Building a network for multicenter, prospective research of central nervous system infections in South America: Process and lessons learned.

Multicenter collaborative networks are essential for advancing research and improving clinical care for a variety of conditions. Research networks are particularly important for central nervous system infections, which remain difficult to study due to their sporadic occurrence and requirement for collection and testing of cerebrospinal fluid. Establishment of long-term research networks in resource-limited areas also facilitates diagnostic capacity building, surveillance for emerging pathogens, and provision of appropriate treatment where needed. We review our experience developing a research network for encephalitis among twelve hospitals in five Peruvian cities since 2009. We provide practical suggestions to aid other groups interested in advancing research on central nervous system infections in resource-limited areas.

Herpes simplex virus encephalitis in Peru: a multicentre prospective study.

Herpes simplex virus (HSV) is one of the most commonly identified infectious aetiologies of encephalitis in North America and Europe. The epidemiology of encephalitis beyond these regions, however, is poorly defined. During 2009-2012 we enrolled 313 patients in a multicentre prospective study of encephalitis in Peru, 45 (14·4%) of whom had confirmed HSV infection. Of 38 patients with known HSV type, 84% had HSV-1 and 16% had HSV-2. Patients with HSV infection were significantly more likely to present in the summer months (44·4% vs. 20·0%, P = 0·003) and have nausea (60·0% vs. 39·8%, P = 0·01) and rash (15·6% vs. 5·3%, P = 0·01) compared to patients without HSV infection. These findings highlight differences in the epidemiology and clinical presentation of HSV encephalitis outside of the Northern Hemisphere that warrant further investigation. Furthermore, there is an urgent need for improved HSV diagnostic capacity and availability of intravenous acyclovir in Peru.

Aedes aegypti (Diptera: Culicidae) production from non-residential sites in the Amazonian city of Iquitos, Peru.

Programmes for the surveillance of Aedes aegypti (L.) often focus on residential areas, ignoring non-residential sites. Between November 2003 and October 2004, pupal/demographic surveys were therefore conducted in non-residential sites in the Peruvian city of Iquitos. The sampled sites included schools, factories, ports, public markets, petrol stations, commercial zones, airports, government buildings, animal-production areas, and recreational areas. Compared with the residential sites that had been surveyed a few years earlier, the non-residential sites generally had fewer pupae/ha, even though pupae were found in a high percentage of the sites investigated. Nonetheless, although <56 pupae/ha were observed in the industrial, commercial, recreational and school sites, the river boats in the ports and the areas in and around public markets sometimes had pupal abundances (of 122-213 pupae/ha) that were comparable with those previously recorded in the residential sites. When the relative production of Ae. aegypti was calculated by container type and characteristic (lidded/lidless, indoors/outdoors, and water-use patterns), no single container category was found to be a major producer of Ae. aegypti, with the exception of flower vases in cemeteries. In general, almost all (97%) of the pupae collected in the non-residential sites came from unlidded containers, although 91% of those collected in river boats came from lidded storage areas. With the exception of lumber mills, plant nurseries and markets (where only 39%-60% of the pupae were collected outdoors), >70% of pupal production was outdoors. In commercial areas, 41% of the pupae came from manually-filled containers, compared with <12% in residential sites. These results indicate that non-residential sites can be highly productive for Ae. aegypti and that the role of such sites in dengue transmission requires further investigation.

Aspectos epidemiológicos de la leishmaniasis tegumentaria americana en el distrito de Santa Cruz*Ancash / Epidemiological aspects of the tegumentary leishmaniasis in Santa Cruz*Ancash

Se realizó un estudio epidemiológico, clínico y ecológico de Leishmaniasis Tegumentaria en el caserío de Cashapampa, del Departamento de Ancash (Diciembre 1990 * Enero 1991). Se realizó la prueba de Leishmanina en 100 personas: 23 con signos clínicos compatibles con Leishmaniasis (2 en fase activa y 21 en fase cicatricial) fueron positivos a las 72 horas, y 77 que no presentaban signos clínicos de Leishmaniasis fueron negativos. La intradermorreacción de Montenegro tiene importancia en estos casos. La población total de Cashapampa es de 200 habitantes; los resultados encontrados, tienen importancia significativa; el 11.5 por ciento de la población total presentaron signos clínicos compatibles con Leishmaniasis, debe considerarse zona endémica. Esta investigación induce a corroborar que la infección se adquiere en zonas rurales de los valles serranos donde están los vectores y reservorios naturales. Cashapampa no presenta zona urbana