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Estudo do perfil epidemiológico molecular de Giardia doudenalis em crianças dos 0 aos 59 meses de idade no Hospital Central de Nampula e a sua associação com o estado nutricional, diarreia e VIH.
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A giardíase é uma doença causada pelo protozoário intestinal Giardia duodenalis. Esta doença tem uma distribuição ubíqua e afeta todos os grupos etários apesar de apresentar uma maior incidência nos países de baixo e médio rendimento, bem como em crianças. Este protozoário intestinal inclui oito genótipos (A-H), dos quais apenas A e B são infeciosos para o homem. Vários estudos têm sido realizados no sentido de esclarecer a sua relação com a gravidade da doença diarreica. No entanto, existem poucas publicações onde se explora a sua associação com o estado nutricional e menos ainda com a infeção pelo VIH, em crianças com menos de cinco anos de idade.
Este trabalho teve como objetivo principal o estudo da associação entre a infeção por G. duodenalis e o estado nutricional, diarreia e infeção pelo VIH em crianças dos 0 aos 59 meses de idade no Hospital Central de Nampula (HCN), Moçambique. Para tal, foram incluídas 831 crianças internadas ou assistidas nas consultas externas do HCN, das quais se obteve uma amostra de fezes, os seus dados socio-demográficos, clínicos e antropométricos (comprimento/estatura e peso). A análise parasitológica de fezes foi efetuada por exame direto e concentração de Ritchie e a deteção de antigénio de G. duodenalis por teste imunocromatográfico rápido. As amostras com identificação positiva para G. duodenalis em qualquer um dos métodos foram conservadas para posterior extração de DNA e análise molecular. A caraterização genotípica foi realizada através do estudo de polimorfismos únicos de posição para o gene da β-giardina (bg), tendo sido realizada a análise estatística através da regressão logística binária e regressão logística múltipla.
O diagnóstico parasitológico revelou que G. duodenalis foi o parasita intestinal mais comum na população estudada (23,9%, 199/831). Os resultados obtidos não demonstraram nenhuma associação estatisticamente significativa entre o estado nutricional, diarreia ou infeção pelo VIH e a infeção pelos genótipos de G. duodenalis. No entanto, verificou-se que as crianças que viviam em habitações com três ou mais pessoas por divisão eram mais suscetíveis à infeção total e simples por G. duodenalis (p=0,034 e p=0,048, respetivamente). Em relação ao estado nutricional observou-se que as crianças com infeção simples por G. duodenalis apresentavam uma menor probabilidade de terem desnutrição aguda (p=0,041). Para além disso, as crianças com idades inferiores a 24 meses pareciam ser mais suscetíveis a terem desnutrição por baixo-peso e aguda, a apresentarem diarreia, dor abdominal e falta de apetite (p<0,05).
Este estudo evidencia a importância do diagnóstico deste protozoário em contextos semelhantes, bem como a necessidade de mais contributos para o esclarecimento do papel dos genótipos de G. duodenalis no estado de saúde infantil. Outro aspeto relevante inclui uma melhor compreensão sobre o impacto da infeção em crianças com menos de cinco anos de idade com desnutrição aguda.
Study of the molecular epidemiological profile of Giardia duodenalis in children aged 0-59 months at the Central Hospital of Nampula and its association with nutritional status, diarrhea and HIV. Filipa Santana Ferreira Key words: Giardia duodenalis, genotypes, children, hospital, Mozambique Giardiasis is a disease caused by the intestinal protozoa Giardia duodenalis. This disease has an ubiquitous distribution and affects all age groups, despite having a higher incidence in low- and middle-income countries, as well as in children. This intestinal protozoan includes eight genotypes (A-H), of which only A and B are infectious to humans. Several studies have been carried out in order to clarify their relationship with the severity of diarrheal disease. However, the number of publications exploring its association with nutritional status is small and fewer related to HIV infection in children under five years of age. This study aimed to explore the association between infection with G. duodenalis and nutritional status, diarrhea and HIV infection in children aged 0-59 months at the Central Hospital of Nampula (HCN), Mozambique. For this purpose, 831 children hospitalized or attending the HCN outpatient clinic were included. One single stool sample was obtained from each child. In addition, socio-demographic, clinical and anthropometric data (length/height and weight) were also obtained. Parasitological analysis of feces was performed through direct examination and Ritchie concentration technique and G. duodenalis antigen detection by rapid immunochromatographic test. Samples with positive identification of G. duodenalis with any of these methods were stored until DNA extraction and molecular analysis were conducted. Genetic characterization was done by studying a single nucleotide position polymorphism for the β-giardin gene (bg). Statistical analysis was undertaken through binary logistic regression and multiple logistic regression. The parasitological diagnosis revealed that G. duodenalis was the most common intestinal parasite in the studied population (23.9%, 199/831). The results of this study did not demonstrate any statistically significant association between nutritional status, diarrhea or HIV infection and G. duodenalis genotypes infection. However, it was found that children living in houses with three or more persons per room were more susceptible to total and simple infection with G. duodenalis (p=0.034 and p=0.048, respectively). Regarding nutritional status, it was observed that children with simple infection by G. duodenalis were less likely to have acute malnutrition (p=0.041). In addition, children younger than 24 months appeared to be more susceptible to low-weight and acute malnutrition, having diarrhea, abdominal pain and lack of appetite (p<0.05). This study highlights the importance of the diagnosis of this protozoan in similar contexts, as well as the need for more contributions to clarify the role of G. duodenalis genotypes in child health. Another relevant aspect includes a better understanding of the impact of infection in children under five years of age with acute malnutrition.
Study of the molecular epidemiological profile of Giardia duodenalis in children aged 0-59 months at the Central Hospital of Nampula and its association with nutritional status, diarrhea and HIV. Filipa Santana Ferreira Key words: Giardia duodenalis, genotypes, children, hospital, Mozambique Giardiasis is a disease caused by the intestinal protozoa Giardia duodenalis. This disease has an ubiquitous distribution and affects all age groups, despite having a higher incidence in low- and middle-income countries, as well as in children. This intestinal protozoan includes eight genotypes (A-H), of which only A and B are infectious to humans. Several studies have been carried out in order to clarify their relationship with the severity of diarrheal disease. However, the number of publications exploring its association with nutritional status is small and fewer related to HIV infection in children under five years of age. This study aimed to explore the association between infection with G. duodenalis and nutritional status, diarrhea and HIV infection in children aged 0-59 months at the Central Hospital of Nampula (HCN), Mozambique. For this purpose, 831 children hospitalized or attending the HCN outpatient clinic were included. One single stool sample was obtained from each child. In addition, socio-demographic, clinical and anthropometric data (length/height and weight) were also obtained. Parasitological analysis of feces was performed through direct examination and Ritchie concentration technique and G. duodenalis antigen detection by rapid immunochromatographic test. Samples with positive identification of G. duodenalis with any of these methods were stored until DNA extraction and molecular analysis were conducted. Genetic characterization was done by studying a single nucleotide position polymorphism for the β-giardin gene (bg). Statistical analysis was undertaken through binary logistic regression and multiple logistic regression. The parasitological diagnosis revealed that G. duodenalis was the most common intestinal parasite in the studied population (23.9%, 199/831). The results of this study did not demonstrate any statistically significant association between nutritional status, diarrhea or HIV infection and G. duodenalis genotypes infection. However, it was found that children living in houses with three or more persons per room were more susceptible to total and simple infection with G. duodenalis (p=0.034 and p=0.048, respectively). Regarding nutritional status, it was observed that children with simple infection by G. duodenalis were less likely to have acute malnutrition (p=0.041). In addition, children younger than 24 months appeared to be more susceptible to low-weight and acute malnutrition, having diarrhea, abdominal pain and lack of appetite (p<0.05). This study highlights the importance of the diagnosis of this protozoan in similar contexts, as well as the need for more contributions to clarify the role of G. duodenalis genotypes in child health. Another relevant aspect includes a better understanding of the impact of infection in children under five years of age with acute malnutrition.
Descrição
Palavras-chave
Parasitologia médica Geardia duodenalis Genótipos Crianças Hospital Moçambique
Contexto Educativo
Citação
Editora
Instituto de Higiene e Medicina Tropical