Enterobiasis and its risk factors in urban, rural and indigenous children of subtropical Argentina.

A cross-sectional survey to assess the prevalence of Enterobius vermicularis infection and its associated factors among the child population of infant, preschool and school age in the urban, rural and indigenous population of Iguazú city, in subtropical Argentina was presented. Additionally, the status of enterobiasis at country level was reviewed and analysed. Enterobius vermicularis presence was assessed employing an oviscopic serial sampling technique. Statistical analysis of socio-demographic determinants was performed by generalized linear mixed models at individual, household and community levels. Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines were used to gather national information about E. vermicularis prevalence spanning the decade 2010­2020. A total of 916 children from 470 families participated. Overall prevalence was 29.8%, with 25.3, 30.7 and 34.2% detected for children inhabiting urban, rural and indigenous villages, respectively. The multi-level analysis showed that the presence of E. vermicularis was mostly determined by individual (e.g. age, playing habits, previous pinworm infection) and household-level factors (e.g. family size, overcrowding conditions). Interestingly, WASH variables, such as waste disposal, analysed at community level were also important. Data were analysed to provide eco-epidemiological features of enterobiasis in a heterogeneous subtropical child population in the same territory but with different socio-sanitary realities. The importance of promoting multi-level actions against the determinants identified, to control this public health problem integratively was evidenced. The scoping review of national data updated the state of knowledge of this parasitosis, identifying risk determinants and gaps in knowledge at country level.

Giardia spp., the most ubiquitous protozoan parasite in Argentina: human, animal and environmental surveys reported in the last 40 years.

Giardia is a parasite distributed worldwide and one of the most prevalent intestinal protozoa in Argentina. We analysed all the national information regarding the prevalence of Giardia infections in humans, animals and environmental surveys over the last 40 years. In this work, we used Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines and the period between 1980 and 2019 was defined as time lapse for inclusion of the studies. The analysis was conducted using the LILACS, PubMed, Scopus and Argentina SciELO databases employing as keywords 'Giardia' AND 'Argentina'. We also carried out a manual review of papers. Of 304 articles, 92 fitted the eligibility criteria. Giardia was reported in 15 of the 23 Argentine provinces; human prevalence was between 3.4 and 64.8%. Indigenous children and residents in peri-urban areas had the higher infection rates. In animals, Giardia was identified mainly in dogs with a prevalence of 8.9 ± 7.0%, and studies of wild animals and cattle were notably scarce. Environmental studies showed that Giardia was detected in the soil and water which may act as reservoirs for this parasite revealing the need to modify the national water treatment legislation. The identification of Giardia genetic assemblages in the studies analysed was limited and showed that genotypes AII and B were found in humans while assemblage B was mainly detected in animals. This report provides useful information on epidemiological aspects of giardiasis in Argentina that may help to define future research priorities and provides useful tools for professionals regarding actual information on the prevalence of this infection.

Substantial reduction in child stunting is differentially associated to geographical and socioeconomic disparities in Misiones Province, Argentina.

OBJECTIVE: To estimate trends in the prevalence of child stunting in the population of children under 5 years of age covered by public health programmes, between 2009 and 2014 in Misiones, Argentina. METHODS: Using Bayesian model-based geostatistics, we evaluated 724 872 anthropometric measurements corresponding to 110 633 children. In order to identify disparities at local scale, we evaluated the hypotheses of a differential reduction of stunting according to the geographical location (at two-level spatial resolution) and to the socioeconomic level in a rural or urban environment. RESULTS: The prevalence of stunting had fallen significantly in the province overall. Sex and age defined gender disparities at individual level, and there were regional disparities with higher prevalence values in the north and northeast regions. In these areas, stunting decreased to a greater degree during the studied period, although the spatial pattern remained smoother. Stunting increased in peripheral urban and dispersed rural areas that are socioeconomically vulnerable. CONCLUSIONS: The spatial multi-level geostatistical estimates of child undernutrition provide a precision public health tool to target public policies to those populations with the greatest need, in order to reduce health disparities.

OBJECTIF: Estimer les tendances dans la prévalence du retard de croissance dans la population des enfants de moins de 5 ans couverts par les programmes de santé publique, entre 2009 et 2014 à Misiones, en Argentine. MÉTHODES: En utilisant la géostatistique basée sur un modèle bayésien, nous avons évalué 724.872 mesures anthropométriques correspondant à 110.633 enfants. Afin d'identifier les disparités à l'échelle locale, nous avons évalué les hypothèses d'une réduction différentielle du retard de croissance en fonction de la situation géographique (à une résolution spatiale à deux niveaux) et du niveau socioéconomique en milieu rural ou urbain. RÉSULTATS: La prévalence du retard de croissance avait considérablement diminué dans l'ensemble de la province. Le sexe et l'âge définissaient des disparités entre les sexes au niveau individuel, et il y avait des disparités régionales avec des valeurs de prévalence plus élevées dans les régions du nord et du nord-est. Dans ces régions, le retard de croissance a diminué plus fortement au cours de la période étudiée, bien que le modèle spatial soit resté plus lisse. Le retard de croissance a augmenté dans les zones urbaines périphériques et les zones rurales dispersées qui sont socioéconomiquement vulnérables. CONCLUSIONS: Les estimations géostatistiques spatiales à plusieurs niveaux de la sous-nutrition infantile fournissent un outil de santé publique de précision pour cibler les politiques publiques sur les populations qui en ont le plus besoin, afin de réduire les disparités en matière de santé.

Twice upon a time: The progression of canine visceral leishmaniasis in an Argentinean city.

Canine Visceral Leishmaniasis (CVL) prevalence, spatial distribution and associated factors were assessed in four locations in Iguazú department in 2014 and in Puerto Iguazú city again in 2018. The city areas were divided into a grid of 400x400m cells. All cells were sampled in 2014 and a random subsampling was developed in 2018. In each cell, five dogs clustered in a 'critical scenario' (prone to have vectors) were sampled. A rapid immunochromatographic dipstick was used to detect antibodies against Leishmania infantum, confirming by lymph node smears observation and PCR. For Puerto Iguazú, Generalized Linear Models (GLMs) were constructed considering environmental, dog and clinical variables. Pearson's Chi square and Fisher's exact tests were employed to evaluate the association between CVL, dog clinical signs and infestation with other parasites. Cartographic outputs were made and Moran's I indices were calculated as spatial autocorrelation indicators. CVL prevalence rates were 26.18% in 2014 and 17.50% in 2018. No associations were established in environmental models, but dog age and repellent use were significant when running 2014 dog models. Clinical models showed significant associations between seropositive dogs and ophthalmological, dermal signs and onychogryphosis in 2014. In 2018, only adenomegaly was associated. The results of global Moran´s I were not significant but regarding local analysis, six sites in 2014 and one in 2018 presented autocorrelation with neighboring sites. The decrease in CVL prevalence may be associated to transmission stabilization, which could explain the lack of associations with dog-related variables. Further, spatial distribution of CVL is a poor evidence for design of transmission control measures but could be important in case of intensive parasite circulation or when the first autochthonous cases appear. For control success, sensitivity of diagnostic methods, political will and adequate material resources remain critical. Modeling of multiple variables will be required to identify factors that drive disease stabilization/destabilization.

Environmental and socio-demographic individual, family and neighborhood factors associated with children intestinal parasitoses at Iguazú, in the subtropical northern border of Argentina.

BACKGROUND: Intestinal parasitoses are a major concern for public health, especially in children from middle and low-income populations of tropical and subtropical areas. We examined the presence and co-infection of parasites in humans as well as parasitic environmental contamination in Puerto Iguazú, Argentina. We explored the environmental and socio-demographic characteristics of the persistence of parasites in children and their environment. METHODOLOGY/PRINCIPAL FINDINGS: This cross-section survey was conducted among children population comprised into the area of the public health care centers of Iguazú during June 2013 to May 2016. Copro-parasitological status of 483 asymptomatic children was assessed. Simultaneously, a design-based sampling of 744 soil samples and 530 dog feces was used for characterize the environmental contamination. The 71.5% of these sites were contaminated. Sixteen genera were detected in the environment being hookworms (62.0%) the main pathogens group detected followed by Toxocara spp (16.3%), Trichuris spp (15.2%) and Giardia (6.5%). Total children prevalence raised 58.8%, detecting twelve genera of parasite with Giardia intestinalis as the most prevalent pathogen (29.0%) followed by Enterobius vermicularis (23.0%), Hymenolepis nana (12.4%) and hookworms (4.4%). Through questionnaires and census data, we characterized the socio-demographics conditions at an individual, family and neighborhood levels. A multi-level analysis including environmental contamination data showed that the ´presence of parasites´ was mostly determined by individual (e.g. age, playing habits, previous treatment) and household level (e.g. UBN, WASH, mother's literacy) determinants. Remarkably, to define the level of 'parasite co-infection', besides individual and household characteristics, environmental factors at a neighborhood level were important. CONCLUSION/SIGNIFICANCE: Our work represents the major survey of intestinal parasites in human and environmental samples developed in the region. High prevalence was detected in the children population as well as in their environment. This work shows the importance of considering and promoting multi-level actions over the identified determinants to face this public health problem from integrative approaches.

Echinococcus oligarthrus in the subtropical region of Argentina: First integration of morphological and molecular analyses determines two distinct populations.

Echinococcosis is a parasitic zoonosis that is considered as a neglected disease by the World Health Organization. The species Echinococcus oligarthrus is one of the causative agents of Neotropical echinococcosis, which is a poorly understood disease that requires a complex medical examination, may threaten human life, and is frequently associated with a low socioeconomic status. Morphological and genetic diversity in E. oligarthrus remains unknown. The aim of this work is to identify and characterize E. oligarthrus infections in sylvatic animals from the Upper Paraná Atlantic Forest in the province of Misiones, Argentina, by following an integrative approach that links morphological, genetic and ecological aspects. This study demonstrates, for the first time, one of the complete life cycles of E. oligarthrus in an important ecoregion. The Upper Paraná Atlantic Forest constitutes the largest remnant continuous forest of the Atlantic Forest, representing 7% of the world's biodiversity. This is the first molecular determination of E. oligarthrus in Argentina. In addition, the agouti (Dasyprocta azarae), the ocelot (Leopardus pardalis) and the puma (Puma concolor) were identified as sylvatic hosts of Neotropical echinococcosis caused by E. oligarthrus. Mitochondrial and nuclear molecular marker analyses showed a high genetic diversity in E. oligarthrus. Moreover, the genetic distance found among E. oligarthrus isolates is higher than the one observed among Echinococcus granulosus genotypes, which clearly indicates that there are at least two different E. oligarthrus populations in Argentina. This study provides valuable information to understand the underlying conditions that favour the maintenance of E. oligarthrus in sylvatic cycles and to evaluate its zoonotic significance for devising preventive measures for human and animal wellbeing.

Arginine deiminase has multiple regulatory roles in the biology of Giardia lamblia.

The protozoan parasite Giardia lamblia uses arginine deiminase (ADI) to produce energy from free L-arginine under anaerobic conditions. In this work, we demonstrate that, in addition to its known role as a metabolic enzyme, it also functions as a peptidylarginine deiminase, converting protein-bound arginine into citrulline. G. lamblia ADI specifically binds to and citrullinates the arginine in the conserved CRGKA tail of variant-specific surface proteins (VSPs), affecting both antigenic switching and antibody-mediated cell death. During encystation, ADI translocates from the cytoplasm to the nuclei and appears to play a regulatory role in the expression of encystation-specific genes. ADI is also sumoylated, which might modulate its activity. Our findings reveal a dual role played by ADI and define novel regulatory pathways used by Giardia for survival.