Freqüência de infecção por Toxocara em crianças atendidas em serviço público de Maringá, sul do Brasil

The lack of specific laboratorial diagnosis methods and precise symptoms makes the toxocariasis a neglected disease in Public Health Services. This study aims to determine the frequency of Toxocara spp. infection in children attended by the Health Public Service of Hospital Municipal de Maringá, South Brazil. To evaluate the association of epidemiological and clinical data, an observational and cross-section study was carried out. From 14,690 attended children/year aged from seven month to 12 years old, 450 serum samples were randomly collected from September/2004 to September/2005. A questionnaire was used to evaluate epidemiological, clinical and hematological data. An ELISA using Toxocara canis larval excretory-secretory products as antigen detected 130 (28.8%) positive sera, mainly between children from seven month to five years old (p = 0.0016). Significant correlation was observed between positive serology for Toxocara, and frequent playing in sandbox at school or daycare center (p = 0.011) and the presence of a cat at home (p = 0.056). From the families, 50% were dog owners which exposed soil backyards. Eosinophilia (p = 0.776), and signs and symptoms analyzed (fever p = 0.992, pneumonia p = 0.289, cold-like symptoms p = 0.277, cough p = 0.783, gastrointestinal problems p = 0.877, migraine p = 0.979, abdominal pain p = 0.965, joint pain p = 0.686 and skin rash p = 0.105) could not be related to the presence of anti-Toxocara antibodies. Therefore, two asthmatics children showed titles of 1:10,240 and accentuated eosinophilia (p = 0.0001). The authors emphasize the needs of prevention activities.A falta de métodos de diagnóstico laboratorial específico e sintomas específicos fazem da toxocaríase uma doença negligenciada nos serviços públicos de saúde. Este estudo teve por objetivo determinar a freqüência de infecção por Toxocara spp. em crianças atendidas no serviço público do Hospital Municipal de Maringá, sul do Brasil, e avaliar a associação com dados epidemiológicos e clínicos, em estudo observacional e transversal. De 14.690 crianças/ano atendidas, com idade entre sete meses a 12 anos, foram coletados 450 soros de setembro/2004 a setembro/2005. Um questionário foi utilizado para avaliar dados epidemiológicos, clínicos e hematológicos. Pelo teste ELISA, com antígeno de excreção/secreção de larvas de Toxocara canis, detectou-se 130 (28,8%) soros positivos, principalmente em crianças entre sete meses e cinco anos (p = 0,0016). Houve significante correlação entre sorologia positiva para Toxocara e freqüente recreação das crianças em caixas de areia da escola ou pré escola (p = 0,011) e presença do gato no domicilio (p = 0,056). Das famílias dessas crianças, 50% possuíam cachorros e o quintal com solo exposto. Eosinofilia (p = 0,776), sinais e sintomas (febre p = 0,992, pneumonia p = 0,289, resfriado p = 0,277, tosse p = 0,783, problema gastrointestinal p = 0877, dor de cabeça p = 0,979, dor abdominal p = 0,965, dores articulares p = 0,686, urticária p = 0,105) não se correlacionaram com a soropositividade. Todavia, duas crianças asmáticas apresentaram títulos de 1:10.240 (>; 1:320) e acentuada eosinofilia (p = 0.0001). Os autores enfatizam a necessidade de atividades preventivas

Seroprevalence and Modifiable Risk Factors for <i>Toxocara</i> spp. in Brazilian Schoolchildren

<div><p>Background</p><p>Toxocariasis is a worldwide helminthic zoonosis caused by infection with the larvae of the ascarid worms that comprise the <i>Toxocara</i> spp. Children are particularly prone to infection because they are exposed to the eggs in sandboxes and playgrounds contaminated with dog and cat feces. Certain behaviors, such as a geophagy habit, poor personal hygiene, a lack of parental supervision, close contact with young dogs, and ingestion of raw meat, as well as gender, age, and socioeconomic status, affect the prevalence of the disease. However, previous studies of the risk factors for toxocariasis have generally produced inconsistent results. An epidemiological cross-sectional study was conducted to evaluate the seroprevalence of IgG anti-<i>Toxocara</i> spp. antibodies and associated factors in schoolchildren from a region in the southeast of Brazil.</p><p>Methodology/Principal Findings</p><p>A total of 252 schoolchildren aged 1 to 12 years (120 males and 132 females) were assessed. An enzyme-linked immunosorbent assay based on <i>Toxocara canis</i> larval excretory-secretory antigens was used to determine outcomes. A questionnaire was used to collect information on children, family, and home characteristics. Clinical and laboratory data completed the dataset investigated in this study. Seroprevalence was 15.5% (95%CI 11.5–19.8). Geophagy (aPR 2.38 [95%CI 1.36–4.18], <i>p-value</i> 0.029) and the habit of hand washing before meals (aPR 0.04 [95%CI 0.01–0.11], <i>p-value</i> ≤0.001) were factors associated with increased and decreased seroprevalence, respectively. The income factor and its related variables lost statistical significance after adjustment with a multiple Poisson regression model.</p><p>Conclusions/Significance</p><p>The current study confirms that toxocariasis is a public health problem in the evaluated area; modifiable factors such as soil contact and personal hygiene appear to have a greater influence on the acquisition of infection than sociodemographic attributes, thus representing direct targets for disease prevention and control.</p></div

Frequency of parasites and commensals found in parasitological stool examinations from schoolchildren aged 1 to 12 years from urban areas of Fernandópolis, in the northwest of São Paulo State, Brazil.

†<p>Based on 221 analyzed samples.</p>††<p>Based on Exact Mid-P.</p>†††<p>Based on Fisher exact test.</p

Crude and adjusted prevalence ratio with a 95% confidence interval (95% CI) based on independent variables for schoolchildren aged 1 to 12 years from urban areas of Fernandópolis, in the northwest of São Paulo State, Brazil.

<p>cPR - crude prevalence ratio (considering the design effect).</p><p>aPR - adjusted prevalence ratio (considering the design effect).</p>†<p>ELISA anti-<i>Toxocara</i> spp. antibodies: positivity is the outcome.</p>††<p>Refers to the families who have no health insurance at their disposal and are solely and exclusively dependent on the Brazilian Unified Health System.</p>£<p>Note these habits at least 3 times in the past month.</p>µ<p>Note the habit of hand washing before meals (at least 3 times a day).</p>‡<p>Pearson chi-squared test.</p>‡‡<p>Wald chi-squared test.</p>€<p>Fisher exact test.</p

Proportions with a 95% confidence interval (95% CI) pertaining to the characteristics of 252 schoolchildren aged 1 to 12 years from urban areas of Fernandópolis, in the northwest of São Paulo State, Brazil.

ˇ<p>Design effect considering income strata.</p>†<p>The % refers to the distribution in the studied sample. The confidence interval (95% CI) was estimated based on 1,000 bootstrap samples.</p>††<p>Refers to the families who have no health insurance at their disposal and are solely and exclusively dependent on the Brazilian Unified Health System.</p>£<p>Note these habits at least 1 time in the past month.</p>µ<p>Note the habit of hand washing before meals (at least 3 times a day).</p>¥<p>Based on clinical presentation (signs and symptoms) and laboratory results (serology and eosinophilia).</p>‡<p>Relative frequency in the Fernandópolis population.</p>‡‡<p>Proportion Z-test comparing sample vs. population.</p><p>-There are no population data available.</p

Geographic location of the study area.

<p>São Paulo is located in southeast Brazil, and Fernandópolis is situated in the northwest of São Paulo State.</p

Crude prevalence ratio with a 95% confidence interval (95% CI) based on the sampling strata of schoolchildren aged 1 to 12 years from urban areas of Fernandópolis, in the northwest of São Paulo State, Brazil.

<p>st – stratum.</p><p>cPR - crude prevalence ratio</p>†<p>Chi-squared test</p>††<p>Fisher exact test</p>¥<p>Based on clinical presentation (signs and symptoms) and laboratory results (serology and eosinophilia).</p