Immune complex detection in saliva samples: an innovative proposal for the diagnosis of human strongyloidiasis.

Human strongyloidiasis is caused by helminth Strongyloides stercoralis. It has a worldwide distribution, often neglected and cause of severe morbidity. The parasitological diagnosis is hindered by the low and irregular amount of larvae in feces. The goal of the present study was to detect IgG and IgG immune complex using conventional serum samples and saliva as alternative samples. We collected samples from 60 individuals, namely: group I composed of 30 healthy individuals; and group II composed of 30 individuals eliminating S. stercoralis larvae in feces. We calculated the area under the curve, general index of diagnostic accuracy, Kappa index and determined the correlations between different diagnostic tests. The detection of IgG levels was performed by an immunoenzymatic assay with alkaline extract of S. venezuelensis larvae as antigen. Positivity of anti-S. stercoralis IgG in serum samples from group I was 3·3%, and from group II 93·3%. The detection of immune complex indicated that group I exhibited 3·3% and group II 56·7%. In the saliva samples, IgG detection was 26·7% for group I and 43·3% for group II. Immune complex was detected in 20% of group I, and 30% of group II. IgG immune complex in conventional serum samples and saliva as alternative samples can be considered biomarkers for the diagnosis of active strongyloidiasis.

Use of larval, parasitic female and egg antigens from Strongyloides venezuelensis to detect parasite-specific IgG and immune complexes in immunodiagnosis of human strongyloidiasis.

The aim of this study was to use larval, parasitic female and egg antigens from Strongyloides venezuelensis to detect parasite-specific IgG and immune complexes in human serum samples by enzyme-linked immunosorbent assay (ELISA). In total, 95 serum samples were analysed, consisting of 30 patients harbouring S. stercoralis larvae, 30 healthy subjects and 35 patients with other parasites. Sensitivity, specificity and diagnostic efficiency were calculated. A significant statistical difference was found in the detection of immune complexes and antibodies in patients harbouring S. stercoralis larvae from larval and eggs antigens, with higher positivity using larval antigen. The larval antigen showed the highest values for sensitivity, specificity and diagnostic efficiency in ELISA from detection of immune complexes. For the first time we used IgG anti-larvae, IgG anti-parasitic females or IgG anti-eggs for immune complex detection. We concluded that the association of antibody and immune complex detection could be used in the diagnosis of human strongyloidiasis.

Evaluation of strongyloidiasis in kennel dogs and keepers by parasitological and serological assays.

Strongyloides stercoralis is an intestinal nematode with worldwide distribution, particularly in tropical and subtropical regions. Due to the low sensitivity of traditional parasitological methods, the detection of serum specific antibodies may serve as an alternative test for the diagnosis. The aims of the present study were to verify the occurrence of S. stercoralis and the presence of specific IgG antibodies to the parasite in kennel dogs and keepers, using parasitological and serological assays. A total of 181 dogs were examined from 7 breeding kennels in the city of Uberlândia, southeastern region of Brazil and distributed as follows: kennel A (n=41), kennel B (n=16), kennel C (n=11), kennel D (n=63), kennel E (n=11), kennel F (n=18) and kennel G (n=21). Fecal and serum samples from 11 keepers responsible for kennel cleaning and dog control were also collected in five of the seven kennels (two from kennel A, one from kennel B, four from kennel D, two from kennel E and two from kennel G). Overall, enteroparasites were detected by parasitological assays in 66, 36.5% (95% CI: 2.5-43.4%) of the 181 dogs tested. Only one (0.6%) dog was copropositive for S. stercoralis. Among the keepers only one fecal sample, 9.1% (95% CI: 8.6-9.4%) was positive for hookworm by the Lutz method. Serological assays showed that 44 (24.3%) of the 181 dogs were seropositive for S. stercoralis in at least one of the tests in the following kennels: 21 (11.6%) in kennel A; 1 (0.6%) in kennel B; 5 (2.7%) in kennel C; 6 (3.3%) in kennel D; 1 (0.6%) in kennel E; 9 (4.9%) in kennel F and 1 (0.6%) in kennel G. Among the keepers no S. stercoralis seropositive samples were identified using IFAT but 2 (18.2%) of the keepers from kennel D and 1 (9.1%) from kennel G were seropositive by ELISA. The present study demonstrated that the occurrence of S. stercoralis infection in kennel dogs and keepers is low in the city of Uberlândia and that serological assays can contribute to the diagnosis of canine as well as human strongyloidiasis.

Critical steps in fluoroquinolones and carbapenems prescriptions: results from a prospective clinical audit.

Antibiotic misuse is associated with emergence of resistance and high expenditures. Fluoroquinolones (FQ) and carbapenems (CP) are drugs with considerable potential of resistance development and its disseminated use is a concern. We undertook a prospective clinical audit to evaluate prescriptions of FQ and CP in a multistep process. Each prescription was unfolded in the following steps: indication for antimicrobial therapy; adequacy of initial prescription, dosage and route; previous cultures; and parenteral-oral transition. There was no antibiotics indication in 8.9% of FQ and 1.5% of CP group (p = 0.07). In CP 25.8% of initial schemes were inappropriate (21% in FQ). Lack of switch to oral therapy comprised 25% of monthly costs of FQ. Inadequacy in initial choice accounted for 13.6% of CP expenses. We concluded that, in spite of infection control restrictive policies, inappropriateness of antibiotic usage is worrisome. Clinical audit in a multistep approach may identify possible flaws in this process.

Parasitological and serological diagnosis of Strongyloides stercoralis in domesticated dogs from southeastern Brazil.

Canine strongyloidiasis is a parasitic infection caused by the nematode Strongyloides stercoralis and presents a great zoonotic potential. Its confirmation, using coproparasitological methods, is difficult. The detection of serum specific antibodies, however, may facilitate the diagnosis. The aims of this study were to determine the presence of S. stercoralis through the use of parasitological methods and to detect specific antibodies to the parasite in serum samples from domestic dogs by using the indirect fluorescent antibody test (IFAT) on slides and the enzyme-linked immunosorbent assay (ELISA). A total of 215 dogs of various breeds, from the cities of Uberlândia, Araxá and Campo Belo in the State of Minas Gerais, were examined and distributed according to age into the following groups: (I) 19 males and 20 females of 1-2 months old; (II) 11 males and 20 females of 2-month- to 1-year-old and (III) 41 males and 104 females, from 1 to 7 years old. Coproparasitological results showed that 63/215 (29.3%) of the dogs presented some kind of parasite, with two (0.9%) dogs (one from Araxá and the other from Uberlândia) passing S. stercoralis larvae in the feces. Serological results revealed antibodies to S. stercoralis in 45/215 (20.9%) of the dogs, with seropositivity rates of 0% (0/39) in Group I, 22.6% (7/31) in Group II, and 26.2% (38/145) in Group III. No serological cross-reactivity between S. stercoralis and hookworms or Ascaridae was found. Hookworm infections were seen in 31 dogs, but only one of these dogs (infected with both hookworm and Cystoisospora spp.) was S. stercoralis seropositive by IFAT. The present study demonstrated, for the first time, natural S. stercoralis infections in dogs diagnosed by coproparasitological and serological methods. It was concluded that the detection of specific antibodies to S. stercoralis by IFAT and ELISA may contribute to the diagnosis of canine strongyloidiasis.

Neurocysticercosis in Brazilian children: report of 10 cases.

In a 6-year period, ten cases of neurocysticercosis were diagnosed in children with ages ranging from 4 to 13 years, in a Brazilian teaching hospital. Most of the children presented epilepsy and/or raised intracranial pressure, but meningoencephalitis and psychotic reactions were also observed. The cerebrospinal fluid (CSF) cell count ranged from 1 to 52 cells per mm3, with pleocytosis in 6 cases, mostly by lymphocytes and eosinophils. Antibodies to Cysticercus cellulosae were detected in the CSF in all cases. A cranial radiograph was abnormal in 5 out of 6 cases, and a computed tomographic (CT) scan in 4 out of 8 cases. Stool examination was positive for ova and/or proglottids of Taenia sp in 4 out of the 10 cases. Seven patients were treated with either praziquantel or albendazole plus dexamethasone; there were no important side effects, and surgical treatment was required in no case. Neurocysticercosis must be included in the differential diagnosis of seizures, raised intracranial pressure, meningitis and psychotic reactions in children living in or having travelled to the tropics. The diagnosis can be suspected by the presence of eosinophils in the CSF, and confirmed by imaging methods such as CT scans and by immunological tests in the CSF.