Schistosomiasis mansoni in families of fishing workers of endemic area of Alagoas / Esquistosomiasis mansónica en familias de trabajadores de la pesca de área endémica de Alagoas / Esquistossomose mansônica em famílias de trabalhadores da pesca de área endêmica de Alagoas

Abstract Objective: To analyze the epidemiological and clinical aspects involved in the transmission and manifestation of schistosomiasis in a community of fishermen from the endemic area of Alagoas. Methods: Epidemiological, transversal, prospective, descriptive, quantitative study. The coproparasitological survey included 275 family units of fish workers and the epidemiological and clinical ones, those with a positive diagnosis for S. mansoni. Results: The prevalence of schistosomiasis was 13.9% (fishermen), 2.1% (shellfish) and 2.1% (family members). The occurrence of the infection varied according to gender, age, ethnicity and socioeconomic status. Exposure occurred near the home. Autochthonous and predominant low parasite burden, intestinal clinical presentation, abdominal pain and diarrhea were observed. There were no nutritional and pressure changes associated with parasitosis. Adherence to drug therapy and use of the schistosomicidal drug was feared. Conclusion: Fish workers are at high risk for contracting the disease with clinical hepatointestinal manifestation, which requires more intense health actions.

Resumen Objetivo: Analizar los aspectos epidemiológicos y clínicos involucrados en la transmisión y manifestación de la esquistosomiasis en una comunidad de pescadores de área endémica de Alagoas. Métodos: Estudio epidemiológico, transversal, prospectivo, descriptivo, cuantitativo. La encuesta coproparasitológica contempló 275 unidades familiares de los trabajadores de la pesca y el epidemiológico y clínico, aquellos con diagnóstico positivo para S. mansoni. Resultados: La prevalencia de la esquistosomiasis fue 13,9% (pescadores), 2,1% (marisqueras) y 2,1% (familiares). La ocurrencia de la infección varió según el género, edad, etnia y condición socioeconómica. La exposición ocurrió cerca del domicilio. Se observó autoctonía y predominio de carga parasitaria baja, presentación clínica intestinal, dolor abdominal y diarrea. No hubo alteraciones nutricionales y presión arterial asociadas a la parasitosis. Existia el temor de la adhesión a la terapia medicamentosa y al uso de la droga esquistomicida. Conclusión: Los trabajadores de la pesca presentan alto riesgo para contraer la enfermedad con manifestación clínica hepatointestinal, lo que requiere acciones de salud más intensas.

Resumo Objetivo: Analisar os aspectos epidemiológicos e clínicos envolvidos na transmissão e manifestação da esquistossomose em uma comunidade de pescadores de área endêmica de Alagoas. Métodos: Estudo epidemiológico, transversal, prospectivo, descritivo, quantitativo. O inquérito coproparasitólogico contemplou 275 unidades familiares de trabalhadores da pesca e o epidemiológico e clínico, àqueles com diagnóstico positivo para S. mansoni. Resultados: A prevalência da esquistossomose foi 13,9% (pescadores), 2,1% (marisqueiras) e 2,1% (familiares). A ocorrência da infecção variou conforme gênero, idade, etnia e condição socioeconômica. A exposição ocorreu próxima ao domicílio. Observou-se autoctonia e predominância de carga parasitária baixa, apresentação clínica intestinal, dor abdominal e diarreia. Não ocorreram alterações nutricionais e pressóricas associadas à parasitose. Houve receio na adesão à terapêutica medicamentosa e ao uso do fármaco esquistossomicida. Conclusão: Os trabalhadores da pesca apresentam alto risco para contrair a doença com manifestação clínica hepatointestinal, o que requer ações de saúde mais fortalecidas.

Epidemiological features, echocardiographic findings, and parasite load in patients with Chagas disease

Abstract INTRODUCTION Chagas disease is a major public health problem that is endemic in Brazil and Latin America. This study aimed to determine the socioeconomic, demographic, and clinical characteristics of 171 patients (mean age, 45 years; female, 65%) with Chagas disease at Hospital Universitário de Brasília, Federal District, Brazil. METHODS We implemented this cross-sectional study using a clinical epidemiological questionnaire, electrocardiography, echocardiography, and quantitative detection of Trypanosoma cruzi DNA in blood using qRT-PCR. RESULTS Among the patients, 26.3% had a full elementary education, and 13.2% were illiterate. Most (63.6%) were economically classified as class C, and 51.5% were born in Bahia state. A total of 62.0% participants reported previous contact with the triatomine bug. The clinical forms of the disease were indeterminate (69.51%), cardiac (15.24%), digestive (10.37%), and mixed (4.88%). The most common electrocardiographic abnormality was complete right bundle branch block in association with a divisional anterosuperior block. Only 14.6% of the patients complied with benznidazole medication for at least 60 days, and 164 of them were assessed by echocardiography. The parasite load was positive in 56% of the patients. CONCLUSIONS: Chagas disease affected mostly women, with the indeterminate chronic form of the disease.

Benznidazole therapy for Chagas disease in asymptomatic Trypanosoma cruzi -seropositive former blood donors: evaluation of the efficacy of different treatment regimens

Abstract: INTRODUCTION: Chagas disease currently affects 5.7 million people in Latin America and is emerging in non-endemic countries. There is no consensus concerning the efficacy of trypanocidal therapy for patients with the chronic form of the disease. We evaluated cardiac function and sociodemographic, clinical, and serologic characteristics of a group of asymptomatic Trypanosoma cruzi-seropositive former blood donors, and compared the effects of benznidazole treatment applied for different lengths of time. METHODS: Blood donors who screened positive for T. cruzi between 1998 and 2002 were recruited 10 years later for follow-up (n = 244); 46 individuals had received treatment. Three subjects had terminated treatment prematurely. The remaining 43 individuals were divided into two groups: individuals who had received benznidazole therapy for 50-60 days (n = 28; BT ≤60 group) or more than 60 days (n = 15; BT >60). Serologic assays, biochemical tests, electrocardiographic, echocardiographic, and clinical examinations were performed on all participants. Parasite loads were determined by qualitative and quantitative polymerase chain reaction. RESULTS: Parasitemia was significantly reduced in the BT ≤60 and BT >60 groups compared with the untreated group. There were no differences in epidemiologic profiles or clinical, biochemical, electrocardiographic, or echocardiographic data between any of the groups. CONCLUSIONS: Despite elimination or significant reduction in parasitemia in patients with chronic Chagas disease who received benznidazole, there was no clinical difference between those who were treated for >60 days and those treated for a shorter duration. Furthermore, the adverse effects of benznidazole appear to be less severe than previous reports would suggest.

Post-splenectomy infections in chronic schistosomiasis as a consequence of bacterial translocation

INTRODUCTION : Bacterial translocation is the invasion of indigenous intestinal bacteria through the gut mucosa to normally sterile tissues and internal organs. Schistosomiasis may cause alterations in the immune system and damage to the intestines, portal system and mesenteric lymph nodes. This study investigated bacterial translocation and alterations in the intestinal microbiota and mucosa in schistosomiasis and splenectomized mice. METHODS : Forty female 35-day-old Swiss Webster mice were divided into the following four groups with 10 animals each: schistosomotic (ESF), splenectomized schistosomotic (ESEF), splenectomized (EF) and control (CF). Infection was achieved by introduction of 50 Schistosoma mansoni (SLM) cercariae through the skin. At 125 days after birth, half of the parasitized and unparasitized mice were subjected to splenectomy. Body weights were recorded for one week after splenectomy; then, the mice were euthanized to study bacterial translocation, microbiota composition and intestinal morphometry. RESULTS : We observed significant reductions in the weight increases in the EF, ESF and ESEF groups. There were increases of at least 1,000 CFU of intestinal microbiota bacteria in these groups compared with the CF. The EF, ESF and ESEF mice showed decreases in the heights and areas of villi and the total villus areas (perimeter). We observed frequent co-infections with various bacterial genera. CONCLUSIONS : The ESEF mice showed a higher degree of sepsis. This finding may be associated with a reduction in the immune response associated with the absence of the spleen and a reduction in nutritional absorption strengthened by both of these factors (Schistosoma infection and splenectomy). .