RESUMO
BACKGROUND: Strongyloides stercoralis is widespread; however, there is limited information on its prevalence owing to laboratory underestimation and low clinical manifestations. The Baermann method and agar culture stand out among the parasitological techniques. Strongyloides stercoralis is present in Bolivia, but its prevalence in children remains unknown. The objective of this study was to estimate the applicability of simple parasitological techniques to increase the detection of this parasite in children living in the tropics. METHODS: This cross-sectional study was conducted in a tropical village in Cochabamba, Bolivia. Participants were 304 children aged 5 - 12 years who provided stool samples for different parasitological analyses (direct examination, Ritchie, Baermann, and Dancescu techniques), and their parents provided informed consent. RESULTS: Up to 64.8% of pathogenic parasites were detected using the modified Ritchie method. The Baermann technique identified 17.8% of Strongyloides stercoralis cases, and a high sensitivity with respect to the Baermann technique was only for the Dancescu technique (75.9%) that is also specific for Strongyloides stercoralis, followed by 66.7% for the modified Ritchie technique, which is used in second-line care. DISCUSSION: The Baermann technique is the best parasitological option for improving Strongyloides stercoralis diagnosis in the first-line care of the Primary Health Care System. A particular cycle of reinfection, combined with the environment and some other risk factors are related with persistence. Control is difficult without a proper diagnosis, and the Baermann technique is an approach to the solution. We conclude that with a high suspicion of the presence of Strongyloides stercoralis, the use of the Baermann technique is strongly recommended as support for direct examination in primary health care systems especially in tropical areas.
Assuntos
Strongyloides stercoralis , Estrongiloidíase , Criança , Animais , Humanos , Estrongiloidíase/diagnóstico , Bolívia/epidemiologia , Estudos Transversais , Fezes/parasitologia , Atenção à SaúdeRESUMO
BACKGROUND: A high percentage of the population in Latin America lives with intestinal parasitic infections, a neglected tropical disease frequently not treated. Intestinal parasitism is associated with other disorders, but information about the epidemiological situation in countries like Bolivia is scarce. Environmental conditions play a role in the prevalence of certain parasites. The main objective was to know the current situation of parasitic infections among children under 12 years old from different geographical areas of Cochabamba - Bolivia. METHODS: We analysed the laboratory reports of four second-line hospitals in different areas and the Tertiary Care Hospital. Results of stool examinations performed between 2011 and 2015 in children under 12 years of age were collected. RESULTS: We gathered the results of 23,221 examinations. The 89% of children were less than five years old. Pathogenic parasites were found in 31%. Entamoeba histolytica and Giardia lamblia were the two most prevalent parasites in all areas. Helminths were 19% of positive samples and Ascaris lumbricoides was the most prevalent. Parasitic infections are more frequent in tropical areas where helminths are highly concentrated. Pre-school age children (OR: 5.296; 95% CI: 4.81-5.83) and semi-tropical area (OR: 3.26; 95% CI: 2.90-3.66) were strongly associated to the presence of pathogenic parasites. CONCLUSIONS: Parasitic infections in children are still very prevalent in Bolivia. Protozoan infections are a major problem, while the prevalence of helminths seems to be decreasing. The most vulnerable population is still concentrated in semi-tropical and tropical areas, where the risk of parasitic infection is probably increased due to poor environmental conditions. Our results could allow reconsideration of more effective parasitic disease control policies, taking into account regional characteristics.