Population-based surveillance and a case-control study of risk factors for endemic lymphocutaneous sporotrichosis in Peru.

Population-based surveillance and a case-control study were conducted in Abancay, Peru, to estimate the burden of disease and to determine risk factors for sporadic lymphocutaneous sporotrichosis (LS). Laboratory records from local hospitals were reviewed for the years of 1997 and 1998, and prospective surveillance was conducted for the period of September 1998 through September 1999. A case-control study was conducted with 2 matched control subjects per case patient. The mean annual incidence was 98 cases per 100,000 persons. Children had an incidence 3 times higher than that for adults and were more likely to have LS lesions on the face and neck. Identified risk factors included owning a cat, playing in crop fields, having a dirt floor in the house, working mainly outdoors, and having a ceiling made of raw wood or conditions associated with a lower socioeconomic status. Decreased environmental exposure, such wearing protective clothing during construction activities for adults or limiting contact with cats and soil for children, and improvements in living spaces may decrease the incidence of LS.

Determinación de la variedad de cepas de Cryptococcus neoformans aisladas de pacientes con sida / Determination of the variety of Criptococcus neoformans` strains isolated from aids` patients

Cryptococcus neoformans tiene 2 variedades: neoformans y gattii. El primero afecta a pacientes inmunosuprimidos y la variedad gattii produce enfermedad en individuos aparentemente sanos originando compromiso neurológico. En nuestro país no se realizan pruebas bioquímicas diferenciales, por lo que este estudio permitió estandarizar un método de tipificación de las variedades en cepas de C. neoformans de origen mantenidas en el Instituto Nacional de Salud del Perú (INS). Entre abril de 1997 y diciembre de 1998, el INS recibió 18 cepas de C. neoformans aisladas de pacientes con SIDA. la confirmación de las especies fue realizada según métodos convencionales: observación de levaduras encapsuladas, prueba de la urea, asimilación de carbohidratos y tolerancia a la temperatura. Adicionalmente se verificó la ausencia de la enzima nitrato reductasa y se realizó la prueba de la fenoloxidasa modificada. Las 18 cepas fueron tipificadas como variedad neoformans usando el agar CGB. No se encontró ninguna cepa de variedad gattii

Nuevos casos de paracoccidioidomicosis / New cases of Paeacoccidioidomycosis

La paracoccidioidomicosis es causada por el hongo Paracoccidoides brasiliensis. Esta infección es crónica y usualmente asintomática en niños. La distribución geográfica está limitada a Centroamérica y América del Sur. En el presente estudio se describen las características clínicas y epidemiológicas de 06 casos confirmados de paracoccidioidomicosis por el Instituto Nacional de Salud. Se observó la presencia del hongo por examen directo y cultivo en muestras de biopsias, absceso, y aspirado de ganglio. Las pruebas de inmunodifusión fueron realizadas en muestras de sangre provenientes de 04 pacientes. Todos los pacientes proceden de zonas tropicales o semitropicales (Tingo María, Oxapampa, Pucallpa y Chanchamayo) que tienen una precipitación media anual de 1500 mm/año, humedad relativa del 82, temperatura anual de 28ºC-30ºC y altura inferior a 1814 m.s.n.m. Las principales características sintomatológicas encontradas incluyen aumento del tamaño de ganglios y tuberculosis pulmonar. P. brasiliensis fue aislado en 2/6 pacientes y en 4/6 de los casos se observó la presencia de anticuerpos precipitantes por inmunodifusión. Se concluye que le 83 de los pacientes presentaron linfoadenopatías y el laboratorio permite confirmar el diagnóstico

Rapid and inexpensive approaches to managing abnormal vaginal discharge or lower abdominal pain: an evaluation in women attending gynaecology and family planning clinics in Peru.

OBJECTIVES: To assess low abdominal pain, yellow vaginal discharge, other symptoms and signs, and demographic and behavioural variables as predictors for cervical or vaginal infection. METHODS: A cross sectional study of women attending gynaecology and family planning clinics in Lima, Peru was undertaken. 630 consecutive eligible female patients with chief or elicited complaints of yellow vaginal discharge, low abdominal pain, or both were interviewed and examined, together with a comparable reference group without these complaints. Vaginal specimens were tested for trichomoniasis and bacterial vaginosis. Endocervical specimens were tested for Neisseria gonorrhoeae and Chlamydia trachomatis using the ligase chain reaction. RESULTS: Infections found included chlamydial infection in 69 women (10.9%), gonorrhoea in 10 (1.6%), and either infection in 77 (12.2%); trichomoniasis in 46 (7.3%), bacterial vaginosis in 189 (30%), and either infection in 209 (33.2%). Cervical infection with C trachomatis and/or N gonorrhoeae was independently associated with history of a new sex partner within the last 3 months, more than one sex partner within the last year, use of condoms never or in less than 50% of sex acts, history of sex partner with STD within the last year; with symptoms of persistent low abdominal pain and of yellow vaginal discharge; and with signs of profuse and yellow vaginal discharge, cervical ectopy, easily induced endocervical bleeding, or brown cervical secretion. Using these findings, an algorithm was created that had a positive predictive value (PPV) of 36% for cervical infection among women reporting chief or elicited complaint of this abnormal vaginal discharge and a PPV of 25% among those without a complaint. A chief complaint of yellow vaginal discharge had a PPV of 50% for trichomoniasis or bacterial vaginosis. Among women without a chief complaint of yellow vaginal discharge, clinical findings of yellow vaginal discharge had a PPV of 55%. CONCLUSIONS: Where economic and technical constraints preclude testing, clinical findings and risk assessment are helpful in detecting vaginal and cervical infections. Several demographic, behavioural, clinical, and laboratory variables were predictive of infection in this population.