[Outbreak of cutaneous larva migrans in a nursery school in Belo Horizonte, Minas Gerais (Brazil)]

SOIL CONTAMINATION IN PUBLIC SQUARES IN BELO HORIZONTE, MINAS GERAIS, BY CANINE PARASITES IN DIFFERENT DEVELOPMENTAL STAGES

SUMMARY To evaluate soil contamination by parasites in different developmental stages in public squares used as recreation and leisure areas for children in Belo Horizonte (MG, Brazil), 210 soil samples and 141 canine fecal samples were collected from 42 squares in the city. These samples were analyzed by the Caldwell and Caldwell technique and the Hoffman, Pons, and Janer technique. Of the samples analyzed, 89 (42.4%) soil samples and 104 (73.5%) fecal samples were contaminated with Ancylostoma sp., Toxocara sp., Trichuris sp., or Dipylidium sp. eggs; Giardia sp. cysts; or Isospora sp. oocysts. The commonest parasite was Ancylostoma sp., found in 85% soil and 99% fecal samples, followed by Toxocara sp., found in 43.7% soil and 30.7% fecal samples.

Acute morbidity associated with scabies and other ectoparasitoses rapidly improves after treatment with ivermectin

In resource-poor settings, scabies is associated with considerable morbidity. Which factors determine morbidity and how rapidly it recedes after specific treatment is not known. Patients with scabies were recruited in three urban slums in Fortaleza, Northeast Brazil. Diagnosis was established according to dermatoscopy, skin scraping, or adhesive film test. Severity of scabies-associated morbidity was assessed semiquantitatively. Patients and close contacts were treated with oral ivermectin (200 μg/kg, repeated after 7 days) and followed up for 2 weeks. Ninety-five patients were included in the study. Papules were the most common lesion type (98.9%). Excoriations due to scratching were observed in 43.2% and bacterial superinfection in 24.2%. Predilection sites were the arms (82.1%) and the abdomen (81.1%). At baseline, 36.3% of patients complained about intense or severe itching. Intense or severe itch decreased to 6.3% 2 weeks after treatment (p=0.02). Whereas 37.5% of the patients complained about intense or severe itch-related sleep disturbances at baseline, only 8.8% reported the symptom 2 weeks after treatment (p=0.35). At baseline, the degree of itching was correlated with the degree of sleep disturbance (ρ=0.64; p<0.001). One week after the first dose of ivermectin, the intensity of itching and of sleep disturbance decreased significantly (p<0.001). In patients living in resource-poor setting, scabies was associated with considerable morbidity. Treatment with ivermectin rapidly reconstituted health in almost all cases.

Prevalence and zoonotic potential of canine hookworms in Malaysia

BACKGROUND

Canine hookworm infection is endemic in Southeast Asian countries with a prevalence ranging from 70% to 100%, with zoonotic transmission representing a potentially significant public health concern. However, there are limited data available on the prevalence of canine hookworms in Malaysia. This study was conducted to determine the prevalence of hookworm and Ancylostoma species among dogs in Malaysia.

METHODS

Faecal samples were collected from 221 dogs living in urban areas, rural areas and animal shelters in Selangor. Faecal samples were processed using the formal-ether concentration technique followed by wet mount preparation and iodine staining for the detection of hookworm eggs. Samples positive for hookworm eggs were examined using PCR, targeting ITS2 and 28 s rRNA region, and subsequently sequenced in both directions. The sequences were phylogenetically analysed using MrBayes for Bayesian Inference.

RESULTS

The overall prevalence of hookworm among dogs was 48% (95%CI; 41.41-54.95). Rural stray dogs had the highest prevalence 71.4% (95%CI; 61.13-81.49) followed by urban stray dogs, recording 48% (95%CI; 34.15-61.85) and lastly dogs in shelters with 28.7% (95%CI; 19.56-37.84). Logistic regression identified rural stray dogs as a high risk group (OR = 4.55, 95%; 2.50-8.31) and keeping dogs in shelters as a protective factor (OR = 0.24, 95%; 0.14-0.43). Molecular methods identified both Ancylostoma ceylanicum and Ancylostoma caninum with A. ceylanicum being predominant among urban stray dogs. Rural dogs had a higher prevalence of A. caninum than A. ceylanicum, while both species showed equal distribution among dogs in shelters. Phylogenetic analysis placed A. ceylanicum isolated from dogs in one group with A. ceylanicum human isolates.

CONCLUSION

This study indicates that dogs have the potential to act as reservoir hosts of human hookworm infection in Malaysia. This finding necessitates the inclusion of dogs in any interventions to combat hookworm in the country.

Epidemiological and clinical characteristics of hookworm-related cutaneous larva migrans

Hookworm-related cutaneous larva migrans is caused by the migration of animal hookworm larvae in the human skin. The disease mainly occurs in resource-poor communities in the developing world, but it is also reported sporadically in high-income countries and in tourists who have visited the tropics. Diagnosis is made clinically in the presence of a linear serpiginous track moving forward in the skin, associated with itching and a history of exposure. Itching is typically very intense and can prevent patients from sleeping. Bacterial superinfection occurs as a result of scratching. Treatment is based on oral drugs (albendazole or ivermectin) or the topical application of tiabendazole. To control hookworm-related cutaneous larva migrans at the community level, regular treatment of dogs and cats with anthelmintic drugs is necessary, but this is seldom feasible in resource-poor settings. Animals should be banned from beaches and playgrounds. For protection at the individual level, unprotected skin should not come into contact with possibly contaminated soil.

[Helminthes in sandboxes of day care centers of a city in Southeastern Brazil]

The objective of the study was to test for helminthes in sandboxes in day care centers in the city of Uberlândia, Southeastern Brazil in 2005. Fourteen private and 14 public day care centers with playgrounds were selected. One collection was carried out during the dry season (June and August), and the second one was in the rainy season (September and November). Samples were tested using Willis and Baermann methods. In the first collection, 17 (61%) day care centers were positive for helminthes larvae and 14 (50%) for eggs. In the second collection, 18 (64%) day care centers were positive for larvae and 10 (36%) for eggs. No influence of either season of the year or day care finance condition was seen.

Clinical features and associated morbidity of scabies in a rural community in Alagoas, Brazil

OBJECTIVE

To describe the clinical characteristics of scabies and the associated morbidity in an impoverished rural community in northeast Brazil.

METHOD

A door-to-door survey was made to examine twice the population of an endemic area; first at the end of the rainy season, and a second time in the dry season 4 months later.

RESULTS

In total, 2005 individuals were examined. The overall prevalence of scabies was 9.8% (95% CI 8.5-11.2). Predilection sites with similar relative frequencies in all age groups were the abdomen (83.7%) and the inguinal area/inner part of the thighs (66.3%). Hands, feet, genitals and the scalp/neck/face were significantly more often affected in children <7 years (all P < 0.03). Fifty-five per cent of the patients showed scabies lesions simultaneously at > or = 12 distinct topographic areas. Papular lesions were most commonly found, followed by papular-crusted lesions. Vesicles were significantly more often observed in children (P = 0.04). Sixty-four per cent of the patients had three or more types of lesions. Local lymphadenopathy was present in 53.6% and superinfection in 36.7% of the cases. The number of topographic areas affected, as well as the proportion of superinfected lesions, was inversely correlated with age (rho = -0.22, P = 0.002 and rho = -0.358, P < 0.05, respectively). The quantity of skin surface infested, the proportion of superinfected lesions and the presence of a superinfected lesion distal to an enlarged lymphnode were predictors of lymphadenopathy. Seventy-two per cent of the patients suffered from sleep disorders, mainly because of itching.

CONCLUSION

Scabies is associated with considerable morbidity in this endemic community. Predilection sites, clinical presentation, quantity of skin surface affected and proportion of secondary infected lesions show a dichotomy between children and adults.

A Study in a Community in Brazil in Which Cutaneous Larva Migrans Is Endemic

BACKGROUND

Cutaneous larva migrans (CLM) is a common but neglected parasitic skin disease in impoverished communities of the developing world.

METHODS

To describe the clinical features and the morbidity associated with CLM, active-case finding was performed during rainy and dry seasons in a rural community in the state of Alagoas, Northeast Brazil.

RESULTS

A total of 62 individuals received a diagnosis for CLM, and among them there were a total of 75 larval tracks. The number of tracks per person ranged from 1 to 3. Children <9 years old were affected significantly more often than other age groups (P<.001). Children had their lesions mainly on the buttocks, genitals, and hands, whereas in older patients, the majority of lesions were located on the feet. Twenty-four percent of the 75 lesions were superinfected. Bacterial superinfection was more common among children. All but 1 patient complained about itching, and 84% of the 62 patients complained about sleep disturbances. Itching was classified as being severe by 61% of patients. Approximately 40% of the 62 patients had attempted to treat their creeping eruption previously. Larvae moved forward 2.7 mm per day. There was a significant correlation between the length of the track and the duration of infestation ( rho =.53; P<.0001).

CONCLUSIONS

CLM is a common parasitic skin disease in this rural community, with different topographic patterns of lesions in children and adults. CLM is associated with considerable morbidity. The length of the track can be used to estimate the duration of infestation.

PREVALÊNCIA DE ENDOPARASITAS EM CÃES DA ÁREA URBANA DO MUNICÍPIO DE MONTE NEGRO, RONDÔNIA

RESUMO De julho a agosto de 2001, foram colhidas amostras de fezes de 95 cães (13,8% da população canina) da área urbana do Município de Monte Negro, Rondônia. As amostras de fezes foram examinadas pelos métodos coproparasitológicos de Willis, centrífugo-flutuação em solução de sacarose e centrífugo-sedimentação em água-éter. Das 95 amostras de fezes, somente 15 (15,8%) foram negativas. Foram encontrados helmintos pertencentes a 5 gêneros: Ancylostoma, Toxocara, Trichuris, Spirocerca, Physalopterae 5 protozoários: Sarcocystis, Giardia, Cystoisospora, Cryptosporidium, Hammondia-Neospora. Ovos de Ancylostoma spp. foram os mais prevalentes (73,7% de amostras positivas), seguidos por ovos de Toxocara canis (18,9%) e esporocistos de Sarcocystis spp. (18,9%). Os demais parasitos tiveram prevalências abaixo de 10%. Os resultados encontrados foram comparados com outros trabalhos brasileiros, demonstrando que o gênero Ancylostoma é o mais freqüentemente diagnosticado em cães no Brasil.

Contaminação de canteiros da orla marítima do Município de Praia Grande, São Paulo, por ovos de Ancylostoma e Toxocara em fezes de cães

Avaliou-se a contaminação dos canteiros da orla marítima de Praia Grande, SP, Brasil, por ovos de Ancylostoma e Toxocara, em amostras de fezes de cães. Do total das amostras analisadas, 45,9% estavam contaminadas por ovos de Ancylostoma e 1,2% com ovos de Toxocara.

Cutaneous larva migrans (creeping eruption) in an urban slum in Brazil

BACKGROUND

Cutaneous larva migrans (CLM) is caused by the penetration of larvae of animal hookworms into the skin. Knowledge about this ectoparasitosis is mainly based on the examination of travelers or other expatriates. Population-based studies in an endemic area have never been performed.

METHODS

A representative population sample of an urban slum in a Brazilian city was examined for the presence of CLM and asked about symptoms associated with the ectoparasitosis.

RESULTS

In total, 3.1% (95% confidence interval, 2.2-4.3%) of the 1185 inhabitants examined presented CLM. Forty-three per cent had more than one larval track (range, 1-17). The prevalence rate in males was 4.2% vs. 2.3% in females. CLM occurred at similar prevalence rates in all age groups. All patients complained of moderate or severe itching. In three cases (8.1%), superinfection was present. Most lesions were located on the trunk, legs, and arms. Not a single lesion was located on the feet.

CONCLUSIONS

This population-based study showed that CLM is endemic in this deprived community. The number of lesions and their topographic localization are in contrast with those obtained in previous reports based on the examination of individuals or groups affected in small outbreaks. We conclude that the clinico-epidemiologic pattern of CLM in a deprived community is different from that observed in travelers.

[Cutaneous larva migrans: reports of pediatric cases and contamination by Ancylostoma spp larvae in public parks in Taciba, São Paulo State]

Cutaneous larva migrans in children from Taciba, São Paulo, Brazil, was related to contact with sand in public squares, where Ancylostoma spp larvae were detected. The outbreaks were controlled by sanitary education, temporary deactivation and isolation of the squares in order to impede the access of animals and substitution of the sand.

A longitudinal study on cutaneous larva migrans in an impoverished Brazilian township

BACKGROUND

The objective of this study was to describe the clinical pathology and seasonal variation of cutaneous larva migrans (CLM) in an impoverished community.

METHOD

A representative sample of the population of a poor urban neighbourhood in Fortaleza, northeast Brazil, was examined for CLM four times during a period of eleven months.

RESULTS

In total, 4107 individuals were examined. Sixty-three individuals were diagnosed to have CLM with a total of 132 larval tracks. The prevalence varied from 3.1% (95% CI: 2.2-4.3) in the middle of the rainy season to 0.2% (95% CI: 0.0-0.9) in the peak of the dry season. This corresponds to an incidence of 1841 cases of CLM per 10,000 inhabitants per year. The male sex was significantly more often affected (P<0.01). Eighty-three percent of the lesions were located at the trunk, legs or feet. Moderate or severe itching was present in all patients; 31.2% complained of insomnia due to itching, and 21% of the lesions were superinfected.

CONCLUSIONS

CLM is a common parasitic skin disease in this deprived community, it is associated with significant morbidity, and its occurrence varies according to the rainfall.

Parasitic skin diseases: health care-seeking in a slum in north-east Brazil

Ectoparasitic diseases are endemic in many poor communities in north-east Brazil, and heavy infestation is frequent. We conducted two studies to assess disease perception and health care seeking behaviour in relation to parasitic skin diseases and to determine their public health importance. The first study comprised a representative cross-sectional survey of the population of a slum in north-east Brazil. Inhabitants were examined for the presence of scabies, tungiasis, pediculosis and cutaneous larva migrans (CLM). The second study assessed health care seeking behaviour related to these ectoparasitic diseases of patients attending a Primary Health Care Centre (PHCC) adjacent to the slum. Point prevalence rates in the community were: head lice 43.3% (95% CI: 40.5-46.3), tungiasis 33.6% (95% CI: 30.9-36.4), scabies 8.8% (95% CI: 7.3-10.6) and CLM 3.1% (95% CI: 2.2-4.3). Point prevalence rates of patients attending the PHCC were: head lice 38.2% (95% CI: 32.6-44.1), tungiasis 19.1% (95% CI: 14.7-24.1), scabies 18.8% (95% CI: 14.4-23.7) and CLM 2.1% (95% CI: 0.8-4.5). Only 28 of 54 patients with scabies, three of 55 patients with tungiasis, four of six patients with CLM and zero of 110 patients with head lice sought medical assistance. The physicians of the PHCC only diagnosed a parasitic skin disease when it was pointed out by the patient himself. In all cases patients were correctly informed about the ectoparasites they carried. The results show that tungiasis and pediculosis, and to a lesser extent scabies and CLM, are hyperendemic but neglected by both population and physicians, and that prevalence rates of tungiasis and scabies at the PHCC do not reflect the true prevalence of these diseases in the community.

[Presence of larva migrans in sand boxes of public elementary schools, Araçatuba, Brazil]

There are sandboxes in public elementary school playground areas in Brazil, which can be harmful to children. They are at risk of cutaneous and visceral larva migrans infection caused by Ancylostoma spp. and Toxocara spp., respectively. The study was designed to investigate contamination by Toxocara spp. and/or their eggs and Ancylostoma spp. larvae in sand samples collected from the schools' sandboxes. Five hundred and thirty-five sand samples from 28 public elementary schools were collected during summer and winter and analyzed by both Baerman's method and centrifugal flotation technique. Ancylostoma spp. larvae were found in 35.7% (10/28) schools in summer time and in 46.4% (13/28) schools in the winter time. Eggs of Toxocara spp. could not be recovered from the samples analyzed and eggs from Ancylostoma spp. were seen in 0.56% (3/535) of the samples.

[Cutaneous larva migrans in children in a school of center-western Brazil]

This paper reports an outbreak of cutaneous larva migrans in children of a school located in Campo Grande, MS. Six out of the 16 students (37.5%) acquired this parasitic dermatitis in two playgrounds contaminated by cat feces, in which ancylostomid larvae were found. The serpiginous lesions and/or papules were located in the hands, feet, buttocks, thighs, vulva and scrotum. Control measures of this parasitosis are discussed.

[Contamination of public squares of Campo Grande, Mato Grosso do Sul, Brazil, with eggs of Toxocara and Ancylostoma in dog feces]

From February to October 1998, the contamination of public squares of Campo Grande, MS, Brazil, by eggs of Toxocara and Ancylostoma was evaluated in dog fecal samples. Out of the 74 public parks examined, 42 (56.8%) were found to be contaminated with Ancylostoma eggs, 8 (10.8%) with Toxocara eggs and 7 (9.5%) with both.

[Ancylostoma and Toxocara infestation in dogs and cats captured in the streets, São Paulo (Brazil)]

Foram examinadas fezes, coletadas após o sacrifício, de 9.150 cães e 674 gatos, capturados nas vias públicas do Município de São Paulo, SP (Brasil), visando o encontro de ovos e parásitos das famílias Ancylostomidae e Ascaridae. A coleta do material ocorreu durante os anos de 1980-1985. As seguintes taxas de infestação foram observadas: 59,83% dos cães e 22,26% dos gatos estiveram positivos para ovos de Ancylostoma sp., enquanto que 11,70% dos cães e 17,65% dos gatos apresentaram ovos de Toxocara sp.