Population-based data on sexually transmitted infections (STI), bacterial vaginosis (BV), and candidiasis reflect the epidemiological situation more accurately than studies performed in specific populations, but such data are scarce. To determine the prevalence of STI, BV, and candidiasis among women of reproductive age from a resource-poor community in Northeast Brazil, a population-based cross sectional study was undertaken. All women from seven hamlets and the centre of Pacoti municipality in the state of Ceará, aged 12 to 49 years, were invited to participate. The women were asked about socio-demographic characteristics and genital symptoms, and thereafter examined gynaecologically. Laboratory testing included polymerase chain reaction (PCR) for human papillomavirus (HPV), ligase chain reaction (LCR) for Chlamydia trachomatis and Neisseria gonorrhoeae, ELISA for human immunodeficiency virus (HIV), venereal disease research laboratory (VDRL) and fluorescent treponema antibody absorption test (FTA-ABS) for syphilis, and analysis of wet mounts, gram stains and Pap smears for trichomoniasis, candidiasis, and BV. Only women who had initiated sexual life were included in the analysis (n = 592). The prevalences of STI were: HPV 11.7% (95% confidence interval: 9.3-14.7), chlamydia 4.5% (3.0-6.6), trichomoniasis 4.1% (2.7-6.1), gonorrhoea 1.2% (0.5-2.6), syphilis 0.2% (0.0-1.1), and HIV 0%. The prevalence of BV and candidiasis was 20% (16.9-23.6) and 12.5% (10.0-15.5), respectively. The most common gynaecological complaint was lower abdominal pain. STI are common in women in rural Brazil and represent an important health threat in view of the HIV pandemic.

Several different plant extracts have been evaluated with respect to their antimicrobial effects against oral pathogens and for reduction of gingivitis. Given that a large number of these substances have been associated with significant side effects that contraindicate their long-term use, new compounds need to be tested. The aim of this study was to assess the short-term safety and efficacy of a Lippia sidoides ("alecrim pimenta")-based essential oil mouthrinse on gingival inflammation and bacterial plaque. Fifty-five patients were enrolled into a pilot, double-blinded, randomized, parallel-armed study. Patients were randomly assigned to undergo a 7-day treatment regimen with either the L. sidoides-based mouthrinse or 0.12% chlorhexidine mouthrinse. The results demonstrated decreased plaque index, gingival index and gingival bleeding index scores at 7 days, as compared to baseline. There was no statistically significance difference (p>0.05) between test and control groups for any of the clinical parameters assessed throughout the study. Adverse events were mild and transient. The findings of this study demonstrated that the L. sidoides-based mouthrinse was safe and efficacious in reducing bacterial plaque and gingival inflammation.

A tungíase, ectoparasitose causada pela pulga Tunga penetrans, é endêmica em comunidades brasileiras de baixo poder aquisitivo. Neste estudo foram identificados habitantes de uma favela urbana em Fortaleza com carga parasitária elevada. Número de lesões, localização, estadiamento e patologias associadas foram registrados. Os 142 indivíduos identificados apresentaram condições de moradia extremamente precárias. Contou-se no total 3.445 lesões localizadas nos pés (mediana = 17 lesões; máximo = 98 lesões). Quase sem exceção, os indivíduos apresentaram deformações ungueais e edema e mais de 70% dor e fissuras. Perda de unha foi observada em 46% dos casos e deformação de dígitos em 25%; 42% apresentaram abscessos e 59% queixaram-se de dificuldade de andar. Nossos dados mostram que a tungíase em comunidade urbana de baixa renda típica no nordeste brasileiro está associada a patologia grave. A doença precisa ser reconhecida como problema de saúde pública na região estudada e em outras áreas endêmicas semelhantes.

The parasitic skin disease tungiasis, caused by the jigger flea Tunga penetrans, is endemic in low-income communities in Brazil. In this study, inhabitants of a shantytown in Fortaleza, northeastern Brazil, who had an elevated parasite load, were identified. The number of lesions, localization, staging and associated diseases were recorded. The 142 individuals identified were living in extremely precarious housing conditions. A total of 3,445 lesions located on the feet were counted (median = 17 lesions; maximum = 98 lesions). Almost without exception, the individuals had nail deformation and edema, and more than 70% presented with pain and fissures. There was nail loss in 46%; deformation of the digits in 25%; abscesses in 42%; and complaints of walking difficulty in 59%. Our data show that tungiasis in this low-income urban community typical of northeastern Brazil was associated with severe morbidity. Tungiasis needs to be recognized as a public health problem in this study area and other similar endemic areas.

Tungiasis is a parasitic skin disease widespread in resource-poor urban and rural communities in Brazil. Inhabitants of an urban slum in Northeast Brazil were examined for the presence of tungiasis lesions and followed-up twice a week for a period of three weeks. Each time the number, stages, and topographic localization of lesions were recorded on a documentation sheet. The infestation rate (number of newly embedded sand fleas per individual and day) remained stable during the observation period. The infestation rate was significantly related to the intensity of infestation (total number of lesions present) (rho = 0.70, p < 0.0001) and the proportion of viable lesions (rho = 0.28, p < 0.0001). The results indicate that in an endemic area the infestation intensity and the proportion of viable lesions can be used as a proxy to assess the exposure of individuals at risk for tungiasis. Persistently high infestation rates during the transmission season favour the use of prevention measures against invading sand fleas (such as a repellent) rather than a drug to kill already embedded parasites.

Tungiasis is an ectoparasitosis causing considerable pathology in endemic areas. Standard therapy consists of removing the embedded parasite with a sterile needle. There is no effective chemotherapy at hand. To fill this gap, a double-blinded randomized controlled trial with oral ivermectin was conducted. A total of 54 individuals (27 in the placebo group, 27 in the ivermectin group) was followed up for seven days. They presented a total of 192 lesions. Patients received either ivermectin (300 µg/kg body weight at a single dose, repeated after 24 h) or placebo. Outcome measures included the clinical stage of lesion, presence of erythema, pain, itching, signs of viability of the parasite, and total lysis of flea. The ratio of fleas with total lysis per total number of fleas was slightly higher in the ivermectin group; however, this difference was not statistically significant. There was no significant difference in any of the other outcome measures between the treatment and the placebo group. The results show that oral ivermectin is without any clinically significant efficacy against embedded sand fleas at the dose given.

OBJECTIVE: To assess the short-term and long-term impact of selective mass treatment with ivermectin on the prevalence of intestinal helminthiases and parasitic skin diseases in an economically depressed community in north-east Brazil. METHODS: An intervention was carried out in a traditional fishing village in north-east Brazil where the population of 605 is heavily affected by ectoparasites and enteroparasites. The prevalence of intestinal helminths was determined by serial stool examination and the prevalence of parasitic skin diseases by clinical inspection. A total of 525 people out of a target population of 576 were treated at baseline. The majority of these were treated with ivermectin (200 µg/kg with a second dose given after 10 days). If ivermectin was contraindicated, participants were treated with albendazole or mebendazole for intestinal helminths or with topical deltamethrin for ectoparasites. Follow-up examinations were performed at 1 month and 9 months after treatment. FINDINGS: Prevalence rates of intestinal helminthiases before treatment and at 1 month and 9 months after mass treatment were: hookworm disease 28.5%, 16.4% and 7.7%; ascariasis 17.1%, 0.4% and 7.2%; trichuriasis 16.5%, 3.4% and 9.4%; strongyloidiasis 11.0%, 0.6% and 0.7%; and hymenolepiasis 0.6%; 0.4% and 0.5%, respectively. Prevalence rates of parasitic skin diseases before treatment and 1 month and 9 months after mass treatment were: active pediculosis 16.1%, 1.0% and 10.3%; scabies 3.8%, 1.0% and 1.5%; cutaneous larva migrans 0.7%, 0% and 0%; tungiasis 51.3%, 52.1% and 31.2%, respectively. Adverse events occurred in 9.4% of treatments. They were all of mild to moderate severity and were transient. CONCLUSION: Mass treatment with ivermectin was an effective and safe means of reducing the prevalence of most of the parasitic diseases prevalent in a poor community in north-east Brazil. The effects of treatment lasted for a prolonged period of time.

OBJETIVO: Evaluar el impacto del tratamiento masivo selectivo con ivermectina, a corto y a largo plazo, en la prevalencia de las helmintiasis intestinales y las parasitosis cutáneas en una comunidad económicamente deprimida del noreste del Brasil. MÉTODOS: Se llevó a cabo una intervención en un pueblo tradicional de pescadores del noreste del Brasil cuya población, de 605 habitantes, está gravemente afectada por diversos ectoparásitos y enteroparásitos. La prevalencia de los helmintos intestinales se determinó mediante examen coproparasitoscópico seriado, y la prevalencia de las parasitosis cutáneas, mediante inspección clínica. En total se trató al principio del estudio a 525 personas, de una población destinataria de 576. La mayoría de ellas fueron tratadas con ivermectina (200 µg/kg de peso, con una segunda dosis al cabo de 10 días). Cuando la ivermectina estaba contraindicada, el participante era tratado con albendazol o mebendazol si tenía helmintos intestinales, o con deltametrina tópica si tenía ectoparásitos. Los exámenes de seguimiento se realizaron al cabo de un mes y 9 meses del tratamiento. RESULTADOS: Las tasas de prevalencia de las helmintiasis intestinales antes del tratamiento y al cabo de un mes y 9 meses del tratamiento masivo fueron las siguientes: anquilostomiasis, 28,5%, 16,4% y 7,7%; ascariasis, 17,1%, 0,4% y 7,2%; tricuriasis, 16,5%, 3,4% y 9,4%; estrongiloidiasis, 11,0%, 0,6% y 0,7%; y himenolepiasis, 0,6%, 0,4% y 0,5%, respectivamente. Las tasas de prevalencia de las parasitosis cutáneas antes del tratamiento y al cabo de un mes y 9 meses del tratamiento masivo fueron las siguientes: pediculosis activa, 16,1% 1,0% y 10,3%; sarna, 3,8%, 1,0% y 1,5%; larva migrans cutánea, 0,7%, 0% y 0%; y tungiasis, 51,3%, 52,1% y 31,2%, respectivamente. Se registraron acontecimientos adversos en el 9,4% de los tratamientos, todos ellos entre leves y moderados y de carácter transitorio. CONCLUSIÓN: El tratamiento masivo con ivermectina fue un método eficaz y seguro de reducción de la prevalencia de la mayoría de las enfermedades parasitarias prevalentes en una comunidad pobre del noreste del Brasil. El tratamiento tuvo efectos prolongados.

OBJECTIF: Evaluer l'impact à court et à long terme d'un traitement de masse sélectif par l'ivermectine sur la prévalence des helminthiases intestinales et des dermatoses parasitaires dans une communauté économiquement défavorisée du nord-est du Brésil. MÉTHODES: Une intervention a été réalisée dans un village de pêcheurs traditionnel du nord-est du Brésil dont la population (605 habitants) est sévèrement touchée par des ectoparasites et des parasites intestinaux. La prévalence des helminthes intestinaux a été déterminée par examen en série de selles et celle des dermatoses parasitaires par inspection clinique. Au total, 525 personnes sur les 576 de la population cible ont été traitées en début d'intervention. La plupart ont reçu de l'ivermectine (200 µg/kg, avec une deuxième dose au bout de 10 jours). Lorsque l'ivermectine était contre-indiquée, les participants étaient traités par l'albendazole ou le mébendazole contre les helminthes intestinaux ou par la deltaméthrine en application locale contre les ectoparasites. Des examens de contrôle ont été réalisés 1 mois et 9 mois après le traitement. RÉSULTATS: La prévalence des diverses helminthiases intestinales avant le traitement et au bout d'un mois et de 9 mois après le traitement était, respectivement, de : ankylostomiase 28,5 %, 16,4 % et 7,7 % ; ascaridiase 17,1 %, 0,4 % et 7,2 % ; trichocéphalose 16,5 %, 3,4 % et 9,4 % ; strongyloïdose 11,0 %, 0,6 % et 0,7 % ; et hyménolépiase 0,6 %, 0,4 % et 0,5 %. La prévalence des diverses dermatoses parasitaires avant le traitement et au bout d'un mois et de 9 mois était, respectivement, de : pédiculose active 16,1 %, 1,0 % et 10,3 % ; gale 3,8 %, 1,0 % et 1,5 % ; larva migrans cutanée 0,7 %, 0 % et 0 % ; et tungose 51,3 %, 52,1 % et 31,2 %. Des effets indésirables ont été observés avec 9,4 % des traitements. Il s'agissait dans tous les cas d'effets passagers, de gravité faible à modérée. CONCLUSION: Le traitement de masse par l'ivermectine était un moyen efficace et sans danger pour réduire la prévalence de la plupart des affections parasitaires présentes dans une communauté pauvre du nord-est du Brésil, et ses effets étaient durables.

Doenças ectoparasitárias como a escabiose, a pediculose, a tungíase e a larva migrans cutânea são hiperendêmicas em inúmeras comunidades carentes no Brasil, e não raramente associadas à severidade considerável. Entretanto, programas que priorizem o controle de ectoparasitas não existem em nível de saúde pública no país. Como conseqüência da alta contagiosidade, de manejo inadequado, de negligência tanto da população como dos profissionais de saúde e/ou da presença de reservatórios animais, além de ciclos de vida complexos, o controle efetivo das ectoparasitoses é um desafio para a saúde pública. Aqui discutimos possíveis medidas de intervenção para o controle de doenças ectoparasitárias em comunidades afetadas, baseadas em tratamento em massa, educação em saúde e, caso se aplique, na erradicação dos reservatórios animais.

Parasitic skin diseases such as scabies, pediculosis, tungiasis, and cutaneous larva migrans are hyperendemic in the numerous poor communities in Brazil and are commonly associated with considerable morbidity. However, programs to control ectoparasites are non-existent in the country's public health system. Due to neglect of these diseases by the population itself and health care professionals, the diseases' highly contagious characteristics, and lack of effective treatment and/or presence of animal reservoirs together with a complex life cycle, effective control of ectoparasites is an enormous public health challenge. This article discusses potential measures to control parasitic skin diseases in affected communities, based on mass treatment, health education, and (when applicable) eradication of animal reservoirs.

Doenças ectoparasitárias como a escabiose, a pediculose, a tungíase e a larva migrans cutânea são hiperendêmicas em inúmeras comunidades carentes no Brasil, e não raramente associadas à severidade considerável. Entretanto, programas que priorizem o controle de ectoparasitas não existem em nível de saúde pública no país. Como conseqüência da alta contagiosidade, de manejo inadequado, de negligência tanto da população como dos profissionais de saúde e/ou da presença de reservatórios animais, além de ciclos de vida complexos, o controle efetivo das ectoparasitoses é um desafio para a saúde pública. Aqui discutimos possíveis medidas de intervenção para o controle de doenças ectoparasitárias em comunidades afetadas, baseadas em tratamento em massa, educação em saúde e, caso se aplique, na erradicação dos reservatórios animais.

Parasitic skin diseases such as scabies, pediculosis, tungiasis, and cutaneous larva migrans are hyperendemic in the numerous poor communities in Brazil and are commonly associated with considerable morbidity. However, programs to control ectoparasites are non-existent in the country's public health system. Due to neglect of these diseases by the population itself and health care professionals, the diseases' highly contagious characteristics, and lack of effective treatment and/or presence of animal reservoirs together with a complex life cycle, effective control of ectoparasites is an enormous public health challenge. This article discusses potential measures to control parasitic skin diseases in affected communities, based on mass treatment, health education, and (when applicable) eradication of animal reservoirs.