Factors associated with migration in individuals affected by leprosy, maranhão, Brazil: an exploratory cross-sectional study.

In Brazil, leprosy is endemic and concentrated in high-risk clusters. Internal migration is common in the country and may influence leprosy transmission and hamper control efforts. We performed a cross-sectional study with two separate analyses evaluating factors associated with migration in Brazil's Northeast: one among individuals newly diagnosed with leprosy and the other among a clinically unapparent population with no symptoms of leprosy for comparison. We included 394 individuals newly diagnosed with leprosy and 391 from the clinically unapparent population. Of those with leprosy, 258 (65.5%) were birth migrants, 105 (26.6%) were past five-year migrants, and 43 (10.9%) were circular migrants. In multivariate logistic regression, three independent factors were found to be significantly associated with migration among those with leprosy: (1) alcohol consumption, (2) separation from family/friends, and (3) difficulty reaching the healthcare facility. Separation from family/friends was also associated with migration in the clinically unapparent population. The health sector may consider adapting services to meet the needs of migrating populations. Future research is needed to explore risks associated with leprosy susceptibility from life stressors, such as separation from family and friends, access to healthcare facilities, and alcohol consumption to establish causal relationships.

Human papillomavirus genotype distribution and risk factors for infection in women from a small municipality in north east Brazil.

In order to assess the prevalence of human papillomavirus (HPV) infection, the HPV genotypes and factors associated with infection, we conducted a population-based survey in a small municipality in north east Brazil among women aged between 12 and 49 years. A questionnaire regarding socioeconomic variables, reproductive life and sexual behaviour was used, and women were examined gynaecologically, followed by collection of vaginal lavage with saline solution for HPV DNA determination. HPV DNA was detected by the Digene(®) SHARP Signal(TM)-System, and further genotyped by INNO-LiPA Genotyping System(®). Of 579 women, HPV infection was present in 68 (prevalence: 11.7%; 95% CI: 9.3-14.7). The most common HPV types were 16, 31 and 74, each accounting for 14.7% of infections. Of all HPV-positive women, 35.3% showed multiple HPV genotypes. Variables independently associated with HPV infection were: ≥3 partners in life (adjusted OR [aOR]: 3.06; 95% CI: 1.68-5.60) and the use of oral contraception in the last 12 months (aOR: 2.39; 95% CI: 1.33-4.30). Previous participation in a cervical cancer screening programme was protective (aOR: 0.28; 95% CI: 0.13-0.60). HPV infection is common among women from rural Brazil, and HPV genotypes identified indicate that immunization could be an important preventive measure in this population.

Concurrent urinary and intestinal schistosomiasis and intestinal helminthic infections in schoolchildren in Ilobu, South-western Nigeria.

A cross-sectional study was conducted in a schistosome-endemic rural community in Southwestern Nigeria. We assessed prevalence and intensity of soil-transmitted nematodes and the co-occurrence with Schistosoma haematobium and Schistosoma mansoni. Urine and stool samples from 419 schoolchildren were examined, and a questionnaire was administered to obtain socio-demographic characteristics. In total, 78.3% (328/419) were infected with at least one helminth species, with a prevalence (mean egg-count) of 55.1% (3069.2) of Ascaris lumbricoides, 41.1% (127.5) of S. haematobium, 22.7% (98.6) of hookworms, 17.9% (161.3) of Trichuris trichiura, and 10.3% (12.9) of S. mansoni. Multiple infections were significantly more common among children from households with more playmates, absence of toilet facilities and low income level (all p<0.001). Children with heavy hookworm burden were at a significantly higher chance of acquiring S. mansoni (OR=36.35; 95% Cl: 13.22-100.97; p<0.0001). The risk of S. mansoni and A. lumbricoides infections was increased in co-infections with S. haematobium. Logistic regression analysis revealed infections by hookworms and S. mansoni (adjusted odds ratio [aOR]=3.90, 95% Cl: 2.03-7.46; p<0.0001), and by hookworms and T. trichiura (aOR=2.46, 95% Cl: 1.44-4.22; p=0.001) as significant risk factors for multiple infections. Our study shows that polyparasitism is common in the study area. Focused interventions such as mass treatment with anthelminthics and health education are needed to improve the well-being of the affected population.

Jigger flea infestation (tungiasis) in rural western Tanzania: high prevalence and severe morbidity.

Epidemiologic and clinical data on the parasitic skin disease tungiasis are limited from sub-Saharan Africa, and virtually nonexistent from the East African region. We performed a community-based cross-sectional study in two villages in Kasulu district, western Tanzania. Study participants were examined for the presence of tungiasis and disease-associated morbidity. In total, 586 individuals >5 years of age were enrolled, and 249 (42.5%; 95% CI: 38.5-46.5) diagnosed with tungiasis. The ≥45 year-olds showed highest prevalence of tungiasis (71.1%) and most severe parasite load (median number of embedded fleas: 17.5; interquartile range: 15-22.5). Prevalence was slightly, but not significantly, higher in males than in females (45.3 vs 39.7%; p=0.17). Itching (68.3%), pain (38.6%) and ulcers (30.1%) were common; 22.1% of individuals found it difficult to walk due to tungiasis, and in 21.3% loss of toenails was observed. Considering the high prevalence and considerable morbidity in the population, we conclude that tungiasis is a public health threat in the study villages and that the disease needs to be recognized by health authorities. Future studies on risk factors, animal reservoirs and evidence-based control measures are needed.

Factors associated with urinary schistosomiasis in two peri-urban communities in south-western Nigeria.

In Nigeria, there is only very limited epidemiological information on which the control of human urinary schistosomiasis could be based. In a cross-sectional study, therefore, the prevalences and intensities of, and risk factors for, human infection with Schistosoma haematobium infection were explored in two endemic peri-urban villages in the south-western state of Osun. The villagers' knowledge about the infection and demographic, socio-economic and environmental variables were recorded using a structured questionnaire. Of the 1023 individuals who were investigated, 634 (62.0%) were found infected, with a mean (S.D.) overall intensity of 114.2 (327.7) eggs/10 ml urine. The subjects aged 10-14 years had both the highest prevalence (83.6%) and the highest mean (S.D.) intensity of infection [196.67 (411.7) eggs/10 ml urine]. Most (70.0%) of the subjects appeared to have no knowledge of the transmission of S. haematobium. The results of multivariate regression analysis indicated that infection and moderate-heavy infection (i.e. >50 eggs/10 ml urine) were both associated with: a low family income, of

Occurrence of the off-host life stages of Tunga penetrans (Siphonaptera) in various environments in Brazil.

To explore the local transmission dynamics of Tunga penetrans in brazil, 134 soil samples from various environments were collected in three different endemic regions of the country and checked for the presence of the flea's larvae, pupae and adults. the samples, which came from an urban slum in the north-east, a village of xavante indians in the central-west and a community of yanomami indians living in traditional longhouses (malocas) in the north, were categorized as indoor, outdoor or indoor-outdoor (the latter representing samples collected in the malocas). The proportion of samples found positive for T. penetrans was lowest in the slum (9.3%) and highest in the Yanomami village (32.0%; P=0.01). Soil samples collected below bedsteads or hammocks or from the indoor resting places of dogs were significantly more likely to be positive than the indoor samples collected at other sites (65.0% v. 35.0%; P=0.02). There was no evidence indicating that the presence of T. penetrans in a soil sample was markedly affected by soil temperature, air temperature or air humidity. As no life stages of T. penetrans were found in any outdoor sample, it seems likely that, in resource-poor settings in Brazil, most transmission of T. penetrans occurs indoors. Control measures against the off-host life stages of T. penetrans should therefore be targeted at particular indoor micro-environments.

A simple method for rapid community assessment of tungiasis.

OBJECTIVE: To evaluate a rapid assessment method to estimate the overall prevalence of tungiasis and severity of disease in endemic communities. METHODS: We analysed data from 10 population-based surveys on tungiasis, performed in five endemic communities in Brazil and Nigeria between 2001 and 2008. To assess the association between occurrence of tungiasis on six defined topographic areas of the feet and the true prevalence/prevalence of severe disease, linear regression analyses were performed. Estimated prevalences were calculated for each of the 10 surveys and compared to true prevalences. We then selected the most useful topographic localization to define a rapid assessment method, based on the strength of association and operational aspects. RESULTS: In total, 7121 individuals of the five communities were examined. Prevalence of tungiasis varied between 21.1% and 54.4%. The presence of periungual lesions on the toes was identified as the most useful rapid assessment to estimate the prevalence of tungiasis (absolute errors: -4% to +3.6%; R(2 )=96%; P < 0.0001). Prevalence of severe tungiasis (>20 lesions) was also estimated by the method (absolute errors: -3.1% to +2.5%; R(2 )=76%; P = 0.001). CONCLUSION: Prevalence of tungiasis and prevalence of severe disease can be reliably estimated in communities with distinct cultural and geographical characteristics, by applying a simple and rapid epidemiological method. This approach will help to detect high-risk communities and to monitor control measures aimed at the reduction of tungiasis.

In vitro efficacy of over-the-counter botanical pediculicides against the head louse Pediculus humanus var capitis based on a stringent standard for mortality assessment.

Infestation of the head louse Pediculus humanus var capitis DeGeer (Phthiraptera: Pediculidae) is an important public health problem in Australia, with up to a third of children infested in some primary schools. Insecticide resistance and inadequate attention to the application instructions of topical pediculicides are common reasons for treatment failure. This study evaluated six popular Australian over-the-counter products against head lice, primarily comprised of different botanical extracts, and compared them with permethrin 1% (Quellada) and a non-treatment control in order to assess their in vitro efficacy. We also assessed commonly used criteria for evaluating pediculicide efficacy in vitro. All tested products failed to demonstrate high levels of efficacy with the exception of Tea Tree Gel((R)), which outperformed 1% permethrin. Permethrin had a high level of efficacy, but using stringent criteria 18% of lice were not dead at 3 h, indicating some resistance to Quellada. Commonly used less stringent criteria were shown to overestimate mortality of head lice as a result of the protective phenomenon of stasis or sham death observed in exposed lice that may recover after some time. Using two different levels of stringency resulted in different rankings of efficacy for most products, with the exception of the first ranked product, Tea Tree Gel. Rankings of efficacy also varied over time, even within the different assessment criteria. Government regulatory agencies should require standard in vitro tests using stringent mortality criteria, with an observation period of >or= 6 h, to determine the efficacy of new pediculicides, and only products that cause a minimum mortality rate (e.g. 80%) in head lice collected from the target population should be licensed for sale.

Prevalence and risk factors of hookworm-related cutaneous larva migrans in a rural community in Brazil.

The epidemiology of hookworm-related cutaneous larva migrans (HrCLM) in endemic communities is not well understood. To describe the prevalence of HrCLM and to identify environmental and behavioural risk factors for the infestation, two cross-sectional surveys were conducted in a small village in an endemic area of north-eastern Brazil - one in the rainy season and the other in the dry season. The members of each household were examined clinically for the presence of HrCLM, and information on possible risk factors was collected. HrCLM, which was diagnosed in 45 individuals in the rainy-season survey and in 17 in the dry-season survey, was significantly more prevalent in the rainy season (4.4% v. 1.7%; P<0.001). The age-specific prevalences peaked, at 14.9%, in infants and children aged < or = 4 years. In a logistic regression analysis, the independent risk factors for current infestation or infestation in the preceding 6 months were identified as young age (odds ratio = 0.96; 95% confidence interval = 0.94-0.98), living in a house without a solid floor (odds ratio = 1.99; 95% confidence interval = 1.22-3.23), and walking barefoot (odds ratio = 1.77; 95% confidence interval = 1.12-2.80). In the study area, therefore, HrCLM is a common parasitic skin disease in children, is associated with behavioural and environmental risk factors, and shows marked seasonality in its prevalence. Local control of HrCLM should be based primarily on the health education of mothers and the elder girls who take care of their younger siblings.

Investigations on the life cycle and morphology of Tunga penetrans in Brazil.

In the present study, the life cycle of Tunga penetrans was established in Wistar rats in the laboratory, and the morphology of the resulting developmental stages was studied by means of light and scanning electron microscopy. It was seen that the females enter at a nonfertilized stage through the skin of their hosts. Only there the copulation occurs, while females and males brought together in a Petri dish showed no interest in each other. In any way -- fertilized or not -- the females start about 6 days after penetration and hypertrophy with the ejection of eggs. While fertilized eggs proceed to development, the unfertilized ones remain arrested. The eggs are ovoid and measure about 600 x 320 mum. The larvae hatch from the eggs 1-6 days (mean 3-4) after ejection. Formation of larvae 2 took at least another day, while 4 up to 10 days more were needed until this larva starts pupation (mean 5-7 days). The formation of the adult fleas inside the puparium occurred within 9-15 days (with a maximum hatch at day 12). Adult female fleas having reached the skin of a host start blood sucking within 5 min and prepare to enter the skin. After 24 h, the flea stacked already with two thirds of its body inside the skin. After 40 h, the penetration was completed, and feeding and hypertrophical enlargement started, which was completed on day 6, when eggs became ejected. When studying the morphology of the fleas obtained from different hosts, slight variations were seen, which, however, are not significant for a species separation but may be an indication of the presence of different strains/races or the beginning of such a formation.

High in vitro efficacy of Nyda L, a pediculicide containing dimeticone.

BACKGROUND: The therapy of pediculosis remains a common problem in clinical practice. As resistance to commonly used chemical pediculicides is constantly increasing, there is a need for new effective compounds. STUDY DESIGN: The efficacy of Nyda L, a new pediculicide containing a high concentration of dimeticone, was assessed in an in vitro trial and compared with three reference products (Hedrin containing 4% dimeticone, Lyclear containing 1% permethrin, and Prioderm containing 1% malathion) and a negative control group. Head lice were collected from heavily infested patients in a resource-poor community in Northeast Brazil, where no resistance against pediculicides has been reported thus far. In each of the five groups, 50 adult fully vital lice were tested. We used a dip test (immersing head lice in the undiluted products for 3 min, washing off products after 20 min). Using predefined criteria for mortality, the lice were monitored at different points in time, for a period of 24 h. RESULTS: Nyda L and Prioderm killed all head lice already after 5 min. The efficacy of Nyda L was better than of Lyclear. Lice treated with Hedrin resurrected after several hours and did not show a significantly higher mortality compared with the control group after 24 h. CONCLUSION: Nyda L can be regarded as a very efficacious pediculicidal compound, killing all lice in vitro within 5 min.

Antimicrobial activity of the essential oil from Lippia sidoides, carvacrol and thymol against oral pathogens.

Dental caries and periodontal disease are associated with oral pathogens. Several plant derivatives have been evaluated with respect to their antimicrobial effects against such pathogenic microorganisms. Lippia sidoides Cham (Verbenaceae), popularly known as "Alecrim-pimenta" is a typical shrub commonly found in the Northeast of Brazil. Many plant species belonging to the genus Lippia yield very fragrant essential oils of potential economic value which are used by the industry for the commercial production of perfumes, creams, lotions, and deodorants. Since the leaves of L. sidoides are also extensively used in popular medicine for the treatment of skin wounds and cuts, the objective of the present study was to evaluate the composition and antimicrobial activity of L. sidoides essential oil. The essential oil was obtained by hydro-distillation and analyzed by GC-MS. Twelve compounds were characterized, having as major constituents thymol (56.7%) and carvacrol (16.7%). The antimicrobial activity of the oil and the major components was tested against cariogenic bacterial species of the genus Streptococcus as well as Candida albicans using the broth dilution and disk diffusion assays. The essential oil and its major components thymol and carvacrol exhibited potent antimicrobial activity against the organisms tested with minimum inhibitory concentrations ranging from 0.625 to 10.0 mg/mL. The most sensitive microorganisms were C. albicans and Streptococcus mutans. The essential oil of L. sidoides and its major components exert promising antimicrobial effects against oral pathogens and suggest its likely usefulness to combat oral microbial growth.

Antimicrobial activity of the essential oil from Lippia sidoides, carvacrol and thymol against oral pathogens

Dental caries and periodontal disease are associated with oral pathogens. Several plant derivatives have been evaluated with respect to their antimicrobial effects against such pathogenic microorganisms. Lippia sidoides Cham (Verbenaceae), popularly known as "Alecrim-pimenta" is a typical shrub commonly found in the Northeast of Brazil. Many plant species belonging to the genus Lippia yield very fragrant essential oils of potential economic value which are used by the industry for the commercial production of perfumes, creams, lotions, and deodorants. Since the leaves of L. sidoides are also extensively used in popular medicine for the treatment of skin wounds and cuts, the objective of the present study was to evaluate the composition and antimicrobial activity of L. sidoides essential oil. The essential oil was obtained by hydro-distillation and analyzed by GC-MS. Twelve compounds were characterized, having as major constituents thymol (56.7 percent) and carvacrol (16.7 percent). The antimicrobial activity of the oil and the major components was tested against cariogenic bacterial species of the genus Streptococcus as well as Candida albicans using the broth dilution and disk diffusion assays. The essential oil and its major components thymol and carvacrol exhibited potent antimicrobial activity against the organisms tested with minimum inhibitory concentrations ranging from 0.625 to 10.0 mg/mL. The most sensitive microorganisms were C. albicans and Streptococcus mutans. The essential oil of L. sidoides and its major components exert promising antimicrobial effects against oral pathogens and suggest its likely usefulness to combat oral microbial growth.

Leukocytosis and blood eosinophilia in a polyparasitised population in north-eastern Brazil.

It has long been known that leukocytosis and blood eosinophilia are common in the tropical environment, but data derived from population-based studies are scarce. A study was undertaken in a fishing village in north-east Brazil where both intestinal helminthiases and parasitic skin diseases are common. Of 409 individuals studied, 128 (31.3%) were infected with one intestinal helminth or ectoparasite species, 93 (22.7%) with two, 61 (14.9%) with three, 25 (6.1%) with four and 11 (2.7%) with more than four species; no parasites were found in 91 (22.2%) individuals. Leukocyte counts ranged between 3,300 cells/microl and 16,100 cells/microl (median, 7,200 cells/microl) and eosinophil counts between 40 cells/microl and 5,460 cells/microl (median, 455 cells/microl). Eosinophilia (>500/microl) was detected in 44.7% of the individuals, and hypereosinophilia (>1,000/microl) in 12.9%. Thirty-six (8.8%) individuals showed leukocytosis. While 75% of individuals with normal eosinophil counts were considered parasite-free, only 14% with eosinophilia and 11% with hypereosinophilia did not have enteroparasites or ectoparasites. Multivariate regression showed that the probability of eosinophilia and hypereosinophilia, but not of leukocytosis, increased with the number of parasite species present. The data show that eosinophilia occurs in almost one-half of the individuals from a resource-poor setting and that it is significantly associated with the presence of intestinal helminths, but not with the presence of ectoparasites.

Field trial of the efficacy of a combination of imidacloprid and permethrin against Tunga penetrans (sand flea, jigger flea) in dogs in Brazil.

In a field trial in Brazil 17 dogs penetrated by females of the jigger flea, Tunga penetrans, were topically treated with a combination of 10% imidacloprid and 50% permethrin (Advantix), while 17 dogs remained untreated. The follow-up controls on days 7, 14, 21 and 28 post-treatment clearly showed that, beginning from day 7, the flea load in treated dogs decreased, so that most of the dogs became free of tungiasis lesions, while in the untreated group the flea load remained high. Since the dogs distribute the flea eggs throughout the village, leading to a high incidence of tungiasis in humans, treatment of dogs probably also decreases the number of cases of tungiasis in the latter.

Epidemiology and morbidity of scabies and pediculosis capitis in resource-poor communities in Brazil.

BACKGROUND: Pediculosis capitis and scabies are common parasitic skin diseases, especially in resource-poor communities, but data on epidemiology and morbidity are scanty. OBJECTIVES: To assess the prevalence, seasonal variation and morbidity of pediculosis capitis and scabies in poor neighbourhoods in north-east Brazil. METHODS: The study comprised cross-sectional surveys of a representative population of an urban slum (n = 1460) in Fortaleza, the capital of Ceará State (Brazil) and a fishing community 60 km south of the city (n = 605). Study participants were examined for the presence of scabies and pediculosis capitis. In a longitudinal study in the slum, variation of prevalence in different seasons of the year was assessed. RESULTS: Prevalence of pediculosis capitis was 43.4% in the slum and 28.1% in the fishing community. Children aged 10-14 years and females were most frequently affected. Scabies was present in 8.8% of the population in the slum and in 3.8% of the population in the fishing community. There was no consistent pattern of age distribution. Superinfection was common in patients with scabies, and cervical lymphadenopathy in patients with pediculosis capitis. Multivariate analysis showed that age < or = 15 years, being of female sex and living in the urban slum were independent factors contributing to the simultaneous coinfestation with pediculosis capitis and scabies. The longitudinal data from the urban slum showed a characteristic seasonal variation of pediculosis capitis, but no fluctuation of scabies. CONCLUSIONS: Pediculosis capitis and scabies are hyperendemic in the study areas and are associated with considerable morbidity. There is an urgent need to develop control measures for these parasitic skin diseases in resource-poor communities. This is the first community-based study describing in detail the epidemiology and morbidity of scabies and head lice infestation in Brazil.

Molecular biological investigations of Brazilian Tunga sp. isolates from man, dogs, cats, pigs and rats.

Twenty-four isolates of Tunga were collected from afflicted humans, dogs, cats, pigs and rats in Brazil. To investigate genetic diversity, a hypervariable section of mitochondrial 16S rDNA was amplified using PCR and subsequently sequenced. In order to compare results with another species of the genus Tunga, three isolates of the recently described Tunga trimamillata were also checked. Whereas eleven isolates (five from cats, three from dogs and three from humans) were of identical sequence, thirteen isolates collected from dogs, humans, pigs and rats showed differences in sequence up to 49%, so that the existence of one or more new species of Tunga may be presumed.

An unusual case of ectopic tungiasis with pseudoepitheliomatous hyperplasia

Tungiasis is caused by the penetration of the female sand flea Tunga penetrans into the epidermis, and subsequent hypertrophy of the parasite. In most cases lesions are confined to the feet. During a cross-sectional study, an unusual case of ectopic tungiasis in the inguinal area was detected. Histological examination of tissue samples showed a remarkable pseudoepitheliomatous aspect of the epidermis. Clinical features and differential diagnoses are discussed.

High attack rate of Tunga penetrans (Linnaeus 1758) infestation in an impoverished Brazilian community.

Tungiasis (jigger) is endemic in many impoverished communities in many parts of Brazil. Forty-seven individuals entering an endemic area were followed up for a period of six weeks and regularly examined for the presence of newly embedded sand fleas. At the end of the third week, the attack rate of Tunga penetrans infestation had already approached 100%.