Hydroa vacciniforme-like lymphoproliferative disorder in Ecuadorian children: A case series.

We report the clinical and histopathological features of hydroa vacciniforme-like lymphoproliferative disorder in five indigenous and Mestizo children. All the children resided at higher altitudes, experiencing maximal solar exposure. All cases presented with prurigo along with Epstein-Barr virus infection. Histopathologic examination showed an atypical, CD30 + lymphocytic infiltrate with angiocentricity in all, while three cases demonstrated panniculitis-like infiltrate.

Diagnóstico de lepra en una comunidad ecuatoriana / Diagnosis of leprosy in an Ecuadorian community

Introducción: La lepra es una infección bacteriana compleja causada por el bacilo Mycobacterium leprae, puede causar discapacidad, afecta principalmente a la piel, los nervios periféricos, la mucosa de las vías respiratorias superiores y los ojos. Caso clínico: Paciente de 22 años de edad, con enfermedad de Hansen, facie Leonina, con lesiones nodulares diseminadas en la cara de color violáceo, deformidades en ambas manos, nódulos en ambos brazos y pies y pérdida de la sensibilidad superficial y profunda. Conclusiones: En el Ecuador la Lepra puede ser calificada como de baja endemia, la tasa de detección han ido descendiendo progresivamente en los últimos diez años(AU)

Introduction: Leprosy is a complex bacterial infection caused by the Mycobacterium leprae bacillus. It can cause disability and mainly affects the skin, the peripheral nerves, the mucosa of the upper respiratory tract and the eyes. Case report: 22 years patient with Hansen's disease, Leonine facies, with purplish colour nodular lesions spread out in the face, deformities in both hands, nodules in both arms and feet, and loss of superficial and deep sensitivity. Conclusions: In Ecuador leprosy can be qualified as low endemicity. The detection rate has been falling progressively over the past ten years(AU)

Neotropical Leaf Litter Beetle Genus Motonerus (Coleoptera: Hydrophilidae): New Species, Distribution Data, and Description of Third Instar Larva.

Numerous new material of the genus Motonerus Hansen, 1989 (Coleoptera: Hydrophilidae: Sphaeridiinae) was examined over the past decade, resulting in the discovery of several undescribed species as well as new distributional records for most of the previously described species. Three species are here described as new: Motonerus explanatus sp. nov. (Panama), M. inca sp. nov. (Venezuela, Ecuador, Peru, Bolivia) and M. sofiae sp. nov. (Peru). New country records are provided for M. depressus Fikácek & Short (new for Venezuela, Ecuador, Peru and Bolivia), M. hanseni Fikácek & Short (new for Panama) and M. problematicus Fikácek & Short (new for Panama). An updated identification key and distributional maps are provided for all species, along with complete occurrence data in a DarwinCore formatted file. Potential distribution of the genus is modeled using the maximum entropy approach. Wing morphology is examined in detail, which revealed most species are macropterous, with M. andersoni Fikácek & Short being brachypterous, and M. apterus Fikácek & Short, M. oosternoides Fikácek & Short, and M. explanatus sp. nov. micropterous. The third instar of the putative larva of M. obscurus Hansen is briefly described based on larvae collected in association with adults.

Role of social behaviour in the epidemiology of lobomycosis-like disease (LLD) in estuarine common bottlenose dolphins from Ecuador.

Lobomycosis-like disease (LLD) is a chronic granulomatous skin disorder that affects Delphinidae worldwide. LLD has been observed in common bottlenose dolphins Tursiops truncatus from the Gulf of Guayaquil, Ecuador, since 1990. Although exogenous factors such as salinity and pollution may play a role in the pathogenesis of this disease in estuarine and coastal dolphin communities, we hypothesized that demography and social behaviour may also influence its epidemiology. To address this issue, the role of social behaviour in the distribution and prevalence of LLD was assessed through hierarchical cluster analysis and spatial distribution analysis in 7 dolphin communities inhabiting the inner estuary. Individuals with LLD lesions were observed in 5 of the 7 dolphin communities, with 13 of the 163 (8%) animals being positive, all adults. Among 8 dolphins of known sex, LLD affected mostly males (86%), who usually were found in pairs. Prevalence was low to moderate (5.1-13%) in dolphin communities where low-rank males had LLD. Conversely, it was high (44.4%, n = 9) in a small community where a high-rank male was infected. LLD affected both dolphins in 2 of the 4 male pairs for which large time series data were available, suggesting horizontal transmission due to contact. Thus, association with LLD-positive males seems to be an important risk factor for infections. Additionally, low-rank males had larger home ranges than high-rank males, indicating that low-status LLD-affected dolphins are likely responsible for the geographic dissemination of the disease in this population.

Micobacteriosis pulmonar por Mycobacterium kansasii / Micobacteriosis pulmonar por Mycobacterium kansasii

Micobacterias no tuberculosas (MNT) es una designación utilizada para referirse a un gran número de especies de micobacterias ambientales potencialmente patógenas y no patógenas, distintas de la Mycobacterium tuberculosis y Mycobacterium leprae. Mycobacterium kansasii (M. Kansasii) es una MNT oportunista causante de infecciones pulmonares, cutáneas, entre otras, cuya tasa de incidencia ha ido incrementando en los últimos años a nivel mundial. A través de presentar el siguiente caso se pretende aportar al conocimiento con respecto al abordaje de pacientes con infección por MNT a nivel pulmonar, dirigido a médicos que trabajan en atención primaria de salud (APS). Se trata del caso de una paciente de 46 años de edad que acude al Hospital Provincial General Docente de Riobamba (HPGDR) con infección por MNT a nivel pulmonar. En el examen microscópico se detectaron Bacilos­Ácido­Alcohol­Resistentes (BAAR) mientras en el cultivo de esputo más antibiograma se aisló M. kansasii resistente a los antibióticos utilizados para la terapia convencional de tuberculosis. Se trata de un caso raro en la práctica clínica. Es crucial saber cómo manejar una infección con M. kansasii debido a su implicación para la salud del paciente y el sistema de salud nacional. El médico de APS debe reconocer su papel fundamental y la importancia que tiene un diagnóstico oportuno y tratamiento adecuado.

Non­tuberculous mycobacteria (NTM) is a designation for a large number of mycobacterial species potentially pathogenous and non­pathogenous, different than Mycobacterium tuberculosis and Mycobacterium leprae. Mycobacterium kansasii (M. kansasii) is an opportunistic NTM that causes among other things, pulmonary and cutaneous infections, whose incidence is increasing worldwide. Trough the following case report we seek to provide a guide to physicians working on primary health care (PHC) on the management of patients with pulmonary infection caused by NTM. We report the case of a 46­year­old female patient who came to the Hospital Provincial General Docente de Riobamba (HPGDR) with a pulmonary infection caused by NTM. In the microscopic examination it was identified Acid­Fast Bacilli (AFB), meanwhile the microbiological culture and antibiogram it was isolated M. kansasii resistant to common antibiotics used for conventional tuberculosis therapy. It is a rare case in the clinical practice. It is crucial to know how to manage an infection with M. Kansasii due to its implication on the health of affected subjects and the national health system. A physician working on PHC has to know his/her fundamental role and the importance of an early diagnosis and adequate treatment.

Prevalence of leprous neuropathy determined by neurosensory testing in an endemic zone in Ecuador: Development of an algorithm to identify patients benefiting from early neurolysis.

The success of a microneurosurgical intervention in leprous neuropathy (LN) depends on the diagnosis of chronic compression before irreversible paralysis and digital loss occurs. In order to determine the effectiveness of a different approach for early identification of LN, neurosensory testing with the Pressure-Specified Sensory Device™ (PSSD), a validated and sensitive test, was performed in an endemic zone for leprosy. A cross-sectional study was conducted to analyze a patient sample meeting the World Health Organization (WHO) criteria for Hansen's disease. The prevalence of LN was based on the presence of ≥1 abnormal PSSD pressure threshold for a two-point static touch. A total of 312 upper and lower extremity nerves were evaluated in 39 patients. The PSSD found a 97.4% prevalence of LN. Tinel's sign was identified in 60% of these patients. An algorithm for early identification of patients with LN was proposed using PSSD testing based on the unilateral screening of the ulnar and deep peroneal nerves.

La lepra en el Ecuador / The leprosy in Ecuador

Por recomendación de la OMS/OPS y el apoyo financeiro de la Ayuda Alemana a los Enfermos de Lepra (AYU), el segundo semestre de 1983 se introdujo en el Ecuador la poliquimioterapia para el tratamiento de todos los pacientes de lepra conocidos en el país. A partir de ese año la prevalencia presenta un descenso progresivo, de 2.399 casos, tasa 0.27 x 1.000 habitantes en 1983, baja a 839 pacientes, tasa de 0.08 x 1.000 habitantes em 1990. Igualmente la incidencia disminuye desde 1986 de una tasa de 1.7 x 100.000 habitantes a 1.01 por 100.000 habitantes en 1990. El tratamiento con poliquimioterapia es del 100 por ciento desde 1987, hay predominio de las formas lepromatosas por su mayor período de incubación y tratamiento más prolongado. La incidencia en menores de 15 años es mínima por lo que se puede interpretar que existe una disminución del riesgo de infección en la comunidad. Por último la proporción de casos multibacilares en relación a los casos detectados es en promedio el 48.15 por ciento en 6 años de control de lepra en el Ecuador, menor a las formas paucibacilares, indicando que la endemia es todavía activa en el país

El programa de control de la lepra en el Ecuador / The leprosy control program in Ecuador

As background information on the current problem of leprosy in Ecuador, reference is made to the studies made some years ago on the prevalence of the disese, originally introduced into the country by the Spanish settlers. Since that time various foci have appeared, the most important of which at the present time are those in the Provinces of El Oro, Guayas, Los Ríos, and Loja. The current leprosy control program was initiated in June of 1962 under the direction of the Ecuadorean Department of Health, with the cooperation of the PAHO/WHO and UNICEF pursuant to a tripartite agreement between these organizations and the Ecuadorean Government. An evaluation is being made of the results of operations over a two-year perid, from July 1963 to June 1965. The following activities are cited as the principal elements in the program: detection and treatment of patients, control of contacts, training of medical and paramedical personnel, and rehabilitation of patients. Among the methods employed in the detection of cases, the most productive were notification, reporting, and dermatological examination; the least satisfactory were the intensive census and examination of groups (schoolchildren). The total number of persons examined was 354,065, out of the total of 417,260 that had been calculated for the period, which means 82.7 per cent coverage. It is proposed to examine a representative sampling

The leprosy control program in Ecuador

The results of the first two years of the current leprosy control program in Ecuador are evaluated. Data are presented on morbidity, distribution, and the procedures used. The conclusion is reached that definitive control of this endemic disease may be expected within a short time.

El programa de control de la lepra en el Ecuador / The leprosy control program in Ecuador

As background information on the current problem of leprosy in Ecuador, reference is made to the studies made some years ago on the prevalence of the disese, originally introduced into the country by the Spanish settlers. Since that time various foci have appeared, the most important of which at the present time are those in the Provinces of El Oro, Guayas, Los Ríos, and Loja. The current leprosy control program was initiated in June of 1962 under the direction of the Ecuadorean Department of Health, with the cooperation of the PAHO/WHO and UNICEF pursuant to a tripartite agreement between these organizations and the Ecuadorean Government. An evaluation is being made of the results of operations over a two-year perid, from July 1963 to June 1965. The following activities are cited as the principal elements in the program: detection and treatment of patients, control of contacts, training of medical and paramedical personnel, and rehabilitation of patients. Among the methods employed in the detection of cases, the most productive were notification, reporting, and dermatological examination; the least satisfactory were the intensive census and examination of groups (schoolchildren). The total number of persons examined was 354,065, out of the total of 417,260 that had been calculated for the period, which means 82.7 per cent coverage. It is proposed to examine a representative sampling