Comparison of 4 laboratory tests for the detection of bovine rabies viral infection in Paraguay: fluorescent antibody test, rapid detection test, histologic lesions, and RT-PCR

Rabies virus (RABV; Lyssavirus rabies) is a neurotropic virus that can be transmitted to mammals by the hematophagous bat Desmodus rotundus. An accurate, accessible method for the detection of RABV in cattle is necessary in Paraguay; thus, we evaluated the detection of RABV using 4 techniques: fluorescent antibody test (FAT), immunochromatography rapid detection test (RDT; Anigen Rapid Rabies Ag test kit; Bionote), a reverse-transcription PCR (RT-PCR) assay, and histologic lesions in different portions of the CNS of 49 Paraguayan cattle to determine the most sensitive and specific technique. By FAT and RDT, 15 of 49 (31%) samples were positive. By RT-PCR amplification of N and G genes, 13 of 49 (27%) and 12 of 49 (25%) were positive, respectively. RDT had high agreement with FAT (kappa = 1); sensitivity was 100% (95% CI: 97-100%) and specificity was 100% (95% CI: 99-100%). The amplification of the N and G genes resulted in substantial agreement (kappa of 0.9 and 0.8, respectively) compared with FAT, and the sensitivity and specificity of the N gene were 87% (95% CI: 66-100%) and 100% (95% CI: 98-100%), respectively, and those of the G gene were 80% (95% CI: 56-100%) and 100% (95% CI: 98-100%), respectively. Histologic lesions observed were lymphoplasmacytic meningoencephalitis, gliosis, and neuronophagia. The agreement observed between the FAT and RDT tests suggests that RDT is an accurate tool for the detection of RABV. Histopathology can be used to confirm lesions caused by RABV and to rule out other conditions; the RT-PCR assay is useful for molecular epidemiology studies.

Clinical evolution and mortality of critically ill patients with SARS-CoV-2 pneumonia treated with remdesivir in an adult intensive care unit of Paraguay

BACKGROUND

The health crisis due to Covid-19 led to the search for therapeutics that could improve the evolution of the disease. Remdesivir, an antiviral that interferes with viral replication, was one of the first to be used for the treatment of this pathology.

OBJECTIVE

To determine clinical course and mortality of patients with severe SARS-CoV-2 pneumonia treated with remdesivir, in comparison of those who didn't receive the medication.

PATIENTS AND METHODS

Retrospective cohort study, with medical records review of COVID-19 patients, between August 2020 and August 2021. The subjects were divided into two groups, those who received remdesivir before or after admission to intensive care and those who didn't. The primary outcome variable was mortality in intensive care.

RESULTS

Of 214 subjects included, 109 (50,9%) received remdesivir. The median of days for the drug administration was 8 (2-20), IQR: 3. The bivariate analysis prove that the use of remdesivir was related with lower risk of develop Acute Respiratory Distress Syndrome (ARDS) (p = 0,019; OR: 0,521) and lower requirement of mechanical ventilation (p = 0,006; OR:0,450). Additionally, patients treated with remdesivir develop less kidney injury (p = 0,009; OR: 0,441). There was a total of 82 deaths, 29 (26,6%) in the remdesivir group and 53 (50,5%) in the control group [p < 0,001; OR: 0,356 (0,201-0,630)]. All the risk factors associated with mortality in the bivariate analysis were entered into the multivariate analysis by logistic regression, the use of remdesivir remained associated as an independent protective factor to mortality (p = 0.034; OR: 0.429).

CONCLUSION

Critically ill patients with SARS-CoV-2 pneumonia treated with remdesivir had a lower risk of death and need for mechanical ventilation and develop less ARDS as compared to the control group. No differences were found in the presentation of adverse effects.

Serotypes and antimicrobial resistance of Streptococcus pneumoniae in children under 5 years of age pre- and post-pneumococcal conjugate vaccine introduction in Paraguay

Introduction. Streptococcus pneumoniae remains a major cause of mortality and morbidity worldwide in children <5 years of age, even with advances in vaccination programmes.Hypothesis/Gap Statement. Reviewing and reporting trends in the distribution of pneumococcal serotypes and antimicrobial resistance in Paraguay will be useful for decision-making in public health.Aim. This study analysed the serotype distribution and antimicrobial resistance of S. pneumoniae and the characteristics of pneumococcal disease in children <5 years old before and after the introduction of pneumococcal conjugate vaccines (PCVs).Methodology. A total of 885 isolates and 278 S. pneumoniae PCR-positive clinical specimens were referred to the Central Laboratory of Public Health (LCSP) within the meningitis and pneumonia laboratory based-surveillance network in the period 2006-2020. Conventional and molecular microbiological techniques were used for confirmation and characterization.Results. We identified 563 cases of pneumococcal disease in the pre-vaccination period, 325 cases in the post-PCV10 period and 275 cases in the post-PCV13 period. The serotypes covered by PCV10 decreased from 78.6-6.5 %. However, additional serotypes covered by PCV13 increased from 6.6-57.5% and non-PCV13 serotypes increased from 14.8-36.0 % (P<0.001) in the post-PCV13 period. In cases of meningitis, the rate of resistance to penicillin decreased after the introduction of conjugate vaccines. No resistance to ceftriaxone was found in any period. In cases without meningitis, the rate of resistance to penicillin and ceftriaxone decreased slightly. However, the rate of resistance to erythromycin and tetracycline increased and that to trimethoprim-sulfamethoxazole (SXT) decreased in the post-PCV13 period compared to the pre-PCV period. The multidrug resistance rate was 8.5 %.Conclusion. A change in the circulating serotypes and antimicrobial resistance to certain antibiotics was observed. Non-vaccine serotype circulation and multidrug resistance may compromise the success of the conjugate vaccines.

Analysis of antibiotic resistance and genetic profile of conjunctival bacteria flora before and after cataract surgery

PURPOSE

To analyze antibiotic resistance and genetic profile of conjunctival bacteria flora before and after cataract surgery with the focus on coagulase-negative staphylococci (CNS) during cataract surgery and discuss the implications of this colonization as a potential risk of acquiring endophthalmitis.

METHODS

After approval of the institutional review board and informed consent from patients had been obtained, conjunctival swabs for culture from 59 patients undergoing cataract surgery were taken of the fellow eye at baseline (C0) and from the eye to be operated before (T0) and after (T1) irrigation with povine-iodine 5%, and at the end of surgery (T2). Genes responsible for virulence (mecA, ica and atlE) and antibiotic profile were determined; strain clonality of persistent colonizing Staphylococcus epidermidis strains was established by the Multi-locus sequence typing (MLST).

RESULTS

The frequency of CNS was significantly reduced in T1 (13.6%) from 81.4% in T0 and 86.4% in C0. The frequency of mecA, ica and atlE genes was 34.4%, 37.5% and 61.4%, respectively; and methicillin phenotypic resistance was 35.4%. S. epidermidis was the most frequent species isolated in every time point. MLST revealed in 7 patients 100% coincidence of the seven alleles of the S. epidermidis isolated previous to povine-iodine 5% disinfection and at the end of the surgery. CNS isolates from T1 or T2 corresponded to the same species, antibiotic and virulence profile as those isolates from C0 or T0.

CONCLUSION

Povidone-iodine 5% prophylaxis before surgery significantly reduced conjunctival contamination; in those that persisted, the source of contamination was mostly the patient's microbiota confirmed by the MLST system.

Glomerulonefritis aguda posinfecciosa como riesgo para desarrollar insuficiencia renal crónica en una cohorte pediátrica de un hospital de referencia en Paraguay

Contexto: la glomerulonefritis aguda posinfecciosa (GNPI) representa un riesgo para el desarrollo de insuficiencia renal a largo plazo. Objetivo: describir la incidencia de proteinuria persistente y factores asociados en pacientes con antecedente de GNPI en una cohorte pediátrica de un hospital de referencia en Paraguay. Metodología: se incluyó a 121 pacientes con síndrome nefrítico con C3 disminuido, con normalización a los tres meses, aunque no se haya comprobado etiología estreptocócica. Se excluyó a los pacientes con enfermedad renal previa, con síndrome nefrítico secundario y con menos de seis meses de seguimiento. Se analizaron las características sociodemográficas, infecciones precedentes, aclaramiento de creatinina, días de hipertensión arterial y de internación, además de la relación de estas con la persistencia de proteinuria a los seis meses y más de seguimiento. Resultados: de los 121 pacientes entre 2 a 16 años de edad incluidos, 75 pacientes tuvieron un seguimiento médico entre 6 y 48 meses, de los cuales 43 (57,3?%) desarrollaron proteinuria persistente, la cual se asoció con un menor aclaramiento de creatinina (p = 0,03; 67,74 ± 25,69 mL/min/1,73 m2 SC vs. 80,22 ± 2,98 mL/min/1,73 m2 SC), con el número promedio de convivientes (6,3 ± 2,8 vs. 5,3 ± 2,3; p = 0,027) y el número promedio de hijos (4,3 ± 2,7 vs. 3,6 ± 2,3; p = 0,048). No se encontró asociación con las otras características. Conclusiones: la incidencia de proteinuria se asoció con un menor aclaramiento de creatinina y con una mayor frecuencia de los determinantes sociales en salud.  

Asociación del umbral de ciclos (Ct) en prueba RT-PCR para SARS-CoV-2 y severidad de la COVID-19 en pacientes de un hospital de referencia en Paraguay

Algunos estudios han encontrado que la severidad de la COVID-19 se asocia con una alta carga viral determinada por los números de ciclos (Ct) de amplificación de ADN de SARS-CoV-2. El objetivo fue determinar la relación entre el umbral de ciclos de PCR de SARS-CoV-2 y la severidad de la infección por el virus SARS-COV-2 en pacientes internados y ambulatorios en un hospital de referencia entre marzo a junio del 2021. Estudio retrospectivo observacional analítico de corte trasverso de pacientes adultos con COVID-19, ambulatorios e internados en el Hospital Nacional. Se incluyeron los pacientes cuya infección fue confirmada por RT-PCR para SARS-CoV-2, se consideró un punto de corte para Ct<25. Se estudiaron 517 pacientes entre 16 a 98 años de edad (media ± DE: 51,5±17,5), 268 varones (51,8%), edad >60 años (36,6%), estuvieron hospitalizados (69,8%), internados en sala (57,1%), y admitidos en cuidados intensivos (12,8%), tiempo medio de enfermedad 8,48 ± 4,2 días. La mortalidad fue de 22,2%. Se encontró mayor riesgo de fallecer para los pacientes con Ct <25 tanto para el gen E (OR: 1.61; IC95%: 1,06-2,44) como para el N2 (OR: 1.83; IC95%: 1,19-2,80) y con edad >60 años (OR: 3,69; IC95%: 2,39-5,68). Estos dos factores permanecieron asociados con el óbito en el análisis multivariado. Hubo mayor riesgo de hospitalizarse y fallecer en los pacientes con Ct<25. El valor Ct podría ser útil para la predicción del curso clínico y el pronóstico de los pacientes con COVID-19.

Especies y sensibilidad a antifúngicos de cepas de Candida spp. aisladas de la cavidad bucal de pacientes con VIH de Paraguay

Candida albicans es la levadura más aislada de la cavidad oral de personas con VIH. Sin embargo, el uso de antifúngicos ha incrementado el aislamiento de especies no C. albicans resistentes o con sensibilidad reducida. El objetivo del estudio fue determinar las especies de Candida y la sensibilidad a los antifúngicos de aislamientos de la cavidad bucal de pacientes con VIH, que acudieron al Instituto de Medicina Tropical entre julio a diciembre de 2019. Las levaduras se sembraron en Agar Cromogénico Candida (CONDA®, España) para la identificación presuntiva. Las colonias verdes se identificaron por PCR dúplex y las de coloración distinta o PCR negativa mediante el sistema comercial VITEK®2. La susceptibilidad antifúngica de C. albicans se determinó por VITEK®2, y las no albicans por el método de difusión de discos. De 278 levaduras, C. albicans se aisló en 70,9 %, seguido de C. tropicalis (8,3 %) y C. krusei (5 %). C. albicans presentó 93 % de sensibilidad y 2 % de sensibilidad dosis dependiente al fluconazol; 87 % sensibles y 3 % con sensibilidad intermedia frente a voriconazol; 97, 98 y 100 % sensibilidad a flucitosina, anfotericina B y equinocandinas, respectivamente. C. parapsilosis y C. tropicalis no registraron resistencias a fluconazol y voriconazol. Todos los aislamientos de C. glabrata fueron sensibles dosis dependientes a fluconazol y todos los aislamientos de C. krusei resultaron sensibles a voriconazol. La portación oral de Candida spp. resistentes a azoles podría llevar a fracasos terapéuticos en pacientes con VIH que desarrollen candidiasis orofaríngea.

[Delay in diagnosis as a prognostic factor for disability in patients with leprosy in Paraguay. Case and control study]

BACKGROUND

Leprosy, a chronic infectious disease, is one of the major causes of preventable disability. Early treatment prevents neurological damage and disability.

AIM

To identify prognostic factors of disability in individuals with multibacillary and paucibacillary leprosy who completed a drug treatment between 2011 and 2017 in Paraguay.

METHODS

A case-control study was carried out on 34 patients, of them 9 were cases and 25 controls. Cases were those patients with Grade 1, presented lack of sensation in lower or upper limbs, and those of Grade 2 lagophthalmos, rigidity, visible deformity ulcerations, passive claw, active claw. Controls had no disabilities.

RESULTS

Mean age of the patients was 53 ± 15.2 years, 55.9% were male, and 58.9% had primary education or no formal education. Multibacillary leprosy was found in 58.8% of patients; and 64.7% were diagnosed after consulting with two or more physicians. Diagnosis delay of more than one year was significantly (p = 0.047) greater in the cases than in the controls (77.8% vs 12%; OR: 7.44; 95% CI: 1.02-67.86).

CONCLUSION

In this study, a diagnosis delay of more than one year is a prognostic factor for disability.

Características clínico-demográficas de pacientes con ceguera irreversible en el Servicio de Oftalmología General de la Clínica Belén, Coronel Oviedo, Paraguay desde febrero del 2018 a febrero del 2019

Según la Organización Mundial de la Salud, la ceguera está definida como la agudeza visual inferior a 3/60 (20/400) en el mejor ojo y un campo visual menor a 10° desde el punto central de fijación. El objetivo de este trabajo fue describir las características clínico demográficas de pacientes con diagnóstico de ceguera irreversible atendidos en el Servicio de Oftalmología General de la Clínica Belén - Coronel Oviedo (Paraguay). Estudio observacional, descriptivo y retrospectivo de corte transversal. Se realizó la revisión retrospectiva de las historias clínicas de los pacientes con diagnóstico de ceguera irreversible atendidos en el Servicio de Oftalmología General de la Clínica Belén, entre el 1 de febrero 2018 y el 28 de febrero 2019. Se analizaron la edad, sexo, escolaridad, procedencia, agudeza visual, comorbilidades y etiología de la deficiencia visual. El análisis estadístico fue mediante el cálculo de frecuencias absolutas y relativas para las variables cualitativas, y el promedio y desviación estándar para las cuantitativas. Se estudiaron 78 pacientes, con predominio del sexo masculino (56,4%), edad de 71 a 95 años (43,6%) y primaria incompleta (41%). La hipertensión arterial (55,6%) fue la principal comorbilidad y glaucoma (43,6%) la etiología de ceguera más frecuente. El glaucoma fue más frecuente en varones que en mujeres (59% vs 32%) y en pacientes mayores de 50 años de edad (50%). En esta serie, los pacientes presentaron ceguera irreversible bilateral, en mayor frecuencia en varones, mayores de 50 años de edad, hipertensión como comorbilidad y glaucoma como etiología más frecuente.

Conocimientos, actitudes, prácticas y percepción de riesgo de los trabajadores de hatos lecheros de la Colonia 07 Montes frente a las zoonosis específicas

Los trabajadores de hatos lecheros están en constante riesgo de contraer enfermedades zoonóticas como la brucelosis, tuberculosis, leptospirosis y carbunco bacteridiano, por la exposición a agentes biológicos y el contacto directo con animales durante el desarrollo de sus labores. Se describe el nivel de conocimientos, actitudes, prácticas, percepción de riesgo y las características sociodemográficas de los trabajadores de hatos lecheros de la colonia 07 Montes del distrito de Curuguaty, frente a las zoonosis, en el último trimestre del 2019. Fue un estudio cuantitativo, observacional, descriptivo, de corte transversal en el cual se utilizó un cuestionario con 33 preguntas aplicado a 121 trabajadores, con el que se recogieron variables demográficas, conocimientos, actitudes, prácticas y percepción de riesgo. Los datos se analizaron a través del programa estadístico SPSS. Para el análisis univariado, se empleó la estadística descriptiva para representar los datos expresados en frecuencias, porcentajes y tablas. El 52,9 % de los trabajadores tenía conocimiento sobre la brucelosis, tuberculosis y leptospirosis, el 74,4 % tenía actitudes positivas, el 66,9% implementaba prácticas positivas y el 52,9% percibía el riesgo. Menos del 75% de los trabajadores encuestados tenían conocimientos, actitudes, prácticas y percepciones de riesgo óptimos, lo que resulta preocupante considerando la exposición constante de los mismos a las enfermedades zoonóticas, es por ello que se deberían implementar estrategias educativas de carácter multisectorial concernientes a estas patologías y sus medidas preventivas a modo de mejorar esta situación.

Características clínicas, demográficas y acceso a los productos sin gluten de pacientes con enfermedad celíaca registrados en la FUPACEL

La enfermedad celíaca (EC) es una enfermedad inflamatoria autoinmune que afecta la mucosa del intestino delgado que lleva a un estado de mal absorción en pacientes genéticamente susceptibles desencadenada por la ingesta de gluten. Tiene síntomas inespecíficos, complicaciones asociadas y no existe a nivel nacional una ley de apoyo económico para las personas con dificultad para seguir una dieta libre de gluten. El objetivo de este estudio observacional, descriptivo, de corte transversal fue describir las características clínicas, demográficas y acceso a productos sin gluten de 237 pacientes con enfermedad celíaca registrados en la Fundación Paraguaya de Celiacos (FUPACEL) en el 2020 y que aceptaron responder una encuesta en línea publicada en la página oficial de la FUPACEL. El 70,4% de los participantes era del sexo femenino, la edad de diagnóstico fue en el 34,5% entre 20-30 años, 48 % tenía algún familiar con EC, el 69,1% presentó distensión abdominal como sintomatología inicial, 16,8% presentó hipotiroidismo como patología asociada, y 42% fue hospitalizado al menos una vez. El 82,7% de los encuestados respondió que la dieta era suficiente como tratamiento, 48% tenía un trabajo y podía solventar los gastos, sin embargo, el 79,3% opinó tener acceso limitado a los productos sin gluten, el 92% que los alimentos sin gluten eran costosos y que se necesitaba una ley de apoyo económico para solventar los gastos. La mayoría reconoció que la dieta sin gluten como tratamiento era suficiente, sin embargo, por su alto costo se necesita una ley de apoyo económico para las personas con enfermedad celiaca.

Perfil epidemiológico de niños 2 - 5 años con quemaduras atendidos en el Centro Nacional del Quemado y Cirugías Reconstructivas Dr. Arnaldo Bendlin en el periodo 2019-2020

Las quemaduras son lesiones producidas en un tejido vivo por la acción de diversos agentes físicos: térmicos, eléctricos, radiantes, químicos, cáusticos, agentes biológicos, entre otros. El objetivo del estudio fue describir el perfil epidemiológico de niños entre 2 - 5 años de ambos sexos que ingresaron al Centro Nacional del Quemado y Cirugías Reconstructivas Dr. Arnaldo Bendlin de la ciudad de Asunción-Paraguay en el periodo 2019-2020. Estudio observacional, descriptivo en el que se realizó una revisión retrospectiva de las historias clínicas de los niños de entre 2 a 5 años que sufrieron quemaduras y consultaron en el Centro Nacional del Quemado y Cirugías Reconstructivas Dr. Arnaldo Bendlin entre el 2019 y 2020. Se estudiaron 338 pacientes, de los cuales 299 (54,4%) eran del sexo masculino, 131 (38,8%) de 2 años de edad y 215 (63,6%) del departamento Central. En 255 (75,4%) pacientes, la fuente de la quemadura fue líquido caliente, en 118 (34,9%) la lesión fue en miembros inferiores, y en 276 (81,7%) la quemadura fue de segundo grado. En 323 (95,6%) la quemadura ocurrió en su propio hogar, 337 (99,7%) recibieron tratamiento médico y 8 (2,4%) recibieron balneoterapia. La mayoría de las quemaduras fueron de segundo grado y causadas por líquidos calientes. La localización más frecuente fue en los miembros inferiores. Es urgente implementar programas educacionales en las escuelas, centros comunitarios y medios de comunicación ya que gran parte de los accidentes ocurrieron en el ambiente doméstico pudiendo ser evitados.

[Malassezia species causative of pityriasis versicolor in Paraguay]

BACKGROUND

Pityriasis versicolor is a frequent pathology in Paraguay; however, its epidemiology is unknown.

AIM

To determine the frequency of Malassezia species causing pityriasis versicolor and the epidemiological characteristics of the population.

METHODS

Samples from patients with a presumptive diagnosis of pityriasis versicolor were collected. Laboratory diagnosis was carried out by fresh examination and culture in modified Dixon agar and chromogenic Chromagar Malassezia®, incubated at 32° C, and identification by macro and micromorphological features, biochemical and physiological tests.

RESULTS

102 patients were included (51% female) from 1 month to 63 years of age, the predominant age group was 11-20 years (35.3%). The most frequent location was on the back (60.8%). Hipocromic clinical forms (48%) predominated. The most frequent species was M. globosa (52.9%), followed by M. furfur (24.5%), M. sympodialis (18.6%) and M. slooffiae (6.9%).

CONCLUSIONS

The observed epidemiology is similar to other South American studies, with no sex distinction, predominantly hypochromic clinical form and as primary responsible species appears M. globosa. This is the first report on species causing pityriasis versicolor in Paraguay and the characteristics of the affected population.

[Prevalence and intensity of geohelminths infection characterizing the socio-cultural and environmental factors that affect the infection of school children, Paraguay, 2015]

INTRODUCTION

Currently, Paraguay has no data on the prevalence of soil-transmitted geohelminth infection in schoolchildren aged 6 to 12 years.

AIM

To determine the prevalence and intensity of infection by Ascaris lumbricoides, Trichuris trichiura and hookworms and the socio-cultural-environmental characteristics of the affected population.

METHODS

Descriptive, cross-sectional study, in three semi-tropical climatic zones: continental, semi steppe and humid. A total of 1,404 schoolchildren from 20 schools in eight departments were selected from the country's three climate zones. Copro-parasitological exams were analyzed in situ with the Kato-Katz method.

RESULTS

The national prevalence for geohelminthiasis was 3.73% (95% CI = 2.8-4.8). The risk factors found were consumption of well water OR: 2.88 (95% CI = 1.64-2.07), ground floor in housing OR: 2.56 (95% CI = 1.45-4.50) and lack of flushing water baths in households OR: 2.29 (95% CI = 1.23-4.28).

CONCLUSION

Although the national prevalence of geohelminthiasis was low, it is recommended to promote good hygienic practices, use of footwear, and safe water consumption, as well as designing interventions with all relevant sectors to improve access to safe water and improved basic sanitation facilities.

Mental Healthcare for refugees

The aim of this paper is to highlight some of the difficulties that mental health providers face when trying to provide the best standard of mental healthcare to refugees, especially in countries where the political environment is skeptic of, or even hostile to, creating programs specifically designed to improve the standard of living of this population. We also focus briefly on the dichotomy between the need to do research in this population in order to obtain data that will help us offer the best care possible to them, and the peril of undermining their autonomy by subjecting them to studies they might have otherwise refused to be part of, if they were in a less precarious position. Throughout the article, we offer practical advice that mental healthcare providers can follow to ensure that they are offering the best possible care to their patients while remaining respectful of their rights.  Keywords: Mental health providers; Mental healthcare; Refugees.

Effect of antibiotic prophylaxis on Coagulase-negative Staphylococcus virulence factor profiles in patients undergoing cataract surgery

PURPOSE

In this prospective study, multiplex polymerase chain reaction (PCR) was used to identify genes encoding virulence factors (ica, atlE and mecA) in Coagulase-negative Staphylococcus (CNS) isolates from the ocular microbiota of patients undergoing cataract surgery and to investigate possible changes in the CNS profile due to antibiotic prophylaxis.

METHODS

Between 09/2011 and 08/2013, patients undergoing cataract surgery were recruited at the Department of Ophthalmology, National University of Asuncion, Paraguay. In the eye to be operated on, patients received moxifloxacin 0.5 % eye drops four times at the day before surgery and a last drop 1 hour before surgery (T1). The other eye remained as control (T0). Conjunctival swabs were taken from both eyes 1 hour after the last drop. The presence of genes encoding biofilm formation (ica and atlE) and methicillin resistance (mecA) was detected by a multiplex PCR.

RESULTS

Of the 162 patients (162 study eyes, 162 fellow eye as control group), 87 (53.7 %) eyes were positive for CNS at T0 yielding 96 CNS isolates; 70 eyes (43.2 %) were positive at T1 yielding 77 CNS isolates. For this study, 43 CNS isolates (44.8 %) from T0 and 45 (64.3 %) from T1 were used. Of the total isolates, 81.8 % (72/88) had at least one virulence factor gene (37/43 from T0 and 35/45 from T1) (p = 0.314). Simultaneous detection of ica and atlE genes was higher in T0 (58.0 %) than T1 (46.7 %), but the difference was not significant (p = 0.28).

CONCLUSION

A high frequency of genes encoding virulence factors was observed in the coagulase-negative Staphylococcus isolates. The use of moxifloxacin did not significantly modify the CNS virulence factor profiles.

Methicillin resistance and biofilm production of Staphylococcus epidermidis isolates from infectious and normal flora conjunctiva

PURPOSE

Coagulase-negative staphylococci have been reported to be the most frequent cause of bacterial postoperative endophthalmitis. Biofilm formation is the major virulence factor of Staphylococcus epidermidis and is often associated with methicillin resistance. This study aims at evaluating the presence of biofilm-producing and methicillin resistance genes (mecA) in S. epidermidis.

METHODS

S. epidermidis isolated from clinically infected sites (group 1) and from normal human conjunctiva (group 2) were studied. All the isolates were tested for their ability to produce biofilm by the conventional Christensen´s method and the presence of mecA by PCR using the 22-mer oligonucleotides as primers.

RESULTS

In total 20 isolates from group 1 and 22 from group 2 were studied. Biofilm and mecA were detected in 15 (75 %) and in 14 (70 %) in group 1 as compared to 8 (36.3 %) and 4 (18.2 %) in group 2 (p = 0.016). Simultaneously, biofilm production and presence of mecA genes were observed in 13/20 (65.0 %) in group 1, and 4/22 (18.2 %) in group 2 (p = 0.002). Multi-resistance was observed in 55 % in group 1 and 9 % in group 2 (p = 0.002); 57 % of the biofilm-producing strains was multi-resistant in contrast to none of the non-producing strains. In all multi-resistant strains, biofilm production was seen.

CONCLUSIONS

Biofilm formation capacity was widely distributed, particularly among mecA (+) S. epidermidis strains, which also displayed a high diversity of antibiotic resistance profiles.

[Seroprevalence of dengue infection in a district of the Paraguayan Chaco: Population based study]

BACKGROUND

Dengue is an infection of great global importance with different clinical presentations.

OBJECTIVE

To establish the seroprevalence of infection by the dengue virus in a district of the Paraguayan Chaco.

MATERIAL AND METHODS

Cross-sectional study in 418 inhabitants of three villages in the district of Villa Hayes, Paraguay, using a probabilistic household sampling, a questionnaire and blood sampling. Antibodies were determined by the ELISA capture IgG anti dengue method and factors associated with seroprevalence were evaluated.

RESULTS

The overall seroprevalence for dengue virus infection was 24,2% (CI95%: 20,2%-28,6%); 34% (n: 142) of respondents reported history of dengue in the previous 10-year period. Of the 276 people (66%) who reported no history of dengue infection, 37 (13%) tested positive, which points out asymptomatic individuals. The main factors associated with infection were: males with significantly higher prevalence than women (31%); to be over 60 years of age (44%), be residents of Villa Hayes (31,1%). No association with educational level or monthly income of the participants, nor housing condition, drinking water source or type of bathroom were observed. The larval infestation rate was 0,51%.

CONCLUSIONS

The relatively low seroprevalence of infection by the dengue virus is consistent with the small size of the district and highlights the potential risk of infection in future epidemics.

[Seroprevalence of leptospirosis and associated factors in workers of the urban cleaning service of the Municipality of Asuncion, Paraguay]

INTRODUCTION

Leptospirosis is a serious infectious disease that has been linked to occupational activities such as farmers, sewer workers, garbage collectors, butchers and veterinarians. It is acquired through contact with major reservoirs like rodents, pets, or the environment contaminated by their urine. In Paraguay, there are no published reports on the seroprevalence of leptospirosis related to work activity.

OBJECTIVE

To determine the seroprevalence and factors associated with transmission of leptospirosis in urban sanitation workers.

METHODOLOGY

Descriptive transversal study. The study included workers from the Department of Urban Cleanliness of the City of Asuncion, who had completed at least one month on the job and who agreed to particípate in the study. Sampling was stratified and proportional to the number of workers. After informed consent was obtained, participants were surveyed and a blood sample was taken for detection of Leptospira IgG antibodies by ELISA.

RESULTS

Leptospirosis seroprevalence was 8.6% (29/339), all positive cases were male and prevalence was statistically higher in workers of the collection area than in those of other work areas.

CONCLUSION

We found a lower than expected seroprevalence. However, conditions observed at work and at home are conducive to transmission of infection. We recommend the improvement of prevention strategies and health promotion in this population.

[Clinical and epidemiological aspects of toxoplasmosis in patients with vision problems]

INTRODUCTION

Toxoplasmosis is a worldwide disease; it can cause decreased vision or even blindness. The route of transmission in humans may vary according to the habits of the region; probably the ingestion of raw or undercooked meat is the main source of infection.

OBJECTIVE

To determine the seroprevalence of toxoplasmosis in an eye clinic, the frequency of ocular toxoplasmosis (OT) and risk habits for acquiring the infection.

MATERIALS AND METHODS

Adult patients consulting in the Retina Department of the Teaching Hospital of the National University of Asuncion, Paraguay between August and September, 2014 were included. Prior informed consent, socio-demographic and epidemiological data related to T. gondii infection were obtained. In addition a blood sample for the determination of anti T. gondii IgG antibodies by the ELISA method was taken and ophthalmologic evaluation for the diagnosis of OT was made.

RESULTS

A total of 80 patients with mean ± SD age of 53 ± 20 years were studied, with slight predominance of women (55%). The seroprevalence of toxoplasmosis was 84% (67/80) and OT was detected in 8.9% of the 67 seropositive persons. The habit of not washing vegetables with sodium hypochlorite and eat meat from wild animals was related to higher risk of infection in this population.

CONCLUSION

It is important to conduct research at the population level to establish the epidemiology of toxoplasmosis in our country. Information on prophylactic measures to prevent infection by T. gondii should be given to the population.