[Autochthonous Rickettsia parkeri rickettsiosis in the Paranaense Forest, Misiones, Argentina]. / Caso autóctono de rickettsiosis por Rickettsia parkeri en la Selva Paranaense, Misiones, Argentina.

We report an autochthonous case of Rickettsia parkeri rickettsiosis occurred in June 2018 in a forested area of the Urugua-í Provincial Park, Misiones, Argentina. No previous records of this disease in humans have been previously reported in this region. The epidemiological, ecological, clinical, and laboratory features required for a proper diagnosis and adequate treatment are described here. The fact of considering rickettsiosis as a differential diagnosis in a patient with exanthematic acute febrile syndrome is highlighted, being the epidemiological history of exposure to the vector (ticks of the genus Amblyomma) an essential element.

[First report of Echinococcus vogeli in a paca in Misiones province, Argentina]. / Primera identificación de Echinococcus vogeli en una paca en la provincia de Misiones, Argentina.

We report the first finding of Echinococcus vogeli in a paca, Cuniculus paca, in the tropical forest of Misiones, in the north of Argentina. The presence of the bush dog, Speothos venaticus, E. vogelís only natural definitive host, was also reported. The polycystic hydatids, 2 to 3 cm in diameter, were only found in the liver of an adult paca. The size range of the hooks and the relative proportion blade/handle did not show significant differences with respect to the ones reported for E. vogeli. The size of E. granulosus hooks, measured for comparison purposes, was significantly smaller (p E. vogeli in Argentina. The probability of finding neotropical echinococcosis in humans reinforces the need to expand the search for E. vogeli in Argentina. Echinococcosis due to E. vogeli is very aggressive and may cause death in about a third of the human population affected.

[Retroperitoneal hydatidosis secondary to hepatic hydatid cyst]. / Hidatidosis retroperitoneal secundaria a quiste hidatídico de localización hepática.

Hydatid disease is a worldwide zoonosis. It is caused by a parasitic platyhelminth of the genus Echinococcus. We present a patient with a fluctuating lumbar tumor in the retroperitoneal space, secondary to a hepatic cyst. the initial diagnosis was made by identification of rostellar hooks from protoscoleces in the fluid aspirated from the abscess. We herein describe the clinical manifestations, diagnosis and medical and surgical treatment of this unusual case and conclude that the development of an accurate diagnosis requires a proper analysis of the patient's epidemiological history, clinical manifestations, imaging studies and laboratory tests. a multidisciplinary approach and differential diagnosis is paramount to be able to establish a cause of the disease to deliver appropriate treatment.

Records of Human Deaths from Echinococcosis in Brazil, 1995-2016.

Echinococcosis is a zoonotic disease relevant to public health in many countries, on all continents except Antarctica. The objective of the study is to describe the registered cases and mortality from echinococcosis in Brazil, from 1995 to 2016. The records of two national databases, the Hospital Information System (HIS) and the Mortality Information System (MIS), were accessed during the period of 1995-2016. Demographic, epidemiological, and health care data related to the occurrence of disease and deaths attributed to echinococcosis in Brazil are described. The results showed that 7955 records of hospitalizations were documented in the HIS, during the study period, with 185 deaths from echinococcosis, and 113 records of deaths were documented in the MIS Deaths in every state of Brazil in the period. When comparing between states, the HIS showed great variability in mortality rates, possibly indicating heterogeneity in diagnosis and in the quality of health care received by patients. Less severe cases that do not require specialized care are not recorded by the information systems, thus the true burden of the disease could be underrepresented in the country. A change in the coding of disease records in the HIS in the late 1990s, (the integration of echinococcosis cases with other pathologies), led to the loss of specificity of the records. The records showed a wide geographic distribution of deaths from echinococcosis, reinforcing the need to expand the notification of the disease in Brazil. Currently, notification of cases is compulsory in the state of Rio Grande do Sul.

Consenso internacional sobre nomenclatura en equinococosis: traducción y adaptación al español / International consensus on nomenclature about echinococcosis: translation and adapting for spanish

La equinococosis se conoce desde tiempos de Hipócrates. Desde entonces se acuñaron o adaptaron términos y definiciones en diferentes idiomas para referirse a múltiples aspectos relacionados con esta zoonosis. Es importante propiciar un buen entendimiento en la lectura y escritura en la información científica, académica, para el conocimiento general y la difusión masiva. Durante el 27º Congreso Mundial de Equinococosis se esta-bleció un grupo de trabajo con ese propósito. El resultado fue un consenso con recomendaciones aplicables a la ciencia y comunicación entre profesionales, publicado en el año 2020 en idioma inglés. Por recomendación de miembros del Grupo de Trabajo Informal de la OMS sobre equinococosis (WHO-IWGE) se convocó a un grupo de trabajo integrado por expertos en equinococosis de Argentina, Bolivia, Chile, España, Paraguay, Perú y Uruguay para elaborar una propuesta de terminología en español. Este consenso propone una nomen-clatura unificada de aplicación progresiva, que sirve como base de consulta y referencia.

Consenso internacional sobre nomenclatura en equinococosis: traducción y adaptación al español.

La equinococosis se conoce desde tiempos de Hipócrates. Desde entonces se acuñaron o adaptaron términos y definiciones en diferentes idiomas para referirse a múltiples aspectos relacionados con esta zoonosis. Es importante propiciar un buen entendimiento en la lectura y escritura en la información científica, académica, para el conocimiento general y la difusión masiva. Durante el 27º Congreso Mundial de Equinococosis se estableció un grupo de trabajo con ese propósito. El resultado fue un consenso con recomendaciones aplicables a la ciencia y comunicación entre profesionales, publicado en el año 2020 en idioma inglés. Por recomendación de miembros del Grupo de Trabajo Informal de la OMS sobre equinococosis (WHO-IWGE) se convocó a un grupo de trabajo integrado por expertos en equinococosis de Argentina, Bolivia, Chile, España, Paraguay, Perú y Uruguay para elaborar una propuesta de terminología en español. Este consenso propone una nomenclatura unificada de aplicación progresiva, que sirve como base de consulta y referencia.

Pilot field trial of the EG95 vaccine against ovine cystic echinococcosis in Rio Negro, Argentina: 8 years of work.

Cystic echinococcosis (CE) is endemic in the Rio Negro province of Argentina. After 30 years of control using praziquantel in dogs the transmission rate to humans and sheep has decreased significantly, however transmission persists. The objective of the study was to assess the inclusion of the EG95 for sheep in the control program and to determine the vaccine's operative feasibility in field conditions. An intervention study was defined in Rio Negro Province in Argentina comprising, in total, an area of 5820 Km2. Lambs received two vaccinations with the EG95 vaccine followed by a single booster injection when the animals were 1-1.5 years of age. Vaccination of lambs born into one trial site was introduced and continued for 8 years. Evidence for Echinococcus granulosus transmission was monitored before and after vaccination by coproantigen ELISA in faecal samples of dog, purgation of dogs to detect E. granulosus worms, necropsy on adult sheep and by ultrasound screening in children of 6-14 years old. 29,323 doses of vaccine were applied between 2009 and 2017, which a vaccination coverage of 80.1%/85.7% (57.3% average for fully vaccinated). Before the introduction of the vaccine 56.3% of the 6-year-old sheep were infected with E. granulosus at necropsy and 84.2% of the farms had infected sheep; 4.3% of the dogs were positive for E. granulosus infection using the arecoline test, and with coproELISA 9.6% of dog fecal samples were positive and 20.3% of the farms had infected dog.After the vaccine was introduced, 21.6% of sheep older than 6 years were found to be infected at necropsy and 20.2% of the farms were found to be infected; in dogs, 4.5% were found positive for E. granulosus using arecoline purgation and with coproELISA 3.7% of samples were positive, with 8.9% of farms having a positive dog. In 2016 only one case of E. granulosus infection was diagnosed by US screening in a 6-14 years old child. Included in the analysis are discussions of difficulties experienced in the field which affected correct vaccine administration as well as social features and practices that may impact on echinococcosis control and the EG95 vaccination program in Rio Negro. Vaccination of sheep with the EG95 vaccine provides a valuable new tool which improves the effectiveness of CE control activities. Vaccination was effective even in a difficult, remote environment where only approximately half the lambs born into the communities were fully vaccinated.

Caso autóctono de rickettsiosis por Rickettsia parkeri en la Selva Paranaense, Misiones, Argentina / Autochthonous Rickettsia parkeri rickettsiosis in the Paranaense Forest, Misiones, Argentina

Resumen Se informa un caso autóctono de rickettsiosis por Rickettsia parkeri, ocurrido en junio del 2018 en la zona selvática del Parque Provincial Urugua-í, Misiones, Argentina, región sin registros previos de esta enfermedad en humanos. Se describen los aspectos epidemiológicos, ecológicos, clínicos y de laboratorio necesarios para el diagnóstico oportuno y el tratamiento adecuado. Se resalta el hecho de considerar a las rickettsiosis como diagnóstico diferencial ante un paciente con síndrome febril agudo exantemático; el antecedente epidemiológico de exposición al vector característico de la región, garrapatas del género Amblyomma, es un elemento fundamental.

Abstract We report an autochthonous case of Rickettsia parkeri rickettsiosis occurred in June 2018 in a forested area of the Urugua-í Provincial Park, Misiones, Argentina. No previous records of this disease in humans have been previously reported in this region. The epidemiological, ecological, clinical, and laboratory features required for a proper diagnosis and adequate treatment are described here. The fact of considering rickettsiosis as a differential diagnosis in a patient with exanthematic acute febrile syndrome is highlighted, being the epidemiological history of exposure to the vector (ticks of the genus Amblyomma) an essential element.

Implementation of a biosafety level 2 laboratory for molecular diagnosis of SARS-CoV-2 in Puerto Iguazú, Misiones / Implementación de un laboratorio de nivel de bioseguridad 2 para diagnóstico molecular de sars-cov-2 en puerto iguazú, misiones

RESUMEN INTRODUCCIÓN: La pandemia de COVID-19 ha creado desafíos sin precedentes para los laboratorios de todo el mundo. Los gobiernos nacionales y subnacionales se vieron en la necesidad imperiosa de adaptar instituciones para la detección de SARS-CoV-2 en respuesta a la emergencia sanitaria declarada en 2020. Con el objetivo de aumentar la capacidad de diagnóstico en la provincia de Misiones, se implementó un laboratorio de diagnóstico de excelencia dentro del Instituto Misionero de Biodiversidad. Este artículo comparte los pasos realizados y los desafíos enfrentados, con el fin de que sirva de guía a otras instituciones. MÉTODOS: Las etapas para establecer el laboratorio fueron: adquisición de equipamientos/reactivos, adaptación/renovación del laboratorio, incorporación y capacitación del recurso humano, establecimiento de buenas prácticas y bioseguridad, selección de la metodología de extracción y detección, implementación de controles de calidad y habilitación. RESULTADOS: Desde su habilitación el Laboratorio de Análisis Integral procesó 1186 muestras biológicas de casos sospechosos de COVID-19 y se convirtió así en el segundo laboratorio de referencia provincial. DISCUSIÓN: La eficiente articulación entre el Instituto Misionero de Biodiversidad y el Ministerio de Salud de Misiones logró la rápida implementación de este laboratorio de alta complejidad en una región de importancia epidemiológica.

ABSTRACT INTRODUCTION: The COVID-19 pandemic has created unprecedented challenges for laboratories around the world. National and subnational governments faced the urgent need to adapt institutions for the detection of SARS-CoV-2 in response to the health emergency declared in 2020. With the aim of increasing diagnostic capacity in the province of Misiones, a diagnostic laboratory of excellence was established within the "Instituto Misionero de Biodiversidad". This article shares the steps taken and the challenges faced, in order to serve as a guide to other institutions. METHODS: The stages to establish the laboratory were: acquisition of equipment/reagents, adaptation/ renovation of the laboratory, incorporation and training of human resources, establishment of good practices and biosafety, selection of the extraction and detection methodology, implementation of quality controls and authorization. RESULTS: Since its authorization, the "Laboratorio de Análisis Integral" has processed 1186 biological samples from suspected cases of COVID-19, becoming the second reference laboratory in Misiones. DISCUSSION: The efficient articulation between the "Instituto Misionero de Biodiversidad" and the provincial Ministry of Health achieved the rapid implementation of this high complexity laboratory in a region of epidemiological importance.

Implementación de un laboratorio de nivel de bioseguridad 2 para diagnóstico molecular de SARS-COV-2 en Puerto Iguazú, Misiones / Implementation of a biosafety level 2 laboratory for molecular diagnosis of SARS-COV-2 in Puerto Iguazú, Misiones

INTRODUCCIÓN: La pandemia de COVID-19 ha creado desafíos sin precedentes para los laboratorios de todo el mundo. Los gobiernos nacionales y subnacionales se vieron en la necesidad imperiosa de adaptar instituciones para la detección de SARS-CoV-2 en respuesta a la emergencia sanitaria declarada en 2020. Con el objetivo de aumentar la capacidad de diagnóstico en la provincia de Misiones, se implementó un laboratorio de diagnóstico de excelencia dentro del Instituto Misionero de Biodiversidad. Este artículo comparte los pasos realizados y los desafíos enfrentados, con el fin de que sirva de guía a otras instituciones. MÉTODOS: Las etapas para establecer el laboratorio fueron: adquisición de equipamientos/reactivos, adaptación/renovación del laboratorio, incorporación y capacitación del recurso humano, establecimiento de buenas prácticas y bioseguridad, selección de la metodología de extracción y detección, implementación de controles de calidad y habilitación. RESULTADOS: Desde su habilitación el Laboratorio de Análisis Integral procesó 1186 muestras biológicas de casos sospechosos de COVID-19 y se convirtió así en el segundo laboratorio de referencia provincial. DISCUSIÓN: La eficiente articulación entre el Instituto Misionero de Biodiversidad y el Ministerio de Salud de Misiones logró la rápida implementación de este laboratorio de alta complejidad en una región de importancia epidemiológica.

Neotropical Zoonotic Parasites in Bush Dogs (Speothos venaticus) from Upper Paraná Atlantic Forests in Misiones, Argentina.

Wildlife remains an important source of zoonotic diseases for the most vulnerable groups of humans, primarily those living in rural areas or coexisting with forest. The Upper Paraná Atlantic forest of Misiones, Argentina is facing ongoing environmental and anthropogenic changes, which affect the local biodiversity, including the bush dog (Speothos venaticus), a small canid considered Near Threatened globally and Endangered locally. This project aimed to expand the knowledge of zoonotic parasites present in the bush dog and the potential implications for human health and conservation medicine. From May to August 2011, a detection dog located 34 scats that were genetically confirmed as bush dog and georeferenced to northern Misiones. Of these 34 scats, 27 had sufficient quantity that allowed processing for zoonotic parasites using morphological (sedimentation and flotation) and antigen (coproantigen technique) analyses. Within these 27 scats, we determined that the parasitic prevalence was 63.0% (n = 17) with 8 (47.1%) having mixed infections with 2-4 parasitic genera. No significant differences (p > 0.05) between sampling areas, sex, and parasite taxa were found. We were able to summarize the predominant nematodes (Ancylostoma caninum, Toxocara canis, and Lagochilascaris spp.), cestodes (Taenia spp. and Spirometra spp.), and apicomplexa (Cystoisospora caninum) found in these bush dogs. With the copro-ELISA technique, 14.8% (n = 4) of the samples were positive for Echinococcus spp. This study represents the first comprehensive study about parasitic fauna with zoonotic potential in the free-ranging bush dog. This information combined with the innovative set of techniques used to collect the samples constitute a valuable contribution that can be used in control programs, surveillance of zoonotic diseases, and wildlife conservation, both regionally and across the bush dog's broad distribution.

Pilot Field Trial of the EG95 Vaccine Against Ovine Cystic Echinococcosis in Rio Negro, Argentina: Second Study of Impact.

BACKGROUND: Cystic echinococcosis (CE) is an important zoonotic disease caused by the cestode parasite Echinococcus granulosus. It occurs in many parts of the world where pastoral activities predominate, including the Rio Negro province of Argentina. Although CE control activities have been undertaken in the western regions of Rio Negro for more than two decades, the disease continues to remain prevalent in both the human and livestock animal populations. Vaccination of animal intermediate hosts of CE with the EG95 vaccine may provide a new opportunity to improve the effectiveness of CE control measures, although data are lacking about field application of the vaccine. AIMS: Evaluate the impact of EG95 vaccination in sheep on the transmission of Echinococcus granulosus in a field environment. METHODOLOGY: Two trial sites were established in western Rio Negro province within indigenous communities. Vaccination of lambs born into one trial site was introduced and continued for 6 years. Prior to initiation of the trial, and at the end of the trial, the prevalence of CE in sheep was determined by necropsy. Weaned lambs received two injections of EG95 vaccine, approximately one month apart, and a single booster injection one year later. Vaccination was not implemented at the second trial site. A total of 2725 animals were vaccinated in the first year. Animals from this cohort as well as age-matched sheep from the control area were evaluated by necropsy. KEY RESULTS: Introduction of the vaccine led to a statistically significant in the number and size of hydatid cysts in comparison to the situation prior to the introduction of the vaccine, or compared to CE prevalence in the control area where the vaccine was not applied. The prevalence of infection in the vaccinated area was also significantly reduced by 62% compared to the re-intervention level, being lower than the prevalence seen in the control area, although the difference from the control area after the intervention was not significant possibly due to limitations in the numbers of animals available for necropsy. CONCLUSIONS: Vaccination of sheep with the EG95 vaccine provides a valuable new tool which improves the effectiveness of CE control activities. Vaccination was effective even in a difficult, remote environment where only approximately half the lambs born into the communities were fully vaccinated.

Primera identificación de Echinococcus vogeli en una paca en la provincia de Misiones, Argentina / [First report of Echinococcus vogeli in a paca in Misiones province, Argentina].

We report the first finding of Echinococcus vogeli in a paca, Cuniculus paca, in the tropical forest of Misiones, in the north of Argentina. The presence of the bush dog, Speothos venaticus, E. vogelís only natural definitive host, was also reported. The polycystic hydatids, 2 to 3 cm in diameter, were only found in the liver of an adult paca. The size range of the hooks and the relative proportion blade/handle did not show significant differences with respect to the ones reported for E. vogeli. The size of E. granulosus hooks, measured for comparison purposes, was significantly smaller (p E. vogeli in Argentina. The probability of finding neotropical echinococcosis in humans reinforces the need to expand the search for E. vogeli in Argentina. Echinococcosis due to E. vogeli is very aggressive and may cause death in about a third of the human population affected.