Dina Lúcia Morais Falavigna

Frequency of toxocara infection in children attended by the health public service of Maringá, south Brazil

The lack of specific laboratorial diagnosis methods and precise symptoms makes the toxocariasis a neglected disease in Public Health Services. This study aims to determine the frequency of Toxocara spp. infection in children attended by the Health Public Service of Hospital Municipal de Maringá, South Brazil. To evaluate the association of epidemiological and clinical data, an observational and cross-section study was carried out. From 14,690 attended children/year aged from seven month to 12 years old, 450 serum samples were randomly collected from September/2004 to September/2005. A questionnaire was used to evaluate epidemiological, clinical and hematological data. An ELISA using Toxocara canis larval excretory-secretory products as antigen detected 130 (28.8%) positive sera, mainly between children from seven month to five years old (p = 0.0016). Significant correlation was observed between positive serology for Toxocara, and frequent playing in sandbox at school or daycare center (p = 0.011) and the presence of a cat at home (p = 0.056). From the families, 50% were dog owners which exposed soil backyards. Eosinophilia (p = 0.776), and signs and symptoms analyzed (fever p = 0.992, pneumonia p = 0.289, cold-like symptoms p = 0.277, cough p = 0.783, gastrointestinal problems p = 0.877, migraine p = 0.979, abdominal pain p = 0.965, joint pain p = 0.686 and skin rash p = 0.105) could not be related to the presence of anti-Toxocara antibodies. Therefore, two asthmatics children showed titles of 1:10,240 and accentuated eosinophilia (p = 0.0001). The authors emphasize the needs of prevention activities.

Prevalência de enteroparasitas em horticultores e hortaliças da Feira do Produtor de Maringá, Paraná

Few studies have assessed the contamination of vegetables at Brazilian production sites. From April 1996 to December of 1997, the sanitary conditions of raw consumed vegetables sold in the Feira do Produtor de Maringá were investigated. We based the analyses on the contamination of vegetables, of the producers (stool samples and material under the fingernails) and of the water used for irrigation. It was observed that 16.6% of 144 samples of five different types of vegetables were contaminated with intestinal parasites. Forty three of 163 individuals (26%) were infected with one or more parasites. Only three of the 49 samples of material under the fingernails analyzed were positive for intestinal parasites. Analysis of samples of the water used for vegetable irrigation showed that the water did not satisfy bacteriological standards of potability. We conclude that in the investigated area the contamination of vegetables occurred during the production phase and that a sanitary education campaign directed at the producers is needed.Few studies have assessed the contamination of vegetables at Brazilian production sites. From April 1996 to December of 1997, the sanitary conditions of raw consumed vegetables sold in the Feira do Produtor de Maringá were investigated. We based the analyses on the contamination of vegetables, of the producers (stool samples and material under the fingernails) and of the water used for irrigation. It was observed that 16.6% of 144 samples of five different types of vegetables were contaminated with intestinal parasites. Forty three of 163 individuals (26%) were infected with one or more parasites. Only three of the 49 samples of material under the fingernails analyzed were positive for intestinal parasites. Analysis of samples of the water used for vegetable irrigation showed that the water did not satisfy bacteriological standards of potability. We conclude that in the investigated area the contamination of vegetables occurred during the production phase and that a sanitary education campaign directed at the producers is needed. Key-words: Intestinal parasites. Vegetables. Vegetable producers. Deposit under the fingernails. Ana Lucia Falavigna Guilherme, Silvana Marques de Araújo, Dina Lúcia Morais Falavigna, Áurea Regina Teles Pupulim, Maria Luiza G. Goulart Dias, Henrique Sérgio de Oliveira, Elisângela Maroco e Yoshiaki Fukushigue Prevalence of intestinal parasites in horticulturists and vegetables from Feira do Produtor de Maringá, Paraná, BrazilFew studies have assessed the contamination of vegetables at Brazilian production sites. From April 1996 to December of 1997, the sanitary conditions of raw consumed vegetables sold in the Feira do Produtor de Maringa were investigated. We based the analyses on the contamination of vegetables, of the producers (stool samples and material under the fingernails) and of the water used for irrigation. It was observed that 16.6% of 144 samples of five different types of vegetables were contaminated with intestinal parasites. Forty three of 163 individuals (26%) were infected with one or more parasites. Only three of the 49 samples of material under the fingernails analyzed were positive for intestinal parasites. Analysis of samples of the water used for vegetable irrigation showed that the water did not satisfy bacteriological standards of potability. We conclude that in the investigated area the contamination of vegetables occurred during the production phase and that a sanitary education campaign directed at the producers is needed.

Serological, clinical and epidemiological evaluation of toxocariasis in urban areas of south Brazil

Toxocariasis is a worldwide public-health problem that poses major risks to children who may accidentally ingest embryonated eggs of Toxocara. The objectives of this study were to investigate the occurrence of anti-Toxocara spp. antibodies in children and adolescents and the variables that may be involved, as well as environmental contamination by Toxocara spp. eggs, in urban recreation areas of north central mesoregion, Paraná State, Brazil. From June 2005 to March 2007. a total of 376 blood samples were collected by the Public Health Service from children and adolescents one to 12 years old, of both genders. Samples were analyzed by the indirect ELISA method for detection of anti-Toxocara antibodies. Serum samples were previously absorbed with Ascaris suum antigens, and considered positive with a reagent reactivity index >1. Soil samples from all of the public squares and schools located in the four evaluated municipalities that had sand surfaces (n = 19) or lawns (n = 15) were analyzed. Of the 376 serum samples, 194 (51.6%) were positive. The seroprevalence rate was substantially higher among children aging one to five years (p = 0.001) and six to eight years (p = 0.022). The clinical signs and symptoms investigated did not show a statistical difference between seropositive and seronegative individuals (p > 0.05). In 76.5% of the investigated recreation places, eggs of Toxocara were detected in at least one of the five collected samples. Recreation areas from public schools were 2.8 times more contaminated than from public squares. It is important to institute educational programs to inform families and educators, as well as to improve sanitary control of animals and cleaning of the areas intended for recreation in order to prevent toxocariasis.

Blastocystis sp. and other intestinal parasites in hemodialysis patients

Chronic renal insufficiency disease (CRI) leads to uremia in hemodialysis patients and induces a state of immunodepression that results in higher frequencies of infections and diarrhea. Hemodialysis patients resident in the city of Campo Mourão, Paraná, Brazil were analyzed from April 2006 through September 2007 for Blastocystis sp. and other intestinal parasites and for associated diarrhea. Fecal samples from 86 hemodialysis patients and 146 healthy (reference) persons were examined by standard methods for detecting ova, larvae and cysts, which included preservation in 10% formalin and the Kinyoun method. Thirty-three hemodialysis patients (45.1%) and 36 reference individuals (25.7%) were found to be parasitized. The differences in the percentages of parasitism and polyparasitism between the reference group and the chronic renal patients was significant (p= 0.0318 and 0.0019, respectively). Blastocystis sp. (18%-20.1%), Endolimax nana (14%-16.3%), Cryptosporidium sp. (4%-4.7%) and Entamoeba coli (4%-4.7%) were the most frequent protozoa found in the hemodialysis patients. Parasitism was not significantly associated with diarrhea (p=0.9947) or with decreased white blood cell counts (p=0.7046) in these individuals. Because parasitic infections may be an important comorbidity factor in hemodialysis patients, we suggest that parasitological stool examinations, especially for Blastocystis sp. and Cryptosporidium sp., be included in routine medical follow-up examinations of these patients.

Suspected acute toxoplasmosis in pregnant women

OBJECTIVE To determine the prevalence of reagent serology for suspected acute toxoplasmosis in pregnant women and to describe clinical, laboratory and therapeutic profiles of mothers and their children. METHODS A retrospective study was conducted with IgM-anti-Toxoplasma gondii-reagent pregnant women and their children who attended the public health system in the state of Paraná, Southern Brazil, from January 2001 to December 2003. Information were obtained from clinical, laboratory (ELISA IgM/IgG) and ultrasonographic data and from interviews with the mothers. To test the homogeneity of the IgM indices in relation to the treatment used, the Pearsons Chi-square test was applied. Comparisons were considered significant at a 5% level. RESULTS Two hundred and ninety (1.0%) cases of suspected IgM-reagent infection were documented, with a prevalence of 10.7 IgM-reagent women per 1,000 births. Prenatal care started within the first 12 weeks for 214/290; 146/204 were asymptomatic. Frequent complaints included headaches, visual disturbance and myalgia. Ultrasonography revealed abnormalities in 13 of 204 pregnancies. Chemoprophylaxis was administered to 112/227; a single ELISA test supported most decisions to begin treatment. Pregnant women with IgM indices =2.000 tended to be treated more often. Among exposed children, 44/208 were serologically followed up and all were IgG-reagent, and three IgM-reagent cases showed clinical symptoms. CONCLUSIONS The existence of pregnant women with laboratorially suspected acute toxoplasmosis who were not properly followed up, and of fetuses that were not adequately monitored, shows that basic aspects of the prenatal care are not being systematically observed. There is need of implementing a surveillance system of pregnant women and their children exposed to T. gondii.

Enteroparasitosis and their ethnographic relationship to food handlers in a tourist and economic center in Paraná, Southern Brazil

This study reports on the occurrence of enteroparasites based on data from an ethnographic study of food handlers in the city of Cascavel, Paraná, Brazil. Fecal material from 343 food handlers of both sexes, between 14 and 75 years of age, was analyzed using Lutz, modified Ritchie and Ziehl-Neelsen techniques. Ethnographic relationships were investigated by means of specific questionnaires. Positive fecal samples were found for 131 (38.2%) handlers. Endolimax nana (67.9%) was the predominant species, followed by Entamoeba coli (35.9%), Blastocystis hominis (28.2%), Entamoeba histolytica/dispar (10.1%) and Giardia duodenalis (8.4%). Protozoan infections were more common than helminth infections (p = 0.00). The positive results for some parasites were associated with the male sex, professional category, and the performance of other activities (p < 0.05). The high overall occurrence of enteroparasites found indicates improper hygiene and sanitation conditions. Effective educational measures should be implemented to prevent the transfer of pathogenic organisms to food via handling.

Monitoramento de gestantes com toxoplasmose em serviços públicos de saúde

The monitoring of 290 pregnant women with suspicion of acute toxoplasmosis attended by Public Health Services is discussed. In 69% a single test (Elisa-IgM) led to the treatment. Of 112 treated, the system did not offer any drug to 24%. In 12.1% there was a progressive increase of IgM and IgG. In 48.2% the treatment was begun thirty days after the laboratorial diagnosis.

Giardia Spp. and Cryptosporidium Spp. in the Ivaí Indigenous Land, Brazil

The objective of this study was to investigate the occurrence of cysts of Giardia spp. and oocysts of Cryptosporidium spp. in waters of the Ivaí Indigenous Land, Brazil. Samples of river and spring water and of treated water were filtered and analyzed by direct immunofluorescence (Merifluor kit, Meridian Bioscience, Cincinnati, Ohio). Of 21 samples, 7 from each locality, 3 (3/7, 42.8%) from a river were positive for Giardia (mean concentration 2.57 cysts/L), and 1 (1/7, 14.3%) was positive for Cryptosporidium (6 oocysts/L). From springs, 1 sample (1/7, 14.3%) was positive for Cryptosporidium (6 oocysts/L). One sample (1/7, 14.3%) from treated water was positive for both, with 4 oocysts/L and 2 cysts/L. Giardia was the more frequent protozoan present.

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.

Perfil clínico-epidemiológico de pacientes com neurocisticercose atendidos no Hospital Universitário Regional de Maringá, Paraná, Brasil

The aim of this study was to drawn an epidemiological and clinical profile of the neurocysticercosis (NCC) patients assisted by Hospital Universitario Regional de Maringa. A transversal, retrospective and descriptive study based on 6,100 records of the Neurology, Neuropediatry, Neurosurgery and Psychiatry clinics was done from January/1998 to December/2004. Of these, 48 were selected with diagnosis of NCC. The prevalence was greater in female (p<0.001), 31-60 years (43.7%), and urban zone (93.8%). The number of NCC cases overcame those notified to the Epidemic Surveillance in 1998, 1999, 2001, 2002 and 2004. The epilepsy due to NCC (CI=1.77;16.07; p=0.0024) was generalized and of late onset in 91.7% patients, being associated to headache in 37.5% ones. There was need of hospitalization in 22.9% of the patients (medium time of 3.91±3.35 days). It was concluded that the epidemiological and clinical profile observed is peculiar, displaying some common points with other Brazilian studies.