Abordagens distintas à Interação entre Anopheles spp. e Plasmodium spp.: estabelecendo um modelo murino de laboratório, estudando o escape dos esporozoítos e a microbiota

Nas Américas, a região Amazônica é a área com o maior risco de transmissão de malária. No entanto, a falta de modelos experimentais adequados de anofelinos das Américas tem limitado o progresso para compreender a biologia de transmissão de malária nesta região. Entretanto, com colonização de vetores naturais da Amazônia, como o A. aquasalis, abriu pela primeira vez a possibilidade de estudar sua interação com o Plasmodium sp. No presente trabalho, questões básicas dessa interação foram investigadas tais como: 1) a susceptibilidade do A. aquasalis à diferentes espécies de Plasmodium sp. 2) o processo de escape dos esporozoítos dentro do vetor 3) a dinâmica microbiana do A. aquasalis em diferentes estágios de vida e fonte alimentar. Como resultados, (1) O A. aquasalis se mostrou refratário às infecções com P. falciparum (NF54 e 7G8), P. berghei e P. yoelii 17xnl, e altamente susceptível ao P. yoelii N67 tornando a utilização do P. yoelii N67/A. aquasalis um bom modelo de estudo de laboratório. (2) Nesse trabalho foi descrita a microanatomia do escape dos esporozoítos de oocistos de quatro espécies de Plasmodium: P. gallinaceum e P. berghei, e as duas espécies principais que causam a malária em humanos, P. vivax e P. falciparum. Verificou-se que os esporozoítos possuem mecanismos específicos de escape do oocisto.

O P. berghei e o P. gallinaceum têm um mecanismo comum, na qual a parede do oocisto se decompõe antes dos esporozoítos escaparem. Em contraste, os esporozoítos de P. vivax e P. falciparum possuem um mecanismo de escape ativo, através de propulsão polarizada. (3) A diversidade microbiana descrita demonstrou que as pupas possuem uma riqueza maior de fOTUs comparado aos outros grupos estudados. Foi visto que, a abundância das fOTUs de Enterobacteriaceae aumenta nos mosquitos pós infectados com P. vivax comparado aos outros grupos, sugerindo uma possível relação com o parasito. Acreditamos que com estes conhecimentos, poderemos abrir novas fronteiras para estudos de controle da malária focado no contexto epidemiológico brasileiro, como, por exemplo, produção de insetos geneticamente modificados potencialmente resistentes ao patógeno, ou mesmo indicar candidatos para estudo de vacinas de bloqueio de transmissão

Estimation of vectorial capacity of Anopheles minimus Theobald & An. fluviatilis James (Diptera: Culicidae) in a malaria endemic area of Odisha State, India.

Background & objectives: Anopheles minimus and An. fluviatilis were incriminated as the major malaria vectors in Keonjhar district of Odisha State recently. This study was carried out to elucidate the potential role of these two vector species in transmission of malaria during different seasons, and vectorial capacity of these species was also estimated. Methods: Three hilly and forested villages of Keonjhar district were randomly selected. Vectorial capacity (C) was calculated using the Macdonald’s formula as modified by Garret-Jones. The human landing density of the vector species was obtained from all night human landing collections (bait protected by bed-net). Man feeding habit was estimated by multiplying the human blood index with feeding frequency, which was obtained on daily basis from the duration of gonotrophic cycle. The probability of survival through the extrinsic incubation cycle was calculated from the probability of survival through one day and duration of sporogonic cycle. Results: The estimated vectorial capacity of An. minimus varied between 0.014 and 1.09 for Plasmodium falciparum (Pf) and between 0.1 and 1.46 for P. vivax (Pv). The C of An. minimus for both Pf and Pv was higher during rainy season than the other two seasons. The estimated C of An. fluviatilis varied between 0.04 and 1.28 for Pf and between 0.20 and 1.54 for Pv. Interpretation & conclusions: Based on the estimated values of vectorial capacity of the two vector species, the area could be stratified and such stratification would reflect the difference in the intensity of transmission between different strata and accordingly the appropriate control strategy could be adopted for each stratum.

Presencia larval de anopheles albimanus (Diptera: Culicidae) en La Habana, Cuba 2010-2012 / Larval presence of anopheles albimanus (Diptera: Culicidae) in Havana, Cuba, 2010-2012

INTRODUCCIÓN: Anopheles albimanus es el principal vector de la malaria en Cuba, éste también se encuentra distribuido en varios países del continente americano. OBJETIVO: determinar la presencia larval de An. albimanus en la provincia de La Habana durante 2010-2012. MÉTODOS: el muestreo se llevó a cabo con una frecuencia semanal en el período 2010-2012. Los sitios de cría encuestados fueron clasificados como naturales permanentes y temporales así como depósitos artificiales. RESULTADOS: se registra la presencia de An. albimanus en 9 (60,0 por ciento) del total de los municipios muestreados en el 2010 y en 12 (80 por ciento) en los años 2011 y 2012. Los municipios que no lo registraron en los tres años fueron Centro Habana, Plaza de la Revolución y Habana Vieja. La provincia obtuvo un promedio de 1173,8 y 97,7 muestras larvales de ésta especie por año y por mes respectivamente. El municipio Boyeros mostró un promedio de muestras de 922,6 por año y 76,8 por mes siendo el que mantiene la mejor vigilancia sobre An. albimanus. Los sitios de cría con mayor presencia de An. albimanus correspondieron al grupo de naturales permanentes destacándose las zanjas y lagunas naturales, además se encontraron criaderos en 26 tipos diferentes de depósitos artificiales. A partir de mayo ocurre un incremento del número de muestras hasta octubre. CONCLUSIONES: se encontró presencia larval de An. albimanus en la mayoría de los municipios durante todo el año; por lo que mantener un constante monitoreo sobre la especie debe ser una prioridad en la vigilancia de la malaria en La Habana(AU)

INTRODUCTION: Anopheles albimanus is the main malaria vector in Cuba. It is also distributed in several countries in the Americas. OBJECTIVE: determine the larval presence of An. albimanus in the province of Havana in the period 2010-2012. METHODS: sampling was conducted on a weekly basis during the period 2010-2012. The breeding sites surveyed were classified as natural permanent, natural temporary and artificial containers. RESULTS: presence of An. albimanus was reported in 9 (60.0 percent) of the municipalities sampled in 2010 and 12 (80 percent) of those sampled in 2011 and 2012. The municipalities of Centro Habana, Plaza de la Revolución and Habana Vieja did not report any larval presence of An. albimanus in any of the three years. The province had an average 1 173.8 and 97.7 larval samples per year and month, respectively. In the municipality of Boyeros, the average was 922.6 per year and 76.8 percent month. This is the municipality with the best surveillance of An. albimanus. The greatest presence of An. albimanus was found in natural permanent breeding sites, particularly ditches and natural ponds. Breeding sites were also found in 26 different types of artificial containers. An increase in the number of samples was observed from May to October. CONCLUSIONS: larval presence of An. albimanus was found in most municipalities throughout the year. Therefore, permanent monitoring of the species should be a priority of malaria surveillance in Havana(AU)

Pruebas de campo sobre la eficacia y persistencia de tres formulaciones de Bacillus sphaericus contra larvas de Anopheles aquasalis Curry en manglares del municipio Mariño, estado Sucre, Venezuela / Field trials on the efficacy and persistence of three formulations of Bacillus sphaericus against larvae of Anopheles aquasalis Curry in mangroves of Mariño municipality, Sucre state, Venezuela

Anopheles aquasalis Curry es el principal vector de malaria de la región nororiental de Venezuela. Un estudio sobre el control biológico de la especie fue realizado en Rio Chiquito Abajo, municipio Mariño, estado Sucre. El objetivo del mismo fue evaluar en condiciones de campo, la eficacia y persistencia de tres formulaciones comerciales de Bacillus sphaericus contra larvas de An. aquasalis. Los criaderos típicos de esta especie son humedales de agua dulce con vegetación herbácea emergente y manglares salobres estacionales con vegetación arbórea (Avicennia germinans). El hábitat seleccionado para realizar los bioensayos fue un típico manglar de Avicennia germinans. En este criadero de An. aquasalis, se evaluaron estas formulaciones de B. sphaericus: dos formulaciones liquidas (GRISELESF-Cepa 2362 y VECTOLEX® WGD-51,2%) y una formulación granulada (VECTOLEX® CG-7,5%). En cada prueba, se aplicó un diseño completamente al azar con 4 repeticiones por tratamiento y por control. Los resultados fueron expresados como porcentajes de reducción larval, después de aplicar la formula de Mulla. De acuerdo con los resultados obtenidos, la formulación granulada VECTOLEX® CG-7,5% con dosis de 30 Kg/ha (3 g/m²), resultó ser altamente eficaz hasta 7 días post-aplicación con 92,3% de reducción, la misma fue menos efectiva después de 14 días post-aplicación con 74,8%. Al aumentar la dosis a 40 Kg/ha (4 g/m²), la eficacia después de 7 días de la aplicación fue de 93,9 %, es decir muy similar que a la dosis anterior. Ambas dosis presentaron la misma eficacia contra larvas de An. aquasalis. Por otra parte, la otra formulación VECTOLEX® WGD-51,2%, con la dosis de 2,0 Kg/ ha, resultó ser eficaz hasta 8 días post-aplicación con 85,2% de reducción larval; la misma produjo 13,3% de reducción a los 16 días post-tratamiento; sin embargo, esta formulación con la dosis de 2,5 Kg/ha, fue altamente eficaz hasta 16 días postaplicación con más de 90% de reducción larval. En cambio, en el mismo manglar el producto GRISELESF fue menos eficaz tanto a 2,0 Kg/ha como a 2,5 Kg/ha, obteniéndose porcentajes de reducción muy bajos a los 8 y 16 días post-aplicación.

Anopheles aquasalis Curry is the main vector of malaria in northeastern Venezuela. A study of biological control of An. aquasalis larvae was carried out in Río Chiquito Abajo, Sucre State, Venezuela. The objective of this study was to evaluate effectivity and persistence of three formulations of Bacillus sphaericus against larval populations of An. aquasalis. The main breeding-sites of An. aquasalis are seasonal brackish mangrove with Avicennia germinans and semi-permanent freshwater wetlands with herbaceous emergent vegetation. A typical seasonal brackish mangrove with Avicennia germinans was selected. In these breeding-sites of An. aquasalis, three commercial formulations of B. sphaericus: VECTOLEX® CG-7.5%, VECTOLEX® WGD-51.2% and GRISELESF were evaluated in field trials. According to the results obtained VECTOLEX® CG-7.5% was effective against An. aquasalis larvae during 7 days post-treatment at rates not lower than 30 Kg/ha (3 g/m²), producing a larval reduction greater than 92.3%. This granular formulation provided very good larval control during 7 days. The two dosages (30 and 40 Kg/ha) had the same efficacy against An. aquasalis larvae. The second commercial formulation VECTOLEX® WGD-51.2% was effective against An. aquasalis larvae at dose of 2.0 Kg/ ha, producing a larval reduction greater than 85 % during 8 days post-treatment, and only 13.3 % larval reduction at 16 days after treatment; but the same formulation with at dose of 2.5 Kg/ha was more effective, producing a larval reduction greater than 90 % during 16 days posttreatment. In the same brackish mangrove, GRISELESF at rates not lower than 2.0 and 2.5 Kg/ha, appears to be less effective against An. aquasalis larvae, producing very low larval reduction at 8 and 16 days post-treatment.

Nuevos registros de mosquitos (Diptera Culicidae) para el estado Bolívar, Venezuela: Dos de ellos nuevos para el país / New records of mosquitoes (Diptera Culicidae) for the state of Bolivar, Venezuela: Two of them new to the country

En el presente trabajo se hace referencia por primera vez para el estado Bolívar de diez y nueve especies de mosquitos (Diptera Culicidae), pertenecientes a diez (10) géneros: Anopheles, Chagasia, Culex, Aedes, Mansonia, Coquilletidia, Uranotaenia, Psorophora, Limatus y Wyeomyia, de las subfamilias Anophelinae y Culicinae. Dos de estas especies, son citadas por primera vez para Venezuela: Chagasia bonneae Root, 1927 y Chagasia ablusa Harbach, 2009.

First report of 19 Culicidae species (Diptera: Culicidae) from Bolivar State is made, belonging to 10 genera of Anophelinae and Culicinae: Anopheles, Chagasia, Culex, Aedes, Mansonia, Coquilletidia, Uranotaenia, Psorophora, Limatus and Wyeomyia. Chagasia bonneae Root, 1927 and Chagasia ablusa Harbach, 2009 are reported for the first time in Venezuela.

Anopheles Gambiae no Brasil 1930 a 1940 / Anopheles Gambiae in Brazil 1930 to 1940

Fred L. Soper e D. Bruce Wilson lideraram uma campanha sanitária no Nordeste brasileiro que culminou com a erradicação, em tempo recorde – apenas 35 meses –, do mais eficiente dentre os vetores da malária, o mosquito Anopheles gambiae. Considerado leitura obrigatória para os interessados em saúde pública no Brasil, o relatório final dessa campanha – que descreve detalhadamente os procedimentos e métodos de trabalho sob o ponto de vista de seus diretores – foi originalmente publicado em inglês, em 1943. Pouco depois, em 1945, o relatório ganhou uma edição em português, mas não uma tradução fiel. Ela se voltava para as atividades do Serviço de Malária do Nordeste e a questão dos doentes de malária, enquanto o original era centrado nas ações da Fundação Rockefeller e na campanha de erradicação do mosquito. Decidiu-se, então, retraduzir o original – encontrado hoje em dia somente na seção de obras raras de bibliotecas especializadas –, incorporando alguns elementos de destaque da primeira versão em português. O resultado desse esforço é este novo volume da Coleção História e Saúde; Clássicos e Fontes.

Impact of etofenprox (Vectron® 20 WP) indoor residual spray on malaria transmission.

Background & objectives: A longitudinal study was carried out to assess the impact of indoor residual spray with Vectron® 20 WP (etofenprox) against Anopheles culicifacies and on malaria transmission in a selected village of Dadri primary health centre (PHC), District Gautam Budh Nagar, Uttar Pradesh, India. Methods: Two villages, namely Patadi and Anandpur in District Gautam Budh Nagar, Uttar Pradesh, with similar malaria incidence and vector prevalence were selected for the present evaluation. In one village two rounds of indoor spraying of etofenprox (0.1 g/m2) were done at an interval of 12 wk and the other village was kept as control where no intervention except intensive active surveillance for early detection and prompt treatment (EDPT) was undertaken during the study period. Entomological and epidemiological data were collected using standard procedures. Results: Persistence of the effectiveness of etofenprox against An. culicifacies was observed up to 12 wk. Spraying of etofenprox signifi cantly reduced the density signififi (P<0.001) and proportion of parous An. culicifacies mosquitoes (P<0.05) in the experimental village. There was a signififi cant reduction in malaria cases in the experimental village during the post-spray period when compared to the control village (P<0.05). No adverse effect was reported by the spraymen and inhabitants during and after the spray. Interpretation & conclusion: Indoor residual spray of etofenprox (0.1 g/m2) with an interval of three months in between two rounds of spray produced the desired impact in reducing the indoor resting density of vector mosquitoes and also in curtailing malaria transmission in the sprayed village when compared with the control village without spray.

Registro de larvas de anofelinos (Diptera: Culicidae) em recipientes artificiais na Região Noroeste do Espírito Santo, Brasil / Anophelines Larvae (Diptera: Culicidae) Found in Artificial Containers in the Northwest Region of Espirito Santo State, Brazil

Registra-se o encontro de larvas de anofelinos em caixas d’água, barris, garrafas, pneus e vasos de plantas na Região Noroeste do Estado do Espírito Santo, Brasil. As larvas foram coletadas entre 2000 a 2005, durante o controle de Aedes aegypti. Os recipientes artificiais descartados pela população tornam-se opção para postura das fêmeas dos anofelinos, principalmente quando os criadouros naturais secam nessa região de baixa pluviosidade.

Anophelines larvae are found in water reservoirs, barrels, bottles, tires and plant pots in the Northwest Region of Espirito Santo State, Brazil. The larvae were collected between 2000 and 2005 during Aedes aegypti control activities. Artificial containers discarded by the population become options for oviposition mainly after the drying of the natural breeding sites in that region of low rainfall.

Distribuição das espécies do gênero Anopheles (Diptera, Culicidae) no Estado do Maranhão, Brasil / Distribution of species from genus Anopheles (Diptera, Culicidae) in the State of Maranhão, Brazil

Estudou-se a distribuição e diversidade de espécies de Anopheles em 123 municípios do Estado do Maranhão, Brasil. O método básico foi a captura de fêmeas dentro e nos arredores das habitações humanas, em intervalos compreendidos entre 18h e 6h, no período de janeiro de 1992 a dezembro de 2001. Foram capturados 84.467 exemplares distribuídos em 24 espécies, com o predomínio de A. triannulatus sensu lato (20.788), A. darlingi (19.083), A. nuneztovari (16.884), A. albitarsis s.l. (14.352), A. aquasalis (8.202) e A. evansae (2.885). As outras 18 espécies juntas representaram apenas 2,7 por cento. As espécies encontradas no maior número de municípios foram: A. albitarsis s.l. (109 municípios), A. triannulatus s.l. (106), A. nuneztovari (93), A. darlingi (87) e A. evansae (64). A riqueza e a ampla distribuição das espécies de anofelinos no Maranhão concordam com a posição geográfica do estado, entre as macrorregiões que caracterizam o Brasil, resultando em uma fauna mista, com elementos representativos dessas regiões.

We studied the distribution and diversity of Anopheles species in 123 counties (municipalities) in the State of Maranhão, Brazil. The basic method consisted of capturing female specimens inside and around human dwellings between 6 PM and 6 AM from January 1992 to December 2001. A total of 84,467 specimens belonging to 24 species were captured, with a predominance of A. triannulatus sensu lato (20,788), A. darlingi (19,083), A. nuneztovari (16,884), A. albitarsis s.l. (14,352), A. aquasalis (8.202), and A. evansae (2,885). The other 18 species together accounted for only 2.7 percent of the total. The species found in the most counties were A. albitarsis s.l. (109 counties), A. triannulatus s.l. (106), A. nuneztovari (93), A. darlingi (87), and A. evansae (64). The richness and wide distribution of anopheline species in Maranhão agree with the State's geographic position among Brazil's macro-regions, resulting in a mixed fauna with representative elements from these regions.

Effect of some environmental factors on the predation efficiency of the mosquito; Toxorhynchites splendens [diptera: culicidae]

The present work investigates the optimum conditions for the application of the predaceous mosquito, Toxorhynchites splendens as a biological control agent for other vector mosquito species in Egypt such as, Culex pipiens, Anopheles pharoensis and Aedes caspius under field conditions. The predation efficiency of T. splendens larvae was found to increase as the temperature increased. At 30-35C the predaceous larvae consumed greater numbers of both C. pipiens and Ae. Caspius than that of A. pharoensis. The predation of T. splen -dens occurred almost similarly in all degree of salinity. On the other hand, light was found to have little effect on Toxorhynchites larvae where predation efficiency was decreased in the dark. The crowding had no effect on the predation. Also no mortality or natural diseases were observed among the tested insect larvae during the experim ental period, whereas the insect preferred to live in highly concentrated population. Toxorhynchites splendens larvae could live in turbid and distilled water. The maximum number of prey larvae consumed by all instars of T. splendens was at PH [8] followed by [7] and [9]. However, pH, below [6] and above 11 had a bad effect on the predaceous activity. The predation efficiency of T. splendens larvae increased gradually as the depth of water decreased .However captures of prey occurred either on the surface or at the bottom of the container

Malaria transmission

No Brasil, a malária está restrita à regiäo amazônica, onde ocorre mais de 95 por cento dos casos registrados no país. Somente as fêmeas de mosquitos do gênero Anopheles säo capazes de transmitir os parasitos da malária humana. Treze espécies de anofelinos do Brasil foram encontradas naturalmente infectadas com Plasmodium, mas somente poucas estäo envolvidas na transmissäo. Anopheles darlingi é o principal vetor de malária nas ecorregiões de savana e floresta plana enquanto que o A. aquasalis é responsável pela transmissäo desta infecçäo na área costeira. Todavia, A. deaneorum, A. oswaldoi e A. marajoara tem sido incriminados como vetores locais de malária. Controlar a transmissäo de malária na regisäo Amazônica é uma tarefa muito difícil por causa de suas características ecológicas, ambientais, sociais e econômicas. Nos últimos 10 anos, os assentamentos desordenados (invasões) têm sido uma das principais causas de disseminaçäo de malária humana nos grandes centros urbanos, como é o caso da cidade de Manaus e Belém.

Aplicación intradomiciliar de malatión y deltametrina en bajo volumen para el control de Anopheles sp / The effectiveness of low volume house-spraying of malathion and deltamethrin in the control of Anopheles sp

La eficacia del rociado intradomiciliar de deltametrina al 0.027 por ciento y malatión al 20 por ciento, aplicados en bajo volumen (BV) pra el control de anofelinos fue evaluada en dos localidades del municipio de Balancán, Tabasco, México durante el segundo semestre de 1987. Se efectuaron dos rociados con un intervalo de tres meses, usando máquinas de rociamiento espacial Fontan R-12 tipo mochila, aplicados a todas las viviendas de cada localidad. La acción residual y la relación costo-beneficio de estos rociados fue evaluada y comparada con la aplicación de DDT en forma tradicional con máquinas aspersoras HUDson X-pert en otra localidad del mismo municipio. La evaluación entomológica consistió en la medición de índices de picadura intra y peridomiciliares, densidad de reposo intradomiciliar, bioensayos y pruebas de trampa cortina. En todas estas pruebas se determinó la mortalidad a las 24 horas. Los resultados indicaron que ambos insecticidas aplicados mediante la técnica de BV ejercieron un control eficaz de los anofelinos. Malatión presentó una actividad residual de ocho semanas en promedio, mientras que deltametrina persistió hasta 12 semanas. Deltamtrina mostró un mayor efecto en la disminución de índices de reposo en superficies rociadas en comparación con los otros insecticidas. En análisis de costos indicó que la aplicación de bajo volumen de deltametrina y malatión fue 2.56 veces mayor y 0.89 veces menor, respectivamente, que el costo de la aplicación de DDT en forma tradicional. El ahorro en costos, aunado a la eficacia y utilidad práctica de esta técnica de rociado, la convierten en una alternativa viable para el control de vectores

The effectiveness of low volume (LV) house-spraying of deltamethrin 0.027 per cent and malathion 20 per cent in the control of Anopheles spwas evaluated in two villages of Tabasco, México during the last semester of 1987. Two spray rounds were carried out at three-month intervals, using Fontan R-12 back pack-space sprayers. Residual effect and cost-benefit were evaluated and compared to the standard DDT spraying technique using the Hudson X pert sprayer. The entomological evaluation focused on mortality rates and density levels observed from infra and peridomicillary man biting collections, indoor mosquito resting densities, curtain trap and the standard WHO wall bioassay. It was determined that when using the LV method these insecticides were highly effective. Malathion showed a residual effect of eight weeks whereas deltamethrin was found to have a residual activity of up to 12 weeks. Deltamethrin was more effective in reducing infra and peridomiciliary biting rates, and indoor resting mosquitoes. The cost-benefit ratio of deltamethrin and malathion LV house-spraying was 2.56 and 0.89, respectively, as compared to the standard DDT house-spraying. Considering its effectiveness in anopheline control and its cost-benefit, in addition to being a functional technique, intradomicilar LV insecticide spraying should be considered as a practical alternative in malaria control programs.

Problemas actuales del control y erradicación de la malaria en América Latina / Current problems of malaria control and eradication in Latin America

Los problemas que presentan la malaria en América Latina no se reduce a decidir si lo que en la actualidad debe realizarse es simplemente la aplicación de medidas que conduzcan a su control o a su erradicación. La introducción del DDT con insecticida de acción residual para aspersiones intradomiciliarias en ausencia de resistencia fisiológica, si los mosquitos son endófilos, lleva a la erradicación. En este caso la malaria es responsiva al insecticida y continúa siendo la medida más económica y útil en amplias porciones que todavía existen en America Latina. En los programas de control, fuera del reparto gratuito de un medicamento eficaz como medida humanitaria, los gastos deben reducirse a medidas que disminuyan la incidencia y por ello descartar todo lo que no sea útil para ese fin, como el diagnóstico mocrocóspico rutinario de casos. Indices parasitario y esplénico en localidades representativas de las varias zonas epidemiológicas bastarán para medir el efecto de los procedimientos aplicados. Estos programas deben llevar consigo investigaciones continuas para explorar y determinar cuáles son las medidas más eficaces. En las áreas de malaria responsiva deberá trabajarse persiguiendo la erradicación. Siempre es necesario ensayar en nuestro medio los consejos que se nos den y probar los resultados que se obtengan con ellos antes de adoptarlos como procedimientos de rutina. interesa tener presente que con malaria, parasitosis intestinales y otras infecciones parasitarias, tales como las de origen hídrico por carencia de agua potable en los domicilios, resulta una despreciable utopía..