ABSTRACT The human toxocariasis is the most important cosmopolite helminth infection in the world. The infection can modulate the immune response of the infected paratenic host, and it is suggested that it is an important risk factor for the development of asthma and be associated with increased levels of different markers of atopy. The aim of this study was to conduct a systematic review and meta-analysis of the association between human toxocariasis with asthma and atopic diseases. The literature search identified 1705 papers on the association of Toxocara spp with asthma, Then, 24 papers were selected based on the inclusion and exclusion criteria, following the PRISMA protocols. These papers served to analyze association data as a risk factor for increased asthma and investigate the association of this infection with the appearance of atopy markers (specific IgE). The results did not indicate association between asthma and Toxocara spp seropositivity, although there was a positive trend (OR 1.47; 95% CI 0.92-2.33). However, when studies were classified by type a positive association in the case-control type studies was found (OR 1.69; 95% CI 1.06-2.70). Furthermore, there was a positive association with this atopic marker in the analysis of the association of toxocariasis with specific IgE (OR 1.77; 95% CI 1.19-2.64). The evidence found was not entirely conclusive regarding the possibility of having T. canis infection as a risk factor for the development of asthma, although there is a positive statistical trend. On the other hand, the association with specific IgE results supports previous findings in the literature, where helminth infections can stimulate the production of this type of antibody, leading to a positive association with atopy.

RESUMEN La toxocariasis humana es la helmintiasis cosmopolita más importante del mundo. La infección puede modular la respuesta inmune del huésped paraténico infectado, y se sugiere que es un factor de riesgo importante para el desarrollo de asma y estar asociado con niveles elevados de diferentes marcadores de atopia. El objetivo de este estudio fue realizar una revisión sistemática y un metanálisis de la asociación entre la toxocariasis humana con asma y enfermedades atópicas. La búsqueda bibliográfica identificó 1705 artículos sobre la asociación de Toxocara spp con asma. Luego, se seleccionaron 24 artículos con base en los criterios de inclusión y exclusión, siguiendo los protocolos PRISMA. Estos trabajos sirvieron para analizar datos de asociación como factor de riesgo de aumento del asma e investigar la asociación de esta infección con la aparición de marcadores de atopia (IgE específica). Los resultados no indicaron asociación entre asma y seropositividad a Toxocara spp, aunque hubo una tendencia positiva (OR 1,47; IC 95% 0.92-2.33). Sin embargo, cuando los estudios se clasificaron por tipo se encontró una asociación positiva en los estudios de tipo caso-control (OR 1,69; IC 95% 1.06-2.70). Además, hubo una asociación positiva con este marcador atópico en el análisis de la asociación de la toxocariasis con la IgE específica (OR 1.77; IC 95% 1.19-2.64). La evidencia encontrada no fue del todo concluyente respecto a la posibilidad de tener infección por T. canis como factor de riesgo para el desarrollo de asma, aunque existe una tendencia estadística positiva. Por otro lado, la asociación con resultados de IgE específica respalda hallazgos previos en la literatura, donde las infecciones por helmintos pueden estimular la producción de este tipo de anticuerpos, lo que lleva a una asociación positiva con la atopia.

ABSTRACT The aim of this study was to evaluate the sensitivity of four coprodiagnostic techniques to quantitatively determine the presence of Toxocara canis eggs in fresh canine stool samples. For this, eggs were extracted from the uterus of adult female T. canis obtained from canine puppies. Eight concentrations of eggs were used (10, 50, 75, 100, 250, 500, 750 and 1 000 eggs per gram of faeces epg), being considered as the gold standard to determine the degree of precision of the Kato-Katz, McMaster, Improved Modified McMaster and Faust techniques. Three repetitions were used per technique and per concentration. The sensitivity of each test was performed by arithmetic calculation and ROC curve (95% CI), comparing them with the gold standard by means of a nonparametric test of the Wilcoxon signed ranges (p<0.05). The Faust technique detected T. canis eggs regardless of concentration, but in statistical inequality with the gold standard (p<0.001 to p<0.0001). The Kato-Katz technique did not show significant differences with the gold standard, but it was unable to detect the presence of T. canis eggs in 10 and 50 epg concentration, while the improved modified McMaster technique showed similarity with the gold standard in 100 and 250 epg. The McMaster method detected eggs from 100 epg, obtaining epg values below the gold standard (p<0.05 and p<0.001). Sensitivities of 74.72% (95% CI 72.93-80.22) were obtained for the Kato-Katz technique and between 30 and 40% (95% CI 26.71-48.29) for the other tests. It is concluded that the Kato-Katz technique obtained a better performance showing a constant quantitative diagnostic sensitivity when compared with other routine quantitative stool diagnosis techniques in veterinary laboratories for T. canis eggs in fresh dog faeces samples.

RESUMEN El estudio tuvo como objetivo evaluar la sensibilidad de técnicas coprodiagnósticas para determinar cuantitativamente la presencia de huevos de Toxocara canis en muestras de heces frescas de caninos. Para ello, se extrajeron huevos del útero de hembras adultas de T. canis obtenidas de cachorros caninos. Se utilizaron ocho concentraciones de huevos (10, 50, 75, 100, 250, 500, 750 y 1 000 huevos por gramo de materia fecal - hpg), siendo considerados como el gold standard para determinar el grado de precisión de las técnicas Kato-Katz, McMaster, McMaster modificado mejorado y Faust. Se utilizaron tres repeticiones por técnica y por concentración. La sensibilidad de cada prueba se realizó mediante el cálculo aritmético y curva ROC (IC95%), comparándolas con el gold standard mediante una prueba no paramétrica de los rangos con signo de Wilcoxon (p<0.05). La técnica Faust detectó huevos de T. canis sin importar la concentración, pero en desigualdad estadística con el gold standard (p<0.001 a p<0.0001). La técnica KatoKatz no presentó diferencias significativas con el gold standard, pero no detectó la presencia de huevos de T. canis en 10 y 50 hpg, mientras que la técnica McMaster modificado mejorado presentó similitud con el gold estandar en 100 y 250 hpg. El método de McMaster detectó huevos a partir de 100 hpg, obteniendo valores de hpg por debajo del gold standard (p<0.05 y p<0.001). Se obtuvieron sensibilidades de 74.72% (IC95% 72.93-80.22) para la técnica de Kato-Katz y entre 30 y 40% (IC95% 26.71-48.29) para las demás pruebas. Se concluye que la técnica Kato-Katz obtuvo un mejor desempeño en sensibilidad diagnóstica cuantitativa constante al comprarse con técnicas cotidianas cuantitativas de diagnóstico coprológico en laboratorios veterinarios para huevos de T. canis en muestras de heces frescas de canes.

Intervalo de referências para leucócitos e linfócitos atualmente utilizados pela maioria dos laboratórios clínicos, apresentam limitações e são primariamente derivados de indivíduos Norte-americanos e europeus. O objetivo deste trabalho foi determinar os valores de referências para linfócitos B e subpopulações de linfócitos T (CD4+, CD8+, naive, memória, regulatórias, TCRαβ and TCRγδ) e células Natural Killers em doadores de sangue em Salvador-Bahia, Brasil. Resultados: A proporção de homens incluídos foi de 73.7% e média de idade em homens (34) e mulheres (35) foram similares. Para os linfócitos totais foram encontrados em ambos os gêneros, valores absolutos na ordem de 1.956 (1.060-4.186) células e 34% para média relativa. Para linfócitos T CD4+ e T CD8+, os valores relativos foram de 51% (20-62) e 24% (9-28), respectivamente. Os mais altos índices de significância estatística encontrados foram alto percentuais de linfócitos B (p=0,03) em mulheres. Os resultados encontrados para outras populações celulares foram consistentes em relação a muitas populações de diferentes áreas geográficas.

The reference intervals for leukocytes and lymphocytes currently used by most clinical laboratories present limitations as they are primarily derived from individuals of North American and European origin. The objective this study was to determine reference values for peripheral blood B lymphocytes, T lymphocyte subsets (CD4+, CD8+, naïve, memory, regulatory, TCRαβ and TCRγδ+) and NK cells from blood donors in Salvador-Bahia, Brazil. Results: The proportion of included male subjects was 73.7% and the median ages of males (34) and females (35) were found to be similar. Absolute counts total lymphocytes subsets to both gender was 1,956 (1,060-4,186) cells and relative values 34%. The T CD4+ and T CD8+ lymphocytes relative values was 51% (20-62) and 24% (9-28), respectively. The most statistically significant finding observed was a higher percentage of B lymphocytes (p=0.03) in females. Commonly cited subset reference intervals were found to be consistent with values in several populations from different geographic areas.

INTRODUÇÃO: Larva migrans visceral é causada por Toxocara sp e nunca foi estudada na Bahia. Neste trabalho, investigou-se a prevalência e fatores de risco de infecção por Toxocara canis, em indivíduos de Salvador. MÉTODOS: Trezentos e trinta e oito indivíduos foram investigados para presença de anticorpos IgG séricos anti-T. canis. RESULTADOS: IgG anti-T. canis foi mais alta em indivíduos de classe social baixa com maior contato com cães e gatos, indicando que estas variáveis são fatores de risco para esta infecção. CONCLUSÕES: A prevalência de infecção por T. canis foi alta. Os fatores de risco desta infecção encontrados estão de acordo com a literatura.

INTRODUCTION: Larva migrans visceral is caused by Toxocara sp and has never been studied in Bahia. This work investigated the prevalence and risk factors for infection by Toxocara canis in individuals from Salvador, State of Bahia. METHODS: Three hundred and thirty-eight individuals were investigated for the presence of serum IgG anti-T. canis. RESULTS: IgG anti-T. canis was higher in individuals from lower social classes who had more contact with dogs and cats, indicating that these variables are factors risk for this infection. CONCLUSIONS: The prevalence of T. canis infection was high. The risk factors for this infection identified are in agreement with in the literature.

OBJECTIVE: This study aimed to explore the association between asthma and atopy in a cohort of children living in a large urban center in Brazil. Atopy was defined by the presence of allergen-specific IgE in serum or by a positive skin prick test. METHODS: In a sample of 1 445 Brazilian children, the association between the prevalence of asthma, skin prick test positivity, and allergen-specific IgE in serum was investigated. RESULTS: The prevalence of asthma was 22.6%. The presence of serum allergen-specific IgE was frequent in asthmatics and nonasthmatics, and the prevalence of asthma increased only with levels of allergen-specific IgE > 3.5 kilounits/L. The proportion of asthma attributable to atopy was estimated to be 24.5% when atopy was defined by the presence of allergen-specific IgE. With a given level of specific IgE, no association between skin test reactivity and asthma was observed. Skin prick tests were less sensitive than specific IgE for detection of atopy. CONCLUSIONS: Most asthma cases in an urban underprivileged setting in Brazil were not attributable to atopy. This observation has important implications for understanding the risk factors for the asthma epidemic in Latin America

OBJETIVO: Explorar la relación entre el asma y la atopia en una cohorte de niños que viven en un gran centro urbano de Brasil. En este estudio, se considera atopia la detección de IgE sérica específica de algún alérgeno o un resultado positivo a la prueba de punción cutánea. MÉTODOS: Se estudió la relación entre la prevalencia del asma, el resultado positivo a la prueba de punción cutánea y la detección de IgE sérica específica de algún alérgeno en una muestra de 1 445 niños brasileños. RESULTADOS: El asma registró una prevalencia de 22,6%. La presencia de IgE séricas específicas de alérgenos fue frecuente tanto en los asmáticos como en los no asmáticos, y la prevalencia del asma fue mayor solo cuando el valor detectado de la IgE específica del alérgeno era > 3,5 kilounidades/litro. Se calculó que la atopia definida como la detección de IgE específicas de alérgenos es responsable de 24,5% de los casos de asma. No se observó ninguna relación entre la reactividad a la prueba de punción cutánea y el asma en función de los valores de IgE específicas. La prueba de punción cutánea es menos sensible que la detección de IgE específicas en lo que respecta al diagnóstico de atopia. CONCLUSIONES: La mayoría de los casos de asma que se registran en entornos urbanos desfavorecidos de Brasil no son atribuibles a atopia. Esta observación tiene implicaciones importantes en lo que respecta a la comprensión de los factores de riesgo que predisponen a la epidemia de asma en América Latina