Medically important trombiculids: a systematic review of the global distribution and clinical consequences of their bites

Background: Mites are among the smallest arthropods that can be seen without magnification, were the use of dermatoscopy is an invaluable tool. They are a cosmopolitan pest, and at the moment more than 250 species have been shown to produce problems for humans and animals alike. These mites are capable of producing a wide array of clinical signs and symptoms, from local to systemic, from mild to severe, as well as transmitting pathogens. This study aimed to provide an update to the clinical impact on human health, the distribution and species involved in the clinical conditions produced by trombiculids through a systematic review. Background: Mites are among the smallest arthropods that can be seen without magnification, were the use of dermatoscopy is an invaluable tool. They are a cosmopolitan pest, and at the moment more than 250 species have been shown to produce problems for humans and animals alike. These mites are capable of producing a wide array of clinical signs and symptoms, from local to systemic, from mild to severe, as well as transmitting pathogens. This study aimed to provide an update to the clinical impact on human health, the distribution and species involved in the clinical conditions produced by trombiculids through a systematic review. Methods: A systematic literature review was conducted in Medline, Lilacs, Redalyc, Scopus, SciELO and Google Scholar, were we use as a threshold of publication date the year 2008. We limited the search strategy to articles published in Portuguese, French, English and Spanish. Eligible studies were case reports and case series that reported outcomes in humans caused by trombiculid bites. Patient-level and study-level information was extracted. Results: The literature search yielded 832 studies; 13 were case reports, 4 case series and 2 descriptive studies reporting a total of 49 cases. Most patients were male, and the median age was 33.7±6.4 years old. The most frequently reported symptoms were local erythema, pruritus and papules. No deaths were documented. Trombiculids from the genera Trombicula, Eutrombicula and Leptotrombidium appear to be the most commonly reported. Discussion: Trombiculiasis is an infestation caused by the larval stage of various types of mites, known as chiggers, they belong to the class Arachnida and the family Trombiculidae. This systematic review provides an overview of the trombiculids of clinical importance, their distribution and effects of the bite on human health. Our results show that there are different species of mites that can have important consequences for human health. No fatal cases owere registered.Even so, the transmission of scrub typhus is important and remains one of the most life-threatening rickettsial infections in some regions of Asia. Conclusions: The bite of different species of trombiculids around the world can cause a wide array of clinical consequences to human health. Even as mortality appear to be nonexistent, trombiculid bites must be adequately diagnosed and treated properly: A systematic literature review was conducted in Medline, Lilacs, Redalyc, Scopus, SciELO and Google Scholar, were we use as a threshold of publication date the year 2008. We limited the search strategy to articles published in Portuguese, French, English and Spanish. Eligible studies were case reports and case series that reported outcomes in humans caused by trombiculid bites. Patient-level and study-level information was extracted. Results: The literature search yielded 832 studies; 13 were case reports, 4 case series and 2 descriptive studies reporting a total of 49 cases. Most patients were male, and the median age was 33.7±6.4 years old. The most frequently reported symptoms were local erythema, pruritus and papules. No deaths were documented. Trombiculids from the genera Trombicula, Eutrombicula and Leptotrombidium appear to be the most commonly reported. Discussion: Trombiculiasis is an infestation caused by the larval stage of various types of mites, known as chiggers, they belong to the class Arachnida and the family Trombiculidae. This systematic review provides an overview of the trombiculids of clinical importance, their distribution and effects of the bite on human health. Our results show that there are different species of mites that can have important consequences for human health. No fatal cases owere registered.Even so, the transmission of scrub typhus is important and remains one of the most life-threatening rickettsial infections in some regions of Asia. Conclusions: The bite of different species of trombiculids around the world can cause a wide array of clinical consequences to human health. Even as mortality appear to be nonexistent, trombiculid bites must be adequately diagnosed and treated properly.Antecedentes: Los ácaros están entre los artrópodos más pequeños que pueden ser vistos a simple vista , donde el uso de la dermatoscopia es una herramienta invaluable. Son una plaga cosmopolita, y hasta el momento se ha demostrado que más de 250 especies producen problemas tanto para los humanos como para los animales. Estos ácaros son capaces de producir una amplia gama de signos y síntomas clínicos, desde los locales hasta los sistémicos, de leves a graves, así como la transmisión de patógenos. El objetivo de este estudio fue proporcionar una actualización del impacto clínico en la salud humana, la distribución y las especies implicadas en estas condiciones clínicas producida por los trombiculidos a través de una revisión sistemática. Métodos: Se realizó una revisión sistemática de la literatura en Medline, Lilacs, Redalyc, Scopus, SciELO y Google Scholar, utilizamos como umbral de fecha de publicación el año 2008. Limitamos la estrategia de búsqueda a los artículos publicados en portugués, francés, inglés y español. Los estudios elegibles fueron informes de casos y series de casos que informaron de resultados en humanos causados por mordeduras de trombicúlidos. Se extrajo información a nivel de paciente y a nivel de estudio. Resultados: La búsqueda bibliográfica arrojó 832 estudios, de los cuales 13 fueron reportes de caso, 4 series de caso and 2 estudios descriptivos de casos que informaban de un total de 49 casos. La mayoría de los pacientes eran varones y la edad media era de 33,7±6,4 años. Los síntomas más frecuentes fueron el eritema local, el prurito y las pápulas. No se documentaron muertes. Los trombicúlidos de los géneros Trombicula, Eutrombicula y Leptotrombidium parecen ser los más comúnmente reportados. Discusión: La trombiculiasis es una infestación causada por varios tipos de ácarosen la etapa larval, también conocidas como niguas o coloraditos, pertenecen a la clase Arachnida y a la familia Trombiculidae. Esta revisión sistemática ofrece una visión general de los trombicúlidos de importancia clínica, su distribución y los efectos de la picadura en la salud humana. Nuestros resultados muestran que hay diferentes especies de ácaros que pueden tener importantes consecuencias para la salud humana. No se registraron casos de mortalidad. Aún así, el tifus de los matorrales sigue siendo una de las enfermedades producidas por rickettsiosis más peligrosas para la vida en algunas regiones de Asia. Conclusiones: La mordedura de diferentes especies de trombicúlidos en todo el mundo puede causar una amplia gama de consecuencias clínicas para la salud humana. Aunque la mortalidad parece no existir, las mordeduras de trombicúlidos deben ser adicionalmente diagnosticadas y tratadas adecuadamente

Estratificación del riesgo de transmisión malárica en la región Caribe colombiana.

Objective: Determine the malaria risk transmission in Colombian Caribbean. Methods: A descriptive and retrospective observational study was conducted in 167 municipalities Colombian Caribbean between 2010-2019. The municipalities were classified as: S4: Municipalities with native cases of active and residual foci; S3: Receptive, without native cases, and with risk importation of parasite; S2: Receptive without transmission and low vulnerability; S1: Non-receptive located above 1.600 meters above sea level in which there is no proven risk transmission, according to criteria proposed by PAHO. Results: The municipalities classified as S4 were 5 % (8): seven in Bolívar and one in La Guajira department. The municipalities classified as S3 were 72,4% (121) and S4 were 22,8% (38). The accumulated burden of cases in the region was 23.285 cases, with a predominance of Plasmodium vivax, and 80,8% (18.804 cases) of the burden was registered in municipalities S4. Conclusions: The Colombian Caribbean evidence endemic-epidemic transmission, focal and dispersed, variable and of very low intensity. There are two active foci of indigenous transmission in southern Bolivar and rural areas of Riohacha, La Guajira.Objetivo: Determinar el riesgo de transmisión malárica en la región Caribe colombiana. Materiales y métodos: Estudio observacional de tipo descriptivo y retrospectivo en 167 municipios de la región entre los años 2010-2019. Se clasificaron los municipios como: E4: aquellos con casos autóctonos de focos activos y residuales; E3: receptivos, sin casos autóctonos, y con riesgo de importación del parásito; E2: receptivos sin transmisión y baja vulnerabilidad; E1: no receptivos ubicados por encima de los 1.600 msnm donde no existe riesgo comprobado de transmisión; acorde a la metodología de estratificación de la OPS (2019) Resultados: El 5% (8) de los municipios se clasificaron como E4, siete en el departamento de Bolívar y  uno en La Guajira. El 72,4% (121) de los municipios se clasificaron E3 y el 22,8% (38) como E2. La carga acumulada de casos en la región fue de 23.285 casos, con predominio de Plasmodium vivax, y el 80,8% (18.804 casos) de la carga se registró en los municipios E4. Conclusiones: La región Caribe colombiana evidencia transmisión endemo-epidémica, focal y dispersa, variable y de muy baja intensidad. Existen dos focos de transmisión autóctona activa en el sur de Bolívar y el área rural de Riohacha, La Guajira

Quality assessment of clinical practice guidelinesfor Chagas disease

INTRODUCTION: The development of clinical practice guidelines (CPGs) has increased; this study aimed to assess the quality of CPGs for the management of Chagas disease. METHODS: Following a systematic search of the scientific literature, two reviewers assessed the eligible guidelines using the Appraisal of Guidelines Research and Evaluation (AGREE) II instrument. RESULTS: Five CPGs were included. The AGREE domains of scope/purpose, stakeholder involvement, and clarity of presentation were rated well, and the domains of applicability and editorial independence received poor ratings. CONCLUSIONS: The quality of CPGs for Chagas disease is poor, and significant work is required to develop high-quality guidelines

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

Quality assessment of clinical practice guidelinesfor Chagas disease

INTRODUCTION: The development of clinical practice guidelines (CPGs) has increased; this study aimed to assess the quality of CPGs for the management of Chagas disease. METHODS: Following a systematic search of the scientific literature, two reviewers assessed the eligible guidelines using the Appraisal of Guidelines Research and Evaluation (AGREE) II instrument. RESULTS: Five CPGs were included. The AGREE domains of scope/purpose, stakeholder involvement, and clarity of presentation were rated well, and the domains of applicability and editorial independence received poor ratings. CONCLUSIONS: The quality of CPGs for Chagas disease is poor, and significant work is required to develop high-quality guidelines

Caracterización de la población gestante adolescente atendida en el Hospital Militar Central de Bogotá D.C., Colombia. 2012-2015

Introduction: Although adolescent pregnancy prevalence in Colombia is high, adverse obstetric and perinatal adverse outcomes in this population have not yet been established in the country. Objective: To characterize the obstetric and perinatal outcomes of pregnant adolescents treated at Hosptal Militar Central, located in Bogotá D.C., Colombia. Materials and methods: Retrospective cross-sectional observational study. The medical records of 147 pregnant adolescents treated at Hospital Militar Central between May 2012 and December 2015 were reviewed. Results: Adolescents’ average age was 17 ± 1.5 years, 59.8% of them were students (high school and higher education), and 64.6% were single. Regarding prenatal care, 127 (86.4%) had started getting prenatal check-ups late and 108 (73.5%) had poor prenatal care (less than 4 prenatal check-ups). Obstetric complications general frequency was 27.9%, being the most frequent hypertensive disorders of pregnancy (10.2%) and preterm birth (8.2%). There were no maternal death cases. On the other hand, the most frequent perinatal morbidities were jaundice (4.8%) and respiratory distress syndrome (3.4%). Conclusions: Pregnancy-related complications were more frequent in adolescents who started prenatal check-ups late, so strategies aimed at ensuring that adolescents have access to early prenatal care and at improving their adherence rates to prenatal check-ups must be implemented. In addition, the impact that family planning programs have on this population must also be evaluated.Introducción. A pesar de que en Colombia hay una alta prevalencia de embarazos en adolescentes, aún no se han establecido los resultados obstétricos y perinatales adversos en esta población. Objetivo. Caracterizar los desenlaces obstétricos y perinatales de las gestantes adolescentes atendidas en el Hospital Militar Central de Bogotá D.C., Colombia. Materiales y métodos. Estudio observacional, retrospectivo y transversal realizado mediante la revisión de las historias clínicas de 147 gestantes adolescentes atendidas entre mayo de 2012 y diciembre de 2015 en el Hospital Militar Central de Bogotá D.C. Resultados. El promedio de edad fue 17±1.5 años; 59.8% eran estudiantes (secundaria y educación superior) y 64.6%, solteras. En cuanto a los controles prenatales, 127 (86.4%) los iniciaron tardíamente y 108 (73.5%) tuvieron menos de 4. La frecuencia general de complicaciones obstétricas fue 27.9%, entre las que se destacan los trastornos hipertensivos del embarazo (10.2%) y la amenaza de parto pretérmino (8.2%); no se presentaron muertes maternas. Por su parte, las patologías neonatales más comunes fueron ictericia neonatal (4.8%) y síndrome de dificultad respiratoria (3.4%). Conclusiones. Las complicaciones se presentaron con mayor frecuencia en las adolescentes que iniciaron los controles prenatales de forma tardía, por lo que se deben implementar estrategias para garantizar el inicio temprano de estos controles y la adherencia a los mismos. Además, es necesario evaluar el impacto de los programas de planificación familiar en esta población

Therapeutic drug monitoring of benznidazole and nifurtimox: a systematic review and quality assessment of published clinical practice guidelines

Abstract The pharmacological management of adults with chronic-phase Chagas disease is challenging despite it being the recent focus of extensive research. One of the challenges in the current clinical practice guidelines (CPGs) landscape is the existence of non-evidence-based recommendations for the use of laboratory tests in treatment monitoring. This study aimed to systematically assess the quality and consistency of recommendations of CPGs on the pharmacological management of adults with chronic-phase Chagas disease. Systematic literature searches were conducted in MEDLINE, EMBASE, SciELO and Google to identify all published CPGs relevant to the pharmacological management of Chagas disease, between January 2010 and March 2016. Three independent reviewers assessed the quality of each CPG using the Appraisal of Guidelines Research and Evaluation (AGREE) II instrument. A total of five CPGs were included and the overall quality of the guidelines for therapeutic drug monitoring of Chagas disease was moderate-to-low. There was considerable variation in the quality of the CPGs across the AGREE II domains. The domains of scope/purpose, stakeholder involvement, and clarity of presentation were rated well, and the domains of applicability and editorial independence received poor ratings. This review showed that the methodological quality of CPGs for Chagas disease was generally inappropriate, and there was no explicit link between the best available evidence and current recommendations

Paciente con dextrocardia y enfermedad de Chagas. Reporte de caso y revisión de la literatura

Introduction: About half a million patients in Colombia are currently infected with Trypanosoma cruzi. However, little is known about patients with Chagas disease and anatomical defects such as dextrocardia. Case presentation: A 52-year-old male patient with a 4-year history of dyspnea, chest pain, lower limb edema and syncope (requiring hospitalization), arrhythmias and dextrocardia, underwent serological tests for T. cruzi that were positive. A literature review was conducted to find case reports of patients with dextrocardia or situs inversus and Chagas disease in order to determine the proper treatment. Conclusion: Cases of patients with dextrocardia and Chagas disease are rare. Besides the reported case, only three other cases were found in the literature, which were relatively similar, although they could be considered more severe. According to the findings, the use of etiological treatment is acceptable in patients with coronary anatomic abnormalities and T. cruzi infection. The present case draws attention to the importance of adequately approaching and monitoring this type of patient.Introducción. En la actualidad, en Colombia hay aproximadamente medio millón de personas infectadas con Trypanosoma cruzi; sin embargo, no hay mucha información sobre pacientes que viven con enfermedad de Chagas y anomalías anatómicas como la dextrocardia. Presentación del caso. Paciente masculino de 52 años con cuadro clínico de aproximadamente cuatro años de evolución consistente en disnea, dolor torácico, edema de extremidades inferiores, síncope (que requirió hospitalización), arritmias y dextrocardia, a quien se le practicaron pruebas serológicas para T. cruzi que resultaron positivas. Con el fin de establecer el tratamiento adecuado, se realizó una revisión de la literatura buscando reportes de casos de pacientes con dextrocardia o situs inversus y enfermedad de Chagas. Conclusión. Los casos de pacientes con dextrocardia y enfermedad de Chagas son poco frecuentes: además del caso reportado, en la literatura solo se encontraron tres reportes adicionales, los cuales fueron relativamente similares, aunque podrían considerarse más severos. Según los hallazgos, el uso de tratamiento etiológico es adecuado en pacientes con anormalidades anatómicas cardiovasculares e infección por T. cruzi. El presente caso llama la atención sobre la importancia de tener un enfoque y seguimiento adecuados en este tipo de pacientes

Ocular toxocariasis caused by toxocara canis in an adult woman. Case report

Introduction: Toxocariasis is a zoonosis caused by the Toxocara canis and Toxocara cati nematodes larvae. These are intestinal parasites found in canids and felids, respectively. Case presentation: This paper presents the case of a 22-year-old woman from Caquetá, with a three-month history of vision loss in her left eye, eye pain, diplopia, photophobia and bilateral red eye. Retinal detachment in the left eye was diagnosed by ultrasound. The ophthalmology service made a differential diagnosis of retinoblastoma and pars planitis. Symptomatic management was initiated with oral and topical corticosteroids, obtaining symptom improvement, although loss of visual acuity persisted. Discussion: Coexistence and cohabitation of the patient with pets (dogs and cats) was an important factor to consider ocular toxocariasis. Complete blood count revealed mild leukocytosis and lymphocytosis without eosinophilia. Antibodies against Toxoplasma gondii and Taenia solium cysticercus were negative, as well as the VDRL. The ELISA test for Toxocara canis was positive, with IgG titers of 1:64 (positive ≥1:32, specificity >90%). Management with ophthalmic and systemic corticosteroids, albendazole and vitrectomy was initiated. The vitreous band was released by means of surgery, making the diplopia disappear, although residual peripheral granuloma persisted and will be operated by ophthalmology. Conclusions: Knowledge on ocular toxocariasis is important for physicians because it might be mistaken with retinoblastoma, a malignant neoplasm that may require enucleation of the eye