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Marín D, Basagaña X, Amaya F, Aristizábal LM, Muñoz DA, Domínguez A, Molina F, Ramos CD, Morales-Betancourt R, Hincapié R, Rodríguez-Villamizar L, Rojas Y, Morales O, Cuellar M, Corredor A, Villamil-Osorio M, Bejarano MA, Vidal D, Narváez DM, Groot H, Builes JJ, López L, Henao EA, Lopera V, Hernández LJ, Bangdiwala SI, Marín-Ochoa B, Oviedo AI, Sánchez-García OE, Toro MV, Riaño W, Rueda ZV. Early-life external exposome in children 2-5 years old in Colombia. Environ Res 2024; 252:118913. [PMID: 38643821 DOI: 10.1016/j.envres.2024.118913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2024] [Revised: 04/07/2024] [Accepted: 04/08/2024] [Indexed: 04/23/2024]
Abstract
Exposome studies are advancing in high-income countries to understand how multiple environmental exposures impact health. However, there is a significant research gap in low- and middle-income and tropical countries. We aimed to describe the spatiotemporal variation of the external exposome, its correlation structure between and within exposure groups, and its dimensionality. A one-year follow-up cohort study of 506 children under 5 in two cities in Colombia was conducted to evaluate asthma, acute respiratory infections, and DNA damage. We examined 48 environmental exposures during pregnancy and 168 during childhood in eight exposure groups, including atmospheric pollutants, natural spaces, meteorology, built environment, traffic, indoor exposure, and socioeconomic capital. The exposome was estimated using geographic information systems, remote sensing, spatiotemporal modeling, and questionnaires. The median age of children at study entry was 3.7 years (interquartile range: 2.9-4.3). Air pollution and natural spaces exposure decreased from pregnancy to childhood, while socioeconomic capital increased. The highest median correlations within exposure groups were observed in meteorology (r = 0.85), traffic (r = 0.83), and atmospheric pollutants (r = 0.64). Important correlations between variables from different exposure groups were found, such as atmospheric pollutants and meteorology (r = 0.76), natural spaces (r = -0.34), and the built environment (r = 0.53). Twenty principal components explained 70%, and 57 explained 95% of the total variance in the childhood exposome. Our findings show that there is an important spatiotemporal variation in the exposome of children under 5. This is the first characterization of the external exposome in urban areas of Latin America and highlights its complexity, but also the need to better characterize and understand the exposome in order to optimize its analysis and applications in local interventions aimed at improving the health conditions and well-being of the child population and contributing to environmental health decision-making.
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Affiliation(s)
- Diana Marín
- School of Medicine, Universidad Pontificia Bolivariana, Medellín, 050034, Colombia.
| | - Xavier Basagaña
- ISGlobal, Barcelona, 08003, España, Spain; Universitat Pompeu Fabra (UPF), Barcelona, 08003, Spain; CIBER Epidemiology and Public Health (CIBERESP), Spain
| | - Ferney Amaya
- School of Engineering, Universidad Pontificia Bolivariana, Medellín, 050034, Colombia
| | | | - Diego Alejandro Muñoz
- Department of Mathematics, National University of Colombia, Medellín, 050034, Colombia
| | - Alan Domínguez
- ISGlobal, Barcelona, 08003, España, Spain; Universitat Pompeu Fabra (UPF), Barcelona, 08003, Spain; CIBER Epidemiology and Public Health (CIBERESP), Spain
| | - Francisco Molina
- Environmental School, School of Engineering, Universidad de Antioquia UdeA, Medellin, 050010, Colombia
| | - Carlos Daniel Ramos
- Environmental School, School of Engineering, Universidad de Antioquia UdeA, Medellin, 050010, Colombia
| | | | - Roberto Hincapié
- School of Engineering, Universidad Pontificia Bolivariana, Medellín, 050034, Colombia
| | - Laura Rodríguez-Villamizar
- Department of Public Health, School of Medicine, Universidad Industrial de Santander, Bucaramanga, 680002, Colombia
| | - Yurley Rojas
- School of Engineering, Universidad Industrial de Santander, Bucaramanga, 680002, Colombia
| | - Olga Morales
- School of Medicine, Pediaciencias Group, Universidad de Antioquia, Noel Clinic Medellin, 050010, Colombia; Department of Pediatrics, Hospital San Vicente Fundación, Medellín, 050010, Colombia
| | - Martha Cuellar
- School of Medicine, Pediaciencias Group, Universidad de Antioquia, Noel Clinic Medellin, 050010, Colombia; Department of Pediatrics, SOMER Clinic, Medellín, Colombia
| | - Andrea Corredor
- Department of Pediatrics, ONIROS Centro Especializado en Medicina Integral del Sueño, Bogotá, Colombia
| | - Milena Villamil-Osorio
- Department of Pediatrics, Fundación Hospital Pediátrico la Misericordia, Bogotá, Colombia
| | | | - Dolly Vidal
- Department of Pediatrics, Hospital Universitario San José, Popayán, 190003, Colombia
| | - Diana M Narváez
- Human Genetics Laboratory, Universidad de los Andes, Bogotá, 111711, Colombia
| | - Helena Groot
- Human Genetics Laboratory, Universidad de los Andes, Bogotá, 111711, Colombia
| | - Juan José Builes
- Department of Paternity Testing. GENES Laboratory, Medellín, 050024, Colombia
| | - Lucelly López
- School of Medicine, Universidad Pontificia Bolivariana, Medellín, 050034, Colombia
| | | | - Verónica Lopera
- Secretariat of Health, Medellin Mayor's Office, Medellin, 050015, Colombia
| | | | - Shrikant I Bangdiwala
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, L8S 4K1, Canada; Statistics Department, Population Health Research Institute, McMaster University, Hamilton, ON, L8L 2X2, Canada
| | - Beatriz Marín-Ochoa
- School of Social Sciences, Universidad Pontificia Bolivariana, Medellín, 050034, Colombia
| | - Ana Isabel Oviedo
- School of Engineering, Universidad Pontificia Bolivariana, Medellín, 050034, Colombia
| | | | - María Victoria Toro
- School of Engineering, Universidad Pontificia Bolivariana, Medellín, 050034, Colombia
| | - Will Riaño
- School of Medicine, Universidad Pontificia Bolivariana, Medellín, 050034, Colombia; School of Medicine, Pediaciencias Group, Universidad de Antioquia, Noel Clinic Medellin, 050010, Colombia
| | - Zulma Vanessa Rueda
- School of Medicine, Universidad Pontificia Bolivariana, Medellín, 050034, Colombia; Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, MB, R3E 0J9, Canada
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Head BM, Trajtman A, Mao R, Bernard K, Vélez L, Marin D, López L, Rueda ZV, Keynan Y. Inflammatory Patterns Associated with Legionella in HIV and Pneumonia Coinfections. Pathogens 2024; 13:173. [PMID: 38392911 PMCID: PMC10892575 DOI: 10.3390/pathogens13020173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 02/07/2024] [Accepted: 02/12/2024] [Indexed: 02/25/2024] Open
Abstract
Legionella infections have a propensity for occurring in HIV-infected individuals, with immunosuppressed individuals tending to present with more severe disease. However, understanding regarding the Legionella host response in immune compromised individuals is lacking. This study investigated the inflammatory profiles associated with Legionella infection in patients hospitalized with HIV and pneumonia in Medellín, Colombia from February 2007 to April 2014, and correlated these profiles with clinical outcomes. Sample aliquots from the Colombian cohort were shipped to Canada where Legionella infections and systemic cytokine profiles were determined using real-time PCR and bead-based technology, respectively. To determine the effect of Legionella coinfection on clinical outcome, a patient database was consulted, comparing laboratory results and outcomes between Legionella-positive and -negative individuals. Principal component analysis revealed higher plasma concentrations of eotaxin, IP-10 and MCP-1 (p = 0.0046) during Legionella infection. Individuals with this immune profile also had higher rates of intensive care unit admissions (adjusted relative risk 1.047 [95% confidence interval 1.027-1.066]). Results demonstrate that systemic markers of monocyte/macrophage activation and differentiation (eotaxin, MCP-1, and IP-10) are associated with Legionella infection and worse patient outcomes. Further investigations are warranted to determine how this cytokine profile may play a role in Legionella pneumonia pathogenesis or immunity.
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Affiliation(s)
- Breanne M. Head
- Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, MB R3E 0J9, Canada; (B.M.H.); (R.M.); (Z.V.R.)
| | - Adriana Trajtman
- Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, MB R3E 0J9, Canada; (B.M.H.); (R.M.); (Z.V.R.)
| | - Ruochen Mao
- Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, MB R3E 0J9, Canada; (B.M.H.); (R.M.); (Z.V.R.)
| | - Kathryn Bernard
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, MB R3E 3P6, Canada;
| | - Lázaro Vélez
- School of Medicine, Universidad de Antioquia, Medellin 050010, Colombia;
- Infectious Diseases Section, Hospital Universitario San Vicente Fundación, Medellin 050010, Colombia
| | - Diana Marin
- School of Medicine, Universidad Pontificia Bolivariana, Medellin 050010, Colombia; (D.M.); (L.L.)
| | - Lucelly López
- School of Medicine, Universidad Pontificia Bolivariana, Medellin 050010, Colombia; (D.M.); (L.L.)
| | - Zulma Vanessa Rueda
- Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, MB R3E 0J9, Canada; (B.M.H.); (R.M.); (Z.V.R.)
- School of Medicine, Universidad Pontificia Bolivariana, Medellin 050010, Colombia; (D.M.); (L.L.)
| | - Yoav Keynan
- Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, MB R3E 0J9, Canada; (B.M.H.); (R.M.); (Z.V.R.)
- Department of Internal Medicine, University of Manitoba, Winnipeg, MB R3A 1R9, Canada
- Department of Community Health Sciences, University of Manitoba, Winnipeg, MB R3E 0W3, Canada
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Peña-Valencia K, Riaño W, Herrera-Diaz M, López L, Marín D, Gonzalez S, Agudelo-García O, Rodríguez-Sabogal IA, Vélez L, Rueda ZV, Keynan Y. Markers of Inflammation, Tissue Damage, and Fibrosis in Individuals Diagnosed with Human Immunodeficiency Virus and Pneumonia: A Cohort Study. Pathogens 2024; 13:84. [PMID: 38251391 PMCID: PMC10820350 DOI: 10.3390/pathogens13010084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2023] [Revised: 01/10/2024] [Accepted: 01/15/2024] [Indexed: 01/23/2024] Open
Abstract
Previous studies have noted that persons living with human immunodeficiency virus (HIV) experience persistent lung dysfunction after an episode of community-acquired pneumonia (CAP), although the underlying mechanisms remain unclear. We hypothesized that inflammation during pneumonia triggers increased tissue damage and accelerated pulmonary fibrosis, resulting in a gradual loss of lung function. We carried out a prospective cohort study of people diagnosed with CAP and/or HIV between 2016 and 2018 in three clinical institutions in Medellín, Colombia. Clinical data, blood samples, and pulmonary function tests (PFTs) were collected at baseline. Forty-one patients were included, divided into two groups: HIV and CAP (n = 17) and HIV alone (n = 24). We compared the concentrations of 17 molecules and PFT values between the groups. Patients with HIV and pneumonia presented elevated levels of cytokines and chemokines (IL-6, IL-8, IL-18, IL-1RA, IL-10, IP-10, MCP-1, and MIP-1β) compared to those with only HIV. A marked pulmonary dysfunction was evidenced by significant reductions in FEF25, FEF25-75, and FEV1. The correlation between these immune mediators and lung function parameters supports the connection between pneumonia-associated inflammation and end organ lung dysfunction. A low CD4 cell count (<200 cells/μL) predicted inflammation and lung dysfunction. These results underscore the need for targeted clinical approaches to mitigate the adverse impacts of CAP on lung function in this population.
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Affiliation(s)
- Katherine Peña-Valencia
- Escuela de Microbiología, Universidad de Antioquia, Medellin 050010, Colombia;
- Grupo de Investigación en Salud Pública, Facultad de Medicina, Universidad Pontificia Bolivariana, Medellin 050010, Colombia; (W.R.); (L.L.); (D.M.); (Z.V.R.)
- Grupo Bacterias & Cáncer, School of Medicine, Universidad de Antioquia, Medellin 050010, Colombia;
| | - Will Riaño
- Grupo de Investigación en Salud Pública, Facultad de Medicina, Universidad Pontificia Bolivariana, Medellin 050010, Colombia; (W.R.); (L.L.); (D.M.); (Z.V.R.)
- School of Medicine, Universidad de Antioquia, Medellin 050010, Colombia;
| | - Mariana Herrera-Diaz
- Department of Medical Microbiology and Infectious Disease, University of Manitoba, Winnipeg, MB R3E 0J9, Canada; (M.H.-D.); (S.G.)
| | - Lucelly López
- Grupo de Investigación en Salud Pública, Facultad de Medicina, Universidad Pontificia Bolivariana, Medellin 050010, Colombia; (W.R.); (L.L.); (D.M.); (Z.V.R.)
- School of Medicine, Universidad Pontificia Bolivariana, Medellin 050010, Colombia
| | - Diana Marín
- Grupo de Investigación en Salud Pública, Facultad de Medicina, Universidad Pontificia Bolivariana, Medellin 050010, Colombia; (W.R.); (L.L.); (D.M.); (Z.V.R.)
- School of Medicine, Universidad Pontificia Bolivariana, Medellin 050010, Colombia
| | - Sandra Gonzalez
- Department of Medical Microbiology and Infectious Disease, University of Manitoba, Winnipeg, MB R3E 0J9, Canada; (M.H.-D.); (S.G.)
- JC Wilt Infectious Diseases Research Center, Winnipeg, MB R3E 3L5, Canada
| | - Olga Agudelo-García
- Grupo Bacterias & Cáncer, School of Medicine, Universidad de Antioquia, Medellin 050010, Colombia;
| | - Iván Arturo Rodríguez-Sabogal
- School of Medicine, Universidad de Antioquia, Medellin 050010, Colombia;
- Infectious Diseases Section, Hospital Universitario San Vicente Fundación, Medellin 050010, Colombia;
| | - Lázaro Vélez
- Infectious Diseases Section, Hospital Universitario San Vicente Fundación, Medellin 050010, Colombia;
| | - Zulma Vanessa Rueda
- Grupo de Investigación en Salud Pública, Facultad de Medicina, Universidad Pontificia Bolivariana, Medellin 050010, Colombia; (W.R.); (L.L.); (D.M.); (Z.V.R.)
- Department of Medical Microbiology and Infectious Disease, University of Manitoba, Winnipeg, MB R3E 0J9, Canada; (M.H.-D.); (S.G.)
| | - Yoav Keynan
- Department of Medical Microbiology and Infectious Disease, University of Manitoba, Winnipeg, MB R3E 0J9, Canada; (M.H.-D.); (S.G.)
- Grupo Investigador de Problemas en Enfermedades Infecciosas-GRIPE, Facultad de Medicina, Universidad de Antioquia, Medellin 050010, Colombia
- Department of Internal Medicine, University of Manitoba, Winnipeg, MB R3E 0J9, Canada
- Department of Community Health Sciences, University of Manitoba, Winnipeg, MB R3E 0J9, Canada
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Herrera M, Taguiam E, Laupland KB, Rueda ZV, Keynan Y. Public health implications of the evolving understanding of tuberculosis natural history. J Assoc Med Microbiol Infect Dis Can 2024; 8:241-244. [PMID: 38250622 PMCID: PMC10797768 DOI: 10.3138/jammi-2023-02-24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
Affiliation(s)
- Mariana Herrera
- Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, Canada
| | - Erwin Taguiam
- Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, Canada
| | - Kevin B Laupland
- Department of Intensive Care Services, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Zulma Vanessa Rueda
- Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, Canada
- Facultad de Medicina, Universidad Pontificia Bolivariana, Medellin, Colombia
| | - Yoav Keynan
- Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, Canada
- Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
- National Collaborating Centre for Infectious Diseases, Winnipeg, Manitoba, Canada
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
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Rueda ZV, Haworth-Brockman M, Sobie C, Villacis E, Larcombe L, Maier K, Deering K, Sanguins J, Templeton K, MacKenzie L, Ireland L, Kasper K, Payne M, Bullard J, Krusi A, Pick N, Myran T, Meyers A, Keynan Y. Social and structural barriers and facilitators to HIV healthcare and harm reduction services for people experiencing syndemics in Manitoba: study protocol. BMJ Open 2023; 13:e067813. [PMID: 37532474 PMCID: PMC10401247 DOI: 10.1136/bmjopen-2022-067813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/04/2023] Open
Abstract
INTRODUCTION In Manitoba, Canada, there has been an increase in the number of people newly diagnosed with HIV and those not returning for regular HIV care. The COVID-19 pandemic resulted in increased sex and gender disparities in disease risk and mortalities, decreased harm reduction services and reduced access to healthcare. These health crises intersect with increased drug use and drug poisoning deaths, houselessness and other structural and social factors most acutely among historically underserved groups. We aim to explore the social and structural barriers and facilitators to HIV care and harm reduction services experienced by people living with HIV (PLHIV) in Manitoba. METHODS AND ANALYSIS Our study draws on participatory action research design. Guiding the methodological design are the lived experiences of PLHIV. In-depth semi-structured face-to-face interviews and quantitative questionnaires will be conducted with two groups: (1) persons aged ≥18 years living or newly diagnosed with HIV and (2) service providers who work with PLHIV. Data collection will include sex, gender, sociodemographic information, income and housing, experiences with the criminal justice system, sexual practices, substance use practices and harm reduction access, experiences with violence and support, HIV care journey (since diagnosis until present), childhood trauma and a decision-making questionnaire. Data will be analysed intersectionally, employing grounded theory for thematic analysis, sex-based and gender-based analysis and social determinants of health and syndemic framework to understand the experiences of PLHIV in Manitoba. ETHICS AND DISSEMINATION We received approval from the University of Manitoba Health Ethics Research Board (HS25572; H2022:218), First Nations Health and Social Secretariat of Manitoba, Nine Circles Community Health Centre, Shared Health Manitoba (SH2022:194) and 7th Street Health Access Centre. Findings will be disseminated using community-focused knowledge translation strategies identified by participants, peers, community members and organisations, and reported in conferences, peer-reviewed journals and a website (www.alltogether4ideas.org).
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Affiliation(s)
- Zulma Vanessa Rueda
- Department of Medical Microbiology and Infectious Diseases, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Margaret Haworth-Brockman
- National Collaborating Centre for Infectious Diseases, University of Manitoba, Winnipeg, Manitoba, Canada
- Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Cheryl Sobie
- Department of Medical Microbiology and Infectious Diseases, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Enrique Villacis
- Department of Medical Microbiology and Infectious Diseases, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Linda Larcombe
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Katharina Maier
- Criminal Justice, The University of Winnipeg, Winnipeg, Manitoba, Canada
| | - Kathleen Deering
- Department of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Gender & Sexual Health Equity, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Julianne Sanguins
- Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Kimberly Templeton
- Manitoba HIV Program, Winnipeg, Manitoba, Canada
- Nine Circles Community Health Centre, Winnipeg, Manitoba, Canada
| | - Lauren MacKenzie
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- Manitoba HIV Program, Winnipeg, Manitoba, Canada
| | - Laurie Ireland
- Manitoba HIV Program, Winnipeg, Manitoba, Canada
- Nine Circles Community Health Centre, Winnipeg, Manitoba, Canada
| | - Ken Kasper
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- Manitoba HIV Program, Winnipeg, Manitoba, Canada
| | - Michael Payne
- Nine Circles Community Health Centre, Winnipeg, Manitoba, Canada
| | - Jared Bullard
- Department of Medical Microbiology and Infectious Diseases, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- Cadham Provincial Laboratory, Shared Health, Winnipeg, Manitoba, Canada
| | - Andrea Krusi
- Department of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Gender & Sexual Health Equity, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Neora Pick
- Division of Infectious Disease, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Tara Myran
- Indigenous Development, University of Winnipeg, Winnipeg, Manitoba, Canada
| | - Adrienne Meyers
- Laboratory Integration, Office of Population and Public Health, Indigenous Services Canada, Winnipeg, Manitoba, Canada
| | - Yoav Keynan
- Department of Medical Microbiology and Infectious Diseases, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- National Collaborating Centre for Infectious Diseases, University of Manitoba, Winnipeg, Manitoba, Canada
- Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
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Herrera M, Keynan Y, Lopez L, Marín D, Vélez L, McLaren PJ, Rueda ZV. Cytokine/chemokine profiles in people with recent infection by Mycobacterium tuberculosis. Front Immunol 2023; 14:1129398. [PMID: 37261336 PMCID: PMC10229054 DOI: 10.3389/fimmu.2023.1129398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 04/26/2023] [Indexed: 06/02/2023] Open
Abstract
Introduction The risk of progression to tuberculosis disease is highest within the first year after M. tuberculosis infection (TBI). We hypothesize that people with newly acquired TBI have a unique cytokine/chemokine profile that could be used as a potential biomarker. Methods We evaluated socio-demographic variables and 18 cytokines/chemokines in plasma samples from a cohort of people deprived of liberty (PDL) in two Colombian prisons: 47 people diagnosed with pulmonary TB, 24 with new TBI, and 47 non-infected individuals. We performed a multinomial regression to identify the immune parameters that differentiate the groups. Results The concentration of immune parameters changed over time and was affected by the time of incarceration. The concentration of sCD14, IL-18 and IP-10 differed between individuals with new TBI and short and long times of incarceration. Among people with short incarceration, high concentrations of MIP-3α were associated with a higher risk of a new TBI, and higher concentrations of Eotaxin were associated with a lower risk of a new TBI. Higher concentrations of sCD14 and TNF-α were associated with a higher risk of TB disease, and higher concentrations of IL-18 and MCP-1 were associated with a lower risk of TB disease. Conclusions There were cytokines/chemokines associated with new TBI and TB disease. However, the concentration of immune mediators varies by the time of incarceration among people with new TBI. Further studies should evaluate the changes of these and other cytokines/chemokines over time to understand the immune mechanisms across the spectrum of TB.
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Affiliation(s)
- Mariana Herrera
- Epidemiology Doctorate, Facultad Nacional de Salud Pública, Universidad de Antioquia, Medellín, Colombia
- Department of Medical Microbiology & Infectious Diseases, University of Manitoba, Winnipeg, MB, Canada
| | - Yoav Keynan
- Department of Medical Microbiology & Infectious Diseases, University of Manitoba, Winnipeg, MB, Canada
- Departments of Internal Medicine and Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Facultad de Medicina, Universidad Pontificia Bolivariana, Medellín, Colombia
| | - Lucelly Lopez
- Facultad de Medicina, Universidad Pontificia Bolivariana, Medellín, Colombia
- Grupo de Investigación en Salud Pública, Universidad Pontificia Bolivariana, Medellín, Colombia
| | - Diana Marín
- Facultad de Medicina, Universidad Pontificia Bolivariana, Medellín, Colombia
- Grupo de Investigación en Salud Pública, Universidad Pontificia Bolivariana, Medellín, Colombia
| | - Lázaro Vélez
- Grupo Investigador de Problemas en Enfermedades Infecciosas (GRIPE), Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia
| | - Paul J. McLaren
- Department of Medical Microbiology & Infectious Diseases, University of Manitoba, Winnipeg, MB, Canada
- JC Wilt Infectious Diseases Research Centre, Public Health Agency of Canada, Winnipeg, MB, Canada
| | - Zulma Vanessa Rueda
- Department of Medical Microbiology & Infectious Diseases, University of Manitoba, Winnipeg, MB, Canada
- Facultad de Medicina, Universidad Pontificia Bolivariana, Medellín, Colombia
- Grupo de Investigación en Salud Pública, Universidad Pontificia Bolivariana, Medellín, Colombia
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Marín D, Keynan Y, Bangdiwala SI, López L, Rueda ZV. Tuberculosis in Prisons: Importance of Considering the Clustering in the Analysis of Cross-Sectional Studies. Int J Environ Res Public Health 2023; 20:5423. [PMID: 37048037 PMCID: PMC10094442 DOI: 10.3390/ijerph20075423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 03/15/2023] [Accepted: 03/27/2023] [Indexed: 06/19/2023]
Abstract
The level of clustering and the adjustment by cluster-robust standard errors have yet to be widely considered and reported in cross-sectional studies of tuberculosis (TB) in prisons. In two cross-sectional studies of people deprived of liberty (PDL) in Medellin, we evaluated the impact of adjustment versus failure to adjust by clustering on prevalence ratio (PR) and 95% confidence interval (CI). We used log-binomial regression, Poisson regression, generalized estimating equations (GEE), and mixed-effects regression models. We used cluster-robust standard errors and bias-corrected standard errors. The odds ratio (OR) was 20% higher than the PR when the TB prevalence was >10% in at least one of the exposure factors. When there are three levels of clusters (city, prison, and courtyard), the cluster that had the strongest effect was the courtyard, and the 95% CI estimated with GEE and mixed-effect models were narrower than those estimated with Poisson and binomial models. Exposure factors lost their significance when we used bias-corrected standard errors due to the smaller number of clusters. Tuberculosis transmission dynamics in prisons dictate a strong cluster effect that needs to be considered and adjusted for. The omission of cluster structure and bias-corrected by the small number of clusters can lead to wrong inferences.
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Affiliation(s)
- Diana Marín
- Facultad de Medicina, Universidad Pontificia Bolivariana, Medellín 050034, Colombia
| | - Yoav Keynan
- Department of Medical Microbiology and Infectious Disease, University of Manitoba, Winnipeg, MB R3E 0J9, Canada
- Department of Community Health Sciences, University of Manitoba, Winnipeg, MB R3E 0J9, Canada
- Department of Internal Medicine, University of Manitoba, Winnipeg, MB R3E 0J9, Canada
| | - Shrikant I. Bangdiwala
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON L8S 4K1, Canada
- Population Health Research Institute, McMaster University, Hamilton, ON L8L 2X2, Canada
| | - Lucelly López
- Facultad de Medicina, Universidad Pontificia Bolivariana, Medellín 050034, Colombia
| | - Zulma Vanessa Rueda
- Facultad de Medicina, Universidad Pontificia Bolivariana, Medellín 050034, Colombia
- Department of Medical Microbiology and Infectious Disease, University of Manitoba, Winnipeg, MB R3E 0J9, Canada
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Keynan Y, Haworth-Brockman M, Laupland KB, Rueda ZV. Beyond HIV: An urgent need for a syndemic and gender-based approach in the Prairie provinces in Canada. J Assoc Med Microbiol Infect Dis Can 2023; 8:1-6. [PMID: 37008586 PMCID: PMC10052900 DOI: 10.3138/jammi-2022-10-13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Affiliation(s)
- Yoav Keynan
- Department of Medical Microbiology and Infectious Diseases, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- National Collaborating Centre for Infectious Diseases, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- The Manitoba HIV Program, Winnipeg, Manitoba, Canada
- Department of Internal Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Margaret Haworth-Brockman
- National Collaborating Centre for Infectious Diseases, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Kevin B Laupland
- Department of Intensive Care Services, Royal Brisbane and Women's Hospital, Butterfield Street, Brisbane, Queensland, Australia
- School of Clinical Sciences, Faculty of Health, Queensland University of Technology (QUT), Brisbane, Australia
| | - Zulma Vanessa Rueda
- Department of Medical Microbiology and Infectious Diseases, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
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Marín D, Orozco LY, Narváez DM, Ortiz-Trujillo IC, Molina FJ, Ramos CD, Rodriguez-Villamizar L, Bangdiwala SI, Morales O, Cuellar M, Hernández LJ, Henao EA, Lopera V, Corredor A, Toro MV, Groot H, Villamil-Osorio M, Muñoz DA, Hincapié RC, Amaya F, Oviedo AI, López L, Morales-Betancourt R, Marín-Ochoa BE, Sánchez-García OE, Marín JS, Abad JM, Toro JC, Pinzón E, Builes JJ, Rueda ZV. Characterization of the external exposome and its contribution to the clinical respiratory and early biological effects in children: The PROMESA cohort study protocol. PLoS One 2023; 18:e0278836. [PMID: 36662732 PMCID: PMC9858469 DOI: 10.1371/journal.pone.0278836] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 11/01/2022] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Air pollution contains a mixture of different pollutants from multiple sources. However, the interaction of these pollutants with other environmental exposures, as well as their harmful effects on children under five in tropical countries, is not well known. OBJECTIVE This study aims to characterize the external exposome (ambient and indoor exposures) and its contribution to clinical respiratory and early biological effects in children. MATERIALS AND METHODS A cohort study will be conducted on children under five (n = 500) with a one-year follow-up. Enrolled children will be followed monthly (phone call) and at months 6 and 12 (in person) post-enrolment with upper and lower Acute Respiratory Infections (ARI) examinations, asthma development, asthma control, and genotoxic damage. The asthma diagnosis will be pediatric pulmonologist-based and a standardized protocol will be used. Exposure, effect, and susceptibility biomarkers will be measured on buccal cells samples. For environmental exposures PM2.5 will be sampled, and questionnaires, geographic information, dispersion models and Land Use Regression models for PM2.5 and NO2 will be used. Different statistical methods that include Bayesian and machine learning techniques will be used for the ambient and indoor exposures-and outcomes. This study was approved by the ethics committee at Universidad Pontificia Bolivariana. EXPECTED STUDY OUTCOMES/FINDINGS To estimate i) The toxic effect of particulate matter transcending the approach based on pollutant concentration levels; ii) The risk of developing an upper and lower ARI, based on different exposure windows; iii) A baseline of early biological damage in children under five, and describe its progression after a one-year follow-up; and iv) How physical and chemical PM2.5 characteristics influence toxicity and children's health.
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Affiliation(s)
- Diana Marín
- School of Medicine, Universidad Pontificia Bolivariana, Medellín, Colombia
| | - Luz Yaneth Orozco
- School of Medicine, Universidad Pontificia Bolivariana, Medellín, Colombia
- School of Engineering, Universidad de Antioquia, Medellín, Colombia
| | | | | | | | | | - Laura Rodriguez-Villamizar
- Department of Public Health, School of Health, Universidad Industrial de Santander, Bucaramanga, Colombia
| | - Shrikant I. Bangdiwala
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada
- Statistics Department, Population Health Research Institute, McMaster University, Hamilton, Canada
| | - Olga Morales
- School of Medicine, Pediaciencias Group, Universidad de Antioquia, Noel Clinic, Medellín, Colombia
- Department of Pediatrics, Hospital San Vicente Fundación, Medellín, Colombia
| | - Martha Cuellar
- School of Medicine, Pediaciencias Group, Universidad de Antioquia, Noel Clinic, Medellín, Colombia
- Department of Pediatrics, SOMER Clinic, Medellín, Colombia
| | | | | | - Verónica Lopera
- Secretaría de Salud, Alcaldía de Medellín, Medellín, Colombia
| | - Andrea Corredor
- Department of Pediatrics, ONIROS Centro Especializado en Medicina Integral del Sueño, Bogotá, Colombia
| | - María Victoria Toro
- School of Engineering, Universidad Pontificia Bolivariana, Medellín, Colombia
| | - Helena Groot
- Human Genetics Laboratory, Universidad de los Andes, Bogotá, Colombia
| | - Milena Villamil-Osorio
- Department of Pediatrics, Fundación Hospital Pediátrico la Misericordia, Bogotá, Colombia
| | | | | | - Ferney Amaya
- School of Engineering, Universidad Pontificia Bolivariana, Medellín, Colombia
| | - Ana Isabel Oviedo
- School of Engineering, Universidad Pontificia Bolivariana, Medellín, Colombia
| | - Lucelly López
- School of Medicine, Universidad Pontificia Bolivariana, Medellín, Colombia
| | | | - Beatriz Elena Marín-Ochoa
- School of Social Communications and Journalism, Universidad Pontificia Bolivariana, Medellín, Colombia
| | | | | | | | | | - Eliana Pinzón
- Secretaria distrital de Salud, Alcaldia de Bogota, Bogota, Colombia
| | | | - Zulma Vanessa Rueda
- School of Medicine, Universidad Pontificia Bolivariana, Medellín, Colombia
- Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, Canada
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10
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Chevrier C, Diaz MH, Rueda ZV, Balakumar S, Haworth-Brockman M, Marin DM, Oliver A, Plourde P, Keynan Y. Introduction of short course treatment for latent tuberculosis infection at a primary care facility for refugees in Winnipeg, Canada: A mixed methods evaluation. Front Public Health 2023; 10:1064136. [PMID: 36726628 PMCID: PMC9885188 DOI: 10.3389/fpubh.2022.1064136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 12/23/2022] [Indexed: 01/18/2023] Open
Abstract
Background The World Health Organization (WHO) End TB strategy document 'Toward tuberculosis elimination: an action framework for low incidence countries'-like Canada- identifies screening and treatment of latent tuberculosis infection (LTBI) for groups at increased risk for TB disease as a priority, including newcomers from endemic countries. In 2015, the clients-centered model offered at a primary care facility for refugees, BridgeCare Clinic, Winnipeg, Canada was evaluated. The model included LTBI screening, assessment, and treatment, and originally offered 9-months of isoniazid as treatment. This mixed methods evaluation investigates LTBI program outcomes since the introduction of two short-course treatment regimens: 4-months of rifampin, and 3-months of isoniazid and rifapentine. Methods This study combined a retrospective analysis of program administrative data with structured interviews of clinic staff. We included LTBI treatment eligibility, the treatment regimen offered, treatment initiation, and completed treatment from January 1, 2015 to August 6, 2020. Results Seven hundred and one people were screened, and infection rates varied from 34.1% in 2015 to 53.3% in 2020. Most people living with LTBI came from high TB burden countries in Africa and South-East Asia WHO regions and were younger than 45 years old. Treatment eligibility increased 9% (75% in 2015 to 86% in 2016-2020) and most people diagnosed with LTBI took the short course treatments offered. There was an increase of 14.5% in treatment initiation (75.6 vs. 90.1%), and an increase of 8% in treatment completion (82.4 vs. 90.4%) after short-course regimens were introduced. The final model showed that the treatment regimen tends to affect the frequency of treatment completion, but there are other factors that influence this outcome, in this population. With the new treatments, BridgeCare Clinic achieved the 90% of treatment coverage, and the 90% treatment completion rate targets recommended in the End TB Strategy. Qualitative interviews with clinic staff further affirm the higher acceptability of the new treatments. Conclusion While these results are limited to government-sponsored refugees in Winnipeg, they highlight the acceptability and value of short-course LTBI treatment as a possibility for reaching End TB targets in primary care settings.
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Affiliation(s)
- Claudyne Chevrier
- National Collaborating Centre for Infectious Diseases, Winnipeg, MB, Canada
| | - Mariana Herrera Diaz
- Maestría en Epidemiología, Fundación Universitaria del Área Andina, Bogotá, Colombia
- Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, MB, Canada
| | - Zulma Vanessa Rueda
- Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, MB, Canada
- Facultad de Medicina, Universidad Pontificia Bolivariana, Medellín, Colombia
| | - Shivoan Balakumar
- National Collaborating Centre for Infectious Diseases, Winnipeg, MB, Canada
| | - Margaret Haworth-Brockman
- National Collaborating Centre for Infectious Diseases, Winnipeg, MB, Canada
- Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Diana Marcela Marin
- Facultad de Medicina, Universidad Pontificia Bolivariana, Medellín, Colombia
| | - Afsaneh Oliver
- BridgeCare Refugee Health Clinic, Winnipeg Regional Health Authority, Winnipeg, MB, Canada
| | - Pierre Plourde
- Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, MB, Canada
- Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Winnipeg Regional Health Authority, Winnipeg, MB, Canada
| | - Yoav Keynan
- National Collaborating Centre for Infectious Diseases, Winnipeg, MB, Canada
- Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, MB, Canada
- Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Department of Internal Medicine, University of Manitoba, Winnipeg, MB, Canada
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11
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Hincapie R, Munoz DA, Ortega N, Isfeld-Kiely HK, Shaw SY, Keynan Y, Rueda ZV. Effect of flight connectivity on the introduction and evolution of the COVID-19 outbreak in Canadian provinces and territories. J Travel Med 2022; 29:6679266. [PMID: 36041018 PMCID: PMC9452173 DOI: 10.1093/jtm/taac100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 08/12/2022] [Accepted: 08/15/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND The COVID-19 pandemic has challenged health services and governments in Canada and around the world. Our research aims to evaluate the effect of domestic and international air travel patterns on the COVID-19 pandemic in Canadian provinces and territories. METHODS Air travel data were obtained through licensed access to the 'BlueDot Intelligence Platform', BlueDot Inc. Daily provincial and territorial COVID-19 cases for Canada and global figures, including mortality, cases recovered and population data were downloaded from public datasets. The effects of domestic and international air travel and passenger volume on the number of local and non-local infected people in each Canadian province and territory were evaluated with a semi-Markov model. Provinces and territories are grouped into large (>100 000 confirmed COVID-19 cases and >1 000 000 inhabitants) and small jurisdictions (≤100 000 confirmed COVID-19 cases and ≤1 000 000 inhabitants). RESULTS Our results show a clear decline in passenger volumes from March 2020 due to public health policies, interventions and other measures taken to limit or control the spread of COVID-19. As the measures were eased, some provinces and territories saw small increases in passenger volumes, although travel remained below pre-pandemic levels. During the early phase of disease introduction, the burden of illness is determined by the connectivity of jurisdictions. In provinces with a larger population and greater connectivity, the burden of illness is driven by case importation, although local transmission rapidly replaces imported cases as the most important driver of increasing new infections. In smaller jurisdictions, a steep increase in cases is seen after importation, leading to outbreaks within the community. CONCLUSIONS Historical travel volumes, combined with data on an emerging infection, are useful to understand the behaviour of an infectious agent in regions of Canada with different connectivity and population size. Historical travel information is important for public health planning and pandemic resource allocation.
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Affiliation(s)
- Roberto Hincapie
- Escuela de Ingenierias, Universidad Pontificia Bolivariana, Medellin, Colombia
| | - Diego A Munoz
- Escuela de Matemáticas, Universidad Nacional de Colombia, Medellin, Colombia
| | - Nathalia Ortega
- Escuela de Ingenierias, Universidad Pontificia Bolivariana, Medellin, Colombia
| | | | - Souradet Y Shaw
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada.,Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, Canada
| | - Yoav Keynan
- National Collaborating Centre for Infectious Diseases, Winnipeg, Canada.,Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada.,Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, Canada.,Department of Internal Medicine, University of Manitoba, Winnipeg, Canada
| | - Zulma Vanessa Rueda
- Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, Canada.,Facultad de Medicina, Universidad Pontificia Bolivariana, Medellin, Colombia
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12
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Herrera M, Keynan Y, McLaren PJ, Isaza JP, Abrenica B, López L, Marin D, Rueda ZV. Gene expression profiling identifies candidate biomarkers for new latent tuberculosis infections. A cohort study. PLoS One 2022; 17:e0274257. [PMID: 36170228 PMCID: PMC9518923 DOI: 10.1371/journal.pone.0274257] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 08/25/2022] [Indexed: 11/25/2022] Open
Abstract
Objective To determine the gene expression profile in individuals with new latent tuberculosis infection (LTBI), and to compare them with people with active tuberculosis (TB) and those exposed to TB but not infected. Design A prospective cohort study. Recruitment and follow-up were conducted between September 2016 to December 2018. Gene expression and data processing and analysis from April 2019 to April 2021. Setting Two male Colombian prisons. Participants 15 new tuberculin skin test (TST) converters (negative TST at baseline that became positive during follow-up), 11 people that continued with a negative TST after two years of follow-up, and 10 people with pulmonary ATB. Main outcome measures Gene expression profile using RNA sequencing from PBMC samples. The differential expression was assessed using the DESeq2 package in Bioconductor. Genes with |logFC| >1.0 and an adjusted p-value < 0.1 were differentially expressed. We analyzed the differences in the enrichment of KEGG pathways in each group using InterMiner. Results The gene expression was affected by the time of incarceration. We identified group-specific differentially expressed genes between the groups: 289 genes in people with a new LTBI and short incarceration (less than three months of incarceration), 117 in those with LTBI and long incarceration (one or more years of incarceration), 26 in ATB, and 276 in the exposed but non-infected individuals. Four pathways encompassed the largest number of down and up-regulated genes among individuals with LTBI and short incarceration: cytokine signaling, signal transduction, neutrophil degranulation, and innate immune system. In individuals with LTBI and long incarceration, the only enriched pathway within up-regulated genes was Emi1 phosphorylation. Conclusions Recent infection with MTB is associated with an identifiable RNA pattern related to innate immune system pathways that can be used to prioritize LTBI treatment for those at greatest risk for developing active TB.
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Affiliation(s)
- Mariana Herrera
- Departments of Medical Microbiology & Infectious Diseases, University of Manitoba, Winnipeg, Canada
- Doctorado en Epidemiologia, Facultad Nacional de Salud Pública, Universidad de Antioquia, Medellín, Colombia
| | - Yoav Keynan
- Departments of Medical Microbiology & Infectious Diseases, University of Manitoba, Winnipeg, Canada
- Department of Internal Medicine, University of Manitoba, Winnipeg, Canada
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Paul J. McLaren
- Departments of Medical Microbiology & Infectious Diseases, University of Manitoba, Winnipeg, Canada
- JC Wilt Infectious Diseases Research Centre, Public Health Agency of Canada, Winnipeg, Manitoba, Canada
| | - Juan Pablo Isaza
- Facultad de Medicina, Universidad Pontificia Bolivariana, Medellín, Colombia
| | - Bernard Abrenica
- JC Wilt Infectious Diseases Research Centre, Public Health Agency of Canada, Winnipeg, Manitoba, Canada
| | - Lucelly López
- Facultad de Medicina, Universidad Pontificia Bolivariana, Medellín, Colombia
| | - Diana Marin
- Facultad de Medicina, Universidad Pontificia Bolivariana, Medellín, Colombia
| | - Zulma Vanessa Rueda
- Departments of Medical Microbiology & Infectious Diseases, University of Manitoba, Winnipeg, Canada
- Facultad de Medicina, Universidad Pontificia Bolivariana, Medellín, Colombia
- * E-mail:
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Cabrera R, Mendoza W, López-Mosquera L, Cano MA, Ortiz N, Campo V, Keynan Y, López L, Rueda ZV, Gutiérrez LA. Tick-Borne-Agents Detection in Patients with Acute Febrile Syndrome and Ticks from Magdalena Medio, Colombia. Pathogens 2022; 11:pathogens11101090. [PMID: 36297148 PMCID: PMC9611641 DOI: 10.3390/pathogens11101090] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 09/01/2022] [Accepted: 09/13/2022] [Indexed: 11/16/2022] Open
Abstract
Acute febrile illness (AFI) is a morbid condition with a sudden onset of fever with at least seven days of evolution, where no signs or symptoms related to an apparent infection have been identified. In Latin America, a high proportion of disease is typically due to malaria and arboviruses. However, among the infectious etiologies, tick-borne diseases (TBDs) should also be considered, especially in areas where people come into direct contact with these arthropods. This study aims to describe the etiology and epidemiology related to tick-borne agents in patients with AFI and the tick’s natural infection by agents of TBD in the rural tropical Magdalena Medio region in Colombia, and explore the factors associated with the presence of Coxiella burnetii infection. We conduct a cohort study enrolling 271 patients with AFI to detect the bacteria of the genera Anaplasma, Ehrlichia, Coxiella, Rickettsia, Borrelia, and Francisella through molecular techniques, and additionally evaluate the presence of IgG antibodies with commercially available kits. We also conduct tick collection in the patient’s households or workplaces for the molecular screening of the same bacterial genera. Seropositivity to IgG antibodies was obtained for all the bacteria analyzed, with Francisella being the most common at 39.5% (107/271), followed by R. rickettsii at 31.4% (85/271), Ehrlichia at 26.9% (73/271), R. typhi at 15.5% (42/271), Anaplasma at 14.4% (39/271), and Borrelia at 6.6% (18/271). However, these bacteria were not detected by the molecular techniques used. Coxiella burnetii infection was detected in 39.5% of the patients: 49.5% only by phase I and II IgG antibodies, 33.6% only by real-time PCR, and 16.8% had a concordant positive result for both techniques. A total of 191 adult ticks, 111 females and 80 males, were collected and identified as Rhipicephalus sanguineus s.l. and Rhipicephalus microplus. In the 169 adult ticks in which natural infection was evaluated, Ehrlichia spp. was detected in 21.3% (36/169), Coxiella spp. in 11.8% (20/169), and Anaplasma spp. in 4.7% (8/169). In conclusion, we identified the prior exposition to Francisella, Anaplasma, Ehrlichia, Rickettsia, Borrelia, and Coxiella in patients through serological tests. We also detected the infection of C. burnetii using molecular techniques. In the ticks, we identified bacteria of the genera Coxiella, Anaplasma, and Ehrlichia. These results suggest the importance of these zoonotic agents as possible causes of AFI in this region.
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Affiliation(s)
- Ruth Cabrera
- Grupo Biología de Sistemas, Escuela de Ciencias de la Salud, Facultad de Medicina, Universidad Pontificia Bolivariana, Medellín 050034, Colombia
| | - Willington Mendoza
- Grupo Biología de Sistemas, Escuela de Ciencias de la Salud, Facultad de Medicina, Universidad Pontificia Bolivariana, Medellín 050034, Colombia
| | - Loreth López-Mosquera
- Grupo Biología de Sistemas, Escuela de Ciencias de la Salud, Facultad de Medicina, Universidad Pontificia Bolivariana, Medellín 050034, Colombia
| | - Miguel Angel Cano
- Grupo Biología de Sistemas, Escuela de Ciencias de la Salud, Facultad de Medicina, Universidad Pontificia Bolivariana, Medellín 050034, Colombia
- Grupo de Investigación en Salud Pública, Escuela de Ciencias de la Salud, Facultad de Medicina, Universidad Pontificia Bolivariana, Medellín 050034, Colombia
| | - Nicolas Ortiz
- Grupo Biología de Sistemas, Escuela de Ciencias de la Salud, Facultad de Medicina, Universidad Pontificia Bolivariana, Medellín 050034, Colombia
- Grupo de Investigación en Salud Pública, Escuela de Ciencias de la Salud, Facultad de Medicina, Universidad Pontificia Bolivariana, Medellín 050034, Colombia
| | - Valentina Campo
- Grupo Biología de Sistemas, Escuela de Ciencias de la Salud, Facultad de Medicina, Universidad Pontificia Bolivariana, Medellín 050034, Colombia
- Grupo de Investigación en Salud Pública, Escuela de Ciencias de la Salud, Facultad de Medicina, Universidad Pontificia Bolivariana, Medellín 050034, Colombia
| | - Yoav Keynan
- Department of Internal Medicine, Medical Microbiology & Infectious Diseases and Community Health Sciences, University of Manitoba, Winnipeg, MB R3E 0J9, Canada
| | - Lucelly López
- Grupo de Investigación en Salud Pública, Escuela de Ciencias de la Salud, Facultad de Medicina, Universidad Pontificia Bolivariana, Medellín 050034, Colombia
| | - Zulma Vanessa Rueda
- Grupo de Investigación en Salud Pública, Escuela de Ciencias de la Salud, Facultad de Medicina, Universidad Pontificia Bolivariana, Medellín 050034, Colombia
- Department of Internal Medicine, Medical Microbiology & Infectious Diseases and Community Health Sciences, University of Manitoba, Winnipeg, MB R3E 0J9, Canada
| | - Lina Andrea Gutiérrez
- Grupo Biología de Sistemas, Escuela de Ciencias de la Salud, Facultad de Medicina, Universidad Pontificia Bolivariana, Medellín 050034, Colombia
- Correspondence:
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14
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Ha R, Keynan Y, Rueda ZV. Increased susceptibility to pneumonia due to tumour necrosis factor inhibition and prospective immune system rescue via immunotherapy. Front Cell Infect Microbiol 2022; 12:980868. [PMID: 36159650 PMCID: PMC9489861 DOI: 10.3389/fcimb.2022.980868] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 08/15/2022] [Indexed: 11/22/2022] Open
Abstract
Immunomodulators such as tumour necrosis factor (TNF) inhibitors are used to treat autoimmune conditions by reducing the magnitude of the innate immune response. Dampened innate responses pose an increased risk of new infections by opportunistic pathogens and reactivation of pre-existing latent infections. The alteration in immune response predisposes to increased severity of infections. TNF inhibitors are used to treat autoimmune conditions such as rheumatoid arthritis, juvenile arthritis, psoriatic arthritis, transplant recipients, and inflammatory bowel disease. The efficacies of immunomodulators are shown to be varied, even among those that target the same pathways. Monoclonal antibody-based TNF inhibitors have been shown to induce stronger immunosuppression when compared to their receptor-based counterparts. The variability in activity also translates to differences in risk for infection, moreover, parallel, or sequential use of immunosuppressive drugs and corticosteroids makes it difficult to accurately attribute the risk of infection to a single immunomodulatory drug. Among recipients of TNF inhibitors, Mycobacterium tuberculosis has been shown to be responsible for 12.5-59% of all infections; Pneumocystis jirovecii has been responsible for 20% of all non-viral infections; and Legionella pneumophila infections occur at 13-21 times the rate of the general population. This review will outline the mechanism of immune modulation caused by TNF inhibitors and how they predispose to infection with a focus on Mycobacterium tuberculosis, Legionella pneumophila, and Pneumocystis jirovecii. This review will then explore and evaluate how other immunomodulators and host-directed treatments influence these infections and the severity of the resulting infection to mitigate or treat TNF inhibitor-associated infections alongside antibiotics.
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Affiliation(s)
- Ryan Ha
- Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, MB, Canada
| | - Yoav Keynan
- Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, MB, Canada
- Department of Community-Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Facultad de Medicina, Universidad Pontificia Bolivariana, Medellin, Colombia
| | - Zulma Vanessa Rueda
- Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, MB, Canada
- Facultad de Medicina, Universidad Pontificia Bolivariana, Medellin, Colombia
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15
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Rueda ZV, Aguilar Y, Maya MA, López L, Restrepo A, Garcés C, Morales O, Roya-Pabón C, Trujillo M, Arango C, Copete ÁR, Vera C, Giraldo MR, Herrera M, Vélez LA. Etiology and the challenge of diagnostic testing of community-acquired pneumonia in children and adolescents. BMC Pediatr 2022; 22:169. [PMID: 35361166 PMCID: PMC8968093 DOI: 10.1186/s12887-022-03235-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 03/22/2022] [Indexed: 11/18/2022] Open
Abstract
Background Pneumonia is the leading cause of mortality in pediatric population. The etiology of pneumonia in this population is variable and changes according to age and disease severity and where the study is conducted. Our aim was to determine the etiology of community-acquired pneumonia (CAP) in children aged 1 month to 17 years admitted to 13 Colombian hospitals. Methods Prospective cohort study. Hospitalized children with radiologically confirmed CAP and ≤ 15 days of symptoms were included and followed together with a control group. Induced sputum (IS) was submitted for stains and cultures for pyogenic bacteria and Mycobacterium tuberculosis, and multiplex PCR (mPCR) for bacteria and viruses; urinary antigens for pneumococcus and Legionella pneumophila; nasopharyngeal swabs for viruses, and paired serology for atypical bacteria and viruses. Additional cultures were taken at the discretion of primary care pediatricians. Results Among 525 children with CAP, 71.6% had non-severe pneumonia; 24.8% severe and 3.6% very severe pneumonia, and no fatal cases. At least one microorganism was identified in 84% of children and 61% were of mixed etiology; 72% had at least one respiratory virus, 28% pyogenic bacteria and 21% atypical bacteria. Respiratory syncytial virus, Parainfluenza, Rhinovirus, Influenza, Mycoplasma pneumoniae, Adenovirus and Streptococcus pneumoniae were the most common etiologies of CAP. Respiratory syncytial virus was more frequent in children under 2 years and in severe pneumonia. Tuberculosis was diagnosed in 2.3% of children. IS was the most useful specimen to identify the etiology (33.6%), and blood cultures were positive in 3.6%. The concordance between all available diagnostic tests was low. A high percentage of healthy children were colonized by S. pneumoniae and Haemophilus influenzae, or were infected by Parainfluenza, Rhinovirus, Influenza and Adenovirus. Conclusions Respiratory viruses are the most frequent etiology of CAP in children and adolescents, in particular in those under 5 years. This study shows the challenges in making an etiologic diagnosis of CAP in pediatric population because of the poor concordance between tests and the high percentage of multiple microorganisms in healthy children. IS is useful for CAP diagnosis in pediatric population. Supplementary Information The online version contains supplementary material available at 10.1186/s12887-022-03235-z.
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Affiliation(s)
- Zulma Vanessa Rueda
- Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, Canada.
| | - Yudy Aguilar
- Grupo Investigador de Problemas en Enfermedades Infecciosas (GRIPE), Facultad de Medicina, Universidad de Antioquia UdeA, Medellín, Colombia.,Clínica Universitaria Bolivariana, Universidad Pontificia Bolivariana, Medellín, Colombia
| | - María Angélica Maya
- Unidad de Enfermedades Infecciosas, Hospital Universitario San Vicente Fundación, Medellín, Colombia
| | - Lucelly López
- Facultad de Medicina, Universidad Pontificia Bolivariana, Medellin, Colombia
| | - Andrea Restrepo
- Departamento de Pediatría, Hospital Pablo Tobón Uribe, Medellín, Colombia.,Departamento de Pediatría, Universidad CES, Medellín, Colombia
| | - Carlos Garcés
- Departamento de Pediatría y Puericultura, Grupo Pediaciencias, Universidad de Antioquia UdeA, Medellín, Colombia
| | - Olga Morales
- Departamento de Pediatría y Puericultura, Grupo Pediaciencias, Universidad de Antioquia UdeA, Medellín, Colombia.,Departamento de Pediatría, Hospital Universitario San Vicente Fundación, Medellín, Colombia
| | - Claudia Roya-Pabón
- Departamento de Pediatría y Puericultura, Grupo Pediaciencias, Universidad de Antioquia UdeA, Medellín, Colombia.,Departamento de Pediatría, Hospital Universitario San Vicente Fundación, Medellín, Colombia.,Tuberculosis Clinic, Pima County Health Department, Tucson, USA
| | - Mónica Trujillo
- Clínica Universitaria Bolivariana, Universidad Pontificia Bolivariana, Medellín, Colombia.,Departamento de Pediatría, Hospital Pablo Tobón Uribe, Medellín, Colombia.,Departamento de Pediatría, Universidad CES, Medellín, Colombia
| | - Catalina Arango
- Departamento de Pediatría y Puericultura, Grupo Pediaciencias, Universidad de Antioquia UdeA, Medellín, Colombia.,Departamento de Pediatría, Hospital Universitario San Vicente Fundación, Medellín, Colombia
| | - Ángela Rocio Copete
- Grupo Investigador de Problemas en Enfermedades Infecciosas (GRIPE), Facultad de Medicina, Universidad de Antioquia UdeA, Medellín, Colombia.,Laboratorio Integrado de Medicina Especializada, Universidad de Antioquia UdeA, IPS Universitaria, Medellin, Colombia
| | - Cristian Vera
- Facultad de Medicina, Universidad Pontificia Bolivariana, Medellin, Colombia
| | - Margarita Rosa Giraldo
- Secretaría Seccional de Salud y Protección Social de Antioquia, Gobernación de Antioquia, Medellín, Colombia
| | - Mariana Herrera
- Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, Canada
| | - Lázaro A Vélez
- Grupo Investigador de Problemas en Enfermedades Infecciosas (GRIPE), Facultad de Medicina, Universidad de Antioquia UdeA, Medellín, Colombia.,Unidad de Enfermedades Infecciosas, Hospital Universitario San Vicente Fundación, Medellín, Colombia
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16
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Roya-Pabón C, Restrepo A, Morales O, Arango C, Maya MA, Bermúdez M, López L, Garcés C, Trujillo M, Carmona LF, Giraldo MR, Vélez LA, Rueda ZV. Acute Intrathoracic Tuberculosis in Children and Adolescents with Community-Acquired Pneumonia in an Area with an Intermediate Disease Burden. Pediatr Rep 2022; 14:71-80. [PMID: 35225880 PMCID: PMC8883921 DOI: 10.3390/pediatric14010011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 01/07/2022] [Accepted: 01/20/2022] [Indexed: 02/01/2023] Open
Abstract
Tuberculosis (TB) in the pediatric population is a major challenge. Our objective was to describe the clinical and microbiological characteristics, radiological patterns, and treatment outcomes of children and adolescents (from 1 month to 17 years) with community-acquired pneumonia (CAP) caused by TB. We performed a prospective cohort study of a pediatric population between 1 month and 17 years of age and hospitalized in Medellín, Colombia, with the diagnosis of radiologically confirmed CAP that had ≤ 15 days of symptoms. The mycobacterial culture of induced sputum was used for the bacteriological confirmation; the history of TB contact, a tuberculin skin test, and clinical improvement with treatment were used to identify microbiologically negative TB cases. Among 499 children with CAP, TB was diagnosed in 12 (2.4%), of which 10 had less than 8 days of a cough, 10 had alveolar opacities, 9 were younger than 5 years old, and 2 had close contact with a TB patient. Among the TB cases, 50% (6) had microbiological confirmation, 8 had viral and/or bacterial confirmation, one patient had multidrug-resistant TB, and 10/12 had non-severe pneumonia. In countries with an intermediate TB burden, Mycobacterium tuberculosis should be included in the etiological differential diagnosis (as a cause or coinfection) of both pneumonia and severe CAP in the pediatric population.
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Affiliation(s)
- Claudia Roya-Pabón
- Grupo Pediaciencias, Departamento de Pediatría y Puericultura, Universidad de Antioquia UdeA, Medellin 050010, Colombia; (C.R.-P.); (O.M.); (C.A.); (C.G.)
- Departamento de Pediatría, Hospital Universitario San Vicente Fundación, Medellin 050010, Colombia
- Pima County Health Department, Tuberculosis Clinic, Tucson, AZ 85713, USA
| | - Andrea Restrepo
- Departamento de Pediatría, Hospital Pablo Tobón Uribe, Medellin 050010, Colombia; (A.R.); (M.T.)
- Departamento de Pediatría, Universidad CES, Medellin 050010, Colombia
| | - Olga Morales
- Grupo Pediaciencias, Departamento de Pediatría y Puericultura, Universidad de Antioquia UdeA, Medellin 050010, Colombia; (C.R.-P.); (O.M.); (C.A.); (C.G.)
- Departamento de Pediatría, Hospital Universitario San Vicente Fundación, Medellin 050010, Colombia
| | - Catalina Arango
- Grupo Pediaciencias, Departamento de Pediatría y Puericultura, Universidad de Antioquia UdeA, Medellin 050010, Colombia; (C.R.-P.); (O.M.); (C.A.); (C.G.)
- Departamento de Pediatría, Hospital Universitario San Vicente Fundación, Medellin 050010, Colombia
| | - María Angélica Maya
- Unidad de Enfermedades Infecciosas, Hospital Universitario San Vicente Fundación, Medellin 050010, Colombia; (M.A.M.); (L.A.V.)
| | - Marcela Bermúdez
- Grupo Investigador de Problemas en Enfermedades Infecciosas (GRIPE), Facultad de Medicina, Universidad de Antioquia UdeA, Medellin 050010, Colombia;
| | - Lucelly López
- Grupo de Investigación en Salud Pública, Facultad de Medicina, Universidad Pontificia Bolivariana, Medellin 050031, Colombia;
| | - Carlos Garcés
- Grupo Pediaciencias, Departamento de Pediatría y Puericultura, Universidad de Antioquia UdeA, Medellin 050010, Colombia; (C.R.-P.); (O.M.); (C.A.); (C.G.)
| | - Mónica Trujillo
- Departamento de Pediatría, Hospital Pablo Tobón Uribe, Medellin 050010, Colombia; (A.R.); (M.T.)
- Departamento de Pediatría, Universidad CES, Medellin 050010, Colombia
- Section of Pediatric Infectious Diseases, Clínica Universitaria Bolivariana, Medellin 050010, Colombia
| | - Luisa Fernanda Carmona
- Secretaría Seccional de Salud y Protección Social de Antioquia, Gobernación de Antioquia, Medellin 050010, Colombia; (L.F.C.); (M.R.G.)
| | - Margarita Rosa Giraldo
- Secretaría Seccional de Salud y Protección Social de Antioquia, Gobernación de Antioquia, Medellin 050010, Colombia; (L.F.C.); (M.R.G.)
| | - Lázaro A. Vélez
- Unidad de Enfermedades Infecciosas, Hospital Universitario San Vicente Fundación, Medellin 050010, Colombia; (M.A.M.); (L.A.V.)
- Grupo Investigador de Problemas en Enfermedades Infecciosas (GRIPE), Facultad de Medicina, Universidad de Antioquia UdeA, Medellin 050010, Colombia;
| | - Zulma Vanessa Rueda
- Grupo de Investigación en Salud Pública, Facultad de Medicina, Universidad Pontificia Bolivariana, Medellin 050031, Colombia;
- Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, MB R3E 0J9, Canada
- Correspondence: ; Tel.: +1-204-789-3678
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17
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González-Duran JA, Plaza RV, Luna L, Arbeláez MP, Deviaene M, Keynan Y, Rueda ZV, Marin D. Delayed HIV treatment, barriers in access to care and mortality in tuberculosis/HIV co-infected patients in Cali, Colombia. Colomb Med (Cali) 2022. [DOI: 10.25100/cm.v52i4.4875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Objective:
To determine factors associated with mortality in tuberculosis/HIV co-infected patients in Cali, Colombia
Methods:
This retrospective cohort design included tuberculosis/HIV co-infected persons. Kaplan-Meier and Cox regression were used to estimate survival and risk factors associated with mortality.
Results:
Of the 279 tuberculosis/HIV co-infected participants, 27.2% died during the study. Participants mainly were adults and males. CD4 count information was available for 41.6% (the median count was 83 cells/mm3), and half were subject to tuberculosis susceptibility testing. The median time between HIV diagnosis and antiretroviral therapy initiation was 372 days. HIV was identified prior to tuberculosis in 53% and concurrent HIV-tuberculosis were diagnosed in 37% of patients. 44.8% had tuberculosis treatment success. Body mass index above 18 kg/m2, initiation of tuberculosis treatment within two weeks, having any health insurance coverage and CD4 count information conferred a survival advantage.
Conclusions:
Delays in treatment initiation and factors associated with limited health care access or utilization were associated with mortality. As HIV and tuberculosis are both reportable conditions in Colombia, strategies should be focused on optimizing treatment outcomes within both tuberculosis and HIV programs, particularly improving early HIV diagnosis, early antiretroviral therapy treatment initiation, and adherence to tuberculosis treatment.
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18
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Herrera M, Keynan Y, López L, Marín D, Arroyave L, Arbeláez MP, Vélez L, Rueda ZV. Incidence and Risk Factors Associated with Latent Tuberculosis Infection and Pulmonary Tuberculosis among People Deprived of Liberty in Colombian Prisons. Am J Trop Med Hyg 2022; 106:66-74. [PMID: 34872056 PMCID: PMC8733511 DOI: 10.4269/ajtmh.20-0307] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 08/30/2021] [Indexed: 01/03/2023] Open
Abstract
People deprived of liberty (PDL) are at high risk of acquiring Mycobacterium tuberculosis infection (latent tuberculosis infection [LTBI]) and progressing to active tuberculosis (TB). We sought to determine the incidence rates and factors associated with LTBI and active TB in Colombian prisons. Using information of four cohort studies, we included 240 PDL with two-step tuberculin skin test (TST) negative and followed them to evaluate TST conversion, as well as, 2,134 PDL that were investigated to rule out active TB (1,305 among people with lower respiratory symptoms of any duration, and 829 among people without respiratory symptoms and screened for LTBI). Latent tuberculosis infection incidence rate was 2,402.88 cases per 100,000 person-months (95% CI 1,364.62-4,231.10) in PDL with short incarceration at baseline, and 419.66 cases per 100,000 person-months (95% CI 225.80-779.95) in individuals with long incarceration at baseline (who were enrolled for the follow after at least 1 year of incarceration). The TB incidence rate among PDL with lower respiratory symptoms was 146.53 cases/100,000 person-months, and among PDL without respiratory symptoms screened for LTBI the incidence rate was 19.49 cases/100,000 person-months. History of Bacillus Calmette-Guerin vaccination decreased the risk of acquiring LTBI among PDL who were recently incarcerated. Female sex, smoked drugs, and current cigarette smoking were associated with an increased risk of developing active TB. This study shows that PDL have high risk for LTBI and active TB. It is important to perform LTBI testing at admission to prison, as well as regular follow-up to control TB in prisons.
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Affiliation(s)
| | - Yoav Keynan
- Department of Medical Microbiology and Infectious Diseases, Rady Faculty of Health Sciences University of Manitoba, Winnipeg, Manitoba, Canada
| | - Lucelly López
- Universidad Pontificia Bolivariana, Medellín, Colombia
| | - Diana Marín
- Universidad Pontificia Bolivariana, Medellín, Colombia
| | | | | | - Lázaro Vélez
- Universidad de Antioquia, Medellín, Antioquia, Colombia
| | - Zulma Vanessa Rueda
- Department of Medical Microbiology and Infectious Diseases, Rady Faculty of Health Sciences University of Manitoba, Winnipeg, Manitoba, Canada;,Universidad Pontificia Bolivariana, Medellín, Colombia;,Address correspondence to Zulma Vanessa Rueda, Department of Medical Microbiology and Infectious Diseases, Rady Faculty of Health Sciences, University of Manitoba, Rm 512, Basic Medical Sciences Building, 745 Bannatyne Avenue, Winnipeg, MB, R3E 0J9. E-mail:
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19
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Rueda ZV, Bermúdez M, Restrepo A, Garcés C, Morales O, Roya-Pabón C, Carmona LF, Arango C, Albarracín JL, López L, Aguilar Y, Maya MA, Trujillo M, Copete ÁR, Vera C, Herrera M, Giraldo MR, Niño-Cruz GI, Vélez LA. Induced sputum as an adequate clinical specimen for the etiological diagnosis of community-acquired pneumonia (CAP) in children and adolescents. Int J Infect Dis 2022; 116:348-354. [DOI: 10.1016/j.ijid.2022.01.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 01/10/2022] [Accepted: 01/12/2022] [Indexed: 10/19/2022] Open
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20
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González-Duran JA, Plaza RV, Luna L, Arbeláez MP, Deviaene M, Keynan Y, Rueda ZV, Marin D. Delayed HIV treatment, barriers in access to care and mortality in tuberculosis/HIV co-infected patients in Cali, Colombia. Colomb Med (Cali) 2021; 52:e2024875. [PMID: 35571589 PMCID: PMC9067911 DOI: 10.25100/cm.v52i3.4875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 11/29/2021] [Accepted: 12/06/2021] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To determine factors associated with mortality in tuberculosis/HIV co-infected patients in Cali, Colombia. METHODS This retrospective cohort design included tuberculosis/HIV co-infected persons. Kaplan-Meier and Cox regression were used to estimate survival and risk factors associated with mortality. RESULTS Of the 279 tuberculosis/HIV co-infected participants, 27.2% died during the study. Participants mainly were adults and males. CD4 count information was available for 41.6% (the median count was 83 cells/mm3), and half were subject to tuberculosis susceptibility testing. The median time between HIV diagnosis and antiretroviral therapy initiation was 372 days. HIV was identified prior to tuberculosis in 53% and concurrent HIV-tuberculosis were diagnosed in 37% of patients. 44.8% had tuberculosis treatment success. Body mass index above 18 kg/m2, initiation of tuberculosis treatment within two weeks, having any health insurance coverage and CD4 count information conferred a survival advantage. CONCLUSIONS Delays in treatment initiation and factors associated with limited health care access or utilization were associated with mortality. As HIV and tuberculosis are both reportable conditions in Colombia, strategies should be focused on optimizing treatment outcomes within both tuberculosis and HIV programs, particularly improving early HIV diagnosis, early antiretroviral therapy treatment initiation, and adherence to tuberculosis treatment.
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Affiliation(s)
| | - Regina V Plaza
- Universidad del Cauca, Facultad de Ciencias de la Salud, Popayán, Colombia
| | - Lucy Luna
- Secretaría de Salud de Cali, Programa de tuberculosis, Cali, Colombia
| | | | - Meagan Deviaene
- University of Manitoba, Department of Medical Microbiology and Infectious Diseases, Winnipeg, Manitoba, Canada
| | - Yoav Keynan
- University of Manitoba, Department of Medical Microbiology and Infectious Diseases, Winnipeg, Manitoba, Canada
| | - Zulma Vanessa Rueda
- University of Manitoba, Department of Medical Microbiology and Infectious Diseases, Winnipeg, Manitoba, Canada
| | - Diana Marin
- Universidad Pontificia Bolivariana, School of Medicine, Medellín, Colombia
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21
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Vera C, Rueda ZV. Transmission and Colonization of Pneumocystis jirovecii. J Fungi (Basel) 2021; 7:jof7110979. [PMID: 34829266 PMCID: PMC8622989 DOI: 10.3390/jof7110979] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 11/01/2021] [Accepted: 11/05/2021] [Indexed: 11/17/2022] Open
Abstract
Pneumocystis spp. was discovered in 1909 and was classified as a fungus in 1988. The species that infects humans is called P. jirovecii and important characteristics of its genome have recently been discovered. Important advances have been made to understand P. jirovecii, including aspects of its biology, evolution, lifecycle, and pathogenesis; it is now considered that the main route of transmission is airborne and that the infectious form is the asci (cyst), but it is unclear whether there is transmission by direct contact or droplet spread. On the other hand, P. jirovecii has been detected in respiratory secretions of hosts without causing disease, which has been termed asymptomatic carrier status or colonization (frequency in immunocompetent patients: 0–65%, pregnancy: 15.5%, children: 0–100%, HIV-positive patients: 20–69%, cystic fibrosis: 1–22%, and COPD: 16–55%). This article briefly describes the history of its discovery and the nomenclature of Pneumocystis spp., recently uncovered characteristics of its genome, and what research has been done on the transmission and colonization of P. jirovecii. Based on the literature, the authors of this review propose a hypothetical natural history of P. jirovecii infection in humans.
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Affiliation(s)
- Cristian Vera
- Grupo de Investigación en Salud Pública, Research Department, Facultad de Medicina, Universidad Pontificia Bolivariana, Medellín 050031, Colombia
- Correspondence:
| | - Zulma Vanessa Rueda
- Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg RT3, Colombia;
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22
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Paniagua-Saldarriaga LA, Pelissari DM, Rueda ZV. Factors Associated with Unsuccessful Outcomes of Tuberculosis Treatment in 125 Municipalities in Colombia 2014 to 2016. Am J Trop Med Hyg 2021; 105:1326-1334. [PMID: 34491226 DOI: 10.4269/ajtmh.20-1063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Accepted: 06/10/2021] [Indexed: 11/07/2022] Open
Abstract
Our aim was to identify the risk factors associated with unsuccessful outcomes of tuberculosis (TB) treatment in patients diagnosed between 2014 and 2016 in the 125 municipalities of Antioquia, Colombia. We studied a retrospective cohort of patients with TB diagnosed between 2014 and 2016, from national routine surveillance systems, in 125 municipalities of Antioquia. Factors associated with unsuccessful tuberculosis treatment outcomes (treatment failed, lost to follow up, or death) were identified utilizing a Poisson regression with robust variance. Over 3 years, of the 6,739 drug-susceptible tuberculosis patients, 73.4% had successful treatment and 26.6% unsuccessful outcomes (17% lost to follow up, 8.9% deaths, and 0.7% treatment failures). Patients with subsidized health insurance (Relative risk [RR]: 2.4; 95% CI: 2.1-2.8) and without health insurance (RR: 2.5; 95% CI: 2.1-3.0) had a higher risk for unsuccessful tuberculosis treatment compared to those with contributive health insurance. Other risk factors included age over 15 years, male sex, homelessness, people living with HIV, previous treatment, and primary diagnosis during hospitalization. Protective factors were living in a rural area and extrapulmonary disease. It is important to generate strategies that improves tuberculosis diagnosis in primary healthcare institutions. In addition, it is imperative to initiate new research about the barriers and obstacles related to patients, healthcare workers and services, and the health system, including the analysis of urban violence, to understand why the goal of TB treatment success has not been reached.
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Affiliation(s)
| | | | - Zulma Vanessa Rueda
- Research Department, School of Medicine, Universidad Pontificia Bolivariana, Medellín, Colombia.,Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, Canada
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Walter KS, Martinez L, Arakaki-Sanchez D, Sequera VG, Estigarribia Sanabria G, Cohen T, Ko AI, García-Basteiro AL, Rueda ZV, López-Olarte RA, Espinal MA, Croda J, Andrews JR. The escalating tuberculosis crisis in central and South American prisons. Lancet 2021; 397:1591-1596. [PMID: 33838724 PMCID: PMC9393884 DOI: 10.1016/s0140-6736(20)32578-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 10/26/2020] [Accepted: 11/25/2020] [Indexed: 12/14/2022]
Abstract
In the past decade, tuberculosis incidence has declined in much of the world, but has risen in central and South America. It is not yet clear what is driving this reversal of progress in tuberculosis control. Since 2000, the incarcerated population in central and South America has grown by 206%, the greatest increase in the world. Over the same period, notified tuberculosis cases among the incarcerated population (hereinafter termed persons deprived of their liberty [PDL], following the Inter-American Commission on Human Rights) have risen by 269%. In both central and South America, the rise of disease among PDL more than offsets tuberculosis control gains in the general population. Tuberculosis is increasingly concentrated among PDL; currently, 11% of all notified tuberculosis cases in central and South America occur among PDL who comprise less than 1% of the population. The extraordinarily high risk of acquiring tuberculosis within prisons creates a health and human rights crisis for PDL that also undermines wider tuberculosis control efforts. Controlling tuberculosis in this region will require countries to take urgent measures to prioritise the health of PDL.
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Affiliation(s)
- Katharine S Walter
- Division of Infectious Diseases & Geographic Medicine, School of Medicine, Stanford University, Stanford, CA, USA.
| | - Leonardo Martinez
- Division of Infectious Diseases & Geographic Medicine, School of Medicine, Stanford University, Stanford, CA, USA
| | | | - Victor G Sequera
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain; Department of Health Surveillance, Asunción, Paraguay
| | - G Estigarribia Sanabria
- Instituto Regional de Investigación en Salud, Universidad Nacional de Caaguazú, Coronel Oviedo, Paraguay
| | - Ted Cohen
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA
| | - Albert I Ko
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA; Oswaldo Cruz Foundation, Salvador, Brazil
| | - Alberto L García-Basteiro
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain; Centro de Investigação em Saude de Manhiça (CISM), Maputo, Mozambique
| | - Zulma Vanessa Rueda
- Universidad Pontificia Bolivariana, Medellín, Colombia; University of Manitoba, Winnipeg, Canada
| | - Rafael A López-Olarte
- Pan American Health Organization, Communicable Diseases and Environmental Determinants of Health, Washington, DC, USA
| | - Marcos A Espinal
- Pan American Health Organization, Communicable Diseases and Environmental Determinants of Health, Washington, DC, USA
| | - Julio Croda
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA; School of Medicine, Federal University of Mato Grosso do Sul, Campo Grande, Brazil; Oswaldo Cruz Foundation, Mato Grosso do Sul, Brazil
| | - Jason R Andrews
- Division of Infectious Diseases & Geographic Medicine, School of Medicine, Stanford University, Stanford, CA, USA
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Cabrera Orrego R, Ríos-Osorio LA, Keynan Y, Rueda ZV, Gutiérrez LA. Molecular detection of Coxiella burnetii in livestock farmers and cattle from Magdalena Medio in Antioquia, Colombia. PLoS One 2020; 15:e0234360. [PMID: 32520958 PMCID: PMC7286501 DOI: 10.1371/journal.pone.0234360] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 05/23/2020] [Indexed: 12/11/2022] Open
Abstract
Coxiella burnetii causes Q fever in humans and coxiellosis in animals. In humans, it causes acute febrile illnesses like influenza, pneumonia, hepatitis, and chronic illnesses such as endocarditis, vascular infection, and post-infectious fatigue syndrome. It is widely distributed worldwide, and its main reservoirs are sheep, goats, and cattle. This study aimed to determine the frequency of C. burnetii infection using molecular detection and to identify the associated factors in livestock farmers and cattle from the Magdalena Medio region of Antioquia, Colombia. Using real-time polymerase chain reaction (PCR), molecular detection was performed for the IS1111 insertion sequence of C. burnetii using genomic DNA collected from the peripheral blood of 143 livestock farmers and 192 cattle from 24 farms located in Puerto Berrío, Puerto Nare, and Puerto Triunfo. To confirm the results, bidirectional amplicon sequencing of 16S rRNA was performed in four of the positive samples. Additionally, factors associated with C. burnetii were identified using a Poisson regression with cluster effect adjustment. Real-time PCR showed positive results in 25.9% and 19.5% of livestock farmer samples and cattle samples, respectively. For livestock farmers, factors associated with C. burnetii were the area where the farm was located [Puerto Berrío, adjusted prevalence ratio (aPR): 2.13, 95% confidence interval (CI): 1.10-4.11], presence of hens (aPR: 1.47, 95% CI: 1.21-1.79), horses (aPR: 1.61, 95% CI: 1.54-1.67), and ticks (aPR: 2.36, 95% CI: 1.03-5.42) in the residence, and consumption of raw milk (aPR: 1.47, 95% CI: 1.26-1.72). For cattle, the factors associated with Coxiella genus were municipality (Puerto Nare; aPR: 0.39, 95% CI: 0.37-0.41) and time of residence on the farm (≥49 months; aPR: 2.28, 95% CI: 1.03-5.20). By analyzing sequences of the 16S rRNA molecular marker, C. burnetii infection was confirmed in livestock farmers. However, in cattle, only the presence of Coxiella-type bacteria was identified. Further research is necessary to determine the potential role that these types of bacteria have as etiological agents for disease in livestock farmers and cattle from the study area.
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Affiliation(s)
- Ruth Cabrera Orrego
- Escuela de Ciencias de la Salud, Facultad de Medicina, Grupo Biología de Sistemas, Universidad Pontificia Bolivariana, Medellín, Antioquia, Colombia
| | - Leonardo Alberto Ríos-Osorio
- Escuela de Microbiología, Grupo de Investigación en Microbiología Veterinaria, Universidad de Antioquia, Medellín, Colombia
| | - Yoav Keynan
- Department of Internal Medicine, Medical Microbiology & Infectious Diseases and Community Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Zulma Vanessa Rueda
- Escuela de Ciencias de la Salud, Facultad de Medicina, Grupo de Investigación en Salud Pública, Universidad Pontificia Bolivariana, Medellín, Antioquia, Colombia
| | - Lina Andrea Gutiérrez
- Escuela de Ciencias de la Salud, Facultad de Medicina, Grupo Biología de Sistemas, Universidad Pontificia Bolivariana, Medellín, Antioquia, Colombia
- * E-mail:
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Ríos-Hincapié CY, Rojas M, López M, Porras A, Luque R, Pelissari DM, López L, Rueda ZV. Delays in HIV and TB diagnosis and treatment initiation in co-infected patients in Colombia. Int J STD AIDS 2020; 31:410-419. [PMID: 32183614 DOI: 10.1177/0956462419881074] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We investigated the delays in the diagnosis of tuberculosis and/or HIV, their treatment initiation, and factors associated with each delay. All drug-susceptible tuberculosis cases diagnosed in 2014 and 2015 in Colombia, with a confirmed diagnosis of HIV were included. A total of 1909 patients were registered with tuberculosis/HIV co-infection. Seventy-nine percent of patients were men, 50% had sputum smear-negative tuberculosis, culture was done in 50% of cases, 68.5% had <200 CD4 cell count at diagnosis, and 35% had concurrent tuberculosis/HIV diagnosis. Delays in the tuberculosis diagnosis were identified in 54.8% of the patients, and delays in tuberculosis and HIV treatment initiation in 41.8% and 27.4%, respectively. The risk factors associated with delay in tuberculosis diagnosis were age between 15–34 and ≥45 years, and those patients who received tuberculin skin test. The risk factor associated with antiretroviral therapy initiation delay was previously-treated tuberculosis patients after failure. It is necessary to implement strategies for early detection and treatment initiation of HIV and to use rapid test for tuberculosis diagnosis in this population.
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Affiliation(s)
| | - Marcela Rojas
- Ministerio de Salud y Protección Social, Bogotá, Colombia
| | - Martha López
- Dirección de Vigilancia y Análisis del Riesgo en Salud Pública, Instituto Nacional de Salud, Bogotá, Colombia
| | - Alexandra Porras
- Grupo de Medicina Comunitaria y Salud Colectiva, Universidad del Bosque, Bogotá, Colombia
| | - Ricardo Luque
- Ministerio de Salud y Protección Social, Bogotá, Colombia
| | | | - Lucelly López
- Research Department, School of Medicine, Universidad Pontificia Bolivariana, Medellín, Colombia
| | - Zulma Vanessa Rueda
- Research Department, School of Medicine, Universidad Pontificia Bolivariana, Medellín, Colombia
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26
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López L, Keynan Y, Marin D, Ríos-Hincapie CY, Montes F, Escudero-Atehortua AC, Rueda ZV. Is tuberculosis elimination a feasible goal in Colombia by 2050? Health Policy Plan 2020; 35:47-57. [PMID: 31665295 DOI: 10.1093/heapol/czz122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/06/2019] [Indexed: 11/13/2022] Open
Abstract
Colombia has an underreporting of 30% of the total cases, according to World Health Organization (WHO) estimations. In 2016, successful tuberculosis (TB) treatment rate was 70%, and the mortality rate ranged between 3.5% and 10%. In 2015, Colombia adopted and adapted the End TB strategy and set a target of 50% reduction in incidence and mortality by 2035 compared with 2015. The aims of this study were: To evaluate whether Colombia will be able to achieve the goals of TB incidence and mortality by 2050, using the current strategies; and whether the implementation of new screening, diagnosis and TB treatment strategies will allow to achieve those WHO targets. An ecological study was conducted using TB case-notification, successful treatment and mortality rates from the last 8 years (2009-17). System dynamics analysis was performed using simulated scenarios: (1) continuation with the same trends following the trajectory of the last 8 years (Status quo) and (2) modification of the targets between 2017 through 2050, assuming the implementation of multimodal strategies to increase the screening, to improve the early diagnosis and to improve the treatment adherence. Following the current strategies, it is projected that Colombia will not achieve the End TB strategy targets. Achieving the goal of TB incidence of 10/100 000 by 2050 will only be possible by implementing combined strategies for increasing screening of people with respiratory symptoms, improving access to rapid diagnostic tests and improving treatment adherence. Therefore, it is necessary to design and implement simultaneous strategies according to the population needs and resources, in order to stride towards the End TB targets.
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Affiliation(s)
- Lucelly López
- Research Department Facultad de Medicina, Universidad Pontificia Bolivariana, Calle 78B # 72A-109, Medellín, Colombia
| | - Yoav Keynan
- Department of Medical Microbiology and Infectious Disease, University of Manitoba, Winnipeg, Canada.,Department of Internal Medicine, University of Manitoba, Winnipeg, Canada.,Department of Community Health Science, University of Manitoba, Winnipeg, Canada
| | - Diana Marin
- Research Department Facultad de Medicina, Universidad Pontificia Bolivariana, Calle 78B # 72A-109, Medellín, Colombia
| | | | | | | | - Zulma Vanessa Rueda
- Research Department Facultad de Medicina, Universidad Pontificia Bolivariana, Calle 78B # 72A-109, Medellín, Colombia
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Chen JO, Qiu YB, Rueda ZV, Hou JL, Lu KY, Chen LP, Su WW, Huang L, Zhao F, Li T, Xu L. Correction to: Role of community-based active case finding in screening tuberculosis in Yunnan province of China. Infect Dis Poverty 2020; 9:7. [PMID: 31954401 PMCID: PMC6969473 DOI: 10.1186/s40249-020-0625-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Jin-Ou Chen
- Division of tuberculosis control and prevention, Yunnan Center for Disease Control and Prevention, Kunming, China
| | - Yu-Bing Qiu
- Division of tuberculosis control and prevention, Yunnan Center for Disease Control and Prevention, Kunming, China
| | | | - Jing-Long Hou
- Division of tuberculosis control and prevention, Yunnan Center for Disease Control and Prevention, Kunming, China
| | - Kun-Yun Lu
- Division of tuberculosis control and prevention, Yunnan Center for Disease Control and Prevention, Kunming, China
| | - Liu-Ping Chen
- Division of tuberculosis control and prevention, Yunnan Center for Disease Control and Prevention, Kunming, China
| | - Wei-Wei Su
- Division of tuberculosis control and prevention, Yunnan Center for Disease Control and Prevention, Kunming, China
| | - Li Huang
- Division of tuberculosis control and prevention, Yunnan Center for Disease Control and Prevention, Kunming, China
| | - Fei Zhao
- Clinical trail and research center of Beijing hospital, Beijing, China
| | - Tao Li
- Chinese Center for Disease Control and Prevention, Beijing, China
| | - Lin Xu
- Division of tuberculosis control and prevention, Yunnan Center for Disease Control and Prevention, Kunming, China.
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Gómez LM, Paniagua-Saldarriaga LA, Richert Q, Keynan Y, Montes F, López L, Rueda ZV. Homelessness and HIV: A Combination Predictive of Poor Tuberculosis Treatment Outcomes and in Need of Innovative Strategies to Improve Treatment Completion. Am J Trop Med Hyg 2020; 100:932-939. [PMID: 30860023 DOI: 10.4269/ajtmh.18-0305] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Antioquia Department is the state with the highest burden of tuberculosis (TB) in Colombia. Our aim was to determine the risk factors associated with unsuccessful TB treatment in HIV-seropositive and homeless persons, compared with non-HIV-infected and non-homeless persons with TB. We conducted a retrospective cohort study using observational, routinely collected health data from all drug-susceptible TB cases in homeless and/or HIV-seropositive individuals in Antioquia from 2014 to 2016. Unsuccessful TB treatment was defined as individuals having been lost to follow-up, having died, or treatment failure occurrence during the study period. Successful treatment was defined as cure of TB or treatment completion according to the WHO definitions. We identified 544 homeless persons with TB (432 HIV- and 112 HIV+), 835 HIV+ persons with TB and non-homeless, and 5,086 HIV-/non-homeless people with TB. Unsuccessful treatment rates were 19.3% in HIV-/non-homeless persons, 37.4% in non-homeless HIV+ patients, 61.5% in homeless HIV- patients, and 70.3% in homeless HIV+ patients; all rates fall below End TB strategy targets. More than 50% of homeless patients were lost to follow-up. Risk factors associated with unsuccessful treatment were HIV seropositivity, homelessness, male gender, age ≥ 25 years, noncontributory-type health insurance, TB diagnosis made during hospitalization, and previous treatment for TB. These results highlight the challenge of treating TB in the homeless population. These findings should put an onus on TB programs, governments, clinicians, and others involved in the collaborative care of TB patients to pursue innovative strategies to improve treatment success in this population.
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Affiliation(s)
| | | | - Quinlan Richert
- Department of Internal Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada
| | - Yoav Keynan
- Department of Community Health Science, University of Manitoba, Winnipeg, Canada.,Department of Internal Medicine, University of Manitoba, Winnipeg, Canada.,Department of Medical Microbiology and Infectious Disease, University of Manitoba, Winnipeg, Canada
| | | | - Lucelly López
- Facultad de Medicina, Universidad Pontificia Bolivariana, Medellín, Colombia
| | - Zulma Vanessa Rueda
- Facultad de Medicina, Universidad Pontificia Bolivariana, Medellín, Colombia
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Abstract
To determine the prevalence and incidence of LTBI among prison guards and to the risk factors associated with infection. Two male prisons in Medellín and Itaguí, Colombia. A cohort study was conducted in adult prison guards that consented to participate. Exclusion criteria included: previous or current active TB, or conditions that preclude TST administration. We screened 194 guards and completed 155 TST administrations. The prevalence of LTBI was 55.8% in prison one, and 39.1% in prison two. The risk factors associated with LTBI diagnosis included drug use at least once in a lifetime (PR: 1.75; 95% CI 1.42-2.15) and male sex (PR: 2.16; 95% CI 1.01-4.62). The cumulative incidence of TST conversion over 6 months was 3.2%. All conversions occurred in prison 1. Our findings suggest an occupational risk for LTBI prevalence and incidence among guards (different prevalence and incidence according to the prison they work).
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Affiliation(s)
- Luisa Arroyave
- Facultad Nacional de Salud Pública, Universidad de Antioquia UdeA, Medellín, Colombia
| | - Yoav Keynan
- Department of Medical Microbiology, Department of Internal Medicine, Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Deny Sanchez
- Facultad Nacional de Salud Pública, Universidad de Antioquia UdeA, Medellín, Colombia
| | - Lucelly López
- Facultad de Medicina, Escuela de Ciencias de la Salud, Universidad Pontificia Bolivariana, Calle 78B No. 72A-109, Medellín, Colombia
| | - Diana Marin
- Facultad de Medicina, Escuela de Ciencias de la Salud, Universidad Pontificia Bolivariana, Calle 78B No. 72A-109, Medellín, Colombia
| | - Maryluz Posada
- Facultad Nacional de Salud Pública, Universidad de Antioquia UdeA, Medellín, Colombia
| | - Zulma Vanessa Rueda
- Facultad de Medicina, Escuela de Ciencias de la Salud, Universidad Pontificia Bolivariana, Calle 78B No. 72A-109, Medellín, Colombia.
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Chen JO, Qiu YB, Rueda ZV, Hou JL, Lu KY, Chen LP, Su WW, Huang L, Zhao F, Li T, Xu L. Role of community-based active case finding in screening tuberculosis in Yunnan province of China. Infect Dis Poverty 2019; 8:92. [PMID: 31661031 PMCID: PMC6819334 DOI: 10.1186/s40249-019-0602-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 10/09/2019] [Indexed: 02/02/2023] Open
Abstract
Background The barriers to access diagnosis and receive treatment, in addition to insufficient case identification and reporting, lead to tuberculosis (TB) spreads in communities, especially among hard-to-reach populations. This study evaluated a community-based active case finding (ACF) strategy for the detection of tuberculosis cases among high-risk groups and general population in China between 2013 and 2015. Methods This retrospective cohort study conducted an ACF in ten communities of Dongchuan County, located in northeast Yunnan Province between 2013 and 2015; and compared to 136 communities that had passive case finding (PCF). The algorithm for ACF was: 1) screen for TB symptoms among community enrolled residents by home visits, 2) those with positive symptoms along with defined high-risk groups underwent chest X-ray (CXR), followed by sputum microscopy confirmation. TB incidence proportion and the number needed to screen (NNS) to detect one case were calculated to evaluate the ACF strategy compared to PCF, chi-square test was applied to compare the incidence proportion of TB cases’ demography and the characteristics for detected cases under different strategies. Thereafter, the incidence rate ratio (IRR) and multiple Fisher’s exact test were applied to compare the incidence proportion between general population and high-risk groups. Patient and diagnostic delays for ACF and PCF were compared by Wilcoxon rank sum test. Results A total of 97 521 enrolled residents were visited with the ACF cumulatively, 12.3% were defined as high-risk groups or had TB symptoms. Sixty-six new TB patients were detected by ACF. There was no significant difference between the cumulative TB incidence proportion for ACF (67.7/100000 population) and the prevalence for PCF (62.6/100000 population) during 2013 to 2015, though the incidence proportion in ACF communities decreased after three rounds active screening, concurrent with the remained stable prevalence in PCF communities. The cumulative NNS were 34, 39 and 29 in HIV/AIDS infected individuals, people with positive TB symptoms and history of previous TB, respectively, compared to 1478 in the general population. The median patient delay under ACF was 1 day (Interquartile range, IQR: 0–27) compared to PCF with 30 days (IQR: 14–61). Conclusions This study confirmed that massive ACF was not effective in general population in a moderate TB prevalence setting. The priority should be the definition and targeting of high-risk groups in the community before the screening process is launched. The shorter time interval of ACF between TB symptoms onset and linkage to healthcare service may decrease the risk of TB community transmission. Furthermore, integrated ACF strategy in the National Project of Basic Public Health Service may have long term public health impact.
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Affiliation(s)
- Jin-Ou Chen
- Division of tuberculosis control and prevention, Yunnan Center for Disease Control and Prevention, Kunming, China
| | - Yu-Bing Qiu
- Division of tuberculosis control and prevention, Yunnan Center for Disease Control and Prevention, Kunming, China
| | | | - Jing-Long Hou
- Division of tuberculosis control and prevention, Yunnan Center for Disease Control and Prevention, Kunming, China
| | - Kun-Yun Lu
- Division of tuberculosis control and prevention, Yunnan Center for Disease Control and Prevention, Kunming, China
| | - Liu-Ping Chen
- Division of tuberculosis control and prevention, Yunnan Center for Disease Control and Prevention, Kunming, China
| | - Wei-Wei Su
- Division of tuberculosis control and prevention, Yunnan Center for Disease Control and Prevention, Kunming, China
| | - Li Huang
- Division of tuberculosis control and prevention, Yunnan Center for Disease Control and Prevention, Kunming, China
| | - Fei Zhao
- Clinical trail and research center of Beijing hospital, Beijing, China
| | - Tao Li
- Chinese Center for Disease Control and Prevention, Beijing, China
| | - Lin Xu
- Division of tuberculosis control and prevention, Yunnan Center for Disease Control and Prevention, Kunming, China.
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Mao R, Trajtman A, Head B, Rodríguez Sabogal IA, Cabrera R, Marín D, López L, Rodiño J, Aguilar Y, Herrera Díaz M, Vélez LA, Rueda ZV, Keynan Y. Inflammatory Cell Differentiation and Chemotaxis and Extracellular Tissue Repair Markers Are Correlated with Pulmonary Dysfunction in HIV Infected Individuals Presenting with Community-Acquired Pneumonia. J Interferon Cytokine Res 2019; 40:106-115. [PMID: 31638452 DOI: 10.1089/jir.2019.0090] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Prior studies have shown that HIV patients develop permanent pulmonary dysfunction following an episode of community-acquired pneumonia (CAP). However, the mechanism causing pulmonary dysfunction remains an enigma. HIV patients experience chronic inflammation. We hypothesized that CAP exacerbates inflammation in HIV patients resulting in an accelerated decline in lung function. A prospective cohort pilot study enrolled HIV patients hospitalized in Medellin, Colombia, with a diagnosis of CAP. Sixteen patients were eligible for the study; they were split into 2 groups: HIV and HIV+CAP. Plasma, sputum, and pulmonary function test (PFT) measurements were retrieved within 48 h of hospital admission and at 1 month follow-up. The concentrations of 13 molecules and PFT values were compared between the 2 cohorts. The HIV+CAP group had lower lung function compared to the HIV group; forced vital capacity (FVC)% predicted and forced expiratory volume in 1 s (FEV1)% predicted decreased, while FEV1/FVC remained constant. APRIL, BAFF, CCL3, and TIMP-1 correlated negatively with FVC% predicted and FEV1% predicted; the relationships however were moderate in strength. Furthermore, the concentrations of BAFF, CCL3, and TIMP-1 were statistically significant between the 2 groups (P ≤ 0.05). Our results indicate that HIV patients with CAP have a different inflammatory pattern and lower lung function compared to HIV patients without CAP. BAFF, CCL3, and TIMP-1 were abnormally elevated in HIV patients with CAP. Future studies with larger cohorts are required to verify these results. In addition, further investigation is required to determine if BAFF, CCL3, and TIMP-1 play a role in the process causing pulmonary dysfunction.
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Affiliation(s)
| | | | | | | | - Ruth Cabrera
- Universidad Pontificia Bolivariana, Medellin, Colombia
| | - Diana Marín
- Universidad Pontificia Bolivariana, Medellin, Colombia
| | - Lucelly López
- Universidad Pontificia Bolivariana, Medellin, Colombia
| | | | | | | | - Lázaro Agustín Vélez
- Universidad de Antioquia, Medellin, Colombia.,Hospital Universitario San Vicente Fundación, Medellin, Colombia
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Gil N, López L, Rodríguez D, Rondón M, Betancourt A, Gutiérrez B, Rueda ZV. Myths and realities about knowledge, attitudes and practices of household contacts of tuberculosis patients. Int J Tuberc Lung Dis 2019; 22:1293-1299. [PMID: 30355408 DOI: 10.5588/ijtld.17.0886] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
SETTING Five Colombian cities: Villavicencio, Pereira, Cucuta, Bucaramanga and Bosa. OBJECTIVE To describe the knowledge, attitudes and practices related to tuberculosis (TB) in household contacts (HHCs) of TB patients. METHODS A cross-sectional study was conducted. The estimated sample size required was 855. The World Health Organization guide 'Advocacy, communication and social mobilization for TB control: a guide to developing knowledge, attitude and practice surveys' was translated into Spanish and adapted to the dialect of each city. HHCs were invited to participate in the study and included if they agreed. RESULTS We interviewed 878 HHCs. Most of them knew that TB was transmitted by airborne droplets; however, 52.2% also said that TB could be transferred from one person to another by sharing plates or clothes or shaking hands. Fifty-five per cent of HHCs acquired TB-related information from health care workers, and 44% from family members and friends. Fear was the main reaction reported by HHCs when they were informed of a TB diagnosis (60%). Eighty-five per cent of HHCs answered that the community rejects or avoids TB cases. CONCLUSION There are significant gaps in the knowledge about TB and the stigmatisation associated with it. Educational strategies should be designed together with the community to demystify many misconceptions about TB.
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Affiliation(s)
- N Gil
- International Organization for Migration, Bogotá, Colombia, Pan American Health Organization, Washington DC, USA
| | - L López
- School of Medicine, Universidad Pontificia Bolivariana, Medellin
| | - D Rodríguez
- International Organization for Migration, Bogotá, Colombia
| | - M Rondón
- Facultad Nacional de Salud Pública, Universidad de Antioquia, Medellín, Colombia
| | - A Betancourt
- International Organization for Migration, Bogotá, Colombia
| | - B Gutiérrez
- International Organization for Migration, Bogotá, Colombia
| | - Z V Rueda
- School of Medicine, Universidad Pontificia Bolivariana, Medellin
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Gonzalez P, MartInez MB, Sierra V, Rueda ZV, Botero-Mariaca P. Tongue position assessment during oral phase deglutition in children with anterior open bite and normal vertical overbite. J Indian Soc Pedod Prev Dent 2019; 37:167-171. [PMID: 31249181 DOI: 10.4103/jisppd.jisppd_333_18] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Tongue position during deglutition presents great variability and can be assessed clinically or with different techniques. AIM This study aims to determine tongue position during deglutition in children aged 8-16 years with anterior open bite (AOB) and normal vertical overbite (NVO) using a fluorescein technique. SETTINGS AND DESIGN A cross-sectional analytical study was conducted to assess tongue contact points during the oral phase of deglutition. SUBJECTS AND METHODS A total of 132 children with AOB and 132 children with NVO were included in this study. The difference between tongue contacts in both groups was performed, and the association between tongue position and anterior occlusion was establish. STATISTICAL ANALYSIS USED Normal distribution analysis, Parson's Chi-square test (P < 0.05). RESULTS In AOB, about 28.8% showed tongue contact on the palatal surface of the incisors during the oral phase, 25.8% at the gingival margin, and 22% on the palatal rugae. Regarding NVO, 53% showed contact on the palatal rugae, 28.8% at the gingival margin, and 13.6% at the palatal surface. CONCLUSION AOB group presented a higher prevalence of impaired tongue positions compared to NVO controls. The palatal surface was the most frequent contact point in the AOB, whereas tongue showed contact points at the palatal rugae in NVO.
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Affiliation(s)
- Paula Gonzalez
- Department of Orthodontics, Cooperative University of Colombia, Medellín, Colombia
| | | | - Valentina Sierra
- Department of Phonoaudiology, Cooperative University of Colombia, Medellín, Colombia
| | - Zulma Vanessa Rueda
- Department of Statistic, Universidad Pontificia, Bolivariana, Medellín, Colombia
| | - Paola Botero-Mariaca
- Department of Orthodontics, Cooperative University of Colombia, Medellín, Colombia
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Delgado-Raygada JE, Sarmiento-Chía M, Lucchetti-Rodríguez A, Vélez L, Rueda ZV, Maya MA, López L, Ruiz L. [Características actuales de la coinfección con tuberculosis y el virus de la inmunodeficiencia humana en pacientes hospitalizados en Medellín, Colombia]. Biomedica 2019; 39:224-228. [PMID: 31021561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Indexed: 06/09/2023]
Affiliation(s)
- José Eduardo Delgado-Raygada
- Escuela de Medicina, Universidad Peruana de Ciencias Aplicadas, Lima, Perú; Sociedad Científica de Estudiantes de Medicina de la Universidad Peruana de Ciencias Aplicadas (SOCIEMUPC), Lima, Perú.
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Head BM, Trajtman A, Bernard K, Burdz T, Vélez L, Herrera M, Rueda ZV, Keynan Y. Legionella co-infection in HIV-associated pneumonia. Diagn Microbiol Infect Dis 2019; 95:71-76. [PMID: 31072645 DOI: 10.1016/j.diagmicrobio.2019.03.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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: 08/31/2018] [Revised: 02/04/2019] [Accepted: 03/11/2019] [Indexed: 10/27/2022]
Abstract
Due to poor diagnostics and increased co-infections, HIV-associated Legionella infections are underreported. We aimed to retrospectively determine the frequency of Legionella infections in bronchoalveolar lavage (BAL) from HIV-associated pneumonia patients hospitalized in Medellin, Colombia, between February 2007 and April 2014. Although culture was negative, 17 BAL (36%) were positive for Legionella by quantitative polymerase chain reaction, most of which were in the Mycobacterium tuberculosis or Pneumocystis jirovecii co-infected patients, and included L. anisa (n = 6), L. bozemanae (n = 4), L. pneumophila (n = 3), and L. micdadei (n = 2). All L. bozemanae and L. micdadei associated with Pneumocystis, while all L. pneumophila associated with M. tuberculosis. Legionella probable cases had more complications and higher mortality rates (P = 0.02) and were rarely administered empirical anti-Legionella therapy while in hospital. Clinicians should be aware of the possible presence of Legionella in HIV and M. tuberculosis or P. jirovecii co-infected patients.
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Affiliation(s)
- Breanne M Head
- Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, Manitoba, Canada.
| | - Adriana Trajtman
- Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, Manitoba, Canada.
| | - Kathryn Bernard
- Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, Manitoba, Canada; Special Bacteriology Unit, National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Manitoba, Canada.
| | - Tamara Burdz
- Special Bacteriology Unit, National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Manitoba, Canada.
| | - Lázaro Vélez
- Grupo Investigador de Problemas en Enfermedades Infecciosas, Universidad de Antioquia, Medellín, Antioquia, Colombia.
| | - Mariana Herrera
- Grupo Investigador de Problemas en Enfermedades Infecciosas, Universidad de Antioquia, Medellín, Antioquia, Colombia
| | - Zulma Vanessa Rueda
- Facultad de Medicina, Universidad Pontificia Bolivariana, Medellín, Antioquia, Colombia.
| | - Yoav Keynan
- Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, Manitoba, Canada; Facultad de Medicina, Universidad Pontificia Bolivariana, Medellín, Antioquia, Colombia; Department of Internal Medicine and Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.
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Guerra J, Mogollón D, González D, Sanchez R, Rueda ZV, Parra-López CA, Murcia MI. Active and latent tuberculosis among inmates in La Esperanza prison in Guaduas, Colombia. PLoS One 2019; 14:e0209895. [PMID: 30682199 PMCID: PMC6347203 DOI: 10.1371/journal.pone.0209895] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 12/13/2018] [Indexed: 12/29/2022] Open
Abstract
Introduction Active tuberculosis (TB) and latent tuberculosis infection (LTBI) are a public health threat in prisons around the world. The objectives of the study were to estimate the prevalence of LTBI and TB as well as to investigate TB transmission inside one prison, in Colombia. Methods A Cross-sectional study was conducted in inmates who agreed to participate. Inmates with respiratory symptoms (RS) of any duration underwent to medical evaluation and three sputum samples were taken for smear microscopy and culture for TB diagnosis. Drug susceptibility was analyzed using BACTEC MGIT 960 and GenoType MTBDRplus. Molecular genotyping of Mycobacterium tuberculosis isolates was performed by 24-Locus MIRU-VNTR and spoligotyping. LTBI was evaluated according to the result of the tuberculin skin test (TST). Close contact investigation was conducted inside the prison for inmates that shared the cell with the index TB case. Results Among 301/2,020 (15%) inmates with RS of any duration, 8% were diagnosed with active TB. The prevalence of active TB was 1,026 cases/100,000 inmates. We isolated M. tuberculosis in 19/24 (79%) TB cases, 94.7% were susceptible to first line drugs and only one was monoresistant to isoniazid. The most prevalent sub-lineage was Haarlem (68.4%), followed by LAM (26.3%) and T superfamily (5.3%). 24-Locus MIRU-VNTR typing results alone or in combination with spoligotyping identified three clusters containing two isolates each. Two clusters corresponded to inmates that shared the same cell, but each one was located in different blocks of the prison. Inmates from the last cluster were in the same block in nearby cells. TST reading was performed in 95.6% inmates, and 67.6% had a positive reaction. Conclusions The prevalence of LTBI and TB was higher in prison than in the general population. Molecular genotyping suggests that TB in this prison is mainly caused by strains imported by inmates or endogenous reactivation.
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Affiliation(s)
- Julio Guerra
- Grupo MICOBAC-UN, Departamento de Microbiología, Facultad de Medicina, Universidad Nacional de Colombia, Bogotá DC, Colombia
| | - Daniel Mogollón
- Grupo MICOBAC-UN, Departamento de Microbiología, Facultad de Medicina, Universidad Nacional de Colombia, Bogotá DC, Colombia
| | - Deccy González
- Programa de Tuberculosis y Lepra, Secretaría de Salud de Cundinamarca, Bogotá DC, Colombia
| | - Ricardo Sanchez
- Departamento de Psiquiatría, Facultad de Medicina, Universidad Nacional de Colombia, Bogotá DC, Colombia
| | - Zulma Vanessa Rueda
- Facultad de Medicina, Universidad Pontificia Bolivariana, Medellín, Antioquia, Colombia
| | - Carlos A. Parra-López
- Grupo MICOBAC-UN, Departamento de Microbiología, Facultad de Medicina, Universidad Nacional de Colombia, Bogotá DC, Colombia
| | - Martha Isabel Murcia
- Grupo MICOBAC-UN, Departamento de Microbiología, Facultad de Medicina, Universidad Nacional de Colombia, Bogotá DC, Colombia
- * E-mail:
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Botero-Mariaca P, Sierra-Alzate V, Rueda ZV, Gonzalez D. Lingual function in children with anterior open bite: A case-control study. Int Orthod 2018; 16:733-743. [DOI: 10.1016/j.ortho.2018.09.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Botero-Mariaca P, Sierra-Alzate V, Rueda ZV, Gonzalez D. Fonction linguale chez les enfants présentant une béance antérieure : une étude cas témoin. Int Orthod 2018; 16:733-743. [DOI: 10.1016/j.ortho.2018.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Vera C, Aguilar YA, Vélez LA, Rueda ZV. High transient colonization by Pneumocystis jirovecii between mothers and newborn. Eur J Pediatr 2017; 176:1619-1627. [PMID: 28913714 DOI: 10.1007/s00431-017-3011-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Revised: 08/23/2017] [Accepted: 09/04/2017] [Indexed: 12/20/2022]
Abstract
UNLABELLED The aim of the study was to explore the frequency and dynamics of acquisition and colonization of Pneumocystis jirovecii among neonates, as well as the epidemiological and genotypic characteristics in mother-child binomial. In a prospective enrolled cohort of women in their third trimester of pregnancy, nasopharyngeal swabs (NPS) and clinical and epidemiological data were collected at four different times: 17 days, 2nd, 4th, and 6th month of life of the newborn. P. jirovecii was detected by nested-PCR for the mtLSU-rRNA gene in each NPS; the genotypes were determined amplifying four genes. Forty-three pairs and 301 NPS were included. During the third trimester, 16.3% of pregnant women were colonized. The rate of colonization in mothers at delivery was 16, 6, 16, and 5% and in their children 28, 43, 42, and 25%, respectively. Within pregnant women, 53% remained negative throughout follow-up, and among these, 91% of their children were positive in at least one of their samples. In both, mothers and children, the most frequent genotype of P. jirovecii was 1. CONCLUSION The frequency of colonization by P. jirovecii was higher in newborns than in their respective progenitors. Colonization of both mothers and children is transitory; however, the mother of the newborn is not necessarily the source of primary infection. What is Known: • We did not find studies comparing P. jirovecii colonization between mothers and children simultaneously, yet the frequency of colonization by serologic and molecular methods in pregnant women has been reported. What is New: • According to our findings, 3/4 of the children had transient colonization during the first 6 months of life, in only half in the mothers, without proof of mother-to-child transmission or vice versa.
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Affiliation(s)
- Cristian Vera
- Grupo investigador de Problemas en Enfermedades Infecciosas (GRIPE), Universidad de Antioquia, Medellín, Colombia.
- Facultad Nacional de Salud Pública, Universidad de Antioquia, Medellín, Colombia.
| | - Yudy A Aguilar
- Grupo investigador de Problemas en Enfermedades Infecciosas (GRIPE), Universidad de Antioquia, Medellín, Colombia
| | - Lázaro A Vélez
- Grupo investigador de Problemas en Enfermedades Infecciosas (GRIPE), Universidad de Antioquia, Medellín, Colombia
- Sección de Enfermedades Infecciosas, Hospital Universitario San Vicente Fundación, Medellín, Colombia
| | - Zulma Vanessa Rueda
- Facultad de Medicina, Universidad Pontificia Bolivariana, Medellín, Colombia
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Copete AR, Aguilar YA, Rueda ZV, Vélez LA. Genotyping and macrolide resistance of Mycoplasma pneumoniae identified in children with community-acquired pneumonia in Medellín, Colombia. Int J Infect Dis 2017; 66:113-120. [PMID: 29155089 PMCID: PMC7129344 DOI: 10.1016/j.ijid.2017.11.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Revised: 11/07/2017] [Accepted: 11/09/2017] [Indexed: 01/19/2023] Open
Abstract
The majority of the Mycoplasma pneumoniae isolates obtained from the children with community-acquired pneumonia in this study were a variant of type 2. There was an absence of the mutations in the 23S rRNA gene related to macrolide resistance. Induced sputum sample has higher percentage of positive PCR to diagnose Mycoplasma pneumoniae compared to nasopharyngeal swab.
Objectives The aim of this study was to describe the genotypes and the main characteristics of community-acquired pneumonia (CAP) caused by Mycoplasma pneumoniae in hospitalized children in Medellín and neighboring municipalities during the period 2011–2012. Methods The M. pneumoniae genotype was determined by PCR and sequencing of the p1 and 23S rRNA genes from induced sputum samples and nasopharyngeal swabs (NPS). Samples were obtained from children with CAP who were hospitalized in 13 healthcare centers. In addition, a spatio-temporal analysis was performed to identify the potential risk areas and clustering of the cases over time. Results A variant of type 2 was the dominant genotype in the induced sputum (96.1%) and NPS (89.3%) samples; the type 1 variant was identified in 3.9% and 10.7% of these samples, respectively. No strains with mutations in the 23S rRNA gene associated with macrolide resistance were found. The cases in Medellín were mainly concentrated in the northeastern areas and western districts. However, no temporal relationship was found among these cases. Conclusions A variant of type 2 of M. pneumoniae prevailed among children with CAP during the study period. No strains with mutations associated with macrolide resistance were found.
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Affiliation(s)
- Angela Rocio Copete
- Research Group of Problems in Infectious Diseases (GRIPE), School of Medicine, Universidad de Antioquia UdeA, Medellín, Colombia.
| | - Yudy Alexandra Aguilar
- Research Group of Problems in Infectious Diseases (GRIPE), School of Medicine, Universidad de Antioquia UdeA, Medellín, Colombia.
| | | | - Lázaro Agustín Vélez
- Research Group of Problems in Infectious Diseases (GRIPE), School of Medicine, Universidad de Antioquia UdeA, Medellín, Colombia; Unit of Infectious Diseases, Hospital Universitario San Vicente Fundación, Medellín, Colombia.
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van Gaalen S, Duff M, Arroyave LF, Rueda ZV, Kasper K, Keynan Y. Characteristics of hospital admissions for pneumonia in HIV-positive individuals in Winnipeg, Manitoba: a cross-sectional retrospective analysis. Int J STD AIDS 2017; 29:115-121. [PMID: 28661231 DOI: 10.1177/0956462417717654] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Lung infection in human immunodeficiency virus (HIV)-positive individuals remains an important cause of morbidity and mortality, even in the current antiretroviral therapy era. Pneumonia is the most common cause of admission in HIV-positive individuals in our centre as reported in a previously published study. The objective of this retrospective observational study was to further characterize these admissions, with respect to index of disease severity at presentation, organisms identified, and investigations pursued including bronchoalveolar lavage (BAL). There were 123 unique patients accounting for a total of 209 admissions from 2005 to 2015. An organism was isolated in only 33% of all admissions (68/209). The most common organism was Pneumocystis jirovecii with a frequency of 29% of all admissions. Eighty-seven percent of presentations were mild, and 13% were moderate by CURB-65 criteria. A total of 39 BALs were performed, of which 27 yielded an organism (69%). Considering the burden of disease, low diagnostic yield of the current diagnostic strategy and increased morbidity and mortality caused by pneumonia in HIV-positive individuals, further methods are needed to more accurately target therapy. The preponderance of mild disease in this study suggests that better diagnostic tests may identify individuals that can be candidates for outpatient therapy.
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Affiliation(s)
- S van Gaalen
- 1 Department of Internal Medicine, 8664 University of Manitoba , Winnipeg, Canada
| | - Michael Duff
- 2 Department of Engineering, 8664 University of Manitoba , Winnipeg, Canada
| | | | - Zulma Vanessa Rueda
- 3 27983 Universidad de Antioquia , Medellin, Colombia.,4 28025 Universidad Pontificia Bolivariana , Medellin, Colombia
| | - Ken Kasper
- 1 Department of Internal Medicine, 8664 University of Manitoba , Winnipeg, Canada.,5 Department of Infectious Diseases, 8664 University of Manitoba , Winnipeg, Canada
| | - Y Keynan
- 1 Department of Internal Medicine, 8664 University of Manitoba , Winnipeg, Canada.,5 Department of Infectious Diseases, 8664 University of Manitoba , Winnipeg, Canada
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Cossio L, López J, Rueda ZV, Botero-Mariaca P. Morphological configuration of the cranial base among children aged 8 to 12 years. BMC Res Notes 2016; 9:309. [PMID: 27301441 PMCID: PMC4908802 DOI: 10.1186/s13104-016-2115-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Accepted: 06/02/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cranial base is used as reference structure to determine the skeletal type in cephalometric analysis. The purpose was to assess the cranial base length on lateral cephalic radiographs of children between 8 and 12 and compare these measurements with baseline studies in order to evaluate the relationship between the length and the cranial base angle, articular angle, gonial angle and skeletal type. METHODS A Cross-sectional study in 149 children aged 8-12 years, originally from Aburrá Valley, who had lateral cephalic radiographs and consented to participate in this study. The variables studied included: age, sex, sella-nasion, sella-nasion-articular, sella-nasion-basion, articular-gonion-menton, gonion-menton, sella-nasion-point B, sella-nasion-point A y point A-nasion-point B. These variables were digitally measured through i-dixel 2 digital software. One-way ANOVA was used to determine mean values and mean value differences. The values obtained were compared with previous studies. A p value <0.05 was considered significant. RESULTS Cranial base lengths are smaller in each age and sex group, with differences exceeding 10 mm for measurement, compared both with the study by Riolo (Michigan) and the study carried out in Damasco (Antioquia). No relation was found between the skeletal type and the anterior cranial base length, the sella angle and the cranial base angle. Also, no relation was found between the gonial angle and sella angle or the cranial base angle. CONCLUSION The cranial base varies from one population to another. Accordingly, compared to other studies it is shorter for the assessed sample.
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Affiliation(s)
- Lina Cossio
- Universidad Cooperativa de Colombia, Carrera 47 # 37 South 18, Medellín, Antioquia, Colombia
| | - Jorge López
- Universidad Cooperativa de Colombia, Carrera 47 # 37 South 18, Medellín, Antioquia, Colombia
| | - Zulma Vanessa Rueda
- Universidad Cooperativa de Colombia, Carrera 47 # 37 South 18, Medellín, Antioquia, Colombia
| | - Paola Botero-Mariaca
- Universidad Cooperativa de Colombia, Carrera 47 # 37 South 18, Medellín, Antioquia, Colombia.
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Herrera M, Aguilar YA, Rueda ZV, Muskus C, Vélez LA. Comparison of serological methods with PCR-based methods for the diagnosis of community-acquired pneumonia caused by atypical bacteria. J Negat Results Biomed 2016; 15:3. [PMID: 26932735 PMCID: PMC4774004 DOI: 10.1186/s12952-016-0047-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Accepted: 02/05/2016] [Indexed: 02/01/2023] Open
Abstract
Background The diagnosis of community-acquired pneumonia (CAP) caused by Legionella pneumophila, Mycoplasma pneumoniae, and Chlamydophila pneumoniae is traditionally based on cultures and serology, which have special requirements, are time-consuming, and offer delayed results that limit their clinical usefulness of these techniques. We sought to develop a multiplex PCR (mPCR) method to diagnosis these bacterial infections in CAP patients and to compare the diagnostic yields obtained from mPCR of nasopharyngeal aspirates (NPAs), nasopharyngeal swabs (NPSs), and induced sputum (IS) with those obtained with specifc PCR commercial kits, paired serology, and urinary antigen. Results A total of 225 persons were included. Of these, 10 patients showed serological evidence of L. pneumophila infection, 30 of M. pneumoniae, and 18 of C. pneumoniae; 20 individuals showed no CAP. The sensitivities were mPCR-NPS = 23.1 %, mPCR-IS = 57.1 %, Seeplex®-IS = 52.4 %, and Speed-oligo®-NPA/NPS = 11.1 %, and the specificities were mPCR-NPS = 97.1 %, mPCR-IS = 77.8 %, Seeplex®-IS = 92.6 %, and Speed-oligo®-NPA/NPS = 96.1 %. The concordance between tests was poor (kappa <0.4), except for the concordance between mPCR and the commercial kit in IS (0.67). In individuals with no evidence of CAP, positive reactions were observed in paired serology and in all PCRs. Conclusions All PCRs had good specificity but low sensitivity in nasopharyngeal samples. The sensitivity of mPCR and Seeplex® in IS was approximately 60 %; thus, better diagnostic techniques for these three bacteria are required. Electronic supplementary material The online version of this article (doi:10.1186/s12952-016-0047-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Mariana Herrera
- Grupo Investigador de Problemas en Enfermedades Infecciosas (GRIPE), Sede de Investigación Universitaria, Calle 62 # 52-59, Laboratorio 630, Universidad de Antioquia, Medellín, Colombia. .,Corporación de Ciencias Básicas Biomédicas, Universidad de Antioquia UdeA, Medellín, Colombia.
| | - Yudy Alexandra Aguilar
- Grupo Investigador de Problemas en Enfermedades Infecciosas (GRIPE), Sede de Investigación Universitaria, Calle 62 # 52-59, Laboratorio 630, Universidad de Antioquia, Medellín, Colombia. .,Corporación de Ciencias Básicas Biomédicas, Universidad de Antioquia UdeA, Medellín, Colombia.
| | | | - Carlos Muskus
- Programa de Estudio y Control de Enfermedades Tropicales (PECET), Universidad de Antioquia UdeA, Medellín, Colombia.
| | - Lázaro Agustín Vélez
- Grupo Investigador de Problemas en Enfermedades Infecciosas (GRIPE), Sede de Investigación Universitaria, Calle 62 # 52-59, Laboratorio 630, Universidad de Antioquia, Medellín, Colombia. .,Infectious Disease Section, School of Medicine, Universidad de Antioquia UdeA, Medellín, Colombia.
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Rodiño JM, Aguilar YA, Rueda ZV, Vélez LA. Usefulness of FTA® cards as aPneumocystis-DNA extraction method in bronchoalveolar lavage samples. Infect Dis (Lond) 2016; 48:367-72. [DOI: 10.3109/23744235.2015.1129550] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Keynan Y, Rueda ZV, Bresler K, Becker M, Kasper K. HLA B51 is associated with faster AIDS progression among newly diagnosed HIV-infected individuals in Manitoba, Canada. Int J Immunogenet 2015; 42:336-40. [PMID: 26263514 DOI: 10.1111/iji.12219] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Revised: 05/05/2015] [Accepted: 06/21/2015] [Indexed: 11/29/2022]
Abstract
Human leucocyte antigen (HLA) alleles influence the rate of CD4 decline among HIV-infected individuals. We investigated the association between HLA B35 and HLA B51 and the rate of CD4 decline and/or opportunistic infections, among 294 HIV-positive individuals from Manitoba, Canada. All individuals presenting with a CD4 count >200 cells μL(-1) , who had at least two CD4 counts, and no evidence of co-infection were included. Individuals bearing HLA B35 or HLA B51 were compared to controls. A multivariate model demonstrated that HLA B35 allele was associated with a hazard ratio of 2.05 (95% CI 1.31-3.18) for reaching AIDS and HLA B51 allele with HR of 2.03 (95% CI 1.18-3.49) for reaching the same end-point. High prevalence of HLA B35 was seen in the patient population receiving care in Manitoba. Our observations confirm the association of HLA B35 with rapid disease progression. We report, for the first time, faster CD4 decline among individuals with HLA B51 allele.
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Affiliation(s)
- Y Keynan
- Manitoba HIV Program, Winnipeg, MB, Canada.,Department of Medical Microbiology, University of Manitoba, Winnipeg, MB, Canada.,Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada.,Department of Medical Microbiology, University of Nairobi, Nairobi, Kenya
| | - Z V Rueda
- Universidad Pontificia Bolivariana, Medellin, Colombia
| | - K Bresler
- Manitoba HIV Program, Winnipeg, MB, Canada
| | - M Becker
- Manitoba HIV Program, Winnipeg, MB, Canada.,Department of Medical Microbiology, University of Manitoba, Winnipeg, MB, Canada.,Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada.,Centre for Global Public Health, University of Manitoba, Winnipeg, MB, Canada
| | - K Kasper
- Manitoba HIV Program, Winnipeg, MB, Canada.,Department of Medical Microbiology, University of Manitoba, Winnipeg, MB, Canada.,Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada.,Department of Medical Microbiology, University of Nairobi, Nairobi, Kenya
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Ocampo-Parra A, Escobar-Toro B, Sierra-Alzate V, Rueda ZV, Lema MC. Prevalence of dyslalias in 8 to 16 year-old students with anterior open bite in the municipality of Envigado, Colombia. BMC Oral Health 2015; 15:77. [PMID: 26160356 PMCID: PMC4498501 DOI: 10.1186/s12903-015-0063-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2014] [Accepted: 06/23/2015] [Indexed: 11/30/2022] Open
Abstract
Background Anterior open bite AOB is the most common malocclusion associated with speech disorders and the literature has shown that problems of occlusion involve all oral functions. AOB not only produce aesthetic and occlusal problems for the patient and modifies the union of the lips, tongue, teeth, palate, palatal rugae and oropharynx, and thus affecting the ability to communicate well with their surroundings. The prevalence of AOB in children and adolescent in our population is unknown. Furthermore, the most frequent type of dyslalias in children with this malocclusion is also unknown. Therefore, the aim of the study was to describe the frequency and types of dyslalia in students between 8-16 years with AOB, as well as the difference in the types of dyslalia according to the magnitude of AOB. Methods A cross-sectional study was conducted. Clinical assessment of AOB in students from the municipality of Envigado, Colombia, was performed. Students from 8 to16 years of age were examined during the second semester of 2011 and first semester of 2012. Phonoaudiological assessment was carried out in students in the mixed or permanent dentition. Exclusion criteria included children with history of systemic disease, altered skeletal development, neurological and psychiatric disorders, and residents in other departments. In addition, students undergoing orthodontic treatment at the time of evaluation or with history of previous orthodontic treatment, as well as those who did not cooperate with the oral cavity evaluation, were excluded. Results Six thousand one hundred sixty five children were evaluated. One hundred sixty six presented AOB (prevalence: 2.7 %; 95 % CI: 2.28–3.10). Thirty four students were excluded. 26.5 % of the sample presented mild AOB, 66.7 % moderate, and 6.8 % severe. Some type of dyslalia was found in 77.4 % of the students, being distortion (75.8 %) the most common. The most frequently altered phonemes were: / d / t / s / ch / ñ /. No significant association between different types of dyslalia and AOB severity (p-value = 0.974) was found. Conclusion Prevalence of AOB in Envigado is low (2.7 %). Phonation alterations are very common in children with AOB (77.8 %), and distortion is the most frequent type of dyslalia (75.8 %). In order to diagnose and treat occlusal and phonetic problems, and to avoid possible recurrence, interdisciplinary approach is recommended.
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Affiliation(s)
- Andrea Ocampo-Parra
- Faculty of Dentistry. Universidad Cooperativa de Colombia, Carrera 47 # 37 sur 18, Envigado, Antioquia, Colombia.
| | - Bibiana Escobar-Toro
- Faculty of Dentistry. Universidad Cooperativa de Colombia, Carrera 47 # 37 sur 18, Envigado, Antioquia, Colombia.
| | | | - Zulma Vanessa Rueda
- Epidemiology. Faculty of Dentistry. Universidad Cooperativa de Colombia, Medellin, Colombia.
| | - María Clara Lema
- Faculty of Dentistry. Universidad Cooperativa de Colombia, Carrera 47 # 37 sur 18, Envigado, Antioquia, Colombia.
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Rueda ZV, Arroyave L, Marin D, López L, Keynan Y, Giraldo MR, Pulido H, Arbeláez MP. High prevalence and risk factors associated with latent tuberculous infection in two Colombian prisons. Int J Tuberc Lung Dis 2015; 18:1166-71. [PMID: 25216829 DOI: 10.5588/ijtld.14.0179] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
SETTING Two prisons in Medellín and Itagüí, Colombia. OBJECTIVE To determine the prevalence of tuberculin skin test (TST) positivity in prisoners and the annual risk of tuberculous infection (ARTI), to identify risk factors associated with a positive result, and to describe progression to active disease. DESIGN Cross-sectional study. Inmates were included if time of incarceration was ⩾1 year and excluded if subjects had had previous or active tuberculosis (TB), or conditions that could hamper TST administration or interpretation. RESULTS We screened 1014 inmates. The overall prevalence of TST positivity was 77.6%. The first TST administration resulted in 66% positivity, and the second TST an additional 11.6%. In Prison One, the ARTI was 5.09% in high TB incidence cell blocks and 2.72% in low TB incidence blocks. In Prison Two, the ARTI was 2.77%. Risk factors associated with TST positivity were history of previous incarceration and length of incarceration. Among all those included in the study, four individuals developed active pulmonary TB. CONCLUSION Prevalence of TST positivity in prisoners and the ARTI were higher than in the general population, but differed between prisons; it is important to apply a second TST to avoid an overestimation of converters during follow-up.
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Affiliation(s)
- Z V Rueda
- Facultad de Medicina, Universidad Pontificia Bolivariana, Medellín, Colombia
| | - L Arroyave
- Facultad Nacional de Salud Pública, Medellín, Colombia
| | - D Marin
- Grupo de Demografía y Salud, Facultad Nacional de Salud Pública, Medellín, Colombia
| | - L López
- Grupo MICROBA, Escuela de Microbiología, Universidad de Antioquia, Medellín, Colombia
| | - Y Keynan
- Laboratory of Viral Immunology, Department of Internal Medicine, Medical Microbiology and Community Health Sciences, University of Manitoba, Winnipeg, Canada
| | - M R Giraldo
- Secretaría Seccional de Salud y Protección Social de Antioquia, Gobernación de Antioquia, Medellín, Medellín, Colombia
| | - H Pulido
- Secretaría de Salud de Bello, Alcaldía de Bello, Bello, Colombia
| | - M P Arbeláez
- Grupo de Epidemiología, Facultad Nacional de Salud Pública, Universidad de Antioquia, Medellín, Colombia
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Rueda ZV, López L, Marín D, Vélez LA, Arbeláez MP. Sputum induction is a safe procedure to use in prisoners and MGIT is the best culture method to diagnose tuberculosis in prisons: a cohort study. Int J Infect Dis 2015; 33:82-8. [PMID: 25578262 DOI: 10.1016/j.ijid.2015.01.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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: 08/20/2014] [Revised: 12/04/2014] [Accepted: 01/01/2015] [Indexed: 10/24/2022] Open
Abstract
OBJECTIVES To evaluate the concordance and safety of induced sputum (IS) and spontaneous sputum (SS), and estimate concordance and time to detection of M. tuberculosis between Lowenstein-Jensen (LJ), thin-layer agar (TLA), and the Mycobacteria Growth Indicator Tube system (MGIT). METHODS This was a cohort study. Prisoners with pulmonary tuberculosis (PTB) were followed for 2 years. At baseline and every follow-up visit, three sputum samples were taken on consecutive days (one IS and two SS) and adverse events occurring before, during, and 30 min after IS were registered. All sputum samples were stained with auramine and cultured in LJ, TLA (to test resistance), and MGIT. RESULTS Five hundred eighty-six IS and 532 SS were performed on 64 PTB patients. Breathlessness (1.6%), cough (1.2%), hemoptysis (0.3%), and cyanosis (0.2%) were the only complications. Concordance between IS and SS was 0.78 (95% confidence interval 0.69-0.87); 11 positive cultures from IS samples were negative in SS, and 11 positive cultures from SS samples were negative in IS. One hundred seventy-eight cultures were positive by any technique: MGIT 95%, LJ 73%, and TLA 57%. Time to detection of M. tuberculosis in LJ, TLA, and MGIT was 31, 18, and 11 days, respectively. CONCLUSIONS The IS procedure is safe in prisons. The MGIT system is better and faster than LJ and TLA in the diagnosis of M. tuberculosis.
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Affiliation(s)
- Zulma Vanessa Rueda
- Grupo Investigador de Problemas en Enfermedades Infecciosas, Facultad de Medicina, Calle 62 # 52-59, lab 630, Sede de Investigación Universitaria, Universidad de Antioquia, Medellín, Colombia.
| | - Lucelly López
- Facultad de Medicina, Universidad Pontificia Bolivariana, Medellín, Colombia
| | - Diana Marín
- Grupo Demografía y Salud, Facultad Nacional de Salud Pública, Universidad de Antioquia, Medellín, Colombia
| | - Lázaro A Vélez
- Grupo Investigador de Problemas en Enfermedades Infecciosas, Facultad de Medicina, Calle 62 # 52-59, lab 630, Sede de Investigación Universitaria, Universidad de Antioquia, Medellín, Colombia
| | - María Patricia Arbeláez
- Grupo de Epidemiología, Facultad Nacional de Salud Pública, Universidad de Antioquia, Medellín, Colombia
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Torres-Restrepo AM, Quintero-Monsalve AM, Giraldo-Mira JF, Rueda ZV, Vélez-Trujillo N, Botero-Mariaca P. Agreement between cranial and facial classification through clinical observation and anthropometric measurement among Envigado school children. BMC Oral Health 2014; 14:50. [PMID: 24886038 PMCID: PMC4018620 DOI: 10.1186/1472-6831-14-50] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Accepted: 04/24/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND To evaluate the agreement between cranial and facial classification obtained by clinical observation and anthropometric measurements among school children from the municipality of Envigado, Colombia. METHODS This cross-sectional study was carried out among 8-15-year-old children. Initially, an indirect clinical observation was made to determine the skull pattern (dolichocephalic, mesocephalic or brachycephalic), based on visual equivalence of right eurion- left eurion and glabella-opisthocranion anthropometric points, as well as the facial type (leptoprosopic, mesoprosopic and euryprosopic), according to the left and right zygomatic, nasion and gnation points. Following, a direct measurement was conducted with an anthropometer using the same landmarks for cranial width and length, as well as for facial width and height. Subsequently, both the facial index [euryprosopic (≤80.9%), mesoprosopic (between 81% - 93%) and leptoprosopic (≥93.1%)] and the cranial index [dolichocephalic (index ≤ 75.9%), mesocephalic (between 76% - 81%), and brachycephalic (≥81.1%)] were determined. Concordance between the indices obtained was calculated by direct and indirect measurement using the Kappa statistic. RESULTS A total of 313 students were enrolled; 172 (55%) were female and 141 (45%) male. The agreement between the direct and indirect facial index measurements was 0.189 (95% CI 0.117-0261), and the cranial index was 0.388 (95% CI 0.304-0.473), indicating poor concordance. CONCLUSIONS No agreement was observed between direct measurements conducted with an anthropometer and indirect measurements via visual evaluation. Therefore, the indirect visual classification method is not appropriate to calculate the cranial and facial indices.
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Affiliation(s)
- Adriana M Torres-Restrepo
- Universidad Cooperativa de Colombia, Carrera 47 # 37 sur 18. Envigado, Antioquia, Medellín, Colombia
| | - Ana M Quintero-Monsalve
- Universidad Cooperativa de Colombia, Carrera 47 # 37 sur 18. Envigado, Antioquia, Medellín, Colombia
| | - Juan F Giraldo-Mira
- Universidad Cooperativa de Colombia, Carrera 47 # 37 sur 18. Envigado, Antioquia, Medellín, Colombia
| | - Zulma Vanessa Rueda
- Universidad Cooperativa de Colombia, Carrera 47 # 37 sur 18. Envigado, Antioquia, Medellín, Colombia
| | - Natalia Vélez-Trujillo
- Universidad Cooperativa de Colombia, Carrera 47 # 37 sur 18. Envigado, Antioquia, Medellín, Colombia
| | - Paola Botero-Mariaca
- Universidad Cooperativa de Colombia, Carrera 47 # 37 sur 18. Envigado, Antioquia, Medellín, Colombia
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Yepes E, Quintero P, Rueda ZV, Pedroza A. Optimal force for maxillary protraction facemask therapy in the early treatment of class III malocclusion. Eur J Orthod 2013; 36:586-94. [DOI: 10.1093/ejo/cjt091] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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