Toxoplasmosis outbreak in São Paulo, Brazil: Epidemiology and visual outcome

ABSTRACT Purpose: To describe a 2019 acute toxoplasmosis outbreak in the city of São Paulo, Brazil, and to evaluate the laboratory serological profile for toxoplasmosis for three consecutive years. The ophthalmological manifestations of the patients involved in the outbreak were also studied. Methods: A cross-sectional descriptive study of a toxoplasmosis outbreak in São Paulo, Brazil, between February and May 2019. Epidemiological data were described, as were the observed ocular manifestations. As part of this study the number of patients with positive IgM toxoplasmosis serology was obtained from a large laboratory network (DASA) for three consecutive years, including the year of the outbreak (2018, 2019, 2020). Results: Eighty-three individuals were identified in the outbreak and two clusters were studied. The clinical picture of at least 77% of the patients, the epidemiological analysis, and the short incubation period (5-8 days) suggested contamination by oocysts. Serological laboratory data analysis revealed an increase of positive toxoplasmosis IgM in 2019 of 73% compared to the previous year. Ophthalmological examination revealed that at least 4.8% of the patients developed toxoplasmic retinochoroiditis, none of whom had been treated during the acute systemic disease. Conclusion: Our findings indicate vegetable contamination as the possible source of this outbreak, a high prevalence of toxoplasmosis in São Paulo during the outbreak period, and a drop in the number of tests during the COVID-19 pandemic. Retinochoroiditis was observed in at least 4.8% of the cases. We confirm the need to implement effective means for the prevention, diagnosis, and treatment of the disease. This may involve raising awareness among the population of the importance of vegetable hygiene, and improved quality control of food and water.

Occurrence of parasites in salads in restaurants in Aparecida de Goiânia, Goiás, Brazil

Parasitoses are the most widespread diseases in the world. They are transmited via contaminated water or food. Considering that the daily consumption of vegetables is estimated at 142g per person, the purpose of this study was to evaluate the occurrence of parasites in salads available for consumption in restaurants in Aparecida de Goiânia, Goiás State. Salad samples were collected from the restaurants and parasitological analysis was performed using the Willis, Hoffman, Faust and Ziehl Neelsen techniques as well as cultures for the isolation of free-living amoebae. 51 samples were analyzed, 16 (31.4%) were positive. The parasites detected were: Acanthamoeba spp. in 12 (23.5%); free-living larvae, Schistosoma mansoni and Entamoeba coli in 1 (2.0%); Endolimax nana in 2 (3.9%). The PCR technique determined that 17.6% of the samples presented Toxoplasma gondii DNA. These techniques evidenced that the salad samples presented parasite contamination not only in the restaurants with the lowest price per Kg, but also in the most expensive ones. Therefore, in addition to effective sanitary surveillance, prophylactic measures are necessary regarding suppliers, handlers and restaurant owners to prevent the spread of these and other parasites.

Contaminação por enteroparasitas em Alfaxces (Lactuca sativa) comercializadas na cidad de Araraquara (SP) e na micro-região (Américo Brasiliense, Matão, Santa Lúcia, Rincão e Taquaritinga),Brasil / Enteroparasite contamination in Alfaces (Lactuca sativa) commercialized in the city of Araraquara (SP) and in the micro region (Américo Brasiliense, Matão Santa Lúcia Rincão and Taquaritinga), Brazil

Objetivo ­ Conhecer o estado higiênico-sanitário de alfaces (Lactuca sativa) comercializadas na cidade de Araraquara e região (Américo Brasiliense,Matão, Santa Lúcia, Rincão e Taquaritina) SP, quanto a presença de enteroparasitas. Métodos ­ As amostras foram adquiridas em diversos tipos de estabelecimentos (alface in natura) ou em restaurantes self-service, prontas para consumo; as folhas (250 g para folhas in natura e 150 g para folhas prontas para consumo, aproximadamente) foram friccionadas por 5 min em saco plástico contendo 300 ml de solução NaCl 0,9% com 1% de detergente neutro e o líquido de lavagem, após filtração por gaze, sedimentado por 24 horas; o sedimento foi avaliado por exame microscópico direto e também após ser submetido ao método de Faust. Resultados ­ 53% das amostras in natura avaliadas apresentaram algum tipo de contaminação por enteroparasitas (larvas de Helmintos, cistos de protozoários intestinais e ovos de helmintos), sendo que a maior parte das amostras avaliadas foram comercializadas em supermercados na cidade de Araraquara. Na alface pronta para consumo, foi encontrada elevada sujicidade em 3 das 10 amostras analisadas. Conclusão ­ Os resultados obtidos reforçam a necessidade de cuidados de higiene durante toda a cadeia de produção e comercialização da alface, e principalmente no alimento pronto para consumo

Objective ­ To know the hygienic-sanitary state of lettuces (Lactuca sativa) in natura and hygienized commercialized in the city of Araraquara and region (Américo Brasiliense, Matão, Santa Lucia, Rincão and Taquaritina) SP, as for the presence of enteroparasites. Methods ­ The samples were obtained in several types of establishments (lettuce in natura) or self-service restaurants ready for consumption; the sheets were rubbed for 5 min in a plastic bag containing 300 ml 0.9% NaCl solution with 1% neutral detergent and the washing liquid settled for 24 hours; the sediment was evaluated by direct microscopic examination and also after being submitted to the Faust method. Results ­ 53% of the in natura samples evaluated showed some type of enteroparasite contamination (helminth larvae, intestinal protozoa cysts and helminth eggs), and most samples were commercialized in supermarkets in the city of Araraquara. In the ready - to - eat lettuce, high dirt was found in 3 of the 10 analyzed samples. Conclusion ­ The results obtained reinforce the need for hygiene care throughout the production chain and commercialization of lettuce, but mainly in food ready for consumption

Epidemiological Scenario of Anisakidosis in Spain Based on Associated Hospitalizations: The Tip of the Iceberg.

BACKGROUND: The risk of infection with Anisakis has been recognized for some time, but it is now emerging due to major awareness, better diagnostic techniques, and increasing preference for raw or lightly cooked food. Spain has the second-highest reported incidence after Japan, though the real anisakidosis burden is unknown because of the scarcity of epidemiological data. This study provides a 19-year review of anisakidosis-related hospitalizations describing epidemiological trends and patient characteristics. METHODS: We performed a retrospective descriptive study using the Spanish Hospitalization Minimum Data Set from 1997 to 2015. Hospitalization rates were calculated and spatial distribution of cases and their temporal behavior were assessed. Clinical characteristics were described, including related codiagnoses and procedures. RESULTS: A total of 2471 hospital discharges were identified. A continuous increasing trend was observed, with several peaks. Most affected communities were located in the northwest inland part of the country. Almost 54% of hospitalized patients were male, with a mean age of 51.3 years. Median length of stay was 5 days, and the hospitalization median cost around €2900. Fatal outcome occurred in 0.5%. Most frequent codiagnoses were digestive diseases, mainly intestinal obstruction. Urticaria, anaphylactic reaction, and angioneurotic edema were only recorded in 2.2%, 2.4%, and 1.2%, respectively. CONCLUSIONS: Knowing that hospitalization is unusual in anisakidosis, we offer calculations of the real disease burden. Improving disease surveillance in parallel to disease control will be useful both in gaining extended disease knowledge and reducing morbidity and related costs.

Intestinal parasites among employees of restaurants and cafeterias in a city of Brazil / Parásitos intestinales entre los empleados de restaurantes y cafeterías en una ciudad de Brasil

ABSTRACT Objective To investigate the frequency of intestinal parasites in employees of restaurants and cafeterias located in the Commercial Center of São Mateus, Espírito Santo, one of the oldest cities of Brazil. Material and Methods Between August 2013 and February 2014, 42 fecal samples were collected and analyzed by spontaneous sedimentation method in the Clinical Analysis Laboratory of the Federal University of Espírito Santo, São Mateus Campus. Results The results were positive in 19 % of the samples. The commensal Entamoeba coli (75 %) was the most common followed by Entamoeba histolytica/dispar (37.5 %) and Giardia lamblia (12.5 %). Conclusions Implementing health education measures in the city of São Mateus is suggested by providing permanent health education, as well as conducting parasitological examinations. Such actions will contribute to the improvement of health conditions of the population.(AU)

RESUMEN Objetivo Investigar la frecuencia de parásitos intestinales en empleados de restaurantes y cafeterías ubicadas en el Centro Comercial de São Mateus, Espírito Santo, una de las ciudades más antiguas de Brasil. Materiales y Métodos Entre agosto de 2013 y febrero de 2014, 42 muestras fecales fueron recolectadas y analizadas por el método de Sedimentación Espontánea en el Laboratorio de Análisis Clínicos de la Universidad Federal de Espírito Santo, campus de São Mateus. Resultados Los resultados fueron positivos en el 19 % de las muestras, y el comensal más frecuente fue Entamoeba coli (75 %), seguido de los parásitos Entamoeba his-tolytica/dispar (37,5 %) y Giardia lamblia (12,5 %). Conclusión Se sugiere la necesidad de adoptar medidas de educación sanitaria para la ciudad de São Mateus, dando charlas permanentes sobre orientación sanitaria y realizando exámenes parasitológicos. Estas acciones contribuirán a la mejora de las condiciones de salud de la población.(AU)

Relationship between shipping amounts of olive flounder aquacultured from Jejudo and the reported events of acute food poisoning by Kudoa septempunctata in 2015, South Korea: an ecological study.

OBJECTIVES: Confirmation of Kudoa septempunctata (K. septempunctata) as the pathogenic agent causing acute food poisoning remains under debate owing to inconsistencies in the reproducibility of experimental evidence. Higher intake of olive flounder infected with K. septempunctata would result in increased diagnosis of food poisoning by K. septempunctata, if the latter was one of the causal agents of acute food poisoning. The aim was to evaluate the relationship between the shipping amount of olive flounder aquacultured from Jejudo and the incidence of K. septempunctata food poisoning in 2015, Korea. METHODS: Data of shipping amounts between March 2014 and February 2016 and of monthly reported events of Kudoa food poisoning were taken from Jejudo Fish-Culture Fisheries Cooperatives and Korea Centers for Disease Control and Prevention, respectively. Non-parametric correlation analyses were conducted. RESULTS: Shipping amounts indicated the seasonal changes according to variation of consumption. Spearman's rho and Kendall's tau-a between the monthly shipping amounts and the reported events in 2015 were 0.39 (p=0.21) and 0.27 (p=0.20), respectively. CONCLUSIONS: An independent relationship was noted between the shipping amount and the reported events, which contrasted with the claim that the virulence of K. septempunctata caused acute food poisoning.

Analysis of Kudoa septempunctata as a cause of foodborne illness and its associated differential diagnosis.

OBJECTIVES: Recently kudoa septempuctata in olive flounders is suggested as a cause of food poisoning, however whether kudoa septempuctata can affect human gastrointestinal systems is controversial and its pathogenecity remains unclear. In view of the field epidemiology, food poisonings caused by kudoa septempuctata should be distinguished from those caused by Staphylococcus aureus and bacillus cereus. METHODS: The statistics of food poisoning investigations published by Korea Centers for Disease Control and Prevention in 2013-2015 were reviewed. The characteristics of kudoa septempuctata food poisoning reported by Korea Centers for Disease Control and Prevention were reviewed. Information regarding clinical symptoms or epidemiology was extracted. RESULTS: Total eleven kudoa septempuctata food poisoning cases were analyzed. Food poisonings caused by kudoa septempuctata, Staphylococcus aureus and bacillus cereus have clinical and epidemiological similarities. Forty five percent of food poisoning outbreaks occurred in Korea was concluded as unknown. The food poisoning caused by Staphylococcus aureus and bacillus cereus accounted for 4.5% (50/1,092) of all food poisoning outbreaks in Korea between 2013 and 2015. CONCLUSIONS: This study suggests the possibilities of misdiagnosis in the investigations of food poisoning by Staphylococcus aureus and bacillus cereus with kudoa septempuctata.

Is there evidence that Kudoa septempunctata can cause an outbreak of acute food poisoning?

After publishing results of a study that revealed diarrheagenic and emetic activity in 4-5-day old mice infected with Kudoa septempunctata (K. septempunctata) spores, the Korea Centers for Disease Control and Prevention reported 11 events of "Kudoa food poisoning" in 2015. The epidemiological design of the previous study was descriptive rather than analytical; therefore, this study aimed to further investigate the pathogenicity of K. septempunctata. Academic articles showing evidence of the pathogenicity of K. septempunctata were searched via PubMed using the citation discovery tool. Information regarding the kinds of experimental animals and inoculum spores used, as well as study results were extracted. Four articles evaluating the pathogenicity of Myxospran parasites were selected; the first article suggested the pathogenicity of K. septempunctata, while the remaining three articles reported no abnormal symptoms or histopathologic changes. Our findings indicate that there is weak evidence supporting the pathogenicity of K. septempunctata. Further studies evaluating the pathogenicity of K. septempunctata are needed urgently.

Analysis of Kudoa septempunctata as a cause of foodborne illness and its associated differential diagnosis / 한국역학회지

OBJECTIVES: Recently kudoa septempuctata in olive flounders is suggested as a cause of food poisoning, however whether kudoa septempuctata can affect human gastrointestinal systems is controversial and its pathogenecity remains unclear. In view of the field epidemiology, food poisonings caused by kudoa septempuctata should be distinguished from those caused by Staphylococcus aureus and bacillus cereus. METHODS: The statistics of food poisoning investigations published by Korea Centers for Disease Control and Prevention in 2013-2015 were reviewed. The characteristics of kudoa septempuctata food poisoning reported by Korea Centers for Disease Control and Prevention were reviewed. Information regarding clinical symptoms or epidemiology was extracted. RESULTS: Total eleven kudoa septempuctata food poisoning cases were analyzed. Food poisonings caused by kudoa septempuctata, Staphylococcus aureus and bacillus cereus have clinical and epidemiological similarities. Forty five percent of food poisoning outbreaks occurred in Korea was concluded as unknown. The food poisoning caused by Staphylococcus aureus and bacillus cereus accounted for 4.5% (50/1,092) of all food poisoning outbreaks in Korea between 2013 and 2015. CONCLUSIONS: This study suggests the possibilities of misdiagnosis in the investigations of food poisoning by Staphylococcus aureus and bacillus cereus with kudoa septempuctata.

Is there evidence that Kudoa septempunctata can cause an outbreak of acute food poisoning? / 한국역학회지

After publishing results of a study that revealed diarrheagenic and emetic activity in 4-5-day old mice infected with Kudoa septempunctata (K. septempunctata) spores, the Korea Centers for Disease Control and Prevention reported 11 events of “Kudoa food poisoning” in 2015. The epidemiological design of the previous study was descriptive rather than analytical; therefore, this study aimed to further investigate the pathogenicity of K. septempunctata. Academic articles showing evidence of the pathogenicity of K. septempunctata were searched via PubMed using the citation discovery tool. Information regarding the kinds of experimental animals and inoculum spores used, as well as study results were extracted. Four articles evaluating the pathogenicity of Myxospran parasites were selected; the first article suggested the pathogenicity of K. septempunctata, while the remaining three articles reported no abnormal symptoms or histopathologic changes. Our findings indicate that there is weak evidence supporting the pathogenicity of K. septempunctata. Further studies evaluating the pathogenicity of K. septempunctata are needed urgently.

Relationship between shipping amounts of olive flounder aquacultured from Jejudo and the reported events of acute food poisoning by Kudoa septempunctata in 2015, South Korea: an ecological study / 한국역학회지

OBJECTIVES: Confirmation of Kudoa septempunctata (K. septempunctata) as the pathogenic agent causing acute food poisoning remains under debate owing to inconsistencies in the reproducibility of experimental evidence. Higher intake of olive flounder infected with K. septempunctata would result in increased diagnosis of food poisoning by K. septempunctata, if the latter was one of the causal agents of acute food poisoning. The aim was to evaluate the relationship between the shipping amount of olive flounder aquacultured from Jejudo and the incidence of K. septempunctata food poisoning in 2015, Korea. METHODS: Data of shipping amounts between March 2014 and February 2016 and of monthly reported events of Kudoa food poisoning were taken from Jejudo Fish-Culture Fisheries Cooperatives and Korea Centers for Disease Control and Prevention, respectively. Non-parametric correlation analyses were conducted. RESULTS: Shipping amounts indicated the seasonal changes according to variation of consumption. Spearman's rho and Kendall's tau-a between the monthly shipping amounts and the reported events in 2015 were 0.39 (p=0.21) and 0.27 (p=0.20), respectively. CONCLUSIONS: An independent relationship was noted between the shipping amount and the reported events, which contrasted with the claim that the virulence of K. septempunctata caused acute food poisoning.

Is there evidence that Kudoa septempunctata can cause an outbreak of acute food poisoning? / 한국역학회지

After publishing results of a study that revealed diarrheagenic and emetic activity in 4-5-day old mice infected with Kudoa septempunctata (K. septempunctata) spores, the Korea Centers for Disease Control and Prevention reported 11 events of “Kudoa food poisoning” in 2015. The epidemiological design of the previous study was descriptive rather than analytical; therefore, this study aimed to further investigate the pathogenicity of K. septempunctata. Academic articles showing evidence of the pathogenicity of K. septempunctata were searched via PubMed using the citation discovery tool. Information regarding the kinds of experimental animals and inoculum spores used, as well as study results were extracted. Four articles evaluating the pathogenicity of Myxospran parasites were selected; the first article suggested the pathogenicity of K. septempunctata, while the remaining three articles reported no abnormal symptoms or histopathologic changes. Our findings indicate that there is weak evidence supporting the pathogenicity of K. septempunctata. Further studies evaluating the pathogenicity of K. septempunctata are needed urgently.

Analysis of Kudoa septempunctata as a cause of foodborne illness and its associated differential diagnosis / 한국역학회지

OBJECTIVES: Recently kudoa septempuctata in olive flounders is suggested as a cause of food poisoning, however whether kudoa septempuctata can affect human gastrointestinal systems is controversial and its pathogenecity remains unclear. In view of the field epidemiology, food poisonings caused by kudoa septempuctata should be distinguished from those caused by Staphylococcus aureus and bacillus cereus.METHODS: The statistics of food poisoning investigations published by Korea Centers for Disease Control and Prevention in 2013-2015 were reviewed. The characteristics of kudoa septempuctata food poisoning reported by Korea Centers for Disease Control and Prevention were reviewed. Information regarding clinical symptoms or epidemiology was extracted.RESULTS: Total eleven kudoa septempuctata food poisoning cases were analyzed. Food poisonings caused by kudoa septempuctata, Staphylococcus aureus and bacillus cereus have clinical and epidemiological similarities. Forty five percent of food poisoning outbreaks occurred in Korea was concluded as unknown. The food poisoning caused by Staphylococcus aureus and bacillus cereus accounted for 4.5% (50/1,092) of all food poisoning outbreaks in Korea between 2013 and 2015.CONCLUSIONS: This study suggests the possibilities of misdiagnosis in the investigations of food poisoning by Staphylococcus aureus and bacillus cereus with kudoa septempuctata.

Relationship between shipping amounts of olive flounder aquacultured from Jejudo and the reported events of acute food poisoning by Kudoa septempunctata in 2015, South Korea: an ecological study / 한국역학회지

OBJECTIVES: Confirmation of Kudoa septempunctata (K. septempunctata) as the pathogenic agent causing acute food poisoning remains under debate owing to inconsistencies in the reproducibility of experimental evidence. Higher intake of olive flounder infected with K. septempunctata would result in increased diagnosis of food poisoning by K. septempunctata, if the latter was one of the causal agents of acute food poisoning. The aim was to evaluate the relationship between the shipping amount of olive flounder aquacultured from Jejudo and the incidence of K. septempunctata food poisoning in 2015, Korea.METHODS: Data of shipping amounts between March 2014 and February 2016 and of monthly reported events of Kudoa food poisoning were taken from Jejudo Fish-Culture Fisheries Cooperatives and Korea Centers for Disease Control and Prevention, respectively. Non-parametric correlation analyses were conducted.RESULTS: Shipping amounts indicated the seasonal changes according to variation of consumption. Spearman's rho and Kendall's tau-a between the monthly shipping amounts and the reported events in 2015 were 0.39 (p=0.21) and 0.27 (p=0.20), respectively.CONCLUSIONS: An independent relationship was noted between the shipping amount and the reported events, which contrasted with the claim that the virulence of K. septempunctata caused acute food poisoning.

Detecção de entero parasitas em hortaliças comercializadas em feiras Livres do município de Caruaru PE / Detection of intestinal parasites in green vegetable comerce in public street markets in Caruaru PE

O desenvolvimento de infecções parasitárias é causado pela precariedadesanitária e por maus hábitos de higiene. O objetivo deste estudo foi pesquisar a ocorrênciade enteroparasitas de interesse para a saúde em hortaliças comercializadas na feira livrede Caruaru PE. Foram colhidas 144 amostras de hortaliças, no período de outubro/2006 a junho 2007 e analisadas pelo método de sedimentação espontânea e método de Fauste cols. Observou-se que 15,27% das amostras estavam contaminadas por enteroparasitas:Alface Lactuca sativa 23,8%, Brócolis Brassica oleracea var. italica10,5%, CebolinhaAllium fistolosum 40,9%, Coentro Coriandrum sativum 19,0% e Couve Brassica oleracea9,5%. Os enteroparasitas encontrados nas amostras de hortaliças contaminadas foram:Ancilostomidae sp. 10,7%, Ascaris lumbricoides 28,5%, Entamoeba coli 10,7%, Fasciolahepatica 3,5% e Strongyloides stercoralis 46,4%. Foi observado ainda que 27,27% dasamostras contaminadas apresentaram mais de uma forma parasitária. Conclui-se que ashortaliças comercializadas nas feiras de Caruaru PE podem veicular parasitas resistentes àscondições ambientais e que, quando não devidamente higienizadas e consumidas cruas, têmpapel fundamental na disseminação de enteroparasitoses.

The objective of this study was to verify the presence of intestinal parasites of healthinterest in green vegetables in Caruarus PE public street markets. From October 2006 to June 2007, one hundred and fortyfour vegetable samples were collected and analyzed by spontaneoussedimentation and by the Faustïs method. It was observed that 15,27% of the samples werecontaminated by enteroparasite forms: Lactuca sativa 23,8%, Brassica oleracea italic variety10,5%, Allium fistolosum 40,9%, Coriandrum sativum 19,0% and Brassica oleracea 9,5%.The enteroparasites species found in contaminated vegetables were: Ancilostomidae sp. 10,7%, Ascaris lumbricoides 28,5%, Entamoeba coli 10,7%, Fasciola hepatica 3,5% and Strongyloidesstercoralis 46,4%. It was also observed that 27,27% of the contaminated samples presentedmore than one parasite species. It may be concluded that green vegetables sold at Caruaru's streetmarkets may be a medium for parasites resistant to environment and if not hygienized properlyor eaten uncooked, play a fundamental role in the dissemination of intestinal parasites.

Malaria and intestinal parasitosis among children presenting to the Paediatric Centre in Sana'a, Yemen

We studied the profile of malaria and intestinal parasitosis among children presenting to the Paediatric Health Centre in Sana'a from January 1998 to December 2000. In stool samples from 9014 children, Ascaris lumbricoides, Entamoeba histolytica, Giardia lamblia and Trichuris trichiura were the most common. Infection with parasites of direct life-cycle were similar in boys and girls. Schistosome infection was significantly higher in boys than girls, but girls were more infected with ascariasis. The only species of malaria parasite found in blood samples from 753 children with suspected malaria was Plasmodium falciparum, with the highest rates in April-June. The majority of positive cases were Yemeni children, but 10.8% were Sudanese or Ethiopian