Severe Inflammatory and Disseminated Cutaneous Leishmaniasis in a Pregnant Woman: A Case Report from Portoviejo, Ecuador.

BACKGROUND Leishmaniasis is a zoonosis with worldwide prevalence that causes dermal lesions and can be serious in humans. This report presents a case of cutaneous leishmaniasis (CL) that was apparently associated with a zoonotic transmission in a peri-urban area of the city of Portoviejo, Ecuador, close to mountainous and forested sites. CASE REPORT For 37 years, we have studied transmission of leishmaniasis in Ecuador, and have seen a wide variety of clinical presentations of the disease caused by different strains of the parasite Leishmania in patients, including pregnant women, without marked difference among them. CL without complications causes painless lesions of different clinical aspect. The present study reports a case of a 25-year-old woman presenting with severely inflamed, disseminated, and painful lesions of CL. The patient was not given antimonial treatment; however, local cryotherapy was given, together with topical anti-inflammatory and antibiotic ointment. All the lesions were observed to heal, and no amastigotes were found in smear stains after clinical healing. Since there was no reactivation after 1.5 years of follow-up, conventional antileishmanial treatment with meglumine antimoniate was not given to the patient. CONCLUSIONS This report shows the importance of a properly done epidemiological and clinical presumtive diagnosis, followed by parasitological confirmation, and the benefit of using an alternative treatment for vulnerable patients, such as this pregnant woman, for whom the therapy with pentavalent antimonials is not indicated. All observed lesions healed and no amastigotes were found in the smears after clinical healing.

Ecoepidemiology of Ancylostoma spp. in Urban-Marginal and Rural Sectors of the Ecuadorian Coast and Prevalence of Cutaneous Larvae Migrans.

BACKGROUND Ancylostoma spp., including A. duodenale, A. braziliense, A. caninum, and A. ceylanicum, are hookworms that are transmitted from infected soil and by contact with domestic animals and rodent hosts, and can cause systemic disease and cutaneous larva migrans. The objective of this study was to describe the ecoepidemiology of Ancylostoma caninum and Ancylostoma spp. in urban-marginal sectors and in rural sectors located in Ecuador. MATERIAL AND METHODS Through addressed sampling, a total of 498 domestic dogs and 40 synanthropic rodents were analyzed via the following coproparasitic methods: direct, flotation, sedimentation with centrifugation using saline (egg identification), modified Baermann (larval identification), and morphometric methods (confirmation). A total of 236 people were surveyed, and a clinical analysis was performed via physical examination. The environmental variables were obtained through reports from the INAMHI of Ecuador and the use of online environmental programs. Through surveys, data related to social determinants were obtained. Epidemiological indicators (prevalence, morbidity, and mortality) were obtained through microbial analysis and surveys. RESULTS A total of 250 domestic dogs were diagnosed with Ancylostoma caninum (50, 20%), and 41 were diagnosed with Ancylostoma spp. (8.23%). One synanthropic rodent (2.5%) was positive for A. caninum. In the clinical analysis, 3 patients were identified as positive (1.27%) for cutaneous larva migrans (CLM). Likewise, environmental variables and social determinants influence the transmission, prevalence, and nature of parasitism by hookworm. CONCLUSIONS People, domestic dogs, and rodents were infected with these parasites. Consequently, there is a risk of ancylostomiasis and cutaneous larvae migrans spreading.

Fully implanted battery-free high power platform for chronic spinal and muscular functional electrical stimulation.

Electrical stimulation of the neuromuscular system holds promise for both scientific and therapeutic biomedical applications. Supplying and maintaining the power necessary to drive stimulation chronically is a fundamental challenge in these applications, especially when high voltages or currents are required. Wireless systems, in which energy is supplied through near field power transfer, could eliminate complications caused by battery packs or external connections, but currently do not provide the harvested power and voltages required for applications such as muscle stimulation. Here, we introduce a passive resonator optimized power transfer design that overcomes these limitations, enabling voltage compliances of ± 20 V and power over 300 mW at device volumes of 0.2 cm2, thereby improving power transfer 500% over previous systems. We show that this improved performance enables multichannel, biphasic, current-controlled operation at clinically relevant voltage and current ranges with digital control and telemetry in freely behaving animals. Preliminary chronic results indicate that implanted devices remain operational over 6 weeks in both intact and spinal cord injured rats and are capable of producing fine control of spinal and muscle stimulation.

A Case of Urbanorum spp. in a Woman from an Urban-Marginal Sector of Ecuador.

BACKGROUND Worldwide, there are few cases of Urbanorum spp. in humans; however, it is associated with gastrointestinal pathologies, where humans probably acquire the disease by fecal-oral transmission, by ingesting food or water with infective cysts. The main symptoms of the patients who have this presumed parasite are fever, vomiting, colic, dyspepsia, and watery diarrhea. Since the first case of Urbanorum spp. was reported in 1994 in Colombia, cases have subsequently been reported in Peru, Ecuador, Colombia, Brazil, and Mexico. In Ecuador, a prevalence of 1.16% has been reported, and the objective of this study was to record another case of Urbanorum spp. infection in Ecuador. CASE REPORT A female patient (mixed race; 40 years old; and thin, weighing 57 to 62 kg) requested help from the FCI Project approved and financed by the University of Guayaquil (Ecuador). She underwent routine tests, such as direct parasitology and sedimentation with centrifugation using saline solution. Samples were observed under an optical microscope with 10x and 40x objectives and stained with and without Lugol's solution. We detected a rounded structure with several filaments similar to light yellow pseudopods. CONCLUSIONS Herein, a case of Urbanorum spp. infection in Ecuador, where current environmental and sanitary conditions have contributed to new cases, is reported, indicating that the community was exposed to this probable parasite with importance in public health. Further studies are recommended to confirm its etiology, life cycle, and epidemiology, in order to create a national registry, in case it is defined as a protozoan.

Zoonotic Transmission of Hepatic Hydatid Cyst from Domestic Dogs: A Case Report from an Urban-Marginal Area in Ecuador.

BACKGROUND Hepatic hydatidosis, or echinococcosis, is a zoonosis with worldwide prevalence and is potentially lethal in humans. This report presents a case of hydatidosis in a 40-year-old woman that was associated with a zoonotic transmission of Echinococcus granulosus from domestic dogs in an urban-marginal area of the city of Guayaquil, Ecuador. This report shows how early diagnosis and awareness favored the correct treatment of the disease. CASE REPORT A 40-year-old woman from the aforementioned sector presented the following symptoms: malaise, pain in the upper right hypochondrium, palpable mass, jaundice, and fever. Next, the patient's fecal samples were analyzed by direct coproparasitic methods, flotation, and sedimentation with centrifugation using saline solution, whereby the presence of Entamoeba histolytica eggs was determined. Likewise, she underwent an ultrasound, in which hepatic hydatid cysts were observed. Subsequently, the cysts were treated and surgically removed, and parasitic forms of E. granulosus were identified. Later, coproparasitic analysis of her 2 domestic dogs for coproantigen ELISA were performed, by which the presence of this cestode was also identified and confirmed. CONCLUSIONS Hydatidosis is a zoonosis that can affect the population, especially in endemic areas of developed and underdeveloped countries. In this case, hepatic hydatidosis was identified in a 40-year-old woman. Additionally, the presence of E. granulosus eggs was determined in the fecal matter of her dogs, which indicated that the patient's relatives and other people around them were exposed to this zoonosis.

Hymenolepiasis Caused by Hymenolepis nana in Humans and Natural Infection in Rodents in a Marginal Urban Sector of Guayaquil, Ecuador.

BACKGROUND Hymenolepiasis is a globally prevalent zoonosis of the monoxenic cycle. Humans acquire the disease through fecal-oral transmission by ingesting food or water with infective eggs from infected rodents. This report presents 3 cases of hymenolepiasis in children, due to zoonotic transmission from rodents and presumably associated with the consumption of powdered milk contaminated with infective eggs of Hymenolepis nana, and shows that awareness and early diagnosis contributed to timely treatment of the disease. CASE REPORT Three children, aged 9, 12, and 13 years, living in a marginal urban area of Guayaquil, Guayas province, Ecuador, presented symptoms of diarrhea, low body weight, abdominal discomfort, anorexia, paleness, and anal itching. Subsequently, their fecal samples were analyzed by direct coproparasitic methods, flotation and sedimentation with centrifugation using saline solution; the presence of H. nana eggs was determined. Blood biometry was performed. Further, 10 rodents were captured and necropsied to obtain intestinal contents. The powdered milk consumed by the children was analyzed, the same powder that contained rodent feces. Subsequently, these were studied with the above-mentioned coproparasitic methods. H. nana eggs were identified in the 6 trapped rodents, the powdered milk, and the feces of rodents found in the milk powder. CONCLUSIONS Hymenolepiasis can affect populations of endemic areas. In this case, the disease was identified in 3 children, who were diagnosed with eosinophilia and anemia. Additionally, the presence of H. nana eggs in captured rodents and in powdered milk was determined, indicating that the community was exposed to this zoonotic disease.

Wireless, fully implantable cardiac stimulation and recording with on-device computation for closed-loop pacing and defibrillation.

Monitoring and control of cardiac function are critical for investigation of cardiovascular pathophysiology and developing life-saving therapies. However, chronic stimulation of the heart in freely moving small animal subjects, which offer a variety of genotypes and phenotypes, is currently difficult. Specifically, real-time control of cardiac function with high spatial and temporal resolution is currently not possible. Here, we introduce a wireless battery-free device with on-board computation for real-time cardiac control with multisite stimulation enabling optogenetic modulation of the entire rodent heart. Seamless integration of the biointerface with the heart is enabled by machine learning-guided design of ultrathin arrays. Long-term pacing, recording, and on-board computation are demonstrated in freely moving animals. This device class enables new heart failure models and offers a platform to test real-time therapeutic paradigms over chronic time scales by providing means to control cardiac function continuously over the lifetime of the subject.

Natural infection of Trypanosoma sp. in domestic sheep from Ecuador / Infecção natural do Trypanosoma sp. em ovelhas domésticas do Equador

Trypanosomosis in sheep is a hemoparasitic disease of worldwide interest due to its effects on the health of animals and the economic impact on producers, is caused by the protozoan Trypanosoma sp. In the present study, the occurrence of Trypanosoma sp. in sheep from the urban-rural area of the canton Salitre was determined, through an applied study with a qualitative descriptive prospective cross-sectional approach, carried out between October 1, 2019, and February 19, 2020. Blood samples were extracted from the jugular vein and analyzed by the blood smear method using the Giemsa and Diff-Quick staining techniques. Previously, in a first study realized between 2018 and 2019, 2 cases (2%) of Trypanosoma sp., 1 case of Babesia sp. (1%), and 4 cases of Anaplasma marginale (4%) were identified, but without the presence of symptoms of the disease. However, in this new research study, of 170 animals sampled from 5 herds and aged between 3 and 8 years, 34 (20%) were positive for Trypanosoma sp., 6 for Babesia sp. (3.52%) and 6 for A. marginale (3.52%) with coinfection between them. In this research, deteriorated clinical aspects and low hematological values were also determined in positive animals; besides of the total of positive cases, 25 presented symptoms of hemoparasitic disease, 3 sheep had abortions and 8 died. The results of this study showed that Trypanosoma sp. could already become an endemic parasitosis in sheep in the country, representing a serious problem of animal health.

A tripanossomose em ovinos é uma doença hemoparasitária de interesse mundial devido a seus efeitos sobre a saúde dos animais e o impacto econômico sobre os produtores, Esta doença é causada pelo protozoário Trypanosoma sp. No presente estudo, foi determinada a ocorrência de Trypanosoma sp. em ovelhas da área urbano-rural do Cantão Salitre, através de um estudo aplicado com uma abordagem transversal descritiva qualitativa prospectiva, realizado entre dia primeiro de outubro de 2019, à 19 de fevereiro de 2020. Amostras de sangue foram extraídas da veia jugular e analisadas pelo método de esfregaço de sangue usando as técnicas de coloração Giemsa e Diff-Quick. Anteriormente, em um primeiro estudo realizado entre 2018 e 2019, dois casos (2%) de Trypanosoma sp., foram identificados um caso de Babesia sp. (1%), e quatro casos de Anaplasma marginale (4%), mas sem a presença de sintomas da doença. Entretanto, neste novo estudo de pesquisa, de 170 animais amostrados de cinco rebanhos e com idades entre três e oito anos, 34 (20%) foram positivos para Trypanosoma sp., seis para Babesia sp. (3,52%) e seis para A. marginale (3,52%) com coinfecção entre eles. Nesta pesquisa, aspectos clínicos deteriorados e baixos valores hematológicos também foram determinados em animais positivos; além do total de casos positivos, 25 apresentaram sintomas de doença hemoparasítica, três ovelhas tiveram abortos e oito morreram. Os resultados deste estudo mostram que o Trypanosoma sp. já poderia se tornar uma parasitose endêmica em ovinos no país, representando um grave problema de saúde animal.

Osseosurface electronics-thin, wireless, battery-free and multimodal musculoskeletal biointerfaces.

Bioelectronic interfaces have been extensively investigated in recent years and advances in technology derived from these tools, such as soft and ultrathin sensors, now offer the opportunity to interface with parts of the body that were largely unexplored due to the lack of suitable tools. The musculoskeletal system is an understudied area where these new technologies can result in advanced capabilities. Bones as a sensor and stimulation location offer tremendous advantages for chronic biointerfaces because devices can be permanently bonded and provide stable optical, electromagnetic, and mechanical impedance over the course of years. Here we introduce a new class of wireless battery-free devices, named osseosurface electronics, which feature soft mechanics, ultra-thin form factor and miniaturized multimodal biointerfaces comprised of sensors and optoelectronics directly adhered to the surface of the bone. Potential of this fully implanted device class is demonstrated via real-time recording of bone strain, millikelvin resolution thermography and delivery of optical stimulation in freely-moving small animal models. Battery-free device architecture, direct growth to the bone via surface engineered calcium phosphate ceramic particles, demonstration of operation in deep tissue in large animal models and readout with a smartphone highlight suitable characteristics for exploratory research and utility as a diagnostic and therapeutic platform.

Biosymbiotic, personalized, and digitally manufactured wireless devices for indefinite collection of high-fidelity biosignals.

Digital medicine, the ability to stream continuous information from the body to gain insight into health status, manage disease, and predict onset health problems, is only gradually developing. Key technological hurdles that slow the proliferation of this approach are means by which clinical grade biosignals are continuously obtained without frequent user interaction. To overcome these hurdles, solutions in power supply and interface strategies that maintain high-fidelity readouts chronically are critical. This work introduces a previously unexplored class of devices that overcomes the limitations using digital manufacturing to tailor geometry, mechanics, electromagnetics, electronics, and fluidics to create unique personalized devices optimized to the wearer. These elastomeric, three-dimensional printed, and laser-structured constructs, called biosymbiotic devices, enable adhesive-free interfaces and the inclusion of high-performance, far-field energy harvesting to facilitate continuous wireless and battery-free operation of multimodal and multidevice, high-fidelity biosensing in an at-home setting without user interaction.

Wireless, battery-free, subdermally implantable platforms for transcranial and long-range optogenetics in freely moving animals.

Wireless, battery-free, and fully subdermally implantable optogenetic tools are poised to transform neurobiological research in freely moving animals. Current-generation wireless devices are sufficiently small, thin, and light for subdermal implantation, offering some advantages over tethered methods for naturalistic behavior. Yet current devices using wireless power delivery require invasive stimulus delivery, penetrating the skull and disrupting the blood-brain barrier. This can cause tissue displacement, neuronal damage, and scarring. Power delivery constraints also sharply curtail operational arena size. Here, we implement highly miniaturized, capacitive power storage on the platform of wireless subdermal implants. With approaches to digitally manage power delivery to optoelectronic components, we enable two classes of applications: transcranial optogenetic activation millimeters into the brain (validated using motor cortex stimulation to induce turning behaviors) and wireless optogenetics in arenas of more than 1 m2 in size. This methodology allows for previously impossible behavioral experiments leveraging the modern optogenetic toolkit.

Wireless battery free fully implantable multimodal recording and neuromodulation tools for songbirds.

Wireless battery free and fully implantable tools for the interrogation of the central and peripheral nervous system have quantitatively expanded the capabilities to study mechanistic and circuit level behavior in freely moving rodents. The light weight and small footprint of such devices enables full subdermal implantation that results in the capability to perform studies with minimal impact on subject behavior and yields broad application in a range of experimental paradigms. While these advantages have been successfully proven in rodents that move predominantly in 2D, the full potential of a wireless and battery free device can be harnessed with flying species, where interrogation with tethered devices is very difficult or impossible. Here we report on a wireless, battery free and multimodal platform that enables optogenetic stimulation and physiological temperature recording in a highly miniaturized form factor for use in songbirds. The systems are enabled by behavior guided primary antenna design and advanced energy management to ensure stable optogenetic stimulation and thermography throughout 3D experimental arenas. Collectively, these design approaches quantitatively expand the use of wireless subdermally implantable neuromodulation and sensing tools to species previously excluded from in vivo real time experiments.

First report of sheep naturally infected with Trypanosoma sp. in Ecuador / Primeiro relato de ovinos naturalmente infectados com Trypanosoma sp. no Equador

ABSTRACT: The prevalence of trypanosomiasis in sheep is of worldwide concern. It is a hemoparasitic disease caused by the protozoan Trypanosoma (T) spp., andthe biological cycle of transmission involves susceptible hosts and certain hematophagous flies, such as Tabanids and Stomoxys. The objective of this study was to determine the presence of Trypanosomasp. in sheep (Ovisaries). Through an applied, descriptive-prospective-cross-sectional qualitative study conducted between October 1, 2018, and January 29, 2019, blood samples extracted from the jugular vein were analyzed by the blood smear method using 2 Romanowsky staining techniques (Giemsa and Diff-Quick). Animals studied were between ages of 3 and 10 years, coming from 3 farms in the city of Colimes (Ecuador). Of 100 sampled and processed animals, 2 (2%) were positive for Trypanosoma sp., constituting the first report of this hemoparasite in sheep in Ecuador, and 1 case of Babesia spp. (1%) and 4 cases of Anaplasma marginale (4%) were also identified. However, none of these cases presented symptomatology of any hemotropic-parasitic disease. Subsequently, the positive animals were dewormed.The presence of these parasites wasconfirmedat the study site and,thus, could become a serious animal health problem.

RESUMO: A tripanossomíase em ovelhas é uma hemoparasitose globalmente prevalente causada pelo protozoário chamado Trypanosoma (T) sp. O ciclo de vida de transmissão envolve hospedeiros suscetíveis e alguns dípteros hematófagos como Tabanids e Stomoxys. O objetivo destetrabalho foi determinar a presença de Trypanosoma sp. em ovelhas (Ovisaries). Através de um estudo aplicado, com abordagem qualitativa, do tipo descritivo prospectivo-transversal, realizado entre o dia primeiro de outubro de 2018 e 29 de janeiro de 2019, foram analisadas amostras de sangue extraídas da veía jugular pelo método do esfregaço de sangue, utilizando duas técnicas de coloração Romanowski (Giensa e Diff-Quick). Os animais estudados tinham entre três e dez anos de idade, de três fazendas no municipio de Colimes (Equador). Dos 100 animais amostrados e processados, dois casos (2%) foram positivos para Trypanosoma sp., constituindo o primeiro relato deste hemoparasita em ovelhas no Equador. Além disso, um caso de Babesia sp. (1%) e quatro casos de Anaplasma marginale (4%); entretanto, em nenhum desses casos houve sintomas de qualquer doença hemotropicoparasitária. Animais positivos foram posteriormente desparasitados. A presença desses parasitas foi confirmada no local do estudo e, portanto, pode se tornar um sério problema de saúde animal.

Wireless, battery-free, fully implantable multimodal and multisite pacemakers for applications in small animal models.

Small animals support a wide range of pathological phenotypes and genotypes as versatile, affordable models for pathogenesis of cardiovascular diseases and for exploration of strategies in electrotherapy, gene therapy, and optogenetics. Pacing tools in such contexts are currently limited to tethered embodiments that constrain animal behaviors and experimental designs. Here, we introduce a highly miniaturized wireless energy-harvesting and digital communication electronics for thin, miniaturized pacing platforms weighing 110 mg with capabilities for subdermal implantation and tolerance to over 200,000 multiaxial cycles of strain without degradation in electrical or optical performance. Multimodal and multisite pacing in ex vivo and in vivo studies over many days demonstrate chronic stability and excellent biocompatibility. Optogenetic stimulation of cardiac cycles with in-animal control and induction of heart failure through chronic pacing serve as examples of modes of operation relevant to fundamental and applied cardiovascular research and biomedical technology.

West Nile virus in Ecuador / Virus del Nilo Occidental en Ecuador

ABSTRACT Several studies have been carried out to determine the presence and circulation of West Nile Virus (WNV) in several species that interact in important ecosystems of Ecuador, such as the Galapagos Islands, where presence and surveillance studies of WNV have been carried out in wild and migratory birds (2003) (2008 to 2010), penguins (2003 to 2004). Studies have also been carried out on birds from different locations in Guayaquil (2011), and on Jauneche horses (2007), but no virus has been demonstrated in any of them. Nevertheless, in the Abras de Mantequilla wetland, two studies were conducted in equines aged between 3 months to 12 years, all of them mixed race, male and female, with no previous vaccination history and with presence of symptoms only in the first study. In the two studies the serum analysis was performed by the ELISA technique (reactivity determination) and Plaque Reduction Neutralization Test (PRNT). In the first study, 8.12% (13/160) of reactivity was determined in 13 horses and 22.22% of reactivity in 2 of 9 people; and only 3.12% (5/160 horses) of the presence of IgM antibodies against WNV. In relation to the second study, 12.6% (52/412) reactivity and 10.4% (43/412 horses) confirmed the serological evidence of WNV, with a final prevalence of 6.76%. Consequently, the WNV is present and circulating in the equines of the Ecuadorian coastal zone, which is a potential risk to the public health, nevertheless there is no updated information on investigations conducted in this regard.

RESUMEN El presente es una revisión bibliográfica sobre estudios realizados para determinar la presencia y circulación del Virus del Nilo Occidental (VNO) en diversas especies que interactúan en importantes ecosistemas del Ecuador, como son las Islas Galápagos, en donde, se han realizado estudios de presencia y vigilancia del VNO en aves silvestres y migratorias (2003) (2008 al 2010) y pingüinos (2003 al 2004). También, se ha realizado estudios en aves de diversos lugares de Guayaquil (2011), y en equinos de Jauneche (2007) pero en ninguno de los lugares se evidenció la presencia del virus. Por otro lado, en el humedal Abras de Mantequilla, Coello y colaboradores realizaron dos estudios en equinos de edades entre 3 meses a 12 años, todos de raza mestiza, sexo machos y hembras, sin antecedentes de vacunación y con presencia de síntomas solo en el primer estudio. El análisis de los sueros en los dos estudios se realizó mediante la técnica de ELISA (determinación de reactividad) y la confirmación a través de Neutralización por Reducción del Número de Placas (NTRP). En el primer estudio se determinó el 8.12% (13/160) de reactividad en 13 equinos y el 22.22% de reactividad en 2 de 9 personas (no se confirmaron); del total de muestras reactivas en equinos, solo se confirmó el 3.12% (5 equinos/160) de la presencia de anticuerpos IgM contra VNO. Respecto al segundo estudio estableció el 12.6% (52/412) de reactividad y el 10.4% (43/412 equinos) se confirmó la evidencia serológica del VNO, con una prevalencia final del 6.76%. Por lo consiguiente, el VNO está presente y circulando en los equinos de la zona costera ecuatoriana, lo cual es un riesgo potencial para la salud pública, sin embargo no hay información actualizada de investigaciones realizadas al respecto.

[Case Report: first case of hantavirus cardiopulmonary syndrome diagnosed in the Second Region of Antofagasta]. / Primer caso de síndrome cardiopulmonar por hantavirus diagnosticado en la Región de Antofagasta, Chile.

Cases of Hantavirus cardiopulmonary syndrome (HCPS) have been reported in Chile between Region V and XI. In our country HCPS is caused by Andes virus. Hantavirus infection is acquired mainly through inhalation of aerosolized rodent fluids. Person to person transmission is considered exceptional. The identified rodent reservoir of the virus extends throughout Region III to XII, and no cases have been reported in the north of Chile. The incubation period is prolonged. We report the first diagnosed patient with HCPS in the north of Chile. In this case we suggest the possibility of person to person transmission.