Virulence factors associated with pediatric shigellosis in Brazilian Amazon.

Shigellosis is a global human health problem and the incidence is highest among children. In the present work, main Shigella virulence genes was examined by PCR and compared to symptoms of pediatric shigellosis. Thirty Shigella isolates were identified from an etiologic study at which 1,339 children ranging 0-10 years old were enrolled. S. flexneri was the most frequent species reaching 60.0% of isolates, 22.2% were S. sonnei, and 6.6% were both S. dysenteriae and S. boydii. All Shigella infected children had diarrhea, but not all were accompanied by others symptoms of bacillary dysentery. Among major virulence genes, the PCR typing revealed ipaBCD was present in all isolates, followed by IpaH7.8, set-1A, set-1B, sen/ospD3, virF, and invE. The pathogenic potential of the ShET-1B subunit was observed in relation to dehydration (P < 0.001) and ShET-2 related to the intestinal injury (P = 0.033) evidenced by the presence of bloody diarrhea. Our results show associations among symptoms of shigellosis and virulence genes of clinical isolates of Shigella spp.

Comparison of the performance of two spontaneous sedimentation techniques for the diagnosis of human intestinal parasites in the absence of a gold standard.

Performance evaluation of diagnostic tests is critical in the search for accurate diagnoses. A gold standard test is usually absent in parasitology, thus rendering satisfactory assessment of diagnostic accuracy difficult. Moreover, reliability (assessed by the study of repeatability) is a rarely studied characteristic of diagnostic tests. This study compared and evaluated the performance (repeatability, concordance and accuracy) of the spontaneous sedimentation technique (SST) and the Paratest for the diagnosis of Giardia lamblia, Entamoeba histolytica complex, Blastocystis spp., Ascaris lumbricoides, hookworm, Trichuris trichiura and Calodium hepaticum. Fecal samples of 143 individuals were separated into three replicates for each test. Concordance and homogeneity of the results between replicates of each test and between tests were evaluated. Proportions of positives, sensitivity and specificity were estimated using a Bayesian Latent Class Model. High repeatability of both tests was found for the detection of intestinal parasites, except for Blastocystis spp. and hookworm. Concordance between tests was generally high (concordance correlation coefficient, 0.72-0.88), except for Blastocystis spp., hookworm and T. trichiura. The Paratest detected more cases of Blastocystis spp. and fewer of hookworm than the SST. The tests were quite discordant in the detection of T. trichiura. A low sensitivity (39.4-49.2% for SST, 35.8-53.8% for Paratest) and a high specificity (93.2-97.2%) were found for both tests. The Paratest presented a slightly higher sensitivity for the diagnosis of Blastocystis spp. (53.8%), and SST did so for hookworm (49.2%). This is the first study on repeatability and accuracy (using a Bayesian approach) of two spontaneous sedimentation techniques. These results suggest underdiagnosis of little dense parasitic forms due to technical limitations in both tests. We conclude that the combined study of repeatability, concordance and accuracy is a key strategy for better evaluation of the performance of tests and is also useful for the identification of technical limitations.

Calodium hepaticum: household clustering transmission and the finding of a source of human spurious infection in a community of the Amazon region.

BACKGROUND: Calodium hepaticum (syn. Capillaria hepatica) is a worldwide helminth parasite of which several aspects of transmission still remain unclear. In the Amazon region, the mechanism of transmission based on the ingestion of eggs present in the liver of wild mammals has been suggested as the cause of the spurious infections described. We performed an epidemiological investigation to determine the incidence, risk of spurious infection and the dynamics of transmission of C. hepaticum in a community of the Brazilian Amazon. METHODOLOGY/PRINCIPAL FINDINGS: Stool samples of 135 individuals, two dog feces and liver tissue from a peccary (captured and eaten by the residents) were analyzed by conventional microscopy. Dog feces were collected from the gardens of households presenting human cases of spurious C. hepaticum infections. Community practices and feeding habits related to the transmission of the parasite were investigated. The individual incidence of spurious infection was 6.7% (95% CI: 2.08-11.24). Cases of spurious infection were observed in 7.5% of the families and the household incidence was from 50% to 83.3%. The risk of spurious infection was 10-fold greater in persons consuming the liver of wild mammals (p = 0.02). The liver tissue of a peccary and one feces sample of a dog presented eggs of C. hepaticum. The consumption of the infected liver was the cause of the spurious infections reported in one household. CONCLUSIONS/SIGNIFICANCE: This is the first identification of a source of spurious infection by C. hepaticum in humans and we describe a high rate of incidence in household clusters related to game liver alimentary habits. The finding of a dog feces contaminating peridomiciliary ground suggests the risk of new infections. We conclude that the mechanism of transmission based on the ingestion of liver is important for the dynamics of transmission of C. hepaticum in the studied area.