Stomach nematodes of three sympatric species of anatid birds off the coast of Patagonia.

The present study focuses on the nematode community in the stomachs of three sympatric anatid bird species from the Central Patagonian coast, Argentina. The bird species include the Chubut steamer duck, Tachyeres leucocephalus, the crested duck, Lophonetta specularioides, and the black-necked swan, Cygnus melancoryphus. Up to 138 nematodes representing five species were recovered from 10 of the 13 ducks examined, with an overall prevalence of 77% and a mean intensity of 13.8. Nematodes isolated from the gizzard were Streptocara formosensis and Sciadiocara legendrei (Acuariidae) in T. leucocephalus, and Epomidiostomum vogelsangi (Amidostomatidae) in C. melancoryphus, whereas Echinuria uncinata (Acuariidae) and Tetrameres (Petrowimeres) fissispina (Tetrameriidae) were found in the proventiculus of L. specularioides. In particular, S. legendrei was registered for the first time in South America and T. leucocephalus, whereas T. fissispina represents a new record in Argentina and L. specularioides. Moreover, E. vogelsangi and E. uncinata were isolated in Patagonia for the first time. The birds studied herein are sympatric in their distribution, and two of them are syntopic breeders; however, they were infected with different parasite species. This situation could be partially due to their diet or their seasonal movements, or a combination of both. Despite the low number of hosts examined, this work enhances our knowledge about parasites from a frequently occurring group of birds on the Patagonian coast, a subject that has not been studied extensively in South America.

Updated recommendations of the International Dengue Initiative expert group for CYD-TDV vaccine implementation in Latin America.

Dengue disease represents a large and growing global threat to public health, causing a significant burden to health systems of endemic countries. For countries considering vaccination as part of their Integrated Management Strategy for Prevention and Control of Dengue, the World Health Organization currently recommends the first licensed dengue vaccine, CYD-TDV for: individuals aged 9 years or above from populations with high transmission rates, based on either seroprevalence criteria or pre-vaccination screening strategies, and for persons with confirmed prior exposure to infection in moderate to lower transmission settings. This paper describes the main conclusions of the Sixth Meeting of the International Dengue Initiative (IDI) held in June 2018, following release of a new product label by the manufacturer, updated WHO-SAGE recommendations, additional scientific evidence on vaccine performance, and reports of experiences by implementing countries. Considerations were made regarding the need for improving the quality of epidemiological and surveillance data in the region to help define the convenience of either of the two vaccination strategies recommended by WHO-SAGE. Extensive discussion was dedicated to the pros and cons of implementing either of such strategies in Latin America. Although, in general, a seroprevalence-based approach was preferred in high transmission settings, when cost-effectivity is favorable pre-vaccination screening is a convenient alternative. Cost-effectiveness evaluations can assist with the decisions by public health authorities of whether to introduce a vaccine. Where implemented, vaccine introduction should be part of a public health strategy that includes the participation of multiple sectors of society, incorporating input from scientific societies, ministries of heath, and civil society, while ensuring a robust communication program.

[Diagnosis of acute hematogenous osteomyelitis by ultrasound in pediatric patients]. / Diagnóstico de osteomielitis aguda hematógena por ultrasonido en el paciente pediátrico.

OBJECTIVE: The objective of this study was to evaluate the efficacy of ultrasound in the diagnosis of acute hematogenous osteomyelitis of long bones in pediatric patients. PATIENTS AND METHODS: A prospective study was performed in a tertiary care pediatric hospital. During 12 months we prospectively studied 46 patients with the clinical diagnosis of acute hematogenous osteomyelitis (AHO) of long bones at the Hospital Nacional de Niños in Costa Rica. In all patients ultrasound (US) was performed within 24-36 hours of admission, before any invasive diagnosis or therapeutic procedure was begun. RESULTS: In those without US findings, but with strongly suspected (AHO), a bone scan was done. Of these patients, 26/46 (57%) was female. The mean age was 6.8 years. Sixty-five percent (30/46) had US findings compatible with AHO affecting the tibia (13), femur (11), humerus (4), and radius (2). The findings included subperiostic fluid (10), periosteal thickening (14), subperiostic abscess (6) and thickening of subcutaneous tissues (26). Patients were surgically drained and puss was obtained from the bone in all 30. Two patients with negative US, but strongly suspected AHO had a bone scan that was negative. Patients with AHO were followed with US within 5-7 days of surgery and all 30 showed marked improvement. CONCLUSIONS: In this study, US showed 100% sensitivity and specificity for the diagnosis of AHO of long bones in pediatric patients. US are a sensitive and non-invasive procedure for the diagnosis and follow-up of AOH of long bones.

Handwashing practices in a tertiary-care, pediatric hospital and the effect on an educational program.

OBJECTIVE: To study the frequency of handwashing and the effects of an educational program. DESIGN: A prospective study. SETTING: A tertiary-care, pediatric hospital. PARTICIPANTS: Three divisions (two general pediatric wards and one infectious disease ward). The personnel observed included 60 medical staff (interns, residents, and attending, including consulting, physicians), 37 nurses, and 15 paramedical staff. INTERVENTIONS: The study was carried out in 5 phases: (1) unobtrusive observation to obtain a baseline handwashing rate; (2) observation after written notification; (3) observation after providing motivating devices: movies, brochures, posters; (4) discontinuation of observation and motivation; (5) unobtrusive observation, to obtain a residual handwashing rate. RESULTS: During this study, 1,123 patient contacts were observed. The baseline handwashing rates before and after patient contact were 52% and 49%, respectively. During phase 2, handwashing rates before and after patient contact increased slightly to 56% and 52%, respectively. During phase 3, rates increased to 74% and 69% (P < .01). However, rates fell during the final phases to 49% and 52%, respectively (P < .01). There were no significant differences among hospital staff in any phase of this study (P > .05). CONCLUSIONS: Constant motivation, using movies, brochures, and posters, transiently increased the frequency of handwashing among the house staff of a tertiary-care facility; however, to be effective, this motivation needs to be sustained.

Systemic cytokine response in children bitten by snakes in Costa Rica.

BACKGROUND: To characterize the host response to venom from snakes of the family Viperidae in Costa Rica, we investigated the release of cytokines: IL-1, IL-6, IL-8, TNF-alpha, MIP-1beta, and RANTES in pediatric patients who were bitten by a snake. METHODS: Patients were included in this study if they were admitted to the hospital within 24 hours of the snakebite. Blood samples were taken immediately on admission to the hospital, and then at intervals of 3, 12, and 24 hours, and on days 3, 5, and 7 after the accident. Patients received gentamicin plus clindamycin or gentamicin plus penicillin intravenously for a minimum of 3 days or longer if necessary. IL-1, IL-8, TNF-alpha, MIP-1beta, and RANTES were determined by monoclonal antibody-based ELISAs, while IL-6 was determined by bioassay. RESULTS: Eighteen patients were included in this study; 15 were bitten by Bothrops asper and three by B. lateralis. Eleven patients were male. Median (range) age was 9 (1-12) years. Nine patients had detectable serum concentrations of IL-6 (200 pg/ mL) and IL-8 (51 pg/mL) on admission, increasing to 500 pg/mL and 115 pg/mL for IL-6 and IL-8, respectively, during the first 12-24 hours. Cytokine concentrations returned to normal or undetectable ranges by 72 hours. TNF-alpha concentrations peaked at 12 hours (mean: 48 pg/mL). Low, but detectable concentrations of MIP-1beta were observed in some patients at various time intervals (48 pg/mL), whereas IL-1 was not detectable at any time point. Regulated on Activation Normal T cell Expressed and Secreted (RANTES) concentrations were evaluated in only five patients, being elevated in all of them. Patients with elevated cytokine concentrations required early fasciotomy (<24 hours after the accident) more often than those who had normal or undetectable cytokine concentrations (P < 0.05). There were no statistically significant associations between severity of envenomation, or outcome, and elevated serum cytokine concentrations (P > 0.05). CONCLUSIONS: Bothrops sp snake venoms induce clinical and pathophysiologic alterations similar to acute trauma, with release of proinflammatory cytokines. A better understanding of the role of the inflammatory response could lead to the development of new therapeutic strategies to improve the outcome in snakebitten patients.

Abscess secondary to facial snakebite

In Costa Rica, approximately 700 snakebite cases occur each year, 5 to 10 of which result in death. At the Hospital Nacional de Ninos (HNN), 6 to 10 cases are reported annually, more than half of these cases and nearly all deaths are result from Bothrops asper snakebite. This venomous snake, popularly known as the "terciople", most often attacks the lower upper limbs and characteristically produces local tissue damage, which can be severe. The following is a report of the first case of a non-fatal and unusual facial bite caused by Bothrops asper in our country.

Venomous snakebites in children and adolescents: a 12 year retrospective review

Snakebite envenomation is a worldwide problem and in Costa Rica. The following is a retrospective review of 79 patients admitted to the Hospital Nacional de Ninos (HNN) from January 1985 to September 1996. Child's age ranged from 9 months to 14 years. The M: F ratio was 1.5:1. Sixty percent of the patients lived in remote rural areas. The most common clinical signs at the time of hospitalization were pain and edema. Fifty patients (63.29 per cent) showed moderate to severe envenomation grades. Fifty-one (64,55 per cent) was caused by Bothrops asper. Complications during hospitalization were compartment syndrome and secondary infection. Three children died, one from disseminated intravascular coagulation, another from renal insufficiency, and the third from a perforated duodenal ulcer. Patients who underwent early fasciotomy had signficantly less hospitalization and fewer infectious complications, (p<0.001). There was no relationship between the envenomation grade and length of hospitalization (p=0.4). The most common pathogen isolated was S. aureus. Early fasciotomy seemed to reduce the complications seen in these patients. Further studies are necessary to identify the factors that may clinicians to decide those who should undergo fasciotomy, as well as the best moment to perform it