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Hermann Feldmeier

Publications and source records attributed to Hermann Feldmeier.

At least 37 records · Page 2Linked to original sources
PubMed2004

Ectoparasites--the underestimated realm.

CONTEXT: Ectoparasitoses (infestations with parasites that live on or in the skin) can cause considerable morbidity. Whereas pediculosis and scabies are ubiquitous, cutaneous larva migrans and tungiasis (sand-flea disease) occur mainly in hot climates. The prevalence of ectoparasitoses in the general population is usually low, but can be high in vulnerable groups. Scientific knowledge on how to deal best with parasitic skin diseases in different settings is scanty, and evidence-based measures for control are not available. For head lice and scabies the situation is daunting, because resistance of Pediculus humanus capitis and Sarcoptes scabiei to insecticides is spreading and unpredictable. STARTING POINT: J Hunter and S Barker reported different patterns of resistance in schoolchildren in Brisbane, Australia: full resistance to malathion, permethrin, and pyrethrum in two schools, whereas head lice were susceptible to malathion and, to a lesser extent, to pyrethrums in three other schools (Parasitol Res 2003; 90: 476-78). K Yoon and colleagues found different resistance patterns in the USA and Ecuador (Arch Dermatol 2003; 139: 994-1000). Head lice from Florida were less susceptible to permethrin than those from Texas, and parasites from Ecuador were susceptible to both insecticides tested. WHERE NEXT? The occurrence of resistant pediculosis and scabies is expected to increase numerically and geographically. Clinicoepidemiological studies are urgently needed to identify the factors which govern the emergence and spread of strains of P humanus capitis and S scabiei that are resistant to insecticide or acaricide. Oral treatment with ivermectin could substitute for topically applied compounds, particularly in resource-poor communities where polyparasitism is common. A better understanding of local epidemiology is required to develop control measures. This knowledge has to be applied in combination with environmental sanitation, health education, and culturally acceptable interventions that are affordable by the underprivileged.

Drug Resistance↗
PubMed2004

Investigations on the biology, epidemiology, pathology and control of Tunga penetrans in Brazil: IV. Clinical and histopathology.

Tungiasis is a parasitic skin disease caused by the sand flea Tunga penetrans. This ectoparasitosis is endemic in South America, the Caribbean and sub-Saharan Africa, where it is an important but neglected health problem in resource-poor communities. As part of a study of tungiasis-related morbidity in a typical slum in Fortaleza, Brazil, we identified 86 individuals with tungiasis. Lesions were counted, classified according to the stage of development, and clinical pathology was documented. One hundred and nine lesions were biopsied and examined by histological sectioning. The patients had between 1 and 145 lesions (median 14.5), the majority occurring in clusters. In all, 77% of patients reported severe pain at the site of the lesion, and 52% had one or more nails lost or severely deformed. Intense inflammation and/or fissures hindered 45% of the patients from walking normally. Signs of superinfection were observed in 29%, and signs of generalized inflammation in 2% of patients. Clinical pathology was significantly related to the number of lesions, and the total number of parasites present correlated with the number of fleas occurring in clusters. Clinical pathology was frequently accompanied by a pathological alteration of the epidermis (predominantly hyperplasia, parakeratosis, hyperkeratosis, and spongiosis) and the dermis. Tungiasis causes a broad spectrum of clinical histopathological alterations, and is a serious health threat in a typical, impoverished community in northeast Brazil. The clinical pathology is closely related to the parasite burden of an individual and the clustering of embedded fleas at certain predilection sites.

Adolescent↗
PubMed2004

Efficacy of ivermectin in a patient population concomitantly infected with intestinal helminths and ectoparasites.

Ivermectin (CAS 70288-86-7) is a potent antiparasitic drug. However, studies have not been published evaluating the efficacy of ivermectin in a patient population concomitantly infected with intestinal helminths and ectoparasites. Here the results of an open trial on the efficacy of ivermectin in a heavily poly-parasitized population in northeast Brazil are presented. Two hundred and fifty-one patients were enrolled. Two doses of ivermectin (200 microg/kg) were given at an interval of 10 days. The cure rates for intestinal helminthiases were: 100% for strongyloidiasis and enterobiasis, 99% for ascariasis, 84% for trichuriasis, 68% for hookworm disease, and 50% for hymenolepiasis. Cure rates for ectoparasitoses were: 100% for cutaneous larva migrans, 99% for pediculosis, 88% for scabies and 64% for tungiasis. The results show that two doses of ivermectin are highly efficacious for most intestinal helminths and ectoparasites simultaneously present in an impoverished population. The drug seems to be particularly useful when polyparasitism is expected to occur or when public health measures aim to reduce both intestinal helminthiases and parasitic skin diseases by mass chemotherapy.

Adolescent↗
PubMed2004

Inequality and leprosy in Northeast Brazil: an ecological study.

BACKGROUND: Leprosy is an important public health problem in many developing countries and many features of its determinants are still obscure. METHODS: To investigate whether the incidence of leprosy is related to certain environmental and socioeconomic determinants, an ecological study was undertaken in 165 municipalities of the state of Ceará, Brazil. Social, economic, education, sanitation, demography, meteorology, and health data were collected. The dependent variable was the average incidence rate of leprosy from 1991 to 1999. Simple and multiple linear regressions were performed to assess the relationship between the dependent and the independent variables. RESULTS: The average incidence rate for all the municipalities for the 1991-1999 period, varied from 0.06 to 14.68 per 10000 persons per year. The level of inequality (beta = 1.67, P = 0.011), the mean years of study among the population >or=25 years old (beta = 1.35, P < 0.001), the population growth from 1991 to 1996 (beta = 0.02, P = 0.007), the percentage of children 7-14 years old that did not go to the school (beta = 0.02, P = 0.028), and the presence of a railroad in the municipality (beta = 0.45, P = 0.038) were found to be predictors of the incidence rate of leprosy in Ceará. CONCLUSION: Our findings fit the assumption that, in Ceará, leprosy is associated with a high level of poverty and uncontrolled urbanization. We put forward the hypothesis that urbanization increases not only social inequality eventually leading to strong polarization, but also excludes people from social and material opportunities. Apparently, such deprivations render them susceptible for leprosy.

Adolescent↗
PubMed2004

Cutaneous larva migrans (creeping eruption) in an urban slum in Brazil.

BACKGROUND: Cutaneous larva migrans (CLM) is caused by the penetration of larvae of animal hookworms into the skin. Knowledge about this ectoparasitosis is mainly based on the examination of travelers or other expatriates. Population-based studies in an endemic area have never been performed. METHODS: A representative population sample of an urban slum in a Brazilian city was examined for the presence of CLM and asked about symptoms associated with the ectoparasitosis. RESULTS: In total, 3.1% (95% confidence interval, 2.2-4.3%) of the 1185 inhabitants examined presented CLM. Forty-three per cent had more than one larval track (range, 1-17). The prevalence rate in males was 4.2% vs. 2.3% in females. CLM occurred at similar prevalence rates in all age groups. All patients complained of moderate or severe itching. In three cases (8.1%), superinfection was present. Most lesions were located on the trunk, legs, and arms. Not a single lesion was located on the feet. CONCLUSIONS: This population-based study showed that CLM is endemic in this deprived community. The number of lesions and their topographic localization are in contrast with those obtained in previous reports based on the examination of individuals or groups affected in small outbreaks. We conclude that the clinico-epidemiologic pattern of CLM in a deprived community is different from that observed in travelers.

Adolescent↗
PubMed2003

[Ecoparasitoses and public health in Brazil: challenges for control].

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.

Animals↗
PubMed2003

Investigations on the biology, epidemiology, pathology and control of Tunga penetrans in Brazil: III. Cytokine levels in peripheral blood of infected humans.

Tungiasis is caused by penetration of the female jigger flea, Tunga penetrans, into the skin of its host. This parasitic skin disease is almost invariably associated with intense inflammation around embedded fleas, the underlying mechanisms being unknown. A study was undertaken to determine whether the inflammatory process can be attributed to immune activation induced by a biologically active foreign body. We determined the concentrations of Th1-mediated (IFN-gamma, TNF-alpha) and Th2-mediated (IL-4) cytokines in the sera of patients with tungiasis. The results were compared with those of controls infected with different helminths or exposed to soil-transmitted helminths. The results show that tungiasis causes a mixed Th1 and Th2 immune response, characterized by significantly increased concentrations of the pro-inflammatory cytokines IFN-gamma and TNF-alpha, with a slightly increased concentration of IL-4. The preponderance of the Th1 immune response was indicated by a significantly increased TNF-alpha/IL-4 ratio in patients with tungiasis, as compared with the control groups.

Adolescent↗
PubMed2003

Investigations on the biology, epidemiology, pathology and control of Tunga penetrans in Brazil. II. Prevalence, parasite load and topographic distribution of lesions in the population of a traditional fishing village.

Tungiasis is hyperendemic in many poor communities in Brazil and is associated with considerable morbidity. In order to understand the factors that determine the distribution of this ectoparasitosis in a rural community, an epidemiological study was carried out in a traditional fishing village in Ceará State, north-eastern Brazil. Based on active case detection and voluntary participation, 91% of the population (belonging to 95% of all families) was examined. Embedded fleas were looked for over all parts of the body, counted, and the lesions were staged. The overall prevalence of infestation was 51.3% (95% CI: 47.0-55.5). More males than females were infested (54.8% vs 48.3%); however, this difference was not statistically significant. Age-specific prevalence rates followed an S-shaped curve with peaks in children aged 5-9 years and people elder than 60 years. The parasite burden was high (range 1-145 lesions; arithmetic mean: 8.9) and particularly elevated in males, children <15 years and the elderly. The distribution of the parasite burden was uneven within the population with the majority of the lesions in a few individuals: the 23 subjects (8% of all infested) with severe infestation (>30 lesions) accounted for 1,366 of the 2,493 lesions (54.8%) documented. The study shows that tungiasis is a highly prevalent ectoparasitosis in this deprived community with a peculiar distribution of prevalence and parasite burden.

Adolescent↗
PubMed2003

Investigations on the biology, epidemiology, pathology and control of Tunga penetrans in Brazil: I. Natural history of tungiasis in man.

Tungiasis is an important health problem in poor communities in Brazil and is associated with severe morbidity, particularly in children. The causative agent, the female flea Tunga penetrans, burrows into the skin of its host, where it develops, produces eggs and eventually dies. From the beginning of the penetration to the elimination of the carcass of the ectoparasite by skin repair mechanisms, the whole process takes 4-6 weeks. The present study is based on specimens from 86 patients, for some of whom the exact time of penetration was known. Lesions were photographed, described in detail and biopsied. Biopsies were examined histologically and by means of scanning electron microscopy (SEM). Based on clinical, SEM and histological findings, the "Fortaleza classification" was elaborated. This allows the natural history of tungiasis to be divided into five stages: (1) the penetration phase, (2) the phase of beginning hypertrophy, (3) the white halo phase, (4) the involution phase and (5) residues in the host's skin. Based on morphological and functional criteria, stages 3 and 4 are divided into further substages. The proposed Fortaleza classification can be used for clinical and epidemiological purposes. It allows a more precise diagnosis, enables the assessment of chemotherapeutic approaches and helps to evaluate control measures at the community level.

Aged↗
PubMed2003

Parasitic skin diseases: health care-seeking in a slum in north-east Brazil.

Ectoparasitic diseases are endemic in many poor communities in north-east Brazil, and heavy infestation is frequent. We conducted two studies to assess disease perception and health care seeking behaviour in relation to parasitic skin diseases and to determine their public health importance. The first study comprised a representative cross-sectional survey of the population of a slum in north-east Brazil. Inhabitants were examined for the presence of scabies, tungiasis, pediculosis and cutaneous larva migrans (CLM). The second study assessed health care seeking behaviour related to these ectoparasitic diseases of patients attending a Primary Health Care Centre (PHCC) adjacent to the slum. Point prevalence rates in the community were: head lice 43.3% (95% CI: 40.5-46.3), tungiasis 33.6% (95% CI: 30.9-36.4), scabies 8.8% (95% CI: 7.3-10.6) and CLM 3.1% (95% CI: 2.2-4.3). Point prevalence rates of patients attending the PHCC were: head lice 38.2% (95% CI: 32.6-44.1), tungiasis 19.1% (95% CI: 14.7-24.1), scabies 18.8% (95% CI: 14.4-23.7) and CLM 2.1% (95% CI: 0.8-4.5). Only 28 of 54 patients with scabies, three of 55 patients with tungiasis, four of six patients with CLM and zero of 110 patients with head lice sought medical assistance. The physicians of the PHCC only diagnosed a parasitic skin disease when it was pointed out by the patient himself. In all cases patients were correctly informed about the ectoparasites they carried. The results show that tungiasis and pediculosis, and to a lesser extent scabies and CLM, are hyperendemic but neglected by both population and physicians, and that prevalence rates of tungiasis and scabies at the PHCC do not reflect the true prevalence of these diseases in the community.

Adolescent↗
PubMed2003

Sexually transmitted infections in a female population in rural north-east Brazil: prevalence, morbidity and risk factors.

OBJECTIVES: To determine the prevalence of major sexually transmitted infections (STIs) and gynaecological morbidity in women of reproductive age living in rural communities in north-east Brazil and to assess risk factors associated with the presence of STIs. METHODS: A total of 341 women (84%) were examined gynaecologically and colposcopically. The gynaecological history was taken by means of a standardized, pre-tested questionnaire. Cervical smears were obtained and vaginal fluid was collected. Vulvovaginal candidiasis (VC), bacterial vaginosis (BV), trichomoniasis (TV) and syphilis seroreactivity were determined by standard laboratory techniques. Infections with Neisseria gonorrhoeae, Chlamydia trachomatis and human papilloma virus (HPV) were diagnosed by hybrid capture assays using vaginal lavage fluid. Odds ratios (OR) were calculated to assess risk factors associated with STIs. RESULTS: The prevalence of HPV, BV and TV was 26%, 15% and 10%, respectively. VC as well as infections with N. gonorrhoeae and C. trachomatis were detected in 6%; syphilis seroreactivity, in 3%. Multiple infections were very common, and 51% of women had at least one STI. Vaginal discharge, the predominant morbidity (56%), was significantly associated with BV (OR = 6.3; P < 0.001), vulvovaginal itching with VC (OR = 3.5; P < 0.05) and lower abdominal pain with C. trachomatis infection (OR = 2.6; P < 0.04). Colpitis was diagnosed in 27% of women and significantly associated with TV (OR = 3.5%; P < 0.001) and VC (OR = 2.9; P < 0.05). Being unmarried was a significant risk factor for having an STI (OR = 2.4; P < 0.05). Among unmarried women, age (<20 years) was a significant risk factor (OR = 3.3; P = 0.01). CONCLUSIONS: The STIs are highly prevalent in this female population in the rural hinterland of north-east Brazil and associated with considerable morbidity. In view of the expected spread of HIV from the urban centres at the coast to the interior there is an urgent need for providing STI-related health care and health education for adolescents and women in rural Brazil.

Adolescent↗
PubMed2003

Leishmaniasis in Germany.

In 2000, a reference center was created to systematically record leishmaniases in Germany. We analyzed 58 cases of leishmaniases imported during a 2-year period. These findings will serve as a baseline for the sandfly vector's anticipated northward move because of global warming and as an advisory for immunocompromised persons traveling to leishmaniasis-endemic areas.

Adolescent↗
PubMed2003

Severe tungiasis in underprivileged communities: case series from Brazil.

Tungiasis is caused by infestation with the sand flea (Tunga penetrans). This ectoparasitosis is endemic in economically depressed communities in South American and African countries. Tungiasis is usually considered an entomologic nuisance and does not receive much attention from healthcare professionals. During a study on tungiasis-related disease in an economically depressed area in Fortaleza, northeast Brazil, we identified 16 persons infested with an extremely high number of parasites. These patients had >50 lesions each and showed signs of intense acute and chronic inflammation. Superinfection of the lesions had led to pustule formation, suppuration, and ulceration. Debilitating sequelae, such as loss of nails and difficulty in walking, were constant. In economically depressed urban neighborhoods characterized by a high transmission potential, poor housing conditions, social neglect, and inadequate healthcare behavior, tungiasis may develop into severe disease.

Adolescent↗
PubMed2002

High prevalence of tungiasis in a poor neighbourhood in Fortaleza, Northeast Brazil.

Tungiasis has been reported to occur in many Latin American, Caribbean and African countries. However, epidemiological data are still very scanty and do not exist at all for Brazil. To fill this gap, a cross-sectional study has been undertaken in a shantytown (favela) in Fortaleza, Ceará State, northeast Brazil. All 327 households of a circumscribed sub-area were visited, and 1185 out of the 1460 household members were thoroughly examined for the presence of tungiasis. Thirty-four% (95% CI: 30.9-36.4) were found to be infected with Tunga penetrans with a significant preponderance of the male sex (p<0.0001). In the children five to nine years old, the age group most heavily affected, the prevalence rate was 65.4% (95% CI: 54.0-75.7) in boys and in 48.3% (95% CI: 37.4-59.2) in girls. The data show that tungiasis is hyper-endemic in the study area. As the favela is typical for the many poor communities in northeast Brazil, it can be assumed that tungiasis is a frequent infection in the underprivileged in this part of the country.

Adolescent↗
PubMed2002

HIV infection and tropical parasitic diseases - deleterious interactions in both directions?

HIV and parasitic infections interact and affect each other mutually. Whereas HIV infection may alter the natural history of parasitic diseases, impede rapid diagnosis or reduce the efficacy of antiparasitic treatment, parasitoses may facilitate the infection with HIV as well as the progression from asymptomatic infection to AIDS. We review data on known interactions for malaria, leishmaniasis, Human African Trypanosomiasis, Chagas' disease, onchocerciasis, lymphatic filariasis, schistosomiasis and intestinal helminthiases. The common immunopathogenetic basis for the deleterious effects parasitic diseases may have on the natural history of HIV infection seems to be a particular type of chronic immune activation and a preferential activation of the T helper (Th)2 type of help. Control of parasitic diseases should complement the tools currently used in combating the HIV pandemic.

Female↗
PubMed2002

Ectopic localization of tungiasis.

Tungiasis is caused by the penetration of the female sand flea Tunga penetrans into the epidermis. It is generally assumed that lesions are confined to the feet. To determine to what degree tungiasis occurs at other topographic sites, 1,184 inhabitants of a poor neighborhood in northeastern Brazil were examined; 33.6% were found to have tungiasis (95% confidence interval = 30.9-36.4%). Six percent presented lesions at locations other than the feet, with the hands being the most common ectopic site (5.5%). Other sites were the elbows, thighs, and gluteal region. Ectopic tungiasis was significantly associated with the total number of lesions (P < 0.001) and an age less than 15 years old (P = 0.02). In 86 patients actively recruited with lesions on their feet, ectopic localizations were observed in 25.6%. Since untreated sand flea lesions are prone to become superinfected, clinicians should be aware of not missing any ectopic localization of tungiasis.

Adult↗