Infection by intestinal parasites in disabled patients and their guardians

Introduction: intestinal parasitic infections are common major problem closely related to poverty, inadequate sanitation, insufficient health care and overcrowding. They cause significant morbidity among institutionalized patients, however, there are few studies that analyze the frequency of intestinal parasites in disabled patients that are not institutionalized. Objective: the aim of the present study was to determine the prevalence of intestinal parasitic infection in disabled patients and their guardians. Methodology: a total of 336 fecal samples were collected from 53 disabled patients and history of diarrhea during the study period and 31 guardians, parents and professional staff of Institution. Parasite research was carried out using zinc sulphate centrifugal-flotation technique, Lutz/Hoffman Pons and Janer method, Rugai method and Gram-Chromotrope, Leishman, Kinyoun, Kato-Katz and Trichrome stains were used. Results: we found 15.5% of positive sample for enteroparasites in all analyzed individuals (13/84), with 11.3% (6/53) of prevalence in disabled patients and 22.5% (7/31) for guardians, with significant difference. There was no difference between gender, but there was a higher number of positives in patients between 6 and 11 years of age. Monoparasitism and the presence of protozoa, especially Blastocystis hominis, were the most prevalent conditions. Conclusions: despite the aforementioned intrinsic susceptibility of patients with special needs, the prevalence of intestinal parasites was low. In guardians, the prevalence was higher, suggesting extreme attention to the care process, which may have prevented the transmission to their disabled patients contact.


Intestinal parasitic infections can have a significant impact on people's quality of life and most of the time it is
related not only to environmental factors but also social, economic and cultural conditions 1 . In developing countries located in tropical areas, lack of access to health services, malnutrition and lack of sanitation are determining factors for the occurrence of parasitic diseases 2,3 .
Disorders of motor and/or cognitive development, including Hipoxic-ischaemic Encephalopathy, Global Developmental Delay, Down Syndrome among others, can reduce the functional capacity of individuals, affecting the neuromotor function of the digestive system, which lead to poor digestion and malabsorption 4 . In addition, they may compromise the ability to learn and/or adopt hygienic measures, which may predispose to enteric parasite infection 5,6 . Thus, it is emphasized that general sanitary conditions related to the treated water network, sewage collection, sanitary inspection of food, soil, water and food contamination, household hygiene, also work in this group, contributing to the occurrence of intestinal parasites 5,6 .
Care institutions for patients with motor and cognitive impairments may present different sources of infection for patients that include the hygienic habits of caregivers, cooks and health professionals, the poor sanitary conditions of the facilities, the quality of the water and the foods offered. Thus, such centers may be epidemiologically linked, with higher prevalence of parasitic infections, with levels of 20.4% of patients with mental disorders were positive for intestinal parasites 7 . In addition, overall infections rate of intestinal parasite was 26.2% in inhabitants of rehabilitiation centers 6 . Thus, the objective of this study was to evaluate the prevalence of intestinal parasites in non-institutionalized disabled patients and their guardians.

METHODOLOGY
The Other aspects related to the susceptibility to enteroparasites were analyzed, such as age and gender, and for these aspects also no significant differences were observed. In the group of disabled patients, considering the gender, the prevalence was 12.0% (3/25) for the female gender and 10.7% (3/28) for the male. In addition, all positive cases were concentrated in the age range of 6 to 11 years, with prevalence in this range of 11.3% (6/53) ( Table 2). In guardians, the positives represented 17.2% (5/29) for the female gender and 100% (2/2) for the male. All subjects were adults and there was no statistical difference in the age group (Table 3).

DISCUSSION
In the present study, the prevalence of intestinal parasites observed in disabled patients was 11.3% with the only meeting of protozoa. In contrast, in Benin-Nigeria, intestinal helminths were investigated in children with chronic neurological diseases treated at the outpatient clinic of the University Hospital and the prevalence was high, 31% 16 17 .
A survey carried out in a socio-educational center in Brazil showed that 42.4% of the analyzed individuals, including minors and employees, were positive for enteroparasitosis, being this prevalence much higher than the one identified in our study 18 . In children living in a welfare institution for minors in the city of Niterói, RJ and its employees, 70 and 44% of positive results were obtained for intestinal parasitic diseases, respectively, in children and staff 19 . Therefore, a great difference between the results observed in the present study and those found by other authors was found, investigating populations of children of similar age, considering that the positive patients were children. It should be emphasized that the presence of neurological diseases with impairment of motor and cognitive abilities was the main difference between this study and the others, generating in the tutors and professionals of the Institution a great concern with hygiene and sanity, probably a preponderant factor to determine this low prevalence of parasitoses.
Regarding the guardians, it was possible to detect 28.5% of positive results, which allowed a lower rate of enteroparasitosis to be observed when compared to the study carried out with employees of a charity, which indicates that 44% of collaborators were positive for enteroparasitosis 18 . It was demonstrated that 38.6% of the positive among the employees of eight daycare centers 19 . Another study showed that the prevalence was 16.7% in the employees analyzed in a daycare center 20 18 . In the present study, only one case of cryptosporidiosis was detected in a 7-year-old patient, presenting symptomatology that varied between diarrhea and constipation. Therefore, the prevalence of this enteropathogen was low, but because it is an opportunistic and zoonotic agent, it is emphasized that the child was treated because it represents a potential source of parasite infection.
In the present study there was no significant difference between genders. On the contrary, in Nigeria, a higher positivity was observed in boys with chronic neurological disease, and the authors related this occurrence to the more adventurous behavior 8 . As in our study all the individuals presented severe motor deficiency, with paralysis/paraplegia, the behavioral factor had no influence.

CONCLUSION
We can conclude that in the study population the prevalence of enteroparasites was 15.5%. When analyzing the groups separately, it was observed that among the disabled patients the positivity was 11.3% and for the guardians was 22.5%. Monoparasitism and protozoan infection were more prevalent. No age or sexual predisposition was observed.