Parasitoses intestinais, estado nutricional e diversidade genética de Giardia duodenalis em crianças atendidas em centro de educação infantil de Itapetininga, São Paulo.
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Data
2018-07-30
Autores
Corrêa, Claudia Rosana Trevisani
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Universidade Estadual Paulista (Unesp)
Resumo
Os centros de educação infantil destacam-se como ambientes para a promoção do desenvolvimento social e cultural da criança em idade pré-escolar, garantindo a oportunidade de uma vida mais saudável, inclusive pela possibilidade de uma alimentação adequada na infância. Entretanto, esses ambientes apresentam características epidemiológicas que favorecem a transmissão de patógenos incluindo os parasitas intestinais. O presente estudo transversal foi conduzido com crianças com idade variando de nove a 71 meses atendidas em EMEI do município de Itapetininga, SP, e teve como objetivos: (1) estimar a frequência de parasitas intestinais, (2) avaliar a diversidade genética de isolados de Giardia duodenalis e (3) avaliar o estado nutricional das crianças, segundo parâmetros antropométricos e dietéticos. De 140 crianças formalmente autorizadas a participar do estudo, 105 forneceram amostra de fezes, 108 tiveram os questionários preenchidos e 131 foram submetidas à avaliação antropométrica. Para a pesquisa de enteroparasitas, as amostras de fezes foram processadas pelos métodos de centrifugo-sedimentação e flutuação com sulfato de zinco. A avaliação do perfil nutricional incluiu parâmetros antropométricos (escore -Z para os índices peso/idade, peso/estatura, estatura/peso e IMC) e dietéticos (análise do cardápio quanto aos valores de macronutrientes). Para a detecção e caracterização moleculares de isolados de Giardia, o DNA extraído das amostras de fezes (oito amostras positivas e 97 amostras negativas para Giardia por microscopia) foi submetido a reações de PCR e os produtos obtidos para os genes β- giardina, gdh e tpi foram sequenciados. Parasitas intestinais foram identificados em 36% (38/105) das amostras com as seguintes frequências: Blastocystis 15% (16/105), Entamoeba coli e Endolimax nana 11% (12/105) cada, Trichuris trichiura e Ascaris lumbricoides 1% (1/105) cada. Em relação à Giardia, 7,6% (08/105) crianças foram positivas pelo exame de fezes e após o diagnóstico molecular foi possível detectar a infecção em 51,4% (54/105). Apenas na infecção por Giardia pode-se observar associação com a idade, uma vez que a frequência de infecção foi significativamente mais elevada no grupo com idade entre um e quatro anos. Quanto à avaliação antropométrica, a despeito do perfil eutrófico prevalecer, notou-se tendência para sobrepeso/obesidade, especialmente em relação ao índice IMC. O cardápio da instituição excedeu a recomendação do PNAE de 70% no que se refere às necessidades diárias de energia, assim como a distribuição de nutrientes para as crianças de todas as faixas etárias. A caracterização molecular de 54 isolados de Giardia revelou a ocorrência de infecção pelos assemblages A (62%; 31/50), subassemblages AI e AII, e B (38%; 19/50), subassemblages BII e BIV. A maior prevalência de subassemblage AII e assemblage B nas infecções detectadas nas crianças reforça o fato de que a transmissão antroponótica é relevante entre as crianças, especialmente em idades expostas ao maior risco de se adquirir a infecção e que se reúnem em ambientes que favorecem a disseminação do parasita. Os resultados obtidos são relevantes e fornecem informações que podem fundamentar ações para a promoção da saúde e melhoria da qualidade de vida da população infantil atendida em centros de educação infantil.
The centers of early childhood education stand out as environments to promote the social and cultural development of pre-school children, providing the opportunity for a healthy life, including the possibility of an adequate diet in childhood. In contrast, these environments present epidemiological characteristics that favor the transmission of pathogens including intestinal parasites. The present cross-sectional study was conducted with children ranging in age from 9 to 71 months attending the EMEI in the city of Itapetininga, State of São Paulo, and had the following objectives: (1) to estimate the frequency of intestinal parasites; (2) to evaluate the genetic diversity of isolates of Giardia duodenalis and (3) to evaluate the nutritional status of children according to anthropometric and dietary parameters. Out of 140 children who were formally authorized to participate in the study, 105 provided a stool sample, 108 had completed questionnaires and for 131, weight and height measurements were obtained for anthropometric evaluation. For the study of enteroparasites, the stool samples were processed by centrifugation-sedimentation and zinc sulfate flotation methods. Nutrition profile evaluation included anthropometric parameters (Z-score for weight /age, weight/height, height/weight and BMI) and dietary (macronutrient values). For the detection and molecular characterization of Giardia duodenalis isolates, DNA extracted from faeces samples (eight positive samples and 97 samples negative for Giardia duodenalis by microscopy) was submitted to PCR reactions and the products obtained for the β-giardin, gdh and tpi were sequenced. Intestinal parasites were identified in 36% (38/105) of the samples with the following frequencies: Blastocystis 15% (16/105), Entamoeba coli and Endolimax nana 11% (12/105) each, Trichuris trichiura and Ascaris lumbricoides 1% (1/105) each. Regarding Giardia duodenalis, 7.6% (08/105) children were positive by stool examination and after molecular diagnosis it was possible to detect infection in 51.4% (54/105). Only in Giardia duodenalis infection was observed association with age, since the frequency of infection was significantly higher in the group aged between one and four years. Regarding the anthropometric evaluation, despite the prevailing eutrophic profile, there was a trend towards overweight/obesity, especially in relation to the BMI index. The institution's menu exceeded the PNAE recommendation of 70% for daily energy needs, as well as nutrient distribution for children of all age groups. The molecular characterization of 54 Giardia isolates revealed the occurrence of infection by assemblages A (62%, 31/50), subassemblages AI and AII, and B (38%, 19/50), subassemblages BII and BIV. The higher prevalence of subassemblage AII and assemblage B in infections detected in children reinforces the fact that anthroponotic transmission is relevant among children, especially at ages exposed to the increased risk of acquiring the infection and meeting in environments that favor dissemination of the parasite. The results obtained are relevant and provide information that can support actions for the promotion of health and improvement of the quality of life of the child population attended in child education centers.
The centers of early childhood education stand out as environments to promote the social and cultural development of pre-school children, providing the opportunity for a healthy life, including the possibility of an adequate diet in childhood. In contrast, these environments present epidemiological characteristics that favor the transmission of pathogens including intestinal parasites. The present cross-sectional study was conducted with children ranging in age from 9 to 71 months attending the EMEI in the city of Itapetininga, State of São Paulo, and had the following objectives: (1) to estimate the frequency of intestinal parasites; (2) to evaluate the genetic diversity of isolates of Giardia duodenalis and (3) to evaluate the nutritional status of children according to anthropometric and dietary parameters. Out of 140 children who were formally authorized to participate in the study, 105 provided a stool sample, 108 had completed questionnaires and for 131, weight and height measurements were obtained for anthropometric evaluation. For the study of enteroparasites, the stool samples were processed by centrifugation-sedimentation and zinc sulfate flotation methods. Nutrition profile evaluation included anthropometric parameters (Z-score for weight /age, weight/height, height/weight and BMI) and dietary (macronutrient values). For the detection and molecular characterization of Giardia duodenalis isolates, DNA extracted from faeces samples (eight positive samples and 97 samples negative for Giardia duodenalis by microscopy) was submitted to PCR reactions and the products obtained for the β-giardin, gdh and tpi were sequenced. Intestinal parasites were identified in 36% (38/105) of the samples with the following frequencies: Blastocystis 15% (16/105), Entamoeba coli and Endolimax nana 11% (12/105) each, Trichuris trichiura and Ascaris lumbricoides 1% (1/105) each. Regarding Giardia duodenalis, 7.6% (08/105) children were positive by stool examination and after molecular diagnosis it was possible to detect infection in 51.4% (54/105). Only in Giardia duodenalis infection was observed association with age, since the frequency of infection was significantly higher in the group aged between one and four years. Regarding the anthropometric evaluation, despite the prevailing eutrophic profile, there was a trend towards overweight/obesity, especially in relation to the BMI index. The institution's menu exceeded the PNAE recommendation of 70% for daily energy needs, as well as nutrient distribution for children of all age groups. The molecular characterization of 54 Giardia isolates revealed the occurrence of infection by assemblages A (62%, 31/50), subassemblages AI and AII, and B (38%, 19/50), subassemblages BII and BIV. The higher prevalence of subassemblage AII and assemblage B in infections detected in children reinforces the fact that anthroponotic transmission is relevant among children, especially at ages exposed to the increased risk of acquiring the infection and meeting in environments that favor dissemination of the parasite. The results obtained are relevant and provide information that can support actions for the promotion of health and improvement of the quality of life of the child population attended in child education centers.
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Palavras-chave
Parasitas intestinais, Crianças, Creche, Estado nutricional, Giardia duodenalis, PCR, Assemblages, Intestinal parasites, Children, Day care, Nutritional status, Giardia duodenalis, PCR, Assemblages