Acute Schistosomiasis In Brazilian Traveler: The Importance Of Tourism In The Epidemiology Of Neglected Parasitic Diseases.

Parasitic infectious diseases acquired in tourist areas may pose a challenge to physicians and to travel medicine practitioners. Acute schistosomiasis may be seen in returning travelers and migrants after primary infection. This form of schistosomiasis is frequently misdiagnosed due to its temporal delay and its nonspecific presentation and might occur even in countries where the disease is endemic, such as in Brazil. The patient developed the acute phase of schistosomiasis with severe clinical manifestations. The quantitative analysis revealed the presence of 240 eggs per gram of stool. The treatment was administered with oxamniquine, and the control of cure of the patient was monitored and was favorable. The present paper aims to emphasize the importance of a detailed clinical history including information regarding travel history.201265092

Impact of CD4 and CD8 dynamics and viral rebounds on loss of virological control in HIV controllers

Objective: HIV controllers (HICs) spontaneously maintain HIV viral replication at low level without antiretroviral therapy (ART), a small number of whom will eventually lose this ability to control HIV viremia. The objective was to identify factors associated with loss of virological control. Methods: HICs were identified in COHERE on the basis of \ue2\u89\ua55 consecutive viral loads (VL) \ue2\u89\ua4500 copies/mL over \ue2\u89\ua51 year whilst ART-naive, with the last VL \ue2\u89\ua4500 copies/mL measured \ue2\u89\ua55 years after HIV diagnosis. Loss of virological control was defined as 2 consecutive VL >2000 copies/mL. Duration of HIV control was described using cumulative incidence method, considering loss of virological control, ART initiation and death during virological control as competing outcomes. Factors associated with loss of virological control were identified using Cox models. CD4 and CD8 dynamics were described using mixed-effect linear models. Results: We identified 1067 HICs; 86 lost virological control, 293 initiated ART, and 13 died during virological control. Six years after confirmation of HIC status, the probability of losing virological control, initiating ART and dying were 13%, 37%, and 2%. Current lower CD4/CD8 ratio and a history of transient viral rebounds were associated with an increased risk of losing virological control. CD4 declined and CD8 increased before loss of virological control, and before viral rebounds. Discussion: Expansion of CD8 and decline of CD4 during HIV control may result from repeated low-level viremia. Our findings suggest that in addition to superinfection, other mechanisms, such as low grade viral replication, can lead to loss of virological control in HICs

Monitoring of Giardia duodenalis and Cryptosporidium spp. in the food chain of oysters (Crassostrea brasiliana), depurated to human consumption in the estuary-lagoon complex of Cananéia, São Paulo

Orientador: Regina Maura Bueno FrancoTese (doutorado) - Universidade Estadual de Campinas, Instituto de BiologiaResumo: Surtos de doenças gastrointestinais associados com a ingestão de moluscos bivalves crus ou mal cozidos têm sido reportados em todo o mundo. O procedimento mais utilizado para purificar os tecidos dos bivalves, consiste na utilização de água desinfetada com radiação UV aplicada em tanques de depuração, previamente à introdução dos animais no mercado. Os riscos de aquisição de infecções mediante o consumo de bivalves são maximizados quando estes são cultivados em áreas inapropriadas, ou quando são comercializados sem serem submetidos ao procedimento de depuração. Os objetivos deste estudo foram: avaliar a contaminação por cistos de Giardia duodenalis e oocistos de Cryptosporidium em ostras destinadas ao consumo humano, antes e após o procedimento de depuração com luz UV, e em águas salobras, nas etapas relacionadas com a cadeia produtiva de ostras no estuário de Cananéia, litoral sul de São Paulo; realizar a caracterização molecular de cistos de Giardia em diferentes etapas da produção de ostras para verificar os genótipos circulantes e aqueles relacionados com a infecção em humanos; enumerar a concentração de indicadores bacteriológicos de contaminação fecal, da área de cultivo até a etapa de depuração para verificar se atende à regulamentação do Conselho Nacional do Meio Ambiente (CONAMA). Quatro pontos foram selecionados para coleta de água e ostras e pesquisa de protozoários: ponto 1: região de cultivo e engorda das ostras; ponto 2: captação de água; ponto 3: etapa de filtração de água e ponto 4: tanque de depuração. As amostras de água foram analisadas por filtração em membranas seguida de separação imunomagnética (IMS) e reação de imunofluorescência direta (RID). A contaminação das ostras foi verificada mediante análise de conteúdo líquido interno e lavado branquial por IMS e RID. A reação em cadeia da polimerase e o sequenciamento foram realizados para pesquisa de Giardia duodenalis e caracterização de seus genótipos. Giardia foi o patógeno mais prevalente em todos os pontos de água, sendo detectada em: 50,0%, 25,0%, 33,3% e 50,0% das amostras dos pontos 1, 2, 3 e 4, respectivamente. O subgenótipo AII foi detectado em algumas amostras hídricas dos pontos 1, 2 e 4 e o genótipo C em duas amostras (pontos 3 e 4). Oocistos de Cryptosporidium foram detectados em 16,6% das amostras de água após a depuração. As ostras da região de cultivo continham cistos de Giardia duodenalis em 41,6% das amostras; o subgenótipo AII foi evidenciado em uma amostra. As ostras depuradas apresentaram a maior contaminação: 58,3% das amostras albergavam cistos de Giardia e 3 delas pertenciam ao subgenótipo AII. As análises bacteriológicas revelaram que o ponto de engorda (P1) estava adequado para o cultivo das ostras. Estes resultados refletem a ineficiência do procedimento de depuração com UV aplicado nesta planta de tratamento e a contaminação do produto - na etapa final que precede sua comercialização - por Giardia duodenalis pertencente ao subgenótipo AII, potencialmente infectante para seres humanos. Os resultados evidenciam a necessidade de monitoramento contínuo de patógenos e adequação da legislação do cultivo de moluscos bivalves no Brasil, a fim de garantir a segurança alimentarAbstract: Many shellfish-borne associated outbreaks have been reported worldwide especially related to its ingestion raw or lightly cooked. In the shellfish industry, the most commonly utilized procedure to purify shellfish tissues consists in the utilization of UV disinfected water employed at depuration tanks, before they are placed on the market. The risks of acquiring gastroenteric diseases, through its consumption, are maximized when they are cultured on inappropriate growing areas or whenever they are sold without depuration procedure. The purposes of this study were: evaluate the contamination by Giardia duodenalis cysts and Cryptosporidium oocysts in oysters destined to human consumption, before and after UV depuration procedure, and in brackish waters at stages related to the food chain of edible oysters, from Cananéia estuary located on the south coast of São Paulo; perform molecular characterization of Giardia cysts at different stages of the production of oysters to verify the main circulating genotypes and those associated with human infection; enumerate bacteriological indicators of fecal contamination from growing site up to depuration site, to check if it complies with the National Environmental Council (CONAMA). Four sampling sites were selected for water and oysters harvesting and protozoa search: site 1- oysters growing area; site 2: catchment water; site 3: filtration stage of water treatment and site 4: oyster's depuration tank. Water samples were analyzed through membrane filtration technique followed by immunomagnetic separation (IMS) and direct immunofluorescence assay (IFA). Oysters' contamination was verified through the analysis of innerwater and gill wash using IMS and IFA. The polymerase chain reaction and sequencing reactions were performed to search for Giardia duodenalis and characterization of its genotypes. Giardia was the most prevalent pathogens in all water sites, where it was detected: 50.0%, 25.0%, 33.3% and 50.0% of water from sites 1, 2, 3 and 4 respectively. The subgenotype AII was detected in several water samples from sites 1, 2 and 4 and the genotype C in two samples (sites 3 and 4). Cryptosporidium oocysts were found in 16.6% of depuration water tank. Oysters from growing area harbored Giardia duodenalis cysts in 41.6% of the samples and subgenotype AII was evidenced once. Depurated oysters were the most contaminated: 58.3% were harboring Giardia duodenalis cysts and 3 belonged to subgenotype AII. Bacteriological analysis demonstrated that site 1 was adequate to growing oysters. These results indicate the ineffectiveness of the UV depuration applied in this shellfish treatment plant, and the contamination of the product - in the final stage which precedes its commercialization - by Giardia duodenalis belonging to subgenotype AII, potentially infectious to humans. The results highlight the need for continued monitoring of pathogens and suit the legislation on the cultivation of bivalve molluscs in Brazil in order to ensure food safetyDoutoradoParasitologiaDoutor em Parasitologi

Giardiasis as a neglected disease in Brazil: systematic review of 20 years of publications

Giardiasis is an intestinal infection that affects more than two hundred million people annually worldwide; it is caused by the flagellated protozoan Giardia duodenalis. In tropical countries and in low or middle-income settings, like Brazil, its prevalence can be high. There is currently no systematic review on the presence of G. duodenalis in patients, animals or water sources in Brazil. This systematic review was performed according to recommendations established by Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). As databases for our searches, we have used PubMed, Embase, Scopus and the Brazilian database SciELO using the keywords «Giardia*» and «Brazil». This systematic review identified research studies related to G. duodenalis in water, giardiasis in animals, prevalence of giardiasis across Brazilian regions, genotyping of strains isolated in humans, and giardiasis in indigenous populations. We also propose a network of G. duodenalis transmission in Brazil based on genotypes analyses. This is the first time within the last twenty years that a review is being published on the occurrence of G. duodenalis in Brazil, addressing relevant issues such as prevalence, molecular epidemiology and analytical methods for parasite detection. || Giardiasis is an intestinal disease that affect millions of people worldwide, including children. Its main route of transmission is by ingestion of food or water contaminated with the protozoan G. duodenalis. Transmission does not require an animal host, although transmission from animals to human (zoonotic transmission) has been confirmed as an important vector of human giardiasis. This study is a comprehensive description of the impact of giardiasis in Brazil based on studies published in the country from the past 20 years. We describe Giardia prevalence in humans (including indigenous populations), animals and water supplies. In addition, we create a transmission network model for the disease, based on genotype data previously identified in animal and human hosts as well as in environmental samples. The data compiled here will be useful for design of policies to prevent giardiasis transmission in Brazil.1110CONSELHO NACIONAL DE DESENVOLVIMENTO CIENTÍFICO E TECNOLÓGICO - CNPQSem informaçã

Giardiasis as a neglected disease in Brazil: Systematic review of 20 years of publications

<div><p>Introduction</p><p>Giardiasis is an intestinal infection that affects more than two hundred million people annually worldwide; it is caused by the flagellated protozoan <i>Giardia duodenalis</i>. In tropical countries and in low or middle-income settings, like Brazil, its prevalence can be high. There is currently no systematic review on the presence of <i>G</i>. <i>duodenalis</i> in patients, animals or water sources in Brazil.</p><p>Methods</p><p>This systematic review was performed according to recommendations established by Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). As databases for our searches, we have used PubMed, Embase, Scopus and the Brazilian database SciELO using the keywords «<i>Giardia</i>^<i>*</i>» and «Brazil».</p><p>Results</p><p>This systematic review identified research studies related to <i>G</i>. <i>duodenalis</i> in water, giardiasis in animals, prevalence of giardiasis across Brazilian regions, genotyping of strains isolated in humans, and giardiasis in indigenous populations. We also propose a network of <i>G</i>. <i>duodenalis</i> transmission in Brazil based on genotypes analyses.</p><p>Conclusion</p><p>This is the first time within the last twenty years that a review is being published on the occurrence of <i>G</i>. <i>duodenalis</i> in Brazil, addressing relevant issues such as prevalence, molecular epidemiology and analytical methods for parasite detection.</p></div

Detection of <i>G</i>. <i>duodenalis</i> assemblages in human hosts across Brazil according to molecular studies performed using the <i>gdh</i>, <i>tpi</i>, <i>bg</i> and <i>18S</i> parasite genes.

<p><b>-</b> Methods used for each analysis include: 1- Sequence analysis of fragments; 2- Single-vessel multiplex real-time PCR (qPCR); 3- Restriction fragment length polymorphisms and DNA sequencing; 4- Allele-specific PCR; 5- Sequencing, Phylogenetic reconstruction and analysis of genealogical relationships.</p

<i>Giardia duodenalis</i> transmission network based on sequences available for partial <i>gdh</i> (n = 342).

<p>Solid Line/N = Non-Ambiguous Changes. Dotted line/A = Ambiguous Changes. Bolder solid lines indicate relatively more host shifts within route on the transmission graph. Number in parentheses represents number of shifts within tree from one host to another.</p