Primer caso del síndrome hemofagocítico asociado con posible infección con Rickettsia sp del grupo de las fiebres manchadas, Meta, Colombia

El presente estudio describe un caso de síndrome hemofagocítico (SHF) probablemente asociado a la infección por una especie de Rickettsia del grupo de las fiebres manchadas (GFM). La paciente fue una niña de ocho años procedente de un área rural tropical del departamento del Meta, en el Oriente Colombiano, la cual fue admitida en el Hospital de Villavicencio con fiebre alta de tres días de evolución, dolor de cabeza, erupción, astenia, dolor abdominal, linfadenopatias y hepatoesplenomegalia. Los estudios serológicos para HIV, hepatitis, citomegalovirus, virus Epstein Barr entre otros resultaron negativos. La paciente fue admitida en un estudio de fiebres tropicales indiferenciadas, las muestras de suero pareadas fueron analizadas mediante inmunofluorescencia indirecta (IFI) para detección de anticuerpos IgG contra Rickettsia spp., del GFM y se encontró seroconversión de títulos de anticuerpos entre fase aguda (IgG 1:64) y convaleciente (IgG 1:1024). Dada la rápida remisión de las manifestaciones clínicas tras la instauración del tratamiento con doxiciclina, la causa del síndrome hemofagocítico fue atribuido a la infección por Rickettsia spp del GFM

Climate changes and infectious diseases: new epidemiological challenges

El Niño / Oscilación Sur (ENSO) es el fenómeno mejor conocido que influye en la variabilidad del clima mundial en escalas de tiempo inter anuales. El término El Niño se refiere al fenómeno climático vinculado a un calentamiento periódico de las temperaturas superficiales del mar en la zona central y oriental del Pacífico ecuatorial central (aproximadamente entre la línea internacional y 120 grados de longitud oeste), y se refiere a veces como un episodio cálido del Pacífico. Lo contrario de lo que es La Niña, la fase fría del fenómeno ENSO. Debido al gran tamaño del Océano Pacífico, los cambios en los patrones de temperatura superficial del mar tienen gran influencia en la circulación atmosférica con efectos pronunciados en la precipitación tropical mundial y los patrones de temperatura. Se ha relacionado el ENSO con las anomalías climáticas y el incremento de las enfermedades infecciosas, especialmente las transmitidas por insectos, por lo que su conocimiento puede permitir ofrecer mejores predicciones a largo plazo de epidemias o epizootia.El Niño/Southern Oscillation (ENSO) is the most well-known phenomenon influencing the global climate variability at inter annual time scales. The term El Niño refers to the largescale ocean-atmosphere climate phenomenon linked to a periodic warming in sea surface temperatures across the central and east-central equatorial Pacific (between approximately the International Date line and 120 degrees west longitude), and thus represents the warm phase of the ENSO, and is sometimes referred to as a Pacific warm episode. The opposite of which is La Niña, a cold phase of ENSO. Given the large size of the Pacific Ocean, changes in the sea surface temperature patterns and gradients across the basin influence atmospheric circulation with pronounced impacts on global tropical precipitation and temperature patterns. Building evidence of the links between ENSO driven climate anomalies and infectious diseases, particularly those transmitted by insects, the knowlodgment could allow providing improved long range forecasts of an epidemic or epizootic

Dengue: a common cause of febrile syndrome in Meta State, Colombia

Introduction:Epidemic Dengue fever is an ancient disease, however in the past 17 years, it’s activity has a dramatic resurgence of Dengue in the tropics areas worldwide. This increased of epidemic activity, has been associated with the geographical expansion of both, the mosquito vectors and the viruses, the development of hyper-endemicity, and the emergence of Dengue hemorrhagic fever. Objective: The goal of this study was to determine the frequency of Dengue infection in patients with acute febrile syndrome in Meta’s Administrative District, Colombia. That ask for a medical advice at the Departmental hospital of Villavicencio. Material and methods: Blood serum were collected from 100 febrile patients in of acute and convalescent stages from the rural and urban zones that arrive for medical advice to the Departmental hospital of Villavicencio during 2013 and 2014. Serologic tests for Dengue (IgM and IgG by ELISA) were performed. Statistical analyses were performed using SPSS 21.0 for Windows (SPSS Inc., USA). The chi-square test was used to make a comparison. Variables that were statistically significant (p&lt;0.05) were kept in the final model. Results: From a total of 100 persons surveyed, (51%) were women, and average age was 23,5 ± 15,6 years, 50%  was students  and  51 % had some type of Dengue, mainly secondary infections (44 %). Conclusions:Dengue is a frequent infection in Meta Administrative District, Colombia, with a high frequency of exposed population with secondary infection which is a risk factor for severe forms of the disease.Keywords: Febrile syndrome, Dengue, ELISA, antibody, IgM, IgG, Colombia.</p

An approach to the situation of pulmonary tuberculosis in indigenous communities of Puerto Gaitán, Meta, Colombia

Introduction: Tuberculosis (TB) is a highly prevalent disease in Colombian indigenous communities of the Orinoquia.  The prevalence and incidence of TB in these communities may be underestimated due to an inadequate detection and treatment, and the lack of reliable information. Objective: To explore the situation of pulmonary tuberculosis in selected indigenous communities of Puerto Gaitan.Materials and Methods: An exploratory cross-sectional study was conducted in indigenous communities of Puerto Gaitan, Meta, Colombia from June 2015 to November 2015. Socio-demographic surveys were applied, and 200 sputum samples from symptomatic patients with respiratory diseases were collected and analyzed with GeneXpert® (real-time polymerase chain reaction, RT-PCR).Results: The surveys showed that the indigenous population is exposed to deteriorating conditions in their quality of life, which expose them to a greater risk of suffering from tuberculosis. Two of the samples analyzed showed to be positive for Mycobacterium tuberculosis 2/191 (1.04%).Conclusions: It is required to implement a differential surveillance system for tuberculosis in indigenous population according to their living conditions, health, and culture, prioritizing a fast and sensitive diagnosis. Keywords: Tuberculosis, indigenous population, health conditions, polymerase chain reaction (PCR).</p

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Primer caso del síndrome hemofagocitico asociado con posible infección con Rickettsia sp del grupo de las fiebres manchadas, Meta, Colombia.

El presente estudio describe un caso de síndrome hemofagocítico (SHF) probablemente asociado a la infección por una especie de Rickettsia del grupo de las fiebres manchadas (GFM). La paciente fue una niña de ocho años procedente de un área rural tropical0000-0001-7024-387

Infección por hantavirus en pacientes de Villavicencio, Colombia

0000-0001-7024-387

Seroprevalencia de leptospirosis en pacientes con síndrome febril no palúdico

Introduction: leptospirosis is a zoonotic disease transmitted by several species of wild and domestic animals, which serve as reservoirs of the causative agent. The disease affects humans from urban and rural areas of the world. Objective: determine Leptospira sp. antibody seroprevalence and dominant serogroups in patients with non-malarial febrile syndrome from Meta Department in Colombia. Methods: across-sectional prospective study was conducted. The study population was all the febrile patients attending a hospital in the city of Villavicencio from May 2013 to June 2014. The paired sera were processed using the microagglutination test with the following serogroups: Australis, Ballum, Bataviae, Canicola, Cynopteri, Panama, Pyrogenes, Sejroe and Semaranga. Diagnostic tests were performed for dengue (IgM and IgG antibody detection by ELISA), rickettsiosis (IgG antibody detection by indirect immunofluorescence), and hantaviral disease (IgG antibody detection by ELISA). Results: of the 100 sera studied, 29 were positive for leptospirosis. The most prevalent serogroups were Canicola and Ballum. Conclusions: prevalence results for leptospirosis show that the disease has been under-recorded in the area. It is thus advisable to include it in the differential diagnosis of febrile syndromes. © 2018, Editorial Ciencias Medicas. All rights reserved.0000-0001-7024-387

Primera detección de Candidatus Rickettsia colombianensi en el departamento del Meta, Colombia

Introduction: Rickettsia is a genus of Gram-negative obligate intracellular bacteria that cause several epidemics around the world and are transmitted mainly by ticks, fleas, lice and mites. Rickettsiosis is a re-emergent infectious disease without epidemiological surveillance in Colombia. Until few years ago, Rickettsia rickettsi was the only tick-borne Rickettsioses in America; however, new species are being described, and although their pathogenicity has not been confirmed, they should be considered as potential pathogens. Objective: The aim of this study was to determine the presence of rickettsial agents in ticks in the state of Meta, Colombia. Material and Methods: A descriptive cross-sectional study was conducted; ticks were collected and, after their taxonomic identification, gltA, ompA and ompB genes were amplified and sequenced. Results: A total of 169 pools were obtained to which PCR were carried out, of which 2 PCR were amplified for the gltA, ompA and ompB genes. Conclusions: These results demonstrate the presence of Rickettsia spp in ticks in the State of Meta. © 2019 Universidad de Ciencias Medicas de La Hab. All rights reserved.0000-0001-7024-387