Respiratory infections and coinfections: geographical and population patterns / Infecciones y coinfecciones respiratorias: patrón geográfico y de circulación poblacional

Abstract Introduction: Acute respiratory infections are the second cause of mortality in children younger than five years, with 150.7 million episodes per year. Human orthopneumovirus (hOPV) and metapneumovirus (hMPV) are the first and second causes of bronchiolitis; type 2 human orthorubulavirus (hORUV) has been associated with pneumonia in immunocompromised patients. Objective: To define hOPV, hMPV and hORUV geographical distribution and circulation patterns. Method: An observational, prospective cross-sectional pilot study was carried out. Two-hundred viral strains obtained from pediatric patients were genotyped by endpoint reverse transcription polymerase chain reaction (RT-PCR). Results: One-hundred and eighty-six positive samples were typed: 84 hOPV, 43 hMPV, two hORUV and 57 co-infection specimens. Geographical distribution was plotted. hMPV, hOPV, and hORUV cumulative incidences were 0.215, 0.42, and 0.01, respectively. Cumulative incidence of hMPV-hORUV and hMPV-hOPV coinfection was 0.015 and 0.23; for hOPV-hMPV-hORUV, 0.035; and for hORUV-hOPV, 0.005. The largest number of positive cases of circulating or co-circulating viruses occurred between January and March. Conclusions: This study successfully identified circulation and geographical distribution patterns of the different viruses, as well as of viral co-infections.

Resumen Introducción: Las infecciones respiratorias agudas constituyen la segunda causa de mortalidad en los niños menores de cinco años, con 150.7 millones de episodios anuales. Entre los principales agentes etiológicos están Orthopneumovirus (hOPV) y metapneumovirus (hMPV) humanos como primera y segunda causa de bronquiolitis, respectivamente; Orthorubulavirus humano tipo 2 (hORUV) se ha asociado a neumonía en pacientes inmunocomprometidos. Objetivo: Definir patrones de distribución geográfica y de circulación de hOPV, hMPV y hORUV. Método: Se llevó a cabo un estudio piloto transversal prospectivo observacional. Se genotipificaron 200 aislamientos virales de pacientes pediátricos mediante transcripción inversa seguida de reacción en cadena de la polimerasa en punto final (RT-PCR). Resultados: Se tipificaron 186 muestras positivas: 84 de hOPV, 43 de hMPV, dos de hORUV y 57 de coinfecciones. Se trazó la distribución geográfica. Las incidencias acumuladas de hMPV, hOPV y hORUV fueron de 0.215, 0.42 y 0.01, respectivamente. Las incidencias acumuladas de la coinfección de hMPV-hORUV y hMPV-hOPV fueron de 0.015 y 0.23; de hOPV-hMPV-hORUV, de 0.035; y de hORUV-hOPV, de 0.005. El mayor número de casos positivos de virus circulantes o cocirculantes se presentó entre enero y marzo. Conclusiones: Fue posible identificar patrones de circulación y distribución geográfica de los diferentes virus, así como de las coinfecciones virales.

Antimicrobial peptides in multiresistant respiratory infections / Péptidos antimicrobianos en infecciones respiratorias multiresistentes

Antimicrobial peptides are small cationic molecules present in almost all living organisms. They show direct or indirect (immunomodulation) activity in a wide range of pathogenic microorganisms as members of the humoral arsenal of innate immunity. In mammals they play a significant role in respiratory airways. The most abundant antimicrobial peptides in the respiratory tract of mammals are lysozymes, lactoferrin, histatins, defensins and cathelicidins. Respiratory and pulmonary infections are combated, primarily, by antimicrobial peptides like LL-37 against Gram-negative bacteria, histatin 5 against Candida albicans and human peptides from neutrophils against adenovirus, influenza and parainfluenza. This paper provides a review of the most important antimicrobial peptides in the respiratory tract and their use in the search for new effective agents against microorganisms that cause respiratory infections based on information published in MedLine, the Web of Science and Scopus in recent years(AU)

Los péptidos antimicrobianos son pequeñas moléculas catiónicas presentes en casi todos los organismos vivos. Muestran actividad directa o indirecta (inmunomodulación) en una amplia gama de microorganismos patógenos como miembros del arsenal humoral de la inmunidad innata. En los mamíferos juegan un papel importante en las vías respiratorias. Los péptidos antimicrobianos más abundantes en el tracto respiratorio son lisozima, lactoferrina, histatinas, defensinas y catelicidinas. Las infecciones respiratorias y pulmonares son combatidas, principalmente, por péptidos antimicrobianos como LL-37 contra bacterias gramnegativas, histatina 5 contra Candida albicans y péptidos humanos de neutrófilos contra adenovirus, influenza y parainfluenza. Este artículo proporciona una revisión sobre los péptidos antimicrobianos más importantes en el tracto respiratorio y su empleo en la búsqueda de nuevos agentes eficaces contra microorganismos causantes de infecciones respiratorias teniendo en cuenta la información publicada al respecto en MedLine, Web of Science y Scopus en los últimos años(AU)

Detection of avian metapneumovirus subtype A from wild birds in the State of São Paulo, Brazil / Detecção de metapneumovirus aviário subtipo A em aves silvestres no estado de São Paulo, Brasil

The present study investigated the circulation of avian metapneumovirus (aMPV) in wild birds in Brazil. To do so, 131 samples from 366 oropharyngeal or cloacal swabs collected from 18 species of birds were tested individually or in pools by RT-PCR. Samples detected by RT-PCR were selected for DNA sequencing. Thirteen (9.9%) samples were detected by the RT-PCR targeting the N gene and four out of 13 samples were sequenced. Sequencing results showed a high identity with the aMPV subtype A. Our results confirm the circulation of the aMPV subtype A in wild birds in Brazil even five years after its last detection.(AU)

O presente estudo investigou a circulação de metapneumovírus aviário em aves silvestres no Brasil. Para tanto, 131 amostras de 366 suabes orofaringeanos ou cloacais coletados de 18 espécies de aves foram testadas individualmente ou na forma de pools por RT-PCR. As amostras detectadas por RT-PCR foram selecionadas para sequenciamento. Treze (9,9%) das amostras foram detectadas por RT-PCR tendo o gene N como alvo; destas, quatro foram sequenciadas com sucesso. Resultados do sequenciamento mostraram alta identidade com o aMPV de subtipo A. Nossos resultados confirmam a circulação de aMPV subtipo A em aves silvestres no Brasil mesmo cinco anos após sua última detecção.(AU)

Viral etiology of acute respiratory infections in children in Southern Iran

Abstract INTRODUCTION: Prevalence of influenza A virus (Flu-A), respiratory syncytial virus (RSV), and human metapneumovirus (hMPV) was assessed in children with acute respiratory infections (ARIs). METHODS: Nasopharyngeal aspirates and throat swabs were subjected to real-time polymerase chain reaction (PCR) to detect RSV and Flu-A and to conventional PCR to detect hMPV. RESULTS: Of the 156 children assessed, 93 (59.6%) carried at least one virus, with 35.9% positive for RSV, 14.1% for hMPV, and 9.6% for Flu-A. The prevalence of co-infections was 2.6%. CONCLUSIONS: The high detection rate may reflect increased sensitivity of real-time PCR compared to traditional PCR and viral culture.

Human metapneumovirus in Southern Brazil

INTRODUCTION Infections caused by respiratory viruses are important problems worldwide, especially in children. Human metapneumovirus (hMPV) is a respiratory pathogen and causes severe infections with nonspecific symptoms. This study reports the hMPV occurrence and dissemination in southern Brazil and compares the frequency of occurrence of this virus and the human respiratory syncytial virus (hRSV) in the epidemiological weeks in a three-year period (2009-2011). METHODS: In total, 545 nasopharyngeal (NP) specimens from individuals with Severe Acute Respiratory Syndrome (SARS) who were negative for other seven respiratory viruses were analyzed for the presence of hMPV. Human metapneumovirus was detected by direct immunofluorescence and real-time reverse transcription polymerase chain reaction. RESULTS: hMPV was detected in 109 patients from the main geographic regions of the southernmost state of Brazil, presenting similar overall prevalence in males (46.8%) and females (53.2%). Among children who were less than six years old, hMPV was detected in 99 samples of all age groups, with a higher frequency in infants who were less than one year old (45.7%) compared to all other age groups until six years. hMPV and hRSV infection occurred in almost the same epidemiological weeks (EWs) of each year, with peaks of incidence between EW 31/37 and EW 26/38 for the years 2009 and 2011, respectively. hMPV was further detected in several cases of SARS and it was the only virus detected in three deaths. CONCLUSIONS These findings indicate that hMPV is in circulation in southern Brazil and highlight the importance of diagnosing hMPV for influenza-like illness in the population. (AU)

Parotiditis en el Hospital General de Agudos Parmenio Piñero y su Área Programática / Parotitis in the Acute General Hospital Parmenio Piñero and its programmatic area

La parotiditis epidémica (fiebre urliana) es una infección viral cuyo único huésped natural es el ser humano. La enfermedad es en general, benigna y autolimitada y un tercio de las personas afectadas tiene una infección subclínica. Puede producir una infección más grave en individuos que han pasado la pubertad que en los niños. Debido a que el diagnóstico de parotiditis es clínico en un 99%, algunos de los casos podrían corresponder a una etiología diferente a la urliana (enterovirus, Epstein Barr, virus Parainfluenza y Adenovirus). Se estima que el esquema de 2 dosis de vacuna triple viral tiene una efectividad de 88% (rango: 66-95%) en la prevención de enfermedad.Se analizaron casos de parotiditis, confirmados o sospechosos, notificados por el Hospital Piñero de la Ciudad de Buenos Aires y/o CeSAC del Área Programática. La fuente de información utilizada fue el SNVS (Módulo C2). Para los estudios etiológicos, se analizó el registro del laboratorio central del Hospital. (AU) .

Detección de virus parainfluenza en pacientes inmunocomprometidos e inmunocompetentes atendidos en un hospital terciario de la Ciudad de São Paulo, Brasil / Detection of parainfluenza virus in immunocompromised and immunocompetent patients in a tertiary hospital in Sao Paulo, Brazil

Parainfluenza virus infections (PIV) were evaluated in patients with mild and severe infections through real time PCR. One thousand and sixty-seven samples were collected from subjects as follows: 233 adult renal transplanted outpatients, 129 children with congenital heart disease, 381 with adult hematopoietic stem cell patients and 324 hospitalized patients suspected of influenza A (H1N1) pdm09 infection. PIV was detected in 74 (6.9%) samples. VPI-3 was the most frequent (60.8%) and a higher risk was observed for older adults (p = 0.018) and for those who were hematopoietic stem cell transplanted. Further studies are needed to understand the VPI role in patients' at risk for developing serious illness.

Se evaluó la infección por virus parainfluenza (VPI) en pacientes con infecciones leves y graves mediante RPC en tiempo real. Se analizó un total de 1.067 muestras: 233 provenían de pacientes ambulatorios adultos receptores de trasplantes renales, 129 de niños con cardiopatía congénita, 381 de pacientes receptores de trasplantes de precursores hematopoyéticos adultos y 324 de pacientes hospitalizados con sospecha de influenza A (H1N1) pdm09. Se detectó VPI en 74 muestras (6,9%). Siendo VPI-3 el virus más frecuente (60,8%), se observó un mayor riesgo para los adultos mayores (p = 0,018) y para aquellos que fueron receptores de precursores hematopoyéticos. Son necesarios estudios adicionales para entender el papel del VPI en pacientes de riesgo para desarrollar enfermedad grave.

Aspectos clínicos e epidemiológicos de pneumonias infantis associadas aos quatro tipos de vírus para influenza em Fortaleza-CE

As pneumonias são problemas de saúde publica mundial, especialmente em crianças menores que cinco anos de idade. Os vírus para influenza (VPI-1, 2 e 3) são agentes frequentes de pneumonia, pouco se conhecendo sobre a participação do VPI-4devido a dificuldades do seu isolamento em cultura de células, a ausência de antígenos específicos para este vírus nos painéis de rotina de detecção dos vírus respiratórios,além de serem relacionados apenas a casos de infecções respiratórias leves. O objetivo do presente estudo é descrever o perfil epidemiológico e clínico das pneumonias causadas pelos quatro tipos de VPI na população de estudo, no período de janeiro de2013 a dezembro de 2014. Para tanto, aspirados nas ofaríngeos de 542 crianças de até cinco anos atendidas no Hospital Infantil Albert Sabin (HIAS), que receberam o diagnóstico de pneumonia, foram submetidos à RT-PCR para a detecção dos VPI-1, 2 e3 e 4. Estas amostras tinham sido analisadas anteriormente por imunofluores cência indireta para vírus sincicial respiratório (VSR), influenza (A e B), adenovírus e VPI (1,2 e 3). Os VPI foram detectados em 165 casos, seguido de VSR (136), adenovírus (34) e influenza (30). As características clínicas e epidemiológicas de pneumonias pelos VPI foram analisadas em 104 amostras que apresentaram infecção isolada por um dos quatro tipos de VPI. Os VPI mais frequentemente detectados, em ordem decrescente, foram os tipos VPI-3 (64,42%), VPI-4 (19,23%), VPI-1(14,42%) e VPI-2 (1,92%). O VPI-4 foi omais associado a co-infecções. O VPI-4 foi o único VPI cuja circulação esteve associada à estação chuvosa dos dois anos de estudo (p<0,0001). O VPI-3 e o VPI-1apresentaram pico de circulação associado à estação seca. Os VPI são agentes frequentes de pneumonias em crianças menores que cinco anos na cidade de Fortaleza.

Pneumonia are public health problems world wide, especially in childrenyounger than five years old. Human parainfluenza virus (HPIV-1, 2 and 3) are commonagents of pneumonia, little was know about the involvement of HPIV-4 due todifficulties of isolation in cell culture, the absence of antigens specific for this virus inpanels routine detection of respiratory viruses, and are associated only with cases ofmild respiratory infections. The aim of this study is to describe the clinical andepidemiological profile of pneumonia caused by four types of HPIV in the studypopulation, from January 2013 to December 2014. To this end, nasopharyngeal aspiratesof 542 children under five treated at Hospital Infantil Albert Sabin (HIAS), who werediagnosed with pneumonia, were subjected to RT-PCR for the detection of HPIV-1, 2, 3and 4. These samples had been previously analyzed by indirect immunofluorescence forrespiratory syncytial virus (RSV), influenza (A and B), adenovirus, and HPIV (1, 2 and3). The HPIV were detected in 165 cases, followed by RSV (136), adenovirus (34) andinfluenza (30). Clinical and epidemiological characteristics of pneumonia by HPIVwere analyzed in 104 samples with isolated infection with one of four types of HPIV.The HPIV most frequently detected, in descending order, were the HPIV-3 types(64.42%), HPIV-4 (19.23%), HPIV-1 (14.42%) and HPIV-2 (1.92 %). The HPIV-4 wasthe most associated with co-infection. The HPIV-4 was the only HPIV whosecirculation was associated with the rainy season of two years of study (p <0.0001). The HPIV-3 and HPIV-1 had a circulation peak associated with the dry season. The HPIVare frequent agents of pneumonia in children younger than five years in the city of Fortaleza.

Relevamiento serológico de anticuerpos contra enfermedades virales de interés sanitario en llamas (Lama glama) de la provincia de Jujuy, Argentina / Serological survey of antibodies aainst vital diseases of public health interest in llamas (Lama glama) from Jujuy rpovince, Argentina

Las poblaciones de llamas de Argentina se concentran principalmente en la provincia de Jujuy; su explotación representa un importante recurso económico de las comunidades altoandinas. El objetivo de este trabajo fue evaluar la seroprevalencia de anticuerpos contra algunos agentes virales asociados a enfermedades de impacto productivo en rodeos de llamas de Jujuy. Se analizaron 349 sueros de llamas adultas de 6 departamentos de la puna jujeña ubicados por encima de los 3300 msnm. Se obtuvo una prevalencia del 100 % para rotavirus grupo A y del 70 % para el virus parainfluenza-3 bovino, mientras que no se detectaron reactores para herpesvirus bovino 1, virus de la diarrea viral bovina, influenza A humana (H1N1) e influenza equina (H3N8). Los resultados obtenidos confirman la amplia distribución de rotavirus y virus parainfluenza y la baja susceptibilidad a herpesvirus y pestivirus en las tropas de llamas de la puna jujeña

Llama population from Argentina is mainly concentrated in the Andean Puna, Jujuy. Llamas represent an important economic resource for the Andean communities. The aim of this study was to investigate the prevalence of antibodies against viral antigens associated to viral diseases of economic impact (neonatal diarrhea, reproductive and respiratory syndromes). A total of 349 serum samples from adult llamas were analyzed. The obtained antibody prevalence was 100 % for Rotavirus A and 70 % for Bovine parainfluenza virus 3. In contrast, no reactors were detected to Bovine herpesvirus 1, Bovine viral diarrhea virus 1, Human influenza A virus (H1N1) and Equine influenza virus (H3N8). These results confirm the wide circulation of rotavirus and parainfluenza virus in Argentinean llamas and suggest that susceptibility to infection with bovine herpesvirus, pestivirus and influenza A viruses is low. This serologic survey provides novel information regarding the epidemiology of viral diseases affecting llamas from the Argentinean Andean Puna

Identificación de virus respiratorios en pacientes pediátricos con infecciones respiratorias en el Hospital Carlos Van Buren, Valparaíso: época estival 2011-2012 / Identification of respiratory viruses in pediatric patients with respiratory tract infections from Carlos Van Buren Hospital, Valparaíso: 2011-2012 summer season

INTRODUCCIÓN: En pediatría, las infecciones respiratorias agudas (IRA) constituyen globalmente una importante causa de morbimortalidad. Los principales agentes etiológicos son los virus respiratorio sincicial, parainfluenza (PIV), influenza y adenovirus. Actualmente existen pruebas de diagnóstico molecular que permiten identificar agentes no convencionales. En este estudio se propuso estudiar la presencia de: PIV, coronavirus (COV), rinovirus (RV) y enterovirus humano (EV), utilizando reacción en cadena de polimerasa previa transcriptasa reversa (RCP-TR) en muestras de niños hospitalizados en el Hospital Carlos Van Buren, negativas a inmunofluorescencia (IF) paravirus respiratorios. MATERIALES Y MÉTODOS: Se analizaron un total de 82 muestras de aspirado nasofaríngeo de pacientes menores de 5 años hospitalizados por IRA en el Hospital Carlos Van Buren, negativos a IF, recolectadas entre Diciembre del 2011y Marzo del 2012. Se utilizó una RCP-TR anidada de tipo múltiplex específica para virus PIV (1, 2, 3, 4AB), COV-OC43 y 229E, y genérica para RV y EV. RESULTADOS: Los virus más frecuentes fueron los PIV, siendo identificados en 9 (10 por ciento) muestras, siendo: un 2 por ciento (n=2) PIV-2, un 7 por ciento (n=6) PIV-3 y un 1 por ciento (n=1) PIV-4AB. Además se detectó COV-OC43 en un 2 por ciento (n=2), RV y EV en un 6 por ciento (n=5). No se detectaron co-infecciones con dos o más virus. No hubo asociación entre edad de los niños y tipo de infección viral. DISCUSIÓN: Se describió la presencia de estos virus respiratorios en niños con IRA. Se logró detectar falsos negativos para PIV y se demostró la existencia de COV, RV y EV en la región.

INTRODUCTION: Acute Respiratory infection (ARI) is a major cause of morbidity and mortality worldwide in pediatrics. The main etiological agents are respiratory syncytial virus, parainfluenzavirus (PIV), influenza virus and adenovirus. Currently there are molecular diagnostic tests that have helped to identify unconventional agents. Our aim was to study the presence of: PIV, coronavirus (hCoV), rhinovirus (hRV) and human enterovirus (hEV), by using Reverse Transcriptase-Polymerase Chain Reaction (RT-PCR) in samples of hospitalized children on Carlos Van Buren Hospital negative to immunofluorescence (IF) for respiratory viruses. MATERIALS AND METHODS: A total of 82nasopharyngeal aspirate samples, negative to IF, were collected from children under five years old hospitalized due to ARI at Carlos Van Buren Hospital, between December 2011 and March2012. A Multiplex nested RT-PCR designed for the specifically detection of PIV (1, 2, 3, 4AB), hCoV (OC43 and 229E) and generic detection of RV and EV was used. RESULTS: Parainfluenza was the most frequently identified virus (n=9, 10 percent) specifically PIV-2 (n=2, 2 percent), PIV-3 (n=6, 7 percent) and PIV-4AB (n=1, 1 percent). Followed by hRV and hEV (n=5, 6 percent) and hCoV-OC43 (n=2, 2 percent). There were no co-infections with two or more viruses. There was no correlation between age and type of infection. DISCUSSION: This study described the prevalence of these respiratory viruses in pediatric patients with ARI. It was possible to detect false negative results for parainfluenza virus and also to demonstrate the existence of hCoV, hRV and hEV in the region.

Sentinel surveillance of influenza and other respiratory viruses, Brazil, 2000-2010

There are scanty data on the epidemiology of influenza and other respiratory viruses in South America and Brazil. The aim of this study was to summarize the data from the Brazilian surveillance system of influenza and other respiratory viruses and discuss the patterns of viral circulation. The system is based on detecting cases of influenza-like illness in sentinel sites and weekly collection of five nasopharyngeal secretions samples, which are processed in state public health laboratories for respiratory viruses by indirect immunofluorescence assay. Data from 2000 to 2010 were described over time, by region, gender, and age group, and an analysis of Spearman correlation was performed between monthly influenza detection and rainfall and temperature data in two state capitals with the highest number of positive samples, one from the northeast region (Maceió) and other from the southern region (Curitiba). There were 3,291,946 visits for influenza-like illness; of these, 37,120 had samples collected and 6421 tested positive: 1690 (26%) influenza A, 567 (9%) influenza B, 277 (4%) parainfluenza 1, 571 (9%) parainfluenza 2, 589 (9%) parainfluenza 3, 742 (12%) adenovirus, and 1985 (31%) respiratory syncytial virus. Overall, increased activity of respiratory syncytial virus was observed from March to June, preceding the peak of influenza activity, from May to August, but with regional differences. In Maceió, there was a weak correlation between temperature and influenza detection (ρ = 0.05), but a moderate positive correlation between rainfall and influenza detection (ρ = 0.36). In Curitiba, a high correlation was observed between the decrease in temperature and rainfall and the increase in influenza detection (ρ = -0.83 and -0.78 respectively). These data are important to guide public health control measures as the best time for influenza vaccination and use of antivirals.

Prevalencia de virus respiratorios en pacientes menores de 2 años internados por infecciones respiratorias bajas en el Hospital de Emergencias Pediátricas durante el año 2011 / Prevalence of respiratory viruses in patients younger than 2 years interned by lower respiratory infections at the Hospital of Pediatric Emergency during the year 2011

Objetivos: Determinar la prevalencia de Virus en Infecciones Respiratorias Bajas en los pacientes internados en el Hospital de Emergencias Pediátricas. Material y métodos: Se realizó un estudio descriptivo, retrospectivo transversal. Se revisaron 274 historias clínicas de pacientes menores de 2 años que ingresaron al Servicio de Hospitalización Pediátrica del Hospital de Emergencias Pediátricas con diagnóstico de Infección Respiratoria Baja y a los que se les realizó algún Tipo de prueba para identificar Virus Respiratorios. Resultados: El 56.6 por ciento de los pacientes fueron del sexo masculino, y el 43.4 por ciento fueron del sexo femenino. Hubo una mayor frecuencia de virus sincicial respiratorio en el 18.6 por ciento de los casos seguido de adenovirus (14.2 por ciento), virus parainfluenza 3 (12 por ciento). El 94.2 por ciento de los casos se detecto con inmunofluorescencia indirecta. El 40.9 por ciento de los pacientes tenían edades entre los 6 a 12 meses. Hubo una mayor frecuencia de internamiento en el mes de Agosto en el 17.2 por ciento de los casos. El diagnóstico de ingreso de mayor frecuencia fue el de síndrome de obstrucción bronquial aguda con un 42 por ciento. El 51.8 por ciento de los casos tuvo una estancia de 4 a 7 días. El hallazgo radiológico de mayor frecuencia fue atrapamiento de aire con un 38.7 por ciento de los casos. El 7.3 por ciento de los pacientes ingresaron a fa UCI. El 41.2 por ciento de los pacientes recibieron tratamiento antibiótico. El 65 por ciento de los pacientes recibieron tratamiento con beta dos agonistas. El 53.6 por ciento recibieron tratamiento con corticoides. El 5.1 por ciento padecían de enfermedad cardiaca. El 4 por ciento tenían el antecedente de prematuridad. El 4.4 por ciento tenían el antecedente de enfermedad pulmonar crónica. La complicación más frecuente fue la atelectasia con un 7.3 por ciento de los casos. Conclusiones: La prevalencia de Virus en Infecciones Respiratorias Bajas en los pacientes...

Profilaxis de infección por virus respiratorios en niños y adultos sometidos a trasplante de órganos sólidos y precursores hematopoyéticos / Prophylaxis against respiratory viral disease in pediatric and adult patients undergoing solid organ and hematopoietic stem cells transplantation

Respiratory viruses have been identified as a cause of morbidity and mortality in patients undergoing SOT and HSCT, specially in children. The most frequent are respiratory syncytial virus (RSV), influenza (FLU), parainfluenza (PI) and adenovirus (ADV). These infections are associated with progression to severe lower respiratory tract infections in up to 60% of the cases. It is advised to apply universal protection recommendations for respiratory viruses (A2) and some specific measures for FLU and AD. FLU: Annual anti-influenza vaccination (from 4-6 months post-transplantation in SOT, 6 months in HSCT (A2)); post- exposure prophylaxis in FLU (oseltamivir for 10 days (B2)). In lung transplantion, the prophylaxis should last as long as the risk period (B2). ADV: There is no vaccine nor valid chemoprophylaxis strategy to prevent ADV disease. In some specific HSCT recipients, weekly PCR monitoring is recommended until day+100 (A3).

Los virus respiratorios se han identificado como causa de morbi-mortalidad en pacientes sometidos a TOS y TPH, particularmente en pediatría. Los más frecuentes son virus respiratorio sincicial (VRS), influenza (FLU), parainfluenza (PI) y adenovirus (ADV). La fuente de contagio está en la comunidad y en el hospital afectando al paciente en cualquier período post-trasplante. Se describe progresión a infecciones graves del tracto respiratorio bajo hasta en 60 % de los casos. Se recomienda aplicar medidas de aislamiento de precaución universal para todos los virus respiratorios (A2) y se describen algunas medidas específicas para FLU y AlDV. Vacunación anti-influenza anual con vacuna inactivada (en TOS a partir de 4-6 meses post-trasplante (A2), en TPH a partir de 6 meses (A2)); profilaxis post exposición a virus FLU (oseltamivir durante 10 días (B2)). En trasplante de pulmón, la duración de la profilaxis se extenderá mientras dure el período de riesgo (B2). Con respecto a ADV, no se dispone de una vacuna adecuada y no existe a la fecha una estrategia validada de quimioprofilaxis para prevenir enfermedad por ADV; en casos específicos de TPH pediátrico, se recomienda vigilancia semanal con RPC en sangre periférica hasta el día +100 post-TPH (A3).

Metaneumovirus humano en niños: primeros casos en Colombia / Human metapneumovirus in children: first cases in Colombia

El metaneumovirus humano es un nuevo patógeno asociado a infecciones respiratorias, principalmente en niños, que produce cuadros clínicos que van desde leves hasta graves, los cuales pueden incluso requerir tratamiento en unidades de cuidados intensivos. Hasta el momento, la reacción en cadena de la polimerasa con transcripción inversa y el cultivo celular son los métodos más usados para su diagnóstico. Se presentan los seis primeros casos de metapneumovirus humano en niños de Medellín, Colombia.

Human metapneumovirus is a newly discovered pathogen associated with respiratory disease and occurring mainly in children. It produces an acute viral respiratory disease picture that varies from mild disease to severe, and which can require strict surveillance in intensive care units. Currently, reverse transcriptase polymerase chain reaction and cell culture are the most common methods for its diagnosis. The first six cases of human metapneumovirus in Colombia are presented from Medellín.

Seasonality of viral respiratory infections in Southeast of Brazil: the influence of temperature and air humidity

Viruses are the major cause of lower respiratory tract infections in childhood and the main viruses involved are Human Respiratory Syncytial Virus (HRSV), Human Metapneumovirus (HMPV), Influenzavirus A and B (FLUA and FLUB), Human Parainfluenza Virus 1, 2 and 3 (HPIV1, 2 and 3) and Human Rhinovirus (HRV). The purposes of this study were to detect respiratory viruses in hospitalized children younger than six years and identify the influence of temperature and relative air humidity on the detected viruses. Samples of nasopharyngeal washes were collected from hospitalized children between May/2004 and September/2005. Methods of viral detection were RT-PCR, PCR and HRV amplicons were confirmed by hybridization. Results showed 54% (148/272) of viral positivity. HRSV was detected in 29% (79/272) of the samples; HRV in 23.1% (63/272); HPIV3 in 5.1% (14/272); HMPV in 3.3% (9/272); HPIV1 in 2.9% (8/272); FLUB in 1.4% (4/272), FLUA in 1.1% (3/272), and HPIV2 in 0.3% (1/272). The highest detection rates occurred mainly in the spring 2004 and in the autumn 2005. It was observed that viral respiratory infections tend to increase as the relative air humidity decreases, showing significant association with monthly averages of minimal temperature and minimal relative air humidity. In conclusion, viral respiratory infections vary according to temperature and relative air humidity and viral respiratory infections present major incidences it coldest and driest periods.

Brote de parotiditis en el centro penitenciario La Modelo, de Bogotá, Colombia, septiembre-diciembre de 2011 / In center penitentiary bud of parotiditis the Model, of Bogotá, Colombia, September- December of 2011 / No centro botão da penitenciária do parotiditis o modelo, de Bogotá, Colômbia, Setembro- Dezembro de 2011

Antecedentes: El virus de la parotiditis es un paramyxovirus de la familia Paramyxoviridae. Ingresa al cuerpo humano por las vías respiratorias y se localiza en la glándula parótida, donde se reproduce; su único reservorio es el ser humano. Su contagio se da por contacto directo, a través de goticas infectadas; es altamente contagioso. En este trabajo se describe un brote de parotiditis en la cárcel La Modelo, en Bogotá, Colombia; se describe a las personas enfermas, el tiempo de duración del brote y qué medidas se tomaron para su control; se evaluará la efectividad del programa de notificación epidemiológica, si este responde a las necesidades de poblaciones especiales y qué aprendizajes quedaron de la experiencia en cuanto al control de este brote en particular. Métodos: El presente es un estudio descriptivo transversal sobre el brote de parotiditis en el centro penitenciario (CP) La Modelo, en Bogotá. Se utilizó la información recolectada durante el brote por la Empresa Social del Estado (ese) del Sur y el Nivel Central, de la Secretaria Distrital de Salud (sds) de Bogotá. Resultados: Se presentaron 330 casos de parotiditis entre los 6905 internos que se encontraban durante el periodo septiembre-noviembre de 2011 en el cp, y un caso en un funcionario del área de sanidad de la misma entidad; se reportaron 2 casos de complicaciones derivadas de la parotiditis. Fueron vacunados 4495 internos con vacuna trivalente (srp), y 170, con vacuna doble viral (sr), y de los cuales se reportaron 2 eventos supuestamente atribuibles a vacunación e inmunización (esavi). Conclusión: Un reporte adecuado y oportuno, una óptima sensibilización en todos los componentes del sistema de vigilancia epidemiológica y la aplicación de medidas (entre otras, la vacunación) son necesarios para evitar la propagación de brotes de parotiditis en sitios de condiciones complejas como las cárceles, donde predominan el hacinamiento y ambientes higiénico sanitarios cuestionables.

Background: Mumps is an acute viral disease highly contagious caused by many viruses like Paramixovirus, Parainfluenza and Newcastle. It enters the body through the respiratory tract and is then located in the parotid gland where it reproduces. The only reservoir is the human body and contagion is given by direct contact with inflected droplets. This work describes a mumps outbreak occurred in the prison La Modelo in Bogota-Colombia, a description of the sick people, duration of the outbreak, and the control measures taken in a special population with complex sanitary and hygienic conditions are provided. The effectiveness of the epidemiological notification program is evaluated, as well as the knowledge acquired during the control of this particular outbreak. Methods: This is a descriptive cross-sectional study of the outbreak of mumps in the penitentiary center (cp) La Modelo in Bogota. Information was collected during the outbreak by the Hospital del Sur and the Central Level of the District Health Secretary of Bogota (sds). Results: 330 cases of mumps were registered between September to November 2011 of the 6905 interns in the cp, one case was of a health staff member of the prison, two cases of complications derived from the virus were reported. 4495 interns were vaccinated with trivalent (srp), and 170 with (sr) of which two people developed events supposedly attributable to vaccination and immunization. Conclusions: An optimal sensitization to all components of the prison's epidemiological surveillance system thus warranting an appropriate and timely report, also specific measures like the vaccination are necessary to prevent the spread of mumps outbreak in sites with complex conditions such as a prison where the overcrowding is predominate and were questionable sanitary hygienic environments exist.

Antecedentes: O vírus da caxumba é um paramixovírus da família Paramyxoviridae, entra por via respiratória e está localizado na glândula parótida, onde se reproduz e o único hospedeiro é o homem, seu contágio ocorre com o contato direto por meio de gotículas infectadas e é altamente contagiosa. Este artigo descreve um surto de caxumba ocorrido na prisão La Modelo, em Bogotá ­ Colômbia. Serão relatados os casos de peso as contagiadas, a duração do surto e as medidas tomadas para controlar a doença, como também avaliar a eficácia do programa de controle epidemiológico e se responde às necessidades da população em quesão e a aprendizagem envolvida no controle desse surto em particular. Métodos: caracteriza como um estudo descritivo transversal de um surto de caxumba no Centro Penitenciário (CP) La Modelo, em Bogotá. Foram utilizadas informações coletadas durante o surto pela Empresa Social do Estado (ESE), do Sul e do Nivel Central da Secretaria de Saúde de Bogotá (sds). Resultados: foram diagnosticados 330 casos de caxumba nos 6905 presos durante os meses de setembro a novembro de 2011 no CP, e um caso em um funcionário de saúde da mesma entidade, como também foi apresentado dois casos com complicações relatadas decorrentes caxumba. Foram vacinados 4495 detentos com trivalente (SRP) e 170 com (SR), dos quais foram notificados 2 eventos supostamente atribuíveis à vacinação e imunização (ESAVI). Conclusão: Um relatório adequado, oportuno e uma sensibilização de todo pessoal da vigilância epidemiológica e medidas de aplicação, incluindo a vacinação, são necessários para evitar a propagação do surto de caxumba em locais com condições complexas, tais como prisões, onde domina a superlotação e ambientes higiênicos sanitários questionáveis

Infección respiratoria por metapneumovirus humano en pacientes adultos mayores / Respiratory infections caused by metapneumovirus in elderly patients

Human metapneumovirus infections are increasingly recognized among adult patients and the aim of this report is to present a series of 4 cases admitted during the winter of 2010. All were detected by direct fluorescence anti-bodies assay of respiratory samples and all were female patients with an age range of 79 to 95 years, including two bedridden cases, one with dementia and three with chronic obstructive pulmonary disease. One patient presented with parainfluenza 3 virus coinfection. Patients presented with pneumonía in 3 cases (interstitial pattern in 2 and lobar consolidation in the other) or acute exacerbation of chronic bronchitis in the remaining case. Symptoms were present for 3 to 7 days before admission and 3 have wheezing. All had hypoxemic or global respiratory failure and lymphopenia (< 1.000/mm³). Hospitalization lasted for 5 to 20 days, marked in the 3 cases that survived by prolonged bronchial obstructive manifestations. Two cases required non invasive mechanical ventilation. Human metapneumovirus infections can decompensate elderly patients with chronic respiratory diseases generating hospital admission and a prolonged morbidity marked by obstructive manifestations and sometimes can become into death.

Las infecciones por metapneumovirus (MPVH) son poco conocidas en pacientes adultos y el objetivo de esta publicación es presentar una serie de 4 casos observados en pacientes hospitalizados durante el invierno de 2010. Los casos se identificaron por inmunofluorescencia directa en muestras respiratorias. Todos los pacientes fueron de sexo femenino con un rango de edad 79 a 95 años, dos de ellos postrados, uno con demencia y 3 con enfermedad pulmonar obstructiva crónica. La manifestación clínica correspondió a neumonía en 3 casos (2 de tipo intersticial y una con consolidación lobar) y bronquitis crónica reagudizada en el caso restante, con una duración sintomática de 3 a 7 días antes de la hospitalización. Un caso presentó co-infección con virus parainfiuenza 3. Las sibilancias estuvieron presentes en 3 casos y todos presentaron falla respiratoria hipoxémica o global con linfopenia (< 1.000/mm³). La hospitalización tuvo una duración de 5 a 20 días, marcada en los 3 casos que sobrevivieron por una signología obstructiva prolongada. Dos pacientes requirieron ventilación mecánica no invasora. Las infecciones por MPVH representan una causa de hospitalización por descompensación de patologías respiratorias crónicas en pacientes adultos ancianos, tienen una morbilidad prolongada con signología obstructiva marcada y pueden ocasionar la muerte.

Estudio seroepidemiológico del virus de parainfluenza 3 en bovinos del municipio de Montería (Colombia) con trastornos reproductivos / Seroepidemiological study of parainfluenza 3 virus in bovines with reproductive failure, from Monteria-Colombia

El virus de parainfluenza-3 (PI-3) se reconoce como parte del síndrome complejo respiratorio bovino, en compañía de otras entidades, como el virus respiratorio sincitial bovino. El presente trabajo se realizó en Montería (Colombia), en bovinos de 28 fincas equidistantes en las coordenadas geográficas, con el fin de establecer la prevalencia serológica del virus PI-3. Se recolectaron 137 muestras de sangre, de hembras con antecedentes de infertilidad. Adicionalmente, se obtuvieron muestras al azar de 26 toros, pertenecientes a las mismas fincas. Para el diagnóstico serológico se empleó la prueba de Elisa. Se realizó un análisis descriptivo, tabulando la información con datos de seropositividad y seronegatividad, obtenidos de cada animal. Se utilizó la prueba del chi-cuadrado para establecer posibles asociaciones entre las variables sexo, edad, estado reproductivo y tipo de explotación, con la reactividad serológica al virus PI-3. La prevalencia obtenida fue de 13,5%; solo se encontró significancia para el grupo etario y no se halló asociación para las otras variables consideradas en el estudio. Se concluyó que existe circulación del virus PI-3 en bovinos del municipio de Montería. Se puede pensar que parte del problema reproductivo observado en las ganaderías de la región puede ser debido al virus PI-3. Se recomienda la realización de estudios más extensos sobre la prevalencia de este virus en el país, incluyendo el impacto económico que el PI-3 pueda tener sobre la ganadería naciona.

The virus of the bovine Parainfluenza 3 is known to be a part of the bovine respiratory complex, along with another infectious agents as the bovine sincitial respiratory virus, which has not as yet been diagnosed at the geographical area of this study. This work was carried out at Monteria, Colombia, in bovines from 28 farms, with the aim of finding the serological prevalence of the PI-3 virus. Blood samples were collected from 137 females, with a history of reproductive failure, and from 26 bulls from the same farms. The serological test used was the ELISA test. A descriptive analysis was carried out, recording data from positives and from negatives sera. A Chi-square test was used to test for association between the variables: sex, age, reproductive condition and type of production system, with serological reactivity to the PI-3 virus. Concerning the results of the study, the point prevalence for the PI-3 virus found was 13,5%, and under statistical bases, statistical significance was found between age groups and association was not found for the others variables taken in account for the study. According to the results, it was concluded that the PI-3 virus is present in bovines of Montería, and that a part of the reproductive failure in females of the region, mostly the return to oestrus and abortions, is due to the effect of that pathological entity. Finally, the authors recommend more extensive studies on PI-3 Infection, at the different cattle raising areas of Colombia, a country of 24 million heads.