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Toxocariasis: seroprevalence in abandoned-institutionalized children and infants
Toxocariosis: seroprevalencia en infantes expósitos, abandonados e institucionalizados
Susana Archellia, Graciela I. Santillanb,
Corresponding author
gsantillan@anlis.gov.ar

Corresponding author.
, Reinaldo Fonrougea, Graciela Céspedesb, Lola Burgosa, Nilda Radmana
a Cátedra de Parasitología Comparada, Laboratorio de Parasitosis Humanas y Zoonosis Parasitarias, Fac. Cs. Vet. UNLP, La Plata, Buenos Aires, Argentina
b Departamento de Parasitología, INEI-ANLIS “Dr. Carlos G. Malbrán”, Ciudad Autonóma de Buenos Aires, Argentina
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Toxocariasis&#44; visceral larva migrans or parasitic granulosis is a disease distributed worldwide with high prevalence in tropical and temperate regions&#46; The agents involved are&#58; <span class="elsevierStyleItalic">Toxocara canis</span> &#40;dog roundworms&#41; and <span class="elsevierStyleItalic">Toxocara cati</span> &#40;cat roundworms&#41;&#44; the former being the most significant due to its frequency in humans<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a>&#46; The soil is the natural reservoir and source of infection where the eggs develop into infective stages &#40;stage J2&#8211;J3&#41;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a>&#44; being able to remain viable for extended periods of one to three years<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">32</span></a>&#46; In humans&#44; the infection is transmitted via the oral route&#44; by accidental ingestion of infective eggs from the fur of animals&#44; consumption of poorly sanitized fruits or vegetables&#44; soil-contaminated hands&#44; geophagy or early stages of nematodes present in tissues of paratenic or transport hosts<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">26</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">29</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">32</span></a>&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Four clinical presentations are known&#58; visceral larva migrans &#40;VLM&#41;&#44; with abscess formation in the organs<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">34</span></a>&#44; allergic asthma and eczema<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> among other manifestations&#59; ocular larva migrans &#40;OLM&#41;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> without the characteristic eosinophilia&#59; neurological toxocariasis<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">30</span></a> with diverse manifestations such as dementia&#44; meningo-encephalitis&#44; myelitis&#44; cerebral vasculitis&#44; epilepsy&#44; or optic neuritis<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">30</span></a> and covert toxocariasis which occurs when the larva is found in striated muscles&#44; with no or few&#44; general and non-specific symptoms<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a>&#46; Several studies have determined the seroprevalence of toxocariasis in different clusters of people and geographical areas&#58; children of low socioeconomic status&#44; middle class&#44; rural areas&#44; indigenous people&#44; developed countries with different pathologies&#44; school age&#44; kindergarten and 12 year-old children<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7&#8211;9</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">20&#8211;22</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">25</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">30</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">33</span></a>&#46; However&#44; investigations on the prevalence of toxocariasis in children younger than 3 years of age are scarce<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">38</span></a> and there are no publications on abandoned-institutionalized children or infant foundlings<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">28</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">38</span></a>&#46; The terms abandoned-institutionalized children or infant foundlings refer to those children whose parents have moved away from them&#44; leaving them on any site or to the care of an institution&#44; due to economic&#44; social or moral reasons&#46; The <span class="elsevierStyleItalic">de facto</span> abandonment may be transient or permanent&#46; This is how &#8220;the family&#44; a social unit&#44; is replaced by a foundling asylum&#8221;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">27</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">36</span></a>&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">The state of helplessness in the strict etymological sense is synonymous with neglect&#44; with the subsequent waiver of all rights and duties of the child&#46; This extreme situation that involves judicial action is at the same time a health concern due to the consequences associated with the growth and development of the child when separated from his family environment<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a>&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">The aim of this work was to determine the seroprevalence of toxocariasis in infant foundlings &#40;abandoned or institutionalized&#41; up to 3 years of age since they are considered to be at high risk for several diseases due to their orphanhood status that leaves them in a situation of maximum vulnerability&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Materials and methods</span><p id="par0025" class="elsevierStylePara elsevierViewall">Study samples&#58; Samples were obtained from 10-month to 3 year-old abandoned and institutionalized children&#46; After the routine hematological testing performed on admission&#44; the remaining serum was used in this study upon approval of the Instituto de Investigaciones Biomedicas &#47; IRB Barcelona&#46; A total of 120 samples were analyzed by ELISA&#46; They were divided into three groups&#58; A &#40;&#60;1 year old&#41;&#44; B &#40;1&#8211;2 years<a name="p5"></a> old&#41; and C &#40;&#62;2 years old&#41;&#59; 60 of them were randomly selected and analyzed by Western blot&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">The ELISA test was performed using a commercial kit &#40;Bordier Affinity products&#44; Crissier 1013&#44; Lausanne&#44; Switzerland&#41; in compliance with the manufacturer&#39;s instructions&#46; The presence of parasite specific serum antibodies was detected with anti-human IgG-alkaline phosphatase conjugate on sensitized plates with <span class="elsevierStyleItalic">T&#46; canis</span> excretory-secretory antigen&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleUnderline">Interpretation</span>&#58; Samples with an absorbance lower than that of the weak positive control serum were considered negative&#44; while those with a higher absorbance were considered positive&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">The Western blot assay was performed according to the technique used in the Department of Parasitology&#44; National Institute of Infectious Diseases ANLIS &#8220;Dr&#46; Carlos G&#46; Malbr&#225;n&#8221;<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">35</span></a>&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleUnderline">Interpretation</span>&#58; It is considered positive when observing bands of 120&#44; 70&#44; 55&#44; 30&#44; 32 kDa and&#47;or bands of 70 and 55 kDa&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">For statistical analyses&#44; Epidat 3&#46;1<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> and Win Episcope 2&#46;0<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">39</span></a> were used&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Results</span><p id="par0055" class="elsevierStylePara elsevierViewall">The ELISA technique was used to analyze 120 serum samples&#44; detecting a total of 46 seropositive children for <span class="elsevierStyleItalic">T&#46; canis</span> IgG &#40;38&#46;33&#37;&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0060" class="elsevierStylePara elsevierViewall">After applying the test &#40;chi-square &#61; 7&#46;77&#44; p&#60;0&#46;05&#41;&#44; there was a significant association between age and seroprevalence&#59; the linear trend was also significant&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Only 60 of the 120 original samples were processed by Western blot&#44; of which 27 &#40;45&#37;&#41; showed the characteristic positive bands for <span class="elsevierStyleItalic">T&#46; canis</span> &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall">The differences observed between the two techniques are&#44; since Westernblot technique presents 100&#37; specificity&#44; predictive value positive 93&#46;3&#37; and predictive value negative 100&#37;&#46; The kappa index &#40;0&#46;762&#41; reported a strong correlation between the two techniques&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Discussion</span><p id="par0075" class="elsevierStylePara elsevierViewall">Toxocariasis is a cosmopolitan parasitic infection observed primarily in childhood&#44; with little recognition as a public health problem&#46; Different authors used the ELISA test for serological diagnosis of toxocariasis&#46; In Resistencia&#44; a subtropical region of Argentina&#44; a seropositivity of 37&#46;9&#37; in children aged 1&#8211;14 was observed<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a>&#46; In the same area&#44; a prevalence of 67&#37; among individuals with similar age and high eosinophilia<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">25</span></a> was reported as well as a prevalence of 20&#37; in children younger than 14 years old from a rural community of Argentina<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">31</span></a>&#46; Taranto et al&#46;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">37</span></a> reported a positivity of 22&#46;1&#37; in an indigenous population of the northern province of Salta&#46; In the province of Buenos Aires&#44; a positivity of 17&#37; and 36&#37; was observed in children up to 12 years old from an urban and suburban area respectively<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">32</span></a>&#46; In two regions of Spain&#44; a seroprevalence of 0&#37; and 4&#46;2&#37; was found in children from Madrid and Tenerife respectively<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a>&#46; In the same country&#44; a prevalence of 0&#37; vs&#46; 37&#37; was reported in middle class infants&#44; aged 2&#8211;5 years old&#44; in contrast with others of the same age but socially disadvantaged in Iran<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a>&#44; using two kinds of ELISA assays&#44; in which frequencies of 11 and 25&#37; respectively were observed&#44; in children ranging from one month to 30 months of age&#44; without significant differences regarding age&#46; However&#44; this study found that 38&#46;33&#37; of children were positive for <span class="elsevierStyleItalic">T&#46; canis</span> using the ELISA technique and 36&#46;66 &#37; using Western blot&#46; Significant differences among groups A&#44; B and C were also observed&#46; In this research&#44; children in group A showed 23&#46;91&#37; of seropositivity&#44; group B 42&#46;85&#37; and group C 56&#37;&#44; which indicates an increase in the frequency of occurrence as age advances&#44; probably due to greater chances of contact with the parasite infective stages&#46; As stated before&#44; canines and soil are very often infected with <span class="elsevierStyleItalic">T&#46; canis</span><a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">28</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">40</span></a>&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Not all individuals are equally likely to get infected or die&#44; but for some&#44; this alternative is greater&#46; Abandoned children also belong to deprived households where as previously mentioned<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">28</span></a>&#44; poor hygienic conditions resulting from lack of water and sewage networks and frequent promiscuity with canines&#44; favor the presence of parasitic diseases&#46; These&#44; coupled with the condition of helplessness&#44; cause a state of high vulnerability&#46; This situation is reflected in the results obtained in this research in infants&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">The bibliographic research conducted does not reveal any studies on seroprevalence of toxocariasis in the area of abandoned or institutionalized children&#46; The results herein obtained showed that the determination of this disease should be included in routine hematology tests when admitted to an institution&#44; especially in the case of abandoned children under the age of 3&#44; considering that&#44; as they are very young&#44; the possibility of having contracted the disease might affect not only their physical and mental integrity but also their future growth&#44; maturation and cognitive development or even lead to fatal consequences&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Ethical responsabilites</span><p id="par0090" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Protection of human and animal subjects&#46;</span> The authors declare that no experiments were performed on humans or animals for this investigation&#46;<a name="p6"></a></p><p id="par0095" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Confidentiality of data&#46;</span> The authors declare that no patient data appears in this article&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Right to privacy and informed consent&#46;</span> The authors declare that no patient data appears in this article&#46;</p></span></span>"
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          "titulo" => "Introduction"
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          "titulo" => "Materials and methods"
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          "titulo" => "Results"
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          "titulo" => "Discussion"
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          "identificador" => "sec0025"
          "titulo" => "Ethical responsabilites"
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          "identificador" => "xack214229"
          "titulo" => "Conflicts of interest"
        ]
        10 => array:1 [
          "titulo" => "References"
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    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2013-08-27"
    "fechaAceptado" => "2014-01-16"
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          "clase" => "keyword"
          "titulo" => "Keywords"
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          "palabras" => array:5 [
            0 => "Seroprevalence"
            1 => "Toxocariasis"
            2 => "Foundlings"
            3 => "Abandoned"
            4 => "Institutionalized children"
          ]
        ]
      ]
      "es" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec648279"
          "palabras" => array:5 [
            0 => "Seroprevalencia"
            1 => "Toxocariosis"
            2 => "Ni&#241;os exp&#243;sitos"
            3 => "Ni&#241;os abandonados"
            4 => "Ni&#241;os institucionalizados"
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        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Toxocariasis is an infection that has worldwide distribution&#46; <span class="elsevierStyleItalic">Toxocara canis</span> is the most relevant agent due to its frequent occurrence in humans&#46; Soil contamination with embryonated eggs is the primary source of <span class="elsevierStyleItalic">T&#46; canis</span>&#46; This study aimed to determine the seroprevalence of toxocariasis in 10-month to 3 year-old abandoned infants&#44; considered to be at high risk because of their orphanhood status and early age&#46; Blood samples were collected from 120 children institutionalized in an orphanage in the city of La Plata&#46; In this study&#44; we observed 38&#46;33&#37; of seropositive cases for <span class="elsevierStyleItalic">T&#46; canis</span> by ELISA and 45&#37; by Western blot techniques&#59; significant differences among groups A &#40;&#60;1 year&#41;&#44; B &#40;1&#8211;2 years&#41; and C &#40;&#62;2 years&#41; were also found&#46; In research group A&#44; children presented a seropositivity rate of 23&#46;91&#37;&#44; in group B of 42&#46;85&#37; and in group C of 56&#37;&#44; which indicates an increase in frequency as age advances&#44; probably because of greater chances of contact with infective forms of the parasite since canines and soil are frequently infected with <span class="elsevierStyleItalic">T&#46; canis</span> eggs&#46; Abandoned children come from poor households&#44; under highly unsanitary conditions resulting from inadequate or lack of water supply and sewer networks&#44; and frequent promiscuity with canines&#44; which promotes the occurrence of parasitic diseases&#46; These children are highly vulnerable due to their orphanhood status and age&#46;<a name="p4"></a></p></span>"
      ]
      "es" => array:2 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">La toxocariosis es una enfermedad presente en todo el mundo&#46; Como causa primaria de infecci&#243;n se cita la contaminaci&#243;n de los suelos con huevos embrionados de <span class="elsevierStyleItalic">Toxocara canis</span>&#46; Nuestro objetivo fue determinar la seroprevalencia de toxocariosis en ni&#241;os exp&#243;sitos &#40;abandonados&#41; de 10 meses hasta 3 a&#241;os&#44; los que se consideran de alto riesgo por su condici&#243;n de orfandad y escasa edad&#46; Las muestras de sangre fueron recolectadas de 120 ni&#241;os institucionalizados en un orfelinato de la ciudad de La Plata&#46; En este estudio&#44; se observ&#243; un porcentaje de seropositivos para <span class="elsevierStyleItalic">T&#46; canis</span> de 38&#44;33 &#37; por la t&#233;cnica de ELISA y de 45 &#37; por la t&#233;cnica de Western blot&#44; con diferencias significativas entre los grupos etarios estudiados &#40;A&#58; &#60; 1 a&#241;o&#44; B&#58; 1&#8211;2 a&#241;os&#44; C&#58; &#62; 2 a&#241;os&#41;&#46; Los ni&#241;os del grupo A presentaron una frecuencia de seropositividad de 23&#44;91 &#37;&#59; los del grupo B&#44; de 42&#44;85 &#37; y en los ni&#241;os del grupo C fue del 56 &#37;&#46; Esto indica un incremento de la frecuencia de presentaci&#243;n a medida que aument&#243; la edad&#44; debido probablemente a las mayores posibilidades de contactar con estados infectantes del par&#225;sito&#44; ya que los caninos y el suelo se hallan frecuentemente infectados por huevos de <span class="elsevierStyleItalic">T&#46; canis</span>&#46; Los ni&#241;os abandonados provienen de hogares carenciados&#44; donde a las malas condiciones de higiene resultantes de la ausencia de red de agua y cloacal se le agrega la frecuente promiscuidad con caninos&#44; lo cual propicia la presencia de parasitosis&#46; Sumado a la condici&#243;n de desamparo&#44; esto produce un estado de m&#225;xima vulnerabilidad&#46;</p></span>"
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                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Age&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Positive&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Negative&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Total&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">A&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60; 1a&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">35&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">46&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">23&#46;91&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">B&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1 to 2a&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">21&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">28&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">49&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">42&#46;85&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">C&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#62; 2 a&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">56&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Total&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">46&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">74&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">120&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">38&#46;33&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\tvoid\n
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                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">WB &#40;&#43;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">WB &#40;&#8722;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Total&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">ELISA &#40;&#43;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="center" valign="top">22&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="center" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="center" valign="top">24&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">ELISA &#40;&#8722;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="center" valign="top">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="center" valign="top">31&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="center" valign="top">36&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Total&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="center" valign="top">27&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="center" valign="top">33&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="center" valign="top">60&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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          "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Results of the 60 serum samples analyzed by both techniques&#46;</p>"
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    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
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              "etiqueta" => "1&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Human and dogs <span class="elsevierStyleItalic">Toxocara canis</span> infection in a poor neighborhood in Bogota"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "C&#46; Agudelo"
                            1 => "E&#46; Villareal"
                            2 => "E&#46; C&#225;ceres"
                            3 => "C&#46; L&#243;pez"
                            4 => "J&#46; Eljach"
                            5 => "N&#46; Ram&#237;rez"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Mem Inst Oswaldo Cruz"
                        "fecha" => "1990"
                        "volumen" => "85"
                        "paginaInicial" => "75"
                        "paginaFinal" => "78"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2215237"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0010"
              "etiqueta" => "2&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "<span class="elsevierStyleItalic">Toxocara</span> seroprevalence in children from a subtropical city in Argentina"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "J&#46;M&#46; Alonso"
                            1 => "M&#46;V&#46; Bojanich"
                            2 => "M&#46; Chamorro"
                            3 => "J&#46;O&#46; Gorodner"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Rev Inst Med Trop Sao Paulo"
                        "fecha" => "2000"
                        "volumen" => "42"
                        "paginaInicial" => "235"
                        "paginaFinal" => "237"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10968888"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0015"
              "etiqueta" => "3&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "<span class="elsevierStyleItalic">Toxocara</span> y Toxocariosis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "S&#46;M&#46; Archelli"
                            1 => "L&#46; Kozubsky"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
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es en pt

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?

Você é um profissional de saúde habilitado a prescrever ou dispensar medicamentos