Burden and transmission of zoonotic foodborne disease in a rural community in Mexico.

BACKGROUND: The foodborne transmission and human health impact of Salmonella and Campylobacter infections have rarely been evaluated at the population level in highly endemic settings. METHODS: A prospective 15-month cohort study of 127 infants and 119 elderly people was combined with animal and food surveillance to determine the incidence and severity of Salmonella and Campylobacter gastroenteritis in a comparatively prosperous rural community in Mexico. RESULTS: Salmonella and Campylobacter were isolated in up to 75% and 57%, respectively, of raw retail meat and in up to 4.5% of ready-to-eat foods. Rates of acute gastroenteritis of any etiology in infants and elderly people were, respectively, 2.1 and 0.7 episodes per person per year. The annual incidence density rate of Salmonella gastroenteritis was 17.8 per 100 infants and 7.9 per 100 elderly people; the rate of Campylobacter gastroenteritis was 11.7 per 100 infants and 0 per 100 elderly people. Pulsed-field gel electrophoresis analysis yielded multiple clusters of human, meat, and/or animal Salmonella and Campylobacter isolates with indistinguishable patterns. On average, gastroenteritis episodes with these pathogens lasted 3 days in infants and 2 days in elderly people. Medical attention was sought in 44% of diarrheal episodes in infants and in 26% of diarrheal episodes in elderly people; none required hospitalization. Infants with multidrug-resistant Salmonella gastroenteritis had a higher frequency of bloody stools and medical visits (50% vs 11%; odds ratio, 8.5; P = .04) than those with more susceptible strains. CONCLUSIONS: In this relatively advantaged Mexican rural community, the human health impact of a food chain heavily contaminated with Salmonella and Campylobacter was of low magnitude.

Antimicrobial-resistant Campylobacter in the food chain in Mexico.

We describe prevalence and antimicrobial susceptibility results for thermophilic Campylobacter isolates collected from humans, food, and food-animals in an integrated food chain surveillance network in Mexico. From 2003 to 2006, stool samples were collected from children with diarrhea at state sentinel hospitals. Concurrently, fecal samples from asymptomatic children in kindergartens, as well as raw chicken, pork and beef from retail outlets, and food-animal intestines from slaughterhouses were all collected in 65 cities from four different states. C. jejuni was identified with a standardized hippurate test. Hippurate negative, indoxyl acetate positive isolates were classified as Campylobacter spp. Susceptibility testing was performed by agar dilution according to Clinical and Laboratory Standards Institute guidelines. A total of 1,259 C. jejuni and 1,797 Campylobacter spp. isolates were recovered from 11,811 samples. Chicken was significantly more contaminated for both intestinal samples (93.6%) and meat products (58.3%), compared with swine (71.4%)/pork (14.6%) samples, and cattle (25.1%)/beef (5.3%) samples (p<0.001). Campylobacter was recovered from 5.1% of children with diarrhea and from 3.2% of asymptomatic children. Chicken was significantly more likely to harbor ciprofloxacin-resistant C. jejuni (85.8%) than swine (62.5%, OR=3.6), cattle (39.8%, OR=9.3), or humans (58.2%, OR=4.4). No significant differences were found for ciprofloxacin-resistant Campylobacter spp. among food-animals, but the rate in food-animals was significantly higher than in humans (84% vs. 56.7%, OR=4.0). Swine was significantly more likely to harbor erythromycin-resistant C. jejuni (14.8%) than chicken (3.5%, OR=4.9), cattle (1.8%, OR=9.3), or humans (3.0%, OR=5.7), and was associated with higher rates of erythromycin-resistant Campylobacter spp. (41.9%) than chicken (10.5%, OR=6.1) and humans (11.9%, OR=5.3). The high resistance rates to ciprofloxacin preclude the use of fluoroquinolones for treatment of campylobacteriosis in Mexico. Our results emphasize the need for ongoing and integrated surveillance of antimicrobial usage and antimicrobial susceptibility in humans and animals.

New Insights into Avian Infectious Bronchitis Virus in Colombia from Whole-Genome Analysis.

Infectious Bronchitis (IB) is a respiratory disease caused by a highly variable Gammacoronavirus, which generates a negative impact on poultry health worldwide. GI-11 and GI-16 lineages have been identified in South America based on Infectious Bronchitis virus (IBV) partial S1 sequences. However, full genome sequence information is limited. In this study we report, for the first time, the whole-genome sequence of IBV from Colombia. Seven IBV isolates obtained during 2012 and 2013 from farms with respiratory disease compatible with IB were selected and the complete genome sequence was obtained by NGS. According to S1 sequence phylogenetic analysis, six isolates belong to lineage GI-1 and one to lineage GVI-1. When whole genome was analyzed, five isolates were related to the vaccine strain Ma5 2016 and two showed mosaic genomes. Results from complete S1 sequence analysis provides further support for the hypothesis that GVI-1, considered a geographically confined lineage in Asia, could have originated in Colombia. Complete genome information reported in this research allow a deeper understanding of the phylogenetic evolution of variants and the recombination events between strains that are circulating worldwide, contributing to the knowledge of coronavirus in Latin America and the world.

Genetic diversity of Mycobacterium tuberculosis clinical isolates from HIV-TB patients from two public hospitals at Bogotá, Colombia.

The co-infection of TB/HIV is an increasing problem for public health worldwide. In Colombia, of 13.871 confirmed cases of TB in 2016 (prevalence of 0,028%) 14% correspond to HIV co-infection. However, we have scarce information regarding genetic diversity of strains infecting HIV patients. In this study, we carried-out an active search of cases of TB in 356 HIV-infected individuals, who were enrolled in two Public Hospitals at Bogotá-Colombia, between 2014 and 2015. We found 49 patients with HIV-TB co-infection. Genetic characterization of Mycobacterium tuberculosis (Mtb) isolates from these patients showed a predominance of three major sub-lineages: Haarlem (n = 26), LAM (n = 12) and T (n = 11). Remarkably, the most predominant pattern in the present study (SIT62/H1, n = 11) is very specific to this country. Indeed, taking in account distribution in countries with at least 3% of SIT62/H1, 36% of all such patterns collected worldwide were from Colombia. Furthermore, Colombia alone is responsible for almost all the SIT62/H1 strains in South America, suggesting a successful transmission of this genotype inside TB/HIV population from Colombia.

[Prevalence and risk factors associated to tuberculosis and non-tuberculous mycobacterial infections in HIV-positive patients in Bogotá].

INTRODUCTION: Tuberculosis is one of the most widely distributed infectious diseases worldwide. It is the most common cause of mortality among AIDS patients. In Colombia, 12,918 tuberculosis cases were notified, and 926 deaths were reported in 2015. OBJECTIVE: To determine the prevalence and risk factors associated to mycobacterial infections in HIVpositive patients in two public hospitals from Bogotá. MATERIALS AND METHODS: A prospective and descriptive study was carried out by an active search for tuberculosis cases and non-tuberculous mycobacterial infections in HIV-positive patients. We considered demographic, social, clinical, and personal habits as variables. Statistical analyses were done using Stata 13™ software. RESULTS: Three hundred and fifty six patients were included, 81.2% were men and 18.8% were women; the mean age was 36.5 years. Tuberculosis infection had a frequency of 19.9% (95% CI: 15.9-24.5%) and non-tuberculous mycobacterial infection had a 3.9% frequency (95% CI: 2.16-6.5%). Bivariate analysis showed a statistically significant association between tuberculosis infection and CD4+ T cell counts (p=0.003), viral load (p=0.008), antiretroviral therapy (p=0.014), and body mass index (BMI) <18 kg/m2 (p=0.000). In non-tuberculous mycobacterial infections there was a statistically significantassociation with BMI (p=0.027) and CD4+ T cell counts (p=0.045). CONCLUSION: Factors associated with an impaired immune system caused by HIV infection are an important risk factor for developing tuberculosis. The lack of antiretroviral therapy and the BMI were also important risk factors for tuberculosis.

Nontyphoidal Salmonella from human clinical cases, asymptomatic children, and raw retail meats in Yucatan, Mexico.

BACKGROUND: We report the results of a 3-year Salmonella surveillance study of persons with diarrhea; asymptomatic children; and retail pork, poultry, and beef in Yucatan, Mexico. METHODS: Isolates were characterized according to serotype, antimicrobial susceptibility, and genetic relatedness with pulsed-field gel electrophoresis. RESULTS: Salmonella Typhimurium was the most common serotype found in ill humans (21.8% of isolates), followed by Salmonella Agona (21% of isolates). Salmonella Enteritidis was a minor serotype (4.2% of isolates). Asymptomatic children carried S. Agona (12.1% of isolates), Salmonella Meleagridis (11.6% of isolates), Salmonella Anatum (8% of isolates) and S. Enteritidis (5.8% of isolates). A high percentage of retail meat samples contained Salmonella; it was most commonly found in pork (58.1% of samples), followed by beef (54% of samples) and poultry (39.7% of samples). Resistance to oral drugs used for the treatment of salmonellosis was observed for ampicillin (14.6% of isolates were resistant), chloramphenicol (14.0% of isolates), and trimethoprim-sulfamethoxazole (19.7% of isolates). Resistance to ceftriaxone emerged in 2002 and was limited to the serotype S. Typhimurium. Twenty-seven percent of the isolates were resistant to nalidixic acid, and none were resistant to ciprofloxacin. Multidrug resistance was most common among isolates of serotypes S. Typhimurium and S. Anatum. Pulsed-field gel electrophoresis showed that strains found in retail meats were genetically identical to strains found in both asymptomatic children and ill patients. CONCLUSIONS: Our study found a high prevalence of Salmonella in retail meats and persons with enteric infection; many of these isolates were resistant to clinically important antimicrobials. A random selection of isolates from people and retail meat showed genetic relatedness, which suggests that, in Yucatan, considerable transfer of Salmonella occurs through the food chain.

Incidence, clinical presentation, and antimicrobial resistance trends in Salmonella and Shigella infections from children in Yucatan, Mexico.

BACKGROUND: Salmonella and Shigella cause significant morbidity and mortality among children worldwide. Increased antimicrobial resistance results in greater burden of disease. MATERIALS AND METHODS: From 2005 to 2011, Salmonella and Shigella isolates collected from ill children at a major hospital in Yucatan, Mexico, were subjected to serotyping and antimicrobial susceptibility testing by disk diffusion and agar dilution. The identification of bla CTX, bla CMY, bla SHV, bla TEM, and bla OXA and qnr resistance genes was conducted by PCR and sequencing. RESULTS: Among 2344 children with acute gastroenteritis, salmonellosis decreased from 17.7% in 2005 to 11.2% in 2011 (p < 0.001). In contrast, shigellosis increased from 8.3% in 2010 to 12.1% in 2011. Compared to children with Salmonella, those with Shigella had significantly more bloody stools (59 vs 36%, p < 0.001), dehydration (27 vs 15%, p = 0.031), and seizures (11 vs 3%, p = 0.03). In Salmonella (n = 365), there was a significant decrease in resistance to ampicillin (43 to 16%, p < 0.001), trimethoprim-sulfamethoxazole (44 to 26%, p = 0.014), and extended-spectrum cephalosporins (27 to 10%, p = 0.009). Reduced susceptibility to ciprofloxacin in Salmonella rose from 30 to 41% (p < 0.001). All ceftriaxone-resistant isolates harbored the bla CMY-2 gene. qnr genes were found in 42 (36%) of the 117 Salmonella isolates with a ciprofloxacin MIC ≥ 0.125 µg/ml. Four were qnrA1 and 38 were qnrB19. Resistance to ampicillin (40%) and trimethoprim-sulfamethoxazole (58%) was common in Shigella (n = 218), but isolates remained fully susceptible to ceftriaxone and ciprofloxacin. CONCLUSION: Illness from Salmonella has decreased while severe Shigella infections have increased among children with gastroenteritis in the Yucatan Peninsula. While Shigella resistance to clinically important antibiotics remained unchanged, resistance to most of these, except ciprofloxacin, declined in Salmonella. bla CMY-2 and qnr genes are common in Salmonella isolates.

Prevalencia y factores asociados a la tuberculosis y las micobacteriosis en pacientes positivos para HIV en Bogotá / Prevalence and risk factors associated to tuberculosis and non-tuberculous mycobacterial infections in HIV-positive patients in Bogotá

Resumen Introducción. La tuberculosis es una de las enfermedades infecciosas de más amplia distribución en el mundo y constituye una de las primeras causas de muerte en pacientes con sida. En Colombia, en el 2015, se notificaron 12.918 casos de tuberculosis y 926 muertes. Objetivo. Determinar la prevalencia y los factores asociados a infecciones micobacterianas en pacientes infectados con el virus de inmunodeficiencia humana (HIV) en dos hospitales públicos de Bogotá. Materiales y métodos. Se hizo un estudio descriptivo de corte transversal con búsqueda activa de casos de tuberculosis y micobacteriosis en pacientes positivos para HIV. Se estudiaron variables demográficas, sociales, clínicas y de hábitos personales. Los análisis estadísticos se hicieron con el programa Stata 13TM. Resultados. Se incluyeron en el estudio 356 pacientes: 81,2 % hombres y 18,8 %, mujeres, con una media de edad de 36,5 años. La frecuencia de la tuberculosis fue de 19,9 % (IC95% 15,9-24,5 %) y la de infecciones por micobacterias no tuberculosas, de 3,9 % (IC95% 2,16-6,5 %). El análisis bivariado evidenció una asociación estadísticamente significativa entre la tuberculosis y el conteo de linfocitos TCD4+ (p=0,003), la carga viral (p=0,0008), el tratamiento antirretroviral (p=0,017) y un índice de masa corporal (IMC) menor de 18 kg/m2 (p=0,000). En las micobacteriosis solamente se presentó asociación estadísticamente significativa con el IMC (p=0,017) y con el conteo de linfocitos TCD4+ (p=0,045). Conclusión. Los factores asociados al deterioro del sistema inmunitario causados por el HIV, así como el no administrar el tratamiento antirretroviral de gran actividad y el IMC, constituyeron factores de riesgo para desarrollar la tuberculosis.

Abstract Introduction. Tuberculosis is one of the most widely distributed infectious diseases worldwide. It is the most common cause of mortality among AIDS patients. In Colombia, 12,918 tuberculosis cases were notified, and 926 deaths were reported in 2015. Objective. To determine the prevalence and risk factors associated to mycobacterial infections in HIV-positive patients in two public hospitals from Bogotá. Materials and methods. A prospective and descriptive study was carried out by an active search for tuberculosis cases and non-tuberculous mycobacterial infections in HIV-positive patients. We considered demographic, social, clinical, and personal habits as variables. Statistical analyses were done using Stata 13TM software. Results. Three hundred and fifty six patients were included, 81.2% were men and 18.8% were women; the mean age was 36.5 years. Tuberculosis infection had a frequency of 19.9% (95% CI: 15.9-24.5%) and non-tuberculous mycobacterial infection had a 3.9% frequency (95% CI: 2.16-6.5%). Bivariate analysis showed a statistically significant association between tuberculosis infection and CD4+ T cell counts (p=0.003), viral load (p=0.008), antiretroviral therapy (p=0.014), and body mass index (BMI) <18 kg/m2 (p=0.000). In non-tuberculous mycobacterial infections there was a statistically significant association with BMI (p=0.027) and CD4+ T cell counts (p=0.045). Conclusion. Factors associated with an impaired immune system caused by HIV infection are an important risk factor for developing tuberculosis. The lack of antiretroviral therapy and the BMI were also important risk factors for tuberculosis.

Caracterización epidemiológica del bajo peso al nacer en Centro de Salud Bárbara años 2014 y 2015

Introducción. Los recién nacidos (RN) con bajo peso al nacer (BPN) tienen 20 veces más riesgo de morir. En Guatemala se reportó 12.9% de los recién nacidos en 2014 como bajo peso al nacer. Objetivo: Determinar las características epidemiológicas y la incidencia de los factores de riesgo maternos, asociados a RN con BPN durante los años 2014 a 2015 en Centro de Salud Bárbara (CSB). Métodos: Se revisaron los expedientes de 506 partos ocurridos en CSB durante el período de tiempo establecido y se identificó a los RN con BPN. Se documentaron los factores de riesgo de cada recién nacido. Resultados: Se encontró una prevalencia de 10.67% de BPN Los factores de riesgo fueron, bajo IMC materno, período intergenésico corto, multiparidad, ocupación ama de casa e inadecuado control prenatal. En su mayoría procedían de las aldeas Comunidad de Ruiz, Cruz Blanca, Montufar y Cerro Alto; 35% eran analfabetas. Conclusión: Los resultados de este estudio ponen en relieve la necesidad de intervención con grupos específicos de mujeres con mayor riesgo de presentar embarazos con resultados adversos, específicamente BPN. Palabras clave: Peso al nacer, bajo peso al nacer, factores de riesgo, incidencia, prevalencia, intergenésico, multiparidad

Introduction. Several studies have demonstrated that new born infants with low birth weight (LBW) have up to 20 times more risk of dying. In Guatemala 12.9% of LBW newborn were reported in 2014. Objective: To determine the incidence of maternal risk factors associated to LBW during the period 2014-2015 in a health care post (CSB). Methods: Medical records of 506 deliveries occurred in CSB during this period were reviewed and LBW infants were identified. Maternal risk factors were documented for each new born. Results: A prevalence of 10.67% low birth weight infants were found. Prevalent risk factors were, maternal low BMI, short intergenesic interval, multiparity, being a housewife as an occupation, and inadequate prenatal care. Thirty-five (35%) of patients were illiterate and mostly came from the out of town villages (Comunidad de Ruiz, Cruz Blanca, Montufar y Cerro Alto). Conclusion: Findings highlight the need of intervention for specific groups of women with higher risk of adverse pregnancy outcomes, specifically low birth weight. Key words: Low Birth Weight, risk factor, incidence, prevalence, intergenesic, multiparous

Immunohistochemical expression of anti-CD68 antibody in atherosclerotic plaque.

UNLABELLED: Inflammation of the vascular wall is an essential event in the development of atherosclerosis, the main leukocytes of the inflammatory infiltrate being the monocyte/macrophages. These cells are very heterogeneous and rapidly change their function in response to signals received from the local environment. PURPOSE: The aim of this research was to study the immunohistochemical expression of the anti-CD68 antibody at the level of the atherosclerotic plaque. MATERIALS AND METHODS: We used tissue samples obtained by endarterectomies in patients with symptomatic atherosclerotic lesions. Inflammatory reaction was highlighted in the arterial wall by immunohistochemistry using an anti-CD68 monoclonal antibody that marks normal or pathological monocytes/macrophages. RESULTS AND DISCUSSION: The types of analyzed atherosclerotic lesions showed a positive reaction with the anti-CD68 antibody, varying in distribution and intensity in the vascular intima. The CD68 was positive in macrophages depending on the extent of the inflammatory reaction. CONCLUSIONS: The presence of many macrophages in the atherosclerotic plaques indicates a chronic inflammatory reaction, accompanied by fibroblast proliferation and connective tissue changes that influence the stability of the plaques.

Conocimiento sobre los beneficios de la Lactancia Materna en mujeres embarazadas y/o post-parto no primigestas en el Hospital General San Juan de Dios

Introducción: Se sabe que la leche materna es el alimento óptimo para el lactante durante los primeros seis meses de vida. Objetivo: Se realizó este estudio para identificar los conocimientos sobre lactancia materna en mujeres embarazadas y/o postparto no primigestas del departamento de maternidad en el Hospital General San Juan de Dios (HGSJDD). Diseño experimental: Se condujo el estudio en el HGSJDD en una población de 100 madres embarazadas y/ o post parto no primigestas. Métodos: Se utilizó un cuestionario de 23 preguntas, el cual se evaluó sobre 100 puntos, considerándose un conocimiento adecuado cuando se obtenía 60 ó más puntos. Se pasó el cuestionario a las 100 mujeres participantes. Resultados: Solamente 4 madres del grupo estudiado demostró tener conocimiento adecuado a través de la prueba, el resto obtuvieron una calificación menor a 60 puntos. Conclusiones: El nivel de conocimiento sobre LM en el grupo de madres estudiado en el HGSJDD es muy bajo.

Introduction: It is well known that exclusive breastmilk is the best intake for the newborn during the first six months of life. Mothers who are providing this diet need to have the right information in order to achieve best results. Objective: This study was performed to identify the knowledge about breast feeding in no primiparous woman who are pregnant and/or postpartum from HGSJDD. Experimental design: It was conducted at the Obstetrics Department of HGSJDD, which involved 100 no primiparous woman who are pregnant and/or postpartum. Method: A questionnaire of 23 questions was used with a total value of 100 points, with a score of 60 points or higher representing an adequate level of knowledge of breastfeeding in primiparous postpartum mothers. The survey was passed to the 100 participating mothers. Results: Mostly mothers between 27 and 31 years demonstrated a lack in the basic knowledge about breastfeeding. Only 4 mothers of the studied group showed an adequate level of knowledge, the rest of the group showed a score lower than 60 points. Conclusions: Even though most of the participating women received prenatal control, it was concluded, that exist a lack of knowledge about maternal breastfeeding.

Conocimiento sobre los beneficios de la Lactancia Materna en pacientes mujeres embarazadas y/o en post-parto no primigestas en San Juan Sacatepéquez / Knowledge about breastfeeding benefits in pregnant and postpartum female patients from San Juan Sacatepéquez

Introducción. La leche materna es el alimento óptimo para el lactante especialmente en los primeros seis meses de vida. Objetivo: Se realizó este estudio para identificar los conocimientos sobre lactancia materna en mujeres embarazadas y/o en posparto, no primigestas que acuden a la consulta externa del Centro de Salud Bárbara en San Juan Sacatepéquez. Diseño experimental: Se condujo el estudio en SJS, con una población de 100 madres embarazadas, y/ o post parto no primigestas. Métodos: Se utilizó un cuestionario de 23 preguntas, el cual se evaluó sobre 100 puntos, considerándose un conocimiento adecuado cuando se obtenía 60 o más puntos. Resultados: La mayoría de las madres en un rango de edad entre 27 y 31 años demostraron carecer de los conocimientos básicos sobre la lactancia materna. Conclusiones: Aunque la mayoría de mujeres participantes llevaron control prenatal, se concluyó que sus conocimientos básicos sobre la lactancia materna son pobres.

Introduction: It is well known fact that exclusive breastfeeding is the best nutrition for the newborn during the first six months of life. Mothers who are providing this diet need to have the right information in order to achieve best results. Objective: This study was performed to identify the knowledge about breast feeding in non primiparous pregnant women and/or in postpartum from San Juan Sacatepéquez. Experimental design: The study was conducted in San Juan Sacatepéquez´ Health Center Bárbara, in 100 non primiparous pregnant women and/or in postpartum. Method: A questionnaire of 23 questions was used with a total value of 100 points. It was considered a score of 60 points or higher representing an adequate level of knowledge about breastfeeding. Results: Mostly mothers between 27 and 31 years demonstrated a lack in basic knowledge about breastfeeding. Conclusions: Even though most of the participating women received prenatal control, it was concluded that there is a lack of knowledge about maternal breastfeeding in this group.

Correlations between C-reactive protein and metabolic syndrome or other associated diseases.

The aim of the paper is to present few aspects about the implication of the C-reactive protein (CRP) in the metabolic syndrome. High-sensitivity (hs) CRP is a marker of subclinical inflammation and it is a mediator of atherosclerotic disease. A recent study indicates a possible dose-effect relationship between waist circumference and hs-CRP levels. Elevated level of hs-CRP was associated with risk of developing metabolic syndrome (MS). However, cross-sectional studies have reported increased concentration of these inflammatory markers in both MS and over type 2 diabetes mellitus (DM) and prospective studies have found strong, graded relations between hs-CRP and incident diabetes. A growing number of large-scale studies are finding positive correlations of CRP with cardiovascular disease and these correlations are independent of smoking. The studies show that it is an association between chronic inflammation and depressive symptoms.