Point shear-wave elastography for the diagnosis of veno-occlusive disease in children and young adults.

BACKGROUND: Hepatic veno-occlusive disease or sinusoidal obstruction syndrome is a potentially life-threatening complication of hematopoietic stem cell transplantation. OBJECTIVE: To assess the usefulness of point shear-wave elastography (pSWE) for the early diagnosis of sinusoidal obstruction syndrome (SOS) in children. MATERIALS AND METHODS: A retrospective study was carried out in 43 patients with suspected SOS assessed between March 2018 and November 2021. Diagnosis of SOS was confirmed in 28 patients based on the European Society for Blood and Marrow Transplantation diagnostic criteria. Abdominal ultrasound and pSWE of the liver were performed before and after hematopoietic stem cell transplantation on first suspicion of SOS. RESULTS: Liver stiffness on initial suspicion was higher in patients diagnosed with SOS and these values increased compared to the pre-transplantation values. A cutoff value of 1.37 m/s was found for the diagnosis of SOS, with an area under the curve of 0.779 (95% CI 0.61-0.93). CONCLUSION: Point shear wave elastography of the liver is a promising technique for the early diagnosis of pediatric SOS.

Are soft tissues of urban rats good indicators of exposure to heavy metal pollution? A study conducted in one of the most polluted basins of Buenos Aires, Argentina.

The overall goal of this work was to analyze the relationship between the concentration of lead in the kidney, liver, and stomach contents of rats captured in a polluted urban basin and the concentration of this metal in the environment, meteorological factors, and different intrinsic characteristics of the individuals. To this end, we determined the concentration of lead in the kidney, liver, and stomach contents of 133 Norway rats (Rattus norvegicus) captured in the Matanza-Riachuelo River Basin (Buenos Aires, Argentina). This basin is one of the most severe cases of water pollution in Latin America and metals like lead represent the most common chemical pollutants. Rats were trapped in nine sites with different soil and water lead concentrations, between 2014 and 2015. A positive relationship was found between lead concentration in the liver and kidney of R. norvegicus and the environmental concentration of this metal in water and soil. Although the remaining variables analyzed were also related to the lead concentration in soft tissues, they did not affect the association between the lead concentration in soft tissues and that in the environment. The lead concentration in the stomach contents was not related to any of the variables analyzed. Our results constitute the first study in an urban basin with a gradient of environmental lead concentration and suggest that the quantification of lead in the kidney and liver of rats can be used as an indicator of exposure to this metal within a large city.

Structure of parasite communities in urban environments: the case of helminths in synanthropic rodents.

Identifying patterns with sufficient predictive power is a constant challenge for ecologists to address ecological problems related to species conservation, pollution or infectious disease control. During the last years, the amounts of parasitological studies in this sense increased, but they are still scarce in urban environments. The main aim of this study was to investigate if the helminth communities of urban rodents are structured within host assembly (compound community) or they are a result of random events occurring at each individual host scale (infracommunity). A total of 203 rodents belonging to four species, Rattus rattus (Linnaeus), Rattus norvegicus (Berkenhout), Mus musculus Linnaeus and the native Oligoryzomys flavescens (Waterhouse) and captured in different landscape units of the City of Buenos Aires (industrial-residential neighbourhoods, shantytowns and parklands) were analysed. The results showed that infracommunities could be grouped according to composition and relative abundances and that they respond to the structure of the host community. Thus, the component communities defined in this study could be identified as subsets of the compound community (rodent assemblage) and infracommunities (each host) as random samples within each one. Quantitative differences among component communities were denoted by comparing the infection levels of helminths described as central species. Therefore, infracommunities of R. norvegicus and O. flavescens were the most predictable because of the high abundance of the nematodes Heterakis spumosa Schneider, 1866 and Nippostrongylus brasiliensis (Travassos, 1914), and Stilestrongylus flavescens (Sutton et Durette-Desset, 1991), respectively. Several mechanisms contribute to complexity of the structure of parasite communities, where specific parasites, definitive and intermediate hosts, and environmental and anthropogenic factors all play a role in the dynamics of the compound community.

Global population divergence and admixture of the brown rat (Rattus norvegicus).

Native to China and Mongolia, the brown rat (Rattus norvegicus) now enjoys a worldwide distribution. While black rats and the house mouse tracked the regional development of human agricultural settlements, brown rats did not appear in Europe until the 1500s, suggesting their range expansion was a response to relatively recent increases in global trade. We inferred the global phylogeography of brown rats using 32 k SNPs, and detected 13 evolutionary clusters within five expansion routes. One cluster arose following a southward expansion into Southeast Asia. Three additional clusters arose from two independent eastward expansions: one expansion from Russia to the Aleutian Archipelago, and a second to western North America. Westward expansion resulted in the colonization of Europe from which subsequent rapid colonization of Africa, the Americas and Australasia occurred, and multiple evolutionary clusters were detected. An astonishing degree of fine-grained clustering between and within sampling sites underscored the extent to which urban heterogeneity shaped genetic structure of commensal rodents. Surprisingly, few individuals were recent migrants, suggesting that recruitment into established populations is limited. Understanding the global population structure of R. norvegicus offers novel perspectives on the forces driving the spread of zoonotic disease, and aids in development of rat eradication programmes.

Gorgonia mariae and Antillogorgia bipinnata populations inferred from compensatory base change analysis of the internal transcribed spacer 2.

The systematics within some families of octocorals (Class Anthozoa: Sub-class Octocorallia) remains uncertain in terms of morphological variability and unresolved molecular phylogenies. Elucidating the phylogenetic relationships among octocorals can help for understanding the origin of its huge biodiversity and optimizing conservation plans. The phylogenetic relationships within Gorgoniidae family remain highly polyphyletic. This research explores Gorgonia mariae and Antillogorgia bipinnata populations from several study sites in the Caribbean sea using for the first time the compensatory base changes (CBCs) analysis of the internal transcribed spacer 2 (ITS2) as a molecular tool to elucidate the phylogenetic relationships within the gorgonians. In addition, the mitochondrial gene mtMutS was sequenced in order to complement the nuclear information. This research shows that the presence of CBCs and hemi-CBCs is useful as a complementary tool for providing insights between octocoral species and populations, as well as an approach to figure out the origin of the octocorals biodiversity.

Genotypes of pathogenic Leptospira spp isolated from rodents in Argentina.

Leptospirosis is the most widespread zoonosis in the world and significant efforts have been made to determine and classify pathogenic Leptospira strains. This zoonosis is maintained in nature through chronic renal infections of carrier animals, with rodents and other small mammals serving as the most important reservoirs. Additionally, domestic animals, such as livestock and dogs, are significant sources of human infection. In this study, a multiple-locus variable-number tandem repeat analysis (MLVA) was applied to genotype 22 pathogenic Leptospira strains isolated from urban and periurban rodent populations from different regions of Argentina. Three MLVA profiles were identified in strains belonging to the species Leptospira interrogans (serovars Icterohaemorrhagiae and Canicola); one profile was observed in serovar Icterohaemorrhagiae and two MLVA profiles were observed in isolates of serovars Canicola and Portlandvere. All strains belonging to Leptospira borgpetersenii serovar Castellonis exhibited the same MLVA profile. Four different genotypes were isolated from urban populations of rodents, including both mice and rats and two different genotypes were isolated from periurban populations.

Reaching new lands: Updating the distribution of Angiostrongylus cantonensis in South America with the first record in Argentina.

BACKGROUND: Angiostrongylus cantonensis, commonly known as the rat lungworm, is a metastrongyloid nematode found primarily not only in tropical and subtropical regions but also in temperate areas and considered the leading cause of eosinophilic meningitis in humans. Synanthropic rodents such as Rattus norvegicus and Rattus rattus are the most frequent definitive hosts of this parasite. METHODS AND RESULTS: The presence of this parasite was detected in the pulmonary arteries of three specimens of R. norvegicus in the city of Buenos Aires representing the species' southernmost known record in natural hosts. Species confirmation was achieved through partial sequences of 18S and COI genes. By comparing the COI gene sequences with those available in GenBank through the construction of a haplotype network, we obtained that the analysed specimen presents high similarity with those reported in Japan and Southeast Asia. CONCLUSIONS: All infected rats were captured in an area surrounding a port with significant import and export activity, suggesting that A. cantonensis may have been introduced through commercial ships. Specifically, the parasite was detected in a neighbourhood with vulnerable socio-economic conditions and in a nature reserve, which exhibit biotic and abiotic characteristics conducive to sustaining high-density rat populations, scattered waste, areas of spontaneous vegetation, debris accumulation and flooded areas or lagoons offering suitable habitats for intermediate hosts such as snails. Thus, the close proximity of the port to these sites creates a favourable ecological context for the establishment of A. cantonensis. This study shows the need to conduct research to detect A. cantonensis in non-endemic areas but with the characteristics that promote its arrival and development of its life cycle in order to implement control measures to prevent expansion of this parasite and its transmission to humans and other animals.

Intra- and inter-annual variations in metal concentrations in the superficial water of a highly polluted urban basin of Argentina.

To protect ecosystems impacted by human activities and prevent their degradation, it is imperative to evaluate variations in the concentration of environmental pollutants over time. Here, we evaluated the intra- and inter-annual variations of several metals from 15 sites in the Matanza Riachuelo River basin (one of the most polluted in the world) and determined the physicochemical and meteorological parameters associated with these changes from 2008 to 2015. For this, in each site, we used Asymmetric Eigenvector Maps and Redundancy Analysis. The results highlighted temporal patterns of metal concentrations and several factors associated with them, perhaps related to the actions performed in the area since 2008. Additionally, we found that the effects of physicochemical and meteorological factors on metal concentrations were site-dependent, possibly related to the presence of different local sources of pollution or characteristics of the river in each site, such as its sediments. This approach could be applied to different scenarios (aquatic and terrestrial) and could provide a tool to help decision-makers address the harmful consequences of the continuous advance of human activities on human and ecosystem health.

A review of the diversity of Cryptosporidium in Rattus norvegicus, R. rattus and Mus musculus: What we know and challenges for the future.

The aim of this paper is to review the diversity of Cryptosporidium species and genotypes infecting synantropic rodents. A total of 27 papers published between 1990 and 2020 assed the presence of Cryptosporidium in these rodents worldwide and described 17 different species and genotypes of Cryptosporidium. A great variation in the prevalence values were observed (0-63%). The most frequent species/genotypes were Rat genotype I and IV for R. norvegicus and Rat genotype II and III R. rattus, while C. tyzzeri was for M. musculus. Cryptosporidium parvum, the second most common species after C. hominis involved in human cryptosporidiosis cases, was the third most detected Cryptosporidium species in R, norvergicus (9.4% of the positive samples) and the 3 rodent species are common host for C. muris, also recognized as zoonotic. Besides, these synanthopic rodents can harbor Cryptosporidium species whose natural hosts are cattle, bovids, pigs, other rodent species, birds and a broad range of mammals. Considering the diversity described so far, it would have a great epidemiological impact to know how the variation of Cryptosporidium species composition along urban-rural gradients is like, including synanthropic rodents, wild and domestic animals and environmental samples, and to analyze the causal factors of such variation.

Co-occurrence of and risk factors for Cryptosporidium and Giardia in brown rats from Buenos Aires, Argentina.

A rodent survey was conducted in different landscape units of the city of Buenos Aires (Argentina) to determine the prevalence of Cryptosporidium and Giardia in Rattus norvegicus and to, ultimately, assess the biotic, environmental and meteorological factors that explain the variations of the likelihood of infection for both parasites in an urban environment. The results of this study revealed a ubiquitous presence of Cryptosporidium and Giardia in R. norvegicus within an urban environment with the likelihood of infection depending on environmental and meteorological conditions for both parasites. The overall prevalence was greater for Cryptosporidium (p = 50.4%) than for Giardia (20.3%). The prevalence for both parasites separately was higher in parks compared to shantytowns and scrap metal yards. Generalized Linear Mixed Models revealed that the occurrence of these parasites separately, at an individual level, was positively related with rainfall variables and that the effect of temperature depended on the landscape unit. The similarities in the transmission modes, which are affected by common extrinsic factors, may facilitate the co-occurrence of Cryptosporidium and Giardia in urban rats. Rattus norvegicus is recognized as a good model for epidemiological studies and the results of this work suggest that, from an epidemiological point of view, the probability of contact with infectious oocysts and cysts of these parasites can be modulated through environmental management and healthy behaviour towards risk factors. The information presented here will be useful to improve the understanding of the dynamics of zoonotic diseases within urban environments and to contribute to the decision-making of new and effective prophylactic measures.

Genotoxicity evaluation using micronucleus test in Rattus norvegicus captured in urban ecosystems of Buenos Aires, Argentina.

The overall goal of the present study was to evaluate and compare the existence of genotoxic damage in Rattus norvegicus captured in sites with different levels of chemical mixtures along the Matanza-Riachuelo river basin (MRRB). For this, thirty-six wild rats (R. norvegicus) were captured from six different sites in the MRRB. Capture sites were characterized with concentrations of 20 parameters in surface water, including concentrations of metals and its soluble state and physicochemical parameters. To evaluate genotoxic damage in the rats, the bone marrow micronucleus test was performed. For this, the frequency of micronucleated polychromatic erythrocytes (MNPCE) was calculated based on the observation of 2000 polychromatic erythrocytes (PCE) per animal. Also, to detect possible cytotoxic effects, the PCE/TE (total erythrocytes) ratio in 1000 erythrocytes/animal was calculated. The frequency of MNPCE was positively associated with the highest concentration of chrome, lead, copper, biological oxygen demand, and chemical oxygen demand. Also, the decrease on PCE/TE ratio in bone marrow was related with increase of practically all metals and physicochemical parameters in surface water. The results of this study reveal that rats that live in the MRRB were exposed to concentrations of pollutants that can cause genotoxic damage, even though the concentrations of these pollutants are mostly below the safety standards. Therefore, this work highlights the importance of using methods that allow to integrate all environmental parameters in risk assessment, such as sentinel species.

Transformation strategies for healthy organizations.

BACKGROUND: Healthy organizations are based on dynamic relationships between productivity, health and well-being. Understanding and transforming these labor-permeating relationships through health promotion actions is necessary in the present time. OBJECTIVE: To implement an intervention involving strategies likely to enable the transformation of companies into healthy organizations, based on a collective approach and seeking to boost performance and well-being at work. METHODS: Participants were organizations affiliated with an occupational risk management company, selected according to their size, degree of development of workplace health and safety systems and economic activity. We designed and implemented an intervention to evaluate workplace safety and health, to finally suggest strategies to enhance occupational well-being. RESULTS: We detected advances in the implementation of workplace safety and health systems, and also in several other aspects, as e.g. continuous improvement and self-care programs. Additional results include the participating organizations' engagement in several problems common to all, which led to the creation of a collective network. Intervention focused on training, follow-up, consultancy and collective development of healthy organizations. CONCLUSION: Our reflections are grounded on a collective process of creation and seek to elucidate the potential and difficulties inherent to the implemented intervention, outcome expectations, resulting social cooperation networks and the process to formulate strategies to link work to health, well-being and productivity.

INTRODUCCIÓN: Las organizaciones saludables se fundamentan en relaciones dinámicas entre productividad, salud y bienestar. La actualidad requiere entender y transformar estas relaciones inmersas en el trabajo y la ocupación a través de la promoción de la salud. OBJETIVO: Implementar una intervención a través de estrategias que permitan la transformación empresarial bajo los fundamentos de organizaciones saludables con enfoque colectivo, en el desempeño ocupacional y el bienestar laboral. METODOLOGÍA: Se realizó una convocatoria entre organizaciones afiliadas a una administradora de riesgos laborales teniendo en cuenta tamaño empresarial, desarrollo de sistemas de salud y seguridad laboral, y sector económico. Se diseñó e implementó una intervención que evalúa la seguridad y salud en el trabajo, ejecuta acciones y actividades, para finalmente proponer estrategias enmarcadas en el bienestar laboral. RESULTADOS: Se identificaron avances en la implementación del sistema de seguridad y salud en el trabajo; se evidenciaron avances en el desarrollo de ítems como la mejora continua y los programas de autocuidado. Por otro lado, se relacionaron resultados adicionales como la participación de las organizaciones saludables en diferentes problemáticas comunes que permitieron el desarrollo de una red colectiva. Las intervenciones realizadas se enfocaron en la capacitación, acompañamiento, asesoría y construcción colectiva de organizaciones saludables. CONCLUSIONES: La reflexión parte de los procesos de construcción grupal entendiendo las potencialidades y dificultades de las intervenciones planteadas, la expectativa en los resultados, las redes de cooperación social resultantes y el proceso de proponer estrategias que permitan vincular la ocupación participativa laboralmente con la salud, el bienestar y la productividad.

Prevalence of hantavirus infection in wild Rattus norvegicus and R. rattus populations of Buenos Aires City, Argentina.

OBJECTIVE: To determine the prevalence of infection with hantaviruses in wild Rattus norvegicus and R. rattus populations in areas of Buenos Aires city. METHODS: Norway rats and black rats were trapped from 2003 to 2005 at 10 sites throughout Buenos Aires city. Blood samples for serological analysis were collected by cardiac puncture from all individuals captured and tested by enzyme-linked immunosorbent assay for Seoul hantavirus- and Andes virus-specific IgG antibodies. RESULTS: Hantavirus seroprevalence was 11.9% in R. norvegicus (n = 151), varying between 0% and 26.1% depending on the site. Bigger sexually active males were more likely to be infected with Seoul virus than females or juvenile individuals. No antibody-reactive rodents were detected among 33 R. rattus analysed. CONCLUSION: Hantavirus infections are geographically widespread in Buenos Aires city and confirm that they have been enzootic there for at least 20 years.

Long-Term Study of a Hantavirus Reservoir Population in an Urban Protected Area, Argentina.

Green spaces in urban areas can play a key role in protecting wildlife. However, the presence of wildlife in urban areas can lead to human health risks. Although the presence of the rodent species Oligoryzomys flavescens (hantavirus reservoir) has been recorded in cities of Argentina, its population dynamics in this type of habitat is still unknown. Here, we evaluated: (1) long-term spatial and temporal patterns of O. flavescens abundance and how these patterns were influenced by weather factors and (2) the seroprevalence of hantavirus and the identity of the viral lineage circulating in the population that inhabits the Costanera Sur Ecological Reserve, a protected area in the city of Buenos Aires. Genetic results confirmed that the pathogenic ANDES Central Lechiguanas virus is present in O. flavescens populations inhabiting this urban reserve. Abundance of O. flavescens showed interannual and seasonal fluctuations, with maximum values in winter and spring and minimum ones in summer and autumn. Summers with the highest abundances of O. flavescens were preceded by warmer winters, while winters with lower abundances were preceded by warmer summers. On the other hand, accumulated precipitations in the previous 6 months positively affected winter abundance. These results could help the authorities in charge of the green spaces of Buenos Aires to identify priority areas and times of the year for the implementation of preventive measures that minimize the contact of rodents with visitors. Such measures could be intensified when winters are warmer than normal, and summers are cooler and wetter than normal.

Enfermedades de origen laboral en docentes escolares: una revisión sistemática / Occupational Diseases in School Teachers: A Systematic review

Introducción. La docencia es una de las principales profesiones vinculadas con el desarrollo de una sociedad; como cualquier labor, se encuentra expuesta a diferentes factores de riesgo que pueden generar una enfermedad de origen laboral. Objetivo. Identificar y caracterizar la literatura actual que presente las principales enfermedades de los docentes escolares como consecuencia de su trabajo y/o las condiciones laborales. Materiales y Métodos. Revisión sistemática con búsqueda en las bases de datos Academic Search Complete (EBSCOHOST), APA - PSYCNET, ERIC (Education Resources Information Center), MEDLINE (PubMed), SCOPUS y Open Grey. Se realiza selección pareada independiente bajo criterios de inclusión y análisis de forma narrativa, incluyendo generalidades, información de la enfermedad y desenlaces en docentes. Resultados. Se incluyeron 47 estudios, de los cuales el 25,5 % fueron publicados en 2015; Brasil fue el país con mayor aporte temático. La mayoría de los estudios agrupó a los docentes escolares sin distinción de su ciclo (primaria, bachillerato y media). Las principales enfermedades identificadas fueron trastornos de la voz 51,1 %, musculoesqueléticos 23,4 % y psicosociales 21,3 %. Adicionalmente, se identificó que al menos el 50 % de los reportes por país estuvieron relacionados con trastornos de la voz; Brasil e India fueron los países de mayor representatividad. Conclusiones. Las principales enfermedades laborales docentes fueron las relacionadas con trastornos de la voz, musculoesqueléticos y psicosociales; a su vez, estas se relacionan con riesgos físicos, condiciones de seguridad, riesgos biomecánicos y psicosociales en el contexto escolar.

Introduction. Teaching is one of the main professions linked to the development of a society, and like any other labor it is exposed to different risk factors that can generate an occupational disease. Objective. To identify and characterize the current literature on the main illnesses suffered by schoolteachers as a result of their work and/or working conditions. Methodology. Systematic review with search in the databases Academic Search Complete (EBSCOHOST), APA - PSYCNET, ERIC (Education Resources Information Center), MEDLINE (PubMed), SCOPUS and Open Grey. We performed independent paired selection under inclusion criteria and narrative analysis including generalities, disease information and outcomes in teachers. Results. Forty-seven studies were included, 25.5% of which were published in 2015, and Brazil was the country with the largest thematic contribution. Most of the studies grouped schoolteachers regardless of their cycle (primary, secondary and high school). The main illnesses identified were voice disorders 51.1%, musculoskeletal disorders 23.4% and psychosocial disorders 21.3%. In addition, it was found that at least 50% of the reports per country were related to voice disorders, with Brazil and India being the most representative. Conclusions. The main occupational illnesses identified were related to voice, musculoskeletal and psychosocial disorders; these in turn are related to physical, safety, biomechanical and psychosocial risks in the school context.

Helminth Diversity in Synanthropic Rodents from an Urban Ecosystem.

Richness and diversity of parasites depend on a set of interrelated factors related to the characteristics of the host, the environment and the parasites itself. In the City of Buenos Aires, rodent communities vary according to landscape structure. The goal of this paper was to study the variations of helminth richness and diversity among invasive rodent species in different landscape units of the City of Buenos Aires. 73% of the rodents were parasitized with at least one of the 10 identified helminth species. Each rodent species presented its own characteristics in terms of richness, diversity and helminth composition, keeping these characteristics still occupying more than one landscape unit. The infracommunities with greater diversity corresponded to R. norvegicus due to its high values of parasitic richness, proportion of infected hosts and parasite prevalence. Instead, R. rattus and M. musculus infracommunities had lower diversity since a high percentage of them presented a unique helminth species. Within the city, the inhabitants of shantytowns would be the most exposed to zoonotic diseases transmitted by rodents due to high abundance of rodents harboring a high parasite load, including species like Hymenolepis nana and H. diminuta, recognized worldwide from a zoonotic aspect.

Paludismo importado no falciparum: aspectos de interés para el tratamiento de los pacientes / Imported non-falciparum malaria: aspects of interest for patient therapeutic management

Introducción: El paludismo es una enfermedad febril aguda potencialmente mortal causada por parásitos transmitidos por el mosquito Anopheles. El paludismo no falciparum (PNF), producido por otras especies de Plasmodium, está menos documentado en la literatura internacional, a pesar de su prevalencia. Objetivos: Describir aspectos clínicos y epidemiológicos de interés para el tratamiento en pacientes ingresados con diagnóstico de PNF importado, y determinar la relación existente entre la respuesta al tratamiento y otras variables. Métodos: Se realizó un estudio transversal analítico de 89 pacientes adultos con PNF importado, ingresados en el Departamento de Medicina del Instituto de Medicina Tropical Pedro Kourí, entre enero de 1997 a diciembre de 2017. Se determinó la pauta de profilaxis y tratamiento según los criterios de las guías publicadas y los fármacos disponibles en Cuba, y la definición de paludismo complicado según la OMS en 2003. Hubo respuesta demorada al tratamiento, cuando el paciente demoraba más de 7 días en negativizar la gota gruesa. Resultados: Predominaron los pacientes del sexo masculino, y una media de edad de 37,2 años. El 55,1 por ciento de los pacientes provenía de la región de las Américas y en el 85,4 por ciento se aisló Plasmodium vivax. La respuesta al tratamiento fue excelente con los esquemas combinados utilizados a base de cloroquina. Fue significativa la relación existente entre la demorada respuesta al tratamiento con la gravedad del cuadro clínico y el estado no inmune de los pacientes. Conclusiones: El PNF es una importante causa de paludismo importado en pacientes provenientes de áreas endémicas, fundamentalmente de América. Se distingue por parasitemias bajas, un cuadro clínico caracterizado por fiebre, escalofríos, cefaleas y evolución hacia cuadros no complicados. La cloroquina fue el medicamento de elección, aunque la repuesta demorada al tratamiento no justifica su suspensión o variación(AU)

Introduction: Malaria is a potentially fatal acute febrile illness caused by parasites transmitted by the Anopheles mosquito. Non-falciparum malaria (NFM), caused by other Plasmodium species, is less documented in the international literature, despite its prevalence. Objectives: To describe clinical and epidemiological aspects of interest for the treatment of patients hospitalized with a diagnosis of imported NFM, and to determine the relationship between response to treatment and other variables. Methods: It was conducted an analytical cross-sectional study of 89 adult patients with imported NFM, admitted to the Department of Medicine of the Institute of Tropical Medicine Pedro Kourí, between January 1997 to December 2017. The prophylaxis and treatment guideline was determined according to the published guidelines and drugs available in Cuba, and the definition of severe malaria by WHO in 2003. There was delayed response to treatment when the patient took more than 7 days to become negative for thick blood smear. Results: Patients were predominantly male, with a mean age of 37.2 years. Plasmodium vivax was isolated in 85.4 percent of the patients and 55.1 percent were from the Americas region. The response to treatment was excellent with the chloroquine-based combination regimens used. The relationship between the delayed response to treatment and the severity of the clinical picture and the non-immune status of the patients was significant. Conclusions: NFM is an important cause of imported malaria in patients from endemic areas, mainly from the Americas. It is characterized by low parasitemia, clinical manifestations of fever, chills, headache and evolution towards uncomplicated symptoms. Chloroquine was the drug of choice, although the delayed response to treatment does not justify its suspension or variation(AU)

Evolución satisfactoria de un paciente adulto con malaria grave y complicada por Plasmodium falciparum / Satisfactory course of an adult patient with severe complicated Plasmodium falciparum malaria

Introducción: La malaria continúa siendo un importante problema de salud a nivel mundial, su diagnóstico temprano y tratamiento inmediato son fundamentales para prevenir las complicaciones y la muerte. Objetivo: Reportar el caso de un paciente cubano procedente de República de Guinea, que presentó malaria complicada por Plasmodium falciparum, el cual fue hospitalizado en el Instituto de Medicina Tropical Pedro Kourí (IPK). Caso clínico: Paciente masculino, cubano, de piel negra, 63 años de edad, profesión marinero mercante. Sin antecedentes patológicos personales. Llegó al IPK en camilla, con cierto deterioro de la conciencia, debilidad generalizada, dificultad respiratoria y compromiso del ritmo diurético. Ingresó en la Unidad de Cuidados Intensivos donde recibió tratamiento con los antipalúdicos artesunato y primaquina. La parasitemia fue descendiendo en el decursar de los días. El paciente sobrevivió y egresó satisfactoriamente a los 16 días posteriores a su ingreso. Fue debidamente notificado a las autoridades del Ministerio de Salud Pública de Cuba, lo que constituye un procedimiento obligatorio del Sistema Nacional de Vigilancia de Enfermedades Transmisibles en Cuba. Conclusión: La rapidez en el diagnóstico, así como el tratamiento integral, eficaz y oportuno, fue de importancia vital y condujo a un buen desenlace de la enfermedad.

Introduction: Malaria continues to be a major health problem worldwide, its early diagnosis and prompt treatment are critical to prevent complications and death. Objective: To report the case of a Cuban patient from the Republic of Guinea, who presented with complicated Plasmodium falciparum malaria, who was hospitalized at the Institute of Tropical Medicine Pedro Kourí (IPK). Clinical case: Male patient, Cuban, black-skinned, 63 years old, occupation: merchant seaman. No personal pathological history. He arrived at the IPK on a stretcher, with some deterioration of consciousness, generalized weakness, respiratory distress and diuretic rhythm compromise. He was admitted to the Intensive Care Unit where he received treatment with the antimalarial drugs artesunate and primaquine. Parasitemia decreased over the days. The patient survived and was discharged satisfactorily 16 days after admission. This case was duly notified to the authorities of the Ministry of Public Health of Cuba, which is a mandatory procedure of the National Surveillance System of Communicable Diseases in Cuba. Conclusion: Prompt diagnosis, as well as a comprehensive, effective, and timely treatment was vital and led to a good disease outcome.