title: Recurrent wheezing is associated with intestinal protozoan infections in Warao Amerindian children in Venezuela: a cross-sectional survey.
abstract: BACKGROUND
  While in developed countries the prevalence of allergic diseases is rising, inflammatory diseases are relatively uncommon in rural developing areas. High prevalence rates of helminth and protozoan infections are commonly found in children living in rural settings and several studies suggest an inverse association between helminth infections and allergies. No studies investigating the relationship between parasitic infections and atopic diseases in rural children of developing countries under the age of 2 years have been published so far. We performed a cross-sectional survey to investigate the association of helminth and protozoan infections and malnutrition with recurrent wheezing and atopic eczema in Warao Amerindian children in Venezuela.
  
  
  METHODS
  From August to November 2012, 229 children aged 0 to 2 years residing in the Orinoco Delta in Venezuela were enrolled. Data were collected through standardized questionnaires and physical examination, including inspection of the skin and anthropometric measurements. A stool sample was requested from all participants and detection of different parasites was performed using microscopy and real time polymerase chain reaction (PCR).
  
  
  RESULTS
  We observed high prevalence rates of atopic eczema and recurrent wheezing, respectively 19% and 23%. The prevalence of helminth infections was 26% and the prevalence of protozoan infections was 59%. Atopic eczema and recurrent wheezing were more frequently observed in stunted compared with non-stunted children in multivariable analysis (OR 4.3, 95% CI 1.3 - 13.6, p = 0.015 and OR 4.5, 95% CI 0.97 - 21.2, p = 0.055). Furthermore, recurrent wheezing was significantly more often observed in children with protozoan infections than in children without protozoan infections (OR 6.7, 95% CI 1.5 - 30.5).
  
  
  CONCLUSIONS
  High prevalence rates of atopic eczema and recurrent wheezing in Warao Amerindian children under 2 years of age were related to stunting and intestinal protozoan infections respectively. Helminth infections were not significantly associated with either atopic eczema or recurrent wheezing.
authors.affiliation: Laboratory of Pediatric Infectious Diseases, Department of Pediatrics, Radboud University Nijmegen Medical Centre, PO Box 9101 (Internal Post 224), 6500 HB Nijmegen, The Netherlands. marcellaovereem@hotmail.com.
authors.forename: Marcella M A
authors.initials: MM
authors.lastname: Overeem
authors.forename: Lilly M
authors.initials: LM
authors.lastname: Verhagen
authors.forename: Peter W M
authors.initials: PW
authors.lastname: Hermans
authors.forename: Berenice
authors.initials: B
authors.lastname: del Nogal
authors.forename: Adriana Márquez
authors.initials: AM
authors.lastname: Sánchez
authors.forename: Natacha Martinez
authors.initials: NM
authors.lastname: Acevedo
authors.forename: Rosalicia Ramirez
authors.initials: RR
authors.lastname: Murga
authors.forename: Jeroen
authors.initials: J
authors.lastname: Roelfsema
authors.forename: Elena
authors.initials: E
authors.lastname: Pinelli
authors.forename: Jacobus H
authors.initials: JH
authors.lastname: de Waard
mesh_terms: D002675:Child, Preschool; D003430:Cross-Sectional Studies; D003876:Dermatitis, Atopic / Q000453:epidemiology*; D005260:Female; D006373:Helminthiasis / Q000453:epidemiology*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007410:Intestinal Diseases / Q000469:parasitology; D008297:Male; D044342:Malnutrition / Q000453:epidemiology; D011528:Protozoan Infections / Q000453:epidemiology*; D012135:Respiratory Sounds / Q000209:etiology*; D012423:Rural Health; D012424:Rural Population; D011795:Surveys and Questionnaires; D014687:Venezuela / Q000453:epidemiology / Q000208:ethnology