RESUMO
El síndrome pulmonar por hantavirus (SPH) en el Paraguay es una infección relacionada a extensas áreas geográficas del Chaco o Región Occidental. Sin embargo, en los últimos años se han reportado casos fuera del área endémica conocida. Con el objetivo de describir el perfil epidemiológico de la enfermedad en nuestro país, y actualizar las áreas de transmisión, se realizó una revisión retrospectiva de los casos registrados desde el 2013 al 2020. Fueron confirmados 90 casos de SPH, siendo la Región Occidental la de mayor proporción de casos, con 92% en dicho periodo. La Región Oriental registró el 5,5% de los casos, mientras que en el 2,5% de los casos no fue posible determinar el territorio de ocurrencia del contagio. El perfil de la enfermedad en el país se presenta como una afección principalmente de hombres en la edad adulta - joven, ligados a actividades de campo. Los principales desafíos para el abordaje de esta enfermedad son sensibilizar a la población de las nuevas áreas de riesgo identificadas, fortalecer la vigilancia en dichos lugares a fin de captar en forma oportuna a los casos, y actualizar los conocimientos sobre los virus circulantes y los reservorios zoonóticos de la enfermedad.
Hantavirus Pulmonary Syndrome in Paraguay is an infection related to the Chaco area or Western Region. However, in recent years cases it has been reported outside the known endemic area. In order to describe the epidemiological profile of the disease in our country, and update the transmission areas, a retrospective review of the cases registered from 2013 to 2020. Ninety HPS cases were confirmed, being the Western Region the one that contributed the highest proportion of cases, with 92% in the study period. The Eastern Region registered 5.5% of the cases, while in 2.5% of the cases it was not possible to determine the place. The profile of the disease in the country is presented as a condition mainly of men in adulthood - young, linked to field activities. The main challenges were to sensitize the population of the newly identified risk areas, strengthen the surveillance in these places in order to capture cases in a timely manner and update knowledge about the circulating viruses and zoonotic reservoirs of the disease.
RESUMO
INTRODUCCIÓN: La COVID-19, causada por el virus del síndrome respiratorio agudo severo tipo-2 (SARS-CoV-2), fue declarada pandémica en marzo de 2020. Los estudios de seroprevalencia son útiles para efectuar diversas estimaciones: la proporción de la población previamente infectada, cuantificar la magnitud de la transmisión, la tasa de letalidad, evaluar el efecto de intervenciones, y el grado de inmunidad de una población. OBJETIVOS: Determinar la extensión de la infección y la incidencia acumulada de infección mediante el estudio de seropositividad en pobladores de las regiones sanitarias de Asunción y Departamento Central de Paraguay. METODOLOGÍA: Estudio de cohorte poblacional. Se encuestaron 126 hogares en Asunción y 609 en el Departamento Central entre diciembre 2020 y marzo 2021. Se realizaron tres visitas a los hogares seleccionados. RESULTADOS: La tasa de testeo fue 66,6%, 1.699 personas (324 en Asunción y 1.375 en Central) de las 2.553 personas censadas. En la primera, segunda y tercera rondas, las seroprevalencias fueron en Asunción 15,5%, 15,4% y 14,3%, respectivamente; en Central 23,1%, 27,8% y 26,9%, respectivamente. Hubo una seroconversión entre la primera y segunda ronda de 5,9% y en la tercera ronda 6,5%. La seroprevalencia global acumulada fue de 26,9% (IC95%: 24,8-19,1); en Asunción 23,1% (IC95%: 18,9-28,0) y en Central 27,8% (IC95%: 25,5-30,2). El 8,5% de los participantes reportó síntomas; de estos, el 54,2% presentó serología positiva. CONCLUSIÓN: La sero-prevalencia fue alta con una baja proporción de encuestados sintomáticos.
BACKGROUND: COVID-19, caused by the severe acute respiratory syndrome virus type-2 (SARS-CoV-2), was declared a pandemic in March 2020. Seroprevalence studies are useful to estimate the proportion of the population previously infected, quantify the magnitude of transmission, estimate the fatality rate, evaluate the effect of interventions, and estimate the degree of immunity of the population. AIM: To determine the extension of the infection and the cumulative incidence of age-specific infection, determined by seropositivity in the population of the sanitary regions of Asunción and the Central Department of Paraguay. METHODS: Population-based cohort study. In Asunción 126 households and in the Central Department 609 were surveyed between December 2020 to March 2021. Three visits were made to the selected households. RESULTS: The testing rate was 66.6%, 1,699 people (324 in Asunción and 1,375 in Central) of the 2,553 people registered. In the first, second and third rounds, seroprevalences were 15.5%, 15.4% and 14.3% in Asunción, respectively; in Central 23.1%, 27.8% and 26.9%, respectively. There was a seroconversion between the first and second rounds of 5.9%, and in the third round 6.5%; the accumulated global seroprevalence was 26.9% (95% CI: 24.8-19.1); in Asunción 23.1% (95% CI: 18.9-28.0) and in Central 27.8% (95% CI: 25.5-30.2). 8.5% of the participants reported symptoms; of them, 54.2% had positive serology. CONCLUSION: The sero-prevalence was high with a low proportion of people with symptoms.
Assuntos
Humanos , Masculino , Feminino , COVID-19/epidemiologia , Paraguai/epidemiologia , Estudos Soroepidemiológicos , Incidência , Estudos de Coortes , Distribuição por Idade , Pandemias , SARS-CoV-2 , Anticorpos AntiviraisRESUMO
Murine cysticercosis by Taenia crassiceps is a model for human neurocysticercosis. Genetic and/or immune differences may underlie the higher susceptibility to infection in BALB/cAnN with respect to C57BL/6 mice. T regulatory cells (Tregs) could mediate the escape of T. crassiceps from the host immunity. This study is aimed to investigate the role of Tregs in T. crassiceps establishment in susceptible and non-susceptible mouse strains. Treg and effector cells were quantified in lymphoid organs before infection and 5, 30, 90, and 130 days post-infection. The proliferative response post-infection was characterized in vitro. The expression of regulatory and inflammatory molecules was assessed on days 5 and 30 post-infection. Depletion assays were performed to assess Treg functionality. Significantly higher Treg percentages were observed in BALB/cAnN mice, while increased percentages of activated CD127+ cells were found in C57BL/6 mice. The proliferative response was suppressed in susceptible mice, and Treg proliferation occurred only in susceptible mice. Treg-mediated suppression mechanisms may include IL-10 and TGFß secretion, granzyme- and perforin-mediated cytolysis, metabolic disruption, and cell-to-cell contact. Tregs are functional in BALB/cAnN mice. Therefore Tregs could be allowing parasite establishment and survival in susceptible mice but could play a homeostatic role in non-susceptible strains.
Assuntos
Linfócitos T Reguladores , Taenia , Animais , Imunidade , Camundongos , Camundongos Endogâmicos BALB C , Camundongos Endogâmicos C57BLRESUMO
BACKGROUND: Carotid body tumors (CBTs) are rare neoplasms located in the carotid bifurcation. The majority of these tumors are unilateral; bilateral CBTs represent approximately 5% of all affected patients, and the recommended treatment is to surgically remove them in staged-planned surgeries. We describe the experience, outcomes, and the surgical management of bilateral CBTs in our institution. METHODS: A retrospective review of CBTs patients was completed; patient demographics, comorbidities, lesion location, anatomic characteristics, surgical techniques, complications, reinterventions, and other factors that may influence outcomes were evaluated. RESULTS: A total of 109 patients with CBTs were treated surgically; of these, 8 had bilateral CBTs (7%); the mean age was 56 years, and 7 (87%) were females. Thirteen surgical resections were performed, and in 2 of the cases, the pathology report was malignant (15%). Five were classified as Shamblin I (31%), 5 as Shamblin II (31%), and remaining 6 as Shamblin III (38%). The mean time between the first and second procedure was of 10.7 months. Complications included one case of neck hematoma requiring evacuation and postoperative neurologic complications occurred in three patients (one patient with facial and two with vocal cord palsies). None of the studied individuals had a family history of CBT, and all of them lived in altitude areas higher than 2000 meters above mean sea level (mamsl). The mean tumor size was 3.55 cm and 2.75 cm for right and left CBTs, respectively. CONCLUSIONS: A better understanding of the clinical characteristics of patients with bilateral CBTs may lead to a more standardized and optimal management with fewer complications and a better quality of life afterward.
Assuntos
Tumor do Corpo Carotídeo/cirurgia , Procedimentos Cirúrgicos Vasculares , Adulto , Idoso , Tumor do Corpo Carotídeo/diagnóstico por imagem , Tumor do Corpo Carotídeo/epidemiologia , Tumor do Corpo Carotídeo/patologia , Angiografia por Tomografia Computadorizada , Feminino , Humanos , Masculino , México/epidemiologia , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Prevalência , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Carga Tumoral , Procedimentos Cirúrgicos Vasculares/efeitos adversosRESUMO
RESUMEN Una cepa triple reasortante del virus Influenza A emergió en al año 2009 dando origen a una pandemia que alcanzó a Paraguay en junio del mismo año. Con el fin de investigar la evolución genética del virus influenza A (H1N1) pdm09 en Paraguay fueron analizadas las secuencias nucleotídicas del Gen de la Hemaglutinina de 20 cepas de Influenza A(H1N1)pdm09, aisladas en el Centro Nacional de Influenza de Paraguay entre los años 2009 y 2016, y secuenciadas en el Centro Colaborador de OPS/OMS en Atlanta USA. El análisis filogenético muestra la circulación de al menos 5 grupos genéticos bien diferenciados de Influenza A(H1N1)pdm09 en Paraguay desde el 2009. Solamente los virus aislados en el 2016 pertenecen al sub Grupo genético 6B.1 en el cual se encuentra la actual cepa vacunal A/Michigan/45/2015 recomendada para el hemisferio Sur desde el año 2017. Los virus circulantes en años anteriores pertenecen a grupos antigénicamente indistinguibles de la cepa vacunal previa A/California/7/2009. No se encontraron diferencias resaltantes en las secuencias de los virus, relacionadas a severidad clínica ni a distribución geográfica. Los resultados de este estudio reafirman la necesidad de una vigilancia virológica sistemática para orientar el establecimiento de estrategias adecuadas de prevención y control de la influenza.
ABSTRACT A triple reassortant strain of Influenza A virus emerged in 2009, leading to a pandemic that reached Paraguay by June the same year. In order to investigate the genetic evolution of influenza A (H1N1)pdm09 virus in Paraguay, we analized the nucleotide sequences of the Hemagglutinin gene of 20 Influenza A (H1N1)pdm09 strains, isolated at the Paraguayan National Influenza Centre between 2009 and 2016, and sequenced at the PAHO/WHO Collaborating Center in Atlanta, USA. Phylogenetic analysis shows the circulation of at least 5 well-differentiated genetic groups of Influenza A (H1N1) pdm09 in Paraguay since 2009. Only the viruses isolated in 2016 belong to genetic subgroup 6B.1, the same as the current vaccine strain A/Michigan/45/2015, recommended for the Southern hemisphere since 2017. The viruses circulated previous years belong to groups antigenically indistinguishable from the previous vaccine strain A/California/7/2009. No significant differences were found in sequences of the viruses, related to clinical severity or geographic distribution. The results of this study reaffirm the need for systematic virological surveillance to guide the establishment of adequate strategies for the prevention and control of influenza.
RESUMO
El Metapneumovirus humano (hMPV) constituye una importante causa de Infecciones Respiratorias Agudas (IRAs) en niños hospitalizados. En Paraguay, las IRAs están entre las primeras causas de hospitalización durante la infancia, siendo los virus los principales agentes causales. Sin embargo, aún persiste una alta proporción de casos sin etiología identificada. La pandemia de Influenza en el año 2009, condujo a una intensificación de la vigilancia de las infecciones respiratorias, lo cual permitió al mismo tiempo la búsqueda de otros virus como el hMPV. Nuestro objetivo fue detectar hMPV en niños hospitalizados por IRAs en Paraguay durante el año 2009. Fueron estudiadas 240 muestras respiratorias de niños < 5 años internados por IRAs en Paraguay durante el año 2009, que habían resultado negativas para otros virus respiratorios. Fue utilizado el reactivo LightMix Kit human MPV de TIBMOLBIOL, para la detección del gen N de hMPV por PCR en Tiempo Real, siguiendo el procedimiento indicado por el fabricante. De las 240 muestras estudiadas, 29 (12%) resultaron positivas para hMPV, con la mayor detección en julio y agosto; predominando en mayores de 1 año. Los principales signos y síntomas fueron tos, fiebre y dificultad respiratoria; y las complicaciones más frecuentes neumonía y bronquiolitis. Estos resultados proveen las primeras evidencias en Salud Pública, de la importancia del hMPV asociado a niños hospitalizados por IRAs en Paraguay.
Human metapneumovirus (hMPV) is a significant cause of acute respiratory infection (ARI) in hospitalized children. In Paraguay, ARI is one of the leading causes of childhood hospitalization, with viruses being the primary causal agents. However, a large number of cases of unknown etiology remain. The influenza pandemic of 2009 led to intensified vigilance concerning respiratory infections and more thorough efforts to confirm the presence of viruses such as hMPV. Our objective was to detect hMPV in children hospitalized for ARI in Paraguay during 2009. We studied respiratory samples from 240 children age < 5 years hospitalized for IRAs in Paraguay during 2009 who had tested negative for other respiratory viruses. We used the hMPV-reactive LightMix® kit from TIB MOLBIOL for the detection of the nucleoprotein (N) gene by real-time PCR according to manufacturer-specified procedures. Of the 240 samples studied, 29 (12%) were positive for hMPV, with the highest rates detected in July and August (winter) predominating in children over 1 year of age. The most common signs and symptoms were cough, fever, and respiratory distress; while the most common complications were pneumonia and bronchiolitis. These results provide the first evidence concerning the prevalence of hMPV in children hospitalized for ARI in Paraguay.
RESUMO
El Metapneumovirus humano (hMPV) constituye una importante causa de Infecciones Respiratorias Agudas (IRAs) en niños hospitalizados. En Paraguay, las IRAs están entre las primeras causas de hospitalización durante la infancia, siendo los virus los principales agentes causales. Sin embargo, aún persiste una alta proporción de casos sin etiología identificada. La pandemia de Influenza en el año 2009, condujo a una intensificación de la vigilancia de las infecciones respiratorias, lo cual permitió al mismo tiempo la búsqueda de otros virus como el hMPV. Nuestro objetivo fue detectar hMPV en niños hospitalizados por IRAs en Paraguay durante el año 2009. Fueron estudiadas 240 muestras respiratorias de niños <5 años internados por IRAs en Paraguay durante el año 2009, que habían resultado negativas para otros virus respiratorios. Fue utilizado el reactivo LightMix Kit human MPV de TIBMOLBIOL, para la detección del gen N de hMPV por PCR en Tiempo Real, siguiendo el procedimiento indicado por el fabricante. De las 240 muestras estudiadas, 29 (12%) resultaron positivas para hMPV, con la mayor detección en julio y agosto; predominando en mayores de 1 año. Los principales signos y síntomas fueron tos, fiebre y dificultad respiratoria; y las complicaciones más frecuentes neumonía y bronquiolitis. Estos resultados proveen las primeras evidencias en Salud Pública, de la importancia del hMPV asociado a niños hospitalizados por IRAs en Paraguay.
Assuntos
Humanos , Criança , Doenças Respiratórias , Hospitalização , MetapneumovirusRESUMO
We studied the molecular epidemiology of dengue virus type 3 (DENV-3) in Brazil and Paraguay by analyzing the 5' and 3' untranslated regions (5' and 3'UTRs) and the E protein gene of viruses isolated between 2002 and 2004. Both 5' and 3'UTRs were highly conserved. However, the 3'UTR of two isolates from Brazil contained eight nucleotide deletions compared with the remaining 26 viruses. Phylogenetic analyses suggested that DENV-3 was introduced into Brazil from the Caribbean Islands at least twice and into Paraguay from Brazil at least three times.
Assuntos
Vírus da Dengue/genética , Dengue/epidemiologia , Proteínas do Envelope Viral/genética , Regiões 3' não Traduzidas/química , Sequência de Aminoácidos , Sequência de Bases , Brasil/epidemiologia , Sequência Consenso , DNA Complementar/química , DNA Viral/química , Dengue/virologia , Vírus da Dengue/classificação , Humanos , Paraguai/epidemiologia , Filogenia , RNA Viral/genética , RNA Viral/isolamento & purificação , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Proteínas do Envelope Viral/químicaRESUMO
Of a total of 220 stool specimens from children with acute diarrhea, mostly under the age of 3 years, collected in Paraguay between January 1999 and March 2000, 70 (31.8%) were found positive for rotaviruses (RV). Positive samples were characterized by electropherotyping and subgrouping. Sixty-one (87.1%) were classified as group A, subgroup II; one (1.4%) was classified as group A, subgroup I; six (8.6%) were group A, non-I non-II; and two (2.9%) were not tested. RV strains were G and P genotyped by reverse transcription-PCR. The following G types were detected: G4 (34.3%), G1 (21.4%), G2 (1.4%), and G9 (5.7%). Mixtures of human and animal genotypes were detected in 15 (21.4%) samples, and 11 samples (15.7%) were nontypeable. The following P types were detected: P[8] (48.6%), P[4] (1.4%), and P[1] (1.4%). A mixed type was found in 10% of samples, and an unexpectedly high percentage (38.6%) of nontypeable samples was found. The common human G- and P-type combinations P[8], G4 (15.7%) and P[8], G1 (14.2%) were detected. Mixed human and animal genotypes were observed as the following combinations: G4 + G5, G4 + G5 + G10, and G1 + G10 for G types and P[8]-P[1] for P types. The emerging G9 genotype was detected in four samples. These results show for the first time the diversity of RV circulating among children in Paraguay and contribute to the knowledge of this pathogen required to devise strategies to prevent diarrheal illness in this country. The finding of mixed genotypes may indicate interspecies transmission of RV between humans and animals.