Malaria en la Amazonía peruana

Descargue el texto completo en el repositorio institucional de la University of California, San Diego: https://escholarship.org/uc/item/3f70r8c3Se realizaron y publicaron tres estudios en esta tesis doctoral. El primero analiza actividades sociodemográficas y ocupacionales de las personas en riesgo de contraer malaria, y permitió identificar grupos de riesgo entre los sujetos que trabajan en las actividades forestales o agrícolas y sus socios en el hogar. El segundo demostró nuevas herramientas para estudios de epidemiología de malaria: marcadores en tándem y de polimorfismo de longitud de fragmentos de restricción msp3α que tienen una alta capacidad discriminatoria para determinar la microgeografía de la transmisión de la malaria en la Amazonía peruana. El tercero utilizó un análisis de microarrays de proteínas a nivel genoma para identificar antígenos como herramienta serológica para monitorear la infección y dinámica de transmisión, y que las proteínas reconocidas por los anticuerpos IgG humanos tienen más probabilidades de tener polimorfismos de nucleótidos que las proteínas codificadas por el genoma en su conjunto, lo que sugiere selección que surge de interacciones huésped-patógeno. Los nuevos antígenos proteicos tienen importante potencial como herramientas para análisis seroepidemiológico de estrategias de vigilancia, control y eliminación. Estas investigaciones en la Amazonía peruana contribuyen a una mejor comprensión de características biológicas y sociodemográficas de la respuesta inmune humana a Plasmodium vivax.Malaria is the most widespread serious parasitic disease worldwide, with over 2 billion people at risk of infection, over 300 million cases yearly, and over 1 million deaths every year. The primary vector in the Peruvian Amazon, Anopheles darlingi, is a highly anthropophilic rural mosquito. This thesis research focuses primarily on Plasmodium vivax malaria in the Peruvian Amazon, for three reasons: it is the most common form of malaria in the Peruvian Amazon; in comparison with Plasmodium falciparum, Plasmodium vivax malaria is understudied in this region; and the current malaria elimination call to action leads the need for new knowledge on this disease in the Peruvian Amazon. The goal of this thesis research is to contribute with the elimination of malaria transmission by means of testing the overarching central hypothesis that sociodemographics, relapsing Plasmodium vivax malaria, and the use of protein microarray analysis, are current aspects/tools that will help to stopping transmission of Plasmodium vivax malaria within rural villages near Iquitos, and eventually within the Amazon Region of Loreto, Peru. Three studies were conducted and published for this purpose.Beca Fogarty - NI

Relación entre el clima organizacional y el síndrome de burnout en el personal asistencial de Enfermería del Hospital de Huaycan Nivel II- 1, del distrito de Ate Vitarte - 2016

El objetivo del presente estudio, fue determinar la relación que existe entre el clima organizacional y el síndrome de Burnout en el personal asistencial de enfermería del Hospital Huaycán Nivel II – 1, del distrito de Ate Vitarte – 2016, la investigación se llevó a cabo en el poblado de Huaycán, del distrito de Ate Vitarte. El estudio fue de carácter cuantitativo, con un tipo de investigación sustantiva o de base, diseño de investigación descriptivo correlacional, método de investigación hipotético deductivo. La técnica utilizada para recabar la información del caso fue la encuesta y los instrumentos considerados son: cuestionario sobre el clima organizacional y el Cuestionario de Medición del Síndrome Burnout. La muestra del presente estudio estuvo constituida por 70 enfermeras del hospital de Huaycán. La técnica utilizada para recabar la información fue la encuesta, considerando los instrumentos: Cuestionario sobre clima organizacional y cuestionario de medición del síndrome de Burnout. El diseño estadístico incluyó estadísticos descriptivos e inferenciales. Las conclusiones a las cuales se arribó, son las siguientes: Existe relación significativa entre el clima organizacional y el síndrome de Burnout, a nivel total y por las dimensiones: cansancio emocional, despersonalización y baja realización personal, en el personal asistencial de enfermería del Hospital Huaycán Nivel II – 1, del distrito de Ate Vitarte – 2016.Universidad Nacional de Educación Enrique Guzmán y ValleTesi

Infection of laboratory-colonized Anopheles darlingi mosquitoes by Plasmodium vivax.

Anopheles darlingi Root is the most important malaria vector in the Amazonia region of South America. However, continuous propagation of An. darlingi in the laboratory has been elusive, limiting entomological, genetic/genomic, and vector-pathogen interaction studies of this mosquito species. Here, we report the establishment of an An. darlingi colony derived from wild-caught mosquitoes obtained in the northeastern Peruvian Amazon region of Iquitos in the Loreto Department. We show that the numbers of eggs, larvae, pupae, and adults continue to rise at least to the F6 generation. Comparison of feeding Plasmodium vivax ex vivo of F4 and F5 to F1 generation mosquitoes showed the comparable presence of oocysts and sporozoites, with numbers that corresponded to blood-stage asexual parasitemia and gametocytemia, confirming P. vivax vectorial capacity in the colonized mosquitoes. These results provide new avenues for research on An. darlingi biology and study of An. darlingi-Plasmodium interactions

Accelerating to Zero: Strategies to Eliminate Malaria in the Peruvian Amazon.

AbstractIn February 2014, the Malaria Elimination Working Group, in partnership with the Peruvian Ministry of Health (MoH), hosted its first international conference on malaria elimination in Iquitos, Peru. The 2-day meeting gathered 85 malaria experts, including 18 international panelists, 23 stakeholders from different malaria-endemic regions of Peru, and 11 MoH authorities. The main outcome was consensus that implementing a malaria elimination project in the Amazon region is achievable, but would require: 1) a comprehensive strategic plan, 2) the altering of current programmatic guidelines from control toward elimination by including symptomatic as well as asymptomatic individuals for antimalarial therapy and transmission-blocking interventions, and 3) the prioritization of community-based active case detection with proper rapid diagnostic tests to interrupt transmission. Elimination efforts must involve key stakeholders and experts at every level of government and include integrated research activities to evaluate, implement, and tailor sustainable interventions appropriate to the region

Whole genome sequencing analysis of Plasmodium vivax using whole genome capture

Background: Malaria caused by Plasmodium vivax is an experimentally neglected severe disease with a substantial burden on human health. Because of technical limitations, little is known about the biology of this important human pathogen. Whole genome analysis methods on patient-derived material are thus likely to have a substantial impact on our understanding of P. vivax pathogenesis and epidemiology. For example, it will allow study of the evolution and population biology of the parasite, allow parasite transmission patterns to be characterized, and may facilitate the identification of new drug resistance genes. Because parasitemias are typically low and the parasite cannot be readily cultured, on-site leukocyte depletion of blood samples is typically needed to remove human DNA that may be 1000X more abundant than parasite DNA. These features have precluded the analysis of archived blood samples and require the presence of laboratories in close proximity to the collection of field samples for optimal pre-cryopreservation sample preparation. Results: Here we show that in-solution hybridization capture can be used to extract P. vivax DNA from human contaminating DNA in the laboratory without the need for on-site leukocyte filtration. Using a whole genome capture method, we were able to enrich P. vivax DNA from bulk genomic DNA from less than 0.5% to a median of 55% (range 20%-80%). This level of enrichment allows for efficient analysis of the samples by whole genome sequencing and does not introduce any gross biases into the data. With this method, we obtained greater than 5X coverage across 93% of the P. vivax genome for four P. vivax strains from Iquitos, Peru, which is similar to our results using leukocyte filtration (greater than 5X coverage across 96% of the genome). Conclusion: The whole genome capture technique will enable more efficient whole genome analysis of P. vivax from a larger geographic region and from valuable archived sample collections.National Institutes of Health [R21-AI085374-01A1, U19AI089681, 1K24AI068903, D43TW007120, R01AI067727]UCSD Genetics Training Program through an institutional training grant from the National Institute of General Medical Sciences [T32 GM008666]NIH/NCRR Grant [UL1 RR025774

Whole genome sequencing analysis of Plasmodium vivax using whole genome capture

Abstract\ud \ud Background\ud Malaria caused by Plasmodium vivax is an experimentally neglected severe disease with a substantial burden on human health. Because of technical limitations, little is known about the biology of this important human pathogen. Whole genome analysis methods on patient-derived material are thus likely to have a substantial impact on our understanding of P. vivax pathogenesis and epidemiology. For example, it will allow study of the evolution and population biology of the parasite, allow parasite transmission patterns to be characterized, and may facilitate the identification of new drug resistance genes. Because parasitemias are typically low and the parasite cannot be readily cultured, on-site leukocyte depletion of blood samples is typically needed to remove human DNA that may be 1000X more abundant than parasite DNA. These features have precluded the analysis of archived blood samples and require the presence of laboratories in close proximity to the collection of field samples for optimal pre-cryopreservation sample preparation.\ud \ud \ud Results\ud Here we show that in-solution hybridization capture can be used to extract P. vivax DNA from human contaminating DNA in the laboratory without the need for on-site leukocyte filtration. Using a whole genome capture method, we were able to enrich P. vivax DNA from bulk genomic DNA from less than 0.5% to a median of 55% (range 20%-80%). This level of enrichment allows for efficient analysis of the samples by whole genome sequencing and does not introduce any gross biases into the data. With this method, we obtained greater than 5X coverage across 93% of the P. vivax genome for four P. vivax strains from Iquitos, Peru, which is similar to our results using leukocyte filtration (greater than 5X coverage across 96% ).\ud \ud \ud Conclusion\ud The whole genome capture technique will enable more efficient whole genome analysis of P. vivax from a larger geographic region and from valuable archived sample collections

Temporal and Microspatial Heterogeneity in Transmission Dynamics of Coendemic Plasmodium vivax and Plasmodium falciparum in Two Rural Cohort Populations in the Peruvian Amazon.

BACKGROUND: Malaria is highly heterogeneous: its changing malaria microepidemiology needs to be addressed to support malaria elimination efforts at the regional level. METHODS: A 3-year, population-based cohort study in 2 settings in the Peruvian Amazon (Lupuna, Cahuide) followed participants by passive and active case detection from January 2013 to December 2015. Incidence and prevalence rates were estimated using microscopy and polymerase chain reaction (PCR). RESULTS: Lupuna registered 1828 infections (1708 Plasmodium vivax, 120 Plasmodium falciparum; incidence was 80.7 infections/100 person-years (95% confidence interval [CI] , 77.1-84.5). Cahuide detected 1046 infections (1024 P vivax, 20 P falciparum, 2 mixed); incidence was 40.2 infections/100 person-years (95% CI, 37.9-42.7). Recurrent P vivax infections predominated onwards from 2013. According to PCR data, submicroscopic predominated over microscopic infections, especially in periods of low transmission. The integration of parasitological, entomological, and environmental observations evidenced an intense and seasonal transmission resilient to standard control measures in Lupuna and a persistent residual transmission after severe outbreaks were intensively handled in Cahuide. CONCLUSIONS: In 2 exemplars of complex local malaria transmission, standard control strategies failed to eliminate submicroscopic and hypnozoite reservoirs, enabling persistent transmission

Malaria in the Peruvian Amazon /

Malaria is the most widespread serious parasitic disease worldwide, with over 2 billion people at risk of infection, over 300 million cases yearly, and over 1 million deaths every year. The primary vector in the Peruvian Amazon, Anopheles darlingi, is a highly anthropophilic rural mosquito. This thesis research focuses primarily on Plasmodium vivax malaria in the Peruvian Amazon, for three reasons: it is the most common form of malaria in the Peruvian Amazon; in comparison with Plasmodium falciparum, Plasmodium vivax malaria is understudied in this region; and the current malaria elimination call to action leads the need for new knowledge on this disease in the Peruvian Amazon. The goal of this thesis research is to contribute with the elimination of malaria transmission by means of testing the overarching central hypothesis that sociodemographics, relapsing Plasmodium vivax malaria, and the use of protein microarray analysis, are current aspects/tools that will help to stopping transmission of Plasmodium vivax malaria within rural villages near Iquitos, and eventually within the Amazon Region of Loreto, Peru. Three studies were conducted and published for this purpose. The first published manuscript analyzes socio- demographical and occupational activities of people at risk for malaria. This analysis allowed us to identify the main risk group among subjects working in the forest or agricultural activities and their partners at home. The second manuscript demonstrated new tools for malaria epidemiology studies: tandem repeat markers and restriction fragment length polymorphism msp3[alpha] markers that have high discriminatory capacity for determining the micro-geography of malaria transmission in the Peruvian Amazon. The third manuscript used genome- level protein microarray analysis to identify new antigens as serological tool to monitor infection status and transmission dynamics, and that proteins recognized by human IgG antibodies are more likely to have amino acid changes or single nucleotide polymorphisms than proteins coded by the genome as a whole, suggesting selection arising from host-pathogen interactions, immune or otherwise. The new P. vivax protein antigens have important potential as tools for sero-epidemiological analysis of surveillance, control and elimination strategies. More generally, these research in the Peruvian Amazon contribute to a better understanding of biological and socio-demographical characteristics of malaria transmission and fundamental properties of the human immune response to Plasmodium viva

Malaria in the Peruvian Amazon /

Malaria is the most widespread serious parasitic disease worldwide, with over 2 billion people at risk of infection, over 300 million cases yearly, and over 1 million deaths every year. The primary vector in the Peruvian Amazon, Anopheles darlingi, is a highly anthropophilic rural mosquito. This thesis research focuses primarily on Plasmodium vivax malaria in the Peruvian Amazon, for three reasons: it is the most common form of malaria in the Peruvian Amazon; in comparison with Plasmodium falciparum, Plasmodium vivax malaria is understudied in this region; and the current malaria elimination call to action leads the need for new knowledge on this disease in the Peruvian Amazon. The goal of this thesis research is to contribute with the elimination of malaria transmission by means of testing the overarching central hypothesis that sociodemographics, relapsing Plasmodium vivax malaria, and the use of protein microarray analysis, are current aspects/tools that will help to stopping transmission of Plasmodium vivax malaria within rural villages near Iquitos, and eventually within the Amazon Region of Loreto, Peru. Three studies were conducted and published for this purpose. The first published manuscript analyzes socio- demographical and occupational activities of people at risk for malaria. This analysis allowed us to identify the main risk group among subjects working in the forest or agricultural activities and their partners at home. The second manuscript demonstrated new tools for malaria epidemiology studies: tandem repeat markers and restriction fragment length polymorphism msp3[alpha] markers that have high discriminatory capacity for determining the micro-geography of malaria transmission in the Peruvian Amazon. The third manuscript used genome- level protein microarray analysis to identify new antigens as serological tool to monitor infection status and transmission dynamics, and that proteins recognized by human IgG antibodies are more likely to have amino acid changes or single nucleotide polymorphisms than proteins coded by the genome as a whole, suggesting selection arising from host-pathogen interactions, immune or otherwise. The new P. vivax protein antigens have important potential as tools for sero-epidemiological analysis of surveillance, control and elimination strategies. More generally, these research in the Peruvian Amazon contribute to a better understanding of biological and socio-demographical characteristics of malaria transmission and fundamental properties of the human immune response to Plasmodium viva