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Open Access Research article

Recurrent wheezing is associated with intestinal protozoan infections in Warao Amerindian children in Venezuela: a cross-sectional survey

Marcella MA Overeem1*, Lilly M Verhagen12, Peter WM Hermans1, Berenice del Nogal34, Adriana Márquez Sánchez4, Natacha Martinez Acevedo4, Rosalicia Ramirez Murga2, Jeroen Roelfsema5, Elena Pinelli5 and Jacobus H de Waard2

Author Affiliations

1 Laboratory of Pediatric Infectious Diseases, Department of Pediatrics, Radboud University Nijmegen Medical Centre, PO Box 9101 (Internal Post 224), 6500 HB Nijmegen, The Netherlands

2 Laboratorio de Tuberculosis, Instituto de Biomedicina, Universidad Central de Venezuela, al lado del Hospital Vargas, San José, Caracas, Venezuela

3 Departamento de Pediatría, Hospital de Niños “J.M. de los Rios”, Av. Vollmer, Distrito Capital, Caracas, Venezuela

4 Escuela José María Vargas, Facultad de Medicina, Universidad Central de Venezuela, Ciudad Universitaria, Distrito Federal, Caracas, Venezuela

5 Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), PO Box 1, 3720 BA Bilthoven, The Netherlands

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BMC Infectious Diseases 2014, 14:293  doi:10.1186/1471-2334-14-293

Published: 29 May 2014



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.


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).


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).


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.

Atopic eczema; Helminth; Indigenous children; Malnutrition; Protozoa; Recurrent wheezing