Infectious etiology and indicators of malabsorption or intestinal injury in childhood diarrhea. / Etiología infecciosa e indicadores de malabsorción o daño intestinal en diarrea infantil

INTRODUCTION: The multifactorial etiology of gastroenteritis emphasizes the need for different laboratory methods to identify or exclude infectious agents and evaluate the severity of diarrheal disease. OBJECTIVE: To diagnose the infectious etiology in diarrheic children and to evaluate some fecal markers associated with intestinal integrity. MATERIALS AND METHODS: The study group comprised 45 children with diarrheal disease, tested for enteropathogens and malabsorption markers, and 76 children whose feces were used for fat evaluation by the traditional and acid steatocrit tests. RESULTS: We observed acute diarrhea in 80% of the children and persistent diarrhea in 20%. Of the diarrheic individuals analyzed, 40% were positive for enteropathogens, with rotavirus (13.3%) and Giardia duodenalis (11.1%) the most frequently diagnosed. Among the infected patients, occult blood was more evident in those carrying pathogenic bacteria (40%) and enteroviruses (40%), while steatorrhea was observed in infections by the protozoa G. duodenalis (35.7%). Children with diarrhea excreted significantly more lipids in feces than non-diarrheic children, as determined by the traditional (p<0.0003) and acid steatocrit (p<0.0001) methods. Moreover, the acid steatocrit method detected 16.7% more fecal fat than the traditional method. CONCLUSIONS: Childhood diarrhea can lead to increasingly severe nutrient deficiencies. Steatorrhea is the hallmark of malabsorption, and a stool test, such as the acid steatocrit, can be routinely used as a laboratory tool for the semi-quantitative evaluation of fat malabsorption in diarrheic children.

Introducción. La etiología multifactorial de la gastroenteritis enfatiza la necesidad de usar diferentes métodos de laboratorio para identificar o excluir agentes infecciosos y evaluar la gravedad de la enfermedad diarreica. Objetivo. Diagnosticar la etiología infecciosa de la diarrea en niños y evaluar algunos marcadores fecales asociados con la integridad intestinal. Materiales y métodos. Se estudiaron 45 niños con enfermedad diarreica, en los cuales se evaluaron la presencia de enteropatógenos y los marcadores de malabsorción. Se analizaron las muestras fecales de 76 niños, mediante las pruebas de esteatocrito tradicional y esteatocrito ácido, para la cuantificación de la grasa. Resultados. Se observó diarrea aguda en el 80 % de los niños y diarrea persistente en el 20 %. De los individuos con diarrea, el 40 % fue positivo para enteropatógenos; los más diagnosticados fueron rotavirus (13,3 %) y Giardia duodenalis (11,1 %). Entre los pacientes infectados, la sangre oculta fue más evidente en aquellos portadores de bacterias patógenas (40 %) o enterovirus (40%), mientras que la esteatorrea se observó en infecciones por el protozoo G. duodenalis (35,7 %). Los niños con diarrea excretaron significativamente más lípidos en las heces que aquellos sin diarrea, según lo determinado por los métodos de esteatocrito tradicional (p<0,0003) y esteatocrito ácido (p<0,0001). Conclusiones. La diarrea infantil puede provocar deficiencias graves de nutrientes. La esteatorrea es distintiva de la malabsorción intestinal y puede detectarse mediante la estimación del esteatocrito ácido. Esta prueba podría utilizarse de forma rutinaria como una herramienta de laboratorio para la evaluación semicuantitativa de la malabsorción de grasas en niños con diarrea.

Detection of IgG Anti-Giardia duodenalis Antibodies in Sera by Indirect Immunofluorescence and Western Blotting Assays.

INTRODUCTION: Serological assays are alternative laboratory tools for the diagnosis of parasitic infections. The aim of this work was to evaluate the performance of the indirect fluorescent antibody test (IFAT) and Western blotting (WB) for the detection of IgG anti-Giardia antibodies in human sera. METHODOLOGY: Sera from individuals infected with Giardia duodenalis, other parasites or non-parasitized were selected for serological assays. Ninety-seven sera were tested by IFAT at 1:20 and 1:40 dilutions and of these, 40 samples were also analyzed by WB. RESULTS: The sensitivity and specificity of the IFAT was 97% and 46.9% at 1:20 sera dilution, and 39.4% and 59.4% at 1:40 sera dilution. The low molecular weight polypeptides fractions of 25 kDa, 27-31 kDa and 45-55 kDa were the most frequently identified by the sera of individuals infected with G. duodenalis, along with low cross-reactivity, presenting an individual sensitivity of 42.8%, 50.0% and 57.1%, and specificity of 83.3%, 83.3% and 91.7%, respectively. The highest overall sensitivity of WB (85.7%) was based on the immunoreactivity of sera with at least one of those proteins. The concordance between the detection of G. duodenalis in feces by microscopy and the WB results was considered substantial (Kappa = 0.61). CONCLUSION: Constant exposure to Giardia infection throughout a lifetime can maintain high levels of specific antibodies in serum, even without active infection. Moreover, proteins found in intestinal amoebas may hinder the serological diagnosis of giardiasis in endemic areas due to cross-reactivity, which can be partially solved using Giardia low molecular weight proteins.

Seroepidemiological Survey of Chronic Chagas Disease in a Rural Community in Southern Bahia, Brazil, Using Recombinant Chimeric Antigens.

Chagas disease (CD), caused by the parasite Trypanosoma cruzi, is a neglected tropical disease with life-threatening implications. In this study, we conducted a seroepidemiological survey to determine the prevalence and clinical profiles of CD in 217 individuals from an impoverished rural community in Southern Bahia, Brazil. The overall prevalence of CD in the studied community was 0.92%, detected through latent class analysis (LCA). Two individuals tested positive for anti-T. cruzi IgG, both being male farmers. One case was a 22-year-old man born in Camamu, with no evidence of congenital transmission, suggesting other routes of transmission such as vector-borne transmission due to migratory activities. The other case was a 69-year-old man born in São Felipe, who had lived in an adobe/brick house and had a pacemaker due to cardiac involvement caused by CD. The prevalence in this community was lower than expected, given the socioeconomic conditions and environmental factors that contribute to T. cruzi transmission. This could be attributed to the implementation of preventive measures and vector control programs by the Brazilian Government. However, continuous monitoring and surveillance are essential to sustain control efforts and detect any potential re-emergence of the disease. While the overall prevalence was low, the detection of positive cases underscores the need for continued surveillance and control measures in vulnerable populations, such as rural communities. Active surveillance, early diagnosis, and timely treatment are crucial in preventing disease progression and complications, thereby enhancing the effectiveness of screening and treatment programs.

Modulation of circulating cytokine production in alcoholic patients infected with Strongyloides stercoralis.

Strongyloidiasis control is associated with a Th2 immune response. However, alcohol ingestion plays an important role in modulating the immune system. The aim of this study is to evaluate the occurrence of Strongyloides stercoralis infection in alcoholic patients, the levels of circulating cytokines (IFN-γ, IL-2, IL-4, IL-5, IL-10, IL-15 and IL-17), and its correlation with modulation of parasitic load in alcoholic individuals infected with S. stercoralis. A total of 336 alcoholic patients, treated at the Alcoholic Care and Treatment Center were included in this study. The cytokine levels were measured by a commercial ELISA in 80 sera divided into four groups with 20 individuals each: alcoholics infected (ASs+) and not infected (ASs-) with S. stercoralis and non-alcoholics infected (NASs+) and not infected (NASs-) with the helminth. S. stercoralis frequency in alcoholic patients was 16.1% (54/336). The parasitic load varied from 1 to 546 larvae/g of faeces, median and interquartile range (IQR) of 9 and 1.0-62.5 larvae/g of faeces, while in non-alcoholic individuals the parasitic load was less than 10 larvae/g of faeces. Levels of circulating IL-4 were significantly higher in ASs+ when compared with NASs- group (p < .05). An inverse correlation between serum levels of IFN-γ and parasitic load in alcoholic patients infected with S. stercoralis was observed (r = -601; p < 0.01). These results suggest that modulation of IFN-γ production occurs in alcoholic individuals with high parasitic burden.

Cryptosporidium diagnosis in different groups of children and characterization of parasite species.

BACKGROUND: Microscopy and enzyme-linked immunosorbent assay (ELISA) are routinely used for Cryptosporidium diagnosis, without differentiating the parasite species. METHODS: Children's feces were analyzed by modified Ziehl-Neelsen (mZN) and ELISA for Cryptosporidium diagnosis and by polymerase chain reaction-restriction fragment length polymorphism for species identification. RESULTS: Cryptosporidium frequency was 2.6%. The sensitivity and specificity of ELISA were 85.7% and 99.7%, respectively, with excellent concordance with mZN (kappa=0.854). Parasite species were characterized as Cryptosporidium hominis (78.3%), Cryptosporidium felis (17.4%), and Cryptosporidium parvum (4.3%). CONCLUSIONS: Coproantigen ELISA is as efficient as mZN for Cryptosporidium diagnosis. Cryptosporidium genotyping suggests anthroponotic and zoonotic transmission to children.

Ineffectiveness of TF-Test® and Coproplus® Methods in Strongyloides stercoralis Infection Diagnosis.

PURPOSE: S. stercoralis diagnosis is currently performed by parasitological methods, mainly by Baermann-Moraes (BM), although Agar Plate Culture (APC) presents a higher sensitivity. New techniques, such as TF-Test® and Coproplus® have been suggested as more practical alternatives. The aim of this study was to evaluate the sensitivity of TF-Test® and Coproplus®, compared with APC, BM and Spontaneous Sedimentation (SS) methods. METHODS: One-hundred and forty male alcoholic patients, who provided three stools samples collected on alternate days, were included in this study. The most frequently found parasite was S. stercoralis, 20% (28/140), and the most sensitive method was APC, 96.4% (27/28), followed by BM, 89.3% (25/28) and SS, 57.1% (16/28). TF-Test® and Coproplus® presented a sensitivity of 46.4 (13/28) and 39.3% (11/28), respectively. In samples with a parasitic load of 1-10 larvae/g of feces, which occurred in 39.3% (11/28) of the infected patients, both the TF-Test® and Coproplus® methods demonstrated sensitivities of 18.2% (2/11), while APC and BM methods reached a sensitivity of 100% (11/11) (p < 0.05). For other intestinal helminth infections, TF-Test® and Coproplus® sensitivities were 22.2 (4/18) and 11.1% (2/18), respectively, this being lower than the SS, 66.7% (12/18) (p < 0.05). On the other hand, for protozoa infection diagnosis, TF-Test® and Coproplus® presented the highest sensitivities, 62.2 (46/74) and 43.2% (32/74), respectively. CONCLUSION: TF-Test® and Coproplus® methods presented the lowest sensitivities for S. stercoralis and other helminth infection diagnosis; therefore, they can be indicated for use in parasitological diagnosis, only when associated with other more effective methods of helminth identification.

Cryptosporidium diagnosis in different groups of children and characterization of parasite species

ABSTRACT Background: Microscopy and enzyme-linked immunosorbent assay (ELISA) are routinely used for Cryptosporidium diagnosis, without differentiating the parasite species. Methods: Children's feces were analyzed by modified Ziehl-Neelsen (mZN) and ELISA for Cryptosporidium diagnosis and by polymerase chain reaction-restriction fragment length polymorphism for species identification. Results: Cryptosporidium frequency was 2.6%. The sensitivity and specificity of ELISA were 85.7% and 99.7%, respectively, with excellent concordance with mZN (kappa=0.854). Parasite species were characterized as Cryptosporidium hominis (78.3%), Cryptosporidium felis (17.4%), and Cryptosporidium parvum (4.3%). Conclusions: Coproantigen ELISA is as efficient as mZN for Cryptosporidium diagnosis. Cryptosporidium genotyping suggests anthroponotic and zoonotic transmission to children.

Avaliação da anemia e outros biomarcadores em pacientes alcoolistas / Evaluation of anemia and other biomarkers in alcoholic patients

Introdução: os transtornos por uso de álcool afetam milhões de pessoas em todo o mundo e podem comprometer vários órgãos e sistemas, em muitos casos devido à deficiência de micronutrientes. O objetivo deste artigo é avaliar a frequência e caracterizar a anemia e os biomarcadores metabólicos e hepáticos em pacientes alcoolistas. Metodologia: trata-se de um estudo transversal, no qual foram incluídos 65 pacientes alcoolistas, do sexo masculino, internados no Centro de Acolhimento e Tratamento de Alcoolistas, das Obras Sociais Irmã Dulce. Resultados: a maioria dos indivíduos avaliados apresentou contagem de hemácias, teor de hemoglobina e hematócrito abaixo dos valores de referência, com uma frequência de 61,5% (40/65) para todos os parâmetros e uma média de 4,1x106/uL, 13,0 g/dL e 38,6%, respectivamente. Entre os 40 indivíduos que apresentaram anemia, prevaleceu um padrão normocítico (25/40) e normocrômico (32/40) e uma frequência de anisocitose de 35,0% (14/40). Observou-se elevada frequência de indivíduos com altos níveis de AST e GGT, 64,6 (42/65) e 76,9% (50/61), respectivamente, enquanto apenas 13,8 (9/65) e 3,1% (2/63) apresentaram alterações na concentração plasmática de albumina e no tempo de protrombina, respectivamente. Conclusão: neste trabalho, foi possível observar uma elevada frequência de anemia normocítica e normocrômica, bem como altos níveis de AST e GGT, enquanto os biomarcadores da função hepática estavam dentro do valor de referência. Estes resultados contribuem para o entendimento da saúde do indivíduo alcoolista, podendo auxiliar na elaboração de medidas públicas que atuem na prevenção e promoção da saúde desses pacientes.

Introduction: alcohol use disorders affect millions of people around the world and can compromise many organs and systems. The aim of the essay is to evaluate frequency and characterize anemia and metabolic and hepatic biomarkers in alcoholic patients. Methods: it is a cross-sectional study in which 65 male alcoholic patients admitted to treatment at Center for Reception and Treatment for Alcoholics at Sister Dulce Social Works. Results: most evaluated individuals had red blood cell count, hemoglobin content and hematocrit below reference values, with frequency of 61.5% (40/65) for all parameters and a mean of 4.1x106/uL, 13.0 g/dL and 38.6%, respectively. Among 40 individuals who presented anemia, a normocytic (25/40) and normochromic (32/40) pattern prevailed, and anisocytosis frequency of 35.0% (14/40). A high frequency of individuals with increased AST and GGT levels was observed, 64.6 (42/65) and 76.9% (50/61), respectively, while only 13.8 (9/65) and 3.1% (2/63) presented alterations in albumin levels and prothrombin time, respectively. Conclusion: study shows that it was possible to observe a high frequency of normocytic and normochromic anemia, as well as high levels of AST and GGT, while liver function biomarkers were within reference value. Results contribute to the understanding of alcoholic individuals' health, and may help with elaboration of public measures to prevention and promotion of health for these patients

Perfil epidemiológico das parasitoses intestinais em moradores de uma comunidade da Ilha de Boipeba, Bahia, Brasil / Epidemiological profile of intestinal parasites in residents of a community on the island of Boipeba, Bahia, Brazil

Introdução: as parasitoses intestinais constituem-se um importante problema de saúde pública mundial. Estas infecções são mais prevalentes em regiões tropicais impactando na morbimortalidade e aumento nos custos para o sistema de saúde. Objetivo: avaliar a prevalência das enteroparasitoses e sua associação com as condições socioeconômicas, sanitárias, ambientais e hábitos de vida em uma comunidade costeira do Nordeste brasileiro. Metodologia: estudo epidemiológico, descritivo e transversal, realizado de modo não probabilístico entre março a junho de 2017, com 105 moradores da Ilha de Boipeba, localizada no Sul da Bahia. O exame parasitológico de fezes foi realizado pelos métodos de sedimentação espontânea, Baermann-Moraes e FAUST. Um questionário foi aplicado para avaliar o perfil sociodemográfico da população. Resultados: do total de indivíduos avaliados, 52,4% eram do sexo feminino e 57,1% tinham entre 15 a 59 anos. Todos os indivíduos possuíam água encanada, porém não tratada, enquanto 91,4% referiu ingerir vegetais crus e 45,7% não higienizavam as mãos antes as refeições. Sintomas gastrointestinais foram relatados em 82,8% dos indivíduos e infecções enteroparasitárias foram diagnosticadas em 69,6%. Os parasitos mais frequentemente encontrados foram Ancilostomídeo (18,1%) e Entamoeba coli (43,8%). O principal fator de risco potencial para contrair a infecção por ancilostomídeos foi a não existência de poço artesiano na residência (RP=4,35), enquanto para Trichuris trichiura foi não dispor de pia no banheiro (RP=3,82). Conclusão: a comunidade analisada apresentou elevada prevalência de enteroparasitoses. Os hábitos precários de higiene e de acesso à água tratada, associados às condições ambientais e climáticas do local, podem ter contribuído para a elevada transmissão de geohelmintos observada.

Introduction: Intestinal parasitic infections are an important public health problem worldwide. They are more prevalent in tropical regions impacting in morbidity and mortality and costs for the health system. Objective: To evaluate the prevalence of enteroparasitosis and its association with socioeconomic, sanitary and environmental conditions and lifestyle habits in a coastal community in the Northeast Brazil. Methodology: This is an epidemiological, descriptive and cross-sectional study, carried out in a non-probabilistic manner between March and June 2017, with 105 residents of Boipeba Island in the Southern Bahia. The parasitological examination of feces was carried out by the methods of spontaneous sedimentation, Baermann-Moraes and FAUST. A questionnaire was applied to assess the sociodemographic profile of the population. Results: Of the total of individuals evaluated, 52.4% were female and 57.1% were between 15 and 59 years old. All individuals had piped, but untreated water, while 91.4% reported eating raw vegetables and 45.7% did not wash their hands before meals. Gastrointestinal symptoms were observed in 82.8% individuals and 69.6% were diagnosed with enteroparasitic infections. The most frequent parasites were the hookworm (18.1%) and Entamoeba coli (43.8%). The main potential risk factor for hookworm infection was the non-existence of an artesian well in the residence (PR=4.35) and Trichuris trichiura it was not having a sink in the toilet (PR=3.82). Conclusion: The analyzed community has a high prevalence of enteroparasitosis, in addition to environmental and climatic conditions that contribute to the transmission of these infections.

Development of rSs-NIE-1 and rSs-IR Recombinant Antigen-Based Immunoblot for Detection of Antibody to Strongyloides stercoralis.

Strongyloides stercoralis is a soil-transmitted nematode that can cause life-threatening conditions in immunocompromised persons. In the United States, strongyloidiasis should be considered mainly in immigrants, refugees, or travelers. The confirmatory laboratory diagnosis is usually performed by detecting larvae from the stool, duodenal material, and sputum. In persons who are immunocompromised with severe strongyloidiasis, adult worms and eggs can be detected from duodenal material. For serological diagnosis, most assays use crude antigens to detect anti-S. stercoralis IgG. Recently, recombinant proteins such as rSs-NIE-1 and rSs-IR have been used to detect IgG antibodies. We used rSs-NIE-1 and rSs-IR recombinant antigens to develop a biplex Western blot assay to detect the IgG4 antibody in individuals with strongyloidiasis. The sensitivities of rSs-NIE-1 and rSs-IR were 97.4% and 90.8%, respectively, whereas the specificities were 97.6% and 98%, respectively. In conclusion, the biplex rSs-NIE-1 and rSs-IR immunoblot performs well in detecting IgG4 antibody in S. stercoralis-infected persons.

Specific IgG and IgA Antibody Reactivities in Sera of Children by Enzyme-Linked Immunoassay and Comparison With Giardia duodenalis Diagnosis in Feces.

BACKGROUND: Giardia duodenalis is conventionally diagnosed in fecal samples using parasitological methods. However, sensitivity is poor when only a single sample is analyzed, due to intermittent excretion of cysts in feces. Alternatively, the serum antibodies to G. duodenalis can be used for parasite diagnosis and epidemiological studies to determine previous exposure. We compared the rate of G. duodenalis infection between serum anti-Giardia IgG and IgA antibodies and fecal examination in Brazilian children. METHODS: Fecal and serum samples were tested from 287 children at a clinical laboratory and from 187 children at daycare centers. Fecal samples were processed using conventional parasitological methods and coproantigen detection for Giardia diagnosis. Serum samples were tested using an in-house ELISA for detection of anti-Giardia IgG and IgA. RESULTS: G. duodenalis was found in 8.2% (N=39) of the 474 children analyzed. The sensitivity and specificity of ELISA were 80.0% and 90.0% for IgG and 80.0% and 83.3% for IgA, respectively. The total positivity rate of anti-Giardia IgG and IgA in the sera was 13.9% (N=66) and 23.6% (N=112). The agreement between the positivity of specific antibodies and the detection of G. duodenalis in feces was moderate for ELISA-IgG, kappa index (95% CI)=0.543 (0.422-0.664), and mild for ELISA-IgA, kappa index (95% CI)=0.283 (0.162-0.404). Among the children infected with other enteroparasites, 11.6% (N=10) and 24.4% (N=21) showed reactivity to anti-Giardia IgG and to IgA, respectively. This cross-reactivity was more frequent in samples from children infected with Endolimax nana and Entamoeba coli. CONCLUSIONS: The higher frequency of specific antibody reactivity compared with G. duodenalis diagnosis in feces could reflect continuous exposure of children to G. duodenalis infection, resulting in long-lasting immunological memory and/or cross-reactivity with other intestinal amoebas.

Alcohol consumption alters anti-Strongyloides stercoralis antibodies production.

Individuals infected with Strongyloides stercoralis have been reported to produce different immunoglobulins isotypes, yet few studies have evaluated their use in strongyloidiasis diagnosis. The aim of this work was to evaluate the immunoreactivity of different classes and subclasses of anti-S. stercoralis circulating antibodies in alcoholic patients by ELISA and to perform immunoblotting in samples with discordant results between parasitological and immunological methods. 345 male patients with a clinical diagnosis of alcoholism hospitalized at a reference center for alcoholics in Salvador, Bahia, Brazil, were included in this study. The fecal samples were examined by three different parasitological methods (spontaneous sedimentation, Baermann-Moraes and Agar Plate Culture methods). The ELISA was performed for the detection of IgG, IgG1, IgG4, IgE and IgA1 anti-S. stercoralis. Immunoblotting, for the detection of specific IgA1, was used to elucidate discordant results between parasitological and immunological methods. S. stercoralis infection frequency in alcoholic patients by parasitological methods was 21.4% (74/345). Although IgE-ELISA demonstrated a high sensitivity and specificity in non-alcoholic patients, about 30% (22/74) of alcoholics with larvae in feces were negative. IgG1-ELISA detected the lowest frequency of antibodies in alcoholic patients with larvae in feces, only 57% (42/74). IgG4-ELISA was the best assay for S. stercoralis infection immunodiagnosis. Immunoreactivity in the immunoblotting for IgA1 at 90, 75, 26 and/or 17 kDa bands was observed in 92% (33/36) of alcoholics with larvae excretion and negative ELISA for one or more antibody isotypes. In conclusion, IgG4-ELISA showed the highest sensitivity and specificity, thus demonstrating its superiority for strongyloidiasis immunodiagnosis in alcoholic and non-alcoholic individuals. Both, IgE and IgG1-ELISA presented high sensitivities and specificities for S. stercoralis infection diagnosis in non-alcoholics, however there was low reactivity in alcoholic individuals. This can be associated with an increased susceptibility to severe strongyloidiasis in these patients. IgA1-immunoblotting can be used to confirm S. stercoralis infection when there are discordant results between parasitological methods and ELISA.

Enteroparasitoses e aspectos socioeconômicos em pacientes alcoolistas / Intestinal parasites and socioeconomic aspects of alcoholic patients

Introdução: as enteroparasitoses constituem um problema de saúde pública que atinge as populações mais vulneráveis. O alcoolismo é um problema que afeta milhões de pessoas em todo o mundo, apresenta efeitos nocivos à saúde dos indivíduos e predispõe à infecção por S. stercoralis e às formas mais graves da estrongiloidíase. Objetivo: avaliar a prevalência da infecção das enteroparasitoses, bem como fatores socioeconômicos e sanitários de pacientes alcoolistas atendidos em um centro de tratamento especializado em Salvador, Bahia. Metodologia: trata-se de um estudo transversal, realizado com pacientes alcoolistas (n=277), do sexo masculino, atendidos em um centro de tratamento entre julho de 2014 e junho de 2017. O estudo foi realizado através da aplicação de um questionário estruturado para obtenção de dados socioeconômicos, demográficos e sanitários, sendo solicitadas, ainda, pelo menos duas amostras de fezes em dias alternados. O diagnóstico parasitológico foi realizado pelos métodos de sedimentação espontânea, Baermann-Moraes e cultura em placa de ágar. Resultados: a média de idade dos pacientes inclusos foi de 44,8 ± 9,5 anos. Verificouse que 35,7% dos pacientes estavam infectados com algum enteroparasito e, desses, 30,3% eram monoparasitados. Os parasitos mais frequentes foram S. stercoralis, Endolimax nana e ancilostomídeos, correspondendo 16,6%, 11,2% e 5,8%, respectivamente. Conclusão: dessa forma, S. stercoralis foi o parasito mais frequente, e a associação entre a infecção por esse parasito e o alcoolismo pode levar à estrongiloidíase grave. A elevada frequência de enteroparasitoses nesses pacientes, principalmente por protozoários, deve-se à ausência de higiene pessoal, pois esses indivíduos são suscetíveis à infecção oral fecal. A implementação de medidas de saneamento básico e de campanhas de conscientização para prevenção de infecções parasitárias é imprescindível para a saúde das populações mais vulneráveis.

Introduction: intestinal parasitoses are a public health issue that notably affects vulnerable populations. Alcoholism is a problem that affects millions worldwide by causing damaging effects to the health of individuals as it predisposes them to that infection through stercralisàs and more evolved forms of strongyloidiasis. Objective: evaluate the prevalence of intestinal parasite infections as well as socioeconomic and sanitation factors in a population of alcoholic patients at a specialized treatment facility in Salvador, Bahia. Methodology: this cross-sectional study was carried out with male alcoholic patients (n=277) at a treatment facility from July/2014 to June/2017. The research data were collected through a structured questionnaire aimed to obtain socioeconomic, demographic and sanitation information. Stool tests were ordered in alternate days. The parasitological diagnosis was based on methods of spontaneous sedimentation, Baermann-Moraes and Agar plate growth medium. Results: the patients' average age was 44,8 ± 9,5 years. A total of 35% of the patients was infected with a type of enteroparasite, of whom 30,3% was mono-infected. The most commonly found parasites were S. stercoralis, Endolimax nana and hookworm, corresponding to 16,6%, 11,2% e 5,8%, respectively. Conclusion: as such, S. Stercoralis was the most frequent parasite in this population and the association between the infection by this parasite and alcoholism may lead to severe strongyloidiasis. The high rates of enteroparasitism in those patients, particularly protozoa, are due to the lack of adequate personal hygiene, given those individuals are prone to acquire infections transmitted through the oral fecal route. An implementation of public health sanitation measures and the launch of public awareness campaigns in order to prevent parasite infections are vital to the health of vulnerable populations.

Case Report: Strongyloides stercoralis Hyperinfection in a Patient with HTLV-1: An Infection with Filariform and Rhabditiform Larvae, Eggs, and Free-Living Adult Females Output.

Strongyloides stercoralis is the main etiological agent of human strongyloidiasis. Severe strongyloidiasis is commonly associated to alcoholism, corticostereoid use, and human T cell lymphotropic virus type 1 (HTLV-1) coinfection. Herein, we report a case of a 13-year-old boy coinfected with S. stercoralis and HTLV-1, excreting several parasitic forms in the stool. The parasitological examination of his feces showed a large amount of filariform (about 3,000 larvae per gram of feces) and rhabditiform larvae (about 2,000 larvae per gram of feces). In addition, free-living adult females (about 50 parasites per gram of feces) and eggs (about 60 eggs per gram of feces) were detected. The main laboratory findings pointed to high immunoglobulin E (IgE) levels (228 UI/mL) and eosinophila (11.6%). The patient was treated with three courses of ivermectin (200 µg/kg twice, 2 weeks apart), achieving the parasitological cure. An increase of about 19 times in interleucin (IL)-17 level was observed following the parasitological cure, in addition to a decrease in the white blood cell, eosinophil counts, and IgE levels. This is the first case report, to our knowledge, in which an S. stercoralis adult free-living female was described in human feces and where an increase in IL-17 levels after Strongyloides treatment in a HTLV-1 coinfected individual was observed. This finding raises the need for further studies about IL-17 immunomodulation in S. stercoralis and HTLV-1 coinfected patients.

Association between seroprevalence of IgG anti-Toxoplasma gondii and risk factors for infection among pregnant women in Climério de Oliveira Maternity, Salvador, Bahia, Brazil.

Maternal Toxoplasma gondii (T. gondii) infection can lead to spontaneous abortion, fetal malformation, and numerous sequelae in the newborn, including visual and hearing impairment. T. gondii serology was determined in pregnant women and their newborns who were referred to Climério de Oliveira Maternity, Federal University of Bahia, and the possible associations with the risk factors for maternal infection were investigated. This cross-sectional study was conducted from January to December 2014 and included 712 pregnant women, aged 15 to 49 years, and 235 newborns. Seroprevalence was determined by the detection of T. gondii-specific immunoglobulin (Ig) M (IgM) and IgG antibodies using enzyme-linked immunoassay. In addition, mothers completed a questionnaire that focused on socioeconomic aspects, and survey data were tabulated using the SPSS statistical software program (version 21.0 for Windows). The seroprevalence rate for specific IgG antibodies was 51% (362) among mothers and 93% (219) among neonates. All the mothers and their newborns were negative for specific-IgM antibodies. Higher age group and lower maternal education were the only risk factors statistically associated with the presence of specific IgG. In summary, high levels of specific IgG antibodies were observed in pregnant women. The knowledge of risk factors for toxoplasmosis can help in the orientation of newly pregnant women.

Alterations in serum paraoxonase-1 activity and lipid profile in chronic alcoholic patients infected with Strongyloides stercoralis.

The objective of this study was to investigate paraoxonase-1 (PON1) activity, cortisol levels, and the lipid profile in the sera of alcoholic and non-alcoholic Strongyloides stercoralis-infected and uninfected individuals in a sample of 276 individuals attended at the National Health System in Salvador, Bahia, Brazil. The activity of PON1 was measured by the Beltowski method, serum lipids, and cortisol levels using commercial kits. PON1 activity was low in both alcoholic and non-alcoholic individuals infected with S. stercoralis. A positive correlation was observed between PON1 activity and cortisol concentration in alcoholic individuals who were not infected with S. stercoralis; whereas a negative correlation occurred in S. stercoralis-infected nonalcoholic individuals. The levels of triglycerides, LDL-C, and VLDL-C in S. stercoralis-infected alcoholic individuals were significantly lower than in uninfected alcoholic individuals. The high level of HDL-C and the low level of LDL-C, VLDL, triglycerides and PON1 activity in alcoholic patients infected with S. stercoralis evidenced an anti-atherogenic pattern.

[Concordance between the zinc sulphate flotation and centrifugal sedimentation methods for the diagnosis of intestinal parasites].

INTRODUCTION: The diagnosis of intestinal parasitic infections depends on the parasite load, the specific gravity density of the parasite eggs, oocysts or cysts, and the density and viscosity of flotation or sedimentation medium where faeces are processed. OBJECTIVE: To evaluate the concordance between zinc sulphate flotation and centrifugal sedimentation in the recovery of parasites in faecal samples of children. MATERIALS AND METHODS: Faecal samples of 330 children from day care centers were evaluated by zinc sulphate flotation and centrifugal sedimentation techniques. The frequencies of detection of parasites by each method were determined and the agreement between the diagnostic techniques was evaluated using the kappa index, with 95% confidence intervals. RESULTS: The faecal flotation in zinc sulphate diagnosed significantly more cases of Trichuris trichiura infection when compared to centrifugal sedimentation (39/330; 11.8% vs. 13/330; 3.9%, p<0.001), with low diagnostic concordance between methods (kappa=0.264; 95% CI: 0.102-0.427). Moreover, all positive samples for Enterobius vermicularis eggs (n=5) and Strongyloides stercoralis larvae (n=3) were diagnosed only by zinc sulphate. No statistical differences were observed between methods for protozoa identification. CONCLUSIONS: The results showed that centrifugal flotation in zinc sulphate solution was significantly more likely to detect light helminths eggs such as those of T. trichiura and E. vermicularis in faeces than the centrifugal sedimentation process.

Strongyloides stercoralis infection in patients with systemic lupus erythematosus: diagnosis and prevention of severe strongyloidiasis.

AIM: Strongyloides stercoralis infection is usually chronic and asymptomatic and may persist undiagnosed for decades. However, in immunocompromised individuals, the infection can cause hyperinfection and dissemination. Therefore, early diagnosis is essential to prevent severe forms of strongyloidiasis. The aims of this study were: (i) to evaluate the frequency of S. stercoralis infection in patients with systemic lupus erythematous (SLE) and (ii) to estimate specific immunoglobulins G (IgG) and E (IgE) production using an enzyme-linked immunosorbent assay (ELISA) method. METHODS: Seventy-five SLE patients treated with prophylactic anthelmintic therapy were evaluated using the spontaneous sedimentation (SS), Baermann-Moraes (BM) and agar plate culture (APC) methods. Serum anti-S. stercoralis IgG and IgE antibodies were measured by ELISA. RESULTS: Using parasitological methods, the frequency of intestinal parasites was 10.7%, whereas the frequency of S. stercoralis infection was 1.3%. The sensitivity of the ELISA to detect anti-S. stercoralis IgG and IgE was 80% and 76.9%, respectively. Both assays presented the same specificity of 96.7%. The frequency of anti-S. stercoralis IgG and IgE was 16% and 28%, respectively. Six patients were positive for both antibodies. CONCLUSIONS: Diagnostic approaches using high-sensitivity parasitological methods and the detection of specific antibodies are essential for the diagnosis of strongyloidiasis in immunocompromised patients. Early detection of infection can alter the course of the disease via appropriate treatment, preventing the occurrence of severe strongyloidiasis.

Recurrence of strongyloides stercoralis infection in a patient with Hansen's disease: a case report.

In patients with immunosuppressive disorders, S. stercoralis infection may develop into a hyperinfection syndrome which, on rare occasions, may be a life-threatening condition. Therapy of S. stercoralis infection with thiabendazole has been limited, due to its numerous side effects, and has been replaced by albendazole and ivermectin. The present case report describes a case of Strongyloides Hyperinfection Syndrome (SHS) in a patient with Hansen's disease and lack of response to first-line anthelmintic treatment. A 38 year-old man was diagnosed as having borderline lepromatous leprosy. He developed Erythema Nodosum Leprosum and was treated with thalidomide and prednisone. In May 2010 he was diagnosed with S. stercoralis infection and was treated with albendazole. One year later, the stool examination showed continued presence of S. stercoralis larvae. He was treated with ivermectin (6 mg) in a double dose (given 1 month apart) which resulted in larvae excretion clearance. The absence of infection was confirmed three times during a 1 year followup period by stool examination and non-detection of anti-S. stercoralis IgG levels.

Human infection by Trichostrongylus spp. in residents of urban areas of Salvador city, Bahia, Brazil / Infección humana por Trichostrongylus spp. en residentes de zonas urbanas de la ciudad de Salvador, Bahia, Brasil

Introduction: Nematodes of Trichostrongylus genus are mainly parasites of herbivores, although sporadic human infections have been reported in many countries. Objective: To describe the frequency and seasonality of Trichostrongylus spp. infection in individuals attended at a public clinical laboratory. Materials and methods: Fecal samples of 9,283 individuals were evaluated by spontaneous sedimentation (Lutz) in the Parasitology Laboratory of the Pharmacy College, Federal University of Bahia, Brazil, from January of 2006 to May of 2008. The positive samples for either Trichostrongylus spp. or hookworms were further examined to evaluate the morphometry of nematode eggs. Results: One-hundred and ten patients (1.2%) were confirmed to be infected by Trichostrongylus spp. The positive cases were significantly more frequent in females (1.6%; p <0.05), with higher distribution in the age group between 11-20 years (1.9%), compared to those aged 51-60 (0.8%) and older than 60 years (0.9%)( p <0.05), independent of gender. Trichostrongylus spp. infections were more common from March to May (40 cases) and showed a homogeneous distribution over the other periods of the year (21-25 cases). The hematological analyses of 60 Trichostrongylus -infected patients showed normal levels of eosinophils in most of the positive cases. Conclusions: The data reveal that the occurrence of infection by Trichostrongylus spp. in residents of Salvador is more frequent than those reported in other urban regions and that it is essential to distinguish the parasite from other nematodes in routine parasitological examination.

Introducción. Los nematodos del género Trichostrongylus son parásitos principalmente herbívoros, aunque se hayan descrito en muchos países infecciones humanas esporádicas. Objetivo. Describir la frecuencia y estacionalidad de la infección por Trichostrongylus spp. en individuos atendidos en un laboratorio clínico público. Materiales y métodos. Las muestras fecales de 9.283 individuos fueron analizadas mediante sedimentación espontánea (Lutz) en el Laboratorio de Parasitología de la Facultad de Farmacia de la Universidad Federal de Bahía, Brasil, desde enero de 2006 a mayo de 2008. Las muestras positivas para Trichostrongylus o Ancylostoma fueron reexaminadas para evaluar la morfometría de los huevos de nematodos. Resultados. La infección por Trichostrongylus spp. se confirmó en 110 pacientes (1,2 %), con mayor frecuencia en el sexo femenino (1,6 %; p<0,05). La frecuencia fue mayor en el grupo de edad de 11 a 20 años (1,9 %), independientemente del sexo, en comparación con las personas de 51 a 60 (0,8 %) y con los mayores de 60 años (0,9 %) (p < 0,05). Las infecciones por Trichostrongylus spp. fueron más frecuentes entre marzo y mayo (40 casos) con una distribución homogénea en otros periodos del año (21 a 25 casos). Los análisis hematológicos de 60 pacientes infectados con Trichostrongylus spp. presentaron niveles normales de eosinófilos en la mayoría de los casos positivos. Conclusiones. Los datos revelan que la incidencia de la infección por Trichostrongylus spp. en individuos residentes en Salvador es más frecuente que las descritas en otras áreas urbanas y, por ello, es esencial distinguir dicho parásito de otros nematodos en los exámenes parasitológicos de rutina.