Ariella Andrade Marchioro

Association between contamination of public squares and seropositivity for Toxocara spp. in children.

A concomitant study was carried out, of the association of positive serology for Toxocara spp. in 90 children who played in public squares used for leisure, with the frequency with which each child used these areas, and the presence of eggs of Toxocara spp. in the sand or grass in these locations. The sand and grass of their peridomiciles and school playgrounds, as well as the feces of their dogs were also analyzed for Toxocara. Serum samples were tested for IgG antibodies to Toxocara canis excreted-secreted larval antigens by ELISA, and blood samples for eosinophilia. The water-sedimentation technique was used to evaluate the presence of parasite eggs in the sand and grass turfs, and in feces of the dogs that also frequented these locations. 16/90 (17.8%) of the children were seropositive for Toxocara spp. There was a positive association between seropositivity in children who played in the public squares six or seven times a week, with a parasite load above 1.1 eggs/g of sand, as well as with contamination of the peridomicile, even at less than 1.0 egg/g of sand. Eosinophilia, the habit of geophagy, age from one to four years, and the presence of parasitized pet dogs were also positively correlated with seropositivity in the children. Eggs were found in 15/15 (100%) of the public squares, 17/90 (18.9%) of the peridomiciles, 3/13 (23.1%) of the schools, and 12/41 (29.3%) of the dogs living in the peridomiciles investigated.

Toxocariasis in children attending a Public Health Service Pneumology Unit in Paraná State, Brazil

The enzyme-linked immunosorbent assay (ELISA) is the most widely used tool to detect anti-Toxocara IgG antibodies for both serodiagnostic and seroepidemiological surveys on human toxocariasis. In the last eight years a high prevalence of toxocariasis (32.2-56.0%) has been reported in children attending public health units from municipalities in the state of Paraná, Brazil. Therefore, the aim of this work was to compare the frequency found among the general child population with that of children attending a public pneumology service in Maringá, Paraná, Brazil and describe the laboratorial, clinical and epidemiological findings. The research was conducted at the Consórcio Público Intermunicipal de Saúde do Setentrião Paranaense (CISAMUSEP) from July 2009 to July 2010 among children aged between one and 15 years. From a total of 167 children studied, only 4.2% (7/167) tested positive for anti-Toxocara spp. IgG antibodies and presented mild eosinophilia (2/7), increased serum IgE levels (6/7) and a positive allergy test for mites (5/7). The presence of pets (dogs or cats) at home did not correlate with the seroprevalence. In conclusion, cases of toxocariasis involving the respiratory tract are rare in children attending a public health pneumology unit in the northwestern region of Paraná State, despite the high prevalence of this type of toxocariasis among the infantile population attending Basic Health Units in the same geographical area.

Avaliação eosinofílica e soropositividade para anticorpos IgG anti-toxocara em crianças atendidas pelo Sistema Único de Saúde

Objective: To study the association between the presence of eosinophilia and IgG antibodies to Toxocara spp. in children assisted by the public health service, in the northwestern region of Parana State, in southern Brazil. Methods: A retrospective study of children aged seven months to 12 years old assisted by the Public Health Service in northwest state of Parana, Brazil. ELISA test was performed in all children in order to detect IgG antibodies to Toxocara spp. and eosinophil amounts (eosinophilia ≥ 600 cells/mm3). Results: Among 1,199 screened children, 386 (32.2%) had IgG antibodies to Toxocara spp. The seroprevalence of Toxocara spp. and the eosinophilia were more common among children of seven months to five years old. Eosinophilia was observed in 7.8% of seropositive patients to Toxocara spp. Conclusions: There was a high prevalence of anti-Toxocara spp., mainly in children under five years old. With the Endereco para correspondencia: Ana Lucia F. Guilherme Avenida Colombo, 5.790,Bloco I-90, sala 11 CEP 87020-900 – Maringa/PR E-mail: alfguilherme@uem.br Fonte financiadora: Fundo Parana, o qual apoiou com verba a aquisicao de equipamentos e material de consumo para o projeto. Conflito de interesse: nada a declarar Recebido em: 16/10/2009 Aprovado em: 11/6/2010 Rev Paul Pediatr 2011;29(1):80-4. Artigo Original

Identification of public areas with potential toxocariasis transmission risk using Geographical Information Systems

Geographic information system (GIS) or Health geography is a geographical identification of the spatial variation of contagion disease and zoonosis risk in certain conditions.ObjectiveComparing the variation of environmental contamination of Toxocara spp. sands of lawns and public areas through the Geographic Information System.Materials and MethodsWere investigated 98% of Parana recreational urban areas such as, schools, public parks and squares filled with sand and/or lawn. Samples were analyzed using zinc sulphate solution centrifuge-flotation, density 1.420, and water sedimentation. Maps were developed by ESRI Arc GIS 9.2.ResultsTotal 77/98 (78,6%) of public spaces shown Toxocara spp. eggs presence. No significant difference was observed (p = 0,9999) between eggs prevalence in sand 44/56 (78,6%), and lawn 33/42 (78,6%), at school (p = 0,6898) and squares (p = 0,0616). Egg contamination prevailed in periphery areas in the sand 20/27 (74%) and lawn 18/21 (86%). However, no significant difference was observed between sand and lawn contamination from schools and parks to central and peripheral areas. Although schools 62/66 (93,9%) presented a higher number of enclosed spaces, did not provide a lower frequency of pollution (p = 0,3327).ConclusionGIS observed a scattered pattern of zoonosis among schools and public squares sand and lawns, with predominance of contamination in the peripheral areas with presence of dogs/cats.

Association between seropositivity for Toxoplasma gondii, scholastic development of children and risk factors for T. gondii infection

BACKGROUND We evaluated the possible association of seropositivity for Toxoplasma gondii and certain risk factors for T. gondii infection with the scholastic development of children. METHOD One hundred children aged 6-13 years attending the Hospital Municipal de Maringá Paranáa, Brazil, participated in the study. Serologic tests for IgG and IgM anti-T. gondii (indirect immunofluorescence (capture ELISA) were performed. The Scholastic Performance Test (SPT) for writing, mathematics and reading was applied to each child, and the result was classified as high, average or poor. The guardian of each child responded to a questionnaire about certain aspects of the childs living situation and diet. RESULTS The prevalence of seropositivity for T. gondii was 8%. An association between seropositivity for T. gondii and scholastic development in the mathematics subtest and also consumption of fresh cheese were observed. Children with exposed soil, sand or grass lawn in their peridomicile were 9.116 times more likely to be infected by T. gondii. CONCLUSION The findings showed the need to test school-age children for this parasite, educate families with T. gondii-positive children, provide training to educators, monitor recreation areas, and raise awareness of the need for care in handling food.

Association of Cytokines in Individuals Sensitive and Insensitive to Dust Mites in a Brazilian Population

Introduction Allergic reaction to dust mites is a relatively common condition among children, triggering cutaneous and respiratory responses that have a great impact on the health of this population. Anaphylactic hypersensitivity is characterized by an exacerbated response involving the production of regulatory cytokines responsible for stimulating the production of IgE antibodies. Objective To investigate an association of variants in cytokine genes (IL1A −889, IL1B −511, +3962, IL1R 1970, IL1RA 11100, IL4RA +1902, IL12 −1188, IFNG +874, TGFB1 codon 10, codon 25, TNFA −308, −238, IL2 −330, +166, IL4 −1098, −590, −33, IL6 −174, nt565, and IL10 −1082, −819, −592) between patients sensitive to dust mites and a control group. Methods A total of 254 patients were grouped as atopic and non-atopic according to sensitivity as evaluated by the Prick Test and to cytokine genotyping by the polymerase chain reaction-sequence specific primers (PCR-SSP) method using the Cytokine Genotyping Kit. Results A comparison between individuals allergic to Dermatophagoides farinae, Dermatophagoides pteronyssinus, and Blomia tropicalis and a non-atopic control group showed significant differences between allele and genotype frequencies in the regulatory regions of cytokine genes, with important evidence for IL4 −590 in T/C (10.2% vs. 43.1%, odd ratio [OR] = 0.15, p = 5.2 10−8, pc = 0.0000011, and 95% confidence interval [95%CI] = 0.07–0.32) and T/T genotypes (42.9% vs. 13.8%, OR = 4.69, p = 2.5 10−6, pc = 0.000055, and 95%CI = 2.42–9.09). Other associations were observed in the pro-inflammatory cytokines IL1A −889 (T/T, C, and T) and IL2 −330 (G/T and T/T) and the anti-inflammatory cytokines IL4RA +1902 (A and G), IL4 −590 (T/C, T/T, C, and T), and IL10 −592 (A/A, C/A, A, and C). Conclusion Our results suggest a possible association between single nucleotide polymorphisms (SNPs) in cytokine genes and hypersensitivity to dust mites.

Predominance of Giardia duodenalis Assemblage AII in Fresh Leafy Vegetables from a Market in Southern Brazil.

We investigated the presence of Giardia duodenalis cysts and its genotypes in raw leafy vegetables sold in a Brazilian market. These products are different from those sold in most street markets because the producers themselves display and sell their products and rely on specialized technical and sanitary assistance. Vegetable and water samples were collected from 14 (80%) producers who cultivated vegetables that are typically consumed raw for sale at the market, obtained at the market and farms, respectively. A total of 128 samples of leafy greens (chives, parsley, cabbage, arugula, watercress, and chicory) and 14 water samples were analyzed by direct immunofluorescence and PCR techniques. The positive samples were genotyped (GHD gene) using PCR and restriction fragment length polymorphism. The analyses indicated that 16 (12.5%) of 128 samples were positive by PCR, while 1 (0.8%) of 128 samples were positive by immunofluorescence. Giardia cysts were not detected in the water samples obtained at the farms. The molecular technique revealed a genotype with zoonotic potential, which underscores the challenge in the control of giardiasis dissemination via the consumption of raw vegetables.

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.

Eosinophilic count and seropositivity for IgG antibodies to toxocara spp. in children assisted at the public health service

Objective: To study the association between the presence of eosinophilia and IgG antibodies to Toxocara spp. in children assisted by the public health service, in the northwestern region of Parana State, in southern Brazil. Methods: A retrospective study of children aged seven months to 12 years old assisted by the Public Health Service in northwest state of Parana, Brazil. ELISA test was performed in all children in order to detect IgG antibodies to Toxocara spp. and eosinophil amounts (eosinophilia ≥ 600 cells/mm3). Results: Among 1,199 screened children, 386 (32.2%) had IgG antibodies to Toxocara spp. The seroprevalence of Toxocara spp. and the eosinophilia were more common among children of seven months to five years old. Eosinophilia was observed in 7.8% of seropositive patients to Toxocara spp. Conclusions: There was a high prevalence of anti-Toxocara spp., mainly in children under five years old. With the Endereco para correspondencia: Ana Lucia F. Guilherme Avenida Colombo, 5.790,Bloco I-90, sala 11 CEP 87020-900 – Maringa/PR E-mail: alfguilherme@uem.br Fonte financiadora: Fundo Parana, o qual apoiou com verba a aquisicao de equipamentos e material de consumo para o projeto. Conflito de interesse: nada a declarar Recebido em: 16/10/2009 Aprovado em: 11/6/2010 Rev Paul Pediatr 2011;29(1):80-4. Artigo Original

Spontaneous abortion and ocular toxoplasmosis in a couple infected with Toxoplasma gondii

Aims: To report the cases of wife and husband with toxoplasmosis. The woman acquired the infection during pregnancy while her husband was diagnosed with ocular toxoplasmosis 15 years later. Cases report: A woman with twin pregnancy, living in southern Brazil, was seronegative for Toxoplasma gondii IgG and IgM antibodies in the first month of gestation. Seroconversion (positive T. gondii IgM and IgG antibodies) occurred in the seventh week of gestation, resulting in spontaneous abortion. Fifteen years later, her husband presented with eye irritation and blurred vision. The funduscopic examination revealed typical lesions of recurrent chorioretinitis in the right eye. The serological tests were positive for T. gondii IgG and negative for IgM. Conclusions: This report of a couple with important clinical outcomes of two different types of toxoplasmosis underscores the importance of this disease which, in its various manifestations, may have serious consequences for a familys life.