High Prevalence and Increased Severity of Norovirus Mixed Infections Among Children 12-24 Months of Age Living in the Suburban Areas of Lima, Peru.

In an active diarrhea surveillance study of children aged 12-24 months in Lima, Peru, norovirus was the most common pathogen identified. The percentage of mixed (bacterial and noroviral) infections was significantly higher among norovirus-positive samples (53%) than among norovirus-negative samples (12%). The combination of norovirus with the most common bacterial pathogens was associated with increased clinical severity over that of either single-pathogen norovirus or single-pathogen bacterial infections.

[Outbreak of norovirus Group II in a military training center, Peru 2013]. / Brote de infección por norovirus del Grupo II en un centro de entrenamiento militar, Perú 2013.

We report an outbreak of norovirus(NoV) which occurred at a military training center in Peru. Thirteenstool samples that were taken from initial cases turned out positive for NoV GII by RT-PCR. A case-control study was performedto determine factorsassociated with infection.164 probable cases (45.2%clinical attack rate) were identified. The only factor associatedwith infection was "having shared room with a case" (ORa = 1.7; 95% CI 1.1 to 2.7).Epidemiological findings suggestthat the virus was spread person to person. Future investigations of outbreaks of diarrhea in Peru should consider the NoV as an etiologicagent.

Brote de infección por norovirus del grupo II en un Centro de Entrenamiento Militar, Perú 2013 / Outbreak of norovirus group II in a military training center, Peru 2013

Reportamos un brote de norovirus (NoV) ocurrido en un centro de entrenamiento militar peruano. Trece muestras de heces tomadas de casos iniciales resultaron positivas a NoV GII por RT-PCR. Se realizó un estudio caso-control para determinar factores asociados a la infección. Se identificó 164 casos probables (tasa de ataque clínica: 45,2%). El único factor asociado a la infección fue el ôhaber compartido habitación con un casoõ (ORa=1,7; IC95% 1,1 a 2,7). Los hallazgos epidemiológicos sugieren que el virus fue propagado persona a persona. Futuras investigaciones de brotes de diarrea en el Perú deberían considerar al NoV como un agente etiológico.

We report an outbreak of norovirus (NoV) which occurred at a military training center in Peru. Thirteen stool samples that were taken from initial cases turned out positive for NoV GII by RT-PCR. A case-control study was performed to determine factors associated with infection.164 probable cases (45.2% clinical attack rate) were identified. The only factor associated with infection was ôhaving shared room with a caseõ (ORa = 1.7; 95% CI 1.1 to 2.7).Epidemiological findings suggest that the virus was spread person to person. Future investigations of outbreaks of diarrhea in Peru should consider the NoV as an etiologic agent.

Genetic diversity of Mycobacterium tuberculosis in Peru and exploration of phylogenetic associations with drug resistance.

BACKGROUND: There is limited available data on the strain diversity of M tuberculosis in Peru, though there may be interesting lessons to learn from a setting where multidrug resistant TB has emerged as a major problem despite an apparently well-functioning DOTS control programme. METHODS: Spoligotyping was undertaken on 794 strains of M tuberculosis collected between 1999 and 2005 from 553 community-based patients and 241 hospital-based HIV co-infected patients with pulmonary tuberculosis in Lima, Peru. Phylogenetic and epidemiologic analyses permitted identification of clusters and exploration of spoligotype associations with drug resistance. RESULTS: Mean patient age was 31.9 years, 63% were male and 30.4% were known to be HIV+. Rifampicin mono-resistance, isoniazid mono-resistance and multidrug resistance (MDR) were identified in 4.7%, 8.7% and 17.3% of strains respectively. Of 794 strains from 794 patients there were 149 different spoligotypes. Of these there were 27 strains (3.4%) with novel, unique orphan spoligotypes. 498 strains (62.7%) were clustered in the nine most common spoligotypes: 16.4% SIT 50 (clade H3), 12.3% SIT 53 (clade T1), 8.3% SIT 33 (LAM3), 7.4% SIT 42 (LAM9), 5.5% SIT 1 (Beijing), 3.9% SIT 47 (H1), 3.0% SIT 222 (clade unknown), 3.0% SIT1355 (LAM), and 2.8% SIT 92 (X3). Amongst HIV-negative community-based TB patients no associations were seen between drug resistance and specific spoligotypes; in contrast HIV-associated MDRTB, but not isoniazid or rifampicin mono-resistance, was associated with SIT42 and SIT53 strains. CONCLUSION: Two spoligotypes were associated with MDR particularly amongst patients with HIV. The MDR-HIV association was significantly reduced after controlling for SIT42 and SIT53 status; residual confounding may explain the remaining apparent association. These data are suggestive of a prolonged, clonal, hospital-based outbreak of MDR disease amongst HIV patients but do not support a hypothesis of strain-specific propensity for the acquisition of resistance-conferring mutations.

Genomic analysis of two novel human enterovirus C genotypes found in respiratory samples from Peru.

We report the discovery of two enteroviruses detected in nasopharyngeal samples obtained from subjects with respiratory disease in Peru. Phylogenetic analysis indicated that both viruses belong to a clade within the species Human enterovirus C, which includes the recently characterized human enteroviruses 109 and 104. Members of this clade have undergone significant genomic rearrangement, as indicated by deletions in the hypervariable region of the 5' UTR and the VP1 protein, as well as recombination within the non-structural genes. Our findings and review of published sequences suggests that several novel human enterovirus C serotypes are currently circulating worldwide.