Evaluation of the National Case Report Form for dengue and timely case notification before the co-circulation of multiple arboviruses in Barranquilla, Colombia / Evaluación del formulario nacional de informe de caso para dengue y de la puntualidad en la notificación del caso antes de la co-circulación de múltiples arbovirus en Barranquilla-Colombia

ABSTRACT Objective To evaluate the case report forms and times elapsed between the surveillance steps for dengue virus (DENV) infection in a large Colombian city before the emergence of other arbovirus epidemics. Materials and Methods The descriptive epidemiology of DENV infection cases was analyzed from 2009 to 2013. The completeness of the case report forms filed at the Primary Units of Data Generation (PUDG) were evaluated, as well as the accuracy and suitability of the tests (PPV: positive predictive value). The average time-lags between each step were then calculated. Results There were 7.3, 12.38, 4.66, 6.25 and 29.9 annual cases of dengue infection per 10 000 inhabitants in 2009 to 2013, respectively. In this study, only 57.76% of the cases were classified correctly by the physicians and 26.32% of them were questioned about their home conditions and whether their family/friends had similar symptoms. Patients visited a clinic/hospital on average 4.76 days after developing symptoms and the health system was notified on average 1.75 days later, while 70.6% of them were reported within the one-day target period. There were only minor changes in case reporting times even during a DENV epidemic. Some (12.85%) of the case forms were later modified (average 16.7 days). In the period 2009-2013, the IgM confirmed PPV was 58.60%, while 20 mandatory criteria were absent on more than 25% of the forms. Conclusions The system was accurate, simple, flexible, stable and acceptable, but a number of ways are suggested to improve this case detection and reporting system.(AU)

RESUMEN Objetivo Evaluar los formularios de informe de casos y los tiempos entre los pasos de vigilancia para el dengue en una ciudad colombiana antes de la aparición de otras epidemias de arbovirus. Materiales y Métodos Se analizó la epidemiología descriptiva entre 2009 y 2013. Se evaluó la integridad de los formularios de informes de casos, registrados en las Unidades Primarias de Generación de Datos, así como el valor predictivo (VPP) de las pruebas diagnósticas. Se calcularon los intervalos de tiempo promedio entre cada paso de la vigilancia. Resultados Hubo 7.3, 12.38, 4.66, 6.25 y 29.9 casos anuales por cada 10 000 habitantes en 2009-2013, respectivamente. Solo el 57.76% de los casos fueron clasificados correctamente por los médicos, el 26.32% de ellos fueron interrogados sobre las condiciones de su hogar y si sus familiares/amigos tenían síntomas similares. Los pacientes se presentaron a una clínica/hospital en promedio 4.76 días después de desarrollar síntomas y el sistema de salud fue notificado en promedio 1.75 días más tarde, mientras que el 70.6% de ellos se informaron dentro del período objetivo de un día. Algunos (12.85%) de los formularios de casos se modificaron posteriormente (promedio de 16.7 días). Desde 2009-2013, el VPP confirmado por IgM fue de 58.60%, mientras que veinte criterios obligatorios estuvieron ausentes en más del 25% de los formularios. Conclusiones El sistema fue preciso, simple, flexible, estable y aceptable, pero sugerimos varias formas de mejorar este sistema de detección e informe de casos.(AU)

Leptospira spp. y leptospirosis humana / Leptospira spp. and human leptospirosis

La leptospirosis, la enfermedad bacteriana zoonótica y emergente más importante en el mundo, es causada por las especies patógenas de Leptospira spp. Han sido descritas veinte especies de Leptospira spp.; se ha determinado la secuencia del ADN genómico de algunas cepas patógenas; la función de la mayoría de los genes involucrados en su patogénesis permanece desconocida. La leptospirosis humana presenta un rango de síntomas que van desde una fiebre indiferenciada hasta una ictericia, hemorragia, fallas renales y pulmonares severas. La administración temprana e intravenosa de penicilina G es requerida para reducir las tasas de mortalidad, pero los antibióticos pueden no ser efectivos en la enfermedad pulmonar severa. En las Américas, las áreas de alto riesgo son Brasil, Centroamérica y el Caribe. En Colombia se han realizado pocos estudios. La prueba serológica de oro, la microaglutinación, tiene alta sesibilidad y especificidad cuando se usan baterías de serovariedades locales, pero es serogrupo específica. Las vacunas generan respuestas específicas para la serovariedad usada, pero no previenen la infección o trasmisión. Problemas en el diagnóstico de laboratorio de la leptospirosis conllevan a un subregistro en el número de casos; altas tasas de mortalidad asociadas a fallas renal y pulmonar son resultado de las dificultades en el manejo de los casos.

Leptospirosis, the world's most important emerging bacterial zoonotic disease, is caused by pathogenic Leptospira species. To review the latest information on Leptospira spp. and leptospirosis. We reviewed PubMed indexed papers on leptospiral microbiology, epidemiology, clinicalhuman disease, diagnostics, treatment, and disease prevention (vaccines). Twenty Leptospira species have been described and, although the genomic DNA sequences ofsome pathogenic Leptospira spp. strains have been determined, the functions of most genesinvolved in their pathogenicity remain unknown. Leptospirosis is displayed by a range ofsymptoms from undifferentiated fever to severe jaundice, hemorrhage, renal and pulmonary failures. Pulmonary disease has the highest mortalities. An early intravenous penicillin G therapies is urgently required to reduce the mortality rates, but antibiotic therapy may not be effective in severe pulmonary disease. In the Americas, the highest risk areas are Brazil, Central America and the Caribbean islands. Few studies have however been performed in Colombia. The "gold standard" serological assay, the microscopic agglutination test (MAT), has a high sensitive and specificity when used with appropriate panels of Leptospira spp. serovars and it is serogroup specific. Vaccines, are administered to animals to generate serovar-specific protective responses, but may not prevent infection or transmission. Problems in the laboratory based diagnostics of leptospirosis result in under-reporting of the number of disease cases; the high mortality rates associated with severe renal and pulmonary failures result from difficulties in case management.

Molecular serovar characterization of Leptospira isolates from animals and water in Colombia / Caracterización molecular de serovariedades de Leptospira spp. aisladas de muestras de animales y agua en Colombia

Introduction: Leptospirosis is a bacterial disease transmitted directly or indirectly from animals to humans that may result in severe hemorrhagic, hepatic/renal and pulmonary disease. There are 20 known Leptospira species and hundreds of serovars, some of which belong to different species. It is essential to identify pathogenic Leptospira serovars and their potential reservoirs to prepare adequate control strategies. Objective: To characterize the Leptospira serovars isolated from rodents, dogs, pigs and water samples in Colombia. Materials and methods: Leptospira organisms were isolated and cultured, and pathogenic strains were identified using a polymerase chain-reaction (PCR). Leptospira DNA and Salmonella Braenderup H9812 (molecular weight standard) DNA were cleaved using NotI and subjected to pulsed-field gel electrophoresis (PFGE). The PFGE patterns were analyzed based on bacterial strain-typing criteria and Dice coefficients (DCs) between these isolates and over 200 Leptospira organisms isolated from other parts of the world. Results: All of the isolates were pathogenic strains, and five were genetically characterized. The P275 (84% DC) and P282 (95% DC) pig isolates were related to the Leptospira interrogans Pomona serovar; the I15 (DC: 100%) rat isolate was identical to the Leptospira interrogans Icterohameorrhagiae or Copenhageni serovars, while the C67 (64% DC) dog and A42 (60% DC) water isolates were not related (< 73.7% DC) to any of the 200 reference serovars; the closest serovars were the Leptospira noguchii Nicaragua and Orleans serovars, respectively. Conclusion: This was the first molecular characterization of Colombian Leptospira spp isolates; these isolates will be used to develop a Colombian diagnostic panel.

Introducción. La leptospirosis es una infección bacteriana transmitida directa o indirectamente de animales a humanos, la cual puede resultar en una enfermedad hemorrágica grave, hepática o renal y pulmonar. Hay 20 especies de Leptospira conocidas y cientos de serovariedades, algunas de las cuales pertenecen a diferentes especies. Es esencial identificar las serovariedades patógenas y sus reservorios potenciales para enfocar estrategias de control. Objetivo. Caracterizar las serovariedades de Leptospira aisladas de muestras de roedores, perros, cerdos y agua en Colombia. Materiales y métodos. Las cepas de leptospiras aisladas fueron identificadas como patógenas usando la reacción en cadena de la polimerasa (PRC). Sus ADN y el ADN de Salmonella Braenderup H9812 (marcador de peso molecular) fueron cortados con NotI y corridos en electroforesis de campo pulsado. Los patrones de la ECP se analizaron con base en los criterios de tipificación para cepas bacterianas y el coeficiente de Dice, cuando se compararon con 200 cepas aisladas en otras partes del mundo. Los perfiles de ADN con un coeficiente de Dice entre 73,7 % y 100 % se consideraron pertenecientes a la misma especie. Resultados. Todos los aislamientos fueron cepas patógenas y cinco se caracterizaron genéticamente. El aislamiento P275 (coeficiente de Dice: 84 %) y el P282 (coeficiente de Dice: 95 %) de cerdos, se relacionaron con Leptospira interrogans de serovariedad Pomona; el aislamiento de rata (I15) fue indistinguible de Leptospira interrogans de serovariedades Icterohaemorrhagiae o Copenhageni (coeficiente de Dice: 100 %), mientras que los aislamientos de perro (C67) y agua (A42) no se relacionaron (coeficiente de Dice <73,7 %) con ninguna de las 200 cepas de referencia; las más cercanas fueron Leptospira noguchii de serovariedades Nicaragua (coeficiente de Dice: 63 %) y Orleans (coeficiente de Dice: 60 %). Conclusiones. Esta fue la primera caracterización molecular de serotipos de aislamientos colombianos, los cuales serían los primeros miembros de un panel diagnóstico colombiano.

Miasis cutánea por Cochliomyia hominivorax (Coquerel) (Díptera: Calliphoridae) en el Hospital Universidad del Norte, Soledad, Atlántico / Cutaneous myiasis by Cochliomyia hominivorax (Coquerel) (Díptera Calliphoridae) in Hospital Universidad del Norte, Soledad, Atlántico

La miasis humana es el parasitismo de órganos y tejidos producido por especies de larvas del orden Díptera. El diagnóstico se realiza con base en hallazgos clínicos y se confirma con estudios entomológicos. Se presenta el caso de una niña de siete años de edad que fue llevada por su padre al servicio de urgencias por presentar fiebre asociada a una lesión abscedada en el cuero cabelludo, con salida espontánea de larvas. Como hallazgo en el examen físico se reportó pediculosis grave. La paciente fue hospitalizada y tratada con clindamicina, gentamicina e ivermectina, y mostró mejoría de sus condiciones clínicas. Se dio alta médica al cuarto día de estancia hospitalaria. Se recolectaron larvas en estadio dos de Cochliomyia hominivorax (Diptera: Calliphoridae) directamente del área lesionada, observándose la asociación miasis-pediculosis; por lo tanto, se alerta a los trabajadores del área de la salud del riesgo potencial que representa la pediculosis para el desarrollo de la miasis.

Human myiasis is the parasitism of human tissues by fly larvae. Diagnoses are based on clinical pattern of tissue damage and presence of insect stages. Herein, a case myiasis is described in a seven-year-old female child. She presented with fever associated with abscessed scalp lesions containing exposed larvae. Severe pediculosis was also observed. The patient was hospitalized and treated with clindamycin, gentamicin (for bacterial secondary infections) and ivermectin (treatment for lice) after which the patient showed clinical improvement and was discharged four days later. Since human myiasis can be caused by a number of different species, larvae were collected from the patient and identified as those of Cochliomyia hominivorax (Diptera: Calliphoridae). Because other cases of coinfestation of flies and lice are on record, health workers are to be alerted about the possible pediculosis-myasis risk.

Manifestaciones clínicas y factores de riesgo asociados a la infección por Cryptosporidium en pacientes de Barranquilla y tres municipios del Atlántico (Colombia) / Clinical manifestations and risk factors associated with Cryptosporidium spp. infections in patients from Barranquilla and three “municipios” of Atlántico (Colombia)

Objectives: To characterize the clinical manifestations and risk factors associated with cryptosporidiosis.Materials and methods: A descriptive study was performed on 423 patients, with macroscopic and microscopic faecal sample analyses, to identify the clinical manifestations and risk factors associated with cyptosporidiosis in 3 towns and the principal city in Atlantico(Colombia) over a 4-month period. Cryptosporidium spp oocysts were identified after stainingwith modified Ziehl-Neelsen. A saturated NaCl parasite-concentration method was also compared with wet-mount method for the detection of all intestinal parasites in 279/423 (66.0 percent) patients. Statistical analyses were performed using EPI-INFO 6.04.Results: The prevalence of Cryptosporidium spp. was 1.9percent (8/423). Statistical associationswere found between cryptosporidiosis infections and fever (p=0.01), blood in the faecalsamples (p=0.01) and the presence of household animals (p=0.02). Most of the patients(267/423: 63.1percent) were positive for intestinal parasites. The most commonly identifiedparasites were the non-pathogenic protozoa, Entamoeba coli (118/423: 27.9percent) and Endolimaxnana (86/423: 20.3percent), followed by Blastocystis hominis (76/423: 18percent), Entamoebahistolytica/dispar (28/423: 6.6percent) and Giardia lamblia (23/423: 5.4percent). Ascaris lumbricoides(6/423: 1.4percent) was the most common helminth identified. Sensitivities/specificities of99.4percent/95.2percent and 87.5percent/99.6percent were obtained for protozoa and helminths respectivelyusing the saturated NaCl method.Conclusions: Patients with cryptosporidiosis had fever and bloody faecal samples, andwere probably infected by domestic animals. Microscopy, using the modified Ziehl-Neelsenstain, was essential for Cryptosporidium spp. oocyst identification. The saturated NaClmethod efficiently concentrated the parasites.