Leprosy reactions: Unraveling immunological mechanisms underlying tissue damage in leprosy patients.

Leprosy is a chronic granulomatous infectious and disabling disease caused by two mycobacteria, Mycobacterium leprae and Mycobacterium lepromatosis. Acute inflammatory responses, known as leprosy reactions, are significant contributors to disabilities. Three types of leprosy reactions have been identified based on excessive cytokine release (e.g. type 1) or the accumulation of immune complexes in tissues inducing multiorgan damage (e.g. types 2 and 3). The type of leprosy reaction has implications on treatment and management strategies, yet are not well understood by health workers caring for leprosy patients. We attempt to describe the immunologic mechanisms behind the different leprosy reactions and the rationale for tailoring clinical treatment and management to the particular type of leprosy reaction based on the underlying immunologic situation.

Intestinal parasitosis in children from a rural Caribbean area in Colombia / Parasitosis intestinal en niños de una zona rural del Caribe de Colombia

Abstract In Colombia, the prevalence of intestinal parasitosis varies throughout its regions, social classes, and living conditions. We performed a cohort study (2017-2018) on children from 1-10 years old in El Cedro, Ayapel, Colombia. We tested a convenience sampling of those who accepted and signed the consent form. The National Intestinal Parasite Survey was applied; feces and water source sampling were tested for coprological and microbiology analysis, respectively. Education and pharmacologic treatment to the minor and co-inhabitants were performed. After the recruiting, we followed up at 7 and 12 months. Statistical analysis was performed using IBM® SPSS22. Participants 47, 61,7% male, average age 5,7 years. The caretakers had a low educational background. The monthly income of 72,3% of households was < USD 87. The coprological test showed 61,7% with at least one type of parasite; 32,2% with two or more. Trichuris trichiura was the most frequent. Water sources were positive for Escherichia coli. The population tested showed a high frequency of parasitic infection. We did not find a reduction of intestinal parasitosis with educa tion and pharmacologic treatment at the end of the follow-up. It must be necessary to impact social determinants of public health to achieve intestinal parasitosis control.

Resumen En Colombia, la prevalencia de parasitosis intestinal varía por regiones, clases sociales, condiciones de vida. Realizamos estudio de cohorte (2017-2018) en niños de 1-10 años en El Cedro, Ayapel, Colombia. Muestra por conveniencia, se incluyeron aquellos que aceptaron y firmaron el consentimiento. Se aplicó la Encuesta Nacional de Parásitos Intestinales; se analizaron muestras de heces y fuentes de agua para análisis coprológico y microbiológico, respectivamente. Se realizó educación y tratamiento farmacológico al menor y cohabitantes. Después del reclutamiento, seguimiento a los 7 y 12 meses. El análisis estadístico se realizó con IBM® SPSS22. Participantes 47, 61,7% hombres, promedio de edad 5,7 años. Cuidadores con bajo nivel educativo, ingreso mensual del 72,3% de los hogares fue <USD 87. La población analizada mostró una alta frecuencia de infección parasitaria, un 61,7% con al menos un tipo de parásito; 32,2% con dos o más. Trichuris trichiura fue el más frecuente. Las fuentes de agua fueron positivas para Escherichia coli. Al final del seguimiento, no se redujo la frecuencia de la parasitosis intestinal a pesar de educación y tratamiento farmacológico. Se requiere incidir en los determinantes sociales y de salud pública para lograr el control de las parasitosis intestinales.

Mycobacterium lepromatosis as Cause of Leprosy, Colombia.

Leprosy is a granulomatous infection caused by infection with Mycobacterium leprae or M. lepromatosis. We evaluated skin biopsy and slit skin smear samples from 92 leprosy patients in Colombia by quantitative PCR. Five (5.4%) patients tested positive for M. lepromatosis, providing evidence of the presence of this pathogen in Colombia.

Biliary Tract Microbiota Similarities in Pancreatic Ductal Adenocarcinoma / Similitudes en la Microbiota de Tracto Biliar en Adenocarcinoma Ductal de Páncreas

Abstract Objective: to analyze microbiota profiles in the biliary tract, of pancreatic ductal adenocarcinoma (PDAC) patients and gallstones patients, in order to identify dif ferences, which may contribute to a better understanding of PDAC carcinogenesis. Methods: using microbiota analysis, a total of 25 samples from 14 patients were collected during surgery and compared. Samples were divided into three groups; one GS group (N = 3), and two PDAC groups; PDAC gallbladder group (N = 11) and PDAC brush group (N = 11). Results: upon comparison of bacterial communities' alpha and beta diversity indices and relative abundances by group (anatomic site) and condition (GS vs PDAC), we found no statistically significant results. However, we can highlight the high similarity of the compared parameters among the two different anatomic locations over the biliary tract in PDAC patients. Conclusion: to the best of our knowledge, this is the first study comparing two different anatomic locations over the biliary tract in PDAC patients. Among PDAC groups microbiota along the semi-closed duct system of the biliary tract showed substantial similarity, reflected in the alpha and beta diversity indices and relative abundances.

Resumen Objetivo: analizar los perfiles de microbiota en el tracto biliar de pacientes con adenocarcinoma ductal pancreático (PDAC) y pacientes con cálculos biliares (GS), con el fin de identificar diferencias, lo que puede contribuir a una mejor comprensión de la carcinogénesis de PDAC. Métodos: mediante análisis de microbiota, se recolectaron durante la cirugía un total de 25 muestras de 14 pacientes y se compararon. Las muestras se dividieron en tres grupos; Grupo GS (N = 3) y dos grupos PDAC; Grupo de vesícula biliar PDAC (N = 11) y grupo de cepillado PDAC (N = 11). Resultados: al comparar los índices de diversidad alfa y beta de las comunidades bacterianas y las abundancias relativas por grupo (sitio anatómico) y condición (GS vs PDAC), no encontramos diferencias estadísticamente significativas. Sin embargo, podemos destacar la gran similitud de los parámetros comparados entre las dos ubicaciones anatómicas diferentes en el tracto biliar en pacientes con PDAC. Conclusión: hasta donde sabemos, este es el primer estudio que compara dos ubicaciones anatómicas diferentes sobre el tracto biliar en pacientes con PDAC. Entre los dos grupos de PDAC, la microbiota del sistema de conductos semicerrados del tracto biliar, se encontró una similitud sustancial, reflejada en los índices de diversidad alfa y beta y en abundancias.

Cholangiocyte derived carcinomas and local microbiota.

Trillions of bacteria are present in the gastrointestinal tract as part of the local microbiota. Bacteria have been associated with a wide range of gastrointestinal diseases including malignant neoplasms. The association of bacteria in gastrointestinal and biliary tract carcinogenesis is supported in the paradigm of Helicobacter pylori and intestinal-type gastric cancer. However, the association of bacterial species to a specific carcinoma, different from intestinal-type gastric cancer is unresolved. The relationship of bacteria to a specific malignant neoplasm can drive clinical interventions. We review the classic bacteria risk factors identified using cultures and PCR (polymerase chain reaction) with new research regarding a microbiota approach through 16S rRNA (16S ribosomal ribonucleic acid gene) or metagenomic analysis for selected carcinomas in the biliary tract.

Pseudomicosis por oportunistas: desconocimiento y retos diagnósticos / Pseudomycosis due to opportunists: Lack of knowedge and diagnostic challenges

Resumen Se denominan pseudomicosis a las infecciones generadas por microorganismos que parecen hongos pero que no lo son. En esta revisión se abordan desde una perspectiva etiológica, epidemiológica y clínica algunas de las pseudomicosis por oportunistas más frecuentes: actinomicosis, botriomicosis, nocardiosis y prototecosis. Adicionalmente, se revisan las herramientas clínicas y paraclínicas para facilitar su diagnóstico y se actualizan las pautas de tratamiento.

Abstract Infections generated by microorganisms that look like fungi but are not fungal are called pseudomycosis. This review addresses pseudomycosis by more frequent opportunists: actinomicosis, botryomycosis, nocardiosis and prototechosis, from an etiological, epidemiological and clinical perspective. In addition, clinical and paraclinical tools are reviewed to facilitate diagnosis, and and treatment guides are updated.

Micobioma: diversidad fúngica en el cuerpo humano / Mycobiome: Fungal diversity in human body

Resumen Introducción: los hongos hacen parte de los microorganismos que se encuentran en el ser humano y que interactúan con bacterias, virus y archaeas. El equilibrio inter e intra-especies es importante para mantener la salud en los seres humanos. La mayoría de los estudios sobre el micobioma se han relacionado con estados de enfermedad causados por hongos, siendo de relevancia la exploración de las comunidades comensales en individuos sanos. Métodos: se realizó una búsqueda bibliográfica en PubMed, ScienceDirect, Scopus y Google Scholar, usando los términos mycobiome, intestinal fungi, skin mycobiome, vaginal mycobiome, fungal microbiome. Se incluyeron artículos desde 1996 hasta 2020, de revisión y de resultados de investigación en todos los idiomas. Resultados y discusión: existe variabilidad en las comunidades fúngicas en los sitios corporales según sus características intrínsecas y la relación con el medio ambiente. El estado de salud en los seres humanos puede estar influenciado por la densidad y diversidad fúngica, a diferencia de los individuos enfermos en quienes se evidencia una disminución en la diversidad y que se asocia con el oportunismo de agentes patógenos.

Abstract Introduction: Fungi are part of the microorganisms that are found in humans and interact with bacteria, viruses and archaeas. The balance inter and intra-species is important to maintain health in humans. Most studies on mycobiota have been related to disease states caused by fungi, the exploration of commensal communities in healthy individuals being relevant. Methods: literature search in PubMed, ScienceDirect, Scopus and Google Scholar, using the terms: mycobiome, intestinal fungi, skin mycobiome, vaginal mycobiome, fungal microbiome. Articles from 1996 to 2020, review and research results in all languages were included in this review. Results: Variability in fungal communities is determinated according to body site characteristics and the contact with the environment. Health status in humans can be influenced by fungal density and diversity, unlike sick individuals where there is evidence of a decrease in diversity and that is associated with the opportunism of pathogens.

Innate immune response: ally or enemy in cutaneous leishmaniasis?

Cutaneous leishmaniasis (CL) is an infectious and neglected disease caused by parasites of the genus Leishmania, which produces a wide spectrum of cutaneous manifestations. CL research has shown that the innate immune activity of cells such as neutrophils, natural killers, macrophages, dendritic cells and the complement system are capable of controlling this infection. However, Leishmania can also modulate the immune activity of these cells to promote its own survival and proliferation at the intracellular level. This review discusses the role of the innate immune response in the control and spread of this infection.

Oct-6 transcriptional factor a possible biomarker for leprosy diagnosis.

Leprosy is an infectious disease caused by Mycobacterium leprae that affects the skin and nerves. The nerve damage in leprosy may be related to alterations in transcriptional factors, such as Krox-20, Oct-6, Sox-10. Thirty skin biopsies in leprosy patients and 15 non-leprosy skin biopsies were evaluated using RT-qPCR to assess Krox-20, Oct-6, and Sox-10 and these data was related with S-100 immunohistochemistry. Changes in gene expression were observed in the skin and dermal nerves of leprosy patients in Oct-6 and Sox-10. When comparing Oct-6 with S-100 IHC as diagnostic tests for leprosy, Oct-6 showed a sensitivity of 73.3%, and specificity of 100%, while S-100 IHC showed a sensitivity of 96.6% and specificity of 100%. Our data suggest Oct-6 could be an auxiliary biomarker specific to detecting changes in dermal nerves in leprosy and thus useful to health workers and pathologists with no expertise to observe nerve injuries in leprosy.

Primer caso confirmado de brucelosis humana por Brucella melitensis, una zoonosis presente en Colombia / First confirmed case of human brucellosis by Brucella melitensis, a zoonosis present in Colombia

Resumen La brucelosis, principal zoonosis a nivel mundial tiene alta prevalencia en varios países de Latinoamérica. Se asocia con la exposición a ganado infectado por distintas especies del género Brucella. B. melitensis la más virulenta para el humano, causa con frecuencia complicaciones de predominio osteoarticular. En Colombia se cree que la infección por B. melitensis es una entidad ausente, a pesar de su plausibilidad biológica en nuestro contexto; sin embargo, son escasos los estudios sobre su ocurrencia y mínimo el índice de sospecha de la enfermedad, por lo cual creemos está subdiagnosticada. Presentamos el primer caso confirmado de brucelosis por B. melitensis en Colombia en una joven embarazada, con diagnóstico incidental, en quien el análisis retrospectivo de su cuadro clínico alertó sobre puntos clave que pueden impactar en el diagnóstico y tratamiento oportuno de la enfermedad. Se plantean preguntas de prevalencia real de esta entidad en Colombia.

Summary Brucellosis, the principal zoonoses globally is highly prevalent in different countries of Latin America. It is associated with the exposition of livestock infected with different Brucella species, being B. melitensis the most virulent for humans, and frequently causing osteoarticular complications. In Colombia it is believed that B. melitensis infection is an absent entity, despite its biological plausibility in our context; however, there are few studies on its occurrence and a minimum index of suspicion of the disease, which is why we believe it is underdiagnosed. We present the first confirmed case of brucellosis by B. melitensis in Colombia diagnosed in a young pregnant patient, with an incidental diagnosis, in whom a retrospective analysis of her clinical outcome warned of key points that may impact on the diagnosis and timely treatment of the disease. We present several questions surrounding the real prevalence of this entity in Colombia.

Biliary Tract Carcinogenesis Model Based on Bile Metaproteomics.

Purpose: To analyze human and bacteria proteomic profiles in bile, exposed to a tumor vs. non-tumor microenvironment, in order to identify differences between these conditions, which may contribute to a better understanding of pancreatic carcinogenesis. Patients and Methods: Using liquid chromatography and mass spectrometry, human and bacterial proteomic profiles of a total of 20 bile samples (7 from gallstone (GS) patients, and 13 from pancreatic head ductal adenocarcinoma (PDAC) patients) that were collected during surgery and taken directly from the gallbladder, were compared. g:Profiler and KEGG (Kyoto Encyclopedia of Genes and Genomes) Mapper Reconstruct Pathway were used as the main comparative platform focusing on over-represented biological pathways among human proteins and interaction pathways among bacterial proteins. Results: Three bacterial infection pathways were over-represented in the human PDAC group of proteins. IL-8 is the only human protein that coincides in the three pathways and this protein is only present in the PDAC group. Quantitative and qualitative differences in bacterial proteins suggest a dysbiotic microenvironment in the PDAC group, supported by significant participation of antibiotic biosynthesis enzymes. Prokaryotes interaction signaling pathways highlight the presence of zeatin in the GS group and surfactin in the PDAC group, the former in the metabolism of terpenoids and polyketides, and the latter in both metabolisms of terpenoids, polyketides and quorum sensing. Based on our findings, we propose a bacterial-induced carcinogenesis model for the biliary tract. Conclusion: To the best of our knowledge this is the first study with the aim of comparing human and bacterial bile proteins in a tumor vs. non-tumor microenvironment. We proposed a new carcinogenesis model for the biliary tract based on bile metaproteomic findings. Our results suggest that bacteria may be key players in biliary tract carcinogenesis, in a long-lasting dysbiotic and epithelially harmful microenvironment, in which specific bacterial species' biofilm formation is of utmost importance. Our finding should be further explored in future using in vitro and in vivo investigations.

Notch Signaling Pathway Expression in the Skin of Leprosy Patients: Association With Skin and Neural Damage.

Introduction: Leprosy is an infectious disease caused by Mycobacterium leprae, a debilitating disease that affects the skin and peripheral nerves. It is possible that tissue changes during infection with leprosy are related to alterations in the activity of the Notch signaling pathway, an innate signaling pathway in the physiology of the skin and peripheral nerves. Methods: This is a descriptive observational study. Thirty skin biopsies from leprosy patients and 15 from individuals with no history of this disease were evaluated. In these samples, gene expressions of cellular components associated with the Notch signaling pathway, Hes-1, Hey-1, Runx-1 Jagged-1, Notch-1, and Numb, were evaluated using q-PCR, and protein expression was evaluated using immunohistochemistry of Runx-1 and Hes-1. Results: Changes were observed in the transcription of Notch signaling pathway components; Hes-1 was downregulated and Runx-1 upregulated in the skin of infected patients. These results were confirmed by immunohistochemistry, where reduction of Hes-1 expression was found in the epidermis, eccrine glands, and hair follicles. Increased expression of Runx-1 was found in inflammatory cells in the dermis of infected patients; however, it is not related to tissue changes. With these results, a multivariate analysis was performed to determine the causes of transcription factor Hes-1 reduction. It was concluded that tissue inflammation was the main cause. Conclusions: The tissue changes found in the skin of infected patients could be associated with a reduction in the expression of Hes-1, a situation that would promote the survival and proliferation of M. leprae in this tissue.

Micronutrientes: un eslabón clave en la inmunopatogénesis de la lepra / Micronutrients: a key link in the immunopathogenesis of leprosy

The purpose of this work was to analyze the prevalence of fetal mortality (FM) in mothers in early adolescence (10-14 years), late adolescence (15-19 years) and in adults (20-34 years), during the period 2014-2016, in the North Department of Santander-Colombia. The factors taken into account were: gestation time, fetal weight, childbirth, basic causes, area of residence, and educational level of the mothers. Method: The study was retrospective, correlational, analytical-comparative. The database was from a secondary public access source of the National Administrative Department of Statistics (DANE-Colombia). The analysis was performed using the following tests: chi-square, Kruskal-Wallis H, Cramer's V coefficient, Goodman and Kruskal's gamma, Tukey's post-hoc procedures and the Bonferroni method based on Student's t-test. Results: The prevalence of FM for the years 2014-2016 was 10.0 per 1000 live births in mothers in early adolescence, 19.2 in mothers in late adolescence and 18.6 in adult mothers. It emerged that the prevalence of FM in pregnancies of under 22 weeks was higher in adult mothers, before delivery and during childbirth (chi-square = 32.023; p = 0.021), and there was a slight negative relationship between mother's age and weight of the fetus (gamma = -0.186; p = 0.014). The prevalence of FM was higher in adult mothers residing in the municipal district (chi-square = 80.18; p = 0.000), in mothers with primary, secondary and professional-level basic education (chi-square = 105.56; p = 0.000), and greater in adult mothers due to obstetric complications and birth trauma

La lepra es una enfermedad infecciosa crónica causada por Mycobacterium leprae, la cual tiene una notoria afinidad por la piel y los troncos nerviosos periféricos. Esta enfermedad se caracteriza por tener una clínica polimorfa que depende de la respuesta inmune del hospedero. La inmunopatogénesis de esta enfermedad aún representa un reto para los investigadores, y un eslabón faltante en su comprensión es el estudio de los micronutrientes, los cuales se ha demostrado que tienen la capacidad de modular la respuesta inmune innata y adaptativa. El objetivo de esta revisión es describir y relacionar algunos nutrientes, como las vitaminas A, D, E, C y B6, el folato, el zinc y el hierro, con la respuesta inmune en la lepra. Además, proponemos que algunos micronutrientes (vitaminas A, D y C y zinc) serían importantes para mitigar la aparición de reacciones lepróticas por medio de la modulación de la respuesta inmune en el hospedero infectado por M. leprae, y que micronutrientes como las vitaminas A, D, B6 y D, el folato, el hierro y el zinc serían importantes para reducir la incidencia de la lepra, dado que promoverían una mejor respuesta inmune en convivientes. Por lo tanto, el estudio del estado nutricional y el aporte suplementario con micronutrientes en convivientes y en afectados con lepra sería clave en la eliminación de esta enfermedad que ha deformado cuerpos y ha destruido sueños a lo largo de los siglos.

Screening for intestinal parasites in adults from three different regions of Colombia / Tamizaje de parásitos intestinales en adultos de tres regiones de Colombia

Intestinal parasitosis (IP) is a public health problem in developing countries affecting one fourth of the global population. IP are common studied in children, ne glecting the adults that are also at high risk and source of transmission. A screening study was performed with a convenience sample in three Colombian regions: Guachené (Cauca), Quibdó (Chocó), and Urabá (Antioquia). Feces samples from 284 volunteers (older than 18 years old) were tested by microscopy to identify para site ova and cysts. The IP frequency was 14.5%, and 52.1% were males. 63.2% of the parasitized patients exhibited diarrhea, and/or abdominal pain with significant association. 39.5% had single parasitic infection and 60.5% had multiple parasites: Blastocystis hominis (63.9%), Entamoeba hystolitica/dispar (39.4%), Endolimax nana (33.3%), Ascaris lumbricoides (22.2%), Giardia lamblia (19.4%), Entamoeba coli (13.9%), Trichuris trichiura (11.1%), hookworm species (11.1%), Strongyloides stercolaris (5.6%), and Iodamoeba butschlii (2.8%). A multivariate approach was used to determine predictor factors for IP: male gender, rainwater as drinking sour ce, and feces disposal different to toilet, latrine or septic tank were positively associated with infection. This study evidences that adult population, not only children from vulnerable areas of Colombia, must have to include as a risk for intestinal parasitism.

La parasitosis intestinal (PI) es un problema de salud pública en países en desarrollo que afecta un cuarto de la población mundial. Las PI son comúnmente estudia das en niños, olvidando que los adultos están también en riesgo y a su vez pueden ser fuentes de transmisión. Se realizó un estudio de tamizaje con una muestra escogida por conveniencia en tres regiones de Colombia: Guachené (Cauca), Quibdó (Chocó) y Urabá (Antioquia). Las muestras de materia fecal de 284 voluntarios mayores de 18 años, fueron estudiadas por microscopía para identificar parásitos, huevos y quistes. La frecuencia de las PI fue del 14.5%, 52.1% de los positivos fueron hombres. 63.2% de los individuos parasitados tenían asociación significativa con diarrea, y/o dolor abdominal. 39.5% tuvieron infección por un solo parásito y 60.5% fueron positivos para varios parásitos: Blastocystis hominis (63.9%), Entamoeba hystolitica/dispar (39.4%), Endolimax nana (33.3%), Ascaris lumbricoides (22.2%), Giardia lamblia (19.4%), Entamoeba coli (13.9%), Trichuris trichiura (11.1%), Strongyloides stercolaris (5.6%), y Iodamoeba butschlii (2.8%). Se realizó un aná lisis multivariado para determinar factores predictores para PI: el género masculino, el agua lluvia para consumo, y la disposición de excretas diferente a sanitario, letrina o pozo séptico, están asociados positivamente a la PI. Este estudio evidencia que la población adulta, no solo la infantil, residentes en áreas vulnerables de Colombia, deben incluirse como población de riesgo al parasitismo intestinal.

La Lepra: una enfermedad vigente / Leprosy: an ongoing disease

El libro resalta que la lepra continúa siendo una enfermedad presente en Colombia y que aún constituye un problema de salud pública importante por los costos sociales, económicos y de sufrimiento humano que conlleva. Sabiendo que la literatura sobre el tema es escasa en nuestro medio, este libro surge como una herramienta de consulta creada para médicos y otros profesionales de salud, con la certeza de que es preciso mejorar la oportunidad del diagnóstico. Siendo fundamental que, durante su proceso formativo, todos los profesionales de la salud adquieran conocimientos sobre dicha enfermedad, que cada día se hace más visible por sus secuelas y diagnóstico tardío.

The book highlights the fact that leprosy continues to be a disease present in Colombia and that it is still a major public health problem due to the social, economic and human suffering costs it entails. Knowing that the literature on the subject is scarce in our country, this book is intended as a reference tool for doctors and other health professionals, in the knowledge that it is necessary to improve the timeliness of diagnosis. It is essential that, during their training process, all health professionals acquire knowledge about this disease, which is becoming more and more visible every day due to its sequelae and late diagnosis.

Candidiasis mucocutánea crónica: una mirada al entendimiento genético / Chronic mucocutaneous candidiasis: a look at genetic understanding

RESUMEN La candidiasis mucocutánea crónica se caracteriza por infecciones recurrentes o persistentes en la piel, las uñas y las mucosas, producida por especies de Candida sp. Esta va a ser secundaria a cualquier alteración en la inmunidad antimicótica, en la cual no solo la producción de IL-17, sino cualquier defecto en la diferenciación de los linfocitos T hacia su perfil TH17, juegan un papel fundamental y van a desencadenar una susceptibilidad a esta infección, que dependiendo de la etiología genética, puede ser una manifestación sindrómica con otras características clínicas y endocrinológicas asociadas. Aquí revisamos de manera práctica, clara y concisa los defectos genéticos hasta ahora encontrados, implicados en la aparición de la candidiasis mucocutánea crónica.

SUMMARY Chronic mucocutaneous candidiasis is an infectious phenotype characterized by recurrent or persistent infections in the skin, nails and mucous membranes produced by Candida sp. This is secondary to any alteration in the antifungal immunity, in which not only the production of IL-17, but any defect in the differentiation of the T lymphocytes towards their TH17 profile, play a fundamental role and will unchain a susceptibility to this infection; that depending on the genetic etiology, can be a syndromic manifestation with other associated infectious and endocrinological clinical characteristics. Here, we review in a practical, clear and concise manner, the genetic defects so far found to be involved in the appearance of chronic mucocutaneous candidiasis.

Presencia de Salmonella spp. en tortugas de río en cautiverio y en libertad en Urabá, Colombia / Presence of Salmonella spp in captivity and wild river turtles in Urabá, Colombia / Presença de Salmonella spp. em tartarugas de rio em cativeiro e em liberdade em Urabá, Colômbia

Resumen La salmonelosis es una enfermedad infecciosa de alta prevalencia a nivel mundial en la cual las tortugas han sido reconocidas como portadores crónicos. Diferentes estudios han reportado la presencia de Salmonella spp. en tortugas de río en diferentes países, sin embargo, ha sido poco reportada en individuos en libertad. El objetivo de este estudio fue determinar la presencia de Salmonella spp. en tortugas de río en cautiverio (n= 55) y en libertad (n= 50) en el Urabá antioqueño (Colombia) entre 2015-2016. Se incluyeron las especies Trachemys venusta, Rhinoclemmys melanosterna y Kinosternon leucostomum. Se tomó la muestra de materia fecal por hisopado cloacal, se cultivó y de las colonias aisladas se realizó extracción de ADN y reacción en cadena de polimerasa (PCR). De la población muestreada (n=105) se encontraron dos individuos positivos a Salmonella spp., ambos en cautiverio, machos, adultos y pertenecientes a la especie R. melanosterna. Los resultados obtenidos no excluyen la posibilidad de infección debido a la intermitencia en la excreción de la bacteria en heces. Esta investigación aporta evidencia a la presencia de la bacteria en las tortugas de la región de estudio y la necesidad de implementar medidas preventivas que disminuyan el contacto con estas especies, y por lo tanto la probabilidad de transmisión de salmonelosis no tifoidea en la población humana de la región.

Abstract Salmonellosis is a high prevalence infectious diseases worldwide and turties have been recognized as chronic carriers. Studies have reported the presence of Salmonella spp in river turtles in different countries; however, studies in wild individuals are less common. The objective of this study was to identify the presence of Salmonella spp in wild (n=50) and in captivity (n=55) river turtles in Uraba Antioqueño (Colombia) between 201 5-2016. Trachemys venusta, Rhinoclemmys melanosterna, and Kinosternon leucosto-mum were included. Feces samples were taken by cloaca swab׳ cultures were performed, and DNA extraction and PCR were made from the colonies isolated. From total population(n=105) two male, adults in captivity were positive, the specie was R. melanosterna. The results obtained do not exclude infection due to the intermittence in the excretion of the bacteria in feces. This research provides evidence of the presence of the bacteria in turtles from the region and highlights the requirement to implement preventive activities to reduce contact with these species, and decrease the probability of transmission of nontyphoidal salmonellosis in human population around the region.

Resumo Salmonelose é uma doença de alta prevalência mundial. As tartarugas são reconhecidas como portadoras crônicas. Em diferentes países tem sido relatado a presença de Salmonella spp. em tartarugas de rios embora, poucos são os estudos em indivíduos selvagens. O objetivo deste estudo foi identificar na região do Urabá Antioqueño (Colombia) nos anos 2015 e 2016 a presença de Salmonella spp. em tartarugas selvagens (n = 50) e em cativeiro (n = 55). Foram incluídas tartarugas das espécies Trachemys venusta, Rhinoclemmys melanosterna e Kinosternon leucostomum. Foi coletada por esfregaço cloacal e para cultura uma amostra de fezes. A partir das colônias isoladas foi realizada extração de DNA para testes moleculares (PCR). Da população total (n = 105) foram positivos do grupo de cativeiro dois machos adultos da espécie R. melanosterna. Devido à intermitência na excreção das bactérias nas fezes os resultados obtidos não excluem a infecção. Esta pesquisa fornece evidências da presença da bactéria em tartarugas da região do Urabá e destaca a necessidade de implementar atividades preventivas para reduzir o contato com essas espécies selvagens e diminuir a probabilidade de transmissão zoonótica de salmonelose não tifoidal na população humana da região.

A case series of pure neural leprosy in patients diagnosed in a specialized center for the control of Hansen's disease in Colombia / Serie de casos de lepra neural pura en pacientes diagnosticados en un centro especializado en el control de la enfermedad de Hansen en Colombia

Abstract Pure neural leprosy, defined as a peripheral neuropathy in which the patient has no skin lesions, is difficult to diagnose. Its verification by bacteriological index and histopathology is not possible in the majority of the patients. We describe four cases of pure neural leprosy diagnosed by clinical criteria. The clinical outcome of three of the patients after specific treatment was satisfactory, while the other one developed progressive neural damage despite the therapy. All patients were treated in a specialized center for the management and control of Hansen's disease in the municipality of Contratación, Santander, Colombia.

Resumen La lepra neural pura se presenta como una neuropatía periférica sin presencia de lesiones cutáneas. La verificación del diagnóstico mediante el índice bacilary la histopatología, no es posible en la mayoría de los pacientes. Se describen cuatro casos de lepra neural pura diagnosticados por clínica; la evolución de tres de los pacientes que recibieron tratamiento específico fue satisfactoria, en tanto que la otra paciente presentó deterioro progresivo a pesar de las medidas terapéuticas. Todos los pacientes fueron atendidos en un centro especializado en el manejo y control de la enfermedad de Hansen, ubicado en el municipio de Contratación, Santander, Colombia.

Métodos de diagnóstico en micología / Diagnostic methods in mycology

Resumen El diagnóstico de las micosis constituye un problema clínico y terapéutico de interés actual debido al incremento y gravedad de las infecciones diseminadas. Por esta razón, en los últimos años se ha priorizado la búsqueda de nuevos métodos para el diagnóstico rápido y preciso. En la actualidad contamos con métodos tradicionales como KOH, cultivo, histopatología y serología, y, de forma más reciente, con métodos moleculares que permiten mayor rapidez y sensibilidad. En esta revisión se hace énfasis en la importancia de los métodos de diagnóstico micológico para la dermatología y la medicina general, ya que debido al desconocimiento en este campo, la preparación del paciente no es la adecuada y, por otro lado, la dificultad en la interpretación de los resultados lleva a confusión y tratamientos incorrectos.

Abstract Diagnosis of fungal infections is a clinical and therapeutic problem of current interest due to the increase and severity of disseminated infections. For this reason in recent years have been mainly seeking new methods for fast and accurate diagnosis. At present we have traditional methods like KOH, culture, histopathology and serology, and more recently molecular methods that allow greater speed and sensitivity in diagnosis. This review emphasizes the importance of mycological diagnosis methods for dermatology and general medicine, as due to ignorance in this field, patient preparation is not adequate and secondly the difficulty in interpreting results and treatment choice are misleading.

Neuropatía leprótica: una mirada integral de la afección periférica causada por Mycobacterium leprae / Leprous Neuropathy: an integral view of the peripheral damages caused by Mycobacterium leprae

Resumen La lepra es una enfermedad infecciosa granulomatosa crónica, causada por Mycobacterium leprae. El curso natural de esta enfermedad está relacionado con una neuropatía periférica denominada neuropatía leprótica, la cual es responsable de la aparición de discapacidades en ojos, manos y pies. Se realizó una búsqueda estructurada en la base de datos de Pubmed y OVID utilizando los siguientes términos MeSH: lepra, neuropatía, nervio periférico, célula de Schwann, discapacidad, biomarcadores. El 83,8 % de los artículos referenciados en esta revisión fueron seleccionados a través de esta búsqueda. El daño neural en lepra es una patología en la que intervienen múltiples mecanismos fisiopatógenicos, que incluyen: la respuesta inmune del hospedero, la interacción de M. leprae a diferentes ligandos en las células Schwann, lo que permite la activación de vías de señalización celular que inducen inflamación, desmielinización y daños a nivel del axón, que se traducen en discapacidad sensitiva y motora en el paciente con lepra. Pero a pesar de que en las últimas décadas se han realizado avances importantes en el entendimiento de esta neuropatía, esto no se ha visto reflejado en herramientas o biomarcadores que sean útiles en la detección temprana del daño periférico causado por la lepra.

Abstract Leprosy is an infectious disease caused by Mycobacterium leprae. In the course of this disease patients can develop a peripheral neuropathy called leprous neuropathy, which is responsible for the appearance of disabilities in eyes, hands and feet. A structured search was performed in Pubmed and OVID databases using the following MeSH terms: leprosy, neuropathy, peripheral nerves, Schwann cell, disability and biomarkers. 83.8 % of the articles referenced in this review were selected by this search Neural damage in leprosy is an event that involves multiple pathophysiological mechanisms, including the host immune response and the interaction of M. leprae with different ligands in Schwann cells. This allows for the activation of cell signaling pathways that induce inflammation, demyelination and damage to the axon, which results in sensory and motor disability in leprosy patients. Despite the progress that has been made in the lasts decades in understanding this neuropathy, this has not been reflected in tools or biomarkers useful for early detection of peripheral damage caused by leprosy. In the last decades a lot of progress has been made in understanding leprous neuropathy. Unfortunately this has not been reflected in the discovery of tools or biomarkers which are useful for the early detection of peripheral damage.