Estudio de la etiología de meningitis aséptica y meningoencefalitis en el Hospital Universitario Dr. José Eleuterio González, mediante estrategias de virología molecular

Antecedentes: La meningitis aséptica y la meningoencefalitis constituyen problemas de gran importancia clínica. Sus agentes etiológicos más frecuentes son los enterovirus (ECHOvirus, Coxsackievirus, Enterovirus no-polio), Togavirus, Flavivirus, Bunyavirus y otros grupos antes conocidos como ARBOvirus (Arthopod-borne viruses) y el virus del herpes humano. Objetivo: En este trabajo nos propusimos identificar, mediante la reacción en cadena de la polimerasa, los genomas virales de los virus del herpes simple (VHS tipos 1 y 2), del enterovirus y del virus del oeste del Nilo (VON) como causantes de meningitis aséptica y de meningoencefalitis. Material y métodos: Se estudiaron 30 pacientes que ingresaron al Hospital Universitario Dr. José Eleuterio González durante el período de febrero de 2005 a junio de 2008. Se analizaron muestras de líquido cefalorraquídeo (2 mL) para buscar, mediante la reacción en cadena de la polimerasa, el genoma del enterovirus, del VHS tipos 1 y 2, y del virus del oeste del Nilo, siguiendo protocolos estandarizados. Resultados: Ninguno de los pacientes estudiados fue positivo para los virus buscados mediante amplificación por la reacción en cadena de la polimerasa. Entre los datos clínicos relevantes encontramos que la presencia de estupor o el coma se relacionó significativamente con la muerte (p = 0.005). Encontramos, además, que tres muertes ocurrieron en el grupo de pacientes con meningoencefalitis (p = 0.021). Conclusiones: No encontramos el genoma de los virus analizados en el líquido cefalorraquídeo de los pacientes estudiados, probablemente debido al tamaño limitado de la muestra, a su calidad, o a diversos factores epidemiológicos en nuestra región. La información clínica y del laboratorio de los pacientes estudiados es similar a la que está publicada en estudios anteriores. Es necesario realizar estudios más amplios, incluyendo a un mayor número de pacientes que nos permitan conocer la etiología de este tipo de enfermedades en nuestra comunidad. Esto hará posible mejorar la metodología para el diagnóstico en los pacientes con patología del sistema nervioso central

Transmission of Beauveria bassiana from male to female Aedes aegypti mosquitoes

<p>Abstract</p> <p>Background</p> <p>Resistance to chemical insecticides plus high morbidity rates have lead to rising interest in fungi as candidates for biocontrol agents of mosquito vectors. In most studies fungal infections have been induced by exposure of mosquitoes to various surfaces treated with conidia. In the present study eight Mexican strains of <it>Beauveria bassiana </it>were assessed against <it>Aedes aegypti </it>by direct exposure of females to 6 × 10⁸conidia ml ^-1on a filter paper, afterwards, the transmission of the least and most virulent isolates was evaluated by mating behavior from virgin, fungus-contaminated male to females, to examine this ethological pattern as a new approach to deliver conidia against the dengue vector.</p> <p>Methods</p> <p>In an exposure chamber with a filter paper impregnated with 6 × 10⁸conidia ml ^-1of the least and most virulent strains of <it>B. bassiana</it>, 6-8 day old males of <it>A. aegypti </it>were exposed for 48 hours, and then transferred individually (each one was a replicate) to another chamber and confined with twenty healthy females of the same age. Clean males were used in controls. Survival, infection by true mating (insemination) or by mating attempts (no insemination) and fecundity were daily registered until the death of last female. Data analysis was conducted with proc glm for unbalanced experiments and means were separated with the Ryan test with SAS.</p> <p>Results</p> <p>All strains were highly virulent with LT₅₀ranging from 2.70 (± 0.29) to 5.33 (± 0.53) days. However the most (Bb-CBG2) and least virulent (Bb-CBG4) isolates were also transmitted by mating behavior; both killed 78-90% of females in 15 days after being confined with males that had previously been exposed for 48 hours to fungi. Of these mortality rates, 23 and 38% respectively, were infections acquired by copulations where insemination occurred. The LT₅₀for sexually-infected females were 7.92 (± 0.46) and 8.82 (± 0.45) days for both strains, while the one in control was 13.92 (± 0.58). Likewise, fecundity decreased by 95% and 60% for both Bb-CBG2 and Bb-CBG4 isolates in comparison with control. The role of mating attempts in this delivery procedure of <it>B. bassiana </it>is discussed.</p> <p>Conclusions</p> <p>This is the first report about transmission of <it>B. bassiana </it>by mating behavior from virgin, fungus-contaminated males to females in <it>A. aegypti</it>. Fungal infections acquired by this route (autodissemination) infringed high mortality rates (90%) in mated or approached females. However, prior to releasing virgin, fungus-contaminated males to spread <it>B. basasiana </it>among females of <it>A. aegypti</it>, this novel alternative needs further investigations.</p

“CLUPS”: A New Culture Medium for the Axenic Growth of Entamoeba histolytica

Amebiasis remains a major health problem in Mexico. Terefore, the search for better culture media and low-cost diagnostic and therapeutic tools is fundamental. We present a new culture medium for Entamoeba histolytica which allows the microbe to preserve its virulence factors and ability to induce hepatic abscesses in animal models. Te novel CLUPS medium is an improved version of the PEHPS medium, previously designed in our laboratory. Te main diference is the substitution of raw beef liver in PEHPS by raw beef lung in the CLUPS medium. To compare the performance of three-culture media (traditional TYI-S-33, PEHPS, and CLUPS), E. histolytica trophozoites were cultured in quintuplicate, followed by the evaluation of phospholipase activity and the induction of liver abscesses in golden hamsters. E. histolytica trophozoites grew signifcantly better in CLUPS medium than in TYIS-33. Likewise, CLUPS-cultured trophozoites produced signifcantly more phospholipases than TYI-S-33-cultured trophozoites. Finally, trophozoites grown in any of the three tested media had similar potential to induce liver abscesse

Acute Variceal Bleeding: Does Octreotide Improve Outcomes in Patients with Different Functional Hepatic Reserve?

Background. Current guidelines do not differentiate in the utilization of vasoactive drugs in patients with cirrhosis and acute variceal bleeding (AVB) depending on liver disease severity. Material and methods. In this retrospective study, clinical outcomes in 100 patients receiving octreotide plus endoscopic therapy (ET) and 216 patients with ET alone were compared in terms of failure to control bleeding, in-hospital mortality, and transfusion requirements stratifying the results according to liver disease severity by Child-Pugh (CP) score and MELD. Results. In patients with CP-A or those with MELD < 10 octreotide was not associated with a better outcome compared to ET alone in terms of hospital mortality (CP-A: 0.0 vs. 0.0%; MELD < 10: 0.0 vs. 2.9%, p = 1.00), failure to control bleeding (CP-A: 8.7 vs. 3.7%, p = 0.58; MELD < 10: 5.3 vs. 4.3%, p = 1.00) and need for transfusion (CP-A: 39.1 vs. 61.1%, p = 0.09; MELD < 10: 63.2 vs. 62.9%, p = 1.00). Those with severe liver dysfunction in the octreotide group showed better outcomes compared to the non-octreotide group in terms of hospital mortality (CP-B/C: 3.9 vs. 13.0%, p = 0.04; MEL

IV consenso mexicano sobre Helicobacter pylori

Desde el último consenso mexicano para el diagnóstico y tratamiento de la infección por Helicobacter pylori (H. pylori) en el 2007, han existido avances importantes al respecto. Por tal motivo, la Asociación Mexicana de Gastroenterología convocó a 20 expertos para la realización del «IV consenso mexicano sobre H. pylori». Durante febrero y junio del 2017 se organizaron 4 mesas de trabajo, una revisión de la literatura y 3 rondas de votaciones donde se establecieron 32 enunciados para discusión y consenso. Dentro de las recomendaciones se destaca el reconocer a México como un país con riesgo de cáncer gástrico bajo a intermedio a pesar de la alta prevalencia de infección por H. pylori. Se corrobora que enfermedad ulcerosa péptica, presencia de lesiones premalignas, antecedentes de cáncer gástrico y linfoma asociado a la mucosa deben considerarse indicaciones claras para erradicación. La relación del H. pylori con los síntomas dispépticos sigue siendo controversial. La triple terapia de erradicación con amoxicilina, claritromicina y un inhibidor de la bomba de protones ya no debe ser considerada la primera línea de tratamiento. En su lugar, se proponen 2 opciones: la terapia cuádruple con bismuto (inhibidor de la bomba de protones, subcitrato de bismuto, tetraciclina y metronidazol) y la terapia cuádruple sin bismuto (inhibidor de la bomba de protones, amoxicilina, claritromicina y metronidazol). Se establece la necesidad de la realización de sensibilidad antimicrobiana ante la falla a 2 tratamientos de erradicación. Finalmente, se proponen campañas de educación respecto al diagnóstico y tratamiento del H. pylori para médicos de primer contacto y población general. Abstract Important advances have been made since the last Mexican consensus on the diagnosis and treatment of Helicobacter pylori (H. pylori) infection was published in 2007. Therefore, the Asociación Mexicana de Gastroenterología summoned 20 experts to produce ‘‘The Fourth Mexican Consensus on Helicobacter pylori’’. From February to June 2017, 4 working groups were organized, a literature review was performed, and 3 voting rounds were carried out, resulting in the formulation of 32 statements for discussion and consensus. From the ensuing recommendations, it was striking that Mexico is a country with an intermediate-to-low risk for gastric cancer, despite having a high prevalence of H. pylori infection. It was also corroborated that peptic ulcer disease, premalignant lesions, and histories of gastric cancer and mucosaassociated lymphoid tissue lymphoma should be considered clear indications for eradication. The relation of H. pylori to dyspeptic symptoms continues to be controversial. Eradication triple therapy with amoxicillin, clarithromycin, and a proton pump inhibitor should no longer be considered first-line treatment, with the following 2 options proposed to take its place: quadruple therapy with bismuth (proton pump inhibitor, bismuth subcitrate, tetracycline, and metronidazole) and quadruple therapy without bismuth (proton pump inhibitor, amoxicillin, clarithromycin, and metronidazole). The need for antimicrobial sensitivity testing when 2 eradication treatments have failed was also established. Finally, the promotion of educational campaigns on the diagnosis and treatment of H. pylori for both primary care physicians and the general population were proposed

Compromising between European and US allergen immunotherapy schools: Discussions from GUIMIT, the Mexican immunotherapy guidelines

Background: Allergen immunotherapy (AIT) has a longstanding history and still remains the only disease-changing treatment for allergic rhinitis and asthma. Over the years 2 different schools have developed their strategies: the United States (US) and the European. Allergen extracts available in these regions are adapted to local practice. In other parts of the world, extracts from both regions and local ones are commercialized, as in Mexico. Here, local experts developed a national AIT guideline (GUIMIT 2019) searching for compromises between both schools. Methods: Using ADAPTE methodology for transculturizing guidelines and AGREE-II for evaluating guideline quality, GUIMIT selected 3 high-quality Main Reference Guidelines (MRGs): the European Academy of Allergy, Asthma and Immunology (EAACI) guideines, the S2k guideline of various German-speaking medical societies (2014), and the US Practice Parameters on Allergen Immunotherapy 2011. We formulated clinical questions and based responses on the fused evidence available in the MRGs, combined with local possibilities, patient's preference, and costs. We came across several issues on which the MRGs disagreed. These are presented here along with arguments of GUIMIT members to resolve them. GUIMIT (for a complete English version, see Supplementary data) concluded the following: Results: Related to the diagnosis of IgE-mediated respiratory allergy, apart from skin prick testing complementary tests (challenges, in vitro testing and molecular such as species-specific allergens) might be useful in selected cases to inform AIT composition. AIT is indicated in allergic rhinitis and suggested in allergic asthma (once controlled) and IgE-mediated atopic dermatitis. Concerning the correct subcutaneous AIT dose for compounding vials according to the US school: dosing tables and formula are given; up to 4 non-related allergens can be mixed, refraining from mixing high with low protease extracts. When using European extracts: the manufacturer's indications should be followed; in multi-allergic patients 2 simultaneous injections can be given (100% consensus); mixing is discouraged. In Mexico only allergoid tablets are available; based on doses used in all sublingual immunotherapy (SLIT) publications referenced in MRGs, GUIMIT suggests a probable effective dose related to subcutaneous immunotherapy (SCIT) might be: 50–200% of the monthly SCIT dose given daily, maximum mixing 4 allergens. Also, a table with practical suggestions on non-evidence-existing issues, developed with a simplified Delphi method, is added. Finally, dissemination and implementation of guidelines is briefly discussed, explaining how we used online tools for this in Mexico. Conclusions: Countries where European and American AIT extracts are available should adjust AIT according to which school is followed

Clonal chromosomal mosaicism and loss of chromosome Y in elderly men increase vulnerability for SARS-CoV-2

The pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, COVID-19) had an estimated overall case fatality ratio of 1.38% (pre-vaccination), being 53% higher in males and increasing exponentially with age. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, we found 133 cases (1.42%) with detectable clonal mosaicism for chromosome alterations (mCA) and 226 males (5.08%) with acquired loss of chromosome Y (LOY). Individuals with clonal mosaic events (mCA and/or LOY) showed a 54% increase in the risk of COVID-19 lethality. LOY is associated with transcriptomic biomarkers of immune dysfunction, pro-coagulation activity and cardiovascular risk. Interferon-induced genes involved in the initial immune response to SARS-CoV-2 are also down-regulated in LOY. Thus, mCA and LOY underlie at least part of the sex-biased severity and mortality of COVID-19 in aging patients. Given its potential therapeutic and prognostic relevance, evaluation of clonal mosaicism should be implemented as biomarker of COVID-19 severity in elderly people. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, individuals with clonal mosaic events (clonal mosaicism for chromosome alterations and/or loss of chromosome Y) showed an increased risk of COVID-19 lethality

Human-landing rate, gonotrophic cycle length, survivorship, and public health importance of Simulium erythrocephalum in Zaragoza, northeastern Spain

Abstract Background Simulium (Boophthora) erythrocephalum (De Geer, 1776) is one of the blackfly species responsible for major public health problems in Europe. Blackfly outbreaks of this species are becoming more frequent, threatening public health in Spain. In the present study, bionomic parameters of S. erythrocephalum in northeastern Spain were estimated. Methods Simulium erythrocephalum was collected from May through June 2015 in Zaragoza, Spain, using the human-landing-collection (HLC) method. Daily pattern of total and parous landing activity was estimated, as was the gonotrophic cycle (GC) length and survivorship (S) rate, using time series analysis. Results Host-seeking females of S. erythrocephalum showed a bimodal human-landing activity pattern, with a minor and major peak at dawn and dusk, respectively; there was a significant negative association between human daily landing rate and temperature (P = 0.003) and solar radiation (P < 0.001). Overall, a daily landing rate (DLR) of 34 lands/person/day was estimated. Series of sequential data analysis on parity showed the highest significant (P < 0.001) correlation indices (r = 0.45 and r = 0.39 for raw and filtered data) for a 2-day time lag, indicating that the GC length corresponded to 2 days. Daily survivorship and parity rate were 0.85 and 0.72, respectively. Conclusions Simulium erythrocephalum was confirmed as a nuisance species in Zaragoza, using the HLC method for the first time in Spain. The data offer insights into the ecology of S. erythrocephalum, which can improve management strategies of this pest in Spain

Participación social en la Sierra Fría: Área de Protección de Recursos Naturales (APRN), Zacatecas, México.

El manejo de Áreas Naturales Protegidas (ANP) en México ha sido controvertido en lo referente a inclusión social; una herramienta en la que basan el uso, manejo y conservación de estas áreas es el Plan de Conservación y Manejo (PCyM). En este sentido, se tuvo un acercamiento a inicios del año 2013 con 35 habitantes de predios cercanos o dentro del Área de Protección de Recursos Naturales (APRN) Sierra Fría en Zacatecas, se recurrió al uso de encuestas estructuradas y dirigidas, con las que se indagó aspectos de vigilancia ambiental, aprovechamiento, educación ambiental, turismo y gestión. Se encontró que los habitantes tienen apertura para aprender sobre estos temas, sin embargo, también hay desinformación y necesidad de coordinación en las diferentes estructuras tanto sociales como de gobierno, de no atenderse se vislumbran amenaza y daños permanentes para la conservación, uso y manejo del APRN. Se presentan aportaciones precisas para ser consideradas en el PCyM

DNA barcoding of blackflies (Diptera: Simuliidae) as a tool for species identification and detection of hidden diversity in the eastern regions of Spain

Abstract Background Blackflies have negative impact on public and animal health due to the haematophagous habit of females. In recent times, in some regions in Spain, blackfly outbreaks are becoming more and more frequent, threatening the public health. However, there is still a paucity of data concerning the Spanish blackfly fauna. Correct identification of species is of paramount importance in order to provide correct information on species distribution, biology and behaviour, so that control measures could be implemented appropriately. Methods Blackflies specimens (larvae, pupae, reared adults and biting females) were collected in the period 2015–2017 in and near rivers and streams from different regions in Spain. A modified Hotshot technique was used for the DNA extraction and the cox1 DNA barcoding region of the cytochrome c oxidase subunit 1 was sequenced from the specimens collected. Results In total, we collected 239 specimens representing 22 species. Of these, six species are new records for the Aragón region: P. tomosvaryi, S. bertrandi, S. galloprovinciale, S. lineatum, S. rubzovianum and S. xanthinum. Cox1 DNA barcode sequences for 21 species were recovered, including four species of the genus Prosimulium and 17 species of the genus Simulium [Boophthora (1 species), Eusimulium (1 species), Nevermannia (4 species), Simulium (s.s.) (6 species), Trichodagmia (1 species) and Wilhelmia (4 species)]. For the first time the complete DNA barcodes for five species (P. tomosvaryi, S. carthusiense, S. brevidens, S. monticola and S. sergenti) were registered. Most of the specimens belonging to the same recognized species were clustered together in the neighbour-joining tree, except for S. argyreatum, S. monticola and S. variegatum. The overall genetic distance in the dataset was 0.14%. The average of the intraspecific genetic divergence within the different taxa was 1.47% (0.05–3.96%). In contrast, the interspecific divergence varied between 2.50–22.0%. Conclusions In this study we assessed the use of the cox1 DNA barcoding region for the identification of species of blackflies in Spain. Our results showed that combining DNA barcoding with morphology enhanced our taxonomic rationale in identifying the blackflies in the country