Descripción del brote de poliomielitis en la Argentina de 1971 / Description of the 1971 poliomyelitis outbreak in Argentina

La poliomielitis es una enfermedad de antigua data que afecta exclusivamente a los humanos. Sus secuelas de parálisis se encuentran ya documentadas en escritos del antiguo Egipto. Es producida por el poliovirus y se transmite por vía fecal-oral. Uno de cada doscientos niños infectados sufre un ataque vírico a las neuronas motoras del sistema nervioso central, que deja como secuela una parálisis flácida muscular. En la Argentina, las últimas epidemias de poliomielitis ocurrieron entre 1955 y1957, en 1971 y en 1983. La epidemia de 1953 registró 2.700 casos, mientras que en la de 1956 hubo 6.490 casos, con una tasa de mortalidad del 33,7%. Durante 1971, 46 pacientes fueron internados con diagnóstico de poliomielitis en las salas que dependían de la cátedra de Enfermedades Infecciosas de la Facultad de Ciencias Médicas de la Universidad de Buenos Aires, en el predio del Hospital Francisco Javier Muñiz. La cohorte estaba compuesta por 26 varones y 20 mujeres. Hemos realizado una revisión de las historias clínicas de aquellos pacientes, obrantes en el archivo de la cátedra. (AU)

Poliomyelitis is a human disease of ancient origin. Evidence of sequelae of paralysis is documented in ancient Egyptian writings. It is caused by the poliovirus and is transmitted through the fecal-oral route. One out of 200 infected children suffers a viral attack on the central nervous system´s motor neurons, which results in flaccid muscle paralysis. In Argentina, the last polio epidemics occurred between 1955 and 1957, in 1971 and in 1983. The 1953 poliomyelitis epidemic reported a total of 2,700 cases, while in the 1956 outbreak 6,490 cases were recorded with a mortality rate of 33.7%. In 1971, 46 patients were diagnosed with poliomyelitis and admitted to the wards of the Department of Infectious Diseases at the Faculty of Medical Sciences, University of Buenos Aires, located in the Javier Muñiz Hospital. The cohort consisted of 26 men and 20 women. We reviewed the medical records of those patients, recorded in the Department´s archive. (AU)

Asociación entre las tendencias de búsqueda en internet con el número de casos confirmados por la viruela símica: estudio multinacional en diez países

Introducción: La viruela símica es una infección zoonótica que se ha distribuido por todo el mundo. La búsqueda de información en internet refleja el interés y concientización de la población acerca de salud. Objetivo: Determinar la asociación entre el volumen relativo de búsquedas en internet con el número de casos confirmados por la viruela símica en diez países. Métodos: Se realizó un estudio obser- vacional, analítico, retrospectivo, utilizando la herramienta Google Trends (GT™) para encontrar el volumen relativo búsqueda (VRB) sobre viruela símica desde 01 de enero al 31 de agosto del 2022 usando términos de búsqueda en el idioma oficial de los 10 países con mayor número de casos en dichas fechas, registrado por Our World in Data. Para establecer la relación lineal entre el VRB con los nuevos de casos por día se usó el coeficiente de correlación de Pearson con un nivel de significancia (p ≤ 0,05). Resultados: Se encontró un coeficiente de correlación de Pearson fuerte en Brasil (Rp = 0,562,p = 0,001), y débil en países como Alemania (Rp = 0,281, p = 0,004), Estados Unidos de Norteamérica (Rp = 0,255, p = 0,008), España (Rp = 0,122, p = 0,213), Perú (Rp = 0,120, p = 0,333), Canadá (Rp = 0,116, p = 0,238), Francia (Rp = 0,095, p = 0,335), Reino Unido (Rp = 0,085, p = 0,362), Portugal (Rp = 0,024, p = 0,805) y Países Bajos (Rp = 0,067, p = 0,497). Conclusión: Nuestro estudio evidencio que el VRB presento una relación positiva con el número de nuevos casos de viruela símica. Asimismo, se observo un coeficiente de correlación fuerte en Brasil, y en el resto de países fue débil.

Background: Smallpox is a zoonotic infection that has been distributed worldwide. The search for information on the Internet reflects the interest and awareness of the population about health. Aim: To determine the correlation between the relative volume of internet searches and the number of confirmed cases of smallpox in ten countries. Methods: An observational, analytical, retrospective study was conducted using the Google Trends (GT™) tool to find the relative search volume (RSV) on monkeypox from January 1 to August 31, 2022 using search terms in the official language of the 10 countries with the highest number of cases on those dates, as recorded by Our World in Data. To establish the relationship between RSV and new cases per day, Spearman's correlation was used with a significance level (p ≤ 0.05). Results: A. strong Pearson correlation coefficient was found in Brazil (Rp = 0.562, p = 0.001), and weak in countries like Germany (Rp = 0.281, p = 0.004), United States (Rp = 0.255, p = 0.008), Spain (Rp = 0. 122, p = 0.213), Peru (Rp = 0.120, p = 0.333), Canada (Rp = 0.116, p = 0.238), France (Rp = 0.095, p = 0.335), United Kingdom (Rp = 0.085, p = 0.362), Portugal (Rp = 0.024, p = 0.805) and Netherlands (Rp = 0.067, p = 0.497). Conclusion: Our study showed that RSV had a positive relationship with the number of new cases of smallpox. Also, a strong correlation coefficient was observed in Brazil, while the rest of the countries showed a weak correlation coefficient.

Germenectomía de los terceros molares con cefalometría predictiva de brote / Germenectomy of third molars with predictive cephalometry of abnormal eruption

Introducción: Las complicaciones, asociadas al brote anormal de los terceros molares, es posible evitarlas con la germenectomía de estos dientes. Objetivo: Caracterizar la evolución de la germenectomía de terceros molares en pacientes con diagnóstico cefalométrico de brote anormal. Métodos: Se realizó un estudio observacional, descriptivo y transversal en el Servicio de Cirugía Maxilofacial del Hospital Provincial "Saturnino Lora Torres", desde febrero de 2019 hasta marzo de 2021. Se estudiaron 32 pacientes de 13 a 15 años de edad, interviniéndose quirúrgicamente 78 terceros molares. Las variables fueron edad, sexo, color de la piel, localización y posición del tercer molar; así como las complicaciones trans y posoperatorias y la evolución. Resultados: Entre los 32 pacientes incluidos en el estudio predominó el sexo femenino (62,5 por ciento) y la edad de 14 años (40,6 por ciento). Las complicaciones ocurridas durante la germenectomía fueron más frecuentes en la arcada inferior. Aunque no fueron detectadas diferencias estadísticamente significativas según localización (valor de p>0,05); con 30 transoperatorias para un 38,4 por ciento y 75 posoperatorias para un 96,2 por ciento. Conclusiones: Se evidencia una evolución marcadamente favorable posterior a la germenectomía de terceros molares en la población de pacientes con diagnóstico cefalométrico de brote anormal. En ellos el sangrado transoperatorio y el dolor posoperatorio constituyen las complicaciones a considerar en este tipo de procedimiento quirúrgico(AU)

Introduction: Complications associated with the abnormal eruption of third molars can be avoided with germenectomy of these teeth. Objective: To characterize the evolution of third molar germenectomy in patients with a cephalometric diagnosis of abnormal bud. Methods: An observational, descriptive and cross-sectional study was carried out in the Maxillofacial Surgery Service at Saturnino Lora Torres Provincial Hospital, from February 2019 to March 2021. Thirty two patients aged 13 to 15 years were studied, with 78 third molars undergoing surgery. The variables were age, sex, skin color, location and position of the third molar; as well as trans and postoperative complications and evolution. Results: Among the 32 patients included in the study, the female sex (62.5 percent) and the age of 14 years (40.6 percent) predominated. Complications that occurred during germenectomy were more frequent in the lower arch. Although no statistically significant differences were perceived according to location (p value > 0.05); with 30 intraoperative for 38.4 percent and 75 postoperative for 96.2 percent. Conclusions: There is evidence of a markedly favorable evolution after germenectomy of third molars in the population of patients with cephalometric diagnosis of abnormal bud. In them, transoperative bleeding and postoperative pain are the complications to consider in this type of surgical procedure(AU)

First nosocomial outbreak of SME-4-producing Serratia marcescens in South America / Primer brote nosocomial por Serratia marcescens productora de SME-4en Sudamérica

Abstract Carbapenemase-producing-Serratia marcescens isolates, although infrequent, are considered important nosocomial pathogens due to their intrinsic resistance to polymyxins, which limits therapeutic options. We describe a nosocomial outbreak of SME-4-producing S. marcescens in Buenos Aires city which, in our knowledge, represents the first one in South America.

Resumen Los aislamientos de origen nosocomial de Serratia marcescens productores de car-bapenemasa, si bien son infrecuentes, son considerados importantes patógenos debido a su resistencia intrínseca a las polimixinas, lo cual limita aún más las opciones terapéuticas. En este trabajo se describe un brote nosocomial causado por S. marcescens portadora de car-bapenemasa de tipo SME-4 en la Ciudad de Buenos Aires, el cual representaría el primero en Sudamérica.

La viruela símica, alcances sobre lo que se conoce

La viruela símica es una enfermedad zoonótica endémica de África occidental y central, pero el actual brote está presentado una inusual propagación por el mundo a pesar de su limitada capacidad para trasmitirse de humano a humano, situación que ha generado una preocupación sanitaria a nivel mundial. Objetivo. Identificar la viruela símica, descripción del monkeypox virus, brote actual de la viruela símica, etiología, trasmisión, signos y síntomas, diagnóstico, vacunación y tratamiento antiviral. Metodología. Se llevó a cabo una revisión sistemática en PubMed, Ovid y LILACS, empleando operadores booleanos como, "monkeypox" OR "MPXV" OR "human monkeypox" OR "virus monkeypox", en total se identificaron 986 registros, en inglés y español. La fase de cribado recabo 59 registros entre artículos científicos y literatura gris publicados entre el 2010 y el 2022. El proceso de revisión se desarrolló bajo los estándares del método PRISMA; la elegibilidad, incluyó valoración de la calidad científica por listas de comprobación, y la inclusión contempló los criterios de calidad de la evidencia y graduación de la fuerza de recomendación. Resultados. Se encontraron 287 registros en PubMed, 699 en Ovid Medline®, se localizaron en total 986 registros electrónicos. Conclusión. El incremento de la trasmisión de humano a humano pone en peligro al entorno familiar y a quienes brindan el cuidado de salud. Las erupciones cutáneas son el signo patognomónico durante la valoración clínica. La inmunidad colectiva alcanzada durante la vacunación contra la viruela humana se ha reducido, contribuyendo en el aumento de casos y la propagación.

Smallpox is a zoonotic disease endemic to West and Central Africa, but the current outbreak is showing an unusual spread throughout the world despite its limited ability to transmit from human to human, a situation that has raised global health concern. Objective. To identify monkeypox, description of monkeypox virus, current outbreak of monkeypox, etiology, transmission, signs and symptoms, diagnosis, vaccination and antiviral treatment. Methodology. A systematic review was carried out in PubMed, Ovid and LILACS, using Boolean operators such as, "monkeypox" OR "MPXV" OR "human monkeypox" OR "monkeypox virus", a total of 986 records were identified, in English and Spanish. The screening phase collected 59 records between scientific articles and grey literature published between 2010 and 2022. The review process was developed under the standards of the PRISMA method; eligibility included assessment of scientific quality by checklists, and inclusion contemplated the criteria of quality of evidence and grading of the strength of recommendation. Results. A total of 287 records were found in PubMed, 699 in Ovid Medline®, and 986 electronic records were located. Conclusion. The increase in human-to-human transmission endangers the family environment and health care providers. Skin rashes are the pathognomonic sign during clinical assessment. The herd immunity achieved during human smallpox vaccination has been reduced, contributing to the increase in cases and spread.

A varíola é uma doença zoonótica endêmica da África Ocidental e Central, mas o surto atual está mostrando uma disseminação global incomum, apesar de sua capacidade limitada de transmissão de pessoa para pessoa, uma situação que levantou preocupações com a saúde global. Objetivo. Identificar a varíola do macaco, a descrição do vírus da varíola do macaco, o atual surto de varíola do macaco, a etiologia, a transmissão, os sinais e sintomas, o diagnóstico, a vacinação e o tratamento antiviral. Metodologia. Foi realizada uma revisão sistemática no PubMed, Ovid e LILACS, usando operadores booleanos como "monkeypox" OR "MPXV" OR "human monkeypox" OR "monkeypox virus", no total foram identificados 986 registros, em inglês e espanhol. A fase de triagem coletou 59 registros de artigos científicos e literatura cinzenta publicados entre 2010 e 2022. O processo de revisão foi desenvolvido de acordo com os padrões do método PRISMA; a elegibilidade incluiu a avaliação da qualidade científica por meio de listas de verificação, e a inclusão contemplou os critérios de qualidade de evidência e graduação da força de recomendação. Resultados. Foram encontrados 287 registros no PubMed, 699 no Ovid Medline® e um total de 986 registros eletrônicos. Conclusões. O aumento da transmissão de pessoa para pessoa coloca em risco o ambiente doméstico e os prestadores de serviços de saúde. Erupções cutâneas são o sinal patognomônico durante a avaliação clínica. A imunidade de rebanho obtida durante a vacinação contra a varíola humana foi reduzida, contribuindo para o aumento dos casos e da disseminação.

Primer reporte de un brote de dengue en balsas, Amazonas, Perú, durante 2021 y 2022

Introducción: El aumento de casos de dengue en Amazonas es un riesgo para la salud pública. En el 2021, Balsas reportó por primera vez un brote de dengue. Métodos: La población incluyó a pacientes que cumplían con la definición de caso entre diciembre 2021 y febrero 2022. La identificación de los serotipos se determinó mediante una qRT-PCR múltiplex. Resultados: Se identificaron 72 pacientes de los cuales 53 (74%) se confirmaron por serología (Ag NS1). El serotipo prevalente fue DENV-2 (94%), y el 6% fue DENV-1. Los pacientes de 19 a 45 años presentaron el mayor porcentaje de casos (59%). Los síntomas más frecuentes fueron cefalea, mialgias, fiebre y artralgias; el 23 % presentó dolor abdominal intenso. Conclusión: Este fue el primer brote de dengue confirmado en el distrito de Balsas, siendo DENV-2 el principal causante, destacando la necesidad de mejorar la vigilancia en zonas sin transmisión autóctona de la enfermedad.

Introduction: The increase in dengue cases in Amazonas represents a public health risk. In 2021, Balsas reported a dengue outbreak for the first time. Methods: The population included patients who met the case definition between December 2021 and February 2022. Serotype identification was determined using a multiplex qRT-PCR. Results: A total of 72 patients were identified, of which 53 (74%) were confirmed by serology (NS1 Ag). The prevalent serotype was DENV-2 (94%), and 6% were DENV-1. Patients aged 19 to 45 years had the highest percentage of cases (59%). The most frequent symptoms were headache, myalgia, fever, and arthralgia; 23% had intense abdominal pain. Conclusion: This was the first confirmed dengue outbreak in the Balsas district, with DENV-2 being the main cause of the outbreak, highlighting the need to improve surveillance in areas without autochthonous transmission of the disease.

Dengue como fenómeno epidemiológico emergente: dinámica de los brotes en la provincia de Buenos Aires en 2016 Y 2020 / Dengue as an emergent epidemiological phenomenon: dynamics of the outbreaks of 2016 and 2020 in Buenos Aires province

RESUMEN INTRODUCCIÓN: El dengue constituye un problema emergente en Argentina. En la provincia de Buenos Aires se inició un primer brote en 2016, y el de 2020 registró un 82% más de casos y afectó municipios sin antecedentes previos. El objetivo de este estudio fue caracterizar la dinámica de los brotes bonaerenses de 2016 y 2020 . MÉTODOS: Se realizó un estudio descriptivo, retrospectivo y transversal. Los casos fueron registrados en el Sistema Nacional de Vigilancia de la Salud. Fueron calculadas las distribuciones de frecuencia de los casos notificados, considerando también el origen: importados o autóctonos. Las tasas de incidencia y las razones de tasas se calcularon por Región Sanitaria. La difusión de la onda epidémica para ambos brotes fue obtenida mediante el cálculo de métricas adimensionales . RESULTADOS: Ambos brotes manifestaron ondas de similar comportamiento, pero con diferente expansión temporal y velocidades de difusión que se distanciaron en el inicio y luego hacia el final, presentando el último brote una mayor incidencia pero con una tasa de propagación de menor variación . DISCUSIÓN: La investigación realizada permitió caracterizar los brotes ocurridos en 2016 y 2020, y focalizar regionalmente la incidencia del fenómeno reemergente de la infección por arbovirus dengue (principalmente DEN-1 circulante) en la provincia de Buenos Aires, con cifras de incidencia que superaron lo conocido en la historia de la enfermedad en Argentina.

ABSTRACT INTRODUCTION: Dengue is an emerging problem in Argentina. In the province of Buenos Aires, the first outbreak was in 2016, and the one occurred during 2020 caused 82% more cases and affected districts with no previous cases. The objective of this study was to characterize the outbreak dynamics in the province of Buenos Aires in 2016 and 2020 . METHODS: A descriptive, retrospective and crosssectional study was conducted. The cases were registered in the National Health Surveillance System. The frequency distributions of the reported cases were calculated, considering also the origin: imported or autochthonous. Incidence rates and rate ratios were calculated for each Health Region. The diffusion of the epidemic wave for both outbreaks was obtained by calculating dimensionless metrics . RESULTS: Both outbreaks showed waves with similar behavior, but with different temporal expansion and diffusion speeds that distanced from each other at the beginning and then towards the end. The last outbreak had a higher incidence, but a propagation rate with less variation . DISCUSSION: This research allowed to characterize the two outbreaks occurred in 2016 and 2020, and to focus regionally on the incidence of the re-emerging phenomenon of dengue arbovirus infection (mainly circulating DEN-1) in the province of Buenos Aires, with incidence figures that exceeded those known in the history of the disease in Argentina.

Dealing with Outbreak of Monkey Pox Virus in Iran

Iran has raised concerns about the new outbreak of monkeypox (MV), it’s a serious issue for our 85 million population. Iran has identified its first case of monkeypox reported 16, Aug, woman aged 34, in the city of Ahvaz. The outbreak of the Monkeypox virus increasing daily in many areas, and causes deaths are reported. This article deals with the ongoing outbreak of monkeypox virus (zoonotic) that belongs to the genus orthopoxvirus, which was confirmed in May, 2022 and has similar symptoms as of smallpox but is less contagious and less severe illness than smallpox. The article also deals with its signs and symptoms, diagnosis, prevention, and treatment.

Viruela símica grave en un paciente con infección por VIH, Ecuador

En mayo de 2022 se reportó un aumento de casos de viruela símica (mpox en inglés) en el mundo, cuyo comportamiento epidemiológico y clínico, particularmente en pacientes con infección por VIH, condujo a la declaración del brote de mpox 2022 como emergencia de salud pública internacional. Se presenta el caso de un paciente con infección por VIH que cursó con mpox grave y fulminante, con placas necróticas en párpado y membrana inflamatoria sobre la superficie ocular; mucosa oral con lesiones blanquecinas y úlceras en lengua; induración de tejidos blandos y lesiones necróticas en los pies. Tras múltiples complicaciones, se convirtió en la primera víctima fatal reportada en Ecuador en 2022. En pacientes con infección por VIH, mpox puede presentarse como un agente oportunista, causando lesiones cutáneas graves, con o sin manifestaciones sistémicas.

In May 2022 several cases of mpox were reported worldwide, whose epidemiological and clinical outcome, particularly in patients seropositive for HIV, led to declaring the 2022 mpox outbreak as a public health emergency. We describe a case of a patient with HIV infection and severe and fulminant mpox, with necrotic plaques on the eyelid and an inflammatory membrane on the ocular surface; oral mucosa with whitish lesions and ulcers on the tongue; soft tissues induration, and necrotic lesions on the feet. After multiple complications, he became the first fatality reported in Ecuador in 2022. In HIV-infected patients mpox can be considered an opportunistic agent, with severe skin lesions with or without systemic manifestations.

Brote de histoplasmosis en el contexto de la pandemia por COVID-19 / Histoplasmosis outbreak in the context of the COVID-19 pandemic

La histoplasmosis es una micosis profunda de distribución mundial causada por el Histoplasma capsulatum var. capsulatum. Se caracteriza por una variabilidad clínica que depende principalmente de la carga fúngica, del estado inmunológico del paciente y de la virulencia del germen. Se describe un brote de histoplasmosis pulmonar aguda en militares, producido en el contexto epidemiológico de la COVID-19. El episodio tuvo lugar a partir de actividad laboral en cuevas donde participaron cuatro militares, tres de los cuales desarrollaron síntomas y fueron admitidos en el Hospital Dr. Gustavo Aldereguía Lima de Cienfuegos en enero de 2022. La información fue obtenida a través de la entrevista médica y la historia clínica. Se evidenció que en el contexto epidemiológico de la pandemia por COVID-19 no se debe subestimar el diagnóstico de otras enfermedades respiratorias, incluidas las micosis endémicas(AU)

Histoplasmosis is a deep mycotic infection of worldwide distribution caused by Histoplasma capsulatum var. capsulatum. It is characterized by clinical variability that depends mainly on the fungal load, the patient's immune status and the virulence of the germ. We describe an outbreak of acute pulmonary histoplasmosis among military officers, which occurred in the epidemiological context of COVID-19. The episode occurred during work activities in caves in which four soldiers participated, three of whom developed symptoms and were admitted to the "Dr. Gustavo Aldereguía Lima" Hospital in Cienfuegos in January 2022. The information was obtained through medical interviews and clinical records. It was evidenced that in the epidemiological context of the COVID-19 pandemic, the diagnosis of other respiratory diseases, including endemic mycoses, should not be underestimated(AU)

Web-tools for the genomic analysis of the 2022 Monkeypox virus global outbreak / Herramientas web para el análisis genómico del virus de la viruela símica durante el brote mundial de 2022

Abstract The resources and platforms available on the internet for collecting and sharing information and performing genomic sequence analysis have made it possible to follow closely the evolution the evolution of SARS-CoV-2. However, the current monkeypox outbreak in the world brings us back to the need to use these resources to appraise the extent of this outbreak. The objective of this work was an analysis of the information presented so far in the genomic database GISAID EpiPox™, using various tools available on the web. The results indicate that the monkeypox outbreak is referred as MPXV clade II B.1 lineage and sub-lineages, isolated from male patients mainly from the European and American continents. In the current scenario, the access to genomic sequences, epidemiological information, and tools available to the scientific community is of great importance for global public health in order to follow the evolution of pathogens.

Resumen Los recursos y plataformas disponibles en Internet para recopilar, compartir información y realizar análisis de secuencias genómicas han permitido seguir de cerca la evolución del SARS-CoV-2. El actual brote global de viruela del mono en el mundo, requiere de nuevo utilizar estos recursos para conocer el alcance de este brote. El objetivo de este trabajo fue un análisis de la información presentada hasta el momento en la base de datos genómica EpiPox™ de GISAID, utilizando diversas herramientas disponibles en la web. Los resultados indican que el brote de la viruela del mono o símica está referido al linaje y sub-linajes B.1 del clado II de MPXV, aislado principalmente de pacientes hombres de Europa y América. En el escenario actual, el acceso a las secuencias genómicas, la información epidemiológica, y las herramientas disponibles para la comunidad científica son de gran importancia para la salud pública mundial con el fin de seguir la evolución de los patógenos.

Detection of Trypanosoma cruzi DTUs TcI and TcIV in two outbreaks of orally-transmitted Chagas disease in the Northern region of Brazil

ABSTRACT This study describes the laboratory investigation of two acute Chagas disease outbreaks that occurred in the riverside communities of Marimarituba and Cachoeira do Arua, in the Santarem municipality, Para State, located in the Northern region of Brazil, and occurred in March 2016 and August 2017, respectively. The generation of data regarding the diversity of Trypanosoma cruzi parasites circulating in the Amazon region is key for understanding the emergence and expansion of Chagas disease. This study aimed to identify T. cruzi Discrete Typing Units (DTUs) involved in two outbreaks of acute Chagas disease (ACD) directly from the patient's biological sample. Nested and multiplex PCR targeting the 24Sα (rRNA) and mini-exon genes, respectively, were used to identify T. cruzi DTU in blood samples from patients diagnosed with ACD. The samples with positive cPCR were submitted for analysis for T. cruzi DTUs, which included 13 samples from the patients with ACD by oral transmission and two samples collected from two newborns of two women with ACD, from Marimarituba and Cachoeira do Arua. The samples were classified as T. cruzi TcIV, from Marimarituba's outbreak, and T. cruzi TcI, from Cachoeira do Arua's outbreak. The molecular identification of T. cruzi may increase understanding of the role of this parasite in Chagas disease's emergence within the Amazon region, contributing to the improvement of the management of this important, but also neglected, disease.

Acute pulmonary histoplasmosis: a case series from an outbreak in Southeastern Brazil

ABSTRACT Histoplasmosis is a systemic mycosis prevalent in the Americas. Humans become infected via the respiratory route by inhaling aerosols from soil contaminated with bird and bat excretions. Acute pulmonary histoplasmosis is usually asymptomatic and is more often a self-limiting illness. We report a series of seven acute pulmonary cases in adults during an outbreak in Nova Friburgo city, Rio de Janeiro State, Brazil, in a group of volunteers who were cleaning an old, abandoned house without using personal protective equipment. The patients had a favorable evolution after suitable treatment, but all required hospitalization.

Chikungunya virus infection in the southernmost state of Brazil was characterised by self-limited transmission (2017-2019) and a larger 2021 outbreak

BACKGROUND Chikungunya is a mosquito-borne virus that has been causing large outbreaks in the Americas since 2014. In Brazil, Asian-Caribbean (AC) and East-Central-South-African (ECSA) genotypes have been detected and lead to large outbreaks in several Brazilian states. In Rio Grande do Sul (RS), the southernmost state of Brazil, the first cases were reported in 2016. OBJECTIVES AND METHODS We employed genome sequencing and epidemiological investigation to characterise the Chikungunya fever (CHIKF) burden in RS between 2017-2021. FINDINGS We detected an increasing CHIKF burden linked to travel associated introductions and communitary transmission of distinct lineages of the ECSA genotype during this period. MAIN CONCLUSIONS Until 2020, CHIKV introductions were most travel associated and transmission was limited. Then, in 2021, the largest outbreak occurred in the state associated with the introduction of a new ECSA lineage. CHIKV outbreaks are likely to occur in the near future due to abundant competent vectors and a susceptible population, exposing more than 11 million inhabitants to an increasing infection risk.

Brote de transmisión comunitaria de COVID-19 en un municipio de La Habana (marzo-abril, 2021)

Introducción: Una oportuna investigación de los eventos epidemiológicos de la COVID-19 garantiza minimizar la propagación de la enfermedad en la población. Objetivos: Caracterizar el brote de transmisión comunitaria de COVID-19 en un municipio de La Habana. Métodos: Estudio transversal de casos positivos de infección por SARS-CoV-2 del brote Catedral en La Habana Vieja, en 2021. Las variables analizadas fueron: edad, sexo, manzana de residencia, fecha de inicio de síntomas, fecha de diagnóstico, forma clínica, tipo de caso. Se utilizó la metodología para el estudio de brotes. Se calcularon porcentajes, diferencias de proporciones, tasas, número reproductivo efectivo y parámetro de dispersión con intervalos de confianza de 95 %. Resultados: Se notificó el brote el 23 de marzo y se cerró el 22 de abril con 106 casos (tasa de ataque 4,51 %), el pico en la notificación se produjo el 29 de marzo con 40 casos (37,73 %). La edad media fue de 43 años. Resultaron más afectados los adultos de 60 y más años (30,18 %), las mujeres (58,49 %) y la manzana 0024 (45,28 % de los casos). El 77,3 % no presentó síntomas, entre ellos dos superdispersores; los sintomáticos fueron leves y no hubo fallecidos. El número reproductivo efectivo global fue de 0,94 (IC: 0,70-1,21); superior en los asintomáticos (11,43 versus 4,00); y el parámetro de dispersión de 0,89 (IC: 0,51-2,09), superior en los sintomáticos (1,06 versus 0,69). Conclusiones: El control epidemiológico oportuno ante cada caso permitió la corta duración del brote y que no hubiesen fallecidos.

Introduction: A timely investigation of COVID-19 epidemiological events guarantees to minimize the spread of the disease in the population. Objective: To characterize the COVID-19 outbreak of community transmission in a municipality in Havana. Methods: Cross-sectional study of positive cases of SARS-CoV-2 infection of the "Cathedral" outbreak in Old Havana in 2021. The variables analyzed were: age, sex, city block of residence, date of symptom onset, date of diagnosis, clinical manifestations, and type of case. The methodology for the study of outbreaks was used. Percentages, differences in proportions, rates, effective reproductive number, and dispersion parameter with 95% confidence intervals were calculated. Results: The outbreak was reported on March 23 and closed on April 22 with 106 cases (attack rate of 4.51%). The peak was notified on March 29 with 40 cases (37.73%). The mean age was 43 years. Adults aged 60 years and older (30.18%), women (58.49%), and block 0024 (45.28% of cases) were most affected. A total of 77.3% were asymptomatic, including two superspreaders; symptomatic cases were mild and there were no deaths. The overall effective reproductive number was 0.94 (CI: 0.70-1.21); higher in asymptomatic cases (11.43 versus 4.00); and the dispersion parameter was 0.89 (CI: 0.51-2.09), higher in symptomatic cases (1.06 versus 0.69). Conclusions: Timely epidemiological control of each case ensured the short duration of the outbreak and no deaths.

A case of mass occurrence of Sandalodesmus araujoi () in a municipality of São Paulo, Brazil and description of the heretofore unknown female (Polydesmida, Chelodesmidae) / Um caso de ocorrência em massa de Sandalodesmus araujoi () em um município de São Paulo, Brasil e descrição da fêmea até então desconhecida (Polydesmida, Chelodesmidae)

Abstract Somatic characters are shared by many Chelodesmidae groups, and generic placement and species identifications traditionally have been based on gonopodal morphology. Female genitalic characters have been largely neglected and are rarely photographed or illustrated. This is rather unfortunate as the morphology of female genitalia presents important characters and may be decisive for developing a more robust family classification. We describe the heretofore unknown female of Sandalodesmus araujoi (Schubart, 1946), previously known only from the male holotype collected in São Paulo, Brazil in December 1943; discuss the utility of female genitalic characters for species delineation in Sandalodesmus; and report the first case of a mass occurrence in the Chelodesmidae. While an attempt at a formal diagnosis of Sandalodesmus females based on genitalic characters is premature, the vulvar morphology of the three taxa examined in this study suggests that female genitalia are species-specific. Some characters (i.e., asymmetric valves, presence of digitiform projections and reduction of setae on the internal basal portion of the valves) are constant between the species, suggesting utility for generic-level delineation. Mass occurrences of millipedes are typically unpredictable and likely related to variations in environmental conditions and/or anthropogenic modifications of natural habitats. Although the mass occurrence of S. araujoi reported herein was only observed once, the event coincides with the mating period of millipedes during the rainy season in Brazil. On the other hand, the region where the species was found has been the target of intense urban development, including replacement of natural habitats with residential areas, which may have influenced its population dynamics.

Resumo Os caracteres somáticos são compartilhados por muitos grupos de Chelodesmidae, e o posicionamento genérico e as identificações de espécies tradicionalmente têm sido baseadas na morfologia do gonópodo. Carateres genitais das fêmeas foram amplamente negligenciados e raramente são fotografados ou ilustrados. Isso é lamentável, pois a morfologia da genitália feminina apresenta características importantes e pode ser decisiva para o desenvolvimento de uma classificação mais robusta. Neste trabalho, descrevemos a até então desconhecida fêmea de Sandalodesmus araujoi (Schubart, 1946), anteriormente conhecida apenas pelo holótipo macho coletado em São Paulo, Brasil, em dezembro de 1943; discutimos a utilidade de caracteres genitais femininos para delineamento de espécies em Sandalodesmus; e relatamos o primeiro caso de ocorrência em massa para Chelodesmidae. Embora uma tentativa de diagnose formal para fêmeas de Sandalodesmus com base em caracteres genitais seja prematura, a morfologia vulvar dos três táxons examinados neste estudo, sugere que a genitália feminina é espécie-específica. Alguns caracteres (e.g. válvulas assimétricas, presença de projeções digitiformes e redução de cerdas na margem interna das válvas) são constantes entre as espécies do gênero, sugerindo utilidade para delineamento em nível genérico. Ocorrências em massa de milípedes são tipicamente imprevisíveis e provavelmente relacionadas a variações nas condições ambientais e/ou modificações antropogênicas de habitats naturais. Embora a ocorrência em massa de S. araujoi aqui relatada tenha sido observada apenas uma vez, o evento coincide com o período de reprodução dos milípedes durante a estação chuvosa no Brasil. Por outro lado, a região onde a espécie foi encontrada tem sido alvo de intenso desenvolvimento urbano, incluindo substituição de habitats naturais por áreas residenciais, o que pode ter influenciado sua dinâmica populacional.

Working together to overcome difficulties / 中华危重病急救医学

Objective:With the adjustment of epidemic prevention and control policies, the coronavirus disease infection has undergone incredible changes. The number of infected people has exploded in a geometric progression up to an astronomical number. In the face of a new round of stormy tests, it is not only necessary for the whole country to unite and help each other, unite as one, share weal and woe, and overcome the difficulties, but also for us to reflect on the current situation, problems and difficulties.

Investigation report on an outbreak of cutaneous anthrax in Caoxian County, Heze City, Shandong Province in 2021 / 中华地方病学杂志

Objective:To analyze the cause and epidemiological characteristics of an outbreak of cutaneous anthrax in Caoxian County, Heze City, Shandong Province, and to provide scientific basis for anthrax prevention and control.Methods:Using on-site epidemiological investigation methods and the "Anthrax Epidemiological Case Investigation Form", case investigations were conducted based on the epidemiological contact history and close contacts of suspected anthrax cases reported by the national health care system ( n = 83). Scorched skin smears, diseased cattle tissues, soil samples from the slaughter site and smears from slaughter utensils were collected from cases for Real-time PCR testing and pathogenic bacteria isolation and culture, respectively. Anthrax determination criteria were carried out with reference to "Anthrax Diagnosis" (WS 283-2020). Results:A total of 13 cases of cutaneous anthrax were found in this outbreak, including 12 clinically diagnosed cases and one confirmed case (positive Real-time PCR test and isolation of a strain of Bacillus anthracis). The epidemiological investigation determined that the source of infection in this outbreak was diseased cattle, the transmission route was through slaughter of diseased cattle, contact with contaminated utensils and related cattle products, and the patients were mainly engaged in occupations related to cattle slaughter or cattle product collection and sale. A total of 84 samples were collected, including 13 skin scabs, 64 environmental samples and 7 beef samples. Thirty-six positive PCR tests were performed, with a positive rate of 42.86% (36/84). Among them, 100.00% (13/13) were positive for skin scab smear specimens, 29.69% (19/64) for environmental samples and 4/7 for beef samples. A total of 8 strains of Bacillus anthracis were isolated, including 6 environmental specimens, 1 suspected case and 1 beef strain, with an overall detection rate of 9.52% (8/84). Eighty-three close contacts were investigated. Thirteen households involved in the epidemic were disinfected by spraying (200 ml/m 2) with chlorine-containing disinfectant (5 000 mg/L), and a total of 40 households involved in the epidemic were disinfected, covering an area of about 10 765 m 2. Forty-five pieces of suspected contaminated clothing were burned and disposed of, and 152 pieces of kitchenware were soaked. Conclusions:Slaughter of infected cattle, contact with contaminated utensils and related cattle products are the main causes of this skin anthrax outbreak. Strengthening market supervision, deepening inter-animal epidemic prevention, carrying out publicity and education on anthrax prevention and control, and enhancing practitioners' awareness of disease prevention is the key to prevent anthrax from occurring.

Focus on the epidemic cerebrospinal meningitis outbreaks and the global road map of defeating meningitis by 2030 / 中华实用儿科临床杂志

World Health Organization (WHO) reported that a total of 559 meningitis cases and 18 deaths were reported in the southeast of Niger from November 1, 2022 to January 27, 2023.Children were the major of patients.Among the laboratory confirmed cases, 93.7%(104/111) were epidemic cerebrospinal meningitis.Since 2021, the epidemic of meningococcal disease has attacked the gay and bisexual men in Florida, USA.This paper briefly reviews the occurrence and development of the two outbreaks of epidemic cerebrospinal meningitis, as well as the causes and countermeasures.The current prevention and control measures of meningitis is discussed based on the " Defeating meningitis by 2030: Global Road Map" issued by WHO in 2021.This paper is expected to attract the attention and to improve awareness and vigilance of domestic clinical and public health workers, which would lead to strengthen the surveillance, prevention and control of meningitis.

Investigation of an outbreak of Mycoplasma pneumoniae respiratory tract infection in a primary school in Huzhou City， Zhejiang Province / 上海预防医学

ObjectiveTo understand the epidemiological characteristics of an outbreak of respiratory tract infections caused by Mycoplasma pneumoniae （MP） in a primary school in Huzhou City， Zhejiang Province， and to provide scientific reference for future prevention and control of school outbreaks of upper respiratory tract infections caused by M. pneumoniae. MethodsAccording to the requirements for investigating respiratory infectious disease outbreaks， basic information， clinical history and epidemiological information were collected from the cases. Throat swab samples of cases for COVID-19 nucleic acid testing， influenza A and B virus antigen testing， and serum samples for detecting total antibody of mycoplasma were also collected. ResultsA total of 47 cases related to M. pneumoniae infection were identified. The first case occurred on May 4， 2022， and the cases were concentrated between May 22 and May 31， 2022. The last case occurred on June 21， marking a duration of 48 days for the outbreak. All cases were second-grade students， with an incidence rate of 35.07% （47/134） in the affected classes， with Class 206 at 53.330% （24/45）， Class 207 at 38.64% （17/44）， and Class 211 at 13.33% （6/45）. There was a statistically significant difference in the incidence rates among the classes （χ2=16.57，P<0.05）. The incidence rate was 32.39% （23/71） for boys and 38.10% （24/63） for girls， with no statistically significant difference by gender （χ2=0.48，P>0.05）. The main clinical manifestations included cough， fever， and sore throat， and some cases exhibited signs of pneumonia. Pharyngeal swabs and serum samples were collected from 27 patients. The results were negative for pharynx swab samples， and positive for total mycoplasma antibody in 12 serum samples， with a positive rate of 44.44%. ConclusionSymptoms caused by M. pneumoniae are diverse in clinical manifestations， with atypical signs and a slow progression. Early cases tend to exhibit mild symptoms. The onset of the disease is not detected in time when students are attending classes. The school morning health checks fail to promptly detect it and trigger home isolation control measures， which all contribute to the outbreak of the epidemic. Schools should conduct relevant prevention and control campaigns， improve morning and afternoon health checks， and prevent students from attending classes while sick.