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Cucunubá ZM, Valencia-Hernández CA, Puerta CJ, Sosa-Estani S, Torrico F, Cortés JA, Ramirez JD, Vera MJ, Acosta BX, Álvarez CA, Muller EÁ, Beltrán M, Bermúdez MI, Berrío M, Camacho Moreno G, Castellanos YZ, Flórez AC, Criollo I, Guerra Morales P, Herazo RA, Hernández DC, León CM, Medina Camargo M, Medina Alfonso M, Pachón E, Paez Fonseca B, Parra ML, Pavia PX, Quiróz FR, Ríos LC, Roa NL, Torres F, Uribe Rivero LM. First Colombian consensus on congenital Chagas and clinical approach for women of child-bearing age diagnosed with Chagas. Infect 2017. [DOI: 10.22354/in.v21i4.689] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Congenital transmission of Chagas disease has not been extensively studied in Colombia, and there are no standardized processes in the health system regarding the specific diagnosis, treatment and follow-up of this disease. To generate recommendations on congenital Chagas disease and Chagas in women of childbearing age in Colombia, a consensus of experts was developed. An extensive literature search through the Medline database was carried out using the MeSH terms: «Chagas disease/congenital», «prevention and control», «diagnosis», «therapeutics» and «pregnancy». Appropriate abstracts were selected and the full texts were analyzed. The relevant information was synthesized, classified, and organized into tables and figures and was presented to a panel of experts, which was composed of 30 professionals from various fields. Based on the Delphi methodology, three rounds of consultation were conducted. The first and second rounds were based on electronic questionnaires that measured the level of consensus of each question among the participants. The third round was based on a face-to-face discussion focusing on those questions without consensus in the previous consultations. Theevidence was adapted to national circumstances on a case-by-case basis, and the content the final document was approved. These recommendations are proposed for use in routine medical practice by health professionals in Colombia.
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Camargo MC, Beltran M, Conde-Glez C, Harris PR, Michel A, Waterboer T, Flórez AC, Torres J, Ferreccio C, Sampson JN, Pawlita M, Rabkin CS. Serological response to Helicobacter pylori infection among Latin American populations with contrasting risks of gastric cancer. Int J Cancer 2015; 137:3000-5. [PMID: 26178251 PMCID: PMC4817269 DOI: 10.1002/ijc.29678] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Accepted: 06/26/2015] [Indexed: 12/20/2022]
Abstract
Gastric cancer is a rare outcome of chronic Helicobacter pylori infection. Serologic profiles may reveal bacterial, environmental and/or host factors associated with cancer risk. We therefore compared specific anti-H. pylori antibodies among populations with at least twofold differences in gastric cancer mortality from Mexico, Colombia and Chile. Our study included 1,776 adults (mean age 42 years) from three nationally representative surveys, equally divided between residents of high- and low-risk areas. Antibodies to 15 immunogenic H. pylori antigens were measured by fluorescent bead-based multiplex assays; results were summarized to identify overall H. pylori seropositivity. We used logistic regression to model associations between antibody seroreactivity and regional cancer risk (high vs. low), adjusting for country, age and sex. Both risk areas had similar H. pylori seroprevalence. Residents in high- and low-risk areas were seroreactive to a similar number of antigens (means 8.2 vs. 7.9, respectively; adjusted odds ratio, OR: 1.02, p = 0.05). Seroreactivities to Catalase and the known virulence proteins CagA and VacA were each significantly (p < 0.05) associated with residence in high-risk areas, but ORs were moderate (1.26, 1.42 and 1.41, respectively) and their discriminatory power was low (area under the curve < 0.6). The association of Catalase was independent from effects of either CagA or VacA. Sensitivity analyses for antibody associations restricted to H. pylori-seropositive individuals generally replicated significant associations. Our findings suggest that humoral responses to H. pylori are insufficient to distinguish high and low gastric cancer risk in Latin America. Factors determining population variation of gastric cancer burden remain to be identified.
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Affiliation(s)
- M. Constanza Camargo
- Division of Cancer Epidemiology and Genetics, National Cancer
Institute, Rockville, Maryland, USA
| | - Mauricio Beltran
- Dirección de Redes en Salud Pública, Instituto
Nacional de Salud, Bogotá, Colombia
| | - Carlos Conde-Glez
- Centro de Investigación en Salud Poblacional, Instituto
Nacional de Salud Pública, Cuernavaca, Morelos, México
| | - Paul R. Harris
- Departamento de Gastroenterología y Nutrición
Pediátrica, Pontificia Universidad Católica de Chile, Santiago,
Chile
| | - Angelika Michel
- Division of Genome Modifications and Carcinogenesis, Infection and
Cancer Program, German Cancer Research Center (DFKZ), Heidelberg, Germany
| | - Tim Waterboer
- Division of Genome Modifications and Carcinogenesis, Infection and
Cancer Program, German Cancer Research Center (DFKZ), Heidelberg, Germany
| | - Astrid Carolina Flórez
- Laboratorio de Parasitología, Dirección de Redes en
Salud Pública, Laboratorio Nacional de Referencia, Instituto Nacional de
Salud, Bogotá, Colombia
| | - Javier Torres
- Unidad de Investigación en Enfermedades Infecciosas, UMAE
Pediatría, CMN SXXI, Instituto Mexicano del Seguro Social, México
City, México
| | - Catterina Ferreccio
- Crónicas Advanced Center for Chronic Diseases, Departamento
de Salud Pública, Pontificia Universidad Católica de Chile,
Santiago, Chile
| | - Joshua N. Sampson
- Division of Cancer Epidemiology and Genetics, National Cancer
Institute, Rockville, Maryland, USA
| | - Michael Pawlita
- Division of Genome Modifications and Carcinogenesis, Infection and
Cancer Program, German Cancer Research Center (DFKZ), Heidelberg, Germany
| | - Charles S. Rabkin
- Division of Cancer Epidemiology and Genetics, National Cancer
Institute, Rockville, Maryland, USA
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Llano M, Pavía P, Flórez AC, Cuéllar A, González JM, Puerta C. [Preliminary evaluation of the commercial kit Chagas ( Trypanosoma cruzi ) IgG-ELISA ® in Colombian individuals]. Biomedica 2015; 34:228-36. [PMID: 24967928 DOI: 10.1590/s0120-41572014000200009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Received: 03/01/2013] [Accepted: 02/05/2014] [Indexed: 11/21/2022]
Abstract
INTRODUCTION The diagnosis of Chagas' disease is essential to provide early treatment and improve patients' prognosis . The discriminatory efficiency of the serological tests varies according to the disease prevalence and the test- antigen used . OBJECTIVE To evaluate the discriminatory efficiency of the commercial kit Chagas ( Trypanosoma cruzi ) IgG-ELISA ® (Nova Tec Immunodiagnostica GmbBH) in a group of Colombian individuals, using indirect immunofluorescence antibody testing (IFAT) and enzyme immunoassay (ELISA) tests as references. MATERIALS AND METHODS Seventy-eight samples from chronic chagasic patients (36 asymptomatic and 42 symptomatic) and 21 healthy controls were included. Seventeen samples from non-infected people with Chagas' disease epidemiological risk, seven with leishmaniasis and nine with non-chagasic cardiomyopathy were also analyzed. Real time PCR was performed on four individuals whose results differed among tests. RESULTS Significant differences at 450 nm optical absorbance were found (p<0.0001) when the median absorbance values of healthy controls (0.143), asymptomatic (2.401) and symptomatic (2.776) chagasic patients were compared, as well as when asymptomatic and symptomatic patients (p=0.0408) and seronegative people with epidemiological risk (0.232), cardiomyopathy (0.367) or leishmaniasis (0.337) were compared with chagasic patients (p<0.0001). Finally, there were differences among healthy controls and non-infected people with epidemiological risk (p=0.0264), patients with non-chagasic cardiomyopathy (p=0.0015) and patients with leishmaniasis (p=0.002). Real-time PCR was positive in three out of four analyzed cases. CONCLUSIONS The commercial ELISA test allowed us to discriminate the chagasic patients from the controls. A phase II study of diagnostic tests for determining field reliability of this test is required.
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Affiliation(s)
- Mónica Llano
- Laboratorio de Parasitología Molecular, Departamento de Microbiología, Facultad de Ciencias, Pontificia Universidad Javeriana
| | - Paula Pavía
- Laboratorio de Parasitología Molecular, Departamento de Microbiología, Facultad de Ciencias, Pontificia Universidad Javeriana
| | | | - Adriana Cuéllar
- Grupo de Inmunobiología y Biología Celular, Facultad de Ciencias, Pontificia Universidad Javeriana
| | - John M González
- Grupo de Ciencias Básicas Médicas, Facultad de Medicina, Universidad de los Andes
| | - Concepción Puerta
- Laboratorio de Parasitología Molecular, Departamento de Microbiología, Facultad de Ciencias, Pontificia Universidad Javeriana
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Castellanos YZ, Cucunubá ZM, Flórez AC, Orozco-Vargas LC. [Reproducibility of serological tests for the diagnosis of Trypanosoma cruzi infection in pregnant women in an endemic area of Santander, Colombia]. Biomedica 2015; 34:198-206. [PMID: 24967925 DOI: 10.1590/s0120-41572014000200006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Received: 08/14/2013] [Accepted: 01/20/2014] [Indexed: 11/22/2022]
Abstract
INTRODUCTION The diagnosis of chronic Trypanosoma cruzi infection is supported by serological tests whose reproducibility has not been well documented. OBJECTIVE To evaluate the reproducibility of the serological tests ELISA, IFAT and IHAT for the diagnosis of T. cruzi infection in pregnant women in an endemic zone in Santander. MATERIALS AND METHODS Through an evaluation study of diagnostic technologies, the reproducibility of the serological tests ELISA, IFAT and IHAT was determined in serum and eluted blood from pregnant women living in an endemic area for Chagas' disease in Santander. The samples were selected by cross sectional sampling. The software Stata version 10.0 was used for statistical analysis. By means of the comparison of the highest kappa coefficient of each technique, the test with the best reproducibility was determined. RESULTS A total of 777 samples were tested. In serum, ELISA (cutoff point: 0.3), IFAT (cutoff point: 1/32) and IHAT (cutoff point: 1/16) had kappa coefficients greater than 0.8 (0.98, 95% CI: 0.93-1.00; 0.98, 95% CI: 0.92-1.00 and 0.88, 95% CI: 0.74-0.97, respectively); no statistically significant differences among the three tests were found (p> 0.05). For the blood eluates, kappa coefficients were below 0.8 (highest kappa: 0.55, 95% CI: 0.41-0.68). CONCLUSIONS For the three serological tests using serum, the reproducibility determined by the kappa coefficient was perfect. Selecting any of them is useful for the diagnosis of T. cruzi infection. Given its simplicity and cost, the ELISA test is recommended for screening for this infection.
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Cucunubá ZM, Valencia-Hernández CA, Puerta CJ, Sosa-Estani S, Torrico F, Cortés JA, Ramirez JD, Vera MJ, Acosta BX, Álvarez CA, Muller EÁ, Beltrán M, Bermúdez MI, Berrío M, Camacho Moreno G, Castellanos YZ, Criollo I, Flórez AC, Guerra Morales P, Herazo RA, Hernández DC, León CM, Medina Camargo M, Medina Alfonso M, Pachón E, Paez Fonseca B, Parra ML, Pavia PX, Quiróz FR, Ríos LC, Roa NL, Torres F, Uribe Rivero LM. Primer consenso colombiano sobre Chagas congénito y orientación clínica a mujeres en edad fértil con diagnóstico de Chagas. Infectio 2014. [DOI: 10.1016/j.infect.2013.12.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
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Ramírez JD, Hernández C, Montilla M, Zambrano P, Flórez AC, Parra E, Cucunubá ZM. First report of human Trypanosoma cruzi infection attributed to TcBat genotype. Zoonoses Public Health 2013; 61:477-9. [PMID: 25285940 DOI: 10.1111/zph.12094] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2013] [Indexed: 11/30/2022]
Abstract
Chagas disease is an endemic disease of the American continent caused by Trypanosoma cruzi and divided into six discrete typing units (TcI - TcVI). Nearly 10 million people harbour the infection representing a serious issue in public health. Epidemiological surveillance allowed us to detect a bat-related T. cruzi genotype (henceforth named TcBat) in a 5-year-old female living in a forest area in northwestern Colombia. Molecular tools determined a mixed infection of T. cruzi I and TcBat genotypes. This represents the first report of TcBat infection in humans; the epidemiological consequences of this finding are discussed herein.
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Affiliation(s)
- J D Ramírez
- Red Chagas Colombia, Instituto Nacional de Salud, Bogotá, Colombia
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Ramírez JD, Sánchez LV, Bautista DC, Corredor AF, Flórez AC, Stensvold CR. Blastocystis subtypes detected in humans and animals from Colombia. Infect Genet Evol 2013; 22:223-8. [PMID: 23886615 DOI: 10.1016/j.meegid.2013.07.020] [Citation(s) in RCA: 166] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2013] [Revised: 05/10/2013] [Accepted: 07/16/2013] [Indexed: 11/28/2022]
Abstract
Blastocystis is a common enteric protist colonizing probably more than 1 billion people along with a large variety of non-human hosts. This protist has been linked to symptoms and diseases such as abdominal pain, constipation, diarrhea, flatulence and irritable bowel syndrome (IBS). Remarkable genetic diversity has been observed, leading to the subdivision of the genus into multiple subtypes (ST), some of which are exclusively found in non-human hosts. The aim of this study was to determine the distribution of Blastocystis STs in different Colombian hosts. We obtained fecal samples positive for Blastocystis by microscopy from 277 humans, 52 birds, and 117 mammals (25 cattle, 40 opossums, 40 dogs, 10 rats and 2 howler monkeys). The samples were submitted to DNA extraction, PCR and sequencing using primers targeting the small subunit rRNA gene, and ST identification was performed according to DNA barcoding. We observed the occurrence of ST1 (34%) and ST2 (23%) and lower proportions of STs 3 (11.4%), 4 (0.8%), 6 (19.8%) and 8 (10.5%). Domesticated mammals shared the same STs as those usually seen in humans (ST1, ST2, ST3), while birds and marsupials had STs, which are usually rare in humans (ST6, ST8). Further studies implementing high-resolution molecular markers are necessary to understand the phylodynamics of Blastocystis transmission and the role of this stramenopile in health and disease in Colombian populations, and to expand on the phylogeographic differences observed so far with a view to exploring and understanding host-parasite co-evolution.
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Affiliation(s)
- Juan David Ramírez
- Facultad de Medicina, Universidad Militar Nueva Granada, Bogotá, Colombia; Red Chagas Colombia, Instituto Nacional de Salud, Bogotá, Colombia.
| | | | | | | | | | - Christen Rune Stensvold
- Grupo de Parasitología, Instituto Nacional de Salud (INS), Bogotá, Colombia; Department of Microbiology and Infection Control, Statens Serum Institut, Copenhagen, Denmark
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Nicholls RS, Cucunubá ZM, Knudson A, Flórez AC, Montilla M, Puerta CJ, Pavía PX. [Acute Chagas disease in Colombia: a rarely suspected disease. Report of 10 cases presented during the 2002-2005 period]. Biomedica 2007; 27 Suppl 1:8-17. [PMID: 18154241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
INTRODUCTION In Colombia, reported cases of acute Chagas disease are sporadic. OBJECTIVE Ten cases were described that had been reported to the Parasitology Laboratory of the Colombian National Health Institute between December 2002 and November 2005. MATERIALS AND METHODS Information from clinical records, epidemiological report forms, laboratory and blood tests was collated. In addition the following data were compiled: demographic variables, clinical findings, results of laboratory tests and other exams (such as peripheral blood smears), IFAT for IgG antibodies, isolation in culture medium, inoculation in mice, polymerase chain reaction tests and isoenzyme eletrophoresis. RESULTS All the cases presented in known endemic areas for Chagas disease transmission in Colombia. Three cases were from Putumayo Province, two each from the provinces of Arauca, Casanare, Norte de Santander and one from Santander Province. The probable mode of transmission was vector-borne. Seven cases presented in adults aged 18 to 50, three in children aged 6 months to 2 years. Seven were male and three were female. The most frequent symptom was fever in nine cases. Signs of portal of entry were rare; only one patient presented a possible Romahia's sign. Three patients presented myocarditis, two acute cardiac failure and one cardiac tamponade. Parasitemia was evident in nine cases; five had positive IgG serological tests; five cases were confirmed through parasite isolation; isoenzyme electrophoresis showed Trypanosoma cruzi group I. CONCLUSIONS Clinical variability prevailed. In none of the cases was a clinical diagnosis suspected. The diagnosis was made and confirmed through laboratory tests alone. The results highlight the importance of including this disease in the differential diagnosis of febrile syndrome in endemic regions due to its good response to etiological treatment and thereby preventing its progression to the chronic phase.
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Flórez AC, García DA, Moncada L, Beltrán M. [Prevalence of microsporidia and other intestinal parasites in patients with HIV infection, Bogota, 2001]. Biomedica 2003; 23:274-82. [PMID: 14582330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Abstract
Opportunistic intestinal parasites are a common cause of diarrhea in HIV-infected patients. To determine the prevalence of microsporidia and other opportunistic parasites infecting HIV patients in Bogotá, Colombia, 115 patients were examined for these infections during the year 2001. The institution and the sample percent from each are as follows: Santa Clara Hospital, 33.0%; San Pedro Claver, 20.0%; Simón Bolívar Hospital, 14.8%; San José Hospital, 13.9%; Central de la Policía Hospital, 6.1%; Compensar, 5.2%; Colombian League against AIDS, 2.6%; San Ignacio Hospital, 2.6%, and the Military Hospital, 1.7%. The average patient age was 36 years, with a range from 18 to 71 years. Patients with complaint of gastrointestinal symptoms were asked to provide two consecutive stool samples. The samples were concentrated in formalin-ether and examined microscopically for intestinal coccidian parasites by direct wet slide mounts. The prevalence of intestinal opportunistic parasites was 10.4% for Cryptosporidium sp. Initially, 29% of the samples were found to be positive for microsporidian spores using a modified Ziehl Neelsen chromotrope stain, but only 3.5% of them were confirmed as positive when a calcofluor/Gram chromotrope stain was used. The general prevalence of intestinal parasites was 59.1%. The most frequently found pathogens were Blastocystis hominis, 25.2%, and Entamoeba histolytica, 13%. In other studies with HIV patients in Colombia, lower prevalences of Cryptosporidium sp. infection were observed.
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Affiliation(s)
- Astrid Carolina Flórez
- Universidad Colegio Mayor de Cundinamarca, Laboratorio de Parasitología, Instituto Nacional de Salud, Bogotá, D.C., Colombia.
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