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SummaryEctoparasitic 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 ectoparasitoses 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. 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 ectoparasitosis 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.

Two waterborne outbreaks of toxoplasmosis have been described recently in southern Brazil. We present data from a community-based study of pregnant women in northeastern Brazil. Consumption of homemade ice was the only variable associated with seropositivity (adjusted odds ratio, 3.1, 95% confidence interval, 1.53–6.24). Our results suggest water as a source of infection with Toxoplasma gondii.

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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.