Paediatric-onset lymphomatoid papulosis: results of a multicentre retrospective cohort study on behalf of the EORTC Cutaneous Lymphoma Tumours Group (CLTG).

BACKGROUND: Lymphomatoid papulosis (LyP) is a rare cutaneous T-cell lymphoproliferative disorder. Comprehensive data on LyP in the paediatric population are scarce. OBJECTIVES: To characterize the epidemiological, clinical, histopathological and prognostic features of paediatric LyP. METHODS: This was a retrospective multicentre international cohort study that included 87 children and adolescents with LyP diagnosed between 1998 and 2022. Patients aged ≤ 18 years at disease onset were included. LyP diagnosis was made in each centre, based on clinicopathological correlation. RESULTS: Eighty-seven patients from 12 centres were included. Mean age at disease onset was 7.0 years (range 3 months-18 years) with a male to female ratio of 2 : 1. Mean time between the onset of the first cutaneous lesions and diagnosis was 1.3 years (range 0-14). Initial misdiagnosis concerned 26% of patients. LyP was most often misdiagnosed as pityriasis lichenoides et varioliformis acuta, insect bites or mollusca contagiosa. Erythematous papules or papulonodules were the most frequent clinical presentation. Pruritus was specifically mentioned in 21% of patients. The main histological subtype was type A in 55% of cases. When analysed, monoclonal T-cell receptor rearrangement was found in 77% of skin biopsies. The overall survival rate was 100%, with follow-up at 5 years available for 33 patients and at 15 years for 8 patients. Associated haematological malignancy (HM) occurred in 10% of cases (n = 7/73), including four patients with mycosis fungoides, one with primary cutaneous anaplastic large cell lymphoma (ALCL), one with systemic ALCL and one with acute myeloid leukaemia. If we compared incidence rates of cancer with the world population aged 0-19 years from 2001 to 2010, we estimated a significantly higher risk of associated malignancy in general, occurring before the age of 19 years (incidence rate ratio 87.49, 95% confidence interval 86.01-88.99). CONCLUSIONS: We report epidemiological data from a large international cohort of children and adolescents with LyP. Overall, the disease prognosis is good, with excellent survival rates for all patients. Owing to an increased risk of associated HM, long-term follow-up should be recommended for patients with LyP.

Lymphomatoid papulosis is a very rare skin condition caused by an abnormal increase in white blood cells (called 'lymphocytes') in the skin. The condition rarely affects children, so most of the scientific data published about this disease focuses on adults. This study involved 12 academic dermatology centres in Europe, the Middle East and North America, and gathered data from about 87 children who presented with symptoms of lymphomatoid papulosis before the age of 19 years. The aim of this study was to better describe this disease in the paediatric population and discuss its treatment options and evolution. We found that the presentation of the disease in children is roughly the same as in adults. Safe and effective treatment options exist. The disease is not life threatening, but it requires investigation by a dermatologist, both to make a careful diagnosis and to monitor it as sometimes associated cancers that originate from blood cells can occur, mostly on the skin.

Epidemiological study of bee stings in the state of Paraiba, Northeastern Brazil, from 2015 to 2019

INTRODUCTION: In Brazil, envenomation by bee sting is a public health problem due to its incidence in all regions of the country, as well as the severity of cases. Despite the medical and sanitary importance, the literature on this topic in Brazil is scarce, in the Northeast region. OBJECTIVE: To describe the epidemiological characteristics of bee stings in Paraíba, in the Northeast region of Brazil, from 2015 to 2019. METHODS: The current study is a descriptive and retrospective epidemiological investigation conducted through the recovery of secondary data made available by the database from the Ministry of Health Notification Information System. RESULTS: A total of 1,151 cases were analyzed, and they were reported during all the months of the period of the study and were more frequent in the regions Agreste and Sertão of the Paraíba. The victims were men aged 20 to 59 years. Most individuals received medical assistance within 3 hours of the incident. The cases were classified as mild and progressed to cure. CONCLUSION: In Paraíba, bee stings have increased in recent years, especially in regions with a semi-arid climate. In addition, this study provides data that may be used in the development of educational health actions to promote the prevention and control of bee stings in this region.

Semi-field evaluation of human landing catches versus human double net trap for estimating human biting rate of Anopheles minimus and Anopheles harrisoni in Thailand.

Background: Whilst the human landing catch (HLC) technique is considered the 'gold standard' for estimating human-biting rates, it is labor-intensive and fraught with potential risk of exposure to infectious mosquito bites. This study evaluated the feasibility and performance of an alternative method, the human double net trap (HDNT) relative to HLC for monitoring host-seeking malaria vectors of the Anopheles minimus complex in a semi-field system (SFS). Methods: HDNT and HLC were positioned in two rooms, 30 m apart at both ends of the SFS. Two human volunteers were rotated between both traps and collected released mosquitoes (n = 100) from 6:00 pm till 6:00 am. Differences in Anopheles mosquito densities among the trapping methods were compared using a generalized linear model based on a negative binomial distribution. Results: There were 82.80% (2,136/2,580) of recaptures of wild-caught and 94.50% (2,835/3,000) of laboratory-reared mosquitoes that were molecularly identified as An. harrisoni and An. minimus, respectively. Mean density of An. harrisoni was significantly lower in HNDT (15.50 per night, 95% CI [12.48-18.52]) relative to HLC (25.32 per night (95% CI [22.28-28.36]), p < 0.001). Similarly, the mean density of a laboratory strain of An. minimus recaptured in HDNT was significantly lower (37.87 per night, 95% CI [34.62-41.11]) relative to HLC (56.40 per night, 95% CI [55.37-57.43]), p < 0.001. Relative sampling efficiency analysis showed that HLC was the more efficient trap in collecting the An. minimus complex in the SFS. Conclusion: HDNT caught proportionately fewer An. minimus complex than HLC. HDNT was not sensitive nor significantly correlated with HLC, suggesting that it is not an alternative method to HLC.

Epidemiological study of the bee stings in the state of Bahia, northeastern Brazil, from 2010 to 2019 / Estudo epidemiológico dos acidentes por picada de abelha no estado da Bahia, nordeste do Brasil, de 2010 a 2019

Introduction: envenomation and deaths by bee stings have increased in all regions of Brazil. However, there are few epidemiological studies on them, especially in the states of northeastern Brazil. Objective: to determine the epidemiological characteristics of bee stings in the state of Bahia, Northeastern Brazil, from 2010 to 2019. Methodology: this is a descriptive and analytical epidemiological study conducted through a retrospective survey of secondary data provided by the database of the Notifiable Diseases Information System of the Ministry of Health. Results: between 2010 and 2019, a total of 7,979 cases were analyzed. Incidents were distributed in 356 municipalities, with the highest frequency in the regions of Agreste and Sertão da Bahia. Cases occurred in all months of the investigated years, with a greater occurrence in urban areas, affecting mainly adult men. The anatomical region of the body most affected by the sting was the head and most cases received medical care within 3 hours after the incident. Local manifestations were more frequent than systemic ones. The injuries were predominantly classified as mild and progressed to cure. Conclusions: the high number of cases and their extensive spatial distribution reveal that bee stings may be considered an emerging and neglected public health problem in the state of Bahia.

Introdução: os acidentes e os óbitos causados por picada de abelha têm aumentado em todas as regiões do Brasil. Contudo, existem poucos estudos epidemiológicos sobre acidentes com abelha, principalmente nos estados do Nordeste do Brasil. Objetivo:determinar as características epidemiológicas do acidente por picada de abelha no estado da Bahia, Nordeste do Brasil, de 2010 a 2019. Metodologia: trata-se de um estudo epidemiológico descritivo e analítico realizado por meio de uma pesquisa retrospectiva de dados secundários disponibilizados pelo banco de dados do Sistema de Informação de Agravos de Notificação do Ministério da Saúde. Resultados: entre 2010 e 2019, um total de 7.979 casos foi analisado. Os acidentes foram distribuídos em 356 municípios, com a maior frequência nas regiões do Agreste e do Sertão da Bahia. Os casos ocorreram em todos os meses dos anos investigados, com maior ocorrência em áreas urbanas, afetando principalmente homens adultos. A região anatômica do corpo mais atingida pela picada foi a cabeça e a maioria dos casos recebeu assistência médica até 3 horas após o incidente. As manifestações locais foram mais frequentes do que as sistêmicas. Os agravos foram predominantemente classificados como leve e progrediram para a cura. Conclusões: o elevado número de casos e a sua extensa distribuição espacial revelam que o acidente causado por picada de abelha pode ser considerado um emergente negligenciado problema de saúde pública no estado da Bahia.

Tendência temporal e perfil epidemiológico dos acidentes por animais peçonhentos no Brasil, 2007-2019 / Tendencia temporal y perfil epidemiológico de los accidentes por animales venenosos en Brasil, 2007-2019 / Temporal trend and epidemiological profile of accidents involving venomous animals in Brazil, 2007-2019

Objetivo: Analisar a tendência temporal dos acidentes causados por animais peçonhentos no Brasil, de 2007 a 2019. Métodos: Estudo transversal, realizado com dados do Sistema de Informação de Agravos de Notificação (Sinan). Para a análise temporal, utilizou-se a regressão linear de Prais-Winsten. Foram calculadas as incidências por sexo e faixa etária, risco relativo e letalidade. Resultados: No período de estudo, houve 2.102.657 casos de acidentes por animais peçonhentos. Com exceção do ofidismo, os demais acidentes apresentaram tendência temporal crescente na maioria das macrorregiões nacionais. Escorpionismo, ofidismo e araneísmo foram responsáveis por 86% dos acidentes, principalmente entre pessoas do sexo masculino em idade economicamente ativa. A de letalidade foi mais elevada para acidentes ofídicos (0,4%) e apílicos (0,3%). As crianças foram as principais vítimas de acidentes com abelhas, lagartas e "outros". Conclusão: Os acidentes com animais peçonhentos apresentaram tendência temporal crescente para a maioria dos agravos e diferentes perfis epidemiológicos.

Objetivo: Analizar la tendencia temporal de los accidentes con animales ponzoñosos en Brasil de 2007 a 2019. Métodos: Estudio transversal realizado con datos del Sistema de Información de Enfermedades de Declaración Obligatoria (Sinan). Para el análisis temporal se utilizó la Regresión Lineal de Prais-Wisten. Se calcularon las incidencias por sexo y grupo de edad, riesgo relativo y letalidad. Resultados: Durante el período del estudio hubo 2.102.657 casos de accidentes con animales ponzoñosos. Con excepción de la mordedura de serpiente, los demás accidentes mostraron una tendencia temporal creciente en la mayoría de las regiones del país. El escorpionismo, la mordedura de serpiente y la picadura de araña fueron responsables del 86% de los accidentes, afectando principalmente a personas del sexo masculino en edad laboral. Las tasas de letalidad más altas fueron por accidentes de mordedura de serpiente (0,4%) y picadura de araña (0,3%). Los niños fueron las principales vitimas de los acidentes con abejas, lagartas y "otros". Conclusión: Los accidentes com animales ponzoñosos mostraron una tendencia temporal creciente para la mayoría de las enfermedades y diferentes perfiles epidemiológicos.

Objective: to analyze the temporal trend of accidents involving venomous animals in Brazil from 2007 to 2019. Methods: this was a cross-sectional study carried out with data from the Notifiable Health Conditions Information System (SINAN). Prais-Winsten linear regression was used for the temporal analysis. We calculated incidence rates according to sex and age group, relative risk and case fatality ratio. Results: during the study period there were 2,102,657 cases of accidents involving venomous animals. With the exception of snakebite, the remaining accidents showed a rising temporal trend in most regions of the country. Scorpion stings, snake bites and spider bites were responsible for 86% of accidents, mainly affecting male people of working age. Accidents involving snakes (0.4%) and bees (0.3%) had the highest case fatality ratios. Children were the main victims of accidents involving bees, caterpillars and "others". Conclusion: accidents involving venomous animals showed a rising temporal trend for most conditions, as well as different epidemiological profiles.

Hypersensitivity to mosquito bites: A versatile Epstein-Barr virus disease with allergy, inflammation, and malignancy.

Hypersensitivity to mosquito bites (HMB) is a rare disease characterized by transient intense skin reaction and systemic inflammation. Clinical presentation of HMB resembles other mosquito allergic responses, and it can also be difficult to clinically distinguish HMB from other severe allergic reactions. However, a distinctive pathophysiology underlies HMB. HMB belongs to a category of Epstein-Barr virus (EBV)-associated natural killer (NK) cell lymphoproliferative disorders (LPD). Hence, HMB may progress to systemic diseases, such as hemophagocytic lymphohistiocytosis, chronic active EBV disease, and EBV-associated malignancies. A triad of elevated serum IgE, NK lymphocytosis, and detection of EBV DNA in peripheral blood is commonly observed, and identification of EBV-infected NK cells usually facilitates the diagnosis. However, the effective treatment is limited, and its precise etiology remains unknown. Local CD4+ T cell proliferation triggered by mosquito bites appears to help induce EBV reactivation and EBV-infected NK-cell proliferation. These immunological interactions may explain the transient HMB signs and symptoms and the disease progression toward malignant LPD. Further research to elucidate the mechanism of HMB is warranted for better diagnosis and treatment of HMB and other forms of EBV-associated LPD.

Diversity of compounds in Vespa spp. venom and the epidemiology of its sting: a global appraisal.

Poisonous animals imply a risk to human life, because their venom is a complex mixture of low molecular weight components, peptides and proteins. Hornets use the venom for self-defence, to repel intruders and to capture prey, but they can cause poisoning and allergic reactions to people. In particular, they seem to be a health problem in the countries where they are native due to their sting, which in the most severe cases can lead to severe or fatal systemic anaphylaxis. But this situation is being an emerging problem for new countries and continents because hornet incursions are increasing in the global change scenario, such as in Europe and America. Furthermore, 55 detailed cases of hornet sting were found in 27 papers during the current review where 36.4% died due to, mainly, a multi-organ failure, where renal failure and liver dysfunction were the most common complications. Moreover, the great taxonomic, ecological diversity, geographical distribution and the wide spectrum of pathophysiological symptoms of hornets have been the focus of new research. Considering this, the present systematic review summarizes the current knowledge about the components of Vespa venom and the epidemiology of its sting to serve as reference for the new research focused on the development of techniques for diagnosis, new drugs and treatments of its sting.

Epidemiology of envenomation by Africanized honeybees in the state of Rio Grande do Norte, Northeastern Brazil / Epidemiologia dos envenenamentos por abelhas africanizadas no Estado do Rio Grande do Norte, Nordeste do Brasil

ABSTRACT: Introduction: In the American continent, accidents caused by honeybees are a public health problem due to the high incidence and severity of the cases. Despite its medical importance, there are few epidemiological studies on this topic in Brazil, especially referring to the Northeastern states. The present study aims to describe the epidemiological features of honeybee envenomation cases in the state of the Rio Grande do Norte, Northeastern Brazil, from 2007 to 2014. Methods: Data were collected from the Notifiable Diseases Information System database of the Health Department of Rio Grande do Norte. Results: We analyzed a total of 2,168 cases. Cases occurred in all months of the years studied, reaching higher frequencies from June to October. Most incidents happened in urban areas and involved men, with victims aged between 20 and 39 years. Victims were mainly stung on the head and hand, and they received medical care predominantly within 3 hours after the injury. Local manifestations were more frequent than systemic ones. Clinically, most cases were mild and progressed to cure. Conclusion: The high number of honeybee sting cases shows that Rio Grande do Norte may be an important risk area for such injury.

RESUMO: Introdução: No continente americano, os acidentes causados por abelhas são um problema de saúde pública devido à alta incidência e severidade dos casos. Apesar de sua importância médica, há poucos estudos epidemiológicos sobre esse tema no Brasil, especialmente referentes aos estados do Nordeste. O presente estudo tem como objetivo descrever as características epidemiológicas dos casos de envenenamento por abelhas no estado do Rio Grande do Norte, no Nordeste do Brasil, de 2007 a 2014. Metodologia: Os dados foram coletados da base de dados do Sistema de Informação de Agravos de Notificação da Secretaria Estadual de Saúde do Rio Grande do Norte. Resultados: Um total de 2.168 casos foram analisados. Os casos mostraram distribuição em todos os meses dos anos estudados, com maior frequência de junho a outubro. A maioria dos casos ocorreu em áreas urbanas e envolveu homens, com vítimas entre 20 e 39 anos de idade. As vítimas foram principalmente picadas na cabeça e na mão, e receberam assistência médica predominantemente dentro de 3 horas após serem picadas. As manifestações locais eram mais frequentes do que as sistêmicas. Clinicamente, a maioria dos casos foi leve e progrediu para cura. Conclusão: O alto número casos de picadas de abelhas mostra que o Rio Grande do Norte pode ser uma importante área de risco para tal incidente.

Infectivity of Simulium damnosum s.l. and therapeutic coverage of ivermectin distribution 10 years post treatment around Owena Dam, Ondo state, Nigeria

ABSTRACT Background: Studies related to infectivity status of insect vectors are seen as necessities in understanding the epidemiology of vector-borne diseases and planning effective control measures. This study assessed the infectivity ofSimulium damnosum s.l. around Owena River as well as evaluated therapeutic coverage of Ivermectin distribution in the area. Method: Human landing sampling method was used to collect adult flies on human attractants from 07:00 to 18:00 for two consecutive days a month for three months (July 2016 - September 2016). Parity assessment was conducted to determine the age of fly populations. Parous flies were further dissected to detect the presence or absence ofOnchocerca larvae. Biting rates and transmission potentials were calculated using standard methods. A quantitative survey was carried out to determine the therapeutic coverage and compliance to ivermectin treatment for the control of Onchocerciasis in the study area using standard household coverage questionnaires. Results: A total of 914 adult female flies were collected during the study period. The daily biting rate (DBR) varied from 146 fly per man day (FMD) in July to 162.5 FMD in August. The monthly biting rate (MBR) was lowest in September (2170 bites per man per month) but highest in August (3358.3 bites per man per month). MBD ranged from 13.23 fly per man hour (FMH) in July to 14.77 FMH in August. The results indicated that the majority of the flies collected at the sampling points were nulliparous [685 (74.95%)] while others were parous [229 (25.05%)]. The biting activity of the flies showed a marked decrease in population in August compared to July which later increased in September. Infection rates varied from 2 (0.7%) in July to 7 (2.2%) in August while the infectivity rate during the study ranged from zero (July and September) to 3 (1.0%) in August. Conclusion: Despite the years of treatment of onchocerciasis in Owena community, there were still some infective flies capable of transmitting O. volvolus. This could be due to the low rate of therapeutic coverage as a result of non-compliance in the community for various reasons earlier stated.

A field-based modeling study on ecological characterization of hourly host-seeking behavior and its associated climatic variables in Aedes albopictus.

BACKGROUND: The global spread of mosquito-borne diseases (MBD) has presented increasing challenges to public health. The transmission of MBD is mainly attributable to the biting behaviors of female mosquitoes. However, the ecological pattern of hourly host-seeking behavior in Aedes albopictus and its association with climatic variables are still not well understood, especially for a precise requirement for establishing an effective risk prediction system of MBD transmission. METHODS: Mosquito samples and data on mosquito hourly density and site-specific climatic variables, including temperature, relative humidity, illuminance and wind speed, were collected simultaneously in urban outdoor environments in Guangzhou during 2016-2018. Kernel regression models were used to assess the temporal patterns of hourly host-seeking behavior in mosquito populations, and negative binomial regression models in the Bayesian framework were used to investigate the associations of host-seeking behavior with climatic variables. RESULTS: Aedes albopictus was abundant, constituting 82% (5569/6790) of the total collected mosquitoes. Host-seeking behavior in Ae. albopictus varied across time and was significantly influenced by climatic variables. The predicted hourly mosquito densities showed non-linear relationships with temperature and illuminance, whereas density increased with relative humidity but generally decreased with wind speed. The range of temperature estimates for female biting was 16.4-37.1 °C, peaking at 26.5 °C (95% credible interval: 25.3-28.1). During the favorable periods, biting behavior of female Ae. albopictus was estimated to occur frequently all day long, presenting a bimodal distribution with peaks within 2-3 h around both dawn and dusk (05:00-08:00 h and 16:00-19:00 h). Moreover, a short-term association in hourly density between the females and males was found. CONCLUSIONS: Our field-based modeling study reveals that hourly host-seeking behavior of Ae. albopictus exhibits a complex pattern, with hourly variation constrained significantly by climatic variables. These findings lay a foundation for improving MBD risk assessments as well as practical strategies for vector control. For instances of all-day-long frequent female biting during the favorable periods in Guangzhou, effective integrated mosquito control measures must be taken throughout the day and night.

Antivenom use in bite and sting cases presenting to a public hospital.

BACKGROUND: To evaluate the distribution of bite and sting cases presenting to a district public hospital and the use of antivenom in scorpion sting and snake bite cases. METHODS: The demographic characteristics of patients with bites/stings reporting to a public hospital in 2014, the agent involved, the season of reporting, severity of clinical findings during presentation, and use of antivenom in scorpion sting and snake bite cases were evaluated retrospectively. χ2 test was used for statistical analysis. RESULTS: Bite and sting cases comprised 0.5% of all the patients reporting to the hospital's emergency department, with scorpion sting cases comprising almost half (54.2%) of these hospital presentations, followed by Hymenoptera (bee and wasp) sting (30.8%) and snake bite (5.5%) cases. Unnecessary antihistamine administration was found to be significantly high in asymptomatic patients (p=0.00006). Furthermore, antivenom use was found to be significantly high in patients with scorpion sting and snake bite despite the absence of systemic or local indications (p<0.0001, χ2=80.595). CONCLUSION: The study results showed that antivenom was used in scorpion sting and snake bite cases even when it was not indicated. Therefore, primary practitioners should be provided training for management of envenomation cases and should be made aware of the updated guidelines and references to raise their knowledge levels.

Hymenoptera stings in Brazil: a neglected health threat in Amazonas State

Abstract INTRODUCTION: Hymenoptera injuries are commonly caused by stinging insects. In Amazonas state, Brazil, there is no information regarding distribution, profile, and systemic manifestations associated with Hymenoptera injuries. METHODS: This study aimed to identify risk factors for systemic manifestation using the Brazilian Notifiable Diseases Surveillance System (2007 to 2015). RESULTS: Half of Hymenoptera injuries were caused by bee stings. Hymenoptera injuries were concentrated in Manaus, and 13.36% of cases displayed systemic signs. Delayed medical assistance (4 to 12 hours) presented four times more risk for systemic manifestations. CONCLUSIONS: Simple clinical observations and history of injury are critical information for prognostic improvement.

Fatal Anaphylaxis to Yellow Jacket Stings in Mastocytosis: Options for Identification and Treatment of At-Risk Patients.

BACKGROUND: Patients with indolent systemic mastocytosis (ISM) are at risk for severe anaphylactic reactions to yellow jacket (YJ) stings while demonstration of sensitization can be challenging because specific IgE (sIgE) levels are regularly below 0.35 kUA/L. The implication of missing YJ allergy is illustrated by a case of fatal anaphylaxis. OBJECTIVE: To explore the natural course of YJ venom allergy and the diagnostic accuracy and therapeutic consequence of YJ venom sIgE in patients with ISM. METHODS: All patients with ISM seen from 1981 to 2015 (n = 243) were evaluated on the number of YJ stings, reaction severity, and sensitivity and specificity of YJ venom sIgE. YJ venom allergic patients without mastocytosis served as control (n = 313). RESULTS: A total of 153 patients with ISM were stung during adult life. The first systemic reaction was more often severe in patients with ISM than in patients without mastocytosis (69.9% vs 22.0%) and reactions recurred in 40 of 41 re-stung patients with ISM. ISM reactors showed lower YJ venom sIgE levels than nonmastocytosis reactors (0.61 vs 4.83 kUA/L; P < .001) and asymptomatic sensitization was exceedingly rare. In ISM the current clinical threshold of 0.35 kUA/L yields a sensitivity and specificity of 77.6% and 87.5%, respectively. The optimal diagnostic accuracy is achieved at 0.17 kUA/L (sensitivity, 83.6%; specificity, 85.0%). CONCLUSIONS: The high rate of severe reactions and the fatal case underscore the importance of adequate diagnostic sensitivity of sIgE in patients with ISM. The sensitivity of sIgE can be ameliorated by lowering the threshold to 0.17 kUA/L, retaining good specificity. We recommend sIgE screening in all patients with ISM and discussing immunotherapy when YJ venom sIgE exceeds 0.17 kUA/L.

Key Issues in Hymenoptera Venom Allergy: An Update.

In this review, the Hymenoptera Allergy Committee of the SEAIC analyzes the most recent scientific literature addressing problems related to the diagnosis of hymenoptera allergy and to management of venom immunotherapy. Molecular diagnosis and molecular risk profiles are the key areas addressed. The appearance of new species of hymenoptera that are potentially allergenic in Spain and the associated diagnostic and therapeutic problems are also described. Finally, we analyze the issue of mast cell activation syndrome closely related to hymenoptera allergy, which has become a new diagnostic challenge for allergists given its high prevalence in patients with venom anaphylaxis.

Assessing the importance of four sandfly species (Diptera: Psychodidae) as vectors of Leishmania mexicana in Campeche, Mexico.

Localized cutaneous leishmaniasis represents a public health problem in many areas of Mexico, especially in the Yucatan Peninsula. An understanding of vector ecology and bionomics is of great importance in evaluations of the transmission dynamics of Leishmania parasites. A field study was conducted in the county of Calakmul, state of Campeche, during the period from November 2006 to March 2007. Phlebotomine sandfly vectors were sampled using Centers for Disease Control light traps, baited Disney traps and Shannon traps. A total of 3374 specimens were captured in the two villages of Once de Mayo (93.8%) and Arroyo Negro (6.1%). In Once de Mayo, the most abundant species were Psathyromyia shannoni, Lutzomyia cruciata, Bichromomyia olmeca olmeca and Psychodopygus panamensis (all: Diptera: Psychodidae). The Shannon trap was by far the most efficient method of collection. The infection rate, as determined by Leishmania mexicana-specific polymerase chain reaction, was 0.3% in Once de Mayo and infected sandflies included Psy. panamensis, B. o. olmeca and Psa. shannoni. There were significant differences in human biting rates across sandfly species and month of sampling. Ecological niche modelling analyses showed an overall overlap of 39.1% for the four species in the whole state of Campeche. In addition, the finding of nine vector-reservoir pairs indicates a potential interaction. The roles of the various sandfly vectors in Calakmul are discussed.

Epidemiology, diagnosis, and treatment of Hymenoptera venom allergy in mastocytosis patients.

Hymenoptera venom allergy is a typical IgE-mediated reaction caused by sensitization to 1 or more allergens of the venom, and accounts for 1.5% to 34% of all cases of anaphylaxis. Patients suffering from mastocytosis are more susceptible to the anaphylactic reactions to an insect sting. This article aims to answer the most important clinical questions raised by the diagnosis and treatment of insect venom allergy in mastocytosis patients. Total avoidance of Hymenoptera is not feasible, and there is no preventive pharmacologic treatment available, although venom immunotherapy reduces the risk of subsequent systemic reactions.

Etiology and risk factors associated with a pruritic papular eruption in people living with HIV in India.

INTRODUCTION: Papulopruritic eruption (PPE) occurs in people living with HIV in India. Understanding the risk factors associated with this disease may help decrease the prevalence of PPE. METHODS: This study was a case-control study performed at the Government Hospital of Thoracic Medicine, a tertiary care hospital in Chennai, India. Cases included HIV-positive, antiretroviral (ARV) therapy-naïve adults experiencing a pruritic skin eruption for longer than one month, with evidence of multiple papular or nodular lesions and biopsy consistent with arthropod bite. Controls included HIV-positive, ARV-naïve patients without active skin rash. Main outcome measures were CD4 cell count, histology, and environmental exposures. We performed statistical analysis using Epi Info version 3.5.1 and SPSS version 11.0 (SPSS Inc., Chicago, IL). Categorical variables such as gender, urban versus rural residence, occupation, treatment history, CD4 count, use of insect repellents, and environmental exposures were evaluated using the χ(2) test (or the Fisher exact test when an expected value for a category was less than 5). The t-test was used to evaluate differences in age and the duration since HIV diagnosis. The Mann-Whitney test was used to compare non-normally distributed values such as CD4 cell count. A p-value that was less than 0.05 was considered to be statistically significant. RESULTS: Forty-one cases and 149 control subjects were included. Subjects with PPE had significantly lower CD4 cell counts compared to controls (225.5 cells/µL vs. 425 cells/µL; p=0.0001). Sixty-six percent of cases had a CD4 cell count less than 350 cells/µL. PPE cases were less likely to use mosquito repellent techniques (odds ratio 2.81, CI = 1.45-5.45). DISCUSSION: PPE may be an altered and exaggerated immune response to arthropod bites in HIV-positive patients. CD4 cell count is significantly lower in patients with PPE, and therefore it may be considered a qualifying clinical finding for ARV initiation in resource-poor settings. Protective measures against mosquito bites appeared to be important in preventing PPE in subjects at risk.

Comportamiento de picadura de Anopheles darlingi Root,1926 (Diptera: Culicidae) y su asociación con la transmisiónde malaria en Villavicencio (Colombia) / Biting behavior of Anopheles darlingi Root, 1926 (Diptera: Culicidae) and its association with malaria transmission in Villavicencio (Meta, Colombia)

Introducción. Anopheles darlingi es el principal vector de la malaria, o paludismo, en el neotrópico. Esta especie es reconocida por presentar un comportamiento antropofílico y variabilidad en sus hábitos de picadura a lo largo de su rango de distribución. Objetivo. Caracterizar el comportamiento de picadura de An. darlingi y establecer su relación con la transmisión de la malaria en Villavicencio. Materiales y métodos. Entre 2008 y 2009 se llevaron a cabo un estudio de tipo transversal y uno longitudinal, en cinco localidades de Villavicencio con transmisión de malaria. Estos incluyeron recolección de ejemplares inmaduros y de adultos en las viviendas. Se utilizó la prueba ELISA para la detección de infección con Plasmodium spp. Resultados. Se recolectaron 2.772 mosquitos. Anopheles darlingi fue la especie predominante en las capturas con atrayente humano. Los criaderos identificados para esta especie fueron pantanos, caños, lagunas y estanques piscícolas. Anopheles darlingi estuvo presente durante todo el año, con densidades mensuales promedio entre 2,2 y 55,5 mosquitos por persona por noche. Presentó actividad hematofágica durante toda la noche en el intradomicilio y en el peridomicilio. De las 18:00 a las 22:00, se registraron entre el 47 % y el 81 % de los mosquitos capturados en 12 horas de observación. Se encontró una tasa de infección con Plasmodium falciparum de 0,05 % y se estimó una tasa entomológica de inoculación de 2,9 picaduras infecciosas por persona al año. Conclusión. Anopheles darlingi se encontró infectado con P. falciparum, estuvo presente durante todo el año y exhibió características en su comportamiento de picadura que favorecen el contacto entre humano y vector, lo cual es un riesgo permanente para la transmisión de la malaria en Villavicencio.

Introduction: Anopheles darlingi is the main malaria vector in the neotropics. This species is recognized by its anthropophilic behavior and its high variability in biting activity throughout its distribution range. Objective: To characterize the biting behavior of An. darlingi and to establish its association with malaria transmission in Villavicencio. Materials and methods: Between 2008 and 2009, a cross sectional and a longitudinal entomological study were carried out in 5 localities with malaria transmission in Villavicencio. Mosquito collections included breeding sites search and human landing catches in houses. Collected mosquitoes were analyzed for Plasmodium using the ELISA standard protocol. Results: A total of 2,772 mosquitoes were collected in the study. Anopheles darlingi was the most abundant anopheline species. The most common breeding sites for this species were marshes, streams, lakes and fish ponds. Anopheles darlingi was found at all times during the year with monthly average human biting rates between 2.2 y 55.5 mosquitos/person/night. This species was collected throughout the night, indoors and outdoors, and 47 to 81% of An. darling captured during twelve hours of observation (18:00 to 06:00) were collected between18:00 and 22:00. Anopheles darlingi was found positive for P. falciparum with a 0.05% rate and the entomological inoculation rate was estimated at 2.9 infective bites/person per year. Conclusion: Anopheles darlingi was infected with P. falciparum, it was found all year long and it exhibited characteristics in biting behavior that favor human-vector contact, being a permanent risk for malaria transmission in Villavicencio.

Caracterización de la transmisión de la malaria por Plasmodium vivax en la región fronteriza de Panamá con Costa Rica en el municipio de Barú, Panamá / Characterization of Plasmodium vivax malaria transmission at the border of Panamá and Costa Rica

Introducción. Pocos estudios describen los factores asociados con la dinámica de transmisión de la malaria, o paludismo, por Plasmodium vivax en las regiones endémicas de Panamá. Objetivo. Caracterizar la dinámica de transmisión de la malaria producida por P. vivax en la región fronteriza de Panamá con Costa Rica. Materiales y métodos. Se llevó a cabo un estudio observacional, descriptivo y transversal. Se evaluaron la incidencia parasitaria anual, el índice de láminas positivas y el índice anual de exámenes de sangre. Se identificaron los anofelinos vectores, y se caracterizaron sus criaderos preferenciales, densidad larvaria e índice de picada/hombre/noche. Se hizo búsqueda pasiva y activa de casos sospechosos mediante examen de gota gruesa. Resultados. De 10.401 muestras de gota gruesa, 83 resultaron positivas para P. vivax. El 84 % de los casos provenía de zonas rurales, el 79 % constituía una población económicamente activa, la mediana de edad fue de 36 años y, la media, de 30 años. El 58,5 % de los casos fueron de sexo masculino. La incidencia parasitaria anual fue de 4,1 por 1.000 habitantes; el índice de láminas positivas fue de 0,8 % y el índice anual de exámenes de sangre fue de 51,9 %. El 65,0 % de los casos diagnosticados registró entre 100 y 2.000 parásitos/μl de sangre. Se identificaron los mosquitos vectores Anopheles albimanus y An. punctimacula. Conclusión. Es necesario el seguimiento de estudios entomológicos, el fortalecimiento de la vigilancia epidemiológica, la consideración de los factores de riesgo y la realización de un trabajo en coordinación con las autoridades de salud de Costa Rica, para controlar la malaria en esta región.

Introduction. Few studies have described the factors associated with Plasmodium vivax transmission dynamics in endemic regions from Panamá. Objective. Malaria transmission dynamics produced by P. vivax were characterized at the border between Panamá and Costa Rica. Materials and methods. In the municipality of Barú, an observational, descriptive and cross-sectional study was undertaken to measure the annual parasite index (API), slide positivity index (SPR), and the annual blood examination rate (ABER). The most frequent symptoms and signs in malaria patients were recorded. The anopheline species were identified in the area and the preferred larval habitats, the density of larval populations in the larval habitats and the bites/human/night were characterized. Results. Of a total of 10,401 thick smear blood samples, 83 were positive for P. vivax. Of these, 84% came from rural areas and 79% were from economically active individuals. The median and average ages were 36 and 30 years, respectively, and 58.5% of the malaria cases were male. API was 4.1/1,000 inhabitants; SPR was 0.8% and ABER was 51.9%. Of the diagnosed cases, 54% showed blood parasitemias ranging between 100-2,000 parasites/μl. The majority of the cases were observed in May and June. Two mosquito vector species were identified-- Anopheles albimanus and An. punctimacula. Conclusion. These observations indicate the advisibility of continued entomological studies, strengthening of epidemiological surveillance, consideration of additional risk factors and evaluation of work performance in the border region. This will require coordination with health authorities of both countries to control malaria in this region.

Comportamiento general de los accidentes provocados por animales venenosos en Colombia, 2006-2010 / Overall pattern of accidents caused by poisonous animals in Colombia, 2006-2010

Objetivo El conocimiento parcial de estadísticas nacionales acerca de accidentalidad por animales venenosos, con distribución geográfica en Colombia, motiva el estudio de dichas circunstancias. El objetivo fue realizar una línea base de los accidentes por animales venenosos reportados de forma telefónica al Centro de Investigación, Gestión e Información Toxicológica de la Universidad Nacional de Colombia (CIGITOX), provenientes de todo el país, y cuyo registro se encontraba en bases de datos de los cinco años de funcionamiento del centro (2006-2010). Metodología Estudio descriptivo, retrospectivo, de los datos generados por CIGITOX en un período de tiempo de cinco años (2006-2010). El análisis estadístico se hizo en hojas de cálculo de Excel 2011. Resultados Se encontraron, reportados y atendidos, 1 783 casos de los cuales el 47 % correspondió a accidente ofídico (evento de notificación obligatoria para Colombia), 25 % por escorpiones y 11 % por arañas, seguidos de otros que tienen representación epidemiológica menor en los principales departamentos de ocurrencia que fueron Antioquia, Valle del Cauca y Cundinamarca. Discusión Se presenta una perspectiva general de la problemática que puede favorecer programas de salud pública para el mejoramiento de la capacidad de respuesta de las comunidades, instituciones y profesionales del sector salud.

Objective This study was motivated as only partial knowledge is available (regarding national statistics) about accidents caused by poisonous animals in Colombia. The study was aimed at establishing a base-line concerning accidents reported by phone to the Toxicology Management and Research Information Centre (CIGITOX) from all over Colombia; such data was taken from the centre's data-base following its five years of being in operation(2006-2010). Methods This was a descriptive, retrospective study, taking information from the CIGITOX database over a five-year period (2006-2010); Excel 2011was used for statistical analysis. Results The database contained 1,783 cases which had been reported and attended; 47 % concerned snake bite accidents (an obligatory report event in Colombia), 25 % scorpion stings and 11 % spider bites, followed by others having valuable epidemiologic representation in the main areas of occurrence, such as the Antioquia, Valle del Cauca and Cundinamarca departments. Discussion The data provided an overview of the situation which could lead to promoting public health program aimed at raising awareness in communities, institutions and healthcare professional's whilst enforcing their ability to respond effectively.