[Cryptosporidium species in immunodeficient and immunocompetent patients of Valparaíso: a descriptive study]. / Especies de Cryptosporidum en pacientes inmunodeficientes e inmunocompetentes de Valparaíso: Estudio descriptivo.

OBJECTIVE: Genetical characterization of human Cryptosporidium isolates to determine species diversity. PATIENTS AND METHODS: A cross-sectional study in Valparaiso, Chile, was performed. A total of 458 patients participated in the study: 259 immunodeficient (HIV, cancer, renal transplant hyper-IgM syndrome, HIV and unintended pregnancy) and 178 immunocompetent individuals provided stool samples and 21 patients bile samples. RESULTS: We obtained 29 (6.3%) positive samples. 25 (9.7%) derived from immunodeficient patients: 18 (7.3%) from HIV patients and 7 from patients with other immunodeficiencies. The remaining 4 (2.2%) samples originated from immunocompetent individuals. Cryptosporidium genotyping was performed by nested polymerase chain reaction (PCR) and restriction fragments length polymorphism and/or PCR followed by sequencing of the SSU rRNA from oocysts in stool samples. 4 species were identified: C. parvum, C. hominis, C. muris, and C. meleagridis. In immunodeficient patients, 16 C. parvum, 8 C. hominis, and 1 C. muris strain were identified. In immunocompetent participants, 3 C. hominis and 1 C. meleagridis isolate were found. CONCLUSION: The results indicate that zoonotic and anthroponotic transmission occurs and that C. parvum is the predominant species in our study population. Cryptosporidium species of zoonotic transmission accounted for 62% of the human infections detected in this study.

Especies de Cryptosporidum en pacientes inmunodeficientes e inmunocompetentes de Valparaíso: Estudio descriptivo / Cryptosporidium species in immunodeficient and immunocompetent patients of Valparaíso: A descriptive study

Objective: Genetical characterization of human Cryptosporidium isolates to determine species diversity. Patients and Methods: A cross-sectional study in Valparaiso, Chile, was performed. A total of 458 patients participated in the study: 259 immunodeficient (HIV, cancer, renal transplant hyper-IgM syndrome, HIV and unintended pregnancy) and 178 immunocompetent individuals provided stool samples and 21 patients bile samples. Results: We obtained 29 (6.3%) positive samples. 25 (9.7%) derived from immunodeficient patients: 18 (7.3%) from HIV patients and 7 from patients with other immunodeficiencies. The remaining 4 (2.2%) samples originated from immunocompetent individuals. Cryptosporidium genotyping was performed by nested polymerase chain reaction (PCR) and restriction fragments length polymorphism and/or PCR followed by sequencing of the SSU rRNA from oocysts in stool samples. 4 species were identified: C. parvum, C. hominis, C. muris, and C. meleagridis. In immunodeficient patients, 16 C. parvum, 8 C. hominis, and 1 C. muris strain were identified. In immunocompetent participants, 3 C. hominis and 1 C. meleagridis isolate were found. Conclusion: The results indicate that zoonotic and anthroponotic transmission occurs and that C. parvum is the predominant species in our study population. Cryptosporidium species of zoonotic transmission accounted for 62% of the human infections detected in this study.

Objetivo: Caracterizar genéticamente Cryptosporidium spp para determinar la diversidad de especies en seres humanos. Pacientes y Métodos: estudio transversal realizado en Valparaíso, Chile, Un total de 458 pacientes participaron del estudio; 259 inmunodeficientes (pacientes con infección por VIH, oncológicos, con trasplante renal, síndrome de hiper IgM y una mujer embarazada sin infección por VIH) y 178 inmunocompetentes proporcionaron muestras fecales y 21 muestras de bilis. Resultados: Se obtuvieron 29 (6,3%) muestras positivas; 25 (9,7%) de inmunodeficientes: 18 (7,3%) de pacientes con infección por VIH y 7 con otras inmunodeficiencias; los restantes 4 (2,2%) fueron de personas inmunocompetentes. La genotipificación de Cryptosporidium se efectuó mediante reacción de polimerasa en cadena (RPC) anidada y el polimorfismo de la longitud de los fragmentos de restricción y/o RPC - secuenciación de la SSU ARNr, a partir de ooquistes en la muestra fecal. Se identificaron 4 especies: C. parvum, C. hominis, C. muris y C. meleagridis. En pacientes inmunodeficientes, se caracterizaron 16 C. parvum, 8 C. hominis y un C. muris; en inmunocompetentes: 3 C. hominis y un C. meleagridis. Conclusión: Los resultados indican que se produce transmisión zoonótica y antroponótica y que C. parvum es la especie predominante en este estudio. Las especies de Cryptosporidium de transmisión zoonótica representan el 62% en los seres humanos participantes de este estudio.

[Elimination of juvenile stages of Ascaris lumbricoides (Linnaeus, 1758) by mouth. Report of a case and some epidemiological considerations]. / Eliminación de estadios juveniles de Ascaris lumbricoides (Linneo, 1758) por via oral. Reporte de un caso y algunas consideraciones epidemiológicas.

Ascariosis is a parasitic disease caused by Ascaris lumbricoides, a large geohelmint endemic in our country. At present, ascariosis is a rare infection in Chile. We present a case of an adult, resident of the Villa Alemana municipality, Valparaiso Region, who spontaneously expelled two juvenile nematodes by mouth. We review the manifestations produced by the larval and adult stages of this parasite including their diagnosis, treatment, and epidemiological considerations.

Eliminación de estadios juveniles de Ascaris lumbricoides (Linneo, 1758) por via oral: Reporte de un caso y algunas consideraciones epidemiológicas / Elimination of juvenile stages of Ascaris lumbricoides (Linnaeus, 1758) by mouth: Report of a case and some epidemiological considerations

Ascariosis is a parasitic disease caused by Ascaris lumbricoides, a large geohelmint endemic in our country. At present, ascariosis is a rare infection in Chile. We present a case of an adult, resident of the Villa Alemana municipality, Valparaiso Region, who spontaneously expelled two juvenile nematodes by mouth. We review the manifestations produced by the larval and adult stages of this parasite including their diagnosis, treatment, and epidemiological considerations.

La ascariosis es una parasitosis provocada por Ascaris lumbricoides, el geo-helminto de mayor tamaño que afecta al ser humano en nuestro país. En Chile, la ascariosis es una infección poco frecuente en la actualidad. Se presenta el caso de un adulto residente en la comuna de Villa Alemana, Región de Valparaíso, que eliminó en forma espontánea dos ejemplares del nemátodo en estado juvenil por vía oral. Se revisan las manifestaciones producidas por este parásito en la fase larvaria y adulta, el diagnóstico, el tratamiento y algunas consideraciones epidemiológicas.

[Cryptosporidium parvum in wild gastropods as bioindicators of fecal contamination in terrestrial ecosystems]. / Cryptosporidium parvum en gastrópodos silvestres como bioindicadores de contaminación fecal en ecosistemas terrestres.

Cryptosporidium sp oocysts were detected in snails (Helix aspersa Miller) and slug (Deroceras reticulatum Miller) from the Valparaiso Region, Chile. Snails and slug were collected from public squares and private domestic gardens. Cryptosporidium sp oocysts were recovered from faeces of both species. Ziehl Neelsen stain, nested PCR, and sequencing analysis demonstrated a profile similar to that described for genotype C or 2 of the parasite. These results demonstrate that snails and slug could act as a reservoir and mechanic vector of C. parvum infection for humans and animals. Moreover, gastropods could serve as bioindicators of fecal soil contamination.

[Isospora belli infection in HIV positive patients: report of two cases and literature review]. / Infección por Isospora belli en pacientes con infección por VIH: presentación de dos casos y revisión de la literatura.

Isosporosis is an infection caused by parasitic protozoa of the genus Isospora, coccidia affecting various different vertebrate species, including humans. It is an uncommon infection in our country and it is not a zoonosis. We present two cases of Isospora belli infection in HIV positive patients from the Valparaiso region. We discuss the clinical events caused by this agent, its epidemiology, cases published in the local and foreign literature, as well as its treatment and prevention measures.

Infección por Cryptosporidium parvum en una mujer embarazada, inmunocompetente, con riesgo ocupacional / Cryptosporidium parvum infection in a pregnant inmunocompetent woman with occupational risk

La criptosporid iosis es una zoonosis parasitaria provocada por diversas especies de Cryptosporidium. Esta coccidiosis afecta a múltiples vertebrados, incluido el ser humano. En Chile, al igual que en otros países, es una infección poco frecuente en inmunocompetentes y adquiere gran relevancia en pacientes inmunocom-prometidos. Se presenta el caso de una egresada de la carrera de Medicina Veterinaria, embarazada, con 20 semanas de gestación, procedente del sector de Laguna Verde, Región de Valparaíso, que fuera infectada por Cryptosporidium sp. El diagnostico etiológico se realizó con tinción de Ziehl Neelsen, RPC anidada y posterior secuenciación. En el mismo periodo se detectó la infección en sus gatos asintomáticos. En ella y los animales se identificó a C. parvum. Su cónyuge así como sus otras mascotas no estaban infectados. Este corresponde al primer reporte de una posible transmisión de criptos-poridiosis entre ser humano y gato.

Cryptosporidioses is a parasitic zoonoses generated by diverse Cryptosporidium species. This coccidiosis affects multiple vertebrate species, including human beings. In Chile, as it happens in other countries, cryptosporidioses is a low frequency infection in immunocompetent individuals, acquiring a big relevance in immunocompromised ones. We present the following case: a recently graduated student from Veterinary medical school, with a 20 week pregnancy, living in “Laguna Verde” area in the Region of Valparaíso and who was infected with Cryptosporidium sp. Etiologic diagnosis was made by Ziehl Neelsen, and nested PCR followed by PCR product sequencing. During the same period, the infection was detected in her cats which were asymptomatic. In all of them, her and the cats, the species identified was Cryptosporidium parvum. Her husband and her other pets were all asymptomatic and non infected. This is the first report of a possible cryptosporidioses transmission between humans and cat.

Cryptosporidium parvum en gastrópodos silvestres como bioindicadores de contaminación fecal en ecosistemas terrestres / Cryptosporidium parvum in wild gastropods as bioindicators of fecal contamination in terrestrial ecosystems

Cryptosporidium sp oocysts were detected in snails (Helix aspersa Milller) and slug (Deroceras reticulatum Milller) from the Valparaiso Region, Chile. Snails and slug were collected from public squares and private domestic gardens. Cryptosporidium sp oocysts were recovered from faeces of both species. Ziehl Neelsen stain, nested PCR, and sequencing analysis demonstrated a profile similar to that described for genotype C or 2 of the parasite. These results demonstrate that snails and slug could act as a reservoir and mechanic vector of C. parvum infection for humans and animals. Moreover, gastropods could serve as bioindicators of fecal soil contamination.

Se detectó ooquistes de Cryptosporidium sp en caracoles (Helix aspersa Müller) y babosas (Deroce-ras reticulatum Müller) de la Región de Valparaíso, Chile. La recolección de caracoles y babosas se efectuó en parques públicos y jardines de diferentes hogares. Los ooquistes de Cryptosporidium sp fueron recuperados de las deposiciones de ambas especies. Después de la tinción de Ziehl Neelsen y la RPC anidada, el análisis de secuenciación demostró un patrón similar a lo descrito para el genotipo C o 2 del parásito. Estos resultados demuestran que los caracoles y babosas podrían actuar como reservorio y vectores mecánicos de la infección por Cryptosporidium. parvum para humanos y animales. Además, estos gastrópodos podrían ser usados como bio-indicadores de contaminación fecal del suelo.

Infección por Isospora belli en pacientes con infección por VIH: presentación de dos casos y revisión de la literatura / Isospora belli infection in HIV positive patients: report of two cases and literature review

Isosporosis is an infection caused by parasitic protozoa of the genus Isospora, coccidia affecting various different vertebrate species, including humans. It is an uncommon infection in our country and it is not a zoonosis. We present two cases oí Isospora belli infection in HIV positive patients from the Valparaiso region. We discuss the clinical events caused by this agent, its epidemiology, cases published in the local and foreign literature, as well as its treatment and prevention measures.

La isosporosis es una infección parasitaria provocada por protozoos del género Isospora, coccidio que afecta con diversas especies a diferentes vertebrados, entre los que se encuentra el ser humano. Es una infección poco frecuente en nuestro país y no constituye una zoonosis. Se presentan dos casos con infección por Isospora belli en pacientes infectados con el virus de inmunodeficiencia humana procedentes de la Región de Valparaíso. Se analizan las manifestaciones producidas por este agente, la epidemiología de la infección, los casos publicados en la literatura nacional e internacional, así como su tratamiento y las medidas de prevención.

[Animal mites transmissible to humans and associated zoonosis]. / Acarosis y zoonosis relacionadas.

Mites that affect animals (acariasis) can occasionally be transmitted to humans by incidental contact producing pruritus and dermatitis. Animals such as dogs, cats, mice, birds and reptiles, harbour several mite species. Hemophage mites and those that feed on lymph have the potential of transmitting important zoonotic agents (cuales??). The presence of lesions of unclear origin and a history of contact with pets or wild animals should alert towards the possibility of acariasis. Diagnosis is based on direct visualization of the mite,analysis of its morphology and obtaining information on the animal host. Awareness of these acarosis and the responsible care of pets and animals are the most relevant preventive measures.

[Tungiasis affects a chilean turist]. / Tungiasis afecta a un turista chileno.

Tungiasis is a cutaneous ectoparasitosis caused by the female sand flea Tunga penetrans whose higher prevalence occurs in Sub-Saharan Africa, South América and the Caribbean. We report a case of a 23 year old chilean male who presented dermal lesions suggestive of tungiasis on his return from Brazil. The diagnosis was confirmed by biopsy, identifying the arthropod and an egg from one of the lesions. The natural history, co-morbidities and treatment options were reviewed.

Acarosis y zoonosis relacionadas / Animal mites transmissible to humans and associated zoonosis

Mites that affect animals (acariasis) can occasionally be transmitted to humans by incidental contact producing pruritus and dermatitis. Animals such as dogs, cats, mice, birds and reptiles, harbour several mite species. Hemophage mites and those that feed on lymph have the potential of transmitting important zoonotic agents (cuales??). The presence of lesions of unclear origin and a history of contact with pets or wild animals should alert towards the possibility of acariasis. Diagnosis is based on direct visualization of the mite,analysis of its morphology and obtaining information on the animal host. Awareness of these acarosis and the responsible care of pets and animals are the most relevant preventive measures.

Los ácaros de animales (acariasis) pueden transmitirse en forma accidental al hombre al estar en contacto con ellos, produciendo lesiones características (pápulas o vesículas) y ocasionando una dermatitis pruriginosa (acarosis). Existen diversas especies de ácaros, que se encuentran en perros, gatos, roedores, aves y reptiles. Los ácaros hematófagos o los que se alimentan de linfa tienen el potencial de transmitir importantes agentes zoonóticos. La presencia de lesiones sin una etiología clara y el antecedente de contacto con animales, tanto mascotas como animales silvestres, ayudan a plantear esta etiología. El diagnóstico se realiza con la visualización del acaro, morfología y tipo de hospedero animal. El conocimiento de estas acarosis y el control responsable de mascotas y animales, son las principales medidas de prevención.

Tungiasis afecta a un turista chileno / Tungiasis affects a chilean turist

Tungiasis is a cutaneous ectoparasitosis caused by the female sand flea Tunga penetrans whose higher prevalence occurs in Sub-Saharan África, South América and the Caribbean. We report a case of a 23 year old chilean male who presented dermal lesions suggestive of tungiasis on his return from Brazil. The diagnosis was confirmed by biopsy, identifying the arthropod and an egg from one of the lesions. The natural history, co-morbidities and treatment options were reviewed.

La tungiasis es una ectoparasitosis cutánea producida por la hembra de la pulga de arena Tunga penetrans, cuya mayor prevalencia ocurre en África Sub-sahariana, Sudamérica y el Caribe. Comunicamos el caso de un chileno de 23 años que viajó a Brasil y que a su regreso presentó lesiones dérmicas sugerentes de tungiasis. El diagnóstico fue confirmado por una biopsia identificando el artrópodo y un huevo en una de las lesiones. Se revisa la historia natural, las co-morbilidades asociadas y alternativas de tratamiento.

Infección por Dipylidium caninum en un preescolar: presentación del caso y revisión de la literatura / Dipylidium caninum infection in a 2 year old infant: case report and literature review

Dipylidiasis is a zoonotic parasitic infection caused by the dog tapeworm Dipylidium caninum; it affects both feline and canine species and accidentally, humans. In Chile, as well as in other countries, it is an uncommon infection. A case of a 2 year old child from Casablanca, (a city located in the Valparaíso Región), with an infection by D. caninum, is presented. Clinical manifestations are reviewed, as well as epidemiology in domestic and wild animáis, cases among the published national literature and its treatment and prevention strategies.

La dipilidiasis es una zoonosis parasitaria provocada por Dipylidium caninum, teniasis que afecta a cánidos, félidos y, en forma accidental, al hombre. En Chile, al igual que en otros países, es una infección poco frecuente. Se presenta el caso de un preescolar con una infección por D. caninum, residente en la comuna de Casablanca, Región de Valparaíso. Se revisan las manifestaciones producidas por este agente, la epidemiología en animales domésticos y salvajes, los casos publicados en la literatura nacional, así como su tratamiento y las medidas de prevención.

[Pseudoterranovosis and sushi]. / Pseudoterranovosis y sushi.

A case of accidental ingestión of Pseudoterranova decipiens is reported, on account of this patient we review main concepts related to this emerging pathology in Chile. Consumption of raw fish in different preparations such as sushi or sashimi, cebiche and seafood is becoming more and more popular. Through intermediary hosts used in the preparation, one can acquire the third stage larval of Anisakis simplex or P. decipiens. These parasites frequently cause gastritis, acutely after the consumption of raw fish, or more rarely intestinal involvement. It may also cause allergic symptoms such as urticaria, angioedema and anaphylactic shock. The larvae is eliminated spontaneously in most cases; others need to be removed by upper gastrointestinal endoscopio examination. In Chile, the most common species is P. decipiens, which are generally no invasive, rarely migrate beyond the stomach and cause mild or no symptoms. Prevention strategies include avoid eating raw fish or undercooked seafood containing the parasite, to cook food with high temperatures or to freeze raw fish prior to preparation of meals, which inactivates the larvae.

Pseudoterranovosis y sushi / Pseudoterranovosis and sushi

Se comunica un caso de ingestión accidental de Pseudoterranova decipiens. A raíz de esta paciente se revisan los principales conceptos relativos a esta naciente patología en Chile. El consumo de platos preparados con pescados crudos como el sushi, sashimi, cebiche y mariscal es cada vez más popular. A través de la ingesta de hospederos intermediarios usados en la preparación, se puede adquirir la larva de tercer estadio de Anisakis simplex o P. decipiens. Estos parásitos pueden provocar gastritis aguda que se manifiesta inmediatamente después de consumido el pescado crudo. En ocasiones puede haber compromiso intestinal e invasión del tracto gastrointestinal con manifestaciones en otros órganos. Se asocia a manifestaciones alérgicas como urticaria, angioedema y shock anafiláctico. La larva se elimina en forma espontánea en la mayoría de los casos, pero en otros debe removerse por vía endoscópica. En Chile, es más frecuente la presencia de P. decipiens, que por lo general no migra a la mucosa gástrica, no invade y produce pocos síntomas. Las medidas de prevención son no comer pescados crudos, cocinarlos a temperaturas elevadas o congelación previa a la preparación de los alimentos, para inactivar las larvas.

A case of accidental ingestión of Pseudoterranova decipiens is reported, on account of this patient we review main concepts related to this emerging pathology in Chile. Consumption of raw fish in different preparations such as sushi or sashimi, cebiche and seafood is becoming more and more popular. Through intermediary hosts used in the preparation, one can acquire the third stage larval of Anisakis simplex or P. decipiens. These parasites frequently cause gastritis, acutely after the consumption of raw fish, or more rarely intestinal involvement. It may also cause allergic symptoms such as urticaria, angioedema and anaphylactic shock. The larvae is eliminated spontaneously in most cases; others need to be removed by upper gastrointestinal endoscopio examination. In Chile, the most common species is P. decipiens, which are generally no invasive, rarely migrate beyond the stomach and cause mild or no symptoms. Prevention strategies include avoid eating raw fish or undercooked seafood containing the parasite, to cook food with high temperatures or to freeze raw fish prior to preparation of meals, which inactivates the larvae.

[Dipylidium caninum infection in a 2 year old infant: case report and literature review]. / Infección por Dipylidium caninum en un preescolar. Presentación del caso y revisión de la literatura.

Dipylidiasis is a zoonotic parasitic infection caused by the dog tapeworm Dipylidium caninum; it affects both feline and canine species and accidentally, humans. In Chile, as well as in other countries, it is an uncommon infection. A case of a 2 year old child from Casablanca, (a city located in the Valparaíso Region), with an infection by D. caninum, is presented. Clinical manifestations are reviewed, as well as epidemiology in domestic and wild animals, cases among the published national literature and its treatment and prevention strategies.

[Snake bite by Philodryas chamissonis. A case presentation and literature review]. / Mordedura por Philodryas chamissonis. Presentación de un caso y revisión de la literatura.

There are two species of snakes associated with snake bite poisoning in Chile: Philodryas chamissonis and Tachymenis peruviana. A case associated with a P. chamissonis bite occurring during a summer activity in San Antonio, V Region, is presented. The bite compromised the dorsum of the right hand between the thumb and the index finger and was initially painless. During the following 24 hours equimotic edema developed up to the shoulder and pectoral region, with intense pain, headache, nausea, fever and appearance of a serohematic bulla on the elbow fold. The patient was treated with antihistamines, systemic steroids, analgesia and antibiotics for 7 days. Other cases of snake bites published in Chile are reviewed and treatment and prevention strategies are proposed.

Mordedura por Philodryas chamissonis: presentación de un caso y revisión de la literature / Snake bite by Philodryas chamissonis: a case presentation and literature review

El ofidismo es el accidente provocado por la mordedura de una serpiente. En Chile se encuentran 2 tipos de culebras capaces de provocar emponzoñamiento: Philodryas chamissonis y Tachymenis peruviana. Se presenta el caso de una mordedura por P. chamissonis,ocurrida durante una actividad veraniega en la comuna de San Antonio, V Región. La mordedura comprometió la zona del dorso de la mano entre los dedos pulgar e índice de la extremidad superior izquierda, inicialmente indolora. Evolucionó las primeras 24 horas con edema equimótico que abarcó hasta la zona del hombro y pectoral, con dolor intenso, cefalea, náuseas, fiebre y posterior aparición de bulas serohemorrágicas en el pliegue del codo. La paciente se trató con antihistamínicos, corticoides sistémicos, analgesia y antimicrobianos por 7 días. Se discuten los accidentes por mordedura de culebras publicados en la literatura nacional, así como su tratamiento y las medidas de prevención.

There are two species of snakes associated with snake bite poisoning in Chile: Philodryas chamissonis and Tachymenis peruviana. A case associated with a P. chamissonis bite occuring during a summer activity in San Antonio, V Region, is presented. The bite compromised the dorsum of the right hand between the thumb and the index finger and was initially painless. During the following 24 hours equimotic edema developed up to the shoulder and pectoral region, with intense pain, headache, nausea, fever and appearance of a serohematic bulla on the elbow fold. The patient was treated with antihistamins, systemic steroids, analgesia and antibiotics for 7 days. Other cases of snake bites published in Chile are reviewed and treatment and prevention strategies are proposed.