[Blastocystis hominis in symptomatic celiac patients]. / Blastocystis hominis en pacientes celíacos sintomáticos.

INTRODUCTION: Celiac disease (EC) not diagnosed or treated affect histological, immunological and nutritional status of patients who suffer it. These changes allow infection by parasites that cause no symptoms in immunocompetent patients, such as Blastocystis hominis (Bh). OBJETIVE. To analyze the presence of Bh in symptomatic celiac patients and describe the clinical, histological, immune and nutritional status in these patients. MATERIAL AND METHOD An observational descriptive cross sectional study was performed. Thirty symptomatic celiac patients (18 women, mean age 41 years old, range 19-68 years), assisted at the Institute of Gastroenterology of Cuba from January to December 2009, entered the study. RESULTS: Diarrhea and chronic anemia were the most commonly reported clinical manifestations (22 and 4 patients, respectively). The analysis of more than five Bh per field was more frequent in the group ofpatients studied (63.3%), with statistically significant difference in patients with vilous atrophy and low weight (P < 0.03) compared to cases with less than five Bh per feld. No significant differences were found when the immune status of patients was analyzed. CONCLUSIONS. In symptomatic celiac patients with subtotal-total villous atrophy and low weight the finding of more than five Bh perfield should be considered as opportunistic.

Compromised nutrition in gerbils infected by Cystoisospora felis detected through an animal performance analysis tool.

The impact of Cystoisospora felis infection on the nutritional efficiency of gerbils was studied. The variables weight gain and feed intake were measured during four weeks in 28 laboratory gerbils, of which 14 were inoculated with 3.5 × 10(5) sporulated oocysts of C. felis and the remaining 14 were controls. The animals from both groups were weighted, killed, eviscerated and had their carcasses and tissues weighted and compared. A modern tool designed for measuring nutritional performance of farm animals was applied. The results showed compromised nutritional efficiency of the infected animals within the first week after infection. The consequences of these results are discussed here, including the potential impact of infection on farm animals performance.

Compromised nutrition in gerbils infected by Cystoisospora felis detected through an animal performance analysis tool / Comprometimento nutricional em gerbis infectados por Cystoisospora felis detectado através de uma ferramenta de análise de desempenho animal

The impact of Cystoisospora felis infection on the nutritional efficiency of gerbils was studied. The variables weight gain and feed intake were measured during four weeks in 28 laboratory gerbils, of which 14 were inoculated with 3.5 × 10(5) sporulated oocysts of C. felis and the remaining 14 were controls. The animals from both groups were weighted, killed, eviscerated and had their carcasses and tissues weighted and compared. A modern tool designed for measuring nutritional performance of farm animals was applied. The results showed compromised nutritional efficiency of the infected animals within the first week after infection. The consequences of these results are discussed here, including the potential impact of infection on farm animals performance.

O impacto da infecção por Cystoisospora felis na eficiência nutricional de gerbis foi estudado. As variáveis ganho de peso e consumo de ração foram mensuradas durante quatro semanas em 28 gerbis de laboratório, dos quais 14 foram inoculados com 3,5 × 10(5) oocistos esporulados de C. felis e os 14 restantes serviram como controle. Os animais de ambos os grupos foram pesados, mortos, eviscerados e tiveram suas carcaças e tecidos pesados e comparados. Uma ferramenta moderna desenvolvida para mensurar o desempenho nutricional de animais de produção foi aplicada. Os resultados mostraram eficiência nutricional comprometida dos animais infectados na primeira semana após a infecção. As consequências destes resultados são discutidas aqui, incluindo o possível impacto de infecção no desempenho de animais de produção.

Interactions of malnutrition and immune impairment, with specific reference to immunity against parasites.

1. Clinical malnutrition is a heterogenous group of disorders including macronutrient deficiencies leading to body cell mass depletion and micronutrient deficiencies, and these often coexist with infectious and inflammatory processes and environmental problems. 2. There is good evidence that specific micronutrients influence immunity, particularly zinc and vitamin A. Iron may have both beneficial and deleterious effects depending on circumstances. 3. There is surprisingly slender good evidence that immunity to parasites is dependent on macronutrient intake or body composition.

Factors associated with severe anaemia in Zambian children admitted with Plasmodium falciparum malarial anaemia.

Many cases of severe malarial anaemia are clinically stable, but some can deteriorate rapidly. In a cross-sectional survey of 255 children with clinically stable malarial anaemia, 72 had severe anaemia (PCV < or = 15%) and 183 were moderately anaemic (PCV < 15-21%). Being female, or febrile, or a referral and having low parasitaemia or hepatomegaly were the risk factors for severe anaemia.

Intestinal parasitoses and the nutritional status of Veddah children in Sri Lanka.

This study describes and compares the intestinal parasitoses and nutritional statuses of primary school children of Veddah (local indigenous population) and Sinhalese (more advanced society) in rural Sri Lanka. Children attending years 1-3 (age range 6-15 years) at Dambana Primary School (Veddah) and Wewatta Primary School (Sinhalese) were included in the study. Stools and blood samples were examined for evidence of intestinal parasites and anemia. The heights and weights of the children were measured and anthropometric indices calculated. There was a high prevalence of G. intestinalis and B. hominis (Giardia 7.8% and 6.2%; Blastocystis 17.2% and 17.3% at Dambana and Wewatta, respectively) in both communities, the predominant helminth being N. americanus (20.3% at Dambana and 14.8% at Wewatta; p>0.05). Other geohelminth infections were scarce in both communities. A greater proportion of boys than girls were underweight and stunted in both communities. Wasting and anemia was significantly high among the Veddah children.

Defective regulation of the protective IgE response against intestinal helminth Ascaris lumbricoides in malnourished children.

It is well established that malnutrition affects the immune response and increases the susceptibility to parasitic infection. In the present study we evaluated some aspects of the cellular and cytokine network that regulate the IgE responses, which are important components of host defence mechanisms against helminthic parasites in children infected with the intestinal helminth Ascaris lumbricoides, and with differing degrees of malnutrition. We found a defective T cell response in malnourished children, as indicated by diminished levels of circulating total (CD3+), helper (CD4+), IL-2-receptor-bearing (CD4+CD25+) and memory helper T cell responses (CD4+CD45RO+) in keeping with the decreased specific IgE levels against Ascaris lumbricoides. In contrast, the proportions of total B cells (CD20+), and those bearing the low-affinity IgE receptor (CD23+) were increased in the moderated malnourished children. Moreover, serum IL-4 levels and total IgE were also increased in these children. We suggest that malnutrition can cause an imbalance in T cell subpopulations that may lead to a defective T cell maturation and a decreased specific anti-Ascaris IgE response thus increasing the susceptibility to such infections. The high levels of total IgE observed may be related to a non-specific stimulation of the proliferation of activated B cells, probably caused by helminthic parasites and other infectious agents that are frequent in malnourished children.

Intestinal peptide transporter PepT1 is over-expressed during acute cryptosporidiosis in suckling rats as a result of both malnutrition and experimental parasite infection.

Cryptosporidium parvuminfection induces amino acid malnutrition leading to growth retardation in children. Owing to the nutritional efficiency of peptides compared to free amino acids and the resistance of the di-tripeptide transporter PepT1 to mucosal injury, we analyzed the intestinal expression of PepT1 during experimental acute cryptosporidiosis in suckling rats from day 4 to day 50. PepT1 mRNA levels were increased at the peak of infection (day 10) all along the small intestine and normalized after spontaneous clearance of the parasite (day 21). Immunolocalization of PepT1 showed that its expression was maintained in the brush border membrane of enterocytes in infected rats from day 4 to day 50 all along the small intestine. Our results suggest a transcriptional up-regulation during acute cryptosporidiosis in response to both C. parvum-induced malnutrition and parasite implantation. As no treatment is available, a semi-elemental diet should be considered part of the treatment of cryptosporidiosis.

Cryptosporidiosis: biology, pathogenesis and disease.

Ninety-five years after discovery and after more than two decades of intense investigations, cryptosporidiosis, in many ways, remains enigmatic. Cryptosporidium infects all four classes of vertebrates and most likely all mammalian species. The speciation of the genus continues to be a challenge to taxonomists, compounded by many factors, including current technical difficulties and the apparent lack of host specificity by most, but not all, isolates and species.

Cryptosporidiosis: epidemiology and impact.

Cryptosporidium was first recognized in humans in 1976 and came to prominence in the 1980s and 1990s as a cause of severe diarrheal illness in patients with AIDS. Its hardy, chlorine-resistant oocysts, tiny size, low infectious dose, fully infectious development when shed and zoonotic potential make it a threat in drinking and recreational water, contaminated food, day care centers, hospitals, and in persons with exposure to animals or unsanitary conditions, with potentially huge, long-term impact in malnourished children, as reviewed herein.

Phenotypic characterization of Schistosoma mansoni adult worms recovered from undernourished mice: a morphometric study focusing on the reproductive system.

A morphometric study focusing on some features of the reproductive system of Schistosoma mansoni adult worms was performed, aiming to complete previously reported data concerning the effects of undernourishment of the host on the parasites. Male worms were significantly affected (p<0.05) regarding the testicular lobes.

Malnutrition and susceptibility to enteroparasites: reinfection rates after mass chemotherapy.

The evidence that relates malnutrition to enteroparasite infections arises from studies that demonstrate the improvement of nutritional indicators after antiparasitism treatment. However, the role of malnutrition as an aggravating factor to the susceptibility to enteroparasite infections is still not fully understood. We investigated the correlation between malnutrition and enteroparasite infection after mass chemotherapy, in a poor city of São Paulo State, Brazil. The sample comprised 759 children between 1 and 10 years of age of whom 585 were followed up for a period of 1 year and periodically assessed for reinfection with enteroparasites. One year of follow-up after mass chemotherapy demonstrated that 38 of the undernourished children were reinfected with enteroparasites, as compared with 25 of the eutrophic children (P = 0.033). The survival multivariate analysis demonstrated that, after controlling for the potential confounding variables, maternal literacy and per capita income rate, malnutrition was associated with susceptibility to reinfection (P = 0.13). We demonstrate that, although maternal literacy and per capita income rate are indeed confounding variables, malnutrition contributes to an increase in the risk of enteroparasite infections.

Morphological aspects of Schistosoma mansoni adult worms isolated from nourished and undernourished mice: a comparative analysis by confocal laser scanning microscopy.

Malnutrition hampers the course of schistosomiasis mansoni infection just as normal growth of adult worms. A comparative morphometric study on adult specimens (male and female) recovered from undernourished (fed with a low protein diet - regional basic diet) and nourished (rodent commercial laboratory food, NUVILAB) white mice was performed. Tomographic images and morphometric analysis of the oral and ventral suckers, reproductive system and tegument were obtained by means of confocal laser scanning microscopy. Undernourished male specimens presented smaller morphometric values (length and width) of the reproductive system (first, third and last testicular lobes) and thickness of the tegument than controls. Besides that, it was demonstrated that the dorsal surface of the male worms bears large tubercles unevenly distributed, but kept grouped and flat. At the subtegumental region, vacuolated areas were detected. It was concluded that the inadequate nutritional status of the vertebrate host has a negative influence mainly in the reproductive system and topographical somatic development of male adult Schistosoma mansoni, inducing some alterations on the structure of the parasite.

Morphological aspects of Schistosoma mansoni adult worms isolated from nourished and undernourished mice: a comparative analysis by confocal laser scanning microscopy

Malnutrition hampers the course of schistosomiasis mansoni infection just as normal growth of adult worms. A comparative morphometric study on adult specimens (male and female) recovered from undernourished (fed with a low protein diet - regional basic diet) and nourished (rodent commercial laboratory food, NUVILAB) white mice was performed. Tomographic images and morphometric analysis of the oral and ventral suckers, reproductive system and tegument were obtained by means of confocal laser scanning microscopy. Undernourished male specimens presented smaller morphometric values (length and width) of the reproductive system (first, third and last testicular lobes) and thickness of the tegument than controls. Besides that, it was demonstrated that the dorsal surface of the male worms bears large tubercles unevenly distributed, but kept grouped and flat. At the subtegumental region, vacuolated areas were detected. It was concluded that the inadequate nutritional status of the vertebrate host has a negative influence mainly in the reproductive system and topographical somatic development of male adult Schistosoma mansoni, inducing some alterations on the structure of the parasite

Gastrointestinal nematodes, nutrition and immunity: breaking the negative spiral.

Nutritionists have long understood that intestinal nematode parasites have deleterious effects on host nutritional status, but only recently has the importance of malnutrition as a predisposing factor to intestinal nematodes been recognized. Here we review experimental and field studies on the effects of protein, energy, zinc, vitamin A, and iron deficiencies on gastrointestinal (GI) nematodes of humans, livestock, and laboratory rodents, and draw certain conclusions about the state of our current understanding. In general, malnutrition promotes the establishment, survival, and fecundity of these parasites, but the magnitude of the effect depends on factors such as host species, parasite species, particular infection protocol used, magnitude of the infection, severity of the nutritional deficiency, and presence of single or multiple infections and single or multiple nutritional deficiencies. We highlight the Th2 arm of the immune system as a component of primary importance in the association between malnutrition and GI nematode infections. We summarize what is known about underlying mechanisms that may account for the observed patterns. Finally, we suggest future research directions.

Association between nutritional indicators and infectivity of dogs seroreactive for Trypanosoma cruzi in a rural area of northwestern Argentina.

The association between the nutritional state of mongrel dogs naturally infected with Trypanosoma cruzi and their infectivity to Triatoma infestans bugs and immune response to Trypanosoma cruzi were studied in the rural village of Amamá, northwestern Argentina. All of the 97 evaluated dogs were classified into one of three categories of external clinical aspect (ECA) based on the degree of muscle development, external evidence of bone structures, state of the hair of the coat, existence of fatty deposits, and facial expression. ECA was significantly associated with two nutritional indicators, hematocrit and skin-fold thickness, but not with total serum proteins. For all dogs, hematocrit was significantly correlated with skin-fold thickness. The 2-year survival probability decreased significantly from 60.7% for dogs with good ECA to 45.9% and 31.2% for those with regular and bad ECA, respectively. The age-adjusted relative odds of infection for Triatoma infestans xeno-diagnosis nymphs that fed once on a dog seroreactive for Trypanosoma cruzi decreased significantly as ECA improved, when tested by multiple logistic regression analysis. A delayed hypersensitivity reaction was observed in all of the seroreactive dogs with good ECA but only in 45-50% of those with regular or bad ECA. Dogs with bad ECA had a 2.6 and 6.3 times greater probability of infecting triatomines after a single full blood meal than dogs with regular or good ECA, respectively. Our study shows that the reservoir competence of dogs for Trypanosoma cruzi was associated with ECA, which is a surrogate and valid index of nutritional state.

Infección por Cryptosporidium parvum en niños desnutridos y no desnutridos sin diarrea en una población rural mexicana / Cryptosporidium parvum infection in wellnourished and malnourished children without diarrhea in a Mexican rural population

El Cryptosporidium parvum causa enfermedad diarreica y afecta predominantemente a niños y a hospederos inmunocomprometidos. La mayoría de los casos de criptosporidiosis en sujetos inmunocompetentes son asintomáticos. Los objetivos del estudio fueron determinar la prevalencia de infección asintomática causada por el parásito en niños desnutridos y no desnutridos y determinar los factores de riesgo asociados a la infección. Métodos. Se incluyeron niños de 1 a 15 años de edad, sin diarrea. Se investigaron las condiciones socioeconómicas, sanitarias y de urbanismo tanto familiares como comunitarias y se realizó antropometría. Se buscaron parásitos en heces con técnica de Faust y Cryptosporidium parvum con la técnica de Kinyoun. Se calcularon razón de momios (OR), intervalos de confianza al 95 por ciento (IC95 por ciento), se utilizó c 2 de Mantel-Haenszel, c 2 para tendencias y prueba exacta de Fisher para evaluar asociaciones. Resultados. Se incluyeron a 132 niños. En 10/132 (7.5 por ciento) se encontraron ooquistes de Cryptosporidium, 7/71 en niños con desnutrición (9.8 por ciento) y 3/61 sin desnutrición (4.9 por ciento) (p = 0.23). El 69.7 por ciento de los niños cursaba con algún tipo de parasitosis. Al comparar a los niños de acuerdo a la presencia de C. parvum en heces, se obtuvieron los siguientes OR: Diarrea en familiares 5.82 (IC95 por ciento 0.86 - 39.18), no lavado de manos 5.08 (IC95 por ciento 0.62 - 110.49), edad > 5 años 4.90 (IC95 por ciento 0.60 - 106.9), ingesta de agua no intubada 3.34 (IC95 por ciento 0.40 - 73.01) y desnutrición 2.11 (IC95 por ciento 0.46 - 10.89). Se encontró asociación entre el número de habitantes de la vivienda y el riesgo de presentar infección (p= 0.005). La presencia de diarrea en familiares (OR= 4.15, IC95 por ciento 0.47 - 36.91) y el consumo de agua no intubada (OR= 4.19, IC95 por ciento 0.48 - 36.32) se identificaron como variables relevantes por el modelo de regresión logística. Conclusiones. La frecuencia de la infección por C. parvum fue del 7.5 por ciento. La ingesta de agua no intubada, el hacinamiento y la diarrea en familiares se asociaron significativamente con la infección por C. parvum, la desnutrición no fue un factor de riesgo estadísticamente significativo.

Características clínicas de la diarrea crónica asociada a Cryptosporidium / Cryptosporidium-associated chronic diarrhoea in malnourished infants

Introducción. Objetivo: describir las manifestaciones clínicas y de laboratorio de la diarrea crónica asociada a Cryptosporidium en lactantes desnutridos. Material y métodos. Cryptosporidium fue buscado en las heces de niños desnutridos de 2 a 24 meses de vida con diarrea crónica. Se excluyeron pacientes con inmunosupresión. Resultados. De 34 pacientes 20 fueron del sexo masculino, 14 fueron positivos para Cryptosporidium. La pérdida de peso durante su internamiento fue mayor (P= 0.001) en los positivos que en los negativos (24.2 por ciento) ; 83 por ciento de los positivos que no incrementaron peso estuvieron relacionados a la presencia de substancias reductoras en heces. La fiebre y el período más largo de internamiento fueron mayores en el grupo de positivos. Los exámenes de laboratorio no mostraron diferencias entre los grupos; el sodio en evacuaciones fue mayor de 70 mEq/L en los positivos. Conclusión. Los niños desnutridos con Cryptosporidium pueden desarrollar pérdida de peso y malabsorción de carbohidratos

Incidencia de parasitosis intestinales en pacientes pediátricos hematoncológicos de 1 a 15 años de edad / Frequent intestinal parasites in the hematologic patients

Introducción. Se hace referencia a los parásitos intestinales más frecuentes en los pacientes hematoncológicos y la asociación con desnutrición. Material y método. En la Unidad de Pediatría del Hospital General de México SSA, se estudió en forma prospectiva, observacional y descriptiva a un grupo de 85 pacientes hematoncológicos, provenientes de la consulta externa, con o sin síntomas parasitarios. Los pacientes se atendieron entre junio y diciembre de 1994. A todos se les realizaron estudios coproparasitoscópicos en serie de tres, por el método de Faust. Resultados. Se estudió un total de 85 niños de 1 a 15 años de edad; 59 se encontraron parasitados (69.5 por ciento) y 26 (30.5 por ciento) libres de parásitos. Conclusiones. Las afecciones más frecuente fueron: leucemia, tumores del sistema nervioso central y linfomas. Los parásitos más frecuentes fueron: Giardia lamblia, 28.7 por ciento, Entamoeba histolytica 26 por ciento, Ascaris lumbricoides 12.3 por ciento. De los 59 pacientes con algún parásito, 54 (91.4 por ciento) cursaron con algún grado de desnutrición