Epilepsy-associated stigma in Bolivia: A community-based study among the Guarani population An International League Against Epilepsy/International Bureau for Epilepsy/World Health Organization Global Campaign Against Epilepsy Regional Project

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Methicillin-resistant Staphylococcus aureus in hospitalized patients from the Bolivian Chaco

Summary Objectives Information is lacking on the methicillin-resistant Staphylococcus aureus (MRSA) clonal lineages circulating in Bolivia. We investigated the prevalence and molecular epidemiology of S. aureus colonization in hospitalized patients from the Bolivian Chaco, and compared their features with those of the few clinical isolates available from that setting. Methods S. aureus nasal/inguinal colonization was investigated in 280 inpatients from eight hospitals in two point prevalence surveys (2012, n =90; 2013, n =190). Molecular characterization included genotyping ( spa typing, multilocus sequence typing, and pulsed-field gel electrophoresis), detection of virulence genes, and SCC mec typing. Results Forty-one inpatients (14.6%) were S. aureus nasal/inguinal carriers, of whom five were colonized by MRSA (1.8%). MRSA isolates mostly belonged to spa- type t701, harboured SCC mec IVc, and were negative for Panton–Valentine leukocidin (PVL) genes. However, a USA300-related isolate was also detected, which showed the characteristics of the USA300 Latin American variant (USA300-LV; i.e., ST8, spa- type t008, SCC mec IVc, presence of PVL genes, absence of arc A). Notably, all the available MRSA clinical isolates ( n =5, collected during 2011–2013) were also identified as USA300-LV. Conclusions Overall, MRSA colonization in inpatients from the Bolivian Chaco was low. However, USA300-LV-related isolates were detected in colonization and infections, emphasizing the importance of implementing control measures to limit their further dissemination in this resource-limited area

Low prevalence of methicillin-resistant Staphylococcus aureus nasal carriage in urban and rural community settings in Bolivia and Peru☆

Summary Objective To investigate the prevalence of methicillin-resistant Staphylococcus aureus (MRSA) nasal carriage in rural and urban community settings of Bolivia and Peru. Methods MRSA nasal carriage was investigated in 585 individuals living in rural and urban areas of Bolivia and Peru (one urban area, one small rural village, and two native communities, one of which was highly isolated). MRSA isolates were subjected to molecular analysis for the detection of virulence genes, characterization of the staphylococcal cassette chromosome mec (SCC mec ), and genotyping (multilocus sequence typing (MLST) and pulsed-field gel electrophoresis (PFGE)). Results An overall very low prevalence of MRSA nasal carriage was observed (0.5%), with MRSA carriers being detected only in a small rural village of the Bolivian Chaco. The three MRSA isolates showed the characteristics of community-associated MRSA (being susceptible to all non-beta-lactam antibiotics and harboring the SCC mec type IV), were clonally related, and belonged to ST1649. Conclusions This study provides an insight into the epidemiology of MRSA in community settings of Bolivia and Peru. Reliable, time-saving, and low-cost methods should be implemented to encourage continued surveillance of MRSA dissemination in resource-limited countries

Quinolone resistance in absence of selective pressure: the experience of a very remote community in the Amazon forest.

BackgroundQuinolones are potent broad-spectrum bactericidal agents increasingly employed also in resource-limited countries. Resistance to quinolones is an increasing problem, known to be strongly associated with quinolone exposure. We report on the emergence of quinolone resistance in a very remote community in the Amazon forest, where quinolones have never been used and quinolone resistance was absent in 2002.MethodsThe community exhibited a considerable level of geographical isolation, limited contact with the exterior and minimal antibiotic use (not including quinolones). In December 2009, fecal carriage of antibiotic resistant Escherichia coli was investigated in 120 of the 140 inhabitants, and in 48 animals reared in the community. All fluoroquinolone-resistant isolates were genotyped and characterized for the mechanisms of plasmid- and chromosomal-mediated quinolone resistance.Principal findingsDespite the characteristics of the community remained substantially unchanged during the period 2002-2009, carriage of quinolone-resistant E. coli was found to be common in 2009 both in humans (45% nalidixic acid, 14% ciprofloxacin) and animals (54% nalidixic acid, 23% ciprofloxacin). Ciprofloxacin-resistant isolates of human and animal origin showed multidrug resistance phenotypes, a high level of genetic heterogeneity, and a combination of GyrA (Ser83Leu and Asp87Asn) and ParC (Ser80Ile) substitutions commonly observed in fluoroquinolone-resistant clinical isolates of E. coli.ConclusionsRemoteness and absence of antibiotic selective pressure did not protect the community from the remarkable emergence of quinolone resistance in E. coli. Introduction of the resistant strains from antibiotic-exposed settings is the most likely source, while persistence and dissemination in the absence of quinolone exposure is likely mostly related with poor sanitation. Interventions aimed at reducing the spreading of resistant isolates (by improving sanitation and water/food safety) are urgently needed to preserve the efficacy of quinolones in resource-limited countries, as control strategies based only on antibiotic restriction policies are unlikely to succeed in those settings

Sociocultural dimension of epilepsy: an anthropological study among Guaraní communities in Bolivia--an International League Against Epilepsy/International Bureau for Epilepsy/World Health Organization Global Campaign against Epilepsy regional project.

International audienceThis study was performed to analyze sociocultural beliefs about epilepsy among Guaraní communities in Bolivia. People with epilepsy, their family members, the general population, and local health care personnel were interviewed about the meaning of and beliefs, feelings, and practices concerning epilepsy. Epilepsy is called mano-mano, a term that means being in a constant passage between life and death. The disease is attributed mainly to a failure to observe a fasting period and to other eating habits. Natural remedies are the most recommended treatments even though half of respondents reported that antiepileptic drugs may be effective. The concept of epilepsy as an embodied disease with natural causes appears to differ from that documented in other traditional societies. People with epilepsy do not represent a threat to the community, which seems to have an attitude aimed at their protection. Moreover, people from these communities appear to favor a combination of biomedical and traditional care systems

An anthropological study on epilepsy among guarani communities in Bolivia.

International audienc

Features of 28 ciprofloxacin resistant <i>E. coli</i> isolates of human and animal origin.

<p>SXT, trimethoprim-sulfamethoxazole; TET, tetracycline; AMP, ampicillin; S, streptomycin; GEN, gentamicin; CHL, chloramphenicol; CRO, ceftriaxone.</p

Animals carrying antibiotic resistant <i>E. coli</i> as part of their intestinal microbiota.

<p>CI, Confidence Intervals; SXT, trimethoprim-sulfamethoxazole.</p

Characteristics of the study community: 2002 vs. 2009.

a<p>2-hour drive on a unpaved road, 4-hour motor boat ride, 7-hour walk in the jungle.</p>b<p>Chloroquine and primaquine (introduced following a previous malaria epidemic).</p>c<p>Ampicillin, dicloxacillin, erythromycin, and trimethoprim-sulfamethoxazole.</p>d<p>Traveller, an individual with a history of travel to Yurimaguas (the nearest urban area) in the 12 months preceding the survey. No statistically significant difference between 2002 and 2009 (<i>P</i>>0.37).</p>e<p>Individuals reporting antibiotic use in the two weeks preceding the survey. No statistically significant difference between 2002 and 2009 (<i>P</i> = 0.76).</p>f<p>TET, tetracycline; AMP, ampicillin; SXT, trimethoprim-sulfamethoxazole.</p