at Clinical Hospital of the University of São Paulo Medical School, SP.

Cyclospora cayetanensis causes watery diarrhea in tropical countries, among travelers and after ingestion of contaminated water and food. Very little is known about its epidemiology, pathogenic aspects and reservoirs. In Brazil, its prevalence is unknown and to date there have been reports of three outbreaks. We report here a retrospective study of 5,015 stool samples from 4,869 patients attended at Clinical Hospital of the University of São Paulo Medical School, SP, Brazil between April 1996 and January 2002, with 14 cases of Cyclospora cayetanensis being detected there was a prevalence of 0.3%. Of the 14 infected patients, the mean age was 38 years and 71.4% were female. Ten patients presented symptoms; six presented levels of immunological markers and five patients were immunodeficient.

Retrospective study of the occurrence of Cyclospora cayetanensis at Clinical Hospital of the University of São Paulo Medical School, SP

Cyclospora cayetanensis causa diarréia líquida em países tropicais, viajantes e após ingestão de água e alimentos contaminados. Muito pouco é conhecido sobre sua epidemiologia, aspectos patogênicos e reservatórios. No Brasil, sua prevalência é desconhecida com relato de três surtos. Nós relatamos um estudo retrospectivo de 5.015 amostras fecais provenientes de 4.869 pacientes atendidos no Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, SP, Brasil entre abril de 1996 e janeiro de 2002 com detecção de 14 casos de ciclosporíase e prevalência de 0,3%. Deste total 71,4% eram do sexo feminino com idade média de 38 anos. Dez apresentaram sintomatologia, seis tinham níveis de marcadores imunológicos e cinco imunodeficiência.

Pesquisa de ovos "pesados" de helmintos nas fezes: estudo comparativo entre os métodos da sedimentaçäo espontânea em água e de Ritchie / Research of helminth heavy eggs in feces: comparative study between spontaneous sedimentation in water and Ritchie's methods

Com a finalidade de melhor conhecer a sensibilidade do método de Ritchie (centrifugo-sedimentaçäo em formol-éter), quanto ao diagnóstico de parasitoses intestinais pelo exame das fezes, foi investigada a capacidade dele no sentido de detectar ovos "pesados" de helmintos (Schistosoma mansoni e Ascaris lumbricoides inférteis). Houve comparaçäo com o desempenho do processo da sedimentaçäo espontânea em água, usado com o mesmo intuito. Os resultados obtidos e a respectiva avaliaçäo estatística demonstraram que a técnica da sedimentaçäo espontânea em água é mais eficiente, tendo sido analisadas 300 amostras de fezes, metade das quais certamente contendo os dois tipos de ovos citados e a outra parte considerada em trabalho laboratorial rotineiro