Two waterborne outbreaks of toxoplasmosis have been described recently in southern Brazil. We present data from a community-based study of pregnant women in northeastern Brazil. Consumption of homemade ice was the only variable associated with seropositivity (adjusted odds ratio, 3.1, 95% confidence interval, 1.53–6.24). Our results suggest water as a source of infection with Toxoplasma gondii.

By controlling the transmission of Chagas disease, the challenge of providing assistance to millions of infected patients that reach old age arises. In this study, the socioeconomic, demographic and comorbidity records of all elderly chagasic patients followed at the Pharmaceutical Care Service of the Chagas Disease Research Laboratory were assessed. The information related to the clinical form of the disease was obtained from medical records provided by the Walter Cantídio University Hospital. The profile of the studied population was: women (50.5%); mean age of 67 years; retired (54.6%); married (51.6 %); high illiteracy rate (40.2%); and family income equal to the minimum wage (51.5%). The predominant clinical forms of Chagas disease were cardiac (65.3%) and indeterminate (14.7%). The main electrocardiographic changes were the right bundle branch block (41.0%), associated or not with the anterosuperior left bundle branch block (27.4%). The average number of comorbidities per patient was 2.23 ± 1.54, with systemic arterial hypertension being the main one found (67.0%). It was found that the elderly comprise a vulnerable group of patients that associate aging with cardiac and/or digestive disorders resulting from the evolution of Chagas disease and other comorbidities, which requires special attention from health services to ensure more appropriate medical and social care.

Considering the decrease of disease burden caused by intestinal schistosomiasis in many endemic settings, more sensitive diagnostic methods are needed to plan and monitor control measures. We conducted a cross-sectional survey in a rural community in northeast Brazil (317 inhabitants). A combined approach including repeated faecal examinations and ELISA testing was applied. In a first round, single stool samples were collected from 305 (96.2%) participants. Three Kato-Katz (KK) smears were prepared from each sample, and IgG ELISA was performed from serum samples. In the 85 cases of negative KK smears, but positive ELISA results, three additional faecal samples were collected in a second round, and another five KK smears prepared. In the first round of KK analysis, 11/287 (3.8%; 95% confidence interval; 1.92-6.75) were positive. After examining up to eight smears per individual (second round), prevalence of schistosomiasis increased to 8.7% (95% confidence interval: 5.9-12.5). In total, 96/287 (33.4%, 95% confidence interval: 28.0-39.2) samples were positive by ELISA testing. There were no false negative ELISA results. Specificity, positive and negative predictive values of ELISA as compared to up to eight KK smears from three stool samples (reference diagnosis) were 72.9%, 26.0% and 100%, respectively. A single KK smear detected only 12% of the 25 infections; this increased to 44% (three smears, one stool sample), 84% (five smears, three stool samples) and 96% (six smears, four stool samples). We conclude that in low-endemic areas in Brazil the use of KK continues being an important tool. The additional benefit of preparing more than six KK smears from repeated stool samples is negligible. ELISA may be useful for screening populations, with subsequent confirmation of diagnosis by KK or other more sensitive, but highly specific methods.

Introduction:The laboratory diagnosis of schistosomiasis is based mainly on the detection of parasite eggs in stool samples through the Kato-Katz (KK) technique, reading one slide by test. However, a widely known limitation of parasitological methods is reduced sensitivity, particularly in low endemic areas. Methods: To increase sensitivity, we conducted further slide readings from the same stool sample using the parasitological method associated with a serological test. We used the KK method (three slides) and the IgG anti-Schistosoma mansonienzyme-linked immunosorbent assay (ELISA) technique to diagnose schistosomiasis in low endemic areas in the Brazilian State of Ceará. Fecal samples and sera from 250 individuals were analyzed. Results: Sixteen percent and 47.2% of samples were positive in parasitological tests and serological tests, respectively. Parasitological methods showed that 32 (80%) individuals tested positive on the first slide, 6 (15%) on the second slide, and 2 (5%) on the third. The performance of the ELISA test in the diagnosis, using the KK method as diagnostic reference, showed a negative predictive value of 100%, with specificity and positive predictive values of 62.8% and 33.9%, respectively. Conclusions: In this study, the increase from one to three slides analyzed per sample using the KK technique was shown to be a useful procedure for increasing the diagnostic sensitivity of this technique.

In 20 patients with hepatic or hepatosplenic schistosomiasis and 82 individuals infected with S. mansoni, but without liver enlargement, serum parameters reflecting the fibrotic process and hemodynamic alterations as well as immunomodulation were examined. Included as controls were 35 age- and sex-matched healthy individuals from the study region in Northeast Brazil. Peripheral blood cholylglycine levels in patients with hepatomegaly, reflecting the spillover of portal blood into the systemic circulation, were elevated 12-fold over values of patients without liver involvement. Procollagen-III-peptide, a cleavage product of collagen synthesis, was elevated in patients with hepatomegaly (P less than 0.001) but normal in uncomplicated cases. Immunomodulation was assessed by in vivo delayed hypersensitivity to recall antigens and by serum beta 2-microglobulin and neopterin, substances released in the context of lymphocyte activation. Neopterin, predominantly a macrophage product, was elevated most strikingly in hepatomegalic cases (P less than 0.001). The possible interrelation between altered immune responses and excess fibrogenesis is discussed.